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Arginine

Arginine  

Natural Standard Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified health care professional before making decisions about therapies and/or health conditions.

Related Terms

  • 2-Amino-5-guanidinopentanoic acid, agmatine, Arg, arginine, arginine hydrochloride (intravenous formulation), Ark1, decarboxylated arginine, dipeptide arginyl aspartate, HeartBar®, L-arg, L-arginine, L-arginine aspartate, NG-monomethyl-L-arginine, Sargenor®, Spedifen®.
  • Dietary sources of arginine: Almonds, barley, Brazil nuts, brown rice, buckwheat, cashews, cereals, chicken, chocolate, coconut, corn, dairy products, filberts, gelatin, meats, oats, peanuts, pecans, raisins, sesame seeds, sunflower seeds, walnuts.
  • Combination products: Prelox® (Pycnogenol® and L-arginine aspartate).
  • Note: Arginine analogs (N(omega)-nitro-L-arginine methyl ester, N(G)-nitro-L-arginine methyl ester, N-monomethyl-L-arginine, dimethylarginine), and ibuprofen arginate are not specifically discussed in this monograph.

Background

  • L-arginine was first isolated in 1886, reportedly from the extract of a lupine (Lupinus spp.) seedling. Lupinus is a genus in the legume (Fabaceae) plant family.
  • Arginine is a semiessential amino acid; although the body normally makes enough of it, supplementation with additional amounts is sometimes needed. Arginine is found in foods containing protein.
  • Arginine is a chemical precursor to nitric oxide (a blood vessel-widening agent called a vasodilator). Early evidence suggests that arginine may help treat medical conditions that improve with increased vasodilation. These conditions include chest pain, atherosclerosis (clogged arteries), heart disease or failure, erectile dysfunction, intermittent claudication/peripheral vascular disease, and vascular headaches (headache-inducing blood vessel swelling).
  • Arginine also triggers the body to make protein and has been studied for healing wounds, bodybuilding, enhancing sperm production, and preventing tissue wasting in people with critical illnesses. However, caution is warranted. Arginine use was associated with death in certain groups of heart patients. Caution is also needed when using arginine to treat pre-eclampsia (high blood pressure in pregnancy).
  • Arginine hydrochloride has high chloride content and has been used to treat metabolic alkalosis. This use should be under the supervision of a qualified healthcare professional.

Evidence

 

Uses based on scientific evidence 

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare professional.

Grade* 

Growth hormone reserve test / pituitary disorder diagnosis 

Arginine is sometimes injected intravenously to measure growth hormone levels in people being tested for growth hormone deficiencies, such as panhypopituitarism, gigantism, acromegaly, or pituitary adenoma. The U.S. Food and Drug Administration (FDA) has approved this use.

A 

Inborn errors of urea synthesis 

Patients with inborn errors of urea synthesis may have high ammonia levels in the blood and metabolic alkalosis. There is strong evidence supporting the use of arginine for this condition. Arginine should be avoided in patients with hyperargininemia (high arginine levels in the blood). A qualified healthcare professional should supervise use by all patients.

A 

Heart disease 

There is good scientific evidence that dietary supplementation with L-arginine may help patients with coronary artery disease, angina, or atherosclerosis, due to its effects on increasing vasodilation (blood vessel widening). Larger, longer-term studies are needed to confirm these initial positive effects.

B 

Heart failure 

Arginine has been studied in patients with heart failure. Longer-term studies are required to confirm the clinical benefit of L-arginine supplementation in patients with heart disease.

B 

Peripheral vascular disease / claudication 

Peripheral vascular disease, also known as intermittent claudication, is a narrowing of blood vessels in the legs and feet caused by fatty plaque deposits. This condition causes decreased blood flow to the legs and feet, resulting in leg pain and tiredness. A small number of studies report that arginine therapy may improve walking distance in patients with claudication. Further research is needed.

B 

Adrenoleukodystrophy (ALD) 

Adrenoleukodystrophy (ALD) is a rare inherited metabolic disorder characterized by both the loss of fatty coverings (myelin sheaths) on nerves in the brain and the progressive destruction of the adrenal glands. This condition results in dementia and adrenal failure. Arginine injections may help manage this disorder; however, most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD.

C 

Altitude sickness 

Limited research has examined the effect of L-arginine on altitude sickness symptoms. Larger, well-designed trials are required before conclusions can be made.

C 

Anal fissures 

Early research suggests that arginine helps heal chronic anal fissures, which are small tears that develop in the anus. Additional studies are needed.

C 

Anxiety 

In limited research, the combination of L-lysine and L-arginine reduced symptoms of anxiety. The effect of L-arginine alone is unknown. Studies investigating arginine alone are needed.

C 

Autonomic failure 

Arginine has been studied for treating autonomic failure, a condition that may include low blood pressure. Its effect is unclear. Well-designed studies are needed.

C 

Birth outcomes 

The effect of L-arginine on birth outcomes has been studied. Additional research is needed before conclusions can be made.

C 

Blood flow enhancement 

In limited research, L-arginine increased blood flow. Because of conflicting results from one study, additional research is needed.

C 

Breast cancer 

The therapeutic effect of arginine in breast cancer patients is unclear. Results from early human studies are mixed. High-quality studies are needed.

C 

Burns 

Arginine may improve immune function and protein function in burn patients. Further research is needed before a conclusion can be drawn.

C 

Cachexia (weight loss and muscle-wasting disease) 

A combination of beta-hydroxyl beta-methyl butyrate, glutamine, and arginine has been tested in patients with cachexia associated with cancer, but conclusions could not be drawn. Further research is required.

C 

Chemotherapy adjuvant 

Early human studies suggest that arginine supplements may benefit patients undergoing chemotherapy. Larger, high-quality studies are needed.

C 

Chest pain (noncardiac) 

Limited human research reported that arginine taken by mouth improved noncardiac chest pain in patients with esophageal disorders. Large, well-designed studies are needed.

C 

Circulation 

Preliminary evidence indicates that L-arginine may increase blood flow. The clinical importance of this is unclear. Further research is required before conclusions can be made.

C 

Cognitive function 

In preliminary research, L-arginine increased cognitive function in elderly patients with cerebrovascular disease. Better-designed studies are needed.

C 

Critical illness 

The impact of L-arginine supplementation on critical illness is unclear. Further research is needed.

C 

Cyclosporine toxicity 

Results of preliminary studies of the effect of L-arginine on cyclosporine toxicity in renal transplant patients are mixed. Well-designed randomized controlled trials are needed to clarify the effects of L-arginine.

C 

Dental conditions 

Recent studies suggested that an arginine-containing toothpaste reduced teeth sensitivity. An arginine-containing product was also effective in reducing dental caries. Additional research is needed to confirm these effects.

C 

Diabetes (type 2) 

The effect of L-arginine on type 2 diabetic patients has been investigated. Large, well-designed studies are needed to understand the effect of arginine on type 2 diabetes.

C 

Diabetic complications 

Early human research indicates that L-arginine may play a role in reducing complications associated with diabetes. However, further research is required before conclusions can be made.

C 

Erectile dysfunction 

Early studies showed that arginine supplements helped treat erectile dysfunction (ED) in men with low nitrate or nitrite levels in their blood or urine. A combination of L-arginine, glutamate, and yohimbine hydrochloride was used to treat ED. However, because a combination product was used, and yohimbine hydrochloride is an FDA-approved therapy for this condition, the effects of arginine alone are unknown. More research is needed with arginine alone.

C 

Exercise performance 

Despite common use by athletes, the effect of arginine for exercise performance enhancement has not been studied extensively. Well-designed studies investigating arginine alone are needed before conclusions can be made.

C 

Gastrointestinal cancer surgery 

A combination of arginine, RNA, and omega-3 fatty acids may reduce the length of hospital stays and infections after surgery in gastrointestinal cancer patients. More research with arginine alone is needed.

C 

Heart protection during coronary artery bypass grafting (CABG) 

Arginine-supplemented blood cardioplegic solution (solution that stops the heart temporarily, e.g., during surgery) may help protect the heart in patients undergoing coronary artery bypass grafting. Further research is needed before a firm conclusion can be drawn.

C 

High blood pressure 

Early research in humans reported that arginine taken by mouth reduced blood pressure in patients with high blood pressure. Larger, high-quality studies are needed before a conclusion can be made.

C 

High cholesterol 

Some research suggests that arginine may help treat high cholesterol. Results of different studies conflict, however, and more research is needed.

C 

Immunomodulation 

L-arginine has immunomodulating effects in patients undergoing surgery for colorectal cancer and in children with airway infections. In HIV outpatients, L-arginine in combination with omega-3 fatty acids and a nutritional supplement had no additional effects on immune response over a nutritional supplement alone. Additional well-designed research is needed.

C 

Infertility 

Limited research has investigated the effect of L-arginine on male and female infertility. Further research is required before conclusions can be made.

C 

Intrauterine growth retardation 

Preliminary research of pregnant mothers suggests that arginine supplements improve growth in smaller-than-average fetuses. Additional studies are needed.

C 

MELAS syndrome 

Early studies found that supplementation with L-arginine significantly improved endothelial function in patients with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke). Further research is merited in this area.

C 

Metabolic disorders (creatine deficiency syndromes) 

Limited research suggests that L-arginine may decrease symptoms associated with creatine deficiency syndromes. Further research is required before conclusions can be drawn.

C 

Polycystic ovarian syndrome 

In preliminary research, treatment with N-acetyl cysteine (NAC) and L-arginine restored gonadal function in patients with polycystic ovary syndrome. Further research is required before conclusions can be drawn.

C 

Pre-eclampsia (high blood pressure in pregnancy) 

Effects of L-arginine in women with pre-eclampsia are mixed. Longer-term treatment appeared to be more effective than short-term treatment. Further research is needed before a conclusion can be made.

C 

Pressure ulcers 

Studies of arginine for pressure ulcers show mixed results. Further research is needed before a conclusion can be drawn.

C 

Prevention of restenosis after coronary angioplasty (PTCA) 

Injection of L-arginine into surgically inserted stents was investigated, with mixed results. Early research suggested that L-arginine might or might not prevent restenosis (arterial narrowing) in the arteries. Further well-designed studies are required.

C 

Raynaud's phenomenon 

Early research in humans investigated the effect of arginine on blood vessel activity in Raynaud's phenomenon, a condition causing the blood vessels in the fingers, toes, nose, and ears to narrow in response to cold temperatures or stress. However, the effects of arginine are not clear. Large, well-designed trials are needed.

C 

Recovery after surgery 

In early research, arginine combined with other supplements helped recovery after surgery. However, the role of arginine alone is unclear. More research is needed.

C 

Respiratory infections 

Early research suggests that arginine supplements may decrease the risk of respiratory (lung) infections. Large, well-controlled studies are needed to clarify this relationship.

C 

Scleroderma 

Based on preliminary research, L-arginine may be useful for pregnant scleroderma patients. Further research is required before conclusions can be drawn.

C 

Sickle cell anemia 

Clinical studies investigating the effects of L-arginine on sickle cell anemia are limited; however, early research suggests the potential for immune benefits. Further research is required in this field.

C 

Transplants 

In human research, L-arginine improved kidney function in kidney transplant patients, and improved quality of life and exercise tolerance in heart transplant recipients. Additional clinical research is required.

C 

Uterine disorders 

In early research, L-arginine improved endometrial thickness in patients with a thin endometrium. Further studies are required before conclusions can be drawn.

C 

Asthma 

Available evidence argues against supplementary L-arginine taken by mouth or inhaled.

D 

Interstitial cystitis 

Arginine has been proposed as a treatment for interstitial cystitis (inflammation of the bladder). However, most human studies found a lack of effect.

D 

Kidney disease or failure 

Overall evidence from early human research fails to support the use of L-arginine for kidney disease or failure. Until the evidence is more consistent, conclusions cannot be made in this field.

D 

Kidney protection during angiography 

The contrast media, or dye, used during angiography to map a patient's arteries may be poisonous (toxic) to the kidneys, especially among people with kidney disease. Researchers have studied L-arginine as a way to protect the kidneys in patients with long-term kidney failure who were undergoing angiography. The authors found a lack of evidence that injections of L-arginine protected the kidney from damage due to contrast agents.

D 

Wound healing 

In human research, arginine appeared to lack benefit in wound healing. Further research is required before conclusions can be made.

D 

Myocardial infarction (heart attack) 

Until potential safety issues are addressed, L-arginine should be avoided by myocardial infarction patients.

F 

 

*Key to grades: 

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Uses based on tradition or theory 

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified health care professional

Aging, AIDS/HIV (prevention of wasting), ammonia toxicity, amyotrophic lateral sclerosis (ALS), angioplasty, antibacterial, anti-inflammatory, antioxidant, anti-platelet agent, beta-hemoglobinopathies, cancer, chronic pain, cirrhosis, cold prevention, colorectal cancer (diagnosis), cystic fibrosis, dental pain (ibuprofen arginate), depression, endocrine disorders (metabolic syndrome), epilepsy, eye disorders, food uses (meat quality), functional gastrointestinal disorders, glaucoma, growth, heavy metal/lead toxicity, hemolytic uremic syndrome (HUS), hepatic encephalopathy, high blood pressure (newborn; PPHN), hyperhomocysteinemia, increased muscle mass, infection, inflammation, inflammatory bowel disease (IBD), iron overload, ischemic stroke, liver disease, liver protection, lower esophageal sphincter relaxation, malaria, metabolic abnormalities (metabolic syndrome), metabolic acidosis, migraine (ibuprofen arginate), mitochondrial disorders, neurological problems, neuropathy, obesity, osteoporosis / osteopenia, pain, parasites, peritonitis, post-menopausal bone loss, pre-term labor contractions, pruritus (itching), rabies, sepsis, sexual arousal, sexual function in women, stomach motility disorders, stomach ulcers, stress, stroke, supplementation to a low protein diet, thrombotic thrombocytopenic purpura (TTP), trauma (recovery), tuberculosis, tumors, ulcerative colitis, vaccine adjunct (stabilizer), vascular disorders, weight loss.


Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy. Consult a healthcare professional immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to arginine. Symptoms may include rash, itching, or shortness of breath. Anaphylaxis has occurred after arginine injections. In clinical research, one patient experienced a mild allergic skin reaction to intravenous L-arginine. Hives have also been reported.
  • For treatment of allergy to arginine, epinephrine and antihistamines have been suggested.

Side Effects and Warnings

  • Note: According to the U.S. Food and Drug Administration (FDA) website, pediatric overdosing of arginine hydrochloride injection (R-Gene 10®) has been reported, due to packaging and labeling confusion. Revisions have since been made to the product's packaging. The new label warns that R-Gene 10® infusions should be used cautiously in children to prevent overdose, which may result in hyperchloremic metabolic acidosis, cerebral edema, or possibly death.
  • There is no current suggested daily intake or tolerable upper intake for arginine. This amino acid is considered to be nonessential. The therapeutic dosage (maximum dose considered to be safe) is 400-6,000 milligrams.
  • In general, L-arginine is well tolerated when taken by mouth, delivered intravenously, or applied to the skin.
  • Arginine may cause bloating; diarrhea; endocrine changes; gastrointestinal discomfort; hives; increased blood urea nitrogen, serum creatine, and serum creatinine; increased inflammatory response; leg restlessness, lower back pain; nausea, numbness (with arginine injection); rash; reduction in hematocrit; severe tissue necrosis with extravasation; systemic acidosis; or venous irritation. In heart disease patients, arginine may cause high white blood cell count, increased post-heart attack deaths, lack of energy and strength, and vertigo or increased blood pressure (in heart transplant patients).
  • Arginine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Arginine may change blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Use cautiously in patients with impaired kidney function or those at risk for hyperkalemia (abnormally high levels of blood potassium), including those with diabetes or using drugs that elevate potassium levels, such as potassium-sparing diuretics and potassium supplements, as arginine may cause hyperkalemia. Fatal cardiac arrhythmia occurred in one patient.
  • Use caution with phosphodiesterase inhibitors (e.g., sildenafil [Viagra®]), due to a theoretical risk of additive blood vessel widening and blood pressure lowering.
  • Use with caution in postmenopausal patients, as night sweats and flushing have been reported.
  • Use with caution in patients with herpes virus, as L-arginine may worsen this condition. L-arginine may increase the risk of herpes simplex cold sores.
  • Use with caution in individuals at risk for headaches, as headache has been a reported side effect. In mountain climbers, L-arginine increased the risk of developing a headache.
  • Use with caution in patients with immunological disorders.
  • Use cautiously in patients with acrocyanosis, sickle cell anemia, and hyperchloremic acidosis, as arginine may cause worsening of symptoms.
  • Use cautiously in patients with guanidinoacetate methyltransferase (GAMT) deficiency. This enzyme is involved in the conversion of amino acids such as arginine to creatine.
  • Avoid in women with high-risk pregnancies, as, in women with multiple diseases, intravenous arginine resulted in premature delivery, pre-eclampsia, and death in two cases.
  • Avoid use in those with low blood pressure or those using blood pressure-lowering agents, due to the reported blood vessel-widening and blood pressure-lowering effects of L-arginine.
  • Avoid with nitrates, as concurrent use may result in additive blood pressure-lowering and blood vessel-widening effects.
  • Avoid use in patients given spironolactone, because arginine monohydrochloride has resulted in abnormally high potassium levels and fatal cardiac arrhythmia.
  • Avoid use in patients with asthma, as arginine may cause an allergic and response, aggravate airway inflammation, and amplify inflammatory airway response. In human research, L-arginine increased exhaled nitric oxide, suggesting increased inflammatory response in asthmatic and cystic fibrosis subjects.
  • Avoid use in patients at risk for or with a history of heart attack, as arginine may worsen outcomes and increase the risk of mortality.
  • Avoid use in breast cancer patients.
  • Avoid with known allergy or hypersensitivity to arginine. Symptoms may include rash, itching, or shortness of breath. Anaphylaxis has occurred after arginine injections. In clinical research, one patient experienced a mild allergic skin reaction to intravenous L-arginine. Hives have been reported.
  • Avoid in pregnant or breastfeeding women, due to a lack of sufficient available safety and efficacy data.

Pregnancy and Breastfeeding

  • Avoid in pregnant or breastfeeding women, due to a lack of sufficient available safety and efficacy data.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy.

Interactions with Drugs

  • Arginine may cause low blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.
  • Arginine may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Arginine may change blood sugar levels. Caution is advised when using medications that may affect blood sugar levels. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Arginine may also interact with ACE (angiotensin-converting enzyme) inhibitors, agents that increase potassium levels (including angiotensin II receptor antagonists and heparin), agents used to treat blood disorders, aminophylline, antacids, antibiotics, anticancer agents, anti-inflammatories, antimalarials, antiobesity agents, antiseizure agents, aspirin, cardiac glycosides, cholesterol- and lipid-lowering drugs, contraceptives, cyclophosphamide, cyclosporine, diuretics, estrogens, glucagon, growth hormones, H2 blockers, immunosuppressants, iron salts, isoproterenol, nicotine, nitrates, nitroderivatives, phenylephrine, phosphodiesterase inhibitors, potassium salts, propofol, proton pump inhibitors, sertraline, or spironolactone.

Interactions with Herbs and Dietary Supplements

  • Arginine may lower blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.
  • Arginine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Arginine may change blood sugar levels. Caution is advised when using herbs or supplements that may also change blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Arginine may also interact with agents that increase potassium levels, antacids, antibacterials, anticancer agents, anti-inflammatories, antimalarials, antiobesity agents, antioxidants, antiseizure agents, athletic performance enhancers, branched-chain amino acids, cardiac glycosides, cholesterol- and triglyceride-lowering herbs and supplements, citrulline, conjugated linoleic acid, cream, creatine, dietary cholesterol, diuretics, ginkgo, green tea extract, immunosuppressants, iron, L-citrulline, lysine, magnesium, N-acetyl cysteine, omega-3 fatty acids, ornithine, pine bark extract, piplartine, Pycnogenol®, salt, sodium, vitamin C, vitamin E, vulnerary agents, watermelon, yohimbine, or xylitol.

Authors

  • This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Abel T, Knechtle B, Perret C, et al. Influence of chronic supplementation of arginine aspartate in endurance athletes on performance and substrate metabolism - a randomized, double-blind, placebo-controlled study. Int J Sports Med 2005;26(5):344-9.
  2. Bednarz B, Jaxa-Chamiec T, Maciejewski P, et al. Efficacy and safety of oral l-arginine in acute myocardial infarction. Results of the multicenter, randomized, double-blind, placebo-controlled ARAMI pilot trial. Kardiol Pol 2005;62(5):421-7.
  3. Carrier M, Pellerin M, Perrault LP, et al. Cardioplegic arrest with L-arginine improves myocardial protection: results of a prospective randomized clinical trial. Ann Thorac Surg 2002;73(3):837-41; discussion 842.
  4. Cartledge JJ, Davies AM, Eardley I. A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. BJU Int 2000;85(4):421-426.
  5. Facchinetti F, Saade GR, Neri I, et al. L-arginine supplementation in patients with gestational hypertension: a pilot study. Hypertens Pregnancy 2007;26(1):121-30.
  6. Fontanive P, Saponati G, Iurato, A, et al. Effects of L-arginine on the Minnesota Living with Heart Failure Questionnaire quality-of-life score in patients with chronic systolic heart failure. Med Sci Monit 2009;12:CR606-11.
  7. Hackett A, Gillard J, Wilcken B. n of 1 trial for an ornithine transcarbamylase deficiency carrier. Mol Genet Metab 2008;94(2):157-61.
  8. Houwing RH, Rozendaal M, Wouters-Wesseling W, et al. A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Clin Nutr 2003;22(4):401-405.
  9. Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J 2010;9:42.
  10. Lucotti P, Monti L, Setola E, et al. Oral L-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass. Metabolism 2009;58(9):1270-6.
  11. Oka RK, Szuba A, Giacomini JC, et al. A pilot study of L-arginine supplementation on functional capacity in peripheral arterial disease. Vasc Med 2005;10(4):265-74.
  12. Schramm L, La M, Heidbreder E, et al. L-arginine deficiency and supplementation in experimental acute renal failure and in human kidney transplantation. Kidney Int 2002;61(4):1423-32.
  13. Schulman SP, Becker LC, Kass DA, et al. L-arginine therapy in acute myocardial infarction: the Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. JAMA 2006;295(1):58-64.
  14. Sydow K, Schwedhelm E, Arakawa N. ADMA and oxidative stress are responsible for endothelial dysfunction in hyperhomocyst(e)inemia: effects of L-arginine and B vitamins. Cardiovasc Res 2003;57(1):244-52.
  15. Tuchman M, Lee B, Lichter-Konecki U, et al. Cross-sectional multicenter study of patients with urea cycle disorders in the United States. Mol Genet Metab 2008;94(4):397-402.
  16. Yin WH, Chen JW, Tsai C, et al. L-arginine improves endothelial function and reduces LDL oxidation in patients with stable coronary artery disease. Clin Nutr 2005;24(6):988-97.

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