Diabetes Medication

Arginine: A Marvel or Quackery?

Anything that seems too good to be true almost always is. It’s hard for me to believe that taking anything can cure or prevent a huge number of conditions.

That’s why I have kept changing my mind about arginine (also known as L-arginine). I have known about its powers for years. In 1998 a leading endocrinologist, Dr. Joe Prendergast, brought it to my attention for its ability to reverse the most common complication of diabetes, heart disease.

Arginine is one of the 20 amino acids that make up proteins. It is the only amino acid that generates significant amounts of nitric oxide.

It was in 1998 that three American pharmacologists won the Nobel Prize in Physiology or Medicine for their discoveries concerning “nitric oxide as a signalling molecule in the cardiovascular system”. Nitric oxide protects the heart, stimulates the brain, kills bacteria, and has a role in protecting our lungs, preventing cancer and reversing impotence.

Those are huge claims and not the claims of a quack. That is just part of what the Nobel Assembly at Karolinska Institutet, which awards the Nobel Prize in Physiology or Medicine, said in its press release.

The claims of nitric oxide are, if anything, greater in a new book that I just finished reading. Again, the author is no quack. Louis J. Ignarro is one of the three pharmacologists who won the Nobel Prize for their work on nitric oxide. Since 1985 he has been a professor in the department of pharmacology at the UCLA School of Medicine.

His book, NO More Heart Disease : How Nitric Oxide Can Prevent–Even Reverse–Heart Disease and Stroke came out last year. A paperback version just appeared.

Dr. Ignarro says that among other things nitric oxide relaxes and enlarges the blood vessels, prevents blood clots that trigger strokes and heart attacks, and regulates blood pressure and the accumulation of plaque in the blood vessels. Low levels of nitric oxide are associated with several complications of diabetes, he says.

Both Dr. Ignarro and Dr. Joe recommend that we take about 5 grams of arginine together with 200 to 1000 mg of another amino acid, L-citrulline, daily. The L-citrulline is supposed to boost the arginine.

That’s a lot of pills. But that’s what I’m taking, although I will probably stop taking L-citrulline when my present supply runs out.

I am feeling much better. But I made other changes in my life at the same time, particularly starting on Byetta so it’s hard to say why. And, of course, many of the benefits of arginine are hidden in my arteries.

Each of these doctors sells a concoction of these amino acids together with antioxidants through separate multi-level marketers. There is no way that I would ever buy anything from an MLM, and if you are tempted, please read Dr. Stephen Barrett’s “The Mirage of Multilevel Marketing” and other related Quackwatch articles.

Still, there is excellent scientific evidence for arginine There are two caveats. A recent study concluded that you shouldn’t use arginine after having an “acute myocardial infarction,” commonly known as a heart attack. And arginine supplements may be harmful for people with a tendency to develop oral or genital herpes.

On the other hand, there is little scientific evidence for L-citrulline. Dr. Ferid Murad says that except for L-citrulline, Dr. Ignarro’s blend of ingredients makes sense. Dr. Murad shared the 1998 Nobel Prize in Medicine with Dr. Ignarro and Robert Furchgott.

Until now we have had little evidence showing that nitric oxide can directly benefit people with diabetes. But a technical study, “Nitric Oxide Cytoskeletal–Induced Alterations Reverse the Endothelial Progenitor Cell Migratory Defect Associated With Diabetes” just appeared in Diabetes.

Just as Dr. Joe inspired me to take Byetta, he also inspired me to take arginine. He told me about it years ago. I took it for a while in the form of HeartBars, which unfortunately are no longer available.

Now, his new book, The Uncommon Doctor: Dr. Joe’s Rx for Managing Your Health reinspired me. The benefits to his patients are far too remarkable to ignore.

“In 1991, 30 percent of my diabetic patients ended up seeing a cardiologist for bypass procedures,” he writes. “I started routinely recommending L-arginine. In just nine short years, less than 1 percent of my patients needed to see a cardiologist for any reason. Since 1991, my practice has not had one patient suffer from a heart attack or stroke.”

As a journalist, I am naturally skeptical of big claims. But sometimes big claims are true. Anyone who is skeptical of everything will never learn anything. I think that arginine and nitric oxide are worth knowing about.

This comment is from Dr. Joe Prendergast

There are over 40,000 articles which are generally positive on the use of l-arginine to reverse arterial lining (endothelium) elasticity, atherosclerosis, homocysteine and viral damage. How did these authors come to opposite conclusions?

· They started with smaller amounts of l-arginine, 3 gm rather
than the 5 grams thought to be the therapeutic amount.
· They reduced the 3 gm to lower amounts if the patients had “side
effects” symptoms. They did not state who and how much.
· The source of l-arginine is from a company whose product I do
not know.

Patient management had other curious notes.
· Elasticity did not change on treatment. Most research note
that this reflects insufficient l-arginine given to the patient.
· Diabetes was “well controlled” – meaningless in the hands of
cardiologists unless there are HbA1c etc. to prove control.
· Plasma l-arginine changed to less on treatment – how little
were they taking? At what times and how often was it decreased in those who died?

This is cardiologists’ research. If treatment does not change elasticity/vascular stiffness like it did for all the references the authors quote shouldn’t investigators change the treatment to more l- arginine?
· They quoted 6 articles in the introduction that said l-
arginine improved vascular elasticity. Why not follow these articles’ protocol? This study set out to show endothelial integrity (effect on heart attack) not arterial elasticity.
· Why do a study that didn’t achieve the basic starting point
and then pronounce l-arginine is dangerous.
· How long did the patients have diabetes? What were other co-
morbid states? HbA1c values? What treatments were used for those with diabetes? How well were they controlled during the study? Were the cardiologists attentive to the diabetes care?
· Were the cardiologists who reviewed this paper aware of the
prior science of l-arginine?

There are all sorts of bad science with “significant outcomes” that get published and quoted over the years even though the study design is seriously flawed. Put this publication on the list to join,
· The University Group Diabetes Project – Diabetes – 1970 –
don’t give all the Orinase in a maximum dose at one time.
· The Effect of Monochromatic Infrared Energy on Sensation in
Patients With Diabetic Peripheral Neuropathy. Diabetes Care 28:2896-2900, 2005 – don’t use subjective measurement of neuropathy when it can be quantitated with FDA approved testing.

Dr. Joe, the Diabetes Doctor

This article is based on an earlier version of my article published by HealthCentral.

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  • Terra at

    Now it’s 2016. Is L-Argine still thought to be good for Diabetics (Type 2)?

  • Gary Howard at

    This is a great article, however, there is one major contraindication I don’t hear anybody talking about. Dr. Ray Peat, a biologist who has a huge following, has stated that Nitric Oxide (produced by L Arginine Supplements, Beets etc. is a major free radical and insists it causes rapid aging. Peat even refers to the Nitric Oxide Theory of Aging. I have yet to see a study etc. that refutes this. Peat examines what is going on at the cellular level. Any thoughts?

  • Teri Grottke at

    I am a type 2 diabetic that struggles with diabetic foot ulcers regularly. I stumbled across the roll of l-arginine in wound healing in a 24 page study done in Australia for wound healing. It suggests 9 mg dosage daily. I cross referenced it with web md & found that topical use is even more helpful in diabetic wound healing. After 8 grafts, 3 months hospitization to clear up the infection, several other types of dressings, basically everything my Dr. Could think of, I told him what I found online. He said go for it, we’ve tried everything else. Three times daily application of neosporin & arginine powder taken from the supplement capsule. The wound has filled in & scabbed over in a weeks time with minimal seepage. Very encouraging! Can’t wait for doc to see it this Tuesday!

    • David Mendosa at

      Dear Teri,

      Thanks for your report on l-arginine. I have heard a lot of good things about it, particularly from Dr. Joe Prendergast. You two might want to get in touch.



  • Frank Walker at

    I am a recently diagnosed (7/11) type 2 diabetic. Over the past three months I have brought my a1c from 11 to 7 and bgl from 280 to 130. I have been thinking of adding l-arginine to my regimine for ED help, but I’ve read a lot of conflicting info about how it will interact with my diabetes meds (glimepiride). Is there a definitive answer yet? If so, what minimum dose should I start at?

  • Fantastic Four Online Spielen at

    excellente reenso de onditicor y faricu con paramenio proriamon. argues a itemolv y dismo paliv con cemelina sacho!

  • Linda Ragsdale at

    Overall, a good article (although there is obviously much more recent research since its publication date). However, I must take exception to your statement that”There is no way that I would ever buy anything from an MLM, and if you are tempted, please read Dr. Stephen Barrett’s ‘The Mirage of Multilevel Marketing’ and other related Quackwatch articles.” Dr. Barrett has a clearly demonstrated bias against anything outside mainstream, allopathic medicine, and there ARE excellent MLM companies that offer first-rate products for a reasonable price.

    If you investigate Synergy’s parent company, Nature’s Sunshine, you will find that its manufacturing processes and quality control rival the best pharmaceutical companies. I personally checked the price of buying individual ingredients via a well-known retailer’s website, and found that buying that way would cost almost 3x what ProArgi-9 Plus costs (assuming one bought a single, 30-serving can at a time [the most expensive way to purchase]). AND there is no way to verify the quality, purity, and efficacy of most supplement brands (unlike Nature’s Sunshine).

    Some truly astounding research has/is being performed with ProArgi-9 Plus. For your own benefit, please revisit this with Dr. Prendergast!

    Disclosure: I am an extremely satisfied customer of and proud distributor for Synergy WorldWide, the company for which Dr. Prendergast and others developed ProArgi-9 Plus.

  • bob luhrs at

    Don’t count on miracles to get a lot of attention, and the “cream to rise”. It does not. “one would expect it would be used like aspirin..” etc is just not going to happen, and this argument is naive, unfortunately. It is used as a challenge as if that were a test of the science..that everyone would already know it. There are many reasons why great ideas, even ones you can do for yourself, sit there for years. People do not believe each other most of the time. This may be wise, but once in awhile something great is going to be lost due to it.

  • danny at

    Fantastic Pharma grade 10 mg. per serving….www.javaguys.igetpaidtodrinkcoffee.com

  • Charlene at

    Can a Type l diabetic take L-Arginine while
    taking Lipitor and Plavax — or should he be off
    those first?
    He has 4 stents in heart arteries after slight hearty
    attack last August. Is L-Arginine still safe for him
    to take about 5,000 mg. daily?
    Please advise. Thanks

    • David Mendosa at

      Dear Charlene,

      I have never heard of any contraindications.


  • John Dodson at

    Thanks for this honest and helpful assessment of the role of L-Arginine in health care. I have been taking this supplement for several years and have found it to be helpful in the elasticity of my arteries. I measure the elasticity regularly, it continues to be good even if neglect of health has brought about some other issues. I do think you are on the right track to always question and since you do such excellent research we can all trust what you are saying is based on the best knowledge you have to date. Dr Joe and the others are on the track of anti aging medications and I say more power to them. If you don’t do something, nothing happens.

  • KT. Eckardt at

    My mother survived congestive heart failure because of Dr. Joe Prendergast when every other doctor including my mother’s cardiologist said “just make her comfortable.” She’s 95 and could do cartwheels before my controlling DPOA sisters forced her to take inappropriate medications and live with an abusive caretaker to save money… I’m a medical assistant by training with post-grad, pre-med coursework completion. Before L-Arginine, before Drs. Joe, Ignarro, Murad, I used to call standardized medicine, cromagnon. I’m a fan of Dr. Joe’s and I cannot believe he’s nearby!!!

    Thank you, Dr. Joe, Manuel, and staff!!!!

  • Mike O'Neill at

    Todays healthcare costs, cumulatively, threaten to undermine aging Americans’ Healthcare options, to the point of being too expensive for both the Government (Medicare etc.) and or private payers to afford. It would seem that if a treatment such as described (L-Arginine) were even potentially as benificial in its claims toward improving heart health via improved vascular function, then one would easlily expect that the product would be as available and popular as Asprin…or would that be like killing the goose that laid the golden egg? There’s big big money in elderly preventitive medicine such that reducing the insured patient resource stream may be a detriment to thecontinued financial ” health ” of the medical industry as a whole ! As a heart patient myself, on parole as it were, I am attuned to new inroads into arterial ‘cleaning’ and restored aerobic health. However, I’m also a realist, and often side with those who ascribe to the tenent that” if it sounds to good to be true, hope to hell that this time it really is”.