Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of reproductive age.[1,2] PCOS can be described as a complex endocrine condition and is characterised by polycystic ovaries, anovulation, amenorrhoea, hyperandrogenaemia, hirsutism, acne and infertility. All of these characteristics of PCOS affect quality of life and wellbeing.[2]
Metabolic syndrome is diagnosed when any three of the following five risk factors are present:[3]
- elevated fasting plasma glucose level (hyperglycaemia)
- elevated triglyceride levels
- reduced high-density lipoprotein (HDL) cholesterol level
- elevated blood pressure
- increased waist circumference.
Additionally, chronic inflammation[3,4] and oxidative stress[4] have been associated with cardiometabolic syndrome. Women with PCOS have an increased risk of insulin resistance,[1,2,5] glucose intolerance, dyslipidaemia (cholesterol and triglycerides),[2] inflammation, oxidative stress[2] and impaired endothelial dysfunction,[1,2,5] which are indicative of cardiometabolic syndrome.
Nutrition plays a major role in the prevention and management of chronic disease, especially cardiometabolic syndrome.[6] N-acetyl cysteine (NAC) is an amino acid that contains a thiol group.[7] NAC has numerous cardioprotective properties, including antioxidant[7-9] and anti-inflammatory actions,[8] improving lipid profile, as well as decreasing oxidative stress and reducing paracetamol toxicity, along with mucolytic and detoxification properties.[7] NAC is one of the precursors of glutathione, which is an important antioxidant.[7,9]
A randomised double-blind clinical trial investigated the effect of NAC versus metformin on women with a diagnosis of PCOS.[10] In this study, one group took NAC 600mg three times a day. Whereas, the other group took metformin 500mg three times a day. The duration of the trial was 24 weeks. At the completion of the trial, fasting blood glucose and insulin, lipid profile and homeostasis model assessment (HOMA) index (used to quantify insulin resistance) were measured.
In the NAC group 46 women and 48 women in the metformin group finished the study. After 24 weeks of treatment, fasting blood glucose, fasting insulin, HOMA index and low-density lipoprotein (LDL) cholesterol were lower in the NAC group.
Furthermore, another study found that NAC was equally effective as metformin in improving parameters of insulin resistance and metabolic syndrome over a three-month period. In this study, the NAC group took 600mg daily for the first week, 600mg twice daily for the second week and 600mg three times daily for the third week onwards. The metformin group took 500mg daily for the first week, 500mg twice daily for the second week and 500mg three times daily for the third week onwards. NAC resulted in improvements in weight, systolic blood pressure, fasting blood glucose, parameters of insulin resistance and lipid profile.[11]
PCOS and cardiometabolic syndrome are complex health conditions. NAC shows promise in the management of cardiometabolic parameters in women with PCOS, via reducing insulin resistance, blood glucose levels and improving lipid profile. The dosages used in these trials were 1800mg per day for 24 weeks and a step-wise dosage up to 1800mg per day (study length three months).
As always, practitioners need to be mindful of the dosage of nutrients, including NAC, and the individual characteristics of the person presenting in front of them. Further research is suggested to investigate the effects of NAC on both PCOS and cardiometabolic syndrome, with longer trial periods and varying dosages of NAC.
References
- Randeva HS, et al. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev 2012;33(5):812-841. [Abstract]
- Conway G, et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014;171(4):1-29. [Abstract]
- Benjamin EJ, et al. Heart disease and stroke statistics-2018 Update: A report from the American Heart Association. Circulation 2018;137(12):e67-e492.[Abstract]
- Govindarajan G, et al. The cardiometabolic syndrome as a cardiovascular risk factor. Am J Med Sci 2005;330(6):311-318.[Abstract]
- Macut D, et al. Insulin and the polycystic ovary syndrome. Diabetes Res Clin Pract 2017;130:163-170.[Abstract]
- McEwen BJ. The influence of diet and nutrients on platelet function. Semin Thromb Hemost 2014;40(2):214-226.[Abstract]
- Mokhtari V, et al. A review on various uses of N-acetyl cysteine. Cell J 2017;19(1):11-17.[Full Text]
- Skvarc DR, et al. The effect of N-acetylcysteine (NAC) on human cognition - A systematic review. Neurosci Biobehav Rev 2017;78:44-56.[Abstract]
- Dludla PV, et al. Cardioprotective potential of N-acetyl cysteine against hyperglycaemia-induced oxidative damage: a protocol for a systematic review. Syst Rev 2017;6(1):96.[Abstract]
- Javanmanesh F, et al. A comparison between the effects of metformin and N-acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome. Gynecol Endocrinol 2016;32(4):285-289.[Abstract]
- Ali H, Radhakrishnan G, Singh A. Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome. Internl J Reprod, Contracep, Obstetrics and Gynecology 2017;6(7):9.[Full Text]
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