Friday, March 31, 2017

Increasing Glutathione in ME/CFS & Related Illnesses

Glutathione Molecule (Ben Mills - Own work, Public Domain), Link
[NOTE: I am not a doctor. This post describes our own personal experiences & what I have learned from research.  You should work with your own doctor on your own unique case to find what works for you. Don't have a doctor who understands how to treat ME/CFS? Check these databases to find a doctor near you or call local doctors and ask if they treat ME/CFS. You don't necessarily need an expert - just someone willing to learn more and work with you.]

Since the first years of my illness, 15 years ago, I have been hearing how important glutathione is to ME/CFS patients (and those with fibromyalgia and Lyme disease, too). It's taken me all these years, though, to finally learn more about glutathione, understand why it's so important, and see the full positive effects of increasing glutathione.

My son and I saw our ME/CFS specialist, Dr. Susan Levine, in September last year, and she asked what our biggest problems were. I said immune system dysfunction because both of us struggle with chronic yeast overgrowth, and we both get bacterial bronchitis multiple times (sometimes up to 4 or 6 times) a year, which requires antibiotics, which in turn makes the yeast problems even worse. Since we already take the top two immune modulators typically used for ME/CFS - low-dose naltrexone and inosine (aka Imunovir) - and both have helped us (especially in reducing virally-triggered crashes), she suggested we add something new: intramuscular (IM) glutathione injections.

So, we started those after our visit, twice a week, and wow, what a difference it has made! I just went through an entire winter without getting bronchitis once (I usually get it 2 or 3 times a winter), and I get a big energy boost from the glutathione, too. My son has trouble remembering to do his glutathione injections regularly while at college, but when he does, he also notices increased energy and well-being. I am trying to remind him to do them regularly in the hopes that he will also get bronchitis less this year (he had a typical winter, with 3 bouts of bronchitis). It should also help with his Lyme disease and the Herx reactions (worsening) that result from treating it.

What Is Glutathione and Why Is It Important?
In the simplest terms, glutathione is a naturally occurring compound in the human body, a strong antioxidant that helps our bodies to deal with toxins. It is a product of the methylation cycle, which is of primary importance to ME/CFS patients (and those with fibromyalgia and Lyme) and usually severely dysfunctional (see information at the link on how to improve methylation). A lack of glutathione can lead to oxidative stress, which has been shown to be a large part of the exertion intolerance (aka Post-Exertional Malaise or PEM) that is a defining characteristic of ME/CFS.

The Wikipedia entry for glutathione says that the human body makes plenty of glutathione on its own, so it does not need to be supplemented. That is true for healthy people, but glutathione levels have been shown to be low in those with ME/CFS, contributing to low energy, immune dysfunction, detoxing problems, and exercise intolerance. Since our bodies can't make enough glutathione on their own, increasing glutathione through supplementation can be a helpful treatment for ME/CFS patients. My son and I have found it to help increase energy, reduce exercise intolerance, and improve immune function.

How Do I Increase Glutathione?
Increasing glutathione in your body to normal levels is not as simple as just talking a single pill. There are multiple approaches that include helping your body to make more glutathione on its own and supplementing with certain forms of glutathione that your body can use effectively.

Glutathione Precursers:
One way to increase your body's production of glutathione is to give it more of the raw materials (precursers) that it needs to make glutathione. These include:
  • Milk Thistle
  • N-Acetyl-Cysteine (NAC)
  • Turmeric/circumin (not technically a precurser but circumin encourages production of glutathione in the body and helps with detox)
  • Undenatured whey protein (read the label to ensure it has no additives)
[NOTE ON WHEY: For many years, I knew that whey was an important precursor to glutathione but thought that my son and I couldn't take it because we are dairy intolerant (as are 30% of ME/CFS patients, according to a recent study). I was thrilled when our dietician/biochemist explained that when whey is separated from the rest of milk (the curds - remember Miss Muffet, eating her curds and whey?), almost all of the lactose and most of the casein (a protein in milk) is in the curds, leaving whey to be tolerated well by many people who are dairy-intolerant. We tried it and were happy to discover she was right - we can both tolerate whey protein powder with none of the usual side effects we get from full dairy products.]

Supplementing with Glutathione:
Although it is tricky to supplement directly with glutathione - to get it into the cells where it can be useful - there are several approaches that can work:
  • S-Acetyl Glutathione - a form that can get into the cells - our dietician recommended we take this at bedtime.
  • Liposomal Glutathione - glutathione that is encased in little fat spheres (to put it simply!) that enable it to get to the cells where it is needed. We used this before we switched to injections.
  • Intramuscular or intravenous injections of glutathione - these deliver glutathione directly to the bloodstream. We are currently using intramuscular injections, which have been quite effective for us, though our dietician says the IV injections are even better. Both of these require a prescription and must be obtained through a compounding pharmacy (which is simple and inexpensive).
If you are squeamish about self-injections, I am living proof that it can be learned! After years of taking B12 sublingual tablets, while my son did B12 self-injections, he finally said, "Quit being such a baby, Mom! You know the injections are more effective." He was right - I switched to B12 injections at the same time that I started my glutathione injections. We do B12 subcutaneous injections (under the skin) which are tiny amounts and tiny needles, and he was right - I barely feel them. The intramuscular (IM) injections for glutathione require a longer needle and take a little more practice to master, but after 6 months of doing it twice a week, I have gotten pretty good and they barely hurt at all. I recommend this how-to video from the Veteran's Administration to learn how to do your own IM injections. Note that B12 is another critical component in improving methylation.

How To Get Started
It's always best to start with a doctor or other knowledgeable medical personnel (like our dietician who also has a MS in biochemistry). You can see one of the ME/CFS specialists - there are about a dozen across the U.S. and others overseas - or a local doctor or other medical professional who understands ME/CFS or is at least willing to learn. If necessary, print some of the information from this post and its links to help educate your doctor. Most of the treatments listed above are supplements that don't require a doctor, but it is always good to consult with one, if you have one who understands ME/CFS.

You can start with the prescursors listed above, to help your body produce more glutathione on its own. ALWAYS - as with any ME/CFS treatment - start very slowly and go gradually. Begin with just one supplement, at a low dose, and see how you tolerate it. Improving methylation and increasing glutathione can sometimes produce a temporary worsening (a Herx reaction), as your body improves its ability to deal with toxins and moves them into the bloodstream to get rid of them. The best approach to a Herx (worsening) is to reduce the dose to where the Herx is tolerable and wait to increase until you are at least back to baseline or feeling better.

Milk thistle is an ideal supplement to start with, if you aren't already taking it. It has multiple functions, most importantly helping to improve liver function, i.e. helping your body to process medications and supplements as well as harmful byproducts that your body produces. By starting with milk thistle and improving liver function, you can both increase glutathione and help your body to tolerate additional supplements. Turmeric or circumin also has multiple purposes, helping to reduce inflammation, improve detox, and increase glutathione.

When I added NAC (many years ago), I felt an immediate improvement in energy, so that is a good one to add next. My son and I also both get a nice boost from whey protein powder, too - we use it in smoothies. This is our recipe for a Chocolate Smoothie - our favorite lunch! Tastes decadent and has several ingredients that help with energy.

The S-Acetyl Glutathione is absorbed differently by your body, so it can be used WITH either liposomal glutathione or injections (but the liposomal and injections are either/or). You can buy liposomal glutathione as a supplement in various forms, but the injections require a prescription (you get it from a compounding pharmacy which is simple and inexpensive).

(Note that if money is an issue, milk thistle, NAC, and curcumin are all fairly cheap and quite important. Injectable glutathione is MUCH cheaper (and far more effective) than liposomal glutathione in either liquid or pill form. Whey powder seems expensive but one of those big canisters can last quite a while. Beware of buying whey powder at the drugstore or grocery store - read the labels carefully as many of the more common commercial brands sold for athletes have LOTS of additives.)

As with any treatments for ME/CFS, START LOW AND GO SLOW! Add one supplement at a time, starting with a low dose, and increase as tolerated.

I highly recommend you also take a look at this article on Phoenix Rising on Augmenting Glutathione in ME/CFS. It was written by Rich Van Konyenburg, who also developed one of the first methylation protocols and was one of the first to recognize the importance of glutathione in ME/CFS.

I have included some links below to the products we have tried and found to be effective for increasing glutathione. A few notes:

The Natural Force whey powder is a 'cleaner" product with no added ingredients, but my son likes the taste of the Bluebonnet better (it has natural vanilla flavor and MCT oil added in) - also that's two fewer ingredients he needs to remember when he makes his own smoothie! Meriva is a brand of curcumin (and the one our dietician likes) - it has been very helpful to my son in managing his Herx reactions, in addition to its role in promoting glutathione production. Liposomal glutathione is quite expensive (far more so than the injections) and comes in pills or liquid. Fair warning: the liquid is pretty nasty tasting! (the softgel capsules are tasteless).

Please let me know if you have any questions. If you have any experience in increasing glutathione, please share it in the comments below, so we can all learn from each other!

Note: This post contains affiliate links. Purchases from these links provide a small commission to me, to help offset the time I spend writing for this blog, at no extra cost to you.



  1. Anonymous5:47 PM

    "Check these databases to find a doctor near you" - only one of these links worked.

    1. Thanks for letting me know. I know the Good Doctor List is no longer available, unfortunately. If you want to tell me what region you live in (here or you can e-mail me at my profile link up above), I can tell you which ME/CFS expert is closest to you.

  2. Wishing you all the best!

  3. I live in Virginia...where is the closest ME dr? Where is Dr Susan Levine?

    1. Hi, Johanna -

      You are on the right track! Your best approach for making real improvements & progress is to go see one of the ME/CFS experts - unfortunately, they are a bit spread out (but we are lucky to have the ones we do!). Closest to you is Dr. Charles Lapp in NC, who was one of the original doctors involved in CFS in the 80's BUT recently, I have heard from patients that although he is knowledgeable and kind, he's not really offering much in the way of real treatments, so if I were you, I would travel a bit further (though I know how hard that is).

      Next closest to you is Dr. Levine in NYC. That's who we see (about 2 hours away from us here in DE). The good thing about NYC is that you could take Amtrak from Richmond (probably about 6 hrs?). We usually take the train to go see her. It is well worth the trip if you can manage it, and she is used to working with long-distance patients so after that first visit, you'll probably only need to go once a year, and she will work with you via phone & e-mail in between. She is one of the top ME/CFS docs in the world and works closely with the other top docs, so she is up on the very latest research and treatments.

      You other option is to travel south to Florida to see Dr. Nancy Klimas in her clinic. She has a much larger operation than Dr. Levine (who is on her own in a tiny office!), but they generally offer the same treatments and work closely together.

      Sorry - no one in VA, but I encourage you to do whatever you can to get to Dr. Levine or Dr. Klimas - I guarantee it will be life-changing for you!