The Philippine Dermatological Society Position Paper on Glutathione

Rationale : In response to the growing concern regarding the safety and efficacy of GLUTATHIONE, the Philippine Dermatological Society is issuing this position paper

I. Philippine Dermatological Society

The sole authority in the field of dermatology recognized by Philippine Medical Association is the Philippine Dermatological Society. It is composed of members who underwent the prescribed standard training in the specialty of dermatology. There are currently ten training institutions affiliated with the Philippine Dermatological Society. The Society through the Philippine Board of Dermatology certifies the Fellows and Diplomates as specialists in dermatology.

II. Evidence-based Medicine

The universal standard in health care delivery is Evidence-Based Medicine . It seeks to define the practice of Medicine using the best available scientific evidence on any particular health-related issue. Evidence is further classified and ranked according to strength, with testimonial evidence (“this drug works because it cured me and will work for you too”) as weak, while the randomized clinical trials (RCTs) which are controlled, standardized, unbiased studies, rank strongest. Thus, good medicine is defined by good evidence.

III. Glutathione Facts *

What is glutathione?

Glutathione is a compound composed of three amino acids: glutamine, glycine, and cysteine . It is primarily found in body cells. The liver generates most of the body’s glutathione supply.

Glutathione is also naturally found in many food sources. Fresh fruits and vegetable provide high levels of glutathione, but cooking and processing destroy most of it. Glutathione supplements are not normally required because glutathione is so widely distributed in common foods.

What is the role of glutathione in the human body?

Glutathione participates in several cellular and body functions such as antioxidant defense, metabolism, and regulation.

The most well known role of glutathione is as an antioxidant. Glutathione is an efficient scavenger of free radicals and other reactive oxygen species through enzymatic reactions. It is an extra cellular antioxidant, and it is also the main intracellular antioxidant against protein, lipid or enzymatic oxidation.

Glutathione reacts with harmful xenobiotics (synthetic chemicals) and pollutants. It forms soluble compounds with harmful substances, rendering these excretable via the urine, thus detoxifying our body (Guoyao et al., 2004). It is no wonder that diseases such as cancers, neurodegenerative diseases, and AIDS have been associated with depleted intracellular glutathione levels.

What are the commonly available ways to increase glutathione levels in the human body?

Glutathione found in foods are efficiently absorbed in the human intestines. Vitamin C, dietary sources of glutathione and several other nutritional compounds including N-acetylcysteine (NAC), alpha-lipoic acid, glutamine, methionine, and undenatured whey protein can help increase glutathione levels in the body.

In the Philippines, oral and intravenous glutathione are readily available. Researches found no increase in blood glutathione levels after a single oral dose of up to 3,000 mg glutathione to seven healthy subjects (Witschi, 1992). High dose IV glutathione was found to be safe in a study by Bianchi et. al. that evaluated the reduced form (GSH) glutathione kinetics in normal subjects compared to cirrhotic patients (Valencia, 2002)

What are the claims of glutathione distributors?

Claims related to the skin were: whitening, anti-aging, skin rejuvenation. All glutathione distributors claim that their products had whitening effect on the skin. Ninety-five percent (95.5%) had antioxidant effects. Others claimed anti-aging effects by ninety-one (91%).

What is the evidence behind the claims?

Claim No.1: Glutathione supplements or skin products whiten the skin

Glutathione oral supplements and its intravenous form have become very popular because of their reported “side effect – the ‘whitening’ of skin”. Based on animal and human studies (Villarama and Maibach, 2005), glutathione may act by:

  • Direct inactivation of the enzyme tyrosinase, necessary in melanin (pigment) production
  • Conversion of pigment to the lighter phaeomelanin
  • Quenching free radicals and peroxides that contribute to tyrosinase activation and melanin formation
  • Modulation of depigmenting abilities of melanocytotoxic agents

However, regarding the efficacy of glutathione supplements, there are:

  • No published controlled clinical trials
  • No published randomized controlled trials (RCTs)
  • One unpublished RCT (Philippines) – company-sponsored clinical trial using IV glutathione; unable to retrieve copy of the study, results unknown
  • Numerous anecdotes and testimonials (lowest level of evidence)

Hence, good quality evidence is NOT found

Claim No. 2: Glutathione supplements are anti-aging

  • No cohort studies
  • No published controlled clinical trials
  • No published randomized controlled trials (RCTs)

Claim No. 3: Glutathione supplements rejuvenate the skin

  • No published reports

Are glutathione supplements safe?

  • No reported adverse effects found
  • One review (Uretsky, 2005) stated as a precaution – ‘ sensitivity to any of the inactive ingredients in the preparation of glutathione or the products used to stimulate glutathione levels’

There are anecdotal reports of IV glutathione adverse effects (dermatologist, endocrinologists):

  • Erratic blood sugar levels in diabetics
  • Recurrence of arthritic pains
  • Recurrence of hypothyroidism/hyperthyroidism

The precautions of IV glutathione (distributors’ advice)

  • Not for pregnant women
  • Not for patients with acute liver problems
  • Patients must have eaten prior to infusion

IV. SUMMARY

  • The current evidence behind the claims made by distributors is based on
    weak evidence: anecdotal evidence, testimonials, animal studies for efficacy and safety
  • Poor quality, published reports of human clinical trials or case reports.

    • V. RECOMMENDATIONS:

    • Glutathione oral (tablet) supplements and intravenous (IV) injection of glutathione currently do not have scientifically proven skin whitening, ‘ anti-aging’ or skin rejuvenating effects. Beware of retailers and distributors who make such claims.
    • Intravenous glutathione is considered a drug and should only be purchased and administered upon advice and supervision of a physician.

      • References

      1. * Dofitas BL. Glutathione supplements and the skin. Oral Presentation. UPPGH Postgraduate Course ‘Women’s Dermatology’ March 2008.

      2. Guoyao Wu, Yun-Shong Fang, Sheng Yang, Joanne R Lupton, and Nancy D Turner. Glutathione metabolism and its implications for health. J Nutr 2004 Mar;134(3):489-92.

      3. Villarama, CD & Maibach HI. Glutathione as a depigmenting agent: an overview. Int. Journal of Cosmetic Science 2005 June; 27 (3): 147-153.

      4. Valencia, Erik and Gil Hardy. Practicalities of glutathione supplementation in nutritional support. Curr Opin Clin Nutr Metab Care 2002; 5:321-326.

      5. Witschi A, Reddy S, Stofer B, Lauterburg BH. The systemic availability of oral glutathione. Eur J Clin Pharmacol 1992;43(6):667-9.

      6. Miko Enomoto T, Johnson T, Peterson N, Homer L, Walts D, Johnson N. Combination glutathione and anthocyanins as an alternative for skin care during external-beam radiation. Am J Surg 2005 May;189(5):627-30; discussion 630-1.

      Prepared by:

      Lonabel A. Encarnacion, MD, FDPS
      Member, PDS Board of Directors

      Resource Persons:

      Nora R. Cortez, MD, FPDS
      Chair, PDS Task Force onTruth in Commercial and Product Advertising

      Belen L. Dofitas, MD, FPDS
      Chair, PDS Task Force on Health Information & Disease Registry

      Approved by the PDS Board of Directors:
      Arnelfa C. Paliza, MD, FPDS
      President

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