N-ACETYL CYSTEINE: A Natural Insulin-Sensitizer for PCOS?
New research shows women with PCOS who have insulin resistance may benefit from taking the nutritional supplement N-Acetyl Cysteine, also known as NAC.
NAC is both an antioxidant and amino acid (building blocks of protein). Specifially, NAC is a derivative of the amino acid L-cysteine, an essential precursor used by the body to produce glutathione. Glutathione is an extremely important and powerful antioxidant produced by the body to help protect against free radical damage, and is a critical factor in supporting a healthy immune system. NAC is widely sold in Europe as a treatment for the common cold and it has other numerous uses from being a treatment for bronchitis to removing heavy metals and environmental pollutants from the body. NAC has also been found to reduce inflammation, heart disease and most recently, insulin.
PCOS & N-ACETYL CYSTEINE
Only a handful of studies have examined the benefits of NAC in women with PCOS. The most recent study, published in the European Journal of Obstetrics, Gynecology and Reproductive Biology compared the effects of NAC and metformin on insulin levels. In this prospective trial, 100 women with PCOS were divided to receive metformin (500mg three times daily) or NAC (600mg three times daily) for 24 weeks. The results: Both treatments resulted in a significant decrease in body mass index, hirsutism, fasting insulin, free testosterone and menstrual irregularity, and both treatments had equal effectiveness. Furthermore, NAC led to a significant decrease in both total cholesterol and low-density lipoprotein levels, whereas metformin only led to a decrease in total cholesterol level.
This research supports findings published in the Journal of Fertility and Sterility in 2002 where researchers reported significant improvement in insulin levels among women with PCOS who took 1.6-3g/day of NAC and who had elevated insulin levels before the start of study. Women also showed improvements in testosterone, cholesterol and TG levels.
In regards to fertility, when NAC and clomid was compared with metformin and clomid, the metformin-clomid group had more ovulation and a better chance at achieving pregnancy among women with PCOS.
Overall, NAC is well tolerated but can cause gastrointestinal adverse effects including nausea, abdominal pain, vomiting, constipation, and diarrhea, particularly when used in high doses. The therapeutic dosage of NAC to improve insulin levels based on the published studies is 1.6-3 grams/day. If you are overweight, you may benefit from the higher end of the dose range. Fulghesu et al found that obese patients with PCOS did not respond to doses under 3 grams/day. You should not exceed 7grams/daily. As with any nutrition supplement, it is important to discuss use with your physician before taking.
Bottom line: NAC has been shown to improve menstrual regularity but has not been shown to help improve fertility in women with PCOS. NAC may help improve insulin resistance in women with PCOS who have high insulin levels and could be used with metformin or if metformin isn't an option. NAC also seems to have a favorable effect of lowering cholesterol, TG and testosterone. Long-term studies with NAC are needed. It would be interesting to determine the effects of taking NAC in combination with metformin or other supplements proven to improve to improve insulin in women with PCOS.
We want to hear from you: What has been your experience with NAC?
Fulghesu AM, Ciampelli M, Muzj G, Belosi C, Selvaggi L, Ayala GF, Lanzone A. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril. 2002 Jun;77(6):1128-35.
Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Womens Health (Larchmt). 2010 Nov;19(11):2043-8. Epub 2010 Oct 12.
Oner G, Muderris II. Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011 Aug 8.
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I have been taking 1000mg a day - 2x 500mg capsules. Unfortunately I can only find one range of vitamins in South Africa which manufactures NAC - and they only make them in 500mg capsules. Do you think I should increase dose to 1500mg? I have noticed better agility - maybe assisting in reducing inflammation. I am excited to see what long term befits will be and will keep you posted. Please send your thoughts on dosage.
Posted by: Liz | November 2, 2011, 3:13 pm
I have been using 600 mg NAC twice a day for about a month now. I have had some astounding results. My facial hair growth which was increasing steadily and spreading down towards my neck has almost stopped. I alternate between Puritan's Pride and GNC brands and find Puritan's Pride to be slightly more effective. If I miss a dose, I have immense sugar and carb cravings which tells me that the NAC really does help lower insulin levels thereby banishing those cravings.
I am now looking to add Chromium and ALA to my regimen.
Previous to this, I have used fasting as a means to restore my period, but subsequent bouts of overeating have resulted in gaining back the 40 lbs that I lost and now I am back to my PCOS state. But I am confident that soon I'll be back on track with my health.
For those with hirsutism... please try NAC.
Posted by: Sophie | June 4, 2012, 2:20 am
I am on Amazon as I post this, buying NAC and hoping for some sort of improvement. Thanks for the article!!
Posted by: Christy | June 15, 2012, 4:55 am
I started taking 600 mg 3x a day for ten days so far. After day 3 I got my period, which I had not gotten since november (it is June). I can't wait to see the long term results.
Posted by: natasha | June 30, 2013, 7:47 pm
We have supervised patients to use both NAC and Metformin. It is safe but recommend monitoring for any side effects such as low blood sugar. NAC and metformin may work in different ways.
Posted by: Angela Grassi | September 11, 2013, 6:05 pm
I have hypothyroidism and PCOS. I take Levothyroxine 50mcg in the morning for hypothyroidism. For PCOS, I take Metformin 500mg in the noon, and Diane-35 in the night. Diane-35 is the brand name of a contraceptive pill. It contains Cyproterone Acetate 2mg and Ethinyl Estradiol 0.035mg. I read NAC is good for hypothyroidism and for PCOS. I just want to make sure it does not interfere with the contraceptive pill. Can I take NAC when am taking the contraceptive pill and metformin?
Posted by: thypcos | October 15, 2013, 1:00 am
I no longer have PCOS (strict ketogenic diet, lots of fish and other oils) but continued to have problems with insulin resistance and was eventually diagnosed with Diabetes II, despite a continuing low-carb diet.
I could never get to a therapeutic dose of Metformin; made me vomit ALL DAY! However, been taking 2400 mg of NAC and the results have been fantastic. Blood glucose lowered and GOTT trsts back to normal ranges.
Took about three months but really worked.
Posted by: claudia rowe | June 6, 2014, 7:49 pm
Please using it with clomid, does it have any side effect? And how do I combine the 2 if it can work.
Posted by: ijeoma | July 8, 2014, 1:14 pm
Would you take thus with pregnitude or instead of. I am not ttc but manage my weight and hair loss.
Posted by: gemma | July 13, 2014, 5:03 pm
You can take NAC and pregnitude together but may want to start with one first to see if it helps and to monitor side effects. The folic acid in pregnitude may help with hair loss.
Posted by: Angela Grassi, MS, RDN, LDN | July 14, 2014, 9:32 am
I am a type 2 diabetic and am taking metformin 500mg daily, along with 400mg of myo-inositol and other supplements. Would it be beneficial to me to take this too? or am I doing enough? x
Posted by: Laura Ellis | September 1, 2014, 7:43 pm
I can't advise you on what dose you take because I don't know what other supplements and medications you take. If you are interested, we do provide nutrition counseling through the web or phone and can give you the right advice. Contact us at info@PCOSnutrition.com. If you are feeling well and managing your blood sugars ok, you may be doing enough.
Posted by: Angela Grassi, MS, RDN, LDN | September 2, 2014, 1:38 pm
I have taken my first nac capsule 600 mg at noon I am type 1 diabetic and my sugar is very high 400 at 3pm and after taking a lot more insulin it's not going down very much . I always have great numbers with my sugar. I am taking it because it's a very good antioxidant . Has anyone had a problem like this while taking it would like some feed back
Posted by: Mary | September 15, 2015, 12:03 am
I have been directed to take 1800 mg daily and am also taking Co-enzymeQ10 (600 mg daily) - is it safe to take both?
Posted by: Jessica | September 23, 2015, 3:05 pm
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