The sheer volume and variety of glutathione products in the market are staggering, from capsules and intravenous solutions to soaps, lotions, creams, and facial washes. They all feed on the national obsession for fair skin. Some promise visible changes in as short as seven to 14 days. But do they really work as skin-whitening agents, a claim practically all distributors make?
To get to the bottom of the issue, Dr. Belen Lardizabal-Dofitas, a dermatologist at St. Luke’s MedicalCenter and University of the Philippines–Philippine General Hospital, conducted an extensive review of scientific literature and uncovered a surprising answer:
“There are no published clinical studies on the whitening effect of glutathione products or supplements.”
What does Glutathione do?
• Glutathione which is composed of peptides glutamine, glycine, and cysteine, acts as an efficient scavenger of destructive free radicals and reactive oxygen species (ROS).
• It is also a powerful detoxifier: it mops up pollutants and other harmful xenobiotics—drugs and foreign chemicals—forming soluble compounds that are excreted through urine.
• The original reason there are glutathione supplements or intravenous glutathione is it’s a good antioxidant,”
Dofitas said that the glutathione supplements and intravenous solutions differ from the glutathione that the body synthesizes: “It’s not correct to claim that the glutathione you take or inject is the one that will enter the cell. Synthetic glutathione gets digested [in the small intestines] by certain enzymes, so the original glutathione molecule in the supplement is broken down into amino acids like cystine. That is the one that is absorbed in the intestine and converted in the cells to cysteine. We do not absorb glutathione as a whole molecule.”
This means that oral and intravenous glutathione are merely sources of cysteine, one of the necessary substrates the liver uses in creating intrinsic glutathione that is then exported to other tissues. Glutathione supplements are not the only source of cysteine. Other supplements, the so-called “glutathione precursors” can also provide cysteine and other amino acids to the body. Of all the modes of glutathione introduction, including inhalation, parenteral, intramuscular, and intraperitoneal, only the intra-arterial route bypasses portal circulation and goes directly to the tissues without being broken down to component amino acids in the liver.
Change that doesn’t last
If supplements do help increase the amount of cysteine and other building blocks of glutathione, then it stands to reason that taking them should also improve the glutathione levels in the body. But that is not the case, according to a Western research which found that a single dose of 3,000 mg of oral glutathione given to healthy subjects failed to show any increase in circulating glutathione. “It means it’s not well-absorbed in the blood, due to the presence of our natural enzymes in the gut,” she says.
Theories on the Whitening Effect
There are theories that experts say may explain the possible whitening effect of the Glutathione (the tripeptide), based on animal and in vivo studies using melanoma cell lines.
1. Glutathione may directly deactivate tyrosinase, the main enzyme in melanin synthesis;
2. It sops up free radicals and peroxides that promote tyrosinase activation and melanin formation;
3. Enhances the depigmenting abilities of melanocytotoxic agents.
4. Another proposed mechanism is the triggering of a pathway that shifts the production in eumelanin (black to brown pigment) to pheomelanin (yellow to red-brown pigment).
Although theoretically plausible, the desired change may be far from permanent. Dofitas explain: “I think there is a possibility that the effect of the glutathione for skin lightening would be temporary. All of us have a default pathway for making our skin color. If you reduce the amount of glutathione levels within the melanocytes, the pigment-producing cells, of course you’ll switch back to your default mode, which is the darker type of melanin, eumelanin. Can you have a permanent high level of glutathione molecules in the cells? No, because they get consumed.”
Potential adverse reactions from the synthetic substance pose another concern. Dofitas sifted through data of randomized controlled trials on oral and I.V. glutathione for various medical conditions, but found no report of side effects. However, these patients—most of whom were sick and glutathione-deficient—were given an injectable solution that was diluted and slowly introduced into the vein as a drip.
“Now what is the practice in the Philippines?” she asks. “They give the glutathione solution in a small amount of diluent. They put it in a syringe and inject it directly into the vein over a few minutes—that’s not even the recommended way to inject it. In which situation would you probably have more side effects?”
In fact, she came across anecdotal accounts from some local physicians who had observed various reactions in their patients, including:
· erratic blood sugar levels in diabetics
· recurrent hyperthyroidism among previously controlled thyroid patients.
· one oral glutathione user experienced persistent headaches
· another had recurrent arthritic pains, while a few supplement users had papulosquamous skin lesions.
“These are all stories and they need formal documentation. But we have to keep these stories in mind, that there is probably some truth, just as it is possible that it works as a skin-whitening agent,” she cautions.
The dermatologist calls on fellow physicians to “use glutathione supplements judiciously, meaning there is a real good reason to use it, for instance, a patient is sick and needs antioxidant support. This is especially important to remember for I.V. glutathione use.”
“You also have to advise the patient on how much benefit they will probably get from it. If we know that, then of course we can prescribe glutathione supplements or inject glutathione. But if we don’t know our facts, then we don’t give the drug. Remember that for any physician, it is to first do no harm,” she emphasizes.
There are also cases of laypeople who inject glutathione for whitening purposes. “This practice is quite risky because these non-doctors may not know the proper procedure and how to handle side effects.
The cost of “beauty”
For now, while the jury is still out on this issue, Dofitas reminds the public that there are safer options available:
There are proven skin-whitening agents in the market that have been here for a long time. If you were to choose between a relatively new or untested drug and one that is established already, I would go more for the established,” such as hydroquinone and licorice.
Simple measures, like sun avoidance, using protective clothing, and applying sunscreen regularly can also lighten the skin.[pq]Anyone who wants to use glutathione products should only purchase those that are approved by the Philippine Food and Drug Administration (PhilFDA) and stick to the recommended dose. The precaution can also reduce the consumer’s exposure to substandard and even potentially hazardous products.[/pq]
Some brands have, in fact, been recalled by the PhilFDA because they contained insufficient amounts of glutathione.
On top of that, the system has a loophole that allows less scrupulous manufacturers or distributors to wriggle through. Dofitas writes in the Journal of Philippine Dermatological Society: “Human clinical trials on a product’s skin lightening effect are required by regulatory agencies such as the PhilFDA before a product is granted a permit as skin ‘whitener.’ It is possible that glutathione products are granted permits as food supplements but are being marketed as ‘skin whiteners’ as well.” The I.V. glutathione is categorized by PhilFDA as a drug, not as a food supplement.
Unfortunately, such promise may considerably lighten wallets rather than complexions. As of writing, one capsule of the popular US-manufactured Lucida-DS costs PhP48.25 at Mercury drug stores. It contains 500 mg of glutathione, 100 g of alpha-lipoic acid, and 100 mg of vitamin C—two nutrients that may enhance the absorption and efficacy of the active ingredient, as well as “prolong youthfulness.” At the recommended dosage of one capsule a day, a month on the regimen will set you back by PhP1,495.75.
Another leading brand, the Japan-produced Met Tathione sells for PhP44.75 a pop, but at only 250 mg of glutathione (25g alpha-lipoic acid and 125mg vitamin C). Two doses are required daily, which translates to PhP2,774.50 a month.
Injectable glutathione commands a hefty price that hovers between PhP 1,500 with Vitamin C and PhP 5,500 per session, complete with service fee. The intravenous program alone adds up to an astounding sum of PhP25,000 to PhP55,000.
At the Godiva Skin Care Station, a customer representative said that it takes 10 shots before the whitening effect becomes noticeable. The client is also advised to take vitamin-C supplement after each shot to boost the process. To maintain fair skin, she adds that it’s better to augment the intake of glutathione pills with monthly injections.
Amid all the hype raging in a bleak economy, Dofitas offers sound counsel: “If you do put your money into glutathione products, you have to ask, ‘is this worth my money? Am I going to spend a lot of money on something which I’m not even sure would work?’ At this point, glutathione supplements still don’t have strong evidence that they are effective and safe skin-whitening agents.”
Instead of relying on supplements, people should return to the basics of skin care, such as healthy lifestyle and a balanced diet. “I think a lot of people forget that,” she says.[pq]“You also have to ask yourself, why do you want to look like a mestiza? Brown is beautiful. It also comes with a huge benefit—you have a greater protection against the damaging effects of ultraviolet radiation.[/pq]