Nine Ways to Control PCOS with NAC

Women who have polycystic ovary syndrome and use the nutritional supplement NAC (n-acetyl-cysteine) may benefit in several ways, according to medical studies. Research indicates that NAC has a number of possible benefits:

What is NAC?

NAC (n-acetyl-cysteine) is a stable derivative of the amino acid cysteine. It has antioxidant properties and is required for the body's production of glutathione. Glutathione, along with NAC, are powerful antioxidants. Adequate antioxidants are essential for protecting your cells from damage, especially if you have PCOS. Women with polycystic ovarian syndrome tend to need more antioxidants because they are under increased oxidant stress.

NAC is commonly used for these health problems: liver toxicity, acetaminophen poisoning, chemotherapy, detoxification, respiratory problems, heart disease, gallstones, and excess mucus production. However, NAC also has some value for polycystic ovarian syndrome.

NAC is not found in the diet but is available as a nutritional supplement. It is also available as a FDA-approved prescription drug. Safety and dosage information here.

NAC Improves Ovulation and Fertility in PCOS Women

In several medical studies, NAC has been used with Clomid with good results.(1) Clomid (clomiphene) is used to stimulate ovulation and is often the first thing your doctor will give you if you are trying to conceive. However, some women are "resistant" to Clomid and it does not work. So anything that reduces insulin problems and makes Clomid more effective is worth considering.

A medical study has shown that supplemental NAC is helpful for women with PCOS who are trying to conceive and want to reduce risk of miscarriage.

In this study from Assiut University in Egypt, 60 Clomid-resistant women with PCOS were treated. "Clomid resistant" means that the women took the drug Clomid to induce ovulation, but the Clomid treatment did not work.

They then received ovarian drilling. Ovarian drilling is a surgical procedure in which a laser fiber or electrosurgical needle punctures the ovary 4 to 10 times. This treatment may lower the level of male hormones such as testosterone.

After the ovarian drilling, the women were divided into two groups. One group took supplemental NAC while the other group took a placebo for 5 days starting at day 3 of the cycle, for 12 consecutive cycles.

By the end of the study, the NAC group had a significant increase in both ovulation and pregnancy rates vs. the placebo group.

Moreover, miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group.

This study confirms earlier studies indicating NAC is a supplement that has value for women who have polycystic ovary syndrome.

In another study, researchers at Mansoura University in Egypt said that "N-acetyl cysteine is proved effective in inducing or augmenting ovulation in polycystic ovary patients", according to their new study.

In this study, 470 PCOS women were given Clomid (clomiphene citrate) for one menstrual cycle and then given Clomid plus NAC for another cycle. The women took 1,200 mg of NAC for 5 days starting on day 3 of the menstrual cycle.

With Clomid alone, the ovulation rate was 17.9% but when the NAC was added, the ovulation rate was 52.1%. Progesterone levels and thickness of the uterine wall were reported to be also improved.

This study confirms an earlier study that the effectiveness of Clomid is increased when NAC is also taken. NAC is regarded as safe and has no side effects. It also appears useful for reducing insulin resistance, which is a big problem in polycystic ovarian syndrome.

NAC Improves Insulin Sensitivity in Women with PCOS

Insulin resistance, the inability to efficiently utilize the hormone insulin, is thought to be a primary cause of polycystic ovary syndrome. Although not every woman with PCOS has an insulin problem, the majority probably do. Therefore, anything that helps to normalize insulin is worth considering.

An interesting study evaluated the effect of N-acetyl-cysteine (NAC) on insulin secretion and peripheral insulin resistance in subjects with polycystic ovary syndrome (PCOS).(1)

Six lean and 31 obese women, aged 19-33 years, were treated for 5-6 weeks with NAC at a dose of 1.8 g/day orally. A dose of 3 g/day was arbitrarily chosen for massively obese people. Six of 31 obese with PCOS were treated with placebo and served as controls.

Before and after the treatment period, the hormonal and lipid (cholesterol, triglycerides) blood profile and insulin sensitivity were evaluated and an oral glucose tolerance test (OGTT) was performed.

The women who had an exaggerated insulin response to a glucose challenge and who were treated with NAC showed an improvement in insulin function in the peripheral tissues.

This finding is important because women with PCOS frequently have an abnormally high insulin response to sugars and refined starches. The high insulin throws other hormones out of balance and disturbs many body functions.

The NAC treatment also induced a significant fall in testosterone levels and in free androgen index values.

The researchers concluded: "NAC may be a new treatment for the improvement of insulin circulating levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome."

We don't recommend that you start using NAC at the 1.8 - 3 gram (that's 1,800 - 3,000 milligrams) dose used in this study. A health professional should assist you with this, especially if you are taking metformin. However, 500 milligrams or so daily should be OK for a start.

Although this is a small study, it suggests that NAC can play a role in improving your insulin sensitivity. Many of you are taking metformin for the same purpose. Improved insulin sensitivity is crucial to reversing PCOS.

Fatty Liver Degeneration from PCOS Helped by NAC

A startling percentage (possibly 55%) of women with PCOS also have a fatty liver degeneration disease called "nonalcoholic fatty liver disease" or NAFLD. NAFLD can develop into a more serious medical condition called "nonalcoholic steatohepatitis" or NASH, which is a form of liver inflammation.

There is no proven medical therapy for the treatment of non-alcoholic steatohepatitis (NASH).

Oxidative stress and insulin resistance are the mechanisms that seem to be mostly involved in the progression of NAFLD and NASH. Oxidant stress occurs when your antioxidant defenses are insufficient to control biochemical processes. The result is tissue damage and all sorts of health problems, including chronic inflammation.

Medical studies have shown that women who have polycystic ovary syndrome also tend to have both oxidative stress and insulin resistance. Insulin resistance is a condition where insulin does not work efficiently in your body.

Because oxidative stress and insulin resistance are so common in PCOS, it's no surprise that the liver is adversely affected, thus increasing the risk of NAFLD and possibly NASH.

Metformin is a drug that is often prescribed to treat insulin resistance. If insulin resistance can be reduced, stress on the liver is also reduced.

A recent study from the University of São Paulo School of Medicine in Brazil has shown that NAC in combination with metformin may be effective in treating NASH.(3)

NAC (1.2 g/day) and metformin (850-1000 mg/day) were given orally for 12 months. A low calorie diet was prescribed for all patients.

At the end of the 12 months, fat deposits in the liver went down, and liver fibrosis was reduced. Other aspects of liver function were unchanged.

The researchers said: "Based on the biochemical and histological evidence in this pilot study, NAC in combination with metformin appears to ameliorate several aspects of NASH, including fibrosis."

Protect Yourself (and Your Future Baby) from Toxic AGEs (Advanced Glycation End-Products)

"Glycation" is the result of sugars combining with protein or fats. The combined materials are referred to as advanced glycation end-products or AGEs.

Some AGEs are benign but for the most part they are harmful or toxic. Typically, they cause inflammation and have been linked to cardiovascular disease, diabetes, Alzheimer's, cancer, peripheral neuropathy and other chronic disorders. AGEs may also shorten your lifespan.

Other AGEs are found in your diet. Any foods containing sugars, protein and fat will produce AGEs when they are subjected to heat while cooking or processing. Some processed foods also have AGEs added to them to improve flavor or give them a more appealing color.

A few examples are donuts, barbecued meats, baked goods, French fries, and dark colored soda pop. Another example is dark colored agave syrup, which some people mistakenly assume is a healthy sweetener. AGEs in processed foods is one reason why you will not find these types of foods in The Natural Diet Solution for PCOS and Infertility ebook.

Other AGEs occur inside your body as a byproduct of your metabolic processes. You stimulate AGE production when you consume foods that are high in sugars, including especially processed fructose such as high fructose corn syrup.

Another problem with excessive levels of AGEs is that they increase the probability of pregnancy complications such as gestational diabetes and preeclampsia. Moreover, they are toxic to your developing baby.

It appears that NAC might reduce the risk of AGEs to an unborn fetus. The Okayama University Graduate School of Medicine in Japan studied rat embryos that were exposed to AGEs.(4) Some of the embryos were also exposed to NAC. They discovered that NAC reduced the levels of AGEs in the treated embryos.

NAC Provides Antioxidant Protection

NAC is a well-known antioxidant, meaning it protects cells from being damaged by free radical molecules.

An increasing body of evidence indicates that women with polycystic ovarian syndrome have greater oxidant stress and lower antioxidant levels, thus reducing their ability to control inflammation and prevent cell damage.(5)

Chronic inflammation and oxidant stress make PCOS symptoms worse and tend to reduce fertility.

Oxidant stress is a destructive situation where your cells cannot adequately control your "metabolic fires", technically called "oxidation". You don't want your metabolic fires to burn too low or burn too hot. They must burn just right.

So when you have oxidant stress and your metabolic fires are not optimally controlled, cells in your body are damaged. Even the egg cells in your ovaries can be damaged.

Your cells use antioxidants to regulate your oxidation process. You can think of antioxidants like a flue in your fireplace that controls the amount of oxygen that gets into your fireplace and thus regulates the rate of burning of the wood.

The medical research indicates that women with PCOS have a greater need for antioxidants than other people do. Their oxidant stress is associated with blood vessel problems, higher insulin, insulin resistance, excessive homocysteine (undesirable), chronic inflammation and a host of other problems.

There are dozens of antioxidants, found in your diet or available as nutritional supplements. One of these is NAC.

Might NAC Protect You from Some Pregnancy Risks?

We hope you are not exposed to second hand cigarette smoke or other pollutants that could harm your unborn child. If you think you may be exposed to any kind of environmental toxins or pollution, consider taking NAC.

There are a number of animal studies showing the NAC protects the unborn fetus from damage from toxins. For example, a study from Kocaeli University in Turkey exposed pregnant rats to cigarette smoke.(6) One group was given NAC and one group was not. In the mother rats not protected by NAC, the fetuses had significant lung damage whereas much of this damage was prevented in the fetuses of the NAC-treated rats.

We also hope that you do not take unnecessary drugs or take excessive dosages of drugs during pregnancy. For example, acetaminophen (Tylenol) is the most common drug overdose in pregnancy. NAC has been shown to reduce the toxicity of such overdoses.(7)

Homocysteine and NAC

Women with polycystic ovarian syndrome are often prescribed the drug metformin (Glucophage) to deal with their insulin problems. But one of the problems with metformin is that it has a tendency to increase homocysteine levels. And, in general, PCOS women have higher homocysteine levels than normal women.

Homocysteine is an amino acid in the blood. A normal amount is OK. But an elevated level means that your metabolic processes are not working properly. Elevated homocysteine is associated with coronary artery disease, heart attack, chronic fatigue, fibromyalgia, cognitive impairment, and cervical cancer.

Another medical study (8) showed that people taking NAC for two months had a significant decrease in homocysteine levels. Higher doses were more effective than lower doses.

Safety and Dosage

NAC is considered safe.

Although NAC has not been shown to have any adverse effect on the fetus, you should check with your doctor before taking NAC if you are pregnant. Do not take NAC while also taking nitroglycerin.

Before taking NAC in combination with metformin, check with your doctor. If you are taking a substantial dose of NAC, you may need to reduce the dosage of metformin.

Very high doses of NAC may cause some nausea or gastrointestinal problems in a few people.

We do not recommend that you start using NAC at the 1.8 - 3 gram (1,800 - 3,000 milligrams) dose range cited in one of the studies above. However, up to 600 milligrams per day would be a starting point.

Consult with a qualified physician as to whether a higher dose is appropriate for you, especially if you are taking metformin.

A high quality NAC is available from our PCOS Supplements Store.


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