Indications

NAC SAP is expected to reduce severity of symptoms of influenza, HIV and avian flu;
NAC SAP can be used to support glutathione synthesis thereby increasing the body's total antioxidant capacity;
NAC SAP has mucolytic properties and can reduce the viscosity of lung secretions and can be used to reduce symptoms in patients with COPD;
NAC SAP has a protective capacity for the liver and is used to treat acute acetaminophen poisoning;
NAC SAP can be used to treat diabetic neuropathy and encephalopathy through its ability to reduce oxidative stress and apoptosis;
NAC SAP can be used to treat symptoms associated with osteoarthritis as it has the ability to reduce inflammation in synovial fluids;
NAC SAP may reduce the smooth muscle cell proliferation that occurs after venous graft surgery, therefore preventing vessel stenosis;
NAC SAP can be used to treat diseases associated with fibrosis as it reduces oxidative stress, a major factor in conditions such as Dupuytren's disease.

Ingredients

Each capsule contains:
ACTIVE INGREDIENTS
N-Acetylcysteine 500mg

Contains no: preservative, artificial flavor or color, sugar, milk, wheat, gluten, corn or yeast NAC SAP contains 90 capsules per bottle

Description

N-Acetylcysteine (NAC) is a precursor to glutathione synthesis and also acts on its own to reduce the effects of reactive oxygen species. NAC has been demonstrated to have antifibrotic activity and may be a useful treatment in disease processes that involve fibrosis. NAC also has mycolytic properties and decreases viscosity of lung secretions. Due to its ability to reduce oxidative stress and apoptosis, NAC has shown the ability to restore phospholipids and reduce lipid peroxidation, which in turn can reduce symptoms associated with diabetic neuropathy and encephalopathy. NAC is also an effective treatment for influenza. Research has shown NAC treatment can improve recovery from influenza by improving host defense mechanisms and through its antioxidant effect against the oxidative stress associated with viral infections. NAC has a protective effect on the liver and is the main treatment for acetaminophen overdose due to its ability to enhance hepatic and mitochondrial levels of glutathione and by supporting the mitochondrial energy metabolism.

HAT IS N-ACETYLCYSTEINE (NAC)?
NAC is a metabolite of the amino acid cysteine. It is produced within the human body and acts as sulfur donor in the sulfation cycle in phase II detoxification and as a methyl donor in the conversion of homocysteine to methionine. The addition of the acetyl group to cysteine allows it to be more readily absorbed and distributed in the body. NAC is absorbed by cells and hydrolyzed to cysteine. Cysteine is used for many functions in the body and it is the rate-limiting amino acid in gluthathione production by the body. NAC has also been well documented to reduce viscosity of lung secretions and can help symptoms associated with COPD. NAC has immune enhancing qualities and can reduce the severity of symptoms associated with viral infections.

NAC AND NUTRITIONAL RESEARCH
Glutathione and NAC
Glutathione is one of the most important antioxidants found in the human body. NAC is a precursor to intracellular cysteine and glutathione (GSH) (1). NAC and GSH have demonstrated the ability to be chemoprotective against lung cancers and colon cancer(2, 3). A study by Odom et al. [2009] found that one potential mechanism for cancer prevention by NAC is through its ability to inhibit the growth of cancer cells through modulation of intracellular red-ox environments(3). Human colon carcinoma cells were treated with benzyl isothiocyanate, diallyl disulfide, dimethyl fumarate, lycopene, sodium butyrate, or buthione sulfoxamine (a GSH synthesis inhibitor) at concentrations shown to cause oxidation of GSH. A decrease in cell proliferation, as measured by [(3)H]-thymidine incorporation, was observed that could be reversed by pretreatment with the GSH precursor and antioxidant NAC(3). NAC may be able to assist in prevention of cancer and other mutagenic disease via its antioxidant ability, modulation of DNA repair, regulation of cell survival and apoptosis, its anti-angiogenetic activity and as a precursor to GSH(2).

Mucolytic properties
Patients with cystic fibrosis (CF) have a defective chloride transport in the epithelial cells of the lungs which makes the mucous more viscous leaving patients more prone to developing infections(4). NAC is well known for its mucolytic properties and has shown the ability to promote efflux of chloride from the epithelial cells in the lung thus improving hydration of the mucous and decreasing its viscosity(4).
Chronic obstructive pulmonary disease (COPD) leads to irreversible damage of parenchyma and airway walls, and oxidative stress is a major contributor to the pathogenesis and the progression of COPD. Placebo- controlled studies in which patients with chronic bronchitis were given maintenance therapy with NAC showed a reduction in the following symptoms: viscosity of sputum, severity of coughing, the number of bacteria in the airways, the number and severity of influenza-like episodes and the number of exacerbations(5). It is important to note that the number of exacerbations was only affected in patients not using inhaled corticosteroids(5).
Immune modulation

Infection with the influenza virus causes oxidative stress which can lead to pulmonary damage(6). NAC has a protective effect in a mice model given a lethal influenza infection. Studies have shown that administration of NAC significantly decreased the mortality in infected mice(6). NAC has not been demonstrated to have any antiviral activity so present findings suggest that antioxidant therapy can increase survival either by its direct antioxidant effect against the oxidative stress caused by the viral infection, or by improvement in the host defenses mechanisms(6).

A study by Dervabin et al. [2008] explored treatment options for avian flu. Using a nutrient mixture containing lysine, proline, ascorbic acid, green tea extract, N-acetylcysteine and selenium, the researchers demonstrated an inhibitory effect on replication of influenza virus and HIV. A significant advantage that this combination had over antivirals including amantadine and oseltamivir, was that it was still able to affect viral replication during later stages of infection(7).
Fibrosis
NAC has been shown to have antifibrotic properties therefore Kopp et al. [2007] explored the effect of NAC on Dupuytren's disease, a benign fibroproliferative disorder of the palmar fascia(8). The study involved using varying dosages of NAC on isolated fibroblasts from resected fibrotic palmar tissues. NAC was shown to decrease expression of three major indicators of impaired fibrotic matrix turnover including alpha-smooth muscle actin, alpha-1 type-1 procollagen and plasminogen activator inhibitor type-1. This would suggest that the signaling and subsequent expression of fibrogenesis-related proteins in Dupuytren's disease or other fibroproliferative disorders may be reduced by NAC(8).

Smooth muscle proliferation
After venous bypass grafting one important indicator that dictates success versus failure is the formation of neointima characterized by smooth muscle cell proliferation. A study examined the ability of NAC to attenuate smooth muscle cell proliferation and neointima formation both in vivo and in vitro(9). NAC demonstrated the ability to attenuate neointima formation and vein graft stenosis by reducing vascular smooth muscle cell (VSMC) proliferation in vivo, and also was able to prevent hyperoxia-induced cytokine production of VSMC proliferation in vitro(9).

NAC and Chelation Therapy
Meso-2,3-dimercaptosuccinic acid (DMSA) is frequently used as an oral chelator to help remove toxic metals from the body. Studies combining DMSA with NAC for the chelation of lead and arsenic found that the combination of the 2 substances was more effective at reducing total body burden of these 2 metals than using DMSA alone(10, 11). The study also found that there was statistically significant improvement in recovery parameters indicative of oxidative stress with combined administration of NAC with DMSA over monotherapy with DMSA(10).

Safety of NAC supplementation
NAC has been studied for over 40 years as both prophylaxis and therapy for a variety of clinical conditions, with the majority involving GSH depletion and alterations of the red-ox status. These studies have established the safety of NAC, even at very high doses and for long-term treatments(1). One specific study looking at high dose (2800 mg/day) treatment with NAC for patients with cystic fibrosis demonstrated that NAC is a well-tolerated and safe medication for prolonged therapy for patients with CF(12).

Quantity

90

Dose

1–3 capsules daily before meals on an empty stomach, or as directed by your health care practitioner.

Potential side effects/Safety

N-acetylcysteine in NAC SAP is an acetylated form of the amino acid cysteine which is more efficiently absorbed.

References

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1. De Flora, S., A. Izzotti, F. D'Agostini, and R.M. Balanshy. “Mechanisms of N-acetylcysteine in the prevention of DNA damage and cancer, with special reference to smoking-related end-points”. Carcinogenesis 22, No. 7 (2001): 999–1013.
2. Van Zandwijk, N. “N-acetylcysteine (NAC) and glutathione (GSH): antioxidant and chemopreventive properties, with special reference to lung cancer”. Journal of Cellular Biochemistry. Supplement 22 (1995): 24–32.
3. Odom, R.Y., M.Y. Dansby, A.M. Rollins-Hairston, et al. “Phytochemical induction of cell cycle arrest by glutathione oxidation and reversal by N-acetylcysteine in human colon carcinoma cells”. Nutrition and Cancer 61, No. 3 (2009): 332–339.
4. Varelogianni, G., I. Oliynyk, G.M. Roomans, and M. Johannesson. “The effect of N-acetylcysteine on chloride efflux from airway epithelial cells”. Cell Biology International 34, No. 3 (2010): 245–252. 5. Dekhuijzen, P.N. “[Acetylcysteine in the treatment of severe COPD]”. Nederlands Tijdschrift voor
Geneskunde 150, No. 22 (2006): 1222–1226.
6. Garozzo, A., G. Tempera, D. Ungheri, et al. “N-acetylcysteine synergizes with oseltamivir in
protecting mice from lethal influenza infection”. International Journal of Immunopathology and
Pharmacology 20, No. 2 (2007): 349–354.
7. Deryabin, P.G., D.K. Lvov, A.G. Botikov, et al. “Effects of a nutrient mixture on infectious properties of
the highly pathogenic strain of avian influenza virus A/H5N1”. BioFactors 33, No. 2 (2008): 85–97.
8. Kopp, J., H. Seyhan, B. MÜller, et al. “N-acetyl-L-cysteine abrogates fibrogenic properties of fibroblasts isolated from Dupuytren's disease by blunting TGF- β signalling”. Journal of Cellular and
Molecular Medicine 10, No. 1 (2006): 157–165.
9. de Graaf, R., A. Tintu, F. Stassen, et al. “N-acetylcysteine prevents neointima formation in
experimental venous bypass grafts”. The British Journal of Surgery 96, No. 8 (2009): 941–950.
10. Flora, S.J., M. Pande, G.M. Kannan, and A. Mehta. “Lead-induced oxidative stress and its recovery following co-administration of melatonin or N-acetylcysteine during chelation with succimer in male
rats”. Cellular and Molecular Biology (Noisy-le-Grand, France) 50 Online Pub: OL543-51 (2004).
11. Kannan, G.M. and S.J. Flora. “Combined administration of N-acetylcysteine and monoisoamyl DMSA on tissue oxidative stress during arsenic chelation therapy”. Biological Trace Element
Research 110, No. 1 (2006): 43–59.
12. Dauletbaev, N., P. Fischer, B. Aulbach, et al. “A phase II study on safety and efficacy of high-dose
N-acetylcysteine in patients with cystic fibrosis”. European Journal of Medical Research 14, No. 8
(2009): 352–358.
13. Geiler, J., M. Michaelis, P. Naczk, et al. “N-acetyl-L-cysteine (NAC) inhibits virus replication and
expression of pro-inflammatory molecules in A549 cells infected with highly pathogenic H5N1 influenza A virus”. Biochemical Pharmacology 79, No. 3 (2010): 413–420.