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L-Glutathione Antioxidants in The Elderly:
The Major Detoxificants of Medications, Alcohol and Tobacco

Theodore Hersh, MD, MACG
Professor of Medicine, Emeritus, Emory University

Glutathione (GSH), a thiol tripeptide composed of glutamate, cysteine and glycine, is present in most plants and animal tissues and is the body’s most important antioxidant and detoxificant of chemicals and drugs. GSH, which is bioavailable from dietary sources as fruits, vegetables, liver, meats and poultry, is transported both by the buccal and small intestinal mucosa via Na+ dependent and Na+ independent mechanisms. Depletion of glutathione occurs in the elderly, in various chronic diseases and in tobacco and alcohol abusers. GSH depletion is associated with increased risks of drug toxicities, progression of various diseases and development of malignancies. As an antioxidant, GSH works synergistically with its cellular partners to scavenge and neutralize reactive oxygen and other free radical species.

Low GSH levels place healthy elderly subjects, particularly those who smoke tobacco and consume alcohol, at higher risks because of their decreased ability to deal with the oxidative stress phenomena generated by toxic free radicals. Individuals with various chronic diseases such as liver diseases, diabetes, and geriatric conditions also have lower GSH levels and thus are less able to detoxify drugs, including alcohol. This GSH deficiency places the elderly at greater risk of developing drug toxicities such as after acetaminophen or opiate usage. Healthcare providers need to consider all these factors in the elderly and encourage prevention by supplementing glutathione and its synergistic antioxidants in efforts to decrease a senescent individual’s vulnerability to a “relative drug overdose”, albeit even when these are administered at the packet insert’s “recommended daily dosages”.

Tobacco similarly places the elderly at risk since GSH levels are depleted by cigarette or cigar smoking. Decreased antioxidant levels in smokers with all the inhaled and cell generated free radicals increases risks of developing coronary heart disease, emphysema and aerodigestive malignancies. Quitting tobacco generally returns GSH levels to normal, while other studies have shown that antioxidant nutritional supplements, including repletion of tissues with GSH, decrease oxidative stress. These are then valuable therapies in helping to protect the elderly smoker and thereby optimize their life span.

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