Clinical trials for several individual supplements have shown benefit for treatment of cystic fibrosis, including N-acetyl cysteine (NAC),1 the amino acid taurine,2,3 and mineral supplementation with magnesium.4,5 By combining multiple supplements with a demonstrated health benefit, compliance for all is easier to maintain and cost is lower. Sharktank Research Foundation, a cystic fibrosis parent/patient nonprofit organization, sponsored the development of TauriNAC with the goal of keeping the cystic fibrosis community healthier. TauriNAC is specifically formulated for patients with inflammatory or obstructive lung disease, including cystic fibrosis, asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD), and primary ciliary dyskinesia (PCD).
Because NAC is a thiol-containing (sulfur) compound that rapidly breaks down when exposed to air, TauriNAC is packaged as a powdered drink mix in individual air-tight foil packets. By combining TauriNAC with vitamin C and citric acid, which are both natural preservatives, the tendency for NAC to produce a sulfur smell and taste is further reduced. For small children, half the packaged amount or less may be used with the remainder saved for later use. The suggested amount of NAC is 50mg/Kg, however higher amounts may help some patients. The sulfur smell and taste of NAC are not harmful, however this does represent some loss of effectiveness. For this reason, use of individually air-tight packaged NAC is recommended. Individually packaged NAC supplements are typically fizzy drinks, as is TauriNAC. When dissolving TauriNAC in a beverage, ensure that plenty of room in a glass or bottle remains to avoid bubbling over.
All ingredients in TauriNAC are GRAS, or generally recognized as safe by the US Food and Drug Administration, and TauriNAC is manufactured in the USA in an FDA-inspected facility using GMP (Good Manufacturing Practices). The individual ingredients used in TauriNAC are listed individually below and the Supplement Facts panel is also provided.
N-acetyl cysteine (NAC) – NAC is a safe and inexpensive sulfur containing amino-acid derivative used primarily as a mucolytic (mucus-thinning) therapy. In 2015, Stanford University completed CF clinical trials for NAC, with the surprising finding that NAC prevented lung function decline in CF patients, while untreated controls declined.1 NAC is also liver-protective. N Acetyl Cysteine is used to treat liver failure from Acetaminophen overdose and greatly increases survival.6 NAC has also been shown to treat liver failure from excessive alcohol consumption or environmental pollutants.7
Taurine – a sulfur containing amino acid that can be manufactured by the body and is also supplied through the diet by eating meat and fish or from supplements. Taurine is believed to exert its beneficial effects on absorption of fats in cystic fibrosis patients 2, 3 through its effects on bile acid metabolism. Taurine is found in breast milk and is often added to infant formulas. Supplementation with 1.5g of taurine for 2 weeks is shown to reverse diabetes-associated vascular abnormalities in humans.8 Other studies have found that taurine supplementation can be protective against drug-induced hearing loss, for example from use of aminoglycoside antibiotics.9 Taurine supplementation is shown to decrease fecal fatty acid excretion in CF patients 3, 10 and increase weight. 10
Green tea extract (50% polyphenols) – Green tea is an excellent source of dietary polyphenols known as flavonoids and catechins, which are powerful antioxidants. Epigallocatechin gallate (EGCG) is the most abundant catechin in green tea. Several studies show that catechins can kill bacteria and inhibit viruses such as the influenza virus, potentially lowering the risk of infections11-14 Green tea extract is also available at a 98% polyphenols standardization, however for a beverage, a small amount of green tea sufficient to add only a mild tea flavor without bitterness is preferable.
Inositol – Inositol, also known as myo-inositol is a vitamin-like substance found in most foods but highest in grains and citrus fruits. Inositol is one of the safest supplements, and it has reported antianxiety15, 16 and antidepressant17, 18 effects. Myo-inositol has been demonstrated to act as a chemical chaperone (CC), acting with other correctors to restore function of dF508 in vitro and in vivo.19
Inositol hexaphosphate (IP6) – Also known as phytic acid, IP6 is present in many plant foods including beans, grains, seeds and nuts. IP6 is used as an antioxidant dietary supplement. The successful use of IP6 as an antioxidant includes its ability to chelate iron and block generation of iron-driven hydroxyl radicals, in addition to the suppression of lipid peroxidation.20,21 Research has shown that supplementation with IP6 is associated with prevention of lung fibrosis.22,23 Providing IP6 in a beverage allows it to be absorbed quickly. Because IP6 may prevent absorption of iron and zinc, do not take TauriNAC at the same time you take your multivitamin.
Iodide (potassium iodide) – A “dramatic” iodine deficiency is common in cystic fibrosis patients, with iodine deficiency identified in 83.7% of patients with CF. 24 Iodine is necessary for the proper functioning of the thyroid gland. Thyroid hormones are important for normal gastrointestinal activity, 25 for skeletal development, 26 and may even maintain a balanced mood.27 The thyroid produces hormones triiodothyronine (T3) and tetraiodothyronine (T4 or thyroxine), which support many processes in the body; and especially metabolic function. The thyroid produces a third hormone, calcitonin, which is also synthesized in the lungs and intestinal tract. Calcitonin is especially important as it prevents bone loss, and calcitonin may be used as a therapy to treat osteoporosis.28
Magnesium (magnesium taurate, magnesium citrate) – Magnesium is a cofactor for over 300 enzyme systems that regulate diverse biochemical reactions. 29 Magnesium deficiency is common in CF: in one study, 57% of cystic fibrosis patients referred to transplant had hypomagnesaemia.30 Magnesium is important in brain function and mood, with low levels linked to increased risk of depression.31,32 Low magnesium is also linked to chronic inflammation, which is one of the drivers of chronic disease.33,34 A randomized placebo-controlled clinical study of asthmatics showed that oral magnesium supplementation improved objective measures of asthma control and improved quality of life.35 Another important function of magnesium is maintaining bone health. Magnesium deficiency changes how the body metabolizes calcium and hormones that regulate calcium. Magnesium supplementation may help improve bone mineral density and prevent CF-related osteoporosis. Oral magnesium supplementation at the daily dose provided by TauriNAC was shown in children and adolescents with cystic fibrosis to improve clinical variables. 4
Niacinamide (vitamin B3) – Niacinamide is a form of niacin, commonly known as vitamin B3. Both niacin and niacinamide provide the same vitamin functions, although niacinamide doesn’t cause the flushing that can be a problem with niacin. Niacin deficiency can be associated with malabsorption from the gut. 36 Niacin deficiency is known to cause the following signs and symptoms: skin inflammation, mucous membrane swelling and inflammation, digestive disturbances including burning in the pharynx and esophagus, stomach and abdominal discomfort, diarrhea, nausea, vomiting, apathy and depression.37 Niacinamide supplements are typically available in tablets or capsules at doses from 250mg – 1500mg with 500mg the most common. We elected to supplement at 150mg per day with the intent to address deficiency for long term use.
Potassium (potassium bicarbonate, potassium citrate, potassium iodide) – Potassium is essential to maintain fluid and electrolyte balance in the body. Potassium works with sodium to support cellular function with the sodium-potassium pump. 38 Potassium may also provide protection from osteoporosis, as a direct relationship between increased bone density and increased intake of dietary potassium is reported. 39 A 2015 study published in the journal Osteoporosis International found that high consumption of potassium salts significantly decreases the urinary excretion of both acid and calcium, helping bones to maintain vital mineral content. 40 Potassium is required for people of all ages in order to utilize carbohydrates, and is required to build muscle. For children who are still growing, potassium helps ensure growth at a normal, healthy rate. 41 Citrate and bicarbonate salts are two forms of potassium that are naturally found in potassium-rich fruit and vegetables. Potassium iodide was included in TauriNAC as well to provide a source of iodide.
Vitamin C (sodium ascorbate, ascorbic acid) – Vitamin C cannot be synthesized by humans and must be obtained through the diet. 42 In cystic fibrosis patients, vitamin C status is inversely correlated with inflammation, with patients having higher serum values for vitamin C demonstrating clearly lower values for markers of inflammation. 43 Vitamin C is found in normal airway surface liquid, and is depleted during infection. Vitamin C is shown to induce the opening of CFTR at physiological concentrations, 44 therefore, vitamin C supplementation along with CFTR modulating therapies may enhance the benefits of both therapies.
Xylitol – xylitol is a naturally occurring plant sugar alcohol available in many grocery stores (Whole Foods) and is commonly used as a sweetener. Oral consumption of xylitol may be effective in remineralizing teeth, 45 and has been demonstrated to reduce the incidence of middle ear infection in children. 46 Importantly, xylitol is demonstrated to inhibit formation of biofilms of the cystic fibrosis pathogens Staphylococcus aureus and Pseudomonas aeruginosa, and to reduce mature biofilms of Staphylococcus aureus.47 Xylitol may also prevent attachment of the CF pathogen Burkholderia cepacia to airway epithelial cells. 48
|Serving size: 1 packet dissolved in water, tea or juice|
|Suggested use – 3 servings per day|
|Servings per container – 30|
|TauriNAC||PER SERVING (mg)||DELIVER PER DAY (mg)|
|INGREDIENTS:||Per 3 packets|
|Green tea extract (50% polyphenols)||200||600|
|Inositol hexaphosphate (IP6)||600||1800|
|Iodide (potassium iodide)||4||12|
|Magnesium (magnesium taurate, magnesium citrate)||100||300|
|Potassium (potassium bicarbonate, potassium citrate, potassium iodide)||100||300|
|Vitamin C (sodium ascorbate, ascorbic acid)||600||1,800|
|Other ingredients: Citric acid, sodium citrate, sodium bicarbonate, natural flavors, natural color, steviol (from Stevia rebaudiana).|
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- Chun LJ, Tong MJ, Busuttil RW, Hiatt JR. Acetaminophen hepatotoxicity and acute liver failure. J Clin Gastroenterol. 2009 Apr;43(4):342-9. doi: 10.1097/MCG.0b013e31818a3854. Review. PubMed PMID: 19169150.
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