Congestive Heart Failure (CHF) and Arginine

Arginine is an amino acid found in many foods, including dairy products, meat, poultry, and fish. Research suggests that supplementing with arginine might be a helpful treatment for congestive heart failure (CHF).

The body uses arginine for many processes, including making nitric oxide (NO), a substance that relaxes blood vessels and also exerts numerous other effects in the body. Based on this, arginine has been proposed as a treatment for various cardiovascular diseases, including congestive heart failure.

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Three small, double-blind studies enrolling a total of about 70 individuals with CHF found that arginine significantly improved symptoms of CHF, as well as objective measurements of heart function.^29-31

A typical supplemental dosage of arginine is 2 g to 8 g per day. For congestive heart failure, higher dosages up to 15 g have been used in trials.

Normally, the body either gets enough arginine from food (dairy products, meat, poultry, fish, nuts, and chocolate), or manufactures all it needs from other widely available nutrients. Certain stresses, such as severe burns, infections, and injuries, can deplete your body's supply of arginine. For this reason, arginine (combined with other nutrients) is used in a hospital setting to help enhance recovery from severe injury or illness.

• Integrative MD
• Naturopathic doctor
• Clinical nutritionist or registered dietitian

Safety Issues

There is good evidence that arginine is safe and well tolerated at levels up to 20 g per day, ¹ although minor gastrointestinal upset can occur. However, there are some potential safety issues regarding high-dose arginine. These cautions are based on findings from animal studies and hospital experiences of intravenous administration.

For example, arginine may stimulate the body's production of gastrin, a hormone that increases stomach acid. ² For this reason, there are concerns that arginine could be harmful for people with ulcers or who take drugs that are hard on the stomach. In addition, a double-blind trial found that arginine (30 g/day) may increase the risk of esophageal reflux (heartburn) by relaxing the sphincter at the bottom of the esophagus. ³ Arginine might also alter potassium levels in the body, especially in people with severe liver disease. ⁴ This is a potential concern for individuals who take drugs that also alter potassium balance (such as potassium-sparing diuretics and ACE inhibitors ), as well as those with severe kidney disease. If you fall into any of these categories, do not use high-dose arginine except under physician supervision.

Evidence that arginine can improve insulin sensitivity ⁵ raises theoretical concerns that, if you have diabetes and take arginine, your blood sugar could fall too low. However, one study suggests that arginine is safe for use by people with stable type 2 (adult-onset) diabetes. ⁶ The amino acid lysine has been advocated for use in oral or genital herpes . According to the theory behind this recommendation, it is important to simultaneously restrict arginine intake. If true, this would tend to suggest that arginine supplements would be harmful for people with a tendency to develop herpes. However, there is no meaningful evidence to support this hypothesis.

Maximum safe doses in pregnant or nursing women, young children, and those with severe liver or kidney disease have not been established.

Interactions You Should Know About

If you are taking:

• Lysine to treat herpes: Arginine might counteract the potential benefit. ⁷

• Drugs that are hard on the stomach (such as nonsteroidal anti-inflammatory medications ): Taking high doses of arginine might stress your stomach additionally.

• Medications that can alter the balance of potassium in your body (such as potassium-sparing diuretics or ACE inhibitors ): High doses of arginine should be used only under physician supervision.

• Transdermal nitroglycerin : Arginine may help prevent the development of tolerance. ( Note: Your doctor's supervision is essential.)

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29. Hambrecht R, Hilbrich L, Erbs S, et al. Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation. J Am Coll Cardiol. 2000;35:706-713.
30. Rector TS, Bank AJ, Mullen KA, et al. Randomized, double-blind, placebo-controlled study of supplement oral L-arginine in patients with heart failure. Circulation. 1996;93:2135-2141.
31. Watanabe G, Tomiyama H, Doba N. Effects of oral administration of L-arginine on renal function in patients with heart failure. J Hypertens. 2000;18:229-234.