Dr. Vliet’s Health Tip: Acetaminophen (Tylenol) Risks Beyond Autism…for All of Us

© by Elizabeth Lee Vliet MD

First of all, let me set the record straight.  The risks of acetaminophen go far beyond the link with autism announced by President Trump and HHS Secretary Kennedy at the Autism Press Conference. Over my career in medicine, we have known about risk of serious liver toxicity in all of us –young or old, men and women—from excessive use of acetaminophen (brand Tylenol and many others).   All of these people popping lots of Tylenol to spite President Trump for mentioning the link with autism are risking serious liver damage and even death due to liver failure.

In fact, the FDA database over last 35 years shows staggering concerns the average US consumer is never told:

Acetaminophen (OTC Tylenol brand and over SIX HUNDRED other products) is the most common cause of acute liver failure in the U.S., surpassing viral hepatitis & 2^nd most common cause for liver failure requiring transplantation.  Acetaminophen-related overdoses cause > 450 deaths, 26,000 hospitalizations, & 56,000 ED visits per year. Patients presenting with liver failure have 20% – 40% mortality rate.  Severe untreated toxicity = death within 4 – 18 days of ingesting the drug.  FDA has issued warnings or updates in 1998, 2002, 2009, 2013, and 2014.

What is Acetaminophen?

Acetaminophen, also known as paracetamol or APAP, is a widely used medication that functions primarily as a pain reliever (analgesic) and fever reducer (antipyretic),  found in Tylenol and many over the counter and prescription medicines as I listed above.  Acetaminophen, which does NOT have anti-inflammatory actions, is not a very effective pain reliever even though because it is marketed so heavily, it is commonly used to treat headaches, muscle aches, backaches, toothaches, arthritis pain, menstrual cramps, and to reduce fever caused by common illnesses like colds and flu.  It elevates the body’s overall pain threshold and by acting on the central nervous system (brain and spinal cord) to reduce the perception of pain and regulate body temperature, but its exact mechanism is still not fully understood.  There is speculation that it may involve inhibition of certain enzymes in the brain involved in pain and fever pathways.

Acetaminophen Toxicity Beyond Autism

The link between autism and acetaminophen use in pregnancy and for young infants/children is not new: it has been known for more than 20 years, but covered up by Big Pharma and the captured/politicized CDC, FDA, NIH and medical establishment.   Many honest physicians and scientists are discussing on line the autism links, so I wanted to focus on the broader issue of acetaminophen (Tylenol and other brands) potential toxicity for men, women, and children of all ages.

In fact, for many years, I have recommended against using acetaminophen (Tylenol) as a pain reliever.  It is NOT the most effective pain reliever –there are better and safer options—and it isn’t even best for bringing down a true fever (medically defined at temperature greater than 101 degrees).  This health tip will focus on the adverse effects acetaminophen (Tylenol) beyond autism and what the average person urgently needs to know about the safety, appropriate uses, maximum dosing and alternative options.

I remember back to the 1970s and the sabotage poisoning of Tylenol products that led to some deaths. Bottles were tampered with and pulled from the shelves. The manufacturer Johnson & Johnson had a huge image problem on their hands and sales dropped dramatically. Thanks to a great marketing campaign over the years, J&J managed to convince Americans that Tylenol was safest pain reliever since aspirin, and the “go-to product” for reducing fever and pain relief with no questions asked and rarely any warnings from physicians.

I feel that the American public has been lulled into a false sense of security without realizing the potential risks of acetaminophen.   As a physician I feel it is important to explain my concerns about acetaminophen (Tylenol and other products) how excessive use causes risk of serious—even life-threatening—toxicity to the liver in people of all ages.

Symptoms of liver damage include yellowing of the skin or eyes (jaundice), abdominal pain, nausea, vomiting, loss of appetite, fatigue, dark urine, pale stools, unusual bruising or bleeding. Symptoms of liver damage include yellowing of the skin or eyes (jaundice), abdominal pain, nausea, vomiting, loss of appetite, fatigue, dark urine, pale stools, unusual bruising or bleeding. The liver is capable of regenerating new liver cells, but it is not always reversible and severe overdose can overwhelm the liver’s ability to regenerate.

Time is of the essence in this situation though, as mortality increases to 40% when treatment is delayed. Treatment with an antidote like N-acetylcysteine must start early, preferably within 24 hours to allow for proper regeneration and prevent permanent scarring (cirrhosis). IF there is early treatment, the liver can repair itself completely within about a month or two.

Other Adverse Effects of Acetaminophen:

Acetaminophen has other adverse effects, in addition to liver damage and  links to autism. Sadly, doctors rarely explain to patients to help people choose safer options.

1. Acetaminophen (Tylenol) exerts oxidative damage by depleting glutathione.  That’s why it is NOT a good option to take every day. Glutathione is considered the master antioxidant because it protects cells from damage. It is essential for our liver to detox properly and for our overall well-being. So, anything that depletes glutathione is something to avoid using as much as possible.  Acetaminophen damages the mitochondria, increases oxidative stress and affects the ability of the body to detox properly. This affects all of us, but especially babies’ ability to detox heavy metals and viruses from all the many vaccines they are given.
2. In 2016, Ohio State University researchers published alarming evidence showing that acetaminophen use reduced empathic concerns for others’ suffering. This means that the 60 million Americans who use acetaminophen regularly feel less emotional response when witnessing others in pain (this may explain a lot about what we are seeing in this country).  According to the study, acetaminophen achieves this by reducing activation in the anterior insula and anterior cingulate cortex – the same brain regions that process both physical pain and empathy for others’ pain. And in a follow-up study in 2019, the researchers found that acetaminophen reduced participants’ personal pleasure and empathic feelings in response to positive scenarios. This blunted emotional response also seemed to reduce negative emotions, making people feel less afraid when considering risky situations and thereby increasing risk-taking behaviors.
3. Kidney Damage: Severe acetaminophen (Tylenol) overdose can also harm the kidneys and cause kidney failure, especially in the context of liver failure.
4. Severe hypersensitivity reactions including Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can also occur, even with standard doses. Both of these syndromes can be life-threatening and both may be accompanied by evidence of liver injury.

These findings are quite alarming when we consider that the CDC and FDA recommended acetaminophen (Tylenol, most often mentioned) as the treatment for COVID, and pain after the COVID shots, both of which further cause brain information and similar emotional damage these researchers identified in 2016!

I am extremely concerned because right now we are seeing pregnant liberal women making TikTok videos, gobbling down Tylenol, just to spite President Trump and say “I’m showing the safety of Tylenol, I’m taking a whole bunch of it. They are safe.” Unfortunately, a reliable nurse reported in social media this week that one women 23-24 weeks pregnant is in ICU dying of liver failure and her baby may not survive. Don’t think it can’t happen that fast.  Acetaminophen (Tylenol) overdose can happen very fast. People die in the ER from acetaminophen (Tylenol) overdoses.

I think people are overtreating “fever” and many patients are never told that fever is actually a beneficial response to an infection and can shorten the course of illness. So unless the fever is severe, above 101 degrees, and/or prolonged, it can be better to let low grade temperature elevations 101 or less simply run their course.  In fact, studies have shown that treating mild temperature elevations may actually prolong a viral illness or bacterial infection.

But sadly, too many doctors don’t give people this information and people are too quick to grab an OTC product, especially acetaminophen (Tylenol) at the first sign of a rise in temperature to 99 degrees.  If doctors explained better the role of fever, we would let the body do its job first. Fever is the body’s response to inflammation, and fever has many good functions.  But when severe and/or prolonged, that is when an antipyretic (fever-reducer) is used to bring down the fever. Antipyretics can be aspirin or acetaminophen (Tylenol).

I do not take acetaminophen, nor do I generally recommend it to my patients. I find that it is not the most effective over-the-counter solution for a true fever and not the most effective pain reliever. As I have said above, it can be a cumulative toxic effect the longer you take it. I am concerned for the people taking it every day for arthritis pain, and yet it’s not even a very good pain reliever for arthritis because  acetaminophen does not have anti-inflammatory effects.  Many people are taking too much acetaminophen, both with Tylenol and many other of the more than 600 combination products containing acetaminophen.

Beware: Many Products Contain Acetaminophen!

You may be taking too much and not even realize it because acetaminophen is present in more than 600 different medicines, including many pain relievers, fever reducers, cold, flu, allergy, and sleep aid medications. It is important to always check labels for acetaminophen to avoid accidental overdose.  You have to be careful and verify the product labels for acetaminophen content to avoid exceeding the recommended total daily dose.

Common over-the-counter (OTC) cold and flu medicines that contain acetaminophen:

• Tylenol (Cold, Flu, Allergy Sinus Formula, Severe Allergy)
• NyQuil (Cold & Flu Relief Liquid and LiquiCaps)
• DayQuil (Cold and Flu products)
• Alka-Seltzer Plus (Cold, Sinus, Multi-Symptom Cold & Flu)
• Robitussin (Cold, Multi-Symptom Cold & Flu, Honey Flu Liquid)
• Theraflu (Regular and Maximum Strength Caplets and Hot Liquids)
• Mucinex (Fast-Max Day & Night, Sinus-Max, Nightshift formulas)
• Sudafed (Cold & Cough Liquid Caps, Cold & Sinus Liquid Caps, Severe Cold Caplets)
• Triaminic (Cold, Cough & Fever Liquid, Cough & Sore Throat Liquid, Softchews)
• Coricidin (HBP Maximum Strength Flu, Cold & Flu formulas)
• Dimetapp (Non-Drowsy Flu Syrup)
• Vicks (44M Cough, Cold & Flu Relief Liquid and Liquicap)
• Contac (Cold and Flu, Nighttime relief)
• Comtrex (Cold and Flu Maximum Strength, Day and Night)
• Actifed (Cold and Sinus treatments)
• Dristan (Cold treatments)
• Panadol (Cold and flu products)
• Cepacol (Cold and sore throat products)

Common (OTC) Brand Name Medicines Containing Acetaminophen:

• Anacin®
• Benadryl®
• Excedrin®
• Feverall®
• Formula 44®
• Goody’s® Powders
• Liquiprin®
• Midol®
• Nyquil®
• Saint Joseph® Aspirin-Free
• Singlet®
• Sinutab®
• Sudafed®
• Triaminic®
• TYLENOL® Brand Products
• Vanquish®
• Vicks®
• Zicam®
• And various store brands

Common Prescription Medicines Containing Acetaminophen:

• Endocet®
• Fioricet®
• Hycotab
• Hydrocet®
• Hydrocodone Bitartrate
• Lortab®
• Percocet®
• Phenaphen®
• Sedapap®
• Tapanol®
• Tylenol® with Codeine
• Tylox®
• Ultracet®
• Vicodin®
• Zydone®
• And generic equivalents

Four Stages of Acetaminophen Toxicity:

The clinical course of acetaminophen toxicity consists of 4 stages.  Most patients with acetaminophen toxicity are initially asymptomatic or present with mild, nonspecific symptoms.

Stage I: First 30 minutes to 24 hours

• Possibly asymptomatic
• May experience nausea, vomiting, diaphoresis, pallor, lethargy, and malaise
• Laboratory values are generally normal, but liver enzyme, aminotransferase, levels typically increase within 8 to 12 hours
• Central nervous system depression and elevated anion gap metabolic acidosis are possible with a >30 g ingestion

Stage II: 24 to 72 hours

• Clinically, the patient appears improved, but laboratory values worsen and show hepatotoxicity and nephrotoxicity.
• Patients experience right upper quadrant pain and hepatomegaly
• Evidence of abnormal prothrombin time (PT) and total bilirubin, along with oliguria and renal function abnormalities
• Patients may also experience acute pancreatitis, which increases risk of death.

Stage III: 72 to 96 hours.  This is the most common stage for multisystem organ failure leading to death

• Aminotransferase (liver enzymes) levels rise further and peak, with values exceeding 10,000 IU/L
• More pronounced symptoms occur: jaundice, confusion, hyperammonemia, abnormal aminotransferases, and bleeding diathesis, along with recurrence of symptoms from stage 1
• Acute renal failure in 50% of patients with frank liver failure and 10% to 25% of patients with significant liver damage
• Indirect hyperbilirubinemia
• Prolonged PT
• Hypoglycemia
• Lactic acidosis

Stage IV: If the patient survives stage 3

• Recovery phase
• Typically begins by day 4 and completes by day 7
• Symptoms and laboratory values may require several weeks to normalize
• Histopathologic changes in the liver become evident, which often leads to permanent damage.
• Acute renal failure due to acute tubular necrosis manifests as an elevated blood urea nitrogen and creatinine, proteinuria, hematuria, and granular and epithelial cell casts on urinalysis. Patients may require dialysis during this time.  The incidence is less than 2% of all patients, 5% of cases with liver involvement but no hepatic failure, 10% of severe poisonings, and nearly 53% of cases with acute hepatic failure. If the patient survives, renal function generally returns to normal in 1 to 4 weeks.

Maximum Doses for Acetaminophen (Tylenol)

• Typical adult dose: 325-1000 mg every 4 to 6 hours as needed.
• Maximum daily dose: 3000 to 4000 mg (3 to 4 grams) per day for adults.

Warnings: Avoid exceeding the maximum dose since high doses can cause severe liver damage; limit to 3000 mg per day or less especially if using other drugs containing acetaminophen, other medicines that affect the liver, or if consuming alcohol regularly.

Toxic Dose: Acute ingestion above 7.5 to 15 grams or chronic supratherapeutic dosing can cause severe liver injury. Taking more than 4 grams in 24 hours is generally unsafe, and even lower doses can be extremely risky when combined with with alcohol consumption.ncbi.nlm.nih+2

• Chronic therapy with acetaminophen in doses of 4 grams daily has been found to lead to transient elevations in serum aminotransferase levels generally starting after 3 to 7 days, and can progress to more serious ongoing liver damage with daily use.
• It is important to avoid repeat overdoses: Be careful to add up total daily dosage in all products you may be taking.  Avoid taking more than the recommended amount of acetaminophen (Tylenol), as this can lead to a “staggered” overdose which are particularly dangerous and can result in irreversible damage.
• DO NOT COMBINE ACETAMINOPHEN PRODUCTS WITH ALCOHOL!  Drinking alcohol when taking acetaminophen can increase the risk of permanent liver damage. It is always important if you have pre-existing liver conditions or are taking other medications to speak with a healthcare professional before taking acetaminophen or combination products that also contain acetaminophen.

Key Lab Tests to Monitor Potential Drug-induced Liver Injury

• Liver enzymes·
• Cholestasis markers·
• Bilirubin, serum albumin and coagulation measures (such as prothrombin time (PT) or international normalized ratio (INR)

Other OTC Alternatives to Acetaminophen (Tylenol)

If you’re taking acetaminophen (Tylenol) every day, even within daily limits, you may quickly exceed safe cumulative doses and need to be looking at other pain relievers and solutions.

The main types of OTC pain relievers are acetaminophen, ASPIRIN, and nonsteroidal anti-inflammatory drugs (NSAIDs), each with distinct mechanisms of action and recommended uses for various conditions.

• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Aspirin (Bayer, Ecotrin)
• Topical diclofenac gel (Voltaren Arthritis Pain)
• Combination products (Alka-Seltzer, which contains aspirin among other ingredients).

Mechanisms of Action

• Acetaminophen: Blocks pain receptor signals in the brain and acts on the heat-regulating center to lower fever; does not reduce inflammation that causes pain.
• NSAIDs (Ibuprofen, Naproxen, Aspirin, Diclofenac, and others): Inhibit prostaglandin synthesis, reducing pain, inflammation, and fever. Aspirin also has anticoagulant (“blood thinner”) effects, preventing blood clots that can cause pain due to interference with optimal blood flow to tissues.
• Topical Diclofenac: Local action on joints, reducing pain and inflammation with lower risk of systemic side effects and bypassing the liver.

Common Functions/Uses Per Medication

• Acetaminophen: Fever, headache, general aches; not very effective for arthritis inflammatory pain
• Ibuprofen & Naproxen: Inflammation, fever, cold/flu symptoms, back pain, menstrual cramps, headaches, toothaches.
• Aspirin: Pain, fever, cardiovascular risk reduction; not recommended for children due to Reye’s syndrome risk.
• Diclofenac Gel: Joint pain, especially for arthritis.

Each over-the-counter pain reliever offers unique benefits and drawbacks, influencing when they are most appropriate for use.  Discuss these pros and cons with your healthcare professionals. Although many will still say acetaminophen (Tylenol) is considered a safe first choice for many types of pain, and NSAIDs are preferred when inflammation is a primary cause of pain, my preference is for topical options and are especially ideal for targeted joint discomfort.

I tend to use topical medications to avoid the first pass effect in the liver and getting direct anti-inflammatory benefit absorbed into the bloodstream and localized to the area of pain. You can get topical aspirin-containing cream for arthritis in the hands, or the knees or tendonitis in the elbow. You can get topical diclofenac gel, which is wonderful for arthritis pain in hands, knees, elbows, and hips for example. Another option is DMSO used topically as a very effective anti-inflammatory pain reliever. I do not recommend systemic DMSO use, but you can learn more about DMSO in our Faith over Fear seminar.

Nonpharmacologic Alternatives to Relieve Pain:

When analgesics like acetaminophen (Tylenol) or NSAIDS are contraindicated,  nonpharmacologic strategies can be used to manage pain safely and effectively. I try to encourage my patients to use more natural approaches before relying on medications, especially when the medications have side effects and alternative approaches exist.

Supplements:

• TruNAC™ N-acetylcysteine (NAC) helps treat acetaminophen (Tylenol) toxicity primarily by replenishing glutathione, a critical antioxidant in the liver that detoxifies the harmful metabolite of acetaminophen called N-acetyl-p-benzoquinone imine (NAPQI).
• TruMitochondrial Boost™ supports optimal glutathione levels depleted by acetaminophen (Tylenol).
• TruMagnesium™ for a natural alternative for pain relief and better sleep.
• TruOmega Pure™ a high potency fish oil that is anti-inflammatory and helps lubricate painful joints.
• Physical therapy and exercise: Tailored movement and strengthening exercises help improve function and reduce pain, especially for musculoskeletal conditions. Strong muscles support the skeletal system and help with joint pain.
• Gentle stretching: helps release tight muscles and relaxes the entire body by taking stress off joints and pressure off pinched nerves.
• Periodic activity and short walks: Good for circulation to keep joints nourished with oxygen and nutrients and remove waste, great for releasing tension in the body and reducing stress.
• Heat and cold therapy: Ice reduces inflammation and swelling in acute injuries, while heat eases muscle stiffness and chronic pain.
• Acupuncture and massage therapies: Can be effective for certain chronic pain types such as low-back pain, arthritis, and headaches.
• Photo Biomodulation: Deep tissue light therapy that heals damaged soft tissue and reduces pain.
• Taking an Epsom salt bath: Magnesium contained in Epsom salt helps relax the muscles and help with quality of sleep so the body can heal.
• Self-management education: Empowers patients with lifestyle adjustments such as improving sleep, stress management and breath work to reduce tension and regular physical activity go a long way in reducing pain and managing pain.

I encourage you to also consider our other natural medicines with our top quality, cGMP-compliant professional formulas for TruImmune™Boost, TruNAC™, TruImmunoglobulin,™ TruC with BioFlav™ (Vitamin C with complete Bioflavonoids), Tru BioD3™, TruZinc™, TruMitochondrial ™Boost and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.   CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.  All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA. For more information, references from studies are listed in the Product Data Sheets for each product, available on our website.  Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice.

To Your good health and improving resilience!
Elizabeth Lee Vliet, MD

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