In this interesting paper supplementing glutamine and essential (E) amino acids (AA) was followed by diminished output. You hypothized altered homeostasis, but the item was no further discussed. Glutamine is poorly, if not absorbet because intestinal mucosal cells destroy it prior to absorption. Moreover, glutamine if absorbed overwhelming intestinal clearance or peculiarly if given by parenteral route epigenetically modifies expression of glutamine-synthases, thus, with time, those patients may become more and more dependent on exogenous glutamine for maintenance of glutamine levels. Moreover, while from EAA glutamine can be formed by using citric acid cycle intermediates (alfa-ketoglutarate and procursors) , from glutamine EAA cannot be formed. Thus, if insufficient or disproportionate stoichiometric amounts of EAA are given, maintenance of normal values of glutamine may be compromised. Not always it is good to give what lacks to metabolism, the strength of negative feed-back loops may become rapidly dangerous. Or , as happens with abundant exogenous sources of arginine, may induce excess catabolic pathways compromising peripheral availability of arginine as substrate for NOsynthases!
It is far best to give precursors (EAA in adequate stoichiometric ratios) and so induce synthetic pathways, avoiding NEAA supplementation, in my advice.
Article Development of a complex amino acid supplement, Fatigue Revi...
I am surprised by the lack of comments to this provocative question.
Indeed, this topic is one of the most interesting in clinical nutrition. I will ask the question in a different way. Should we always give to our patients the metabolic component that is lowered in plasma, or we should keep in mind the metabolic implications and epigenetic modifications consequent to our intervention?
My solution is that what we have to introduce and has no alternative ( esential elements that cannot be originated from other molecules) should be given, but substances that can be produced by metabolism form different sources requires careful evaluation of their metabolic roots.
And this is the case for the so called conditionally essential amino acids, glutamine and arginine, an important and challenging field for scientists that needs to be understood and discussed. The argument s not only dealing with theoresis, it has many implications, both clinical and financial. Thus, it is difficult ...welcome in the club of the knot loosers!
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