Nopal or prickly pear as it is more commonly called is a member of the cactus family. It is native to the entire western hemisphere as well as Africa, Australia and the Mediterranean. It is a large cactus that can range in height from less than a foot to over 7 feet tall. The pads of the prickly pear are actually the stems of the plant and are where the moisture is stored. Its flowers are range from yellow, to red, to purple and bloom from July to August. Once the flowers are pollinated they produce small oblong fruit about 2 ½ inches long. The use of cactus as a food source dates back to from between 5,000 to 7,000B.C. It was an important staple especially in arid regions. Archeologists believe that the cultivation of the prickly pear cactus allowed for the settlement of the arid lands of Mexico and the southwestern United States.

Active ingredients:

Prickly pear cactus is high in:

• Both soluble and insoluble fiber
• Mucopolysacchrides
• Glycosides
• Saponins
• B-1, B-6, Niacin, riboflavin and pantothenic acid

Traditional uses:

Prickly pear or nopal has been used in Mexican traditional medicine long before Europeans knew that the Western Hemisphere existed. The indigenous native people used nopal for:

• Minor skin irritations and sun and wind burns
• Alleviating the symptoms of hangovers, especially dry mouth and nausea
• Digestive complaints
• Controlling blood sugar levels
• Lowering the blood lipid levels

Clinical uses:

Nopal effectiveness in controlling blood sugar levels has been documented . This is from it high mucilage content that slow the absorption of sugurs from the small intestines. This same mucilage allows it to bind bile and fats and oils giving it the ability to lower blood lipid levels.

Recommended Dosage:

100 to 300grms a day can be taken. Dried nopal should always be followed by ar lest 8 oz of water to prevent intestinal blockage. Fresh nopal can be eaten as a vegetable and its fruit makes a delicious addition as well.

Contra-indications:

There have been cases of allergic reaction the nopal, although they are rare. They include skin rash, hives, chest pain, breathing problems and digestive complaints such as diarrhea or constipation. Women who are pregnant or breastfeeding should not take nopal supplements. As no studies have been done on the safety of these supplements in children and those with liver or kidney disease, a health care practitioner should be consulted before use.

Drug interactions:

People who are on medication for the control of diabetes should consult their health care practitioner before starting taking a nopal supplement or adding it as a vegetable to their diet.

Web References:

1. Opuntia

Printed Reference Material:

1. Chen, Y. D., C. Y. Jeng, C. B. Hollenbeck, M. S. Wu, and G. M. Reaven. "Relationship between plasma glucose and insulin concentration, glucose production, and glucose disposal in normal subjects and patients with non-insulin dependent diabetes." Journal of Clinical Investigation. (1988): 21–25.
2. Frati-Munari, A. C., B. E. Gordillo, P. Altamirano, and C. R. Ariza. "Hypoglycemic effects of Opuntia streptacantha Lemaire in NIDDM." Diabetes Care. (1988): 63–66.
3. Frati-Munari, A. C., J. L. Q. Lazaro, P. Altamirano Bustamante, M. Banales Ham, S. Islas-Andrade, and C. R. Ariza-Andraca. "The effect of different doses of prickly pear cactus (Opuntia streptacantha Lemaire) on the glucose tolerance test in healthy individuals." Archives of Investigative Medicine. (1988): 143–148.
4. Frati-Munari, A. C., B. E. Gordillo, P. Altamirano, C. R. Ariza, R. Cortes-Franco, A. Chavez-Negrete, and S. Islas-Andrade. "Influence of nopal intake upon fasting glycemia in type 2 diabetics and healthy subjects." Archives of Investigative Medicine. (1991): 51–56.
5. Frati-Munari, A. C., N. X. Diaz, P. Altamirano, C.R. Ariza, and R. Lopez-Ledesma. "The effect of two sequential doses of Opuntia streptacantha upon glycemia." Archives of Investigative Medicine (1991): 431–436.
6. Gannon, M. C., F. Q. Nuttall, S. A. Neil, and E. R. Seaquest. "Effects of dose ingested glucose on serum metabolite and hormone responses in type 2 diabetic subjects." Diabetes Care (1989): 544–552.
7. Park, E. H., J. H. Kahng, E. A. Paek. "Studies on the pharmacological action of cactus: identification of its anti-inflammatory effect." Archives of Pharmaceutical Research. (1998): 30–34.
8. Rayburn, K., R. Martinez, M. Escobedo, F. Wright, and M. Farias. "Glycemic effects of various species of nopal (Opuntia sp.) in type 2 diabetes mellitus." Texas Journal of Rural Health. (1998): 68–74.
9. Shapiro, K., and W. C. Gong. "Natural products used for diabetes." Journal of American Pharmacists Association. (2002): 217–226.
10. Nyerges, "C. Prickly pear cactus." Wilderness Way [cited June 14, 2004].
11. "Prickly pear." Wholehealthmd.com [cited June 14, 2004].
12. "Prickly pear and barbary fig." The Worldwide Gourmet [cited June 14, 2004].
13. "Prickly pear cactus crop with multiple uses." The Hindu [cited June 14, 2004].
14. Rodriguez-Felix, A., and M. A. Villegas-Ochoa. "Postharvest handling of cactus leaves (nopalitos)." Paper presented at the International Symposium of Cactus Pear and Nopalitos Processing and Uses. Santiago, Chile (September 24-26, 1998).
15. Savio, Yvonne. Prickly pear cactus. Brochure. Small Farm Center, University of California. July 1989 [cited June 14, 2004].

An enzyme that is known to help lower blood pressure. Also helps to repair capillaries damaged by allergic reactions and restore blood flow to inflamed areas.

Could improve cardiovascular function, reduce inflammation, enhance brain power, address the symptoms of PMS, combat the free radicals that can interfere with cell function and is effective in reducing total cholesterol, triglycerides, and blood sugar while raising the level of beneficial HDL.

Nopal or prickly pear as it is more commonly called is a member of the cactus family. It is native to the entire western hemisphere as well as Africa, Australia and the Mediterranean. It is a large cactus that can range in height from less than a foot to over 7 feet tall. The pads of the prickly pear are actually the stems of the plant and are where the moisture is stored. Its flowers are range from yellow, to red, to purple and bloom from July to August. Once the flowers are pollinated they produce small oblong fruit about 2 ½ inches long.

The use of cactus as a food source dates back to from between 5,000 to 7,000B.C. It was an important staple especially in arid regions. Archeologists believe that the cultivation of the prickly pear cactus allowed for the settlement of the arid lands of Mexico and the southwestern United States.

Common Name: N-Acetylcysteine
Synonyms: NAC, L-cysteine, acetylcysteine, cysteine

Overview:

NAC or N-acetylcysteine is derived from cysteine, an amino acid common in proteins throughout the body. NAC is an antioxidant and a precursor of glutathione. NAC is used in the treatment of acute and chronic bronchitis, as it helps to break down the excessive amounts of thick mucus that is characteristic of these respiratory illnesses. It is also an antioxidant and important in detoxifying substances that are harmful to the body.

Given orally or intravenously, NAC is a hepatoprotectant used prevent the liver and kidney damage associated with overdosing on acetaminophen. NAC works by regenerating glutathione stores. In an acetaminophen overdose (more common in people who consume alcohol) the depletion of the glutathione levels puts enormous oxidative stress on the liver which can ultimately lead to liver failure, hepatic coma and even death.
In the treatment of acute and chronic bronchitis, NAC reduces the sulfide bond in mucoproteins. This causes them to liquefy making them easier to expel. There is also mounting evidence that NAC may have the ability to stop cell death, especially cells in the cells of the pancreas and nerves.

Benefits

Research in to N-acetylcysteine is not only confirming the benefits of this amino acid but uncovering new health benefits to explore. NAC has:

1. been used as an antidote for Amanita phalloides (a poisonous mushroom with an extremely high mortality rate). In 11 people suffering from Amanita phalloides poisoning treated with a regime that included NAC, 10 people recovered with out the need for a liver transplant.
2. Saved many people from liver damage and even death because of its ability to neutralize the toxic effects of acetaminophen overdoses. Acetaminophen overdoses are the most frequent reason for of calls to poison control centers in the United States.
3. Preliminary evidence also suggests that NAC supplements may:
   • Improve symptoms associated with Sjogren's syndrome (an autoimmune disorder characterized by dry mouth and dry eyes)
   • Enhance cognitive functioning in some individuals with Alzheimer's disease
   • Prevent development of cataracts and macular degeneration
   • Slow down motor impairment in amyotrophic lateral sclerosis (ALS, often called Lou Gehrig's disease which is a progressive loss of control of voluntary muscles due to destruction of nerve cells in the brain and spinal cord)
   • Help treat hepatitis C when combined with standard medical treatment
   • Increase HDL cholesterol (the good kind of cholesterol).
4. Proven helpful in the treatment of acute respiratory distress syndrome (ARDS). While a review of studies confirmed that intravenous solutions of NAC helps dissolve mucus and improve symptoms of chronic bronchitis, asthma, emphysema and cystic fibrosis.
5. Been studied and found that NAC supplementation may benefit chronic smokers. Studies on large groups of people have found that N-acetylcysteine appears to have cancer prevention properties in those at high risk of developing lung cancer.
6. Been used in combination with nitroglycerin in people suffering from a heart attack. This combination has proven more effective than when either NAC or nitroglycerin are used alone to reduce subsequent chest pain, heart attack and risk of death. One group of researchers said both long and short term studies have sown that people with unstable angina pectoris and the threat of heart attack when given either oral or intravenous NAC with nitroglycerine was very effective in decreasing the risk of worsening by preventing an acute heart attack.

In animal models, NAC has been shown to inhibit platelet clumping and lower lipoproteins levels to a degree not achieved by drugs or diet. Still other studies have demonstrated that intravenous infusion of NAC during blood cot destruction is associated with a decrease in the size of the infarct and a increase rescue of left ventricular function.

1. Shown to be useful in strengthening the immune system in people suffering from HIV/AIDS and diminish the damage of HIV/AIDS on the body. In one well designed study, people with HIV were given a daily regimen of N-acetylcysteine (2400mg), glutathione (40gms), vitamin C (800mg), vitamin E (500IU), beta-carotene (27,000IU) and selenium (280mcg) for twelve weeks. At the conclusion of this study, the patients that received the daily supplements showed a significant weight gain compared to those who received the placebo. In a smaller study using just NAC the supplement did increase the glutathione level wile the placebo group did not. Studies such as this support the theory that NAC may be a useful tool to be used in conjunction with conventional medical treatment for HIV patients. There have however been a few studies that have shown a negative effect of NAC supplements in HIV patients. Further studies are needed in order to prove its benefits.
2. NAC has shown in animal models to be of some benefit in insulin-dependant diabetes. N-acetylcysteine has shown in animal models to keep pancreatic beta cells apoptosis (cell self destruction) without affecting the production of new beta cells. It has also been shown to moderately decrease blood glucose levels while encouraging glucose stimulated insulin secreation.
3. Early studies are showing that NAC may be helpful in the early stages of some cancers. Some experimental evidence has demonstrated that NAC inhibits mucogenic ( causing a mutation in genetic material) agents, protects DNA and enzymes in the nucleaus of the cell. It was also found to decrease free radical production.
4. More studies are needed on the role NAC plays in immune system support. In a small study eight patients who showed resistance to the drugs used to suppress organ rejection after a transplant were given NAC. In these patients, six showed an immediate response, four of these responses were complete wile two were partial. More and larger studies are needed in this promising area of NAC supplementation.
5. Animal studies have shown that NASC can help prevent the death of nerve cells and help protect the synaptic mitochondria against free radical damage. The mice who received NAC supplementation showed a significant improvement in some memory deficits seen in elderly mice. A significant reduction of free radical destruction in the synaptic mitochondria was also seen when compared with the non supplemented mice.

Dietary Sources

The body makes cysteine from the essential amino acid methionine. Nac is also found in most high protein foods such as:

	Ricotta cheese		Cottage cheese
	Yogurt		Wheat germ
	Oat flakes		Granola
	Poultry		Pork
	Pork sausage		Beef

Recommended Dosage:

NAC is used intravenously in a hospital setting to treat acetaminophen overdoses. Acetaminophen overdose is a medical emergency and treatment needs to begin within 8 hours of ingestion to prevent liver damage.

NAC is available by prescription as:

1. An aerosol spray
2. Liquid solution

NAC is available over the counter as:

1. A powder
2. Capsules in 500mg, 750mg
3. Tablets of 500mg and 600mg

Recommended adult dosage is condition dependant. For:

• A respiratory illness

200mg twice a day for chronic bronchitis

ARDS (acute respiratory distress syndrome) is a medical emergency and treated in the emergency room with intravenous NAC.

• As a nutritional supplement and for antioxidant protection

500mg a day to start. The dosage should be increase only under the guidance of a health care practioner.

Those with HIV/AIDS may be put on a dose as high as 4,000mg per day.

• A multivitamin should be added to an NAC regime to ensure that the B vitamins needed when taking NAC are supplied.

Some forms of cysteine are toxic. D-cysteine, D-evsume and 3-methy cysteine should be avoided.

There are no recommendations for NAC supplementation in children. If lab tests reveal an amino acid imbalance a health care practioner may recommend supplementation and monitor the situation.

Contra-indications

NAC supplements have been known to cause gastrointestinal problems such as nausea, vomiting or diarrhea.

NAC given intravenously has been known to cause severe allergic reactions and even anaphylaxis (a life threatening allergic reaction).

People who have a kidney condition known as cystinuria (a condition that causes an excessive amount of cysteine to be excreted in the urine) should not take NAC or cysteine supplements.

People who have a tendency to form kidney stones particularly cysteine stones should avoid NAC supplements.

NAC and its metabolites (breakdown products) could produce a false positive test for ketone bodies (using nitropusside) in those with diabetes.

Preterm newborns should not receive NAC supplements as their kidneys are not developed to handle its breakdown.

There are no other contraindications for NAC when used as a nutritional supplement except in women who are pregnant or breastfeeding should not take NAC except under the guidance of their health care provider.

Drug interactions

When taking along with nitrates NAC has been known to cause headaches.

Carbamazepine taken with NAC supplements may reduce the serum levels of carbamazepine.

There have been no interactions with nutritional supplements or herbs reported.

Although there have been no reported overdoses with oral NAC supplementation, there have been rports when it is used intravenously to treat acetaminophen overdoses.

Web References

1. http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/ace_0178.shtml
2. http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/ace.cfm&pub_id=8&article_id=1
3. http://en.wikipedia.org/wiki/N-Acetylcysteine
4. http://www.umm.edu/altmed/ConsSupplements/Cysteinecs.html

Printed Reference Material

1. Adair JC, Knoefel JE, Morgan N. Controlled trial of N-acetylcysteine for patients with probable Alzheimer's disease. Neurology. 2001;57(8):1515-1517.
2. Ahola T, Fellman V, Laaksonen R, et al. Pharmacokinetics of intravenous N-acetylcysteine in pre-term new-born infants. Eur J Clin Pharmacol. 1999; 55:645-650.
3. Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.
4. Andreassen OA, Dedeoglu A, Klivenyi P, Beal MF, Bush AI. N-acetyl-L-cysteine improves survival and preserves motor performance in an animal model of familial amylotrophic lateral sclerosis. Neuroreport. 2000;11(11):2491-2493.
5. Ardissino D, Melini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol. 1997; 29:941-947.
6. Ardissino D, Merlini PA, Savonitto S, Demicheli G, et al. Effect of transdermal nitroglycerin or N-Acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol. 1997;29(5):941-947.
7. Arstall MA, Yang J, Stafford I, Betts WH, Horowitz JD. N-acetylcysteine in combination with nitroglycerin and streptokinase for treatment of evolving acute myocardial infarction: safety and biochemical effects. Circulation. 1995;92:2855-2862.
8. Behr J, Maier K, Degenkolb B, Krombach F, Vogelmeier C. Antioxidative and clinical effects of high-dose N-acetylcysteine in fibrosing alveolitis. Am J Respir Crit Care Med. 1997;156:1897-1901.
9. Beloqui O, Prieto J, Suarez M, et al. N-acetyl cysteine enhances the response to interferon-alpha in chronic hepatitis C: a pilot study. J Interferon Res. 1993;13:279-282.
10. Bongers V, de Jong J, Steen I, et al. Antioxidant-related parameters in patients treated for cancer chemoprevention with N-acetylcysteine. Europ J Cancer. 1995; 31A:921-923.
11. Cai J, Nelson KC, Wu M, Sternberg P Jr, Jones DP. Oxidative damage and protection of the RPE. Prog Retin Eye Res. 2000;19(2):205-221.
12. Carter EA. Enhanced acetaminophen toxicity associated with prior alcohol consumption in mice; prevention by N-acetylcysteine. Alcohol. Jan-Feb 1987; 4(1): 69-71.
13. Chevez-Barrios P, Wiseman AL, Rojas E, Ou CN, Lieberman MW. Cataract develoment in gamma-glutamyl transpeptidase deficient mice. Exp Eye Res. 2000;71(6):575-582.
14. Chirkov YY, Horowitz JD. N-Acetylcysteine potentiates nitroglycerin-induced reversal of platelet aggregation. J Cardiovasc Pharmacol. 1996;28(3):375-380.
15. Christman BW, Bernard GR. Antilipid mediator and antioxidant therapy in adult respiratory distress syndrome. New Horiz. Nov 1993; 1(4): 623-630.
16. Colombo AA, Alessandrino EP, Bernasconi P, et al. N-acetylcysteine in the treatment of steroid-resistant acute graft-versus-host-disease: preliminary results. Gruppo Italiano Trapianto di Midollo Osseo (GITMO) Transplantation. 1999; 68:1414-1416.
17. D'Agostini F, Bagnasco M, Giunciuglio D, Albini A, De Flora S. Inhibition by oral N-acetylcysteine of doxorubicin-induced clastogenicity and alopecia, and prevention of primary tumors and lung micrometastases in mice. Int J Oncol. 1998;13:217-224.
18. Davreux CJ, Soric I, Nathens AB, et al. N-acetylcysteine attenuates acute lung injury in the rat. Shock. Dec 1997; 8(6): 432-438.
19. Dawson AH, et al. Adverse reactions to N-acetylcysteine during treatment for paracetamol poisoning. Med J Aust. 1989; 150:329-331.
20. De Flora S, D'Agostini F, Masiello L, Giunciuglio D, Albini A. Synergism between N-Acetylcysteine and doxorubicin in the prevention of tumorigenicity and metastasis in murine models. Int J Cancer. 1996;67:842-848.
21. De Flora S, Grassi C, Carati L. Attenuation of influence-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment. Eur RespirJ. 1997; 10:1535-1541.
22. De Rosa SC, Zaretsky MD, Dubs JG, Roederer M, Anderson M, Green A, et al. N-acetylcysteine replenishes glutathione in HIV infection. Eur J Clin Invest. 2000;30:915-929.
23. DeVries N, De Flora S. N-acetyl-L-cysteine. J Cell Biochem. 1993; Supp 17F:270-277.
24. Domenighetti G, Quattropani C, Schaller MD. Therapeutic use of N-acetylcysteine in acute lung diseases. [Review, French]. Rev Mal Respir. 1999;16(1):29-37.
25. Domenighetti G, Suter PM, Schaller MD, Ritz R, Perret C. Treatment with N-acetylcysteine during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study. J Crit Care. 1997;12(4):177-182.
26. Doroshow JH, Locker GY, Ifrim I, Myers CE. Prevention of doxorubicin cardiac toxicity in the mouse by N-Acetylcysteine. J Clin Invest. 1981;68:1053-1064.
27. Droge W. Cysteine and glutathione deficiency in AIDS patients: a rationale for the treatment with N-acetyl-cysteine. [Review]. Pharmacology. 1993;46(2):61-65.
28. Franceschini G, et al. Dose-related increase in HDL-cholesterol levels after N-acetylcysteine in man. Pharmacol Res. Oct-Nov 1993; 28(3): 213-218.
29. Gavish D, Breslow JL. Lipoprotein (a) reduction by N-acetylcysteine. Lancet. 1991; 337:203-204.
30. Goodman MT, McDuffie K, Hernandez B, Wilkens LR, Selhub J. Case-control study of plasma folate, homocysteine, vitamin B12, and cysteine as markers of cervical dysplasia. Cancer. 2000;89:376-382.
31. Harrison PM, Wendon JA, Gimson AES, et al. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med. 1991; 324:1852-1857.
32. Hershkovitz E, Shorer Z, Levitas A, Tal A. Status epilepticus following intravenous N-acetylcysteine therapy. Isr J Med Sci. 1996;32(11):1102-1104.
33. Ho E, Chen G, Bray TM. Supplementation of N-acetylcysteine inhibits NFkappaB activation and protects against alloxan-induced diabetes in CD-1 mice. FASEB J. 1999; 13:1845-1854.
34. Hogan JC, Lewis MJ, Henderson AH. Chronic administration of N-acetylcysteine fails to prevent nitrate tolerance in patients with stable angina pectoris. Br J Clin Pharmacol. 1990; 30:573-577.
35. Hogan JC, Lewis MJ, Henderson AH. N-acetylcysteine fails to attenuate haemodynamic tolerance to glyceryl trinitrate in healthy volunteers. Br J Clin Pharmacol. 1989; 28:421-426.
36. Holdiness MR. Clinical pharmacokinetics of N-acetylcysteine. Clinical Pharmacokinet. 1991; 20:123-134.
37. Horowitz JD, Henry CA, Syrjanen ML, et al. Nitroglycerine/N-acetylcysteine in the management of unstable angina pectoris. Eur Heart J. 1988; 9 Suppl A:95-100.
38. Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial artery response. Clin Pharmacol Ther. 1992;52:125-133.
39. Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial artieral response. Clin Pharmacol Ther. 1992; 52:125-133.
40. Jackson IM, et al. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res. 1984; 12(3): 198-206.
41. Jones AL, Jarvie DR, Simpson D, et al. Pharmacokinetics of N-acetylcysteine are altered in patients with chronic liver disease. Aliment Pharmacol Ther. 1997; 11:787-791.
42. Kelebic T, Kinter A, Poli G, et al. Suppression of human immunodeficiency virus expression in chronically infected monocyte cells by glutathione, glutathione ester, and N-acetylcysteine. Proc Natl Accd Sci. 1991; 88:986-990.
43. Kozer E, Koren G. Management of paracetamol overdose: current controversies. [Review]. Drug Saf. 2001;24(7):503-512.
44. Lenz AG, Jorens PG, Meyer B, et al. Oxidatively modified proteins in bronchoalveolar lavage fluid of patients with ARDS and patients at-risk for ARDS. Eur Respir J. 1999;13(1):169-174.
45. Louwerse ES, Weverling GJ, Bossuyt PM, et al. Randomized double-blind controlled trial of acetylcysteine in amyotrophic lateral sclerosis. Arch Neurol. 1995; 52:559-564.
46. Mani TGK, et al. Adverse reactions to acetylcysteine and effects of overdose. Br Med J. 1984; 289:217-219.
47. Marchetti G, Lodola E, Licciardello L, Colombo A. Use of N-acetylcysteine in the management of coronary artery diseases. Cardiologia. Jul 1999; 44(7): 633-637.
48. Martinez M, Hernandez AI, Martinez N. N-acetylcysteine delays age-associated memory impairment in mice: role in synaptic mitochondric. Brain Res. 2000; 855:100-106.
49. Micke P, Beeh KM, Schlaak JF, Buhl R. Oral supplementation with whey proteins increases plasma glutathione levels of HIV-infected patients. Eur J Clin Invest. 2001;31(2):171-178..
50. Molnar Z, Schearer E, Lowe D. N-acetylcysteine treatment to prevent the progression of multisystem organ failure: a prospective, randomized placebo-controlled study. Crit Care Med. 1999; 27:1100-1104.
51. Montanini S, Sinardi D, Pratico C, et al. Use of acetylcysteine as the life-saving antidote in Amanita phalloides (death cap) poisoning. Case report on 11 patients. Arzneimittel-forschung. 1999; 49:1044-1047.
52. Muller F, Svardal AM, Nordoy I, Berge RK, Aukrust P, Froland SS. Virological and immunological effects of antioxidant treatment in patients with HIV infection. Eur J Clin Invest. 2000;30(10):905-914.
53. Oikawa S, Yamada K, Yamashita N, et al. N-acetylcysteine, a cancer chemopreventive agent, causes oxidative damage to cellular and isolated DNA. Carcinogenesis. 1999; 20:1485-1490.
54. Ortolani O, Conti A, De Gaudio AR, et al. Protective effects of N-acetylcysteine and rutin on the lipid peroxidation of the lung epithelium during the adult respiratory distress syndrome. Shock. 2000; 13:14-18.
55. Patrick L. Hepatitis C: epidemiology and review of complementary/alternative medicine treatments. Alt Med Rev. 1999;4(4):220-238.
56. Pelle E, et al. Protection against cigarette smoke-induced damage to intact transformed rabbit corneal cells by N-acetyl-L-cysteine. Cell Biol Toxicol. Aug 1998; 14(4): 253-259.
57. Perry HE, Shannon MW. Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen ovedose:results of an open-label, clinical trial. J Pediatr. Jan 1998;132(1): 149-152.
58. Pizzorno JE, Murray MT. Textbook of Natural Medicine. Vol 1. 2nd ed. Edinburgh: Churchill Livingstone; 1999:296-297.
59. Pizzulli, L, Hagendorff A, Zirbes M, Jung W, Lüderitz B. N-Acetylcysteine attenuates nitroglycerin tolerance in patients with angina pectoris and normal left ventricular function. Am J Cardiol. 1997;79:28-33.
60. Ruiz FJ, et al. N-acetyl-L-cysteine potentiates depressor response to captopril and enalaprilat in SHRs. Am J Physiol. Sep 1994; 267 (3 Pt 2): R767-772.
61. Shabert JK, Winslow C, Lacey JM, Wilmore DW. Glutamine antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Nutrition. 1999;11:860-864.
62. Shils, ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins; 1999:543-556.
63. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. Dec 15 1988; 319(24): 1557-1562.
64. Stavem K. Anaphylactic reaction to N-acetylcysteine after poisoning with paracetamol. Tidsskr Nor Laegeforen. May 30 1997; 117(14): 2038-2039.
65. Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J. 2000 Aug;16(2):253-262.
66. Suárez C, Del Arco C, Lahera V, Ruilope LM. N-Acetylcysteine potentiates the antihypertensive effect of angiotensin converting enzyme inhibitors [letter]. Am J Hypertens. 1995;8:859-861.
67. van Hoogdalem EJ, van den Hoven WE, Terpstra IJ, van Zijtveld J, Verschoor, JSC. Nail penetration of the antifungal agent oxiconazole after repeated topical application in healthy volunteers, and the effect of acetylcysteine. Eur J Pharm Sci. 1997;5:119-127.
68. van Zandwijk N. N-acetylcysteine for lung cancer prevention. Chest. 1995;107(5):1437-1441.
69. Walters MT, et al. A double-blind, cross-over, study of oral N-acetylcysteine in Sjogren's syndrome. Scand J Rheumatol Suppl. 1986; 61: 253-258.

Common Name: Niacin
Synonyms: Vitamin B3, niacinamide, nicotinamide, inositol hexaniacinate

Overview:

Niacin, also known as vitamin B3, is a water-soluble vitamin that helps the body convert carbohydrates into glucose, the fuel that keeps the many functions of the body running smoothly. Along with the other B vitamins, niacin is responsible for the breakdown of fats and proteins as well. Niacin is actually essential for the functioning of over 50 enzymes and plays an important role in maintaining muscle tone, a healthy digestive tract, maintaining a healthy nervous system and the production of the sex and sex related hormones in the adrenal glands and elsewhere in the body.

Vitamin B3 comes in two forms, niacin (nicotinic acid) and niacinamide (nicotinamide). Inositol hexaniacinate is a combination of niacin and inositol (another B vitamin). Each of these forms of niacin work in their own way on different processes when taken in high doses.

Good sources of niacin are seeds, yeast, bran, peanuts brown rice, whole wheat, barley, almonds and peas. Niacin can also be synthesized from the amino acid tryptophan. A niacin deficiency can occur when inadequate amounts of niacin or tryptophan are consumed. Niacin deficiency also occurs in cases of Hartnup’s disease (a genetic disease that involves defective tryptophan absorption) and carcinoid syndrome. Prolonged treatment with Isoniazid (an anti-tuberculosis medication) can also result in a niacin deficiency.

The severe and late stage of niacin deficiency is called pellagra. Pellagra occurred throughout the Europe and the United States where corn was the primary stable of the poor and working class. Although corn contains niacin, but it is bound that is not nutritionally available to humans. In the parts of the world where corn originated, Mexico and South America, pellagra is very uncommon. This is despite the fact that these parts of the world are also poor and corn is a staple. In this region corn is prepared by soaking in lime which then releases the niacin in a form that can be used by humans.

The symptoms of pellagra are commonly known as the 4 D’s, dermatitis, diarrhea, dementia and death. In the skin, a thick, scaly and dark pigmented rash appears, especially in areas exposed to sunlight. Digestive system involvement includes a bright red tongue, vomiting and diarrhea. The neurological symptoms of pellagra are headache, apathy, fatigue, depression, disorientation and memory loss. If not treated pellagra is ultimately results in death.

Benefits

Extensive research has been done on niacin and what it can do.

1. Preliminary studies in animals have shown that niacin not only helps to prevent DNA damage but actually assists in its repair. This DNA repair helps prevent the appearance of disorders that can result from cellular damage at the DNA level such as cancer. In vitro (in the laboratory) studies of human cancer lines have shown that the niacin metabolite NAD (niacin and tryptophan are its prcursors) suppresses the tumor suppressor protein p53.
2. The use of niacin supplements to lower elevated LDL (bad cholesterol) levels and triglycerides. It is also more effective in increasing HDL (good cholesterol) levels than cholesterol lowering medications. Several well documented double-blind, placebo-controlled studies have found that niacin can reduce LDL levels by about 10%, triglyceride levels by 25% while raising HDL by 20-30%. Niacin has also been shown to lower the levels of lipoprotein (responsible for atherosclerosis) by as much as 30%. It has also been shown to be a safe and effective treatment for high cholesterol in people with diabetes without raising the blood sugar levels.
3. There has been some evidence that niacin can prolong the “honeymoon” period in the development of juvenile diabetes. This is the period when the pancreas is slowly losing its ability to produce insulin. Preliminary evidence suggested that niacinamide might slightly prolong this period. In another study, niacinamide and vitamin E along with intensive insulin therapy was more effective than insulin plus niacinamide alone in prolonging the honeymoon period.
4. Recent studies have also shown that niacinamide may help improve blood sugar control in type tow diabetes.
5. There has been some eveidence that niacinamide by profide benefits to those with osteoarthritis. In a double-blind study 72 people with arthritis were given 3,000mg of niacinamide in 6 equal doses per day or a placebo for 12 weeks. Those who received the supplement showed a 29% improvement in their symptoms. The only draw back is that at this dose liver damage is a concern.
6. In one small double blind study, the form of niacin known as inositol hexaniacinate proved helpful in Raynaud’s phenomen. The dosage used was 4000,mg daily an amount that could cause liver damage.
7. Diatary B3 along with other nutrients are important for normal vision and the prevention of cataracts. A study of 2900 people in Australia found that those who consumed the most protein, vitamin A, B1 (thiamine), B2 and B3 (niacin) were significantly less likely to develop cataracts. A follow up study also showed that many supplemental B complex vitamins including B3 exerted a protective effect against cataracts.
8. Preliminary research is showing the benefits of niacin in anti-aging skin products, for the treatment of acne, and even possibly the prevention of skin cancer.
9. Some have even linked niacin to an increase in HGH (human growth hormone).

Recommended Dosage:

It should be understood that the amounts of niacin needed to be helpful in most medical conditions are extremely high. These doses are considered “pharmacological and must be prescribed by a qualified healthcare practitioner.

These amounts of niacin should also be taken with a meal to avoid stomach irritation.

Precautions

1. Using niacin to lower blood lipid levels should only be done under a doctor’s direct supervision.
2. Pregnant or nursing mothers should not take more that the RDA for niacian
3. Anyone with liver disease, jaundice, peptic ulcers or gastritis should use high doses of nicotinic acid with caution.
4. Those taking high doses should have their liver enzymes monitored on a regular basis.
5. Do not substitute slow or extended release form of nicotinc acid for the immediate release forms.
6. Niacin can cause an uncomfortable flushing of the skin. This flush is transient and should subside.
7. There are many drug interactions connected with niacin supplementation. Your healthcare practioner should be consulted before a niacin regime is undertaken.

Women who are pregnant or breastfeeding should consult a health care provider before using any supplements. The affects of this supplement has not been tested on children and those suffering from liver or kidney disease. It is recommended that in children and people with liver or kidney disease this supplementation not be used.

Web References

1. http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21769
2. http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/nia_0184.shtml
3. http://www.umm.edu/altmed/ConsSupplements/VitaminB3Niacincs.html
4. http://lpi.oregonstate.edu/infocenter/vitamins/niacin/

Printed Reference Material

1. Adding vitamins to the mix: skin care products that can benefit the skin [press release]. American Academy of Dermatology; March 11, 2000.
2. Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.
3. Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Safety. 1998;19(5):355-371.
4. Brown BG, Zhao XQ, Chalt A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583-1592.
5. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986; 8:1245-1255.
6. Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol. Dec 17, 1998;82:74U–81U.
7. Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm ischemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988; 223:405-418.
8. Cervantes-Laurean D, McElvaney NG, Moss J. Niacin. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams and Wilkins; 1999:401-411.
9. Chojnowska-Jezierska J, Adamska-Dyniewska H. [Prolonged treatment with slow release nicotinic acid in patients with type II hyperlipidemia]. [Article in Polish]. Pol Arch Med Wewn. 1997; 98:391-399.
10. Colletti RB, Neufeld EJ, Roff NK, et al. Niacin treatment of hypercholesterolemia in children. Pediatrics. 1993; 92:78-82.
11. Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology. 2000;107(3):450-456.
12. De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.
13. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.
14. Ding RW, Kolbe K, Merz B, de Vries J, Weber E, Benet Z. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther. 1989;46(6):642-647.
15. Elam M, Hunninghake DB, Davis KB, et al. Effects of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: a randomized trial. Arterial Disease Multiple Intervention Trial. JAMA. 2000;284:1263-1270.
16. Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: The ADMIT Study: A randomized trial. JAMA. 2000; 284:1263-1270.
17. Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.
18. Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother. 1997;31(6):677-682.
19. Gardner SF, Schneider EF, Granberry MC, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacother. 1996;16:419–423.
20. Garg A. Lipid-lowering therapy and macrovascular disease in diabetes mellitus. Diabetes. 1992;41(Suppl 2):111-115.
21. Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol. 2000; 85:1100-1105.
22. Goldberg A, Alagona P, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in management of hyperlipidemia. Am J Cardiol. 2000;85:1100-1105.
23. Gray DR, Morgan T, Chretian SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med. 1994; 121:252-258.
24. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan
25. Gemfibrozil Study Group. Arch Int Med. 2000; 160:1177-1184.
26. Guyton JR, Capuzzi DM. Treatment of hyperlipidemia with combined niacin-statin regimens. Am J Cardiol. Dec 17, 1998;82:82U–84U.
27. Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol. Dec 17, 1998;82:18U–23U.
28. Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol. 1998; 82:18U-23U.
29. Henkin Y, Oberman A, Hurst DC. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991; 91:239-246.
30. Illingworth DR, Stein EA, Mitchel YB, et al. Comparative effects of lovastatin and niacin in primary hypercholesterolemia. Arch Intern Med. 1994; 154:1586-1595.
31. Jacques PF, Chylack LT Jr, Hankinson SE, et al. Long-term nutrient intake and early age related nuclear lens opacities. Arch Ophthalmol. 2001;119(7):1009-1019.
32. Johansson JO, Egberg N, Asplund-Carlson A, Carlson LA. Nicotinic acid treatment shifts the fibrinolytic balance favorably and decreases plasma fibrinogen in hypertriglyceridaemic men. J Cardiovasc Risk. 1997; 4:165-171.
33. Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J ClinPract. 1996;77A(Suppl):28-32.
34. Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: A pilot study. Inflamm Res. 1996;45:330-334.
35. King JM, Crouse JR, Terry JG, et al. Evaluation of effects of unmodified niacin on fasting and postprandial plasma lipids in normolipidemic men with hypoalphalipoproteinemia. Am J Med. 1994; 97:323-331.
36. Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:88-99.
37. Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Dig Dis Sci. 1993;38(9):1614-1618.
38. Kuzniarz M, Mitchell P, Cumming RG, Flood VM. Use of vitamin supplements and cataract: the Blue Mountains Eye Study. Am J Ophthalmol. 2001;132(1):19-26.
39. Lin S-J, Defossez P-A, Guarente L. Requirement of NAD and SIR2 for life-span extension by calorie restriction in Saccharomyces cerevisiae. Science. 2000; 289:2126-2128.
40. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther. 1982;4(6):423-440.
41. McCarty MF. Niacinamide therapy for osteoarthritis – does it inhibit nitric oxide synthase induction by interleukin-1 in chondrocytes? Med Hypotheses. 1999;53(4):350-360.
42. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained-vs immediate-release niacin in hypercholesterolemic patients. JAMA. 1994; 271:672-677.
43. Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.
44. Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.
45. O'Hara J, Nicol CG. The therapeutic efficacy of inositol nicotinate (Hexopal) in intermittent claudication: a controlled trial. Br J Clin Prac. 1988;42(9):377-381.
46. Omray A. Evaluation of pharmacokinetic parameters of tetracylcine hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.
47. Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Co., Inc.: 2000:1519-1523.
48. Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med. 1992; 92:77-81.
49. Rockwell KA. Potential interaction between niacin and transdermal nicotine. Ann Pharmacother. 1993;27(10):1283-1288.
50. Saareks V, Mucha I, Sievi E, Riutta A. Nicotinic acid and pyridoxine modulate arachidonic acid metabolism in vitro and ex vivo in man. Pharmacol Toxicol. 1999; 84:274-280.
51. Tato F, Vega GL, Grundy SM. Effects of crystalline nicotinic acid-induced hepatic dysfunction on serum low-density lipoprotein cholesterol and lecithin cholesteryl acyl transferase. Am J Cardiology. 1998; 81:805-807.
52. Torkos S. Drug-nutrient interactions: a focus on cholesterol-lowering agents. Int J Integrative Med. 2000;2(3):9-13.
53. Trueblood NA, Ramasamy R, Wang LF, Schaefer S. Niacin protects the isolated heart from ischemia-reperfusion injury. Am J Physiol Heart Circ Physiol. 2000; 279:H764-H771.
54. Tsalamandris C, Panagiotopoulos S, Sinha A, et al. Complementary effects of pravastatin and nicotinic acid in the treatment of combined hyperlipidaemia in diabetic and non-diabetic patients. J Cardiovasc Risk. 1994; 1:231-239.
55. Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (the IMDIAB VI). Diabetes Metab Res Rev. 1999;15(3):181-185.
56. Whelan AM, Price SO, Fowler SF, et al. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract. 1992;34(2):165-168.
57. Yee HS, Fong NT, Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother. 1998 Oct;32(10):1030-1043.