NYBC’s ThiolNAC – Antioxidant Supplement

ThiolNAC at NYBC

NYBC’s specially manufactured antioxidant supplement, ThiolNAC, is again in stock at the nonprofit co-op. Below is the product description for this combination supplement, which is available only through NYBC, and which provides a key part of NYBC’s MAC-Pack, our LOW COST alternative to K-PAX:

ThiolNAC (NYBC) Each bottle, 90 tablets, sustained release formula. Each tablet contains 500 mg of NAC and 134 mg of alpha lipoic acid. As part of the MAC Pack, three per day provide the equivalent dose as used in the original neuropathy study published in the journal AIDS: 1500 mg of NAC and 402 mg of alpha lipoic. This is an excellent formula for those suffering from liver inflammation. It is also extremely convenient for many PWHIVs who take both NAC and Lipoic Acid since this 2-in-1 combination eliminates some pills while providing the same, generally accepted dosages. Suggested use is 2-3 tablets daily with meal or as directed. Reduce dose if headaches occur.

Note: This version of NYBC’s ThiolNAC intentionally decreases the alpha lipoic acid amounts per tablet from our original formula’s 200mg/tab to the present formula’s 134mg/tab. This change brings us precisely in line with the dosage studied in Jon Kaiser’s study, and also responds to a concern raised by our colleague Lark Lands regarding higher dose alpha lipoic and hypothyroidism.

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NAC + Alpha Lipoic = ThiolNAC

That’s the equation that sums up NYBC’s combination antioxidant supplement, which includes both NAC (N-acetylcysteine) and alpha lipoic acid. These two are among the most researched antioxidant supplements, with studies of NAC covering issues such as pulmonary function, liver function, HIV, while alpha lipoic acid (sometimes called “thioctic acid,” hence the “thiol” part of our product name) has been investigated for liver health, neuropathy, diabetes, HIV. As a combination, they appear in such products as K-PAX and SuperNutrition’s Super Immune Multivitamin.

NYBC’s combination product ThiolNAC was designed to meet the needs of those who can benefit from supplementation with both of these antioxidants. By combining the two in one supplement, there is also a significant savings in cost as well–always one of the main goals of the nonprofit co-op.

For more information, see the NYBC entry on ThiolNAC:

http://nybcsecure.org/product_info.php?products_id=169

Many Ways to Love Your Liver

Many Ways to Love Your Liver

(reprinted from the NYBC SUPPLEMENT, Summer 2008)

Liver impairment is a frequent concern for people with HIV. There are many different causes, including co-infection with hepatitis, HIV meds that put added stress on the liver, excessive alcohol or recreational drug use, opportunistic infections, repeated resort to antibiotics, or just consuming big doses of the over-processed, nutrient-poor junk that too often passes for food these days! (By the way, we like the rule of thumb for choosing good stuff at the supermarket: if your grandmother wouldn’t recognize the item as “food”—then it’s probably not very good for you.)

The liver is crucial for processing and breaking down wastes, whether those produced by normal body functioning or those absorbed into the system in the form of drugs, alcohol, or toxins. So keeping it in good repair is essential for health. One specific strategy to support liver function is to maintain levels of the intracellular (= “found within cells”) antioxidant glutathione, which plays a key role in protecting the liver as it performs its detoxification duties. Here is a short list of nutritional supplements that are frequently recommended for this purpose: Vitamin C (2–6 grams per day, in divided doses); N-acetyl-cysteine, or NAC (500 mg, 3 times per day); alpha-lipoic acid (300-600 mg, twice daily). (Note that NAC and Lipoic can be taken in the combination form ThiolNAC, one of the key supplements stocked by NYBC.)

Another worthy option for countering stresses to the liver is an herb called Milk Thistle (Silybum marianum), which has a long tradition of use as a botanical remedy. Modern research has isolated compounds referred to as silymarin within this plant, and many studies have pointed to silymarin’s effectiveness in protecting liver cells from toxic chemicals, and even in stimulating the repair and regeneration of liver cells. In 2007, a federally funded investigation identified one component of milk thistle as a potent anti-cancer agent, and suggested that it held much promise in protecting against or treating liver cancer. Be advised that if you consult sources such as the Canadian AIDS Treatment Information Exchange (CATIE) website, you may encounter concerns about whether silymarin interferes with HIV meds. But here’s what one National Institutes of Health study concluded: “Milk thistle in commonly administered dosages should not interfere with indinavir therapy in patients infected with the human immunodeficiency virus.” This and other research, we believe, suggests that milk thistle-HIV med interference is not actually a very signficant issue.

Now here’s a rather unusual dietary supplement that has been investigated for liver health: S-adenosylmethionine (SAM-e). First isolated by Italian researchers in the 1950s, SAMe is synthesized by living cells from the amino acid methionine and can’t be supplemented from food sources. In several European studies of people living with hepatitis B or C, it has been shown to help reduce jaundice, fatigue, and other symptoms. And it’s also been applied to treating alcohol-related damage to the liver. The unusual aspect of SAMe is that there’s also a great deal of published research on its value as an antidepressant and as a treatment for arthritis—so it’s quite a versatile molecule! (See the NYBC Blog at http://www.nybc.wordpress.com for more details.)

Last, we note that the New York Buyers’ Club, like its predecessor DAAIR, has carefully followed the modern, US-based study and dissemination of traditional Chinese herbal remedies for liver disease. For example, NYBC stocks Pacific Biologic’s Hepato-C and Hepato-Detox, and, more recently, has added Health Concern’s Hepatoplex One and Hepatoplex Two to its product list. Both of these California-based companies have a very good reputation for quality, and both have devised blends based on Traditional Chinese Medicine as well as current clinical experience by licensed practitioners. (Please consult the NYBC website for more information about the specific herbs in these formulas, as well as recommendations for their use.) Of course we’re always interested in hearing about the experience of our members in using these products, and so we welcome your comments and questions—just email us at contact@newyorkbuyersclub.org.

Nutrients for Liver Toxicity: Practical Guide from the Canadian AIDS Treatment Information Exchange (CATIE)

CATIE provides an information sheet on liver toxicity as part of its “Practical Guide to Managing HIV Drug Side-Effects.” This info sheet suggests ways of coping with liver impairment, which is frequent in people with HIV, and may result from a variety of factors, including medication side-effects, hepatitis co-infection, repeated use of antibiotics, alcohol or drug use, or a nutrient-poor, chemically-rich diet.

Here’s an excerpt on some supplementation strategies to counteract liver impairment:


In addition to removing, as much as possible, anything that might be stressing the liver, it is very important to add the therapeutic agents that can help the liver to detoxify, repair and protect itself. There are a number of potentially useful agents, listed below:

Nutrients to Maintain Glutathione

Glutathione (GSH) is the most important intracellular antioxidant and is crucially important for protecting the liver against toxicity when it goes about its task of breaking down drugs and other toxins. Taking the following nutrients may help to maintain or increase levels of glutathione:

–vitamin C (2–6 grams per day, in divided doses)
–N-acetyl-cysteine, or NAC (500 mg, 3 times per day; always take with food because taking it on an empty stomach can cause gastrointestinal tract irritation)
–L-glutamine (5 grams per day, increased up to 30–40 grams in those who also have diarrhea or wasting). Note that anyone with seriously compromised liver or kidney function should not take glutamine without a doctor’s approval since it is an amino acid that must be processed by those organs.
–alpha-lipoic acid, or thioctic acid (300-500 mg, twice daily; take on an empty stomach with fluids). Alpha-lipoic acid is a naturally occurring fatty acid that acts as a cellular coenzyme. It is very important to the liver cell metabolic pathways and can be rapidly depleted when the liver is under stress. It appears to help boost repair when there has been either virally induced or drug-induced liver damage. Note that alpha-lipoic acid disappears from the bloodstream very rapidly, so products made in an extended-release form will last longer and work better.

For anyone with liver dysfunction or disease, the above nutrients may be very important as part of a total treatment approach.

For people with fatty livers, another important nutrient is the amino acid carnitine. Researchers say that it may help prevent mitochondrial toxicity, thus helping the body to handle fat better. Early studies of its use for non-HAART-related elevated triglycerides in PHAs did, indeed, show successful lowering of the blood fat levels. Research in animals has shown its successful use in reversal of fatty livers. The usual dosage is two capsules (500 mg each) twice daily. The alternative is Carnitor, the basic form of carnitine, available by prescription only. It is usually prescribed in doses of 3,000 mg daily (three 330-mg capsules, 3 times daily). Too-high doses can cause diarrhea, so watch for this. Doses of plain carnitine need to be higher because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream, using equivalent doses.

Note that in addition to the individual supplements mentioned above, NYBC also stocks its combination of N-acetyl-cysteine and alpha-lipoic acid, ThiolNAC.

PharmaNAC (effervescent n-acteylcysteine) and MAC-Pack (K-Pax alternative)

A few words about PharmaNAC, an effervescent NAC (n-acetylcysteine) that the New York Buyers’ Club has been supplying in the past year. This form of NAC has proven especially useful to people with respiratory conditions like chronic bronchitis. And we were interested to read recently of a person with cystic fibrosis reporting on her use of PharmaNAC.

NAC in various forms has been researched and used more widely in Europe than in the US, although some influential work on this supplement for people with HIV was conducted at Stanford back in the 1990s, and helped lead, for example, to the inclusion of NAC in K-Pax, a multivitamin antioxidant combination that showed significant enough benefit to be added to state government-financed formularies for people with HIV.

NYBC originally imported a German effervescent NAC called ACC Akut (Hexal), but we were delighted when a North American supplier began to offer the very similar PharmaNAC, which we have stocked for the past year. (PharmaNAC is actually a higher dose of NAC per tab–900mg–than ACC Akut’s 600mg, though we have been able to keep the price about the same due to lower shipping costs.)

NYBC’s mission as a nonprofit buyers’ co-op also motivated us to devise a low-cost alternative to K-Pax for those who don’t have access to subsidized versions of this product. The NYBC MAC-Pack provides a close equivalent to K-Pax, but the cost has been brought down to less than half that of K-Pax.

Note: it’s also possible to order non-effervescent NAC and ThiolNAC separately:

NAC 500mg/90 tabs

ThiolNAC (500mg NAC and 200mg alpha lipoic acid/90 tabs)

ThiolNAC (NAC + alpha lipoic acid combination) is back at NYBC

ThiolNAC, a combination of the two antioxidants NAC (N-Acetyl-Cysteine) and Alpha Lipoic Acid, is again available as a combination supplement from the New York Buyers’ Club. The manufacturer of this supplement is Montiff, which also produced NYBC’s previous version of ThiolNAC.

ThiolNAC (NYBC): NAC 500mg, Lipoic 200mg [90 tablets/bottle].

NAC (N-acetyl-cysteine) is recommended for its antioxidant properties and because studies have suggested it may improve immune function. Often used in Europe to treat chronic bronchitis and chronic sinusitis. Also recommended if you are taking acetaminophen (Tylenol). Alpha Lipoic Acid is widely recognized as a potent antioxidant and liver protective agent. Research suggests it has the capacity to protect many organs and tissues from damaging inflammation due its antioxidant power. Long used to treat neuropathy in diabetics.

Note: ThiolNAC can be used to replace the separate NAC and Lipoic components of NYBC’s MAC (Multivitamin Antioxidant Combo) Pack, the purchasing co-op’s low-cost alternative to K-Pax.