Tylenol (acetaminophen) is one of the most commonly used painkillers, but it comes with side effects. The most concerning effects of using Tylenol are liver damage and glutathione depletion. You may be wondering: how can I prevent liver damage and glutathione depletion? In this article, I let you know my favorite strategies and supplements.
What Happens When Glutathione Gets Depleted?
Glutathione is the body’s master antioxidant. Low levels are associated with aging, increased risk of infections (including COVID-19), cancer, neurological problems, diabetes, and more. Low levels of glutathione might make people more susceptible to liver damage from acetaminophen.
What Happens When The Liver Gets Damaged?
The liver is responsible for processing many kinds of chemicals so that our bodies can get rid of them through our bowels. It also regulates blood sugar (via glycogen) and produces bile for fat digestion. When the liver isn’t working optimally, digestive problems and fatigue are common early signs. More serious signs of acetaminophen-induced liver damage include nausea, vomiting, abdominal pain, confusion, drowsiness, and coma.
Luckily, the liver is very resilient, and even if some degree of liver damage is experienced (either from overdoing it with Tylenol or from something else), the liver usually starts to recover within a couple days of stopping the drug and is fully back to normal within several weeks or months.
How To Prevent & Repair Liver Damage
Prevention is preferable to repair. The best way to prevent liver damage from acetaminophen is to use it in the recommended doses for the recommended periods of time and not to take too much. However, it is easy to overdose on acetaminophen because it is often found in combination products, so it is important to always read medication labels. It is also very important that acetaminophen not be combined with alcohol.
The liver will repair itself without outside intervention; however, it needs building blocks for repair either from supplementation or diet. Important nutrients for optimal liver health and function include vitamin C, vitamin D, B-vitamins, B12, folate, zinc and glutathione. Castor oil packs can also be helpful, as can a liver-focused herbal blend.
How To Prevent And Treat Glutathione Depletion
Prevention or treatment of glutathione depletion depends on having a robust network of antioxidants in the body. Glutathione is the “master antioxidant” but there are many other antioxidants which are helpful, including vitamin C, vitamin E, quercetin, beta glucans (eg from medicinal mushrooms), zinc, selenium, and others.
Glutathione can be supplemented directly, or its precursor, N-acetylcysteine (NAC), can be supplemented. Supplementing with Vitamin C is also an effective way to increase glutathione levels.
Eating a diet that supports glutathione levels is another option. N-acetylcysteine can be found in protein-rich foods like meat, yogurt, and egg yolk, and it can be found in vegan sources like oatmeal, cruciferous vegetables, garlic, and onion. Other antioxidants are easy to find in brightly colored fruits and vegetables.
Which Supplements Support Liver & Glutathione Levels While Taking Tylenol?
For most of my adult patients, taking a natural supplement with a potent blend of vitamins, herbs, minerals and probiotics (such as glutathione, quercetin, vitamin C, zinc, and selenium) in addition to a quality multivitamin provides all the protection that their livers need to handle routine acetaminophen use.
Pregnant and breastfeeding mothers can bump up their antioxidant protection by adding extra vitamin C and beta glucans found in medicinal mushrooms to their quality prenatal vitamin.
For children, I’ll often add extra vitamin C and/or zinc to their multivitamins to support the antioxidant network if they are taking Tylenol for more than a day or two. This is especially true if they have trouble getting in the recommended daily servings of fruits and vegetables.
Tylenol is a safe and effective painkiller to use for short periods of time and in the recommended doses. However, Tylenol does carry the risk of liver damage and glutathione depletion, especially if overused or used alongside alcohol.
Maintaining good levels of antioxidants helps the body process acetaminophen with ease and could possibly reduce side effects. Antioxidants can be found in a number of healthy foods and can also be taken as supplements.
Dimova, S., Hoet, P. H., Dinsdale, D., & Nemery, B. (2005). Acetaminophen decreases intracellular glutathione levels and modulates cytokine production in human alveolar macrophages and type II pneumocytes in vitro. The international journal of biochemistry & cell biology, 37(8), 1727–1737. https://doi.org/10.1016/j.biocel.2005.03.005
Koufoglou, E., Kourlaba, G., & Michos, A. (2021). Effect of prophylactic administration of antipyretics on the immune response to pneumococcal conjugate vaccines in children: a systematic review. Pneumonia (Nathan Qld.), 13(1), 7. https://doi.org/10.1186/s41479-021-00085-8
Hay, A. D., Redmond, N. M., Costelloe, C., Montgomery, A. A., Fletcher, M., Hollinghurst, S., & Peters, T. J. (2009). Paracetamol and ibuprofen for the treatment of fever in children: the PITCH randomised controlled trial. Health technology assessment (Winchester, England), 13(27), iii–163. https://doi.org/10.3310/hta13270
Sherbash, M., Furuya-Kanamori, L., Nader, J. D., & Thalib, L. (2020). Risk of wheezing and asthma exacerbation in children treated with paracetamol versus ibuprofen: a systematic review and meta-analysis of randomised controlled trials. BMC pulmonary medicine, 20(1), 72. https://doi.org/10.1186/s12890-020-1102-5
Richie, J. P., Jr, Nichenametla, S., Neidig, W., Calcagnotto, A., Haley, J. S., Schell, T. D., & Muscat, J. E. (2015). Randomized controlled trial of oral glutathione supplementation on body stores of glutathione. European journal of nutrition, 54(2), 251–263. https://doi.org/10.1007/s00394-014-0706-z
Forman, H. J., Zhang, H., & Rinna, A. (2009). Glutathione: overview of its protective roles, measurement, and biosynthesis. Molecular aspects of medicine, 30(1-2), 1–12. https://doi.org/10.1016/j.mam.2008.08.006
Glutathione, reduced (GSH). Monograph. (2001). Alternative medicine review : a journal of clinical therapeutic, 6(6), 601–607.
Lu S. C. (2013). Glutathione synthesis. Biochimica et biophysica acta, 1830(5), 3143–3153. https://doi.org/10.1016/j.bbagen.2012.09.008
Teskey, G., Abrahem, R., Cao, R., Gyurjian, K., Islamoglu, H., Lucero, M., Martinez, A., Paredes, E., Salaiz, O., Robinson, B., & Venketaraman, V. (2018). Glutathione as a Marker for Human Disease. Advances in clinical chemistry, 87, 141–159. https://doi.org/10.1016/bs.acc.2018.07.004
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Clinical Course and Diagnosis of Drug Induced Liver Disease. [Updated 2019 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548733/
Polonikov A. (2020). Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients. ACS infectious diseases, 6(7), 1558–1562. https://doi.org/10.1021/acsinfecdis.0c00288
Liu, L. C., Wang, C. J., Lee, C. C., Su, S. C., Chen, H. L., Hsu, J. D., & Lee, H. J. (2010). Aqueous extract of Hibiscus sabdariffa L. decelerates acetaminophen-induced acute liver damage by reducing cell death and oxidative stress in mouse experimental models. Journal of the science of food and agriculture, 90(2), 329–337. https://doi.org/10.1002/jsfa.3821
Vargas-Mendoza, N., Madrigal-Santillán, E., Morales-González, A., Esquivel-Soto, J., Esquivel-Chirino, C., García-Luna Y González-Rubio, M., Gayosso-de-Lucio, J. A., & Morales-González, J. A. (2014). Hepatoprotective effect of silymarin. World journal of hepatology, 6(3), 144–149. https://doi.org/10.4254/wjh.v6.i3.144
Turan, M. I., Siltelioglu Turan, I., Mammadov, R., Altınkaynak, K., & Kisaoglu, A. (2013). The effect of thiamine and thiamine pyrophosphate on oxidative liver damage induced in rats with cisplatin. BioMed research international, 2013, 783809. https://doi.org/10.1155/2013/783809
Uysal, H. B., Dağlı, B., Yılmaz, M., Kahyaoğlu, F., Gökçimen, A., Ömürlü, İ. K., & Demirci, B. (2016). Biochemical and Histological Effects of Thiamine Pyrophosphate against Acetaminophen-Induced Hepatotoxicity. Basic & clinical pharmacology & toxicology, 118(1), 70–76. https://doi.org/10.1111/bcpt.12496
Matić, M. M., Paunović, M. G., Milošević, M. D., Ognjanović, B. I., & Saičić, Z. S. (2021). Hematoprotective effects and antioxidant properties of β-glucan and vitamin C against acetaminophen-induced toxicity: an experimental study in rats. Drug and chemical toxicology, 44(3), 302–309. https://doi.org/10.1080/01480545.2019.1587451
Ogino, N., Nagaoka, K., Tomizuka, K., Matsuura-Harada, Y., Eitoku, M., Suganuma, N., & Ogino, K. (2021). Compromised glutathione synthesis results in high susceptibility to acetaminophen hepatotoxicity in acatalasemic mice. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association, 156, 112509. https://doi.org/10.1016/j.fct.2021.112509
Akbay, E., Erdem, B., Ünlü, A., Durukan, A. B., & Onur, M. A. (2019). Effects of N-acetyl cysteine, vitamin E and vitamin C on liver glutathione levels following amiodarone treatment in rats. Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery, 16(2), 88–92. https://doi.org/10.5114/kitp.2019.86361
Johnston, C. S., Meyer, C. G., & Srilakshmi, J. C. (1993). Vitamin C elevates red blood cell glutathione in healthy adults. The American journal of clinical nutrition, 58(1), 103–105. https://doi.org/10.1093/ajcn/58.1.103
Minich, D. M., & Brown, B. I. (2019). A Review of Dietary (Phyto)Nutrients for Glutathione Support. Nutrients, 11(9), 2073. https://doi.org/10.3390/nu11092073