Archives For August 2014

Vitamin MakeOver

August 25, 2014 — Leave a comment

This is what I’m going to do for the people who call my blog talk radio show.

Forever Young & Healthy

ImageVitamin MakeOver:

 

DS is a 51 yr old male who took several pills because he heard they were good for him. He has no medical knowledge. This is what he put himself on: high dose vitamin C, vitamin b complex, calcium, multivitamin, arthritis herbal cocktail, magnesium, vitamin D, co-enzyme Q10, l-carnitine, d-ribose, fish oil. His doctor put him on Nexium, an acid blocker, for barrettes disease. 

 

This is how I changed or reinforced his regimen:

 

#1, keep taking the Nexium. You may read articles on natural ways and dietary changes to help a person get off their acid reducing medications, but that does not apply to DS. Those changes are only for people with bad diets who drink too much coffee and diet cokes. They are on a downward spiral of bad consequences as a result of their diet. DS, on the other hand, will develop esophageal…

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(This blog is dedicated to the faithful readers that tweet and favorite my posts. They encourage me to keep giving and keep trying to make the world a better place. It’s my dream that everyone feel good, have great energy, and for the fabulous women to look more fabulous. )

 

I know Dr Oz is always talking about miracle products from remote places all over the world. They are usually expensive, in such short supply and the products on the market really don’t work. But there is one right underneath our noses. It’s been around for a long time. It’s cheap, there is an abundant supply of it, and does not require a prescription. Everyone has access to it. And there is a lot of medical data showing that it really does work. It works so well that we use it in an IV form in the hospital.

 

This product first came to my attention when we had a short child who was not growing properly and so the doctor ordered an IV infusion of this product even thought it can be consumed orally. After the infusion the patient had several blood draws to test for the presence of growth hormone. If the child didnot have growth hormone in her blood stream that ment she was a dwarf. I learned that day that this product released growth hormone, and I knew that growth hormone was the fountain of youth. It preserves muscle mass and neuronal mass, increases neurogenisis and boosts the immune system.

 

I began gathering information on this drug and the next most significant thing I discovered was that it increased nitric oxide production which was a vasodilator of the micro vascular. I thought that was significant because as we age the blood flow to the periphery is diminished. If there was a substance that increased the blood flow to the fingers, toes, facial tissue, organ microvasculature that would be awesome. And it turns out that there are studies hinting that this is occurring.

 

So of course I could not help myself. I had to try this miraculous product for myself. I went to the body builder’s vitamin shop and bought a large powdered drink mix containing this product. I followed the instructions on the label and took it twice a day, morning and night. I felt stronger and was able to drink wine without any health consequences. But after about a month I developed extreme sleepiness around noon and head aches which I am prone to anyhow. It was so unbearable I had to take a 30 minute nap, after which time I returned to my normal state.

 

I did some research and found out that a daytime nap is a side effect of growth hormone injections. I stopped taking the morning dose of it and only took it at night. I should have known not to trust the dose stated on the label. Body builders are notorious for experimenting with their bodies. That’s why they grow breasts and other weird stuff happens to them. I felt fine at the one nightly dose.

 

Eventually, I stopped taking it all together because I have no physical ailments. I’m in the peak of my health. Maybe if I start feeling low on energy and having aches and pains and memory loss then I will reconsider taking it again.

 

But beware because I haven’t told you down side of this drug. All drugs are good and bad and this drug is no exception. You’ll be totally shocked to know the down side. That will have to be in a different blog because this subject could easily turn into another book and this blog is long enough.

 

Another time I saw this product used in the hospital was for a woman in her 30’s who came into the ER with a stroke. She had some weird disease associated with her mitochondria and her mind was being affected. A neurologist in the ER ordered an iv of this product every 6 hours at a dose that was based on her weight.

 

Then I also saw this product subscribed in an oral form for a frail mentally retarded adult to “beef him up.”

 

Okay, Okay, I’ll tell you the name of this product. Just don’t start taking it until you read part two of this blog called the downside to arginine, a miracle product. There, now you know. It’s arginine and below is what the medical literature says about it. But still, don’t take it till you read the next blog or you could develop painful sores on your genitals. I’ll explain in the blog.

 

Senile dementia:Cognitive function improved with arginine treatment Improvement was not maintained after discontinuation of treatment

a) Elderly patients with cerebrovascular disease showed improvement in cognitive function after 3 months of treatment with L-arginine 1.6 grams per day (p less than 0.0001). Also, lipid peroxide levels decreased significantly (p less than 0.001). However, by 3 months after the end of treatment, cognitive function scores had returned to pretreatment values. No side effects of L-arginine were observed [20].

Nutritional support

Summary:

Arginine supplementation appears to significantly increase T-cell function in immunologic responses

a) The mean total number of circulating T-cells increased 7 days postoperatively in a patient group receiving a 20 grams/day arginine-only intravenous infusion [42].

b) An arginine-supplemented enteral diet was shown to improve postoperative immunologic responses in patients with upper gastrointestinal malignancies [43]. Forty-two patients were randomized to either a diet supplemented with arginine, RNA, and omega-3 fatty acids or an isocaloric, isonitrogenous placebo diet; enteral nutrition was started on postoperative day 1 and advanced to the target goal by postoperative day 5. The number of T lymphocytes, helper T cells (CD4), activated T cells (CD3, HLA-DR), and B-lymphocytes were all significantly higher in the supplemented diet group.

c) A reduced incidence of infectious complications and shorter hospital stay were demonstrated in a multicenter trial involving early enteral feedings supplemented with arginine, nucleotides, and omega-3 fatty acids [44]. A total of 296 patients admitted to intensive care units for trauma, surgery, or sepsis, who were candidates for enteral nutrition, were randomized to either a standard enteral formula (Osmolite HN(R)) or supplemented formula (Impact(R)). Although both groups were shown to benefit from early enteral nutrition, there was a significant reduction in the frequency of acquired infections and length of hospital stay in patients who received the arginine-supplemented formula, particularly if they were septic upon initiation of enteral feedings.

Erectile dysfunction

Summary:

Arginine supplementation may enhance penile blood flow

In a controlled study of dietary L-arginine supplementation, men with initially low levels of nitric oxide metabolism products experienced improved sexual function while objective measures remained unchanged

Pycnogenol and L-arginine together improved sexual function in men with confirmed erectile dysfunction (ED) for at least 3 months compared to L-arginine only

a) High doses of oral L-arginine subjectively improved sexual function in men with organic erectile dysfunction (ED) with decreased nitrite/nitrate excretion. In this double-blind study, men aged between 55 and 75 years whose symptoms were diagnosed as ED first underwent a 2-week single-blind placebo run-in and then were randomized to receive L-arginine monohydrochloride 5 grams (n=32) or placebo in identical capsules (n=18), divided in 3 doses, daily over 6 weeks. Although by study end all objective variables remained unchanged in both groups, 31% (9/29) of L-arginine-treated men reported significant improvements in sexual function in diaries compared with 12% (2/17) of placebo-treated men. Three weeks of administration of L-arginine increased levels of nitrite/nitrate in plasma and urine (p less than 0.01, both values) Initial urinary nitric oxide (NO) levels in the 9 men who reported subjective improvements in their sexual activities were significantly lower than those of other patients at baseline (p less than 0.05) and levels of urinary and plasma NO in these responders increased significantly (p less than 0.01, both measures) compared to baseline by study end. Systolic and/or diastolic blood pressure decreased by approximately 10% in supplemented patients, causing no systemic effect and requiring no interruption of the study. Tolerance of the high L-arginine dose was good. Three men withdrew from the L-arginine group because of lack of improvement during the run-in phase and 1 in the placebo group withdrew because of palpitations [25].

b) Changes in erectile function and in satisfaction with sexual life were similar during treatments with arginine and with placebo. In a crossover study, 30 men with mixed-type impotence took placebo and L-arginine 500 milligrams 3 times per day, each for 17-day intervals with a 7-day washout period between. Scores on the Koln Questionnaire of Erectile Dysfunction were notably improved for 17% during arginine treatment and for 20% during placebo treatment. Mild improvements occurred in 57% with arginine and in 43% with placebo. L-arginine is the precursor of nitric oxide (NO), a mediator of penile erection, and may possibly be beneficial in a selected group of patients [26].

Essential hypertension

Summary:

Improves renal vascular resistance and renal plasma flow

a) L-arginine 500 milligrams per kilogram administered intravenously over 30 minutes increased renal plasma flow (RPF) in normotensive patients (n=30) to a greater extent than in patients who had essential hypertension with serum creatinine concentrations of less than 1.5 milligrams per deciliters (mg/dL) and glomerular filtration rate (GFR) of more than 50 milliliters per minute per 1.48 meter squared (n=32) (15.8% versus 10.1%, p less than 0.05). However, RPF decreased by 11.5% in patients with severe essential hypertension (n=7) with renal insufficiency (serum creatinine concentrations of 2.0 mg/dL or more and GFR less than 50 ml/min/1.48 m(2)). Use of L-arginine also resulted in a greater decrease in renal vascular resistance (RVR) in normotensive patients as compared to patients with essential hypertension (20.1% vs 14.3%, p less than 0.05); RVR remained unchanged in the hypertensive patients with renal insufficiency [21].

Exercise-induced angina

Summary:

Intravenously administered arginine improved coronary perfusion during exercise and improved performance

a) When L-arginine was administered intravenously before exercise to 12 patients with syndrome X (angina pectoris in the presence of normal coronary arteriograms), symptom-limited-exercise time was increased and myocardial perfusion was improved in a subset of patients. The absence of response in some patients suggests that factors other than endothelial dysfunction contribute to syndrome X [9].

Female infertility; Adjunct

 Summary:

Addition of arginine to an ovarian stimulation protocol increased the pregnancy rate over that from the ovarian stimulation protocol alone in poor responders

In normally responding women, arginine supplementation had detrimental effects on embryo quality and pregnancy rate

a) Addition of arginine to an ovarian hyperstimulation protocol for normally responding women had detrimental effects on embryo quality and pregnancy rate. In a prospective, double-blind trial, women with tubal infertility of 2 to 6 years’ duration were randomly assigned to 2 stimulation protocols: a gonadotrophin- releasing hormone agonist (triptorelin) and pure follicle stimulating hormone (FSH), with supplemental L-arginine 16 grams/day (n=18) or with placebo (n=19). The cancellation rate due to poor response was 11% in the arginine group and 15% in the placebo group. Duration of FSH treatment was significantly longer in the placebo group (12.3 days) than in the arginine group (10.6 days) (p=0.039). On the day of human chorionic gonadotropin (HCG) administration, the number of recruited follicles was higher in the arginine group (15 vs 10, p=0.021). The number and quality of oocytes retrieved did not differ for the 2 groups. However, embryo morphology was superior in the placebo group to that in the arginine group (p=0.034). The number of embryos transferred was similar for the 2 groups, but the pregnancy rates per cycle and per embryo transferred were significantly higher in the placebo than in the arginine group (p=0.024 and p=0.019, respectively). Follicular concentration of nitrates/nitrites (increased by arginine supplementation) was inversely correlated with embryo quality (r=-0.613, p=0.005). It was speculated that nitrous oxide (NO) derivatives act as vasodilators that cause too early an increase in permeability of the follicular epithelium to plasma proteins, and that this results in the follicles being susceptible to circulating FSH and growth hormone action [37].

b) Three of 17 patients receiving arginine in addition to an ovarian stimulation regimen for in-vitro fertilization achieved pregnancy (though all resulted in pregnancy loss), compared to none of 17 receiving the ovarian stimulation regimen alone. All patients were deemed poor responders on the basis of a previous failure to achieve an adequate number of mature follicles or adequate serum estradiol levels after gonadotrophin stimulation. All patients were given daily subcutaneous gonadotrophin-releasing hormone analogue (GnRHa) 0.1 milligram from day 1 of the menstrual cycle and intramuscular pure follicle stimulating hormone (pFSH) (450 international units in the first 3 days of the menstrual cycle and then an individually assessed dosage). Half of the women were also given oral arginine 16 grams daily. The cancellation rate (i.e. the percentage of cycles in which estradiol plasma concentrations were less than 1.1 picomoles/liter and/or fewer than 3 follicles were recruited by cycle day 8) was significantly lower in the group receiving arginine than in the group receiving no arginine (11% vs 76%, p less than 0.001). The number of oocytes collected and the number of embryos transferred were significantly higher in the arginine group (p less than 0.05). Uterine and perifollicular blood flow resistances were significantly lower in the arginine-treated women at all times points tested (p less than 0.047). Plasma nitrites/nitrates were higher in the arginine group and were inversely correlated with Doppler pulsatility index, suggesting that relaxation of vascular smooth muscle of endometrial vessels may be partially mediated by nitric oxide. It was concluded that oral arginine supplementation in poor responders may improve ovarian response, endometrial receptivity, and pregnancy rate (Battaglie et al, 1999).

Growth hormone deficiency

Summary:

Arginine pyroglutamate may be useful in treating children with growth retardation due to GH deficiency

a) Arginine pyroglutamate (Adjuvant; Manetti & Roberts Pharmaceutical Division, Italy) 3 g orally for three days brought about a statistically significant increase in serum growth hormone (GH)in 17 children (aged 4 to 13) with short stature. It was postulated that arginine pyroglutamate may be useful in treating children with growth retardation due to GH deficiency. No serious side effects were reported [27].

Growth hormone stimulation test

Summary:

Used intravenously as as diagnostic aid to test for growth hormone deficiency [2].

a) Arginine administered intravenously is used to test for growth hormone reserve in patients with suspected growth hormone deficiency [2]. The drug may also be used as an aid to detect growth hormone deficiency in panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, acromegaly, gigantism, and problems of growth and stature [2][3][4].

b) In patients with intact pituitary function, intravenous infusion of arginine will produce a pronounced rise in plasma levels of human growth hormone, usually in the range of 10 to 30 nanograms/milliliter [2][4]. In patients with impaired pituitary function, the rise of growth hormone level will be diminished or absent (0 to 10 nanograms/milliliter increase). In general, growth hormone concentrations of 4 nanograms/milliliter or less indicate pituitary growth hormone deficiency [2].

c) Confirmation of deficiency of pituitary reserve for human growth hormone with the arginine test should be confirmed by a second test with arginine or with the insulin hypoglycemia test, with a waiting period of 1 day between tests [3]. A deficiency of pituitary reserve for human growth hormone may be confirmed with the insulin hypoglycemia test with a recommended one day wait period between tests [2].

d) Some investigators recommend the use of insulin, arginine and levodopa together in determining growth hormone deficiency in short-height patients [5]..

e) Increases in growth hormone levels with arginine are generally greater in women than in men, and greater in pregnant than in non-pregnant women. Response to arginine can be blunted in obese patients and those with hypothyroidism [6][7].

f) Glucose levels increased, followed by a delayed fall, with early hyperglycemia in 13 sexual ateliotic dwarfs (deficient in human growth hormone) compared to control patients, in response to an arginine infusion . No increases in human growth hormone were observed, which did occur in previous normal subjects. Plasma insulin concentrations increased, but only by one-half that observed in control subjects; the rise in insulin was never higher than 50 microunits/mL in dwarfs. Plasma-free fatty acids decreased, with the decrease being as great or greater than normal subjects; however, these patients failed to restore levels to normal values by 120 or 150 minutes as was observed with normal subjects. The age of the patients ranged from 15 to 72 years. Arginine was given in doses of 0.25 to 0.35 grams/pound (g/lb) body weight (20 to 30 g total). The dose was given by intravenous infusion over 30 minutes. Prior to the test, the 5 male patients were given diethylstilbestrol 2.5 milligrams (mg) twice a day for 2 days. [4][8].

 

Intermittent claudication

Summary:

Infusions of arginine increased pain-free walking distance

a) Infusions of arginine increased pain-free walking distance and absolute walking distance in patients with intermittent claudication. Thirty-nine patients with peripheral arterial occlusive disease were randomly assigned to receive 2 infusions daily of L-arginine 8 grams (g) in 50 milliliters (mL), 2 infusions daily of prostaglandin E1 (PGE1) 40 micrograms in 50 mL, or no vasodilator treatment. Patients of all 3 groups were to maintain the same walking training 3 times per day. Active treatments were given for 3 weeks. Arginine treatment produced increases in pain-free walking distance and absolute walking distance that were significantly greater than increases with exercises alone. Increases with PGE1 were between those with arginine and placebo and not significantly different from either. Increases with arginine continued for up to 6 weeks after termination of treatment, while progress did not continue after discontinuation of PGE1. Flow-mediated femoral artery dilation increased progressively with arginine infusions (p less than 0.05 vs baseline in weeks 2 and 3), while that with PGE1 was not significantly enhanced. Pain was reduced more markedly in the arginine group (p less than 0.05). The greater improvements with arginine are thought to be due to increased production of nitric oxide, the principal mediator of flow-induced vasodilation in human peripheral conductance arteries [34].

 

1. 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.
PubMed Abstract: http://www.ncbi.nlm.nih.gov/…
PubMed Article: http://www.ncbi.nlm.nih.gov/…

2. Product Information: R-Gene(R) 10 IV injection, arginine HCl 10% IV injection. Pharmacia & Upjohn Company (per Manufacturer), New York, NY, 2007.

3. Raiti S, Davis WT, & Blizzard RM: A comparison of the effects of insulin hypoglycemia and arginine infusion on release of human growth hormone. Lancet 1967; 2:1182-1183.

4. Merimee TJ, Lillicrap DA, & Rabinowitz D: Effect of arginine on serum-levels of human growth hormone. Lancet 1965; 2:668-670.

5. Rodriguez-Doreste OL: Comparative study of different tests on the secretory stimulation of growth hormone in short height patients. Rev Clin Esp 1977; 147:511-514.

6. Jaquet P, Scornavachi JC, Vague P, et al: Variations in the level of human somatotrophic hormone in the plasma during arginine testing in obesity and emaciation. Ann Endocrinol 1970; 31:80-88.

7. Treychet P: Human growth hormone (HGH) response to arginine infusion test (AIT) in eight cases of primary hypothyroidism. Radioimmunoassay of plasma HGH, thyrotropin (TSH) and insulin. Ann Endocrinol 1970; 31:68-79.

8. Merimee TJ, Burgess A, & Rabinowitz D: Influence of growth hormone in insulin secretion. Studies of growth-hormone deficient subjects. Diabetes 1967; 16:478-482.

9. Fujita H, Yamabe H, & Yokoyama M: Effect of L-arginine administration on myocardial thallium-201 perfusion during exercise in patients with angina pectoris and normal coronary angiograms. J Nucl Cardiol 2000; 7(2):97-102.

10. Blum A, Porat R, Rosenschein U, et al: Clinical and inflammatory effects of dietary L-arginine in patients with intractable angina pectoris. Am J Cardiol 1999; 83(10):1488-1490.

11. Sher GD, Ginder GD, Little J, et al: Extended therapy with intravenous arginine butyrate in patients with B-hemoglobinopathies. N Engl J Med 1995; 332:1606-1610.

12. Heys SD, Ogston K, Miller I, et al: Potentiation of the response to chemotherapy in patients with breast cancer by dietary supplementation with L-arginine: results of a randomised controlled trial. Int J Oncol 1998; 12:221-225.

13. Angdin M, Settergren G, Liska J, et al: No effect of L-arginine supplementation on pulmonary endothelial dysfunction after cardiopulmonary bypass. Acta Anaesthesiol Scand 2001; 45:441-448.

14. Loukides S, Kharitonov S, Wodehouse T, et al: Effect of arginine on mucociliary function in primary ciliary dyskinesia. Lancet 1998; 352(9125):371-371.

15. Watanabe G, Tomiyama H, & Doba N: Effects of oral administration of L-arginine on renal function in patients with heart failure. J Hypertens 2000; 18(2):229-234.

16. Bocchi EA, Vilella de Moraes A, Esteves-Filho A, et al: L-arginine reduces heart rate and improves hemodynamics in severe congestive heart failure. Clin Cardiol 2000; 23:205-210.

17. Kattwinkel J, Agus SG, Taussig LM, et al: The use of L-arginine and sodium dicarbonate in the treatment of malabsorption due to cystic fibrosis. Pediatrics 1972; 50:133-137.

18. Solomons CC, Cotton EK, & Dubois R: The use of buffered L-arginine in the treatment of cystic fibrosis. Pediatrics 1971; 47:384-390.

19. Dietzsch HJ, Gottschalk B, Heyne K, et al: Cistic fibrosis: comparison of two mucolytic drugs for inhalation treatment (acetylcysteine and arginine hydrochloride). Pediatrics 1975; 55:96.

20. Ohtsuka Y & Nakaya J: Effect of oral administratin of L-arginine on senile dementia (letter). Am J Med 2000; 108:439.

21. Higashi Y, Oshima T, Ozono R, et al: Effect of L-arginine infusion on systemic and renal hemodynamics in hypertensive patients. Am J Hypertens 1999; 12:8-15.

22. Chowienczyk PF, Kneale BJ, Brett SE, et al: Lack of effect of vitamin E on L- arginine-responsive endothelial dysfunction in patients with mild hypercholesterolemia and coronary artery disease. Clin Sci 1998; 94:129-134.

23. Higashi Y, Oshima T, Watanabe M, et al: Renal response to L-arginine in salt- sensitive patients with essential hypertension. Hypertens 1996; 27(part 2):643-648.

24. Schulze-Neick I, Penny DJ, Rigby ML, et al: L-arginine and substance P reverse the pulmonary endothelial dysfunction caused by congenital heart surgery. Circulation 1999; 100:749-755.

25. Chen J, Wollman Y, Chernichovsky T, et al: Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo-controlled study. Br J Urol 1999; 83:269-273.

26. Klotz T, Mathers MJ, Braun M, et al: Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study. Urol Int 1999; 63:220-223.

27. Vita F, Spignoli G, & Isidori A: Effects of arginine pyroglutamate (Adjuvant) on growth hormone in children. Clin Trials J 1987; 24:387-390.

28. Kanaya Y, Nakamura M, Kobayashi N, et al: Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure. Heart 1999; 81:512-517.

29. Parsons HG, Scott RB, Pinto A, et al: Argininosuccinic aciduria: long-term treatment with arginine. J Inher Metab Dis 1987; 10:152-161.

30. Brusilow SW & Batshaw ML: Arginine therapy of argininosuccinase deficiency. Lancet 1979; 1:124-127.

31. Batshaw ML, Wachtel RC, Thomas GH, et al: Arginine-responsive asymptomatic hyperammonemia in the premature infant. J Pediatr 1984; 105:86-91.

32. Nagaya N, Uematsu M, Oya H, et al: Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension. Am J Respir Crit Care Med 2001; 163:887-891.

33. Surdacki A, Zmudka K, Bieron K, et al: Lack of beneficial effects of L-arginine primary pulmonary hypertension. Wien Klin Wochenschr 1994; 106:521-526.

34. Boger RH, Bode-Boger SM, Thiele W, et al: Restoring vascular nitric oxide formation by L-arginine improves the symptoms of intermittent claudication in patients with peripheral arterial occlusive disease. J Am Coll Cardiol 1998; 32(5):1336-1344.

35. Korting GE, Smith SD, Wheeler MA, et al: A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. J Urol 1999; 161:558-565.

36. 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; 85:421-426.

37. Battaglia C, Regnani G, Marsella T, et al: Adjuvant L-arginine treatment in controlled ovarian hyperstimulation: a double-blind, randomized study. Hum Reprod 2002; 17(3):659-665.

38. Staff AC, Berge L, Haugen G, et al: Dietary supplementation with L-arginine or placebo in women with pre-eclampsia. Acta Obstet Gynecol Scand 2004; 83:103-107.

39. Khan F, Litchfield SJ, McLaren M, et al: Oral L-arginine supplementation and cutaneous vascular responses in patients with primary Raynaud’s phenomenon. Arthritis Rheum 1997; 40(2):352-357.

40. Khan F & Belch JJF: Skin blood flow in patients with systemic sclerosis and Raynaud’s phenomenon: effects of oral L-arginine supplementation. J Rheumatol 1999; 26:2389-2394.

41. Baldini G, Alabiso V, & Paolinelli C: Clinical evaluation of the treatment of recurrent infections of the respiratory tract in paediatrics by the association arginine-lysine pyrrolidon carboxylate. Clin Trials J 1987; 24:391-403.

42. Sigal RK, Shou J, & Dayl JM: Parenteral arginine infusion in humans: nutrient substrate or pharmacologic agent?. J Parent Enter Nutr 1992; 16:423-428.

43. Kemen M, Senkal M, Homan H-H, et al: Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact(R). Crit Care Med 1995; 23:652-659.

44. Bower RH, Cerra FB, Bershadsky B, et al: Early enteral administration of a formula (Impact(R)) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized clinical trial. Crit Care Med 1995; 23:436-449.

45. Loney LC, Norling LL, & Robson AM: The use of arginine hydrochloride infusion to assess urinary acidification. J Pediatr 1982; 100:95-97.

46. Wallace AW, Ratcliffe MB, Galindez D, et al: L-arginine infusion dilates coronary vasculature in patients undergoing coronary bypass surgery. Anesthesiology 1999; 90:1577-1586.

47. Product Information: R-GENE(R) 10 IV injection, 10% arginine hcl IV injection. Pharmacia & Upjohn Company, Kalamazoo, MI, 2003.

48. Health Canada: Health Canada advises heart patients not to use products containing L-arginine. Health Canada. Ottawa, OntarioAvailable from URL: http://www.hc-sc…. .

49. Imler M, Ruscher H, Peter B, et al: The effect of arginine in a case of recurrent hepatic coma complicating a feminizing cortico-adrenal tumor with hepatic metastasis. Sem Hop Paris 1973; 49:3183-3190.

50. Bushinsky DA & Gennari FJ: Life-threatening hyperkalaemia with arginine. Ann Intern Med 1978; 89:632.

51. Hertz P & Richardson JA: Arginine-induced hyperkalemia in renal failure patients. Arch Intern Med 1972; 130:778-780.

52. Massara F, Cagliero E, Bisbocci D, et al: The risk of pronounced hyperkalaemia after arginine infusion in the diabetic subject. Diab Metab 1981; 7:149-153.

53. Tissot-Favre A & Brette R: Effets therapeutiques dumalate d’arginine dans les cirrhoses alcooliques. Therapie 1970; 25:629-638.

54. Kattwinkel J, Agus SG, Taussig LM, et al: The use of L-arginine and sodium dicarbonate in the treatment of malabsorption due to cystic fibrosis. Pediatrics 1972; 50:133-137.

55. Dietzsch HJ, Gottschalk B, Heyne K, et al: Cistic fibrosis: comparison of two mucolytic drugs for inhalation treatment (acetylcysteine and arginine hydrochloride). Pediatrics 1975; 55:96.

56. Paton W: L-arginine-induced hypotension. Lancet 1990; 336:1016-1017.

57. Elanjian SI: Necrosis caused by extravasation of arginine hydrochloride (letter). Ann Pharmacother 1992; 26:263.

58. Tiwary CM, Rosenbloom AL, & Julius RL: Anaphylactic reaction to arginine infusion. N Engl J Med 1973; 288:218.

59. Bushinsky DA & Gennari FJ: Life-threatening hyperkalaemia with arginine. Ann Intern Med 1978; 89:632.

60. Bode-Boger SM, Boger RH, Galland A, et al: L-arginine-induced vasodilation in healthy humans: pharmacokinetic-pharmacodynamic relationship. Br J Clin Pharmacol 1998; 46:489-497.

61. Tangphao O, Grossmann M, Chalon S, et al: Pharmacokinetics of intravenous and oral L-arginine in normal volunteers. Br J Clin Pharmacol 1999; 47(3):261-266.
PubMed Abstract: http://www.ncbi.nlm.nih.gov/…
PubMed Article: http://www.ncbi.nlm.nih.gov/…

62. Morris SM Jr: Enzymes of arginine metabolism. J Nutr 2004; 134(10 Suppl):2743S-2747S.
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