Glutamine

Note: This review is focused only on aspects of glutamine that may be of greatest interest to individuals with cancer. Please seek additional information sources for a more comprehensive review of glutamine as it relates to other health conditions and diseases.

Overview & Background

Glutamine is an amino acid. Amino acids are the building blocks of protein, so glutamine is a type of protein. People may try a glutamine dietary supplement for a wide variety of reasons. Some popular reasons for using glutamine to address medical conditions include:

• To lessen the severity of cancer treatment side effects
• To promote healing and recovery during critical illness and after surgery
• To help prevent loss of lean body mass (muscle) in individuals with HIV/AIDS
• To manage attention deficit hyperactivity disorder (ADHD), depression, irritability, and other mental and emotional health issues
• To relieve digestive and gastrointestinal ailments and complaints, such as ulcerative colitis, ulcers, and Crohn’s disease

There are many other proposed uses for glutamine, but these are some of the more common reasons for which people use this dietary supplement.

Effectiveness

Cancer Treatment Side Effects

Glutamine has been the subject of numerous studies to determine if it may prevent or minimize cancer treatment side effects including mucositis (mouth sores), neuropathy (numbness, burning, and tingling in the hands and/or feet), arthralgia (bone pain), myalgia (muscle pain), and diarrhea. Unfortunately, several of these studies have been small and of poor quality, so it is unclear if glutamine truly is helpful for managing some of these side effects.

Mucositis

The evidence on using glutamine to manage cancer treatment side effects is strongest for mucositis. Several clinical trials show that taking glutamine may decrease the occurrence and severity of mucositis in people receiving chemotherapy that causes mouth sores and in people receiving radiation therapy to the head and neck areas. Key points on using glutamine to prevent and manage mucositis include:

• The effective dose appears to be 10 grams of glutamine powder, dissolved in water, taken three times per day.
• For best results, the glutamine and water solution should be swished around the mouth and gargled for 30 to 60 seconds before swallowing.
• For best results, glutamine should be used both as a preventive treatment before mucositis has developed, as well as after mucositis has developed, to promote healing of mouth sores.

Neuropathy, Arthralgia, and Myalgia

Several small studies support that taking glutamine may reduce the occurrence and severity of neuropathy, arthralgia, and myalgia among people who are taking chemotherapy medications that can cause these side effects. Most of these studies are not randomized, controlled trials, so they only suggest glutamine can help, but do not prove it will work to prevent and manage neuropathy, arthralgia, and myalgia. On a positive note, glutamine has a very good record of safety. As long as a person does not have contraindications to using glutamine (see contraindications below), it is generally well tolerated and safe. When using glutamine to try to prevent and diminish the severity of these side effects, keep the following key points in mind:

• The effective dose appears to be 10 grams of glutamine powder, dissolved in water, taken three times per day.
• For best results, glutamine should be used both as a preventive treatment before neuropathy, arthralgia, and myalgia have developed, as well as after these symptoms have developed, to minimize the severity of these side effects.

Diarrhea

Several small studies support that taking glutamine may reduce the occurrence and severity of diarrhea among people who are taking chemotherapy medications that causes diarrhea and in people receiving radiation to or around the lower gastrointestinal tract (intestines and/or colon) or pelvis area. Most of these studies are not randomized, controlled trials, so they only suggest glutamine can help prevent diarrhea, but do not prove this. On a positive note, glutamine has a very good record of safety. As long as a person does not have contraindications to using glutamine (see contraindications below), it is generally well tolerated and safe. When using glutamine to prevent or manage diarrhea, keep the following key points in mind:

• The effective dose appears to be 10 grams of glutamine powder, dissolved in water, taken three times per day.
• For best results, glutamine should be used both as a preventive treatment before diarrhea has developed, as well as after it has developed, to minimize the severity of this side effect.

Other Uses

Research supports the use of glutamine to promote healing and recovery during critical illness and after surgery, as well as to help maintain and prevent loss of lean body mass (muscle) in individuals with HIV/AIDS. While a few studies do not support that glutamine is effective for these conditions or situations, several studies have confirmed that this nutrient will address some of the complications of critical illness, surgery, and lean body mass loss associated with HIV/AIDS.

There is very little, if any research evidence to support that glutamine is helpful for managing attention deficit hyperactivity disorder (ADHD), depression, irritability, and other mental and emotional health issues. The evidence of benefit for glutamine to relieve digestive and gastrointestinal ailments and complaints, such as ulcerative colitis, ulcers, and Crohn’s disease is incomplete. Some uncontrolled, small studies suggest glutamine may benefit people with these conditions, but this research is of low quality and does not provide adequate information for an accurate assessment of effectiveness.

While it is possible that more research will prove that glutamine is helpful for these and other conditions and situations, we simply do not have enough information yet to know whether glutamine will provide benefit in these cases.

Contraindications & Cautions for Glutamine

Glutamine is considered safe for use by most people for the duration of cancer care (chemotherapy and/or radiation therapy) in doses up to 40 grams per day. However, like all dietary supplements, glutamine is not appropriate for everyone. There are some people who should NOT use glutamine because it may interact negatively with existing health conditions or medications being used.

Do not use glutamine if you:

• Have kidney failure, kidney dysfunction, or if your kidney function is impaired or abnormal.
• Have liver failure, liver dysfunction, or if your liver function is impaired or abnormal.
• Have ever been diagnosed with or had a period of hepatic encephalopathy (liver function that affects your mental, emotional, or cognitive state).
• Have a history of mental illness, especially bipolar depression (manic depression), mania, or hypomania.
• Have a history of seizure disorders, such as epilepsy or are taking medications to control a seizure disorder.
• Have a history of allergic reaction to monosodium glutamate (MSG), a flavoring agent sometimes used in the preparation of Chinese food in restaurants.
• Are taking or have been prescribed to take a medication called lactulose.

Some of these potential interactions are theoretical, which means they may occur, but are not proven to occur. For this reason, be sure to discuss your individual situation with your health care team before you use glutamine during cancer treatment. Glutamine is generally safe for most individuals with cancer, but only you and your doctor, working together, can decide if glutamine is safe for you.

One additional concern with glutamine is the quality of the product. Independent researchers have confirmed that some glutamine products do not contain the ingredients as claimed on the product label or may be contaminated with other ingredients. If you do use glutamine, go with a good quality, pharmaceutical grade product such as Glutasolve by Nestle Nutrition (formerly Novartis Nutrition), Sympt-X by Baxter Healthcare, or Dymatize Pro Line Glutamine.

For more information on how to chose a good quality dietary supplement, please see the American Cancer Society's information Dietary Supplements: How To Know What Is Safe.

Disclaimer

This list of contraindications is not guaranteed to be complete and is based upon currently available evidence, which is subject to change as new research emerges. There are other medications that may interact negatively with glutamine. This list addresses medications commonly used to treat individuals with cancer and does not address all possible medication interactions. Always discuss your use of dietary supplements with your doctor. Be sure to let your doctor know about any dietary supplements or other over-the-counter medications that you currently use or plan to use during your cancer care.

References

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Publish Date: April 2008