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Q: Emphysema & Immunocal
Will Immunocal help anyone who has emphysema? I have been told that it will but am skeptical of anything helping a person who has emphysema. (May, 2000)
A: Donna Tinnerello, MS, RD, CD/N responds:
Immunocal’s claim to fame is cysteine, an amino acid that converts to glutathione once consumed in the body. Glutathione is an antioxidant that is involved in metabolism and detoxification reactions. It is the major intracellular antioxidant; it protects the cell from oxidative damage and death. In HIV there is a lots of research showing that decreased glutathione in CD4 cells is a good predictor of CD4 cell loss – in otherwords, HIV destroys T cells, AIDS progresses, people can get sicker and die.
Emphysema is a condition of the lung characterized by abnormal permanent enlargement of the alveoli (air cells of the lung). Breathlessness on exertion is a common complaint. Glutathione is the major pulmonary (lung) antioxidant too. In a healthy lung oxidative stress is balanced with antioxidant defenses. In emphysema excessive oxidative stress upsets this balance and therapeutic antioxidant replacement makes good sense. It’s unlikely to reverse the damage, but it should help to prevent or slow down progression of the disease. In the research on lung disease N acetylcysteine (NAC), another well- known oral precursor of glutathione, and a glutathione aerosol that is administered directly have been effective. The cysteine in Immunocal is comparable to the cysteine in NAC and should do the trick.
My concern is that all antioxidants work in concert- vitamin E, vitamin C and glutathione in particular. This supplement is simply casein, milk protein. Cysteine becomes glutathione but the other antioxidants are missing. I might suggest that you add a high antioxidant multivitamin with mineral supplement to make sure you get all the nutrients you need. I would suggest that for anyone living with a chronic disease and emphysema is just that.
One good supplement that combines a wide range of antioxidants, including glutathione, is NutriVir. I would recommend it for people with emphysema whether they're HIV+ or not. NutriVir is paid by ADAP (AIDS Drug Assistance Program) and Medicaid in New York.
A: Charlie Smigelski, RD responds:
I think the main beneficial agent in Immunocal is the whey protein-derived cysteine.
There is a good paper by R. Buhl: "Imbalance between oxidants and antioxidants in the lung of HIV-seropositive individuals". (One can find the abstract by going to AEGIS and search using keywords "Buhl" AND "antioxidants".) Buhl reports that "reduced" glutathione levels in lungs are more common than in HIV-negative control groups. In his conclusion, he worries that this failure to clean up superoxide ions (a form of free radical) will likely pre-maturely corrode lungs. And there was just published a few months ago in the Annals of Intern Medicine a paper by an Ohio group that emphysema does happen prematurely in HIV+ smokers.
So, all the antioxidants that support glutathione: cysteine (NAC), vit C, vit E, and selenium are all a good idea. Immunocal is a pricey way to get these, but I hear they are getting Medicaid reimbursement in some places. This might be the only way some people can afford the NAC.
(Administrator's Note: For more on whey protein and some alternatives to Immunocal, see the Q&A on Whey Protein.)
