A Toronto naturopath’s advertisements were recently criticized on social media for insensitivity and racism:

Glutathione Advertisement TTC Jean-Jacqques Dugoua

Picture used with permission of @emilyknits

Naturopath Jean-Jacqques Dugoua sells glutathione injections, claiming it will give “brighter, lighter and glowing skin”. His URL, lightnaturalskin.com seems to imply that lighter skin is more natural, and he claims the following:

After over 3 years of treating patients for skin concerns, Dr. JJ has developed the Skin Brightening IV, which includes glutathione, vitamin C and other vitamins/minerals. Not only is this treatment effective for most people, it is also safe. The Skin Brightening IV glutathione is a good alternative to skin bleaching creams, which can damage, scar, inflame, discolour or irritate the skin, or microderm abrasion, which is painful and may also irritate the skin and sometimes worsen hyper-pigmentation.

This safe and natural treatment involves principally the use of intravenous (IV) vitamins (excluding vitamin A), minerals and amino acids, including glutathione. All ingredients are regulated by Health Canada and obtained from pharmacies or pharmaceutical companies in Canada or the United States. The treatment is performed in compliance with licensure in Ontario.


Dugoua is not the only naturopath that advertises glutathione injections for skin lightening. The Lococo Wellness Clinic in Hamilton, Ontario claims:

Want to lighten your skin tone? You can with the Glutathione Skin Lightening/Whitening Treatment!

Our Intravenous Glutathione Skin Whitening Treatment can lighten your skin evenly. Glutathione is administered via IV and is able to deposit evenly throughout the body. Glutathione will swop up the oxidative damaged cells (which cause skin to darken) and lighten your skin naturally, safely, evenly and in a healthy manner.

Glutathione is advertised heavily by naturopaths as a panacea for many conditions. Flourish Natural Medicine in Portland claims:

It’s the most important molecule you need to stay healthy and prevent disease — yet you’ve probably never heard of it. It’s the secret to prevent aging, cancer, heart disease, dementia and more, and necessary to treat everything from autism to Alzheimer’s disease. There are more than 89,000 medical articles about it — but your doctor doesn’t know how address the epidemic deficiency of this critical life-giving molecule … What is it? I’m talking about the mother of all antioxidants, the master detoxifier and maestro of the immune system: GLUTATHIONE

Skin lightening has a controversial background. Ideas equating skin lightness with desirability, beauty and even class/caste are prevalent in some cultures. Shadeism (or colorism) is a term used to describe discrimination based on skin tone within a community, with lightness being perceived as more desirable. The marketing of skin lightening products is widespread, as is their use. Worldwide, this is a billion-dollar industry, one with a lot of critics. The official reaction to the naturopath’s advertisement was quick: The Toronto Transit Commission pulled the ads, based on complaints received.

I’m not going to comment on the appropriateness of skin lightening, the social context, or the ethical issues these products present. I’m also not going to comment on intravenous vitamins or the other ingredients naturopaths advertise, as it’s been established that these vitamin injections are useless. What I want to examine is the scientific evidence supporting the efficacy and safety of glutathione injections for the purpose of lightening skin. The naturopathic profession has a reputation for touting products and services that are useless, ineffective, lacking good evidence, and sometimes even dangerous. Is glutathione different? Given the alternatives used by those that desire lighter skin, are glutathione injections preferable, or at least, less harmful than other products?

Before we look at the science, it’s important to consider the context, as these services seem to be delivered exclusively by naturopaths. As a health professional, I see my role as encouraging and supporting patient autonomy and decision-making by providing credible, unbiased, evidence-based scientific information to support treatment decisions. Health care today is a collaborative practice delivered by many disciplines. Whether it’s a doctor, nurse, pharmacist or a physiotherapist, our roles are built on a common foundation: science. Naturopathy is different. Naturopathy has its own definition of “medicine” that differs from that of science-based health professionals. While naturopaths describe themselves a primary care providers, just like medical doctors, they do not practice from a scientific framework. Naturopaths offer an array of disparate health practices like homeopathy, acupuncture and herbalism that are linked by the (now discarded) belief in vitalism – the idea we have a “life force”. From this philosophy can sometimes emerge reasonable health advice, but it’s not because it’s based on credible scientific information. As long as it’s congruent with the naturopathic belief system, it’s acceptably “naturopathic”. Over the past several months I’ve taken a closer look at naturopathy versus science, examining naturopathic advice in several areas against the scientific evidence. It has consistently come up short.

I’ve never recommended or endorsed the use a skin lightening product. But if given a question about glutathione from a patient, I would first seek to understand their rationale – is it simply to lighten one’s complexion? Or are there other skin issues of concern? I’d then turn to the medical literature, understanding the scientific evidence, the risks and the unanswered questions. I’d also look at costs to help the patient evaluate the value-for-money. It should be acknowledged that a lightening product that is safe and effective could be significantly better for consumers than the widely marketed creams and lotions that are the more traditional approaches to lightening. Mercury toxicity and poisoning is not uncommon from these products. Another common ingredient, hydroquinone, is banned in many countries because of the harms it can cause. The sometimes-dubious manufacturing practices heighten the risks.

The evidence

Glutathione is an antioxidant that is naturally synthesized in the body. It is involved with numerous biochemical pathways and may have some role in different diseases, but there is a lack of robust evidence linking supplementation to changes in health outcomes. In spite of this, glutathione seems to be a darling of the alternative medicine industry. Dr. Oz calls glutathione “the superhero of antioxidants.” Mark Hyman calls it “the mother of all antioxidants.” Importantly, while glutathione is also found in food, dietary consumption doesn’t appear to relate to blood levels, suggesting that oral supplementation may not be that effective. And given our bodies synthesize glutathione, the relationship between supplementation, blood levels and disease is not established.

There have been preliminary studies of glutathione for a number of uses, such as Parkinson’s disease. The best scientific evidence for infusions seems to be for its possible use to reduce the side-effects of cancer therapy.

When it comes to skin whitening, glutathione may have anti-melanogenic effects. There have been some studies conducted on the oral version and on a topical lotion. The trials have been small but generally positive.

I could locate no published evidence that demonstrates that intravenous glutathione is an effective skin-lightening agent. I could locate no clinical trials that have studied the injection or established that it is effective for this purpose. The Natural Medicines Comprehensive Database makes not comment on the effectiveness of glutathione (injection or oral) for skin lightening at all, reinforcing the overall lack evidence supporting its use.

Safety

Dugoua makes the following safety statement about glutathione injections:

Glutathione injections are not only safe, they are beneficial for your health. Glutathione helps eliminate toxins from the body, supports the central nervous system, aids in fertility and supports a healthy and strong immune system.

Are there negative long-term effects? There are no known side effects or interactions with IV administration of glutathione.

What are the side effects? I have not observed any side effects with respect to the Skin Brightening IV.

I looked to the medical literature for safety studies and statements. There is very little published safety information on injectable glutathione. The Natural Medicines Comprehensive Database says the tablets and injection are “possibly safe.” As noted above, there are some clinical trials of IV glutathione published for other purposes, and no serious safety signals have been identified. The most authoritative safety statement seems to be from the Phillipines Food and Drug Administration [PDF], which notes:

The alarming increase in the unapproved use of glutathione administered intravenously as a skin-whitening agent at very high doses is unsafe and may result in serious consequences to the health of users. There is inadequate safety documentation on the use of high doses of glutathione administered at 600 mg to 1.2 grams once weekly and even up to twice weekly. The only approved indication of the intravenous format of glutathione is as an adjunctive treatment to reduce neurotoxicity associated with cisplatin chemotherapy. Adverse drug reactions resulting from the use of glutathione IV for skin whitening have been reported and include the following:
1. Reports of adverse drug reactions ranging from skin rashes to the serious and potentially fatal Steven Johnsons Syndrome and Toxic Epidermal Necrolysis.
2. Derangements in the thyroid function
3. Suspected kidney dysfunction potential resulting in kidney failure.
4. Severe abdominal pain in a patient receiving twice-weekly glutathione administered intravenously had been reported.
5. Incorrect technique in intravenous administration especially in association with administration by untrained persons can result in the following:

  • Introduction of harmful microorganisms that can result in serious infections including potential fatal sepsis.
  • Injection of air can lead to embolus which is also potentially fatal.
  • Unsafe use of needles (recycling, sharing) can result in the transmission of hepatitis B and even HIV.
  • Counterfeiting of glutathione has been reported and may lead to use of non-sterile preparations which could lead to serious infections.

Is the Canadian product that’s offered for sale safe? I was unable to find any glutathione products for injection that have been approved for sale by Health Canada (Canada’s version of the FDA). It’s possible the product is being compounded from imported ingredients. Compounded products can be safe when prepared properly, but when problems occur then can be disastrous. Dugoua’s advertisement notes that “ingredients are regulated by Health Canada” and that the “treatment is performed in compliance with licensure in Ontario.” Other providers make few if any statements about where they are obtaining the product and the conditions under which it is being prepared. Buyer beware.

Conclusion

There is very little evidence that establishes either the safety or efficacy of glutathione injections for skin lightening. Based on the limited information that exists, glutathione’s effects on skin tone are plausible, but haven’t been well established. The same can be said for safety: There’s a lack of good safety information when used for this purpose and some international reports of serious harms. Given this product appears to be prepared by naturopaths directly, ensuring the final product is sterile and of high quality is essential, but may be difficult for consumers to confirm. Given the unclear benefits, risks of harm, and the overall lack of medical need, I’m going to recommend consumers think carefully before undertaking skin lightening with glutathione injections.

 

 

Posted by Scott Gavura

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