Firefighters say this antioxidant helped them - their union warns it could be risky

Firefighters say this antioxidant helped them - their union warns it could be risky

David Marquez, a firefighter for more than 25 years, told lawmakers how much benefit he said he got from glutathione.

A few days after helping put out the Eaton Fire in Los Angeles, Pasadena Fire Captain David Marquez took his first dose of glutathione while standing by the roadside outside the Rose Bowl stadium.

The wildfire went on to become the second most destructive in California history, leaving 19 people dead and 9,000 buildings destroyed.

"We were having trouble sleeping," he said about his crew. "Chronic cough, headache, fatigue - just a really rough set of symptoms following the fire."

"I felt much better immediately after the worst exposure of my career," said Marquez, a 25-year firefighting veteran who has dealt with health problems for years.

"We were so desperate because of how messed up we were. We were willing to pretty much try anything," he said.

Scientists have long understood that breathing in toxic smoke from a fire can lead to a wide range of illnesses, including several kinds of cancer. First responders such as firefighters are particularly vulnerable.

According to the US National Institute for Occupational Health and Safety, firefighters have a 14% increased risk of dying from cancer, external, compared with the general American population.

And as awareness of the dangers has grown, interest has also increased in alternative - but often unproven and potentially dangerous - treatments.

Glutathione, an antioxidant naturally made in the human body, has been offered as a treatment at some of the biggest US wildfires in recent years, including most recently in Spokane, Washington. Anecdotal evidence collected by clinicians and fire departments has suggested it may help remove some of the cancer-causing chemicals firefighters absorb during fires. But no large-scale study has yet examined its safety or effectiveness, and there are worries about purity and contaminated supplies.

Last month, the International Association of Fire Fighters (IAFF) issued a rare warning about glutathione. It pointed to two recent recalls tied to contaminants at compounding pharmacies that make glutathione. It also cited scientific trials of other common, naturally occurring vitamins that were found to raise - rather than lower - cancer risk, though none of those vitamins are used in glutathione treatment.

"We don't know if glutathione is affective," said Sean DeCrane, assistant to the general president for health and safety at the IAFF, which represents more than 360,000 firefighters in the US and Canada.

"We don't know if it's a placebo effect. We don't know the long-term effect of this type of treatment."

DeCrane said his organization objects to the way it has been "marketed" to firefighters, including in Spokane, where morning briefings from fire chiefs to crews included suggestions that they visit a volunteer tent for treatment.

"The lack of research really raised concerns for us," he said. He added that the IAFF has spoken with "multiple members who said that they did not feel well after the treatment, [and] that they felt worse."

"The clinician told them, 'Oh, that's just those metals leaving your body'," he said.

The recent surge in glutathione use can be traced to 2017, when a group of naturopaths came together in Santa Rosa, California, to help fire crews fighting the Tubbs Fire.

The Integrated Health Action Network (IHAN), formerly known as the Integrative Healers Network, now sends volunteer clinicians to major wildfires nationwide to provide glutathione, along with other naturopathic treatments such as acupuncture and massage therapy.

After the IAFF warning, the group issued a statement agreeing that more testing is needed and saying it is willing to work with researchers to demonstrate glutathione's effectiveness.

Co-founder Jen Riegle, who is not a medical doctor but is a licensed naturopath, said glutathione treatment often produces "clinically-meaningful improvements in headaches, fatigue and brain fog, which are some of the top symptoms we see in firefighters when they're on a fire". She says the treatments help push out some of the harmful contaminants in firefighters' bodies and can cause short-term side effects right after treatment.

Riegle hopes the data the group has gathered will lead to more research and "to prove that this is a good long-term solution for firefighters". But she says all of IHAN's evidence is anecdotal and far from definitive.

"I just want to be really clear that what we are collecting is data that we have because of a treatment programme," she said.

"It shouldn't ever be misconstrued as clinical trial data, or double-blind, placebo-controlled, peer-reviewed data. It is just meant as a starting point to be able to garner support for future studies." Medical trials for a new drug usually take years before regulatory approval and require rigorous research and standards.

Interest in glutathione increased last year when California's state Board of Pharmacy tried to introduce new rules that would have sharply limited its production.

The proposed rule change sparked strong opposition from some firefighters, who went to the state capital to testify about how it had improved their health. The effort to further restrict it was later dropped.

Marquez was among the firefighters who traveled to Sacramento to testify in uniform. He said he is thankful that glutathione is now being offered more often, including at all fire stations in Pasadena, where he works.

He rejects concerns about whether it works, including claims that any symptom relief could be explained by a placebo effect.

Using an expletive, Marquez said: "I don't [care] it's a placebo - it was working. Guys were saying they felt better. I felt better. And it made me want to seek out more treatments."

Tents were set up for firefighters and health workers to stay out of the smoke

Rules and treatments for firefighters have sometimes lagged behind what is needed. Until last year, National Forest Service firefighters were barred from wearing face masks because of concerns about their ability to work in rugged mountain terrain. There is now a growing recognition of the need for respiratory protection and decontamination to help prevent certain cancers that are more common among firefighters.

Dr Coralynn Sack, an occupational pulmonologist at the University of Washington who specializes in how air pollution affects the body, said the toxic fumes from wildfires are well known to pose "inhalational hazards" to firefighters.

"There's been a lot of interest in using antioxidant supplements for air pollution in general," she said. "Studies have shown mixed responses. Some have even shown worse responses."

Sack said there was "biological plausibility" for thinking such a treatment might work, but added that she was "very underwhelmed by the data that exists". She said there have been no clinical trials of glutathione in firefighters.

Sack said the glutathione debate "shifts the emphasis away from things that we know work" such as giving firefighters access to good personal protective equipment.

Greg Fonts, a fire captain in West Sacramento and vice-president of his local IAFF chapter, said there is a growing understanding of how important firefighter health is. The days of failing to decontaminate equipment and leaving ashes on helmets and jackets to brag about past fires are gone.

"When I got the fire service in 2000, I would say that was the attitude was cancer was just part of the job."

"Culture has changed drastically," said Fonts, who has also been treated with glutathione. "Younger firefighters are taking health way more seriously."