Guarding Against Acetaminophen Liver Damage
Nutrition / Natural Medicine Update No. 84 (March 22, 2018)
with Dr. James Meschino
Research Topic: Guarding Against Acetaminophen Liver Damage
Source: Journal Drug Development Research (2015)
Acetaminophen is an effective pain-killing and fever-lowering medication that is sold in many over-the-counter drugs. The classic one being Tylenol. About 27 billion doses were sold in 2009, the most recent year for which figures are publicly available. The down side is that regular use of acetaminophen can damage the liver and, also to some degree, the kidneys. In fact, acetaminophen is the leading cause of drug-induced liver failure in this part of the world. Fifty percent of these cases occur in people using the drug at the prescribed dosage, which means not exceeding an intake of 4000 mg (4gm) per day. The other fifty percent of cases are, unfortunately, intentional overdose cases in most situations.
Acetaminophen can lead to liver failure because it is metabolized in the liver to a very reactive, aggressive, free radical agent, abbreviated as NAPQI metabolite, which damages, and can kill liver cells. Fortunately, when adequate glutathione is present in liver cells, it quenches and neutralizes the NAPQ metabolite, converting into a harmless substance that the body can easily eliminate. But the chronic use of acetaminophen slowly depletes glutathione levels in the liver and elsewhere in the body, and allows liver cell damage and liver cell death to ensue.
So, what can you do to protect yourself from acetaminophen—induced liver AND kidney damage (some detoxification of acetaminophen also occurs in kidney cells)? Well, in acute acetaminophen overdose cases hospitals administer a natural substance called NAC (N-Acetylcysteine), as NAC serves as a key building block for glutathione synthesis. If administered in time, NAC can quickly raise liver cell levels of glutathione and prevents liver failure and death in acute acetaminophen overdose cases. So, NAC is the anti-dote used in cases of acute acetaminophen over dose.
But recent studies have suggested that the oral ingestion of NAC (taken as a supplement) can help prevent liver damage from the use of acetaminophen in patients who are using it for pain control, headaches, arthritis, fever etc. An important study in the journal Drug Development Research, in 2015, argued this case very well. In fact, the researchers suggest, based on available studies, that acetaminophen-containing drugs should be combined with an equal amount of NAC to prevent liver damage from occurring with each dose of acetaminophen ingested. Law makers and pharmaceutical companies have yet to act on this recommendation, but it’s likely that it will someday be a reality. In the mean time if you are using acetaminophen on any level of frequency you might be very wise to also purchase, from a drug store, health food store, or online, an N-Acetylcysteine supplement. The recommendation is to take 600 mg of NAC with every 600 mg of acetaminophen ingested and to take them simultaneously or within 30 minutes of each other. This will help to raise your liver glutathione levels and mitigate damage otherwise caused by the build up of the NAPQI metabolite, formed from acetaminophen metabolism.
You might want to know that other natural agents can work with NAC to help raise and preserve glutathione levels. These include the following supplements:
- Alpha-lipoic acid – (ALA)
- Silymarin (from Milk thistle) -which may also help in liver repair and protect kidney cells from various free radicals induced by various drugs and toxins
- L-Glutamine – also a required important amino acid in glutathione synthesis
Some companies combine all four of these natural agents into a single supplement containing (NAC, ALA, Silymarin, and L-Glutamine).
Other advice to support liver function and aid in detoxification includes ingesting the following foods:
- Cruciferous Vegetables – indole 3 carbinol and sulforaphane (broccoli, brussels sprouts, cabbage, cauliflower, Bok choy).
Also, note that ingesting alcohol while acetaminophen is in your body greatly amplifies the liver and kidney damaging effects of this drug. So, no alcohol if you are taking acetaminophen -make that a rule.
So, I think you should pay close attention to the information I have shared in this video update to help protect your liver and kidneys over your lifetime if you rely on acetaminophen to any degree.
I have included the research studies with accompanying links in the text below.
1. Owumi S, Andrus JP, et al. Co-administration of N-Acetylcysteine and Acetaminophen Efficiently Blocks Acetaminophen Toxicity. Drug Dev Res 76 : 251-258, 2015. © 2015 Wiley Periodicals, Inc.https://onlinelibrary.wiley.com/doi/full/10.1002/ddr.21262#references-section
2. Deaths from Acetaminophen: https://www.propublica.org/article/tylenol-mcneil-fda-behind-the-numbers
3. Sears S.E. Chelation: Harnessing and Enhancing Heavy Metal Detoxification – A Review. Scientific World Journal. 2013. https://www.hindawi.com/journals/tswj/2013/219840 : Children’s Hospital of Eastern Ontario Research Institute
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