This common compound is handled by all doctors in their weekly duties, and administered to patients without a second thought as to the true extent of its powers. This compound was patented in 1960 and approved for general usage by the FDA in 1968.
Today the compound remains on the World Health Organisation’s list of essential medical tools. The compound is routinely used for treating painkiller overdoses and extreme alcohol poisoning. This compound is about as nondescript as it gets.
The compound that secretly clears acne is N-acetyl-cysteine, a supplement form of the amino acid cysteine, which is found in eggs and dairy.
NAC has a well-established tradition of treating virtually every medical condition under the sun. It might be the best researched supplement in the world outside of the 32 essential vitamins and minerals.
NAC has benefits for major diseases like type 2 diabetes, eyesight decay, and high blood pressure, psychological problems such as depression, schizophrenia, and anxiety, and even cocaine and cannabis addictions. Luckily, acne is the latest on the list.
Classic acne study examines effect of antioxidants
In short, the study below found that n-acetyl-cysteine supplements lowered acne levels by 50%.
First, scientists gathered 56 acne patients of both sexes aged between 14 and 30, and divided them into four equal groups of 14. Every patient had his or her bodily levels of glutathione (GSH), interleukin-8 (IL8), and malondialdehyde (MDA) tested. IL-8 and MDA are inflammatory chemicals. Pimple counts were examined in detail.
For 8 weeks, each group took a different pill every day. Group 1 took a placebo, group 2 took 210mg per day of silymarin, an antioxidant extracted from the milk thistle herb, group 3 took 200mcg of selenium, while group 4 took 1200mg of n-acetyl-cysteine (NAC) per day.
Every two weeks, all the biomarkers were measured again, and with each passing week the reduction in acne grew more and more pronounced. With the placebo pill there was next to no reduction. With the selenium pill, acne fell by a very respectable 40%. But with milk thistle and NAC, acne lesion counts fell by a massive 50%.
Selenium was fantastic and is indeed an essential mineral I recommend that acne patients focus on. But NAC beat it by a significant margin. It could be that because selenium takes longer to accumulate in the human body compared to amino acids, its benefits took longer to kick in.
With NAC, the effects didn’t burst forth from nowhere; the longer the patients took NAC, the more amplified its acne benefits became. After two weeks, acne fell by 15%, after four weeks acne fell by 25% and after six weeks it fell by 40%.
Levels of inflammatory biomarkers plummeted as well; MDA and IL8 fell by 38.8% and 72% respectively in eight weeks. With selenium, MDA and IL8 fell by 35% and 71% and with silymarin it was 39.2% and80%.
Specifically, malondialdehyde (MDA) is a blood marker of free radical levels, while interleukin-8 is a pro-inflammatory chemical which inflames the skin. Acne patients have been shown to have higher IL-8 levels than average (study, study).
Not only did NAC cut acne lesions in half, it easily beat the essential dietary mineral selenium as well.
How does NAC work?
Glutathione is a bodily antioxidant which has been researched furiously over the last ten years in particular. It’s so powerful that it’s been dubbed the king of antioxidants.
Increasing your antioxidant levels is critical for clearing acne. Antioxidants can 1) prevent the pore-clogging squalene peroxide from appearing on your skin, 2) hoover up inflammatory free radicals, and 3) defend your skin against UV rays.
Glutathione is considered to be one of the most potent antioxidants in humans, alongside vitamin C, vitamin E, and alpha-lipoic acid. Furthermore, it’s the number one antioxidant your body manufactures itself.
NAC works by replenishing your glutathione stores when they’re depleted; that’s the power which makes it so useful in medicine. For instance, consider the main usage of NAC in hospitals worldwide – to prevent liver damage from painkiller overdoses.
Many pharmaceutical painkillers such as Tylenol contain Acetaminophen (paracetamol) as an active ingredient. Acetaminophen is useful for lowering pain and combatting fever and is safe in normal amounts, but overdoses are also the number one cause of acute liver failure in the United States.
Whenever you take paracetamol, a minor metabolite called N-acetyl-p-benzoquinone imine (NAPQI) is produced, which accumulates in the body. Normally, glutathione-s-transferase binds to and chelates NAPQI, but if you take a massive overdose of paracetamol, your glutathione will be rapidly depleted.
The paracetamol metabolite is then free to react with hepatic enzymes, damage liver cells, and cause severe liver damage and possibly even death by acute liver failure.
For that reason, normal family doctors always have NAC on hand, ready to administer to those with painkiller induced liver failure. It’s the simplest and most effective way to send glutathione levels sky-high in a short amount of time and avert a disaster.
NAC’s mechanism of action is very simple. All glutathione in the body must be synthesised using the amino acids glycine, l-glutamine and l-cysteine, as well as sulphur and the minerals zinc, magnesium and selenium (which is why selenium performed so well in the study above).
NAC gives your antioxidant systems the resources they need to withstand what would otherwise be a major depletion from free radicals and toxins flooding in. This recent 2013 study found that compared to healthy people, severe acne patients have over 20% less glutathione in their skin than average and moderate acne patients have nearly 20% less.
NAC improves many conditions behind acne
By boosting glutathione, n-acetyl-cysteine doesn’t just increase the level of antioxidants on your face.
When your blood glutathione is higher, that means that other antioxidants on the skin such as vitamin E are relieved from their antioxidant duties elsewhere, like protecting retinal cells, protecting proteins, protecting hormones, etc. That’s extremely useful because vitamin E is the most important antioxidant for preventing blocked pores; you want as much to be concentrated on your face as possible.
Furthermore, free radicals can wreak all kinds of havoc in the body; they can bombard literally every cell, whether your eye cells or brain cells. One example for acne is vitamin A absorption; vitamin A is transported around the body by retinol binding protein, which free radicals can damage if glutathione isn’t there to control them.
NAC’s potent ability to reduce oxidative stress can be seen in the real world, as it’s a commonly recommended cure for a hangover. The fatigue, lethargy, and sickness from a hangover doesn’t come from alcohol itself; it comes from a by-product called acetaldehyde which alcohol produces when it breaks down in the liver.
Like NAPQI from paracetamol, acetaldehyde depletes glutathione levels in excess. By taking NAC, you increase your body’s ability to detoxify acetaldehyde before it makes you feel hungover. One study found that 200mg, which is far below the standard dose of 500mg, worked excellently.
What’s more promising is that NAC seems to have unknown powers, besides increasing glutathione. Studies show that NAC improves conditions which higher blood antioxidant levels should have no effect on. For example:
Chronic inflammation – higher glutathione has a moderate effect on inflammation by keeping free radicals in check, but it doesn’t impact an over-active immune system which churns out far too many pro-acne, pro-inflammatory chemicals like interleulin-8, IL-1b, IL-6 and TNF-a.
However, NAC does. This 2009 study analysed the effect of supplementation with 500mg of NAC for four weeks on 24 patients with type 2 diabetes. Levels of C – reactive protein, the most commonly used biomarker for assessing chronic inflammation, rose by 18% in the placebo group, but fell nicely by 9% in the NAC group. The conclusion was that “this compound may have some efficacy in reducing systemic inflammation”.
Next there’s this 2015 study which fed three treatments, N-acetyl cysteine, alpha-lipoic acid, and bromelain, to mice and observed decreased inflammation. This showed up on the mice’s skin as a reduction in the number of cysts they had.
NAC reduced almost every important marker of inflammation in this 2013 study; a group of inflamed rats had strongly elevated levels of malondialdehyde, IL-1beta, IL-6, and TNF-a, but NAC could reduce all those pro-inflammatory chemicals. NAC also increased blood glutathione and superoxide dismutase levels. The study called NAC a “strongly anti-inflammatory” supplement.
This study was similar; NAC supplementation could inhibit the production of IL-8, IL-6 and TNF-a in glutathione depleted humans in vivo.
This study, meanwhile, found that NAC could reduce systematic inflammation in the small intestine, and a study published just this month (February 2016) observed a protective effect against gastro-intestinal inflammation. That makes NAC very interesting for digestive disorders like leaky gut syndrome (read my eBook Annihilate Your Acne to get the detailed knowledge on that).
Insulin resistance – insulin resistance is when the insulin in your body no longer works as well, your pancreas has to pump out more, your blood levels get chronically elevated, and your skin gets oily and full of acne.
This 2002 study found that supplementation with a high dose of NAC, 1.8 grams daily, for 5-6 weeks improved the insulin sensitivity of women with polycystic ovary syndrome. Even better, blood insulin levels fell.
In 2011, another study examined NAC’s effect on women with polycystic ovary syndrome, this time comparing it to the common diabetes drug metformin. NAC was equally powerful at reducing insulin resistance and fasting blood insulin levels. Metformin is a powerful pharmaceutical drug. The scientists didn’t explain the mechanism behind NAC’s powers.
This 2015 study found that NAC did not reduce insulin resistance in the liver, but it did reduce it virtually everywhere else in the body, while this 2003 study observed increased insulin sensitivity and stated that lowered oxidative stress was responsible.
Here, it’s hard to tell whether NAC has unique powers. Increased antioxidant functioning from glutathione can protect insulin molecules, enhance their potency, and reduce the need for higher blood insulin levels. Nevertheless, the benefits are strong enough that a unique mechanism may be at play.
Defence against toxins – N-acetyl-cysteine dramatically reduces the damage from many common heavy metals and chemicals. It’s not known whether this is from the increase in glutathione, which is a stage 2 detoxification agent, or from a power of NAC itself.
What IS known is that NAC prevents the oxidative stress and inflammation from a seemingly never-ending range of toxins. For instance:
- N-acetyl-cysteine can lower blood levels of lead and reverse antioxidant depletion in factory workers with lead poisoning (study, study).
- Cadmium is a heavy metal which was once used in the US as a pesticide, only to be mostly discontinued when reports of horrific side effects surfaced. NAC can accelerate recovery from cadmium toxicity (study), protect against cadmium induced liver damage in rats (study), and luckily for acne, prevent antioxidant depletion from cadmium (study). NAC can also prevent the uptake of cadmium into cells (study, study).
- NAC can protect against damage from the toxic toothpaste and water additive fluoride, especially against oxidative stress (study, study, study) and reproductive problems (study).
- One of the unique acne toxins found today is arsenic, which increases acne not just through oxidative stress but also by increasing keratin protein production. N-acetyl-cysteine can protect against oxidative stress from arsenic according to three different studies (study, study, study) and even saved one man’s life after a failed suicide attempt using arsenic-containing ant poison (study). The man’s condition deteriorated for 27 hours and only recovered when doctors tried a last ditch megadose of NAC. He was discharged 24 hours later.
- There’s big conflict over NAC’s effect on the heavy metal mercury, with some natural health gurus insisting that it interferes with mercury detoxification, or transports it across the brain blood barrier. However, all the studies I’ve seen have been excellent. NAC can serve as a quick-acting antidote for mercury poisoning (study), can prevent mercury toxicity in mice (study), and can increase urinary removal of methylmercury, the most deadly form of mercury (study). As for the claims that NAC will cross the brain-blood barrier and dump mercury in the brain, this study and this study found that NAC reduced mercury-induced neurotoxicity in the hippocampus of rat brains, so the theory is unlikely.
NAC improves depression symptoms
As you can see, N-acetyl-cysteine does all sorts of great things for acne. It almost certainly possesses extra powers in addition to its glutathione boosting properties. The mechanisms are murky and unclear right now, but they’ll surely be revealed as the research drives onward.
As for its wider benefits for health, NAC can again improve all sorts of conditions, but one that sticks out most is NAC’s stellar benefits for brain health.
Firstly, NAC is spreading like wildfire as a simple yet effective treatment for depression. It’s wildly popular on the internet, but the scientific evidence supports it too; this double-blind placebo controlled trial concluded that “NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder”.
Secondly, NAC seems to cure all sorts of other mental problems. NAC supplementation has been linked to improvements in schizophrenia, addictions, bipolar disorder, OCD, autism, and Alzheimer’s. It even affects impulse related anxiety disorders such as nail biting, hair pulling, teeth grinding, and lip licking.
Considering how NAC works it is not surprising. Glutathione has a dual function; it’s both a super antioxidant and major stage 2 and 3 detoxification enzyme. Hence, taking NAC can increase the clearance of nearly every toxin in the body.
A large proportion of the chemicals and heavy metals we are exposed to in the modern world are detrimental to brain health in one way or another; aluminium accumulation in the brain is known to cause the amyloid plaque formation behind Alzheimer’s, mercury is linked to autism, and fluoride can lower IQ levels at all ages.
The less of these contaminants roaming around your body, the healthier your brain will be. Increasing blood antioxidants will also prevent your neurons and brain cells from getting frazzled.
Downsides of n-acetyl-cysteine
Firstly, NAC has the same problem as milk thistle – its’s central power is hardly unique. Numerous other foods and nutrients can increase glutathione levels substantially.
If you’re deficient in any of them, zinc, magnesium and selenium will increase glutathione levels just as strongly in the long run. In fact, they have other acne benefits which means they absolutely should be prioritised. Zinc is needed to manufacture retinol-binding protein and control an overactive immune system, selenium can lower inflammation, and magnesium reduces stress and improves sleep quality.
Hence, NAC is not a necessary supplement to take in any way, and if you’re short on cash, it’s lower down on the list than the nutrients above.
Even the amino acid cysteine can be obtained from the diet by eating more eggs and dairy. Whey protein is an especially concentrated source of cysteine which could make n-acetyl-cysteine pointless.
Grass-fed gelatin is another great source of amino acids. In fact, Great Lakes Gelatin is an all-round better supplement than NAC; it boosts glutathione output thanks to containing glycine, but also increases collagen formation due to both its glycine and proline content.
It’s possible that with the stellar study showing a 50% reduction, the patients were getting so little glutathione promoting nutrition and so starving for something that the NAC was enough to improve the skin substantially. If your diet is healthy and nutritious already, as it will be if you’re a long time reader of this website, NAC could have far milder benefits than all the amazing studies suggest.
Then there’s the problem of side effects, some of which even include skin conditions such as flushing, red rashes and itchiness. One much feared consequence of NAC is that it forms a red blood cell derived molecule called nitrosothiol which tricks your body into identifying an oxygen shortage. According to one study on mice, NAC can thus cause pulmonary arterial hypertension (PAH) at high doses, a dangerous disease when the arteries in the lungs narrow and lung blood pressure rises.
Additionally, when clearing your acne or taking any area of health to the limit, the greatest strategy is always to focus on whole foods. Why? Because they have a far more complicated array of natural compounds.
For instance, to increase your antioxidant levels you could either eat a whole pomegranate over the course of three days, every three days, or take a daily NAC pill. The NAC would skyrocket glutathione, and the pomegranate contains an antioxidant ORAC score of 10,000, but the pomegranate also contains vitamin C and a power to inhibit the creation of the stress hormone cortisol.
Get antioxidants from dark chocolate and you can feed your acne-friendly gut bacteria strains healthy flavonoids which they use as fuel to multiply. Get antioxidants from just about any fruit, even an apple, and you’ll get some vitamins, and fiber as a prebiotic.
Then again, NAC has additional powers as well according to the studies above. The fate of NAC really hinges on whether NAC does have extra powers outside of its glutathione boosting effects. If it does then it’s a far more worthwhile supplement for acne.
Conclusion – the verdict and best product
Overall, the fact that NAC slashed acne lesions by 50% speaks for itself. NAC beats selenium for a short term increase in glutathione because selenium takes several weeks to build up in bodily tissues.
The basic point with NAC is that while you should always cover the basics of glutathione first (the minerals, glycine, and dietary cysteine), NAC is superb if you’ve got money to burn on an extra weapon. NAC will be particularly excellent at clearing acne if you’re a vegan, because you’ll need the extra cysteine.
In the article on milk thistle supplements, I strongly advised against taking them because milk thistle is not unique and has common side effects like massively reduced libido and sexual function.
Well, NAC is not unique either, but the side effects reported above rarely happen. The lung theory was only ever demonstrated in one study on mice which used enormous doses. The adverse effects happen in people taking well over 2 grams per day. To improve acne you only need 600mg.
NAC is also cheap, as it’s so non-descript and produced on a mass industrial scale for hospitals. Compare eating a pomegranate every three days, which costs about $15 per month, to taking this Jarrow Formulas N-A-C Sustain daily, which costs about $4.50. From that perspective, NAC is an excellent acne antioxidant source.
You should never skip whole complex foods but if you’ve got the bases covered already, NAC is an excellent (and cheap) bonus supplement for taking your skin to the next level.
The best product is this Jarrow Formulas N-A-C Sustain. It’s not only free from fillers, but it’s a delayed digestion formula which will spread the elevated glutathione throughout the day. The dose of 600mg is also optimal.
Thanks for reading!