Arginine - a precautionary reminder

We mention using supplemental arginine periodically, and I recently used this segment of a 2010 post as info for someone wondering about arginine use with AF.

Just FYI… with emphasis on the precaution to consider supplementing with Gamma Tocopherol if you take arginine to help prevent atherosclerosis and inflammation.

Source is from a 2010 interview with Alan R. Gaby MD on Nutritional Factors in the Prevention and Treatment of Cardiovascular Disease.

Jackie



ARGININE
Arginine is a precursor to nitric oxide which is a vasodilator so if you want to Increase blood flow with a failing heart, or perhaps relieve angina by improving blood flow then arginine would be of theoretical value. It has been studied and been shown to improve quality of life in people with heart failure and to relieve angina. In some studies, it’s been shown to lower blood pressure but more negative than positive.

The main concern about arginine is in a study of MI survivors who were randomly assigned to take arginine (either 6 or 9 grams a day). They were followed for 6 months and there were 6 deaths in the arginine group and no deaths in the placebo group. So, this was statistically significant. Death was not an a priori endpoint which means they did a post hoc analysis and therefore it is possible that the increased death rate was due to chance. However that’s the only study that looked at death as an endpoint so it just stands out there and creates some concern.

As we know, arginine is good for erectile dysfunction. Two of the men were found dead on their floor. They didn’t mention if they had a smile on their face …but with that said and for that reason, I don’t put arginine in my top therapies. We’ve got other therapies that are successful for these conditions but I would consider arginine for circumstances where the other don’t work well enough. I’ve come up with a hypothesis why arginine might have caused this problem…if in fact it did…we don’t know for sure.

As we’ve been talking about, high doses of a nutrient might cause imbalances with other ones. With respect to nitric oxide, which is a metabolite of arginine, although it is a vasodilator, it is also an unstable molecule that leads to the formation of reactive oxidants such as peroxynitrate.

Peroxynitrate is not a well-known oxidant but it is one of the well known ‘nitrogen-derived oxidizing agent’ and it forms nitrogen-derived free radicals that promote inflammation and atherosclerosis. So it’s just like oxygen…oxygen is necessary for life and it is also toxic which is why we have all those antioxidants. So we also need a defense against nitrogen-derived free-radicals and it turns out from combing through the literature, what I found is that what seems to be the most important detoxifier of reactive nitrogen species is… Gamma tocopherol!

Back to what we were discussing before. So in the process of quenching nitric-oxide-derived oxidants, Gamma tocopherol is inactivated and, apparently, permanently. So to postulate… if you need arginine for some purpose, if you take mixed tocopherols along with it, if there is in fact an adverse effect on CV mortality, then mixed tocopherols might prevent that. This is an area where it would be very interesting to learn more.

Discussion with moderator about Viagra in a person with blockage..may not be such a good thing?…

Gaby: Well, people make their own collateral circulation which is too small to be seen on angiograms on catherization studies and vasodilation even in the face of what looks like 100% blockage might be clinically beneficial. That’s something in Chapt 75 in my book – there are 342 chapters…75 is on atherosclerosis and ischemic heart disease and it presents information suggesting that blockages in some circumstances may not be the primary cause of mortality in MI’s - because it’s like a sponge, there are all these tiny collateral circulations that are too small to see but they are there and in fact it may be metabolic dysfunction at the cellular level rather than a lack of blood flow that’s a major factor, and if it is cellular dysfunction, nutrients that promote mitochondrial function like magnesium, carnitine, CoQ10 may be more important than we realize.

Moderator: the body always seems to find a way to get collateral circulation..think about stripping leg veins, or left bundle branch block, right bundle branch block; the body seems to figure out a way to get communications or blood to flow another way.

Moderator: So…Arginine might deplete Gamma Tocopherol?…
Gaby: I said ‘hypothetical’ about 10 times here.
Moderator Yes… but the research is on such high doses of arginine…like 10 grams.
Gaby – but the average diet contains about 5 or 6 grams so it’s really not that huge.