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Table of Contents > Supplements > Glutamine
Glutamine
Also Known As:  L-Glutamine
 
Overview
Uses
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

Overview

Glutamine is the most abundant amino acid (building block of protein) in the bloodstream. It is considered a "conditionally essential amino acid" because it can be manufactured in the body, but under extreme physical stress the demand for glutamine exceeds the body's ability to synthesize it. Most glutamine in the body is stored in muscles followed by the lungs, where much of the glutamine is manufactured. Glutamine is important for removing excess ammonia (a common waste product in the body). In the process of picking up ammonia, glutamine donates it when needed to make other amino acids, as well as sugar, and the antioxidant glutathione.

Several types of important immune cells rely on glutamine for energy -- without it, the immune system would be impaired. Glutamine also appears to be necessary for normal brain function and digestion.

Adequate amounts of glutamine are generally obtained through diet alone because the body is also able to make glutamine on its own. Certain medical conditions, including injuries, surgery, infections, and prolonged stress, can deplete glutamine levels, however. In these cases, glutamine supplementation may be helpful.


Uses

Wound Healing
When the body is stressed (such as from injuries, infections, burns, trauma, or surgical procedures), steroid hormones such as cortisol are released into the bloodstream. Elevated cortisol levels can deplete glutamine stores in the body. Since glutamine plays a key role in the immune system, a deficiency in this nutrient can significantly slow the healing process. Studies have shown that glutamine supplements enhance the immune system and reduce infections (particularly infections associated with surgery). Glutamine supplements may also aid in the recovery of severe burns.

Inflammatory Bowel Disease (IBD)
Glutamine helps to protect the lining of the gastrointestinal tract known as the mucosa. Because of this, some experts speculate that glutamine deficiency may play a role in the development of IBD, namely ulcerative colitis and Crohn's disease. These conditions are characterized by damage to the mucosal lining of the small and/or large intestines, which leads to inflammation, infection, and ulcerations (holes). In fact, some preliminary research suggests that glutamine may be a valuable supplement during treatment of IBD because it promotes healing of the cells in the intestines and improves diarrhea associated with IBD. Not all studies have found this positive benefit, however. For this reason, more research is needed before conclusions can be drawn. In the meantime, follow the advice of your healthcare provider when deciding whether to use glutamine for IBD.

HIV/AIDS
Individuals with advanced stages of human immunodeficiency virus (HIV) often experience severe weight loss (particularly loss of muscle mass). A few studies of individuals with HIV have demonstrated that glutamine supplementation, along with other important nutrients including vitamins C and E, beta-carotene, selenium, and N-acetylcysteine, may reduce the severe weight loss associated with this condition.

Obesity
Results from animal studies suggest that glutamine may help suppress appetite. Large-scale research trials of humans would be needed to determine if glutamine supplements are useful in treating obesity in people.

Peritonitis
Glutamine supplementation has long been known to maintain the health of the mucosa (inner wall) of the gastrointestinal tract and inhibit muscle wasting in critically ill patients. Keeping the intestinal mucosa healthy helps prevent infections such as peritonitis (inflammation of the peritoneum, the thin membrane that lines the abdominal wall and covers most of the organs of the body).

Animal studies indicate that a diet supplemented with glutamine may protect the lining of the intestine, inhibit the growth of bacteria, and improve survival rates in animals with peritonitis.

Additional studies of people at high risk for peritonitis infection suggest that diets high in glutamine, arginine, and omega-3 fatty acids may lower the risk of infection by more than 50% and significantly shorten the length of hospital stay. These results are somewhat controversial, however, as the way that these supplements appear to work involves an inflammatory response in the peritoneum -- a reaction known to cause peritonitis.

The bottom line is that in a hospital setting, a physician will determine if glutamine supplementation (generally given intravenously) is necessary in someone who is critically ill, particularly following surgery or trauma. This would be used, in part, to prevent or treat peritonitis.

Athletes
Athletes who train excessively may deplete their glutamine stores. This is because they are overusing their skeletal muscles, where much of the glutamine in the body is stored. Athletes who overstress their muscles (without adequate time for recovery between workouts) may be at increased risk for infection and often recover slowly from injuries. This is also true for people who participate in prolonged exercise, such as ultra-marathon runners. For this select group of athletes, glutamine supplementation may be useful. This is not true, however, for most exercisers who tend to work out at a much more moderate intensity.

Cancer
Many people with cancer have abnormally low levels of glutamine. For this reason, some experts speculate that glutamine may prove to be a good addition to conventional treatment of cancer under certain conditions. In fact, nutritional support with supplemental glutamine is often used in malnourished cancer patients undergoing chemotherapy or radiation treatments and sometimes used in patients undergoing bone marrow transplants.

Glutamine is used to protect the lining of the small and large intestines from damage caused by chemotherapy or radiation. Glutamine may also protect against the development of mucositis (breakdown of the mucosal membranes of the mouth and nasal passages) caused by therapy for head and neck cancer.

There is some question, however, about whether protection of the intestinal mucosa is a desired result for colon cancer. Plus, some studies suggest that this nutrient may actually stimulate the growth of tumors. Therefore, more research is needed to know whether use of glutamine is safe or effective to use as part of the treatment regimen for cancer.

Other
Glutamine can aid in healing stomach ulcers and prevent inflammation of the stomach that is caused by chronic use of nonsteroidal anti-inflammatory medications (NSAIDS).


Dietary Sources

Dietary sources of glutamine include plant and animal proteins such as beef, pork and poultry, milk, yogurt, ricotta cheese, cottage cheese, raw spinach, raw parsley, and cabbage.


Available Forms

Glutamine, usually in the form of L-glutamine, is available as an individual supplement or as part of a protein supplement. These come in powder, capsule, tablet, or liquid form.

Standard preparations are typically available in 500 mg tablets or capsules.


How to Take It

Glutamine should be taken with cold or room temperature foods or liquids. It should not be added to hot beverages because heat destroys glutamine.

Pediatric

If laboratory tests reveal that a child has an amino acid imbalance that requires treatment, a healthcare provider may recommend a complete amino acid supplement that contains glutamine.

Adult

Doses ranging from 500 to 1,500 mg per day are generally considered safe. Amounts as high as 5,000 to 15,000 mg per day (in divided doses) may be prescribed by a healthcare professional.


Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Glutamine powder should not be added to hot beverages because heat destroys this amino acid. Glutamine supplements should also be kept in a dry location. Moisture leads to breakdown of this substance.

People with kidney disease, liver disease, or Reye's syndrome (a rare, sometimes fatal disease of childhood that is generally associated with use of aspirin in conjunction with chicken pox or an upper respiratory illness) should not take glutamine.

Many elderly people have diminished kidney function and may need to reduce the dose of glutamine.

Glutamine is different from glutamate (glutamic acid), monosodium glutamate, and gluten. Glutamine will not cause symptoms (headaches, facial pressure, tingling, or burning sensation) associated with sensitivity to monosodium glutamate. People who are gluten sensitive can use glutamine without problems.


Possible Interactions

If you are currently being treated with any of the following medications, you should not use glutamine supplements without first talking to your healthcare provider.

Cancer Therapy
Glutamine may increase the effectiveness and reduce the side effects of chemotherapy treatments with doxorubicin, methotrexate, and 5-fluorouracil in people with colon cancer. Similarly, preliminary studies suggest that glutamine supplements may prevent nerve damage associated with a medication called paclitaxel, used for breast and other types of cancers.

However, test tube studies suggest that glutamine may actually stimulate growth of tumors. Much more research is needed before it is known whether it is safe to use glutamine if you have cancer.


Supporting Research

Abcouwer SF, Souba WW. Glutamine and arginine. In: Shils, ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins; 1999:559-569.

Abcouwer SF. The effects of glutamine on immune cells [editorial]. Nutrition. 2000;16(1):67-69.

Akobeng AK, Miller V, Stanton J, Elbadri AM, Thomas AG. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr. 2000;30(1):78-84.

Alexander JW, Ogle CK, Nelson JL. Diets and infection: composition and consequences. World J Surg. 1998;22(2):209-212.

Amores-Sanchez MI, Medina MA. Glutamine, as a precursor of glutathione, and oxidative stress. Mol Genet Metab. 1999;67(2):100-105.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Bellows CF, Jaffe BM. Glutamine is essential for nitric oxide synthesis by murine macrophages. J Surg Res. 1999;86(2):213-219.

Berger M, Spertini F, Shenkin A, et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. Am J Clin Nutr. 1998;68:365-371.

Bozzetti F, Biganzoli L, Gavazzi C, et al. Glutamine supplementation in cancer patients receiving chemotherapy: a double-blind randomized study. Nutrition. 1997;13:748-751.

Buchman AL. Glutamine: commercially essential or conditionally essential? A critical appraisal of the human data. Am J Clin Nutr. 2001;74(1):25-32.

Cao Y, Kennedy R, Klimberg VS. Glutamine protects against doxorubicin-induced cardiotoxicity. J Surg Res. 1999;85:178-182.

Castell LM, Newsholme EA. The effects of oral glutamine supplementation on athletes after prolonged, exhaustive exercise. Nutrition. 1997;13:738-742.

Charland SL, Bartlett DL, Torosian MH. A significant methotrexate-glutamine pharmacokinetic interaction. Nutr. 1995;11:154-158.

Clark RH, Feleke G, Din M, et al. Nutritional treatment for acquired immunodeficiency virus-associated wasting using beta-hydroxy-beta-methylbutyrate, glutamine, and arginine: a randomized, double-blind placebo-controlled study. JPEN: J Parenter Enteral Nutr. 2000;24(3):133-139.

Daniele B, Perrone F, Gallo C, et al. Oral glutamine in the prevention of fluorourcil induced intestinal toxicity: a double blind, placebo controlled, randomized trial. Gut. 2001;48:28-33.

Decker GM. Glutamine: indicated in cancer care? Clin J Oncol Nurs. 2002;6(2):112-115.

Decker-Baumann C, Buhl K. Reduction of chemotherapy-induced side-effects by parenteral glutamine supplementation in patients with metastatic colorectal cancer. Eur J Cancer. 1999;35:202-207.

Den Hond E. Hiele M, Peeters M, Ghoos Y, Rutgeerts P. Effect of long-term oral glutamine supplements on small intestinal permeability in patients with Crohn's disease. JPEN: J Parenter Enteral Nutr. 1999;23:7-11.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Dieleman LA, Heizer WD. Nutritional issues in inflammatory bowel disease. Gastroenterol Clin North Am.1998;27(2):435-451.

Duffy MM, Regan MC, Ravichandran P, et al. Mucosal metabolism in ulcerative colitis and Crohn's disease. Dis Colon Rectum. 1998;41(11):1399-1405.

Erickson R, Ross D, Medina J. Effects of glutamine on head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 1999;121(4):348-354.

Field CJ, Johnson IR, Schley PD. Nutrients and their role in host resistance to infection. J Leukoc Biol. 2002 Jan;71(1):16-32.

Fujita T, Sakurai K. Efficacy of glutamine-enriched enteral nutrition in an experimental model of mucosal ulcerative colitis. Br J Surg. 1995;82(6):749-751.

Furukawa S, Saito H, Fukatsu K, et al. Glutamine-enhanced bacterial killing by neutrophils from postoperative patients. Nutrition. 1997;13(10):863-869.

Furukawa S, Saito H, Inaba T, et al. Glutamine-enriched enteral diet enhances bacterial clearance in protracted bacterial peritonitis, regardless of glutamine form. JPEN: J Parenter Enteral Nutr. 1997;21(4):208-214.

Furukawa S. Saito H, Inoue T, et al. Supplemental glutamine augments phagocytosis and reactive oxygen intermediate production by neutrophils and monocytes from postoperative patients in vitro. Nutrition. 2000;1695):323-329.

Garlick PJ. Assessment of the safety of glutamine and other amino acids. [Review].
J Nutr. 2001 Sep;131(9 Suppl):2556S-61S.

Gianotti L, Alexander JW, Pyles T, Fukushima R. Arginine-supplemented diets improve survival in gut-derived sepsis and peritonitis by modulating bacterial clearance. Ann Surg. 1993;217(6):644-654.

Grimm H, Kraus A. Immunonutrition--supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients. Langenbecks Arch Surg. 2001 Aug;386(5):369-376.

Jebb SA, Osborne RJ, Maughan TS. 5-fluorouracil and folinic acid-induced mucositis: no effect of oral glutamine supplementation. Br J Cancer. 1994;70: 732-735.

Levy J. Immunonutrition: the pediatric experience. Nutrition. 1998;14(7-8):641-647.

Medina MA. Glutamine and cancer. J Nutr. 2001;131(9 Suppl):2539S-2542S; discussion 2550S-2551S.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

Miller AL. Therapeutic considerations of L-glutamine: a review of the literature. Altern Med Rev. 1999;4(4):239-248.

Naka S, Saito H, Hashiguchi Y, et al. Alanyl-glutamine-supplemented total parenteral nutrition improves survival and protein metabolism in rat protracted bacterial peritonitis model. J Parenter Enteral Nutr. 1996;20(6):417-423.

Napoli M. Chemo effect alleviated. Health Facts. October 1998;23:6.

Neu J, DeMarco V, Li N. Glutamine: clinical applications and mechanism of action. Curr Opin Clin Nutr Metab Care. 2002;5(1):69-75

Noyer CM, Simon D, Borczuk A, Brandt LJ, Lee MJ, Nehra V. A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestintal permeability in patients with AIDS. Am J Gastroenterol. 1998;93:972-975.

Okuno SH, Woodhouse CO, Loprinzi CL. Phase III controlled evaluation of glutamine for decreasing stomatitis in patients receiving fluorouracil (5-FU)-based chemotherapy. Am J Clin Oncol. 1999;22:258-261.

Opara EC, Petro A, Tevrizian A, et al. L-glutamine Supplementation of a high fat diet reduces body weight and attenuates hyperglycemia and hyperinsulinemia in C57BL/6J mice. J Nutr. 1996;126:273-279.

Pizzorno JE, Murray MT. Textbook of Natural Medicine. Vol 1. 2nd ed. Edinburgh: Churchill Livingstone; 1999:527-528.

Reeds PJ, Burrin DG. Glutamine and the bowel. J Nutr. 2001;131(9 Suppl):2505S-8S.

Rouse K, Nwokedi E, Woodliff JE, et al. Glutamine enhances selectivity of chemotherapy through changes in glutathione metabolism. Ann Surg. 1995;221: 420-426.

Rowbottom DG, Keast D, Morton AR. The emerging role of glutamine as an indicator of exercise stress and overtraining. [Review]. Sports Med. 1996;21(2):80-97.

Rubio IT, Cao Y, Hutchins LF, et al. Effect of glutamine on methotrexate efficacy and toxicity. Ann Surg. 1998;227:772-780.

Shabert JK, Winslow C, Lacey JM, Wilmore DW. Glutamine antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Nutrition. 1999;11:860-864.

Shabert JK, Wilmore DW. Glutamine deficiency as a cause of human immunodeficiency virus wasting. Med Hypotheses. March 1996; 46:252-256.

Skubitz KM, Anderson PM. Oral glutamine to prevent chemotherapy induced stomatitis: a pilot study. J Lab Clin Med. 1996;127:223-228.

Tavares DC, Cecchi AO, Antunes LM, et al. Protective effects of the amino acid glutamine and of ascorbic acid against chromosomal damage induced by doxorubicin in mammalian cells. Teratog Carcinog Mutagen. 1998;18:153-161.

Turowski GA, Rashid Z, Hong F, Madri J, Basson MD. Glutamine modulates phenotype and stimulates proliferation in human colon cancer cell lines. Cancer Res. 1994;54:5974-5980.

Vahdat L, Papadopoulos K, Lange D, et al. Reduction of paclitaxel-induced peripheral neuropathy with glutamine. Clin Cancer Res. 2001;7(5):1192-1197.

Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. [Review]. J Nutr. 2001;131(9 Suppl):2543S-9S; discussion 2550S-1S.

Yoshida S, Matsui M, Shirouzu Y, Fujita H, Yamana H, Shirouzu K. Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer. Ann Surg. 1998;227:485-491.

Ziegler TR. Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy. [Review]. J Nutr. 2001;131(9 Suppl):2578S-84S; discussion 2590S.


Review Date: April 2002
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; Margie Ullmann-Weil, MS, RD, specializing in combination of complementary and traditional nutritional therapy, Boston, MA. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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