Clinical Pearls: Foundations of Glutathione Supplementation
Glutathione levels are significantly correlated to human health, and there isn’t a clinical condition not impacted by glutathione status. Whether directly or indirectly, at a foundational level, all protocols work to increase glutathione levels. Glutathione supplementation can be tricky to navigate, and deciding whether it’s beneficial or not depends on myriad of factors.
Before we dive into the nitty gritty, it’s important to note that it’s worse to have excess amounts of oxidized glutathione (GSSG) than it is to have low levels of glutathione as a whole. In some clients, supplementing with glutathione can cause adverse reactions. In our sensitive or complex clients, a gentler approach to increasing glutathione is often indicated.
Questions to Consider
1) Is cost a barrier for your client?
From a manufacturing standpoint, glutathione is costly. Reflecting this, glutathione supplements have a high price point. A low price point glutathione won’t be effective and the $$ will be better utilized else where in your protocol.
2) Does your client have access to quality glutathione?
Ex - A good liposomal or IV treatments
3) What is your clients baseline health?
Can they handle a large influx of glutathione and are they able to convert oxidized glutathione back to its reduced form? (GSSG --> GHS)
4) If an adverse reaction happens, are you well versed in how to mitigate it?
Building a Base
Glutathione can increase inflammation in the body. High levels of GSSG are physiologically more dangerous than low levels of GHS. When the body can’t reduce GSSG back to GSH and the GSSG:GSH is too high and we can see adverse reactions. For this reason, prepping the body before recommending a glutathione supplement can go along way.
How to Set the Body up for Glutathione Intake
- Reduce inflammatory insults (start with diet, remove liquor, particularly red wine)
- Add in anti-inflammatory foods
- Increase mineral levels, specifically zinc, selenium and magnesium along with B vitamins (B2 and niacin are the most important)
- Increase good quality proteins in the diet
Choosing A Glutathione Supplement
Not all glutathione supplements increase levels of glutathione in the body. The research shows that glutathione capsules across the board are ineffective at increasing glutathione or preserving it. This is due to three factors:
1. The stomach hydrolyzes glutathione into its component’s cysteine, glycine and glutamate. It gets absorbed in its parts and not as a glutathione molecule.
The glutathione molecule is highly unstable. In capsule form, it's often oxidized (degraded)
2. The glutathione molecule is highly unstable. In capsule form, it's often oxidized (degraded) before it leaves the shelf.
3. The half-life of glutathione in the body is 1.6 minutes. Even if it were to pass intact into the blood stream, it would oxidize before it reaches tissues.
When it comes to supplementing oral glutathione, liposomal glutathione is the only method shown to increase glutathione in the body to clinical significance. It’s important to distinguish a true liposomal vs an emulsion as an emulsion, while they often confer some benefit has the same problems as capsules when it comes to glutathione.
Liposomal Encapsulation Technology (LET) is the industry standard for true liposomes. Liposomal glutathione is nearly on par with IV administration.
Pro Tip: Liposomal bottles that tend to be open and closed result in oxidized product- instead opt for individual sachet packaging.
Common Adverse Reactions
When it comes to monitoring adverse reactions, following up with a client before your next appointment to see if they are experiencing any of the following symptoms is good practice. As practitioners we know that sometimes things get worse before they get better, but when it comes to glutathione, if adverse reactions occur, changing the protocol can yield a faster and more enjoyable healing trajectory. Common adverse reactions are:
- Difficulty Breathing
- Joint Pain
- Muscle pain
Common Culprits of Adverse Reactions
- High homocysteine
- Low nutrient status (mg, selenium, amino acids, niacin, b2)
- Infections (EBV, Herpes, Lyme, borrelia, bartonella, H. pylori, parasites etc.) ** Note, these infections are often not diagnosed but are an underlying cause in several conditions. If no underlying co-infection has been diagnosed it does mean they are not present and affecting individual health.
- High metal levels (particularly arsenic)
What to do if a Client has a Reaction
In the case of glutathione induced inflammation, supplementing with molybdenum can help mitigate reactive symptoms. Molybdenum is able to metabolize sulfur compounds, as little as 50 micrograms is usually sufficient, increasing as labs and clinical presentation see fit.
Supplementing with magnesium malate in conjunction with glutathione and molybdenum can offset reactions as well.
Additionally, if you have a higher risk client, supplementation with molybdenum before a reaction occurs is a recommended preventative measure.
If supplementation with complimentary nutrients doesn’t provide relief, cease glutathione use and revert back to optimizing physiology via the base building suggestions before reintroducing it.
Increasing Glutathione Indirectly
1) Supplementing with alpha lipoic acid
2) Supplementing with Vitamin C
4) Increasing dietary antioxidants
5) Reducing inflammation
6) Incorporating cruciferous vegetables
7) Using mineral drops in water
8) Increasing quality protein
In sensitive clients we can recommend an ‘oral rinse’ with liposomal glutathione. Have them swish with liposomal glutathione for 30 seconds, like a mouthwash and then spit out. Half dosing can also be beneficial or supplementing with the precursor, NAC to gradually increase cellular levels.
Glutathione reactions are often seen in individuals with complex chronic illness, high toxic exposure and those with long-standing conditions. In the general population, even those who are coming in for consults, glutathione supplementation will be beneficial and likely without adverse reactions. To further highlight the safety of glutathione, high dose glutathione is often given in IV, and a standard dose of liposomal glutathione is generally regarded as safe. It’s important to have the reactions in the back of our mind and to understand the clinical presentation of someone who is momentarily ‘glutathione intolerant’.
Get to know your clients even better by downloading our free resource 'The 10 Questions that should be on your intake but probably aren't"
Author: Lisa Kowalyk, Co-Founder Fiore Health Academy