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Most patients start during the dose escalation phase of tirzepatide (weeks 4–12) when oxidative stress from rapid fat loss is highest
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Cysteine is also the rate-limiting amino acid in GSH production, given its relative scarcity in our diet.25 Cysteine can become easily depleted in many diets or when cells are exposed to prolonged oxidative stress as seen in autoimmune diseases.26,27 GSH is the major endogenous antioxidant ubiquitous throughout the body28,29 Other antioxidants including vitamin C, vitamin E, and selenium require GSH in order to return to their reduced (nonoxidized) state.30 In this sense, the majority of antioxidants depend on GSH for their normal functioning.31 In addition, GSH is the only antioxidant that does not become a free radical itself after donating a free electron.32 The GSH precursor, Immunocal, has been demonstrated to have positive effects in other conditions of oxidative stress and heightened inflammatory response, such as cystic fibrosis,19 acquired immunodeficiency syndrome/ human immunodeficiency virus,16 anaerobic muscle performance,9 and cancer.20 Based on these previous clinical trials, it prompted the authors to explore whether similar beneficial outcomes could be witnessed in patients with psoriasis vulgaris
