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Obstetric Cholestasis and a Nutriotional Supplement That Helped Me

I will preface this with a warning:

I am not a doctor! Always check with your medical professional before taking ANY medical advice. This goes for blogs, chat boards, facebook posts and anything else you may read. Take all info you gather to your doctor and gain their perspective. 

That being said, many medical professionals in this country don’t know much about this particular application of this supplement (NAC), because the FDA has only approved it as a treatment for certain conditions, but I will explain more on that below. Bottom line: your doc may be skeptical of or unfamiliar with the data, but if they do further research on the  chemistry of and scientific studies done on this compound, they will be able to advise you.

I discovered N ACETYL CYSTEINE many years ago as a supplement for liver health and have been taking it ever since.  I am pregnant at this time, 35 weeks to be exact, and have obstetric cholestasis. I have taken NAC for the entire pregnancy and have had zero complications with it or issues with the baby. My experience is my own, and yours may not be similar in any way.

N Acetyl Cysteine: What the hell is it?

It is derived from the amino acid L-cysteine (amino acids are the building blocks of proteins in the body) and has many medicinal uses. Do a quick Google. As I mentioned, in the USA it is only approved for Tylenol and Carbon Monoxide poisoning, and some bronchial issues, as its waste products crystallize in lung tissue and dry up mucus. It works on the toxicity issues because it boosts liver function and binds to the biproducts in the liver caused by the poisoning. Cysteine is essentially a large portion of your liver, the only organ in your body that regenerates in the way it does. If you have a lobe of liver harvested, you don’t usually have any negative effects. Have a kidney removed and your diet and lifestyle are forever changed. The reason is because the liver regenerates and can rescue itself from even very serious failure, provided the patient is healthy in other respects. The theory behind supplementing with NAC is simple: if you give an organ that can regenerate what it is made of, it will hopefully regenerate.

In other countries and as part of research studies, NAC has been used to combat severe liver failure due to scerois, poisoning, alcohol abuse, hepatitis, and other forms of self-inflicted toxicity due to substance abuse. All with reported success. (To view these studies you can search for them yourself or ask your doctor to do some simple science searches in medical journals. I assure you the information is out there)

There are 3 ways of taking NAC. One is intravenously, one as an inhaled therapy, and the last as an oral supplement in pill or powder form. IV dosage is used for acute, life threatening issues that require very high dosages of this compound. The reason is because it is particularly hard on the stomach when taken in doses large enough to stave off liver failure. It is inhaled to immediately assist in the clearing of fluid. Oral doses are usually quite low. I have had friends report stomach irritations with doses of a gram to 1.5 grams, but for myself, I never take more than a gram, and so have never experienced this. High doses can be taken orally, but only at the risk of severe irritation. I guess if you’re self-medicating for a dangerous condition like alcoholism, it might be worth it to you.

What is obstetric cholestasis?

Obstetric cholestasis is a common pregnancy complication characterized by severely itchy hands and feet, and sometimes other skin. It can sometimes be bad enough that women scratch themselves raw, create bloody cuts and scabs, and acquire secondary infections or skin disorders as a result. It is caused by interference of the flow of bile, but the exact cause of this interference is not known. It may have hormonal, genetic, or dietary causes.  In severe cases it can be quite dangerous for the baby. According to the Mayo Clinic website:

The term “cholestasis” refers to any condition that impairs the flow of bile — a digestive fluid — from the liver. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

It is usually diagnosed by liver function and enzyme tests, and is sometimes confused with allergic reactions and similar skin conditions caused by higher than normal hormone levels. Your medical professional should be able to determine the difference with the necessary tests.

I put 2 and 2 together and…

As I said in my preamble, I take this compound and have done for years, with no negative issues.  Due to my profession and my peer group (scientists) I have access to a large quantity of new and recent scientific data and papers, which I soak up as a matter of professional epistemological inquiry. Since taking NAC, I have noticed a number of positive effects (less hangovers). but for me my entirely normal use of this supplement is not as noteworthy as other anecdotal evidence I can supply.

I had a friend who was a professional in the wine industry. His doctor had given his liver another ten years tops, and would not put him on a transplant list, due to his refusal to change his profession. He mentioned this to me. I suggested he try NAC and forwarded him the relevant research. He began taking it and about six months later, his doctor asked him “Did you quit drinking?” He said no, and when asked what he had changed about his habits, refused to tell the doctor because he was angry the doctor didn’t already know. (He was a grumpy guy) That was about 9 years ago. He no longer suffers from any liver failure symptoms, according to him. Compared to how he looked, I hardly recognize him. His skin, eyes, and hair have utterly changed. He believes this is because his liver is now healthy.

Another friend of mine is an older gentleman who suffers from Hepatitis C. He mentioned his depressing liver function and enzyme tests and his decreasing health, and I sent him the data on NAC. He decided to try it. 3 months later he called me out of the blue to tell me that all of his tests were now normal.

A third friend of mine had a brother who was admitted to a hospital in New Orleans for acute liver failure due to chronic alcoholism. He was given 1 week to live. I spoke to his family at length about NAC. When they asked his doctor, the doctor cited FDA regulation and said they could not administer it, even though I sent her the relevant data and she reviewed it. Her hands were tied. The family made the decision to sneak the supplement in and feed it to him in extremely high doses. He vomited blood, but he walked out of the hospital a week later and survived long enough for his family to get him help. Maybe he got lucky, maybe not. I have no idea.

I tell these stories not as proofs. They are ANECDOTAL in nature. I do not have all the relevant medical data for these cases. My role was very far removed, and at every turn I cautioned these folks to consult with their doctors. As I do you. NAC has side effects.

The side effects:

These are the side effects as listed by the WebMD website:

N-acetyl cysteine is LIKELY SAFE for most adults, when used as a prescription medication. It can cause nausea, vomiting, and diarrhea or constipation. Rarely, it can cause rashes, fever, headache, drowsiness, low blood pressure, and liver problems.

When inhaled (breathed into the lungs), it can also cause swelling in the mouth, runny nose, drowsiness, clamminess, and chest tightness.

N-acetyl cysteine has an unpleasant odor that may make it hard to take.

Special Precautions & Warnings:

Pregnancy or breast-feeding: N-acetyl cysteine is POSSIBLY SAFE when taken by mouth, delivered through a hole in the windpipe, or breathed in. N-acetyl cysteine crosses the placenta, but there is no evidence so far linking it with harm to the unborn child or mother. However, N-acetyl cysteine should only be used in pregnant women when clearly needed, such as in cases of acetaminophen toxicity.

There is not enough reliable information about the safety of taking N-acetyl cysteine if you are breast-feeding. Stay on the safe side and avoid use.

Allergy: Don’t use N-acetyl cysteine if you are allergic to acetyl cysteine.

Asthma: There is a concern that N-acetyl cysteine might cause bronchospasm in people with asthma if inhaled or taken by mouth or through a tube in the windpipe. If you take N-acetyl cysteine and have asthma, you should be monitored by your healthcare provider.

Bleeding disorder
. N-acetyl cysteine might slow blood clotting. There is concern that N-acetyl cysteine might increase the risk of bruising and bleeding in people with bleeding disorders.

. N-acetyl cysteine might slow blood clotting. This might increase the risk of bleeding during and after surgery. Stop taking N-acetyl cysteine at least 2 weeks before a scheduled surgery.

I should mention that this supplement, as common sense dictates, would be contraindicated for things like liver cancer, or any other liver issue that involves abnormal growth. We don’t want something growing abnormally to have what it needs to grow.

So what am I getting at?

If you suffer from Obstetric Cholestasis, you know it can be quite uncomfortable, as in exceedingly obnoxious, as in downright hellish.  Doctors sometimes do not properly diagnose it, or dismiss it. It has no cure other than delivery of the baby, and in severe cases, delivery is induced as soon as the baby’s lungs are viable, as the condition carries a risk of still birth. The only treatments available are for the symptoms, and include things like cold baths, sleeping aids, allergy medicines, topical creams containing steroids, eating activated charcoal, and…yup, drinking bile. Why the charcoal and bile? These are the closest to treating the actual issue. Charcoal is used in poisoning because the carbon molecule binds to certain toxins and pulls them from the liver, this assisting it and temporarily increasing its efficiency. Bile consumption would effectively raise the amount of bile in your system, albeit in a less viable way, since it’s probably cow bile and not entirely similar.

I decided that none of these treatments made any sense to me, since they don’t address the actual functioning of the liver. I made a choice to take NAC instead.

In spite of the above warnings, I have been taking NAC for my entire pregnancy, as I hypothesize it would help the baby build a healthy liver too. I intend to halt use of it as of week 36, because of the potential bleeding risks, though I have noticed no bruising or bleeding issues. 

I decided, when I developed the itchy feet, that it made sense to me to take a slightly higher dose to see if it could assist my liver function. My premise being that if the liver is more efficiently producing bile, more bile will be produced, and offset the lack of bile in my system. The outcome of this experiment has been that when the itching occurs (intermittently and particularly at night) I take a higher than normal dose: about a gram with plenty of water. For me, within the hour, the itching is completely gone. I acknowledge in the spirit of scientific methodology that this could be a placebo effect, but do not believe it is.

If you are dealing with itchy feet and hands:

Research: Learn as much as you can about what tests must be done to diagnose it as obstetric cholestasis. Demand the tests. Read all you can about NAC and other treatments and present your findings to your physician. Feel free to print off this blog entry and show it to them. I don’t mind. They can email me if they like.

Be cautious: Nothing is worth a risk to you or your baby. So make the best decision you can for them and for yourself.

Do not: Go out and buy this at GNC and shove it in your face willy-nilly. There may be a very good reason for you not to take this that only your doctor can point out.

Good luck, and I hope you have a happy, healthy baby and no more itchy feet!

Please note the author is not a doctor. The above blog entry is not intended to diagnose or treat any medical issue. It is based entirely upon personal experience and is intended to express a personal opinion and reflect the outcome of one pregnancy. Please consult your physician with regards to any medical concerns, symptoms, or decisions. The author does not suggest taking any supplements without sound medical consultation, as supplements can have risks including interactions with other medical conditions and medications. The author made her own choice based upon a diagnosis given by a doctor, and does not want anyone to simply follow her. Instead, please do your own research and decide your treatments for yourself with the aid of your physician.

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