Dr. Clark T. Bishop, M.D.: Protocol for Augmentation of GSH Levels in Cystic Fibrosis Patients, and Related Information

In 2001, Dr. Clark T. Bishop (pictured here with Burke's Bear of PACFI) pioneered a protocol for glutathione augmentation in cystic fibrosis patients. He can be reached at clark.bishop29@gmail.com , if your doctor has questions. You should not change your medical regimen without the support of your medical professionals.

Bishop's Protocol

1. When the patient wakes in the morning, have them take a cysteine donor such as NAC (n-acetyl cysteine), 250-600 mg along with their first dose of GSH. (GSH dosing is described in #9 below.)

2. Have them continue to take their GSH dose every 3-4 waking hours.

3. We recommend a mix of oral GSH dosing and inhaled GSH dosing during the patient's waking hours, and further recommend that the patient have at least one oral dose and one inhaled dose every day. The specific mix of doses over the course of the day, e.g., 3 oral, 1 inhaled; 2 oral, 2 inhaled, etc. is up to you.

4. It is not necessary for a patient to take both an oral dose and an inhaled dose during the same 3-4 hour period.

5. We recommend that CF persons start out at a very low dose, about one fourth the recommended dose (see #10 below), and *gradually* increase that dose until the desired total daily dose is achieved. We recommend at least a one week period at one dose before increasing to the next step. The patient may not reach the desired level for almost a month, but this should allow for maximum toleration.

6. GSH that is inhaled should be both buffered and isotonic when in solution. Free acid GSH in solution has a pH of about 2.7, which is too low. We recommend the product GSHPlus (Reduced L-Glutathione Plus Sodium Bicarbonate) by Theranaturals, Inc. (No member of UVICF has any financial connection to any company selling glutathione.) Each capsule of GSHPlus contains about 210 mg of buffered GSH, and when dissolved in 3-4 ml of sterile or distilled water (not saline), this will yield a roughly isotonic solution of pH 6, suitable for nebulizing. How many capsules to use will vary by weight of the patient, see #10 below. If using more than one capsule or less than one capsule, the amount of water should be adjusted proportionately to maintain approximate isotonicity. (Some users do use regular or hypertonic saline as the solution for their GSHPlus, and other users use a smaller amount of water per capsule. Some persons may not be able to tolerate such a hypertonic solution, so it is best to start with an isotonic solution and then adjust according to one's individual toleration of hypertonic solutions.)

7. GSH to be taken orally should ideally have ascorbic acid with it. We recommend two formulations by Theranaturals 1) the first, called "GSH-Curc Caps," contains 300 mg of pharmaceutical grade glutathione, plus curcumin, NAC, ascorbic acid, and a small amount of selenium, and 2) the second, called "GSH Caps," which each contain 500 mg of pharmaceutical grade glutathione. Their website is given in #6 above. No member of UVICF has any financial connection to any company selling glutathione.

8. There may be some initial slightly negative tranistory side effects, such as transitory sulphur-smelling flatulence, lightheadedness, transitory slight aggravation of asthma. These effects will disappear in 7-10 days. However, if the patient notices any negative side effects that you feel are harmful, have them cease taking GSH! Remember that GSH is a vasodilator, so if a patient is prone to bleeds, be very careful when you are using GSH with them.

9. Desired total daily dose is currently an art, not a science. Dr. Bishop used the following formula in his 2002 clinical trial: the formula for total daily dose is 30 mg/pound body weight/day. This formula yields a total daily dose, and must be divided by the number of times that GSH is given during the day to get the dose per dosing period. Most persons take 4 doses per day, so, for example, if the formula yields 2000 mg per day as the total dose, then each of the 4 daily doses would be 500 mg. Remember that a CF person must work up to these doses gradually over time! Also remember that there is no evidence in the scientific literature that taking a larger dose than that recommended here would result in any harm (an adult human male body synthesizes about 10 grams of GSH per day; the liver makes most of this, and the liver will surrender up to half of its GSH stores in an emergency situation to relieve a systemic deficiency). There is no "overdose" level for GSH, because GSH is non-toxic. Please see the Investigator's Brochure of our IND for a full literature search on this issue.

11. Make sure the patient does not take acetaminophen or drink alcohol when on glutathione augmentation therapy, as these will strip GSH from the body. Other substances, such as morphine, will do the same.


Pertinent Information Related to this Protocol