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White skin comes with a price

By LEI CHAVEZ

Glutathione has become a commercial success. But what it really does to the skin remains debatable.

By LEILANI CHAVEZ
Newsbreak’s Maggie de Pano fellow

MANILA, Philippines – Jeimie, 26, carries herself with confidence for obvious reasons: she’s gifted with chinky eyes, a well-endowed figure, and long, dark locks that complement her fair skin.

Although born with a fair complexion, Jeimie’s skin looks much better nowadays (milky, as the TV ads would say), thanks to years of pampering and skin whitening cream. Her morning ritual consists of using Papaya soap and applying layers of whitening lotion and sunblock on her body. Before retiring to bed, she puts on face masks after cleansing with skin-whitening astringents.

Thousands of women--and men--like Jemie made glutathione a market success.

Thousands of women--and men--like Jemie made glutathione a market success.

She has tried everything to maintain her blemish-free skin, a well-known fact among her peers in an office in Ortigas Center in Pasig, where she works as an account executive for a travel magazine. “I’ve tried almost all the whitening products—basta pampaputi,” she tells us.

Not surprisingly, when glutathione capsules became popular in 2007, Jeimie immediately joined the bandwagon of celebrities and early users who could afford the expensive supplements.

Glutathione’s immediate come-on is its seemingly positive side-effect: whitening of the skin. It even became a hot ingredient in whitening topical. Topicals include toners, soaps, facial wash, sun blocks lotions, moisturizers, lotions, and creams.

Jeimie took oral glutathione for three years and consumed around 12 bottles of 250mg capsules a year. She drank the pills twice a day along with her daily intake of Vitamin C.

A bottle of glutathione bottle is around P2,700. So do your math: Jemie spent P32,400 annually or around P97,200 in three years on glutathione capsules alone. Add another P28,000 a year for her Vitamin C capsules.

Fast Facts on Glutathione

Fast Facts on Glutathione

When the glutathione injectibles became a trend, she immediately shifted and to this day, or for almost two years now, she still gets these monthly injections. A 500mg glutathione vial costs P1,500 and dermatologist consultation amounts to P500 per session. Jeimie roughly spends P24,000 per year for the injections, comparatively cheaper than the capsules.

This beauty budget excludes other whitening paraphernalia that Jeimie buys to maintain her fair complexion.

Thousands of women–and men–like Jemie made glutathione a market success. The number of registered topical brands with glutathione increased from 30 in 2008 to 203 in 2011, according to data from the Food and Drugs Authority (FDA).

The number of approved food supplement brands was smaller since 2007: 57 in capsule form, 2 in tablet form, 1 liquid spray, 1 powdered drink, and 2 injectibles.

Through aggressive advertising, oral glutathione, classified as food supplements, became popular as a whitening agent.

Its effectiveness, however, has not been clinically proven.

This 3-part special report looks into the whitening supplement industry in the Philippines and glutathione: burgeoning but uncontrolled by weak government policies and lack of laws; and potentially dangerous as a whitening agent due to aggressive but oftentimes misleading advertisements.

As food supplements, glutathione capsules should not be marketed as drugs or cosmetics. Thus, advertisements claiming that the use of glutathione can whiten complexion and cure certain diseases are clearly against the law, according to the FDA.

Addiction to white

Dr. Sonya Baluyot, a dermatologist, told us that 90% of patients who come to her office everyday seek out ways to whiten their skin. Yet, most of them are already fair-skinned to begin with, like Macky.

In his mid-20s, Macky is a production staff of a prominent advertising agency, and although he is naturally fair-skinned, he wanted a lighter complexion because he thinks his moreno, dark color does not suit him.

He has tried three brands of glutathione capsules so far, all causing different yet positive results. “Di kasi bagay (sa akin) ‘yung moreno. Mukha akong dugyot. Parang kasi ‘pag you’re fair ‘di ka (mukhang) stressed, ‘di ka (mukhang) puyat… parang dinadaan sa puti,” he said. (The moreno color doesn’t suit me; I look dirty with it. When you’re fair you don’t look stressed and haggard.)

Among Asians, spending for whitening products has been continuously growing since 2004, when the sudden upsurge of whitening products began.

In a 2004 Synovate AsiaBUS survey conducted among 2,496 respondents from five Asian countries, skin whitening was most popular in the Philippines. At least 50% of respondents claimed they use whitening products and always opt for the popular brand.

Overall results of this survey showed that 38% of those surveyed in Hong Kong, Malaysia, Korea, the Philippines, and Taiwan admitted to using whitening products.

Oral glutathione, which started around 2004 through direct selling, adds to this continuously increasing spending for fairer skin.

‘Master antioxidant’

Before glutathione in the Philippines became associated with whiter skin, it was first and foremost known as an antioxidant.

Considered as the “master antioxidant,” glutathione or GSH (reduced glutathione) is found in animal and plant tissues and popular for its cell regeneration properties. Glutathione is protein composed of three amino acids: cycteine, glutamine, and glycine.

In a series of columns for the Philippine Daily Inquirer, Dr. Philip Chua writes that “GSH is a detoxifying agent, an essential scavenger and neutralizer of the bad free oxygen radicals and peroxides that destroy cells.”

Oral glutathione helps in boosting the body’s capacity to create glutathione. In ideal situations, glutathione capsules are absorbed in the blood stream and taken to the liver, which will then create natural glutathione. Natural glutathione is then exported to other cells. When glutathione intake exceeds the needs of the liver, it stays in the blood.

Ideally, people who eat fresh fruits, vegetables, fish, and freshly-prepared meats have enough glutathione in their bodies that they do not need any supplements, Dr. Chua says, quoting Dr. Dean Jones, director of nutritional health sciences at the Emory University in Atlanta, considered one of the world’s leading research universities.

In the US, only patients with low glutathione levels are advised to drink supplements, according to Dr. Chua.

Glutathione deficiency is identified through blood tests.

Normally, people with low glutathione levels are those afflicted with the following: diabetes, high blood pressure, HIV/AIDS, low sperm count, cataract, cancer, or are smokers.

Glutathione levels are also depleted by: 1) excessive drinking, 2) use of illegal drugs, 3) old age, and 4) pollution, according to published glutathione studies.

From antioxidant to whitener

The supposed whitening caused by too much glutathione in the body is theoretically possible but has not been proven.

Animal tests showed that a high cysteine level (the main component of glutathione) lowers melanin production. Melanin is the pigment that provides color to the skin, according to Dr. Belen Dofitas of the Philippine Dermatological Society (PDS).

If the number lowers, the skin lightens. People with high cysteine levels gain a yellowish complexion. “Our usual melanin is the black and brown melanin. But when there’s a lot of glutathione in the cells, naa-attract towards the lighter melanin (and produces) yellow-red (pigments). So those who lighten have a yellowish color,” explains Dr. Dofitas.

This whitening effect caused the growth of glutathione capsules in the market starting 2007 until its peak in 2008.

But this pigment color is not desirable. Dr. Dofitas cites to studies that showed that people who have red to yellowish skin color showed a higher possibility of acquiring skin cancer.

The Philippines is a tropical country and the Filipinos’ brown color fends off too much sun. Technically speaking, lighter melanin lowers the body’s defenses to ultraviolet rays.

The co-relation between skin cancer and glutathione use has yet to be proven in the same way that there are no dependable published studies that co-relate glutathione to whitening.

But one thing is certain: glutathione capsules cannot protect you from the sun.

“Whether nagte-take ka ng glutathione (or not), kailangan mo mag-sunblock,” says Dr. Baluyot. “Ang advantage kapag nagte-take ka ng glutathione, especially kapag summer, hindi ka masyadong iitim. Whereas kapag hindi ka nag-glutathione, mas maitim ka.

Whitening debates

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glutathione’s whitening effect remains contestable.

There are two schools of thought in this debate: one side argues that glutathione is not a proven whitening agent; another relies on actual cases of users whose skin lightened.

Studies have proven that once glutathione melts in the stomach, it is not absorbed in the body. If it is indeed absorbed, it would be minimal and would show little effect.

Two skin doctors, Dr. Dofitas and Dr. Chua, agree on this.

Dr. Dofitas says said that this low level absorption is the reason why there are few adverse effects caused by glutathione capsules and why its effectiveness as a whitener is questionable.

On the other hand, some dermatologists attest to actual cases wherein their patients’ skin lightened after drinking glutathione capsules.

Dr. Baluyot, a strong supporter of glutathione capsules and spokesperson for glutathione brand MET Tathione, believes that glutathione indeed causes the whitening of the skin. “Sa studies, sinasabi na it’s not absorbed daw. But in actual, pumuputi talaga ang users when they drink glutathione capsules,” she tells Newsbreak. (Studies say glutathione will not be absorbed in oral forms. But in actual cases, users get fairer complexion after drinking glutathione.)

Insufficient evidence?

In the US, glutathione use is mainly centered on its antioxidant properties. It’s only in Asia—and the Philippines—that it is being used for its skin lightening promise.

“Dermatologists weren’t taught about glutathione as a whitening agent because it is not established (as skin whitener) and their safety profile is also not established,” according to Dr. Dofitas.

Since natural glutathione was first discovered in the human body in 1888, there are more than 90,000 published studies on glutathione as an antioxidant, according to the United States medical studies portal pubmed.com.

But on the use of glutathione as skin whitening, only one study has been published so far.

The study was done in Thailand in 2009 by medical students of the Chulalongkorn University. In the study, 60 students were asked to take 250mg of glutathione capsules for four weeks.

The students were divided into six teams. The results were measured for pigmentation and the lightening of the skin. They showed lower melanin index but when compared to a feeble group, only two of these students manifested skin whitening improvements.

Another study on glutathione as a skin whitener will be released next month, November 2011, conducted by dermatologists from the Philippine Dermatological Society (PDS).

The study was conducted among 40 respondents who were asked to drink 500mg of glutathione capsules in 10 weeks. Only 14 users finished drinking the pills in the controlled group. Of these, 11 manifested minimal whitening of the skin.

“These studies are still small and the results are not remarkable,” Dr. Dofitas, who was

one of the doctors involved in the study, says.

For a study to be clinically accepted, it should be made on hundreds of respondents and results should show lightening effects in around 60% of the respondents with very little or no adverse effects, says Dr. Dofitas. “We have to put it through a formal investigation to find sufficient evidence. Hindi pwede ‘yung walang evidence, ‘yung mga sinabi ko lang, o ng artista. Testimonials are the lowest form of evidence,” she asserts.

But despite the lack of big-scale studies, Dr. Baluyot claims that numerous dermatologists who are open to using glutathione capsules have done informal researches. “Experience na lang ng mga doctor, dermatologists is a research. Kaya lang, informal research. Kasi anything na binigyan mo, tapos sinubaybayan mo, research na ‘yun,” she says in defending her stand on glutathione’s whitening effect.

The lack of study on glutathione’s effectiveness as a whitener is further aggravated by the fact that Filipinos do not solely rely on glutathione capsules to lighten their skin.

Jeimie and Mark use lotions, creams, and soaps to further lighten their complexions. They drink Vitamin E and refrain from walking under the sun without any protection.

Dr. Dofitas puts it bluntly: “May products in the market na halong glutathione and other substances… What do people do for their skin to lighten? It’s not only taking glutathione. What proportion of your lightening is caused by glutathione?”

Illegal, counterfeit

Filipinos’ desire for whiter skin has paved the way for the abuse of glutathione.

Its safety profile was further placed under scrutiny after the injection form (IV) was labeled as “illegal” by the FDA last May 2011.

Injections became a fad because they were perceived to be “more effective” than their capsule and tablet counterparts. Thus, users can immediately see skin lightening after a few injections.

But after glutathione injectibles became popular, counterfeit versions bombarded the market and were bought at insanely low prices.

Worse, they were administered by non-licensed doctors. News broke that these injections were offered in beauty parlors and other hole-in-the-wall areas.

But this “quickness” also sent Filipinos hurrying to hospitals as its side effects took a heavy toll on their bodies. There were even some reported cases of Filipinos staying at Intensive Care Units for days, unable to breathe because of the injections.

Common side effects associated with glutathione injection overdose range from skin rashes and stomachache, to thyroid disease, and serious to potentially fatal conditions such as kidney failure, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, according to the FDA.

Incorrect techniques in intravenous administration, when the injections are done by untrained persons, can also lead to embolism, the introduction of harmful microorganisms that result in serious infections such as fatal sepsis, as well as the transmission of deadly diseases such as Hepatitis B and HIV. (See DOH-FDA Advisory on injectable glutathione.)

This series of cases prompted the FDA to ban the injectibles last May. Only two injectibles were registered and were allowed to be administered–but only in cancer patients.

“The alarming increase in the unapproved use of glutathione administered intravenously (direct into the veins) as a skin-whitening agent at very high doses is unsafe and may result in serious consequences to the health of users,” FDA said in an advisory released last May 12, 2011.

Downside

But even the capsule forms pose its own dangers.

Glutathione capsules cannot be taken in its raw form. These are manufactured in laboratories, which makes these vulnerable to adverse effects, says Dr. Chua. Unlike injections, the adverse effects of glutathione capsules take time to manifest. And it’s on a case-to-case basis.

Jeimie and Macky did not experience any side effects while using glutathione capsules. But the case was different with Aya [not her real name].

Aya is a mid-20s engineer for a telecommunications company and she only took glutathione capsules in 2010 to retain her original fair complexion which she lost after a trip to the beach.

She bought a popular and established brand of glutathione. But instead of a lighter complexion, what Aya got were red spots in her body two weeks later. The dots began coming out in her neck, then her face and arms and eventually her whole body.

“Nakakasar kasi gumastos ako para pumangit,” she said. (I am annoyed—I spent money to be ugly.)

Instead of filing a complaint, she decided to keep the incident to herself and did what any normal Filipino would do in her situation: consult a doctor.

“My doctor told me to drink water to wash out the capsules in my body,” she narrated. After three days of drinking liters of water, the spots disappeared. “Sure ako na ‘yung capsules ang source because when I stopped drinking, nawala din siya.” (I am sure the capsules prompted the allergy because when I stopped drinking, the spots disappeared.)

Alma, another glutathione user, said some of her friends also experienced side effects. Personally, she never experienced any but her clique stopped drinking the capsules after acne breakouts.

Alma works as a medical assistant in a dermatology center in Cubao. Here, she talks to different patients like Aya who sometimes experienced the dreaded negative side effects of glutathione capsules.

“’Yung iba (nakaka-experience ng side-effects), depende rin kasi sa tao. Yung iba, nagkaka-pimples sila tapos’ yung iba (sinasabi) nakakagamot sa pimples,” she shares. “Iba-iba (ang effect niya).”

But one thing is certain: drinking glutathione capsules comes with risks.

Despite its popularity, experts are adamant in saying that glutathione is not a proven whitening product.

“If you are taking glutathione capsules and taking a large amount of it, then there’s a higher risk of side effects occurring. (It happens) Whenever you take anything beyond the recommended dose,” PDS’s Dr. Dofitas notes.

Aside from skin allergies, there are users who experienced thyroid abnormalities due to glutathione use. Some reported diarrhea, headaches, itchiness, chills, and acne breakouts, while some users with diabetes said their case worsened.

Dr. Dofitas says these are based on two unpublished studies of PDS: “Adverse Effects observed by Filipino Dermatologists among Patients using Glutathione-containing Products: An Exploratory Study,” and “Prevalence of Thyroid Dysfunction Among Individuals Taking Glutathione Supplementation: A Cross-Sectional Study Preliminary Report.”

As a precaution, Dr. Chua writes that “people allergic to milk protein and organ transplant patients are advised against using any form of glutathione.”

Users around the world experience similar side effects. The Uppsala Monitoring Center (UMC), the World Health Organization’s Collaborating Center for International Drug Monitoring, gathers all reports on the adverse effects of glutathione.

As of May 2011, 55 instances associated with glutathione products, both IV and non-IV, have been recorded. These happened mostly from Japan and Italy, the prime suppliers of glutathione products.

For Dr. Baluyot, these adverse effects are negligible.

“Negligible ‘yung side effects. Case-to-case basis lang din,” she said. “Ang side effect nga niya mismo ay ‘yung pagputi.” [The side effects are negligible. It’s a case-to-case basis. The primary side effect of drinking glutathione capsules itself is getting whiter skin.]

Dr. Dofitas believes otherwise. As studies on the use of glutathione to whiten the skin are still relatively new, every account of adverse effects is significant.

But whether these side effects are negligible or not, users who plan to drink or are drinking glutathione capsules should be wary and first seek doctor advice.

The PDS is staunch in their stand against oral supplements.

“No for oral glutathione because glutathione supplements are not intended for skin whitening. In the first place, they are not established treatments,” Dr. Dofitas says. “As physicians, a patient’s safety is always our number one concern.” – Newsbreak

 

(Next in the series: Raking in millions)

(The series was produced under the Maggie de Pano Fund for Investigative Reporting on Health. The Fund, which is managed by Newsbreak, is made possible through a grant from Macare Medicals, Inc.)

CATEGORY: Health, In-Depth
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  1. why is my comment awaiting moderation?

  2. Skin whitening is a billion dollar industry in Asia and among orientals worldwide thus quack remedies easily gets snapped by consumers with the help of unethical medical practitioners in the Philippines.

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