Summary of Ornithine
Primary Information, Benefits, Effects, and Important Facts
L-Ornithine is a nonprotein amino acid (not used to create proteins) that is an intermediate of the urea cycle, and provision of ornithine to a cell is actually the rate limiting step of the cycle. Ornithine binds with a molecule known as carbamoyl phosphate which requires ammonia to be produced and then is converted into L-Citrulline giving off urea as a byproduct. Due to this, the conversion is one that reduces ammonia concentrations in the blood and concomitantly increases urea.
L-Ornithine is thought to be important for conditions that are characterized by an excess level of ammonia, and this is mainly focused on either hepatic encephalopathy (clinical liver condition) or prolonged cardiovascular exercise. A reduction in serum ammonia has been repeatedly found in persons with hepatic encephalopathy (most studies use infusions, although it appears to apply to high dose oral supplements as well) while there are only two studies assessing exercise; the one that was better suited to assess the influence of ammonia (using prolonged exercise rather than acute exercise) did find an anti-fatigue effect.
Furthermore, reductions in self-reported fatigue have been noted in persons with hepatic encephalopathy and in persons subject to a hangover (the process of getting drunk off of alcohol will increase serum ammonia) when ornithine is taken before drinking, but only in persons sensitive to alcohol perhaps.
There is currently one study using ornithine paired with arginine that noted improvements in lean mass and power output in weightlifters, but this is an old study that has not been replicated and its practical relevance is uncertain.
Finally, the increases in growth hormone seen with ornithine are similar to those seen with arginine. Technically they exist, but as they are very short lived and the body seems to compensate the overall increaes in whole-day growth hormone are not significant. Since the main properties of growth hormone being concerned with (increased lean mass gain and fat loss) are more related to day-long exposure rather than short-bursts, it is unlikely that ornithine has a role here.
In the end, ornithine looks somewhat promising for reducing ammonia concentrations in the blood and thus enhancing performance of prolonged exercise (45 minutes or more) which is in part due to it being elevated in the blood for a few hours after ingestion despite exercise.
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Things To Know & Note
Arginine is known to cause diarrhea at doses of 10g or higher, and since Ornithine shares the same intestinal transporters (diarrhea occurs when the transporter gets saturated) it is possible that supplemental ornithine can reduce the amount of arginine requires to induce diarrhea
Ornithine itself in high doses can induce diarrhea (10-20g), but is likely a lesser concern than is arginine
How to Take Ornithine
Recommended dosage, active amounts, other details
Ornithine supplementation (as hydrochloride) is taken in the range of 2-6g daily. Most studies use a dose in this range, but despite serum levels being somewhat dose dependent there is a chance of intestinal distress at doses above 10g.
Most studies use Ornithine hydrochloride (Ornithine HCl) which appears to be effective. Ornithine HCl is 78% Ornithine by weight, and so for the 2-6g range an equivalent dose for L-Ornithine L-Aspartate (50% Ornithine) would be 3.12-9.36g and an equivalent dose for L-Ornithine α-ketoglutarate (47% Ornithine) would be 3.3-10g. These two forms are theoretically more effective, but lack sufficient comparative testing.
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Human Effect Matrix
The Human Effect Matrix looks at human studies (it excludes animal and in vitro studies) to tell you what effects ornithine has on your body, and how strong these effects are.
|Grade||Level of Evidence [show legend]|
|Robust research conducted with repeated double-blind clinical trials|
|Multiple studies where at least two are double-blind and placebo controlled|
|Single double-blind study or multiple cohort studies|
|Uncontrolled or observational studies only|
Level of Evidence
? The amount of high quality evidence. The more evidence, the more we can trust the results.
Magnitude of effect
? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.
Consistency of research results
? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.
|-||High See all 3 studies|
|- See 2 studies|
|- See study|
|Minor||Very High See 2 studies|
|Minor||- See study|
|Minor||Moderate See 2 studies|
|-||- See study|
|-||- See study|
|-||- See study|
|-||- See study|
Everything you need to know about the keto diet
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Scientific Research on Ornithine
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L-Ornithine is one of three amino acids found in the urea cycle and similar to its partner L-Citrulline, but not L-Arginine, L-Ornithine is a nonprotein amino acid (not used in creating enzymes and protein structures) nor is it coded by DNA or a dietary essential amino acid.
Dietary L-Arginine, which is a conditionally essential amino acid, provides the substrate for circulating levels of L-Ornithine and L-Citrulline (among other pathways, glutamate and glutamine can also contribute) to maintain a basal circulating concentration of approximately 50nmol/mL L-Ornithine.
L-Ornithine is a nonprotein amino acid that is produced from other amino acids, most notably the two other amino acids in the urea cycle alongside it known as L-Arginine and L-Citrulline
Ornithine is not related to the nitric oxide cycle, but is the intermediate after urea production that combines with ammonia (via carbamoyl phosphate) to create citrulline
The urea cycle is a cycle involving five enzymes and three amino acids (Arginine, Ornithine, and Citrulline) and one other intermediate which is used to regulate urea and ammonia concentrations in the body; this cycle is sometimes seen as a nitrogen detoxifying pathway (as it prevents elevated toxic concentrations of ammonia, a small nitrogen containing compound), and Ornithine provision appears to be the rate-limiting step.
L-Arginine is converted into L-Ornithine via the arginase enzyme (giving off urea as a cofactor) and from there ornithine (using carbamoyl phosphate as a cofactor) is subject to the Ornithine carbamoyltransferase enzyme to produce L-Citrulline. In this sense, the metabolic pathway from arginine towards citrulline (via ornithine) causes an increase in urea and a concomitant decrease in ammonia, which was used by the Carbamoyl phosphate synthase enzyme to create carbamoyl phosphate and a deficiency of this enzyme results in high blood ammonia concentrations which appears to be the most common genetic fault of the urea cycle. If need be, arginine can directly be converted into L-citrulline via a Arginine deiminase enzyme to increase, rather than reduce, ammonia concentrations.
The cycle is formed as citrulline then binds with L-aspartate (related to D-Aspartic acid as its isomer) to form arginosuccinate via the arginosuccinate synthase enzyme, and then the arginosuccinate lysase enzyme degrades arginosuccinate into free arginine and fumarate; arginine then reenters the urea cycle anew. Fumarate can simply enter the TCA (Krebs) cycle as an energy intermediate.
The urea cycle involves Ornithine, Citrulline, and Arginine in an interchangeable cycle to regulate ammonia concentrations
Ornithine, out of the three amino acids of the urea cycle (alongside L-Arginine and L-Citrulline) is the primary parent molecule for production of the polyamines putrescine, spermidine, and spermine.
Ornithine is a precursor for production of polyamine compounds
L-Ornithine can also be converted into a metabolite known as l-glutamyl-c-semialdehyde which can be further converted into the neurotransmitter glutamate via P5C dehydrogenase. This pathway uses pyrroline-5-carboxylate as an intermediate, and is somewhat (indirectly) reversible.
The urea cycle amino acids are connected to neurology, in part, due to ornithine being converted into glutamate (which can then be converted into GABA, and the glutamate:GABA axis is highly important in neurology)
Ornithine is taken up by the same transporters as Arginine. Although the research into an oral dose-response is not as extensive with ornithine as it is with arginine, it is plausible that they share similar motifs (fairly good bioavailability at low oral doses of around 2-6g and then progressively getting lower at higher doses and thus being less efficiently absorbed)
Oral ingestion of 40-170mg/kg Ornithine (as hydrochloride; for a 70kg person this is 3-12g) is able to dose-dependently increase serum ornithine concentrations within 45 minutes, which holds stable until 90 minutes. The exact increases in serum ornithine were not quantified.
Elsewhere, 100mg/kg has been noted to increase serum ornithine from approximately 50nmol/mL to around 300nmol/mL within one hour which persisted elevated to a similar degree after some exhaustive exercise (15 minutes or so) and a 15 minute break and another study using a structure where 3g ornithine was given in the morning and another dose 2 hours later noted that, even 380 minute later, plasma ornithine was elevated beyond placebo (65.8% higher) although it appeared to be on the decline (measurement after 240 minutes was 314% higher).
Ornithine is fairly well absorbed and peaks about 45 minutes after oral dosing (or perhaps a tad earlier) and then seems to maintain afterwards for up to around 4 hours (somewhere between 4 hours and 6 hours it starts to decline)
Ornithine supplementation (2,000mg) has been noted to not increase serum citrulline nor arginine concentrations by itself or as hydrochloride and only has been noted to increase plasma arginine once as ornithine α-ketoglutarate (as a specific nutrient interaction).
Supplementation of Ornithine (100mg/kg as hydrochloride) before exhaustive exercise has been noted to increase plasma glutamate concentrations at both rest and after exhaustive exercise (to a small degree, around 50nmol/mL or 9%).
One study has noted a transient increase in the three branched chain amino acids after 4 hours of exhaustive exercise that was preloaded with 6g ornithine (two doses of 3g separated by 2 hours) in the range of 4.4-9%.
A slight increase in glutamate may occur after exhaustive exercise, and Ornithine at low doses does not appear to significantly influence concentrations of Arginine nor citrulline
The accumulation of ammonia in skeletal muscle is able to induce muscular fatigue secondary to inhibiting muscle protein contractility, and normally accumulates in serum and the brain during exercise, where accumulation into the brain promotes the sensation of fatigue.
Ammonia has been found to, at 100mg/kg L-Ornithine, be increased after exhaustive exercise (15 minutes or so) while not significantly affected at rest prior to exercise although in more prolonged exercise (2 hours at 80% VO2 max) the increase in serum ammonia seen with exercise is attenuated.
Theoretically should reduce ammonia, but has oddly been noted to both increase and decrease ammonia concentrations. Requires more studies to investigate this topic
Skeletal muscle itself can directly buffer ammonia somewhat (both alanine and glutamine can directly buffer ammonia) while ammonia can be converted to urea in the liver; however, supplementation of 100mg/kg ornithine does not appear to influence urea concentrations after exhausitve exercise lasting around 15 minutes but urea has been noted to be increased relative to placebo in a trial using 2 hours of cycling (2g ornithine daily and 6g day of testing), which appeared to be due to preventing the exercise-induced reduction (was 8.9% in placebo, no change in ornithine).
Although enhancement of the urea cycle follows ornithine supplementation, serum urea concentrations do not appear significantly altered following supplementation of ornithine
One study using 1g or 2g of L-ornithine alongside an equal amount of L-arginine (to total 2g or 4g) has been noted to, over the course of 5 weeks in adult men subject to a strength training program, increase both lean mass and power accrual.
A lone study to support increases in muscle mass, but the conclusions that can be drawn from this are highly limited; plus, it is confounded with the inclusion of arginine
A cycle ergometer test following 100mg/kg L-ornithine as hydrochloride failed to significantly affect exercise performance (time to exhaustion, heart rate, oxygen consumption) in a short duration cycle to exhaustion lasting about 15 minutes. A longer trial of 2 hours (80% VO2 max) after taking 2g ornithine daily for 6 days following by a single dose of 6g prior to testing noted that the fatigue rating seen with ornithine was 52% that of placebo and an anti-fatigue effect was noted in a 10 second sprint (similar at baseline, with the decline in performance being less with ornithine relative to placebo after testing); mean speed overall was unaffected.
There is possible an anti-fatigue effect associated with ornithine supplementation and prolonged exercise. The antifatigue effect only appears to occur during prolonged exercise, which correlates with the time when ammonia would normally cause problems. That being said, there are not many interventions overall to draw conclusions from
Hepatic encephalopathy is a liver condition (affecting up to 84% of those with liver cirrhosis) which, due to excess ammonia concentrations in the blood and brain, adversely affects cognitive functioning; in a sense, it is ammonia toxicity. Therapy of hepatic encephalopathy tends to be focused on reducing blood ammonia concentrations.
Infusions of L-Ornithine appear to be able to reduce circulating ammonia concentrations in clinical settings while oral supplementation of L-Ornithine-L-Aspartate at 6g thrice a day (18g total) for 14 days was able to effectively reduce blood ammonia in both postprandial and fasted states.
The reviews that investigate this topic (one review assessing four interventions and meta-analysis) noted some degree of promise, but limitations include study size and benefits may be limited to those with overt encephalopathy rather than those merely at risk thereof.
Hepatic Encephalopathy is a condition of the liver characterized by high ammonia concentrations in the blood and brain with cognitive side-effects. Ornithine supplementation may be able to reduce ammonia concentrations following oral ingestion in persons with encephalopathy associated with cirrhosis, but there is limited evidence using oral dosing (most studies conducted with intravenous ornithine in clinical settings)
Ornithine infusions (injections) have been noted to increase circulating growth hormone concentrations which is dependent on the hypothalamus.
2,200mg ornithine paired with 3,000mg arginine and 12mg B12 for 3 weeks has been noted to increase plasma growth hormone concentrations by 35.7% (measured immediately after exercise), an increase which attenuated an hour later but was still greater than placebo.
A study conducted in 12 bodybuilders who received an acute dose of 40, 100, or 170mg/kg Ornithine hydrochloride noted that only the highest dose (170mg/kg, or 12g for a 70kg man) was able to increase GH concentrations after 90 minutes to 318% above baseline with no significant effect at 45 minutes. Despite the percentage increase, the authors suggest it may not be overly relevant as the increase was from 2.2+/-1.4ng/mL to 9.2+/-3.0ng/mL while normal diurnal variations in growth hormone fluctuate between nondetectable and 16ng/mL.
Ornithine supplementation is able to cause an acute increase in growth hormone secretion following supplementation. However, due to the interactions between Arginine and growth hormone (specifically, the idea that an acute increase does not confer day-long benefit) applies to ornithine as well. These results may not be practically relevant
A combination supplement of Ornithine and Arginine has failed to significantly influence testosterone concentrations in resistance trained adults given 2,200mg Ornithine and 3,000mg Arginine for 3 weeks.
No known positive influences of ornithine supplementation on testosterone levels
There are various effects of ornithine on cortisol, with an intravenous infusion or ornithine being able to stimulate ACTH and subsequently cortisol yet another study using 400mg ornithine prior to alcohol consumption noting a relative decrease the next morning (thought to be secondary to accelerating alcohol metabolism).
Beyond that, one study using both L-Ornithine and L-Arginine (2,200mg and 3,000mg) for 3 weeks with exercise has failed to significantly influence cortisol.
Various different effects of ornithine on cortisol. An increase has been noted with infusions (somewhat tied into the growth hormone increase, so practical relevance of such an increase in not sure) while it can attenuate a hangover-induced rise in cortisol. In the most practical situation of just taking ornithine as a preworkout, it did not do anything
Ornithine is sometimes supplemented as L-Ornithine α-ketoglurate with the two molecules in a 1:2 stoichiometric ratio. These two molecules (Ornithine and α-ketoglutarate) are metabolically related, as ornithine can convert into α-ketoglurate via conversion into glutamate semi-aldehyde, glutamylphosphate, glutamate, and finally α-ketoglutarate; the pathway is fully reversible, and it is thought that providing supplemental α-ketoglurate alongside ornithine reduces the amount of flux from ornithine to α-ketoglurate and instead encourages production of other products of ornithine. This has been noted in a study using either Ornithine (6.4g as hydrochloride), α-ketoglurate (3.6g as calcium salt), or the combination with equal amounts (10g) where only combination therapy increased plasma levels of arginine and proline (all treatments increased glutamate).
The supplementation of ornithine alongside α-ketoglurate is able to suppress the conversion of ornithine into α-ketoglurate (normally occurs anyways) and indirectly promote conversion of ornithine into other metabolites such as arginine
α-ketoglurate may also be an intermediate in amino acid metabolism that combines with ammonia (under the influence of a reducing agent) to form glutamine, which is an ammonia buffering mechanisms independent of the urea cycle. The reducing agent was initially thought to be NADH or possibly formate (produced in the urea cycle)
α-ketoglurate may be the intermediate in glutamine metabolism that can buffer ammonia independently of the urea cycle via using ammonia to reform glutamine
The provision of Ornithine to a liver cell appears to be the rate-limiting step in urea syntesis and ammonia detoxification, and provision of both L-Arginine (218% at 0.36mM) and the isomer D-Arginine (204% at 1mM) are able to promote ornithine uptake into cells.
Supplemental arginine and/or citrulline (which provides arginine) also has the ability to reduce ammonia, secondary to increasing uptake of ornithine. That being said, it appears to be an inefficient workaround, and synergism between arginine and ornithine for ammonia detoxification has not yet been thoroughly investigated
L-Aspartate (not to be confused with D-aspartic acid) is commonly used alongside ornithing in the form of L-Ornithine L-aspartate for the purpose of treating hepatic encephalopathy. This is thought to be of use since treatment of hepatic encephalopathy requires ammonia detoxification and both ornithine and asparate are involved in the urea cycle (ornithine converts to citrulline to sequester ammonia via carbamoyl phosphate production, and then citrulline starts to be converted back into arginine only with L-asparate as a cofactor).
Due to the ability of ornithine to stimulate the urea cycle and accelerate ammonia excretion and alcohol consumption causing a quick rise in ammonia concentrations (and some evidence that there may be interactions with their metabolic pathways), it is thought that Ornithine may have a role in reducing symptoms of hangovers or drunkedness.
Ingestion of 400mg L-Ornithine a half hour before drinking alcohol (0.4g/kg 90 minutes before bed) was able improve some measurements taken the next morning (self-reported ratings of anger-hostility, confusion, sleep length, and fatgiue) and a reduction in cortisol in persons defined as 'flushers' (persons, usually asian, with a defect in the aldehyde dehydrogenase gene which metabolizes alcohol; 'flushers' are more sensitive to the effects of alcohol) but overall ethanol metabolism and the state of drunkedness were unaffected.
This study also makes note of a preliminary study (unable to be found online) where 800mg Ornithine L-Asparatate was effective on improving subjective parameters in flushers only, with those not classified as flushers not having any benefit.
Limited evidence, but it may be useful to alleviate the 'morning after' side effects in persons sensitive to alcohol. The preliminary evidence also suggests that this does not apply to those not characterized as 'flushers', so practical relevance of this information for frequent drinkers is not known
L-Ornithine α-ketoglutarate (specifically) is thought to be beneficial for burn healing since it is a precursor for both arginine and for glutamine (also proline, but this is usually not of concern), both of the former amino acids are known to be helpful as enteral additions during clinical settings (arginine and glutamine respectively).
L-Ornithine α-ketoglutarate appears to accelerate wound healing in clinical instances of burns, but the usage of L-Ornithine α-ketoglutarate as a general healing accelerator is not known (clinical studies may not necessarily apply to real world application of this supplement)
Ornithine shares the same intestinal transporters as L-Arginine supplementation, and due to that large boluses of ornithine may also cause diarrhea. As this is secondary to the transporter being saturated, the safe upper limit of intake (4-6g rarely causes side-effects) may apply to arginine, ornithine, and other amino acids that share the transporter (L-cysteine) collectively.
The diarrhea is due to these amino acids causing nitric oxide production in the colon, which stimulates water resorption in the colon and osmotic diarrhea. Elsewhere, intravenous or nasogastric infusions of ornithine at 20g or so have been noted to induce diarrhea.
High oral doses of ornithine can plausibly induce diarrhea, but there appears to be a larger safety buffer between the active dose and the diarrhetic dose with ornithine than there is with arginine (with citrulline being free of known intestinal side-effects)
- Demura S, et al. The effect of L-ornithine hydrochloride ingestion on performance during incremental exhaustive ergometer bicycle exercise and ammonia metabolism during and after exercise. Eur J Clin Nutr. (2010)
- Bommarius AS, Makryaleas K, Drauz K. An enzymatic route to L-ornithine from L-arginine--activation and stabilization studies on L-arginase. Biomed Biochim Acta. (1991)
- Bommarius AS, Drauz K. An enzymatic route to L-ornithine from arginine--activation, selectivity and stabilization of L-arginase. Bioorg Med Chem. (1994)
- Brusilow SW, Maestri NE. Urea cycle disorders: diagnosis, pathophysiology, and therapy. Adv Pediatr. (1996)
- Metoki K, Hommes FA. A possible rate limiting factor in urea synthesis by isolated hepatocytes: the transport of ornithine into hepatocytes and mitochondria. Int J Biochem. (1984)
- Häberle J, et al. Suggested guidelines for the diagnosis and management of urea cycle disorders. Orphanet J Rare Dis. (2012)
- Choi DE, et al. Hyperammonemia in a patient with late-onset ornithine carbamoyltransferase deficiency. J Korean Med Sci. (2012)
- Tuchman M, et al. Mutations and polymorphisms in the human ornithine transcarbamylase gene. Hum Mutat. (2002)
- Applegarth DA, Toone JR, Lowry RB. Incidence of inborn errors of metabolism in British Columbia, 1969-1996. Pediatrics. (2000)
- Targeted cellular metabolism for cancer chemotherapy with recombinant arginine-degrading enzymes.
- Wallace HM. The physiological role of the polyamines. Eur J Clin Invest. (2000)
- Wallace HM, Fraser AV, Hughes A. A perspective of polyamine metabolism. Biochem J. (2003)
- Jones ME. Conversion of glutamate to ornithine and proline: pyrroline-5-carboxylate, a possible modulator of arginine requirements. J Nutr. (1985)
- Grimble GK. Adverse gastrointestinal effects of arginine and related amino acids. J Nutr. (2007)
- Ornithine ingestion and growth hormone release in bodybuilders.
- Sugino T, et al. L-ornithine supplementation attenuates physical fatigue in healthy volunteers by modulating lipid and amino acid metabolism. Nutr Res. (2008)
- Cynober L, et al. Action of ornithine alpha-ketoglutarate, ornithine hydrochloride, and calcium alpha-ketoglutarate on plasma amino acid and hormonal patterns in healthy subjects. J Am Coll Nutr. (1990)
- MacLean DA, et al. Plasma and muscle amino acid and ammonia responses during prolonged exercise in humans. J Appl Physiol. (1991)
- Sahlin K, Katz A, Broberg S. Tricarboxylic acid cycle intermediates in human muscle during prolonged exercise. Am J Physiol. (1990)
- Mutch BJ, Banister EW. Ammonia metabolism in exercise and fatigue: a review. Med Sci Sports Exerc. (1983)
- Nybo L, et al. Cerebral ammonia uptake and accumulation during prolonged exercise in humans. J Physiol. (2005)
- Graham TE, MacLean DA. Ammonia and amino acid metabolism in human skeletal muscle during exercise. Can J Physiol Pharmacol. (1992)
- Hirai T, et al. Metabolic inter-organ relations by exercise of fed rat: carbohydrates, ketone body, and nitrogen compounds in splanchnic vessels. Physiol Behav. (1995)
- Elam RP, et al. Effects of arginine and ornithine on strength, lean body mass and urinary hydroxyproline in adult males. J Sports Med Phys Fitness. (1989)
- Minimal hepatic encephalopathy: diagnosis, clinical signiﬁcance and recommendations.
- Szerb JC, Butterworth RF. Effect of ammonium ions on synaptic transmission in the mammalian central nervous system. Prog Neurobiol. (1992)
- Raabe W. Synaptic transmission in ammonia intoxication. Neurochem Pathol. (1987)
- Butterworth RF. Hepatic encephalopathy and brain edema in acute hepatic failure: does glutamate play a role. Hepatology. (1997)
- Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut. (1982)
- Staedt U, et al. Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomized study using a four-fold crossover design. J Hepatol. (1993)
- Kircheis G, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study. Hepatology. (1997)
- Ahmad I, et al. L-ornithine-L-aspartate infusion efficacy in hepatic encephalopathy. J Coll Physicians Surg Pak. (2008)
- Stauch S, et al. Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol. (1998)
- Soárez PC, et al. A critical analysis of studies assessing L-ornithine-L-aspartate (LOLA) in hepatic encephalopathy treatment. Arq Gastroenterol. (2009)
- Rees CJ, et al. Effect of L-ornithine-L-aspartate on patients with and without TIPS undergoing glutamine challenge: a double blind, placebo controlled trial. Gut. (2000)
- Jiang Q, et al. L-Ornithine-l-aspartate in the management of hepatic encephalopathy: a meta-analysis. J Gastroenterol Hepatol. (2009)
- Evain-Brion D, et al. Simultaneous study of somatotrophic and corticotrophic pituitary secretions during ornithine infusion test. Clin Endocrinol (Oxf). (1982)
- Zajac A, et al. Arginine and ornithine supplementation increases growth hormone and insulin-like growth factor-1 serum levels after heavy-resistance exercise in strength-trained athletes. J Strength Cond Res. (2010)
- Psychologic and Neural Regulation of Growth Hormone Secretion.
- Kokubo T, et al. A randomized, double-masked, placebo-controlled crossover trial on the effects of L-ornithine on salivary cortisol and feelings of fatigue of flushers the morning after alcohol consumption. Biopsychosoc Med. (2013)
- Cynober L. Metabolic interaction between ornithine and alpha-ketoglutarate as a basis for the action of ornithine alpha-ketoglutarate. Clin Nutr. (1993)
- Morowitz H, Peterson E, Chang S. The synthesis of glutamic acid in the absence of enzymes: implications for biogenesis. Orig Life Evol Biosph. (1995)
- Maughan Q, Miller SL. Does formate reduce alpha-ketoglutarate and ammonia to glutamate. Orig Life Evol Biosph. (1999)
- Saavedra-Molina A, Piña E. Ornithine uptake by rat liver mitochondria: effect of calcium and arginine. Biochem Int. (1987)
- Saavedra-Molina A, Piña E. Stimulation of L-ornithine uptake and L-citrulline and urea biosynthesis by D-arginine. Biochem Int. (1991)
- Acharya SK, et al. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology. (2009)
- Ndraha S, Hasan I, Simadibrata M. The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition. Acta Med Indones. (2011)
- Morris SM Jr. Regulation of enzymes of the urea cycle and arginine metabolism. Annu Rev Nutr. (2002)
- Krebs HA, Hems R, Lund P. Accumulation of amino acids by the perfused rat liver in the presence of ethanol. Biochem J. (1973)
- Rejniuk VL, Schafer TV, Ivnitsky JJ. Ammonia potentiates the lethal effect of ethanol on rats. Bull Exp Biol Med. (2008)
- Cascales C, Cascales M, Santos-Ruiz A. Effect of chronic ethanol or acetaldehyde on hepatic alcohol and aldehyde dehydrogenases, aminotransferases and glutamate dehydrogenase. Rev Esp Fisiol. (1985)
- Maier KP, et al. Urea-cycle enzymes in normal liver and in patients with alcoholic hepatitis. Eur J Clin Invest. (1974)
- Goedde HW, Harada S, Agarwal DP. Racial differences in alcohol sensitivity: a new hypothesis. Hum Genet. (1979)
- Wernerman J, et al. Glutamine and ornithine-alpha-ketoglutarate but not branched-chain amino acids reduce the loss of muscle glutamine after surgical trauma. Metabolism. (1989)
- Le Bricon T, et al. Ornithine alpha-ketoglutarate metabolism after enteral administration in burn patients: bolus compared with continuous infusion. Am J Clin Nutr. (1997)
- Kirk SJ, et al. Arginine stimulates wound healing and immune function in elderly human beings. Surgery. (1993)
- Kudsk KA, et al. A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications. Ann Surg. (1996)
- Ziegler TR, et al. Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med. (1992)
- Hall JC, Heel K, McCauley R. Glutamine. Br J Surg. (1996)
- Donati L, et al. Nutritional and clinical efficacy of ornithine alpha-ketoglutarate in severe burn patients. Clin Nutr. (1999)
- Coudray-Lucas C, et al. Ornithine alpha-ketoglutarate improves wound healing in severe burn patients: a prospective randomized double-blind trial versus isonitrogenous controls. Crit Care Med. (2000)
- Cynober LA. The use of alpha-ketoglutarate salts in clinical nutrition and metabolic care. Curr Opin Clin Nutr Metab Care. (1999)
- Arginine: beyond protein.
- Colonic secretory effect in response to enteral feeding in humans.
- Colonic responses to enteral tube feeding.