SUPLEMENTS - Arginine, Carnitine, Citrulline, Omega 3 Fish Oil & Others

[slowandsteady]

There's an interesting thread at imminst.org about l-arginine and sleep. Perhaps it's better taken at bedtime as it promotes restful sleep. For nocturnal erections, that timing sounds good too. I'm going to try this tonight.

[newguy]

Does long does it remain in the system for? A take it whenever I take pentox. In combination with cialis, which I take regularly so it always in my system, I'm trying to make sure that they are always working. I had noticed that bedtime thread myself, so for those taking it once a day, it does seem to be the most sensible option.  

[Ashen]

Is it recommended to take l-arginine with pentox?  I have been on pentox for 6 months now (hopefully get this extended tomorrow when I see my uro as I'm out of refills).  I have never incorporated l-arginine into the mix.  If so whats a good brand and dosage to go with?  Sorry if this is a tiny bit off topic.

Also it seems that pycnogenol can up the effectiveness of l-arginine.  Anyone taking both of these?  Is it worth it?  Dosages.

Ahhh so many questions  

[skunkworks]

Does anyone know how long it takes arginine to raise nitric oxide levels?

Is it a case of hours, weeks or days?

[slowandsteady]

From PMID 10355867:

Plasma L-arginine concentrations change during the day and are influenced by dietary intake. Importantly, plasma NOx do not seem to vary with this pattern in healthy individuals.

They found when people ate a fixed amount of l-arginine in their diet at meals, the plasma NOx didn't change much over the course of the day. That's not how we are taking it though.

Another study gave intravenous l-arginine and found that NOx peaked 10 hours later.

So, I'm calling it 11 hours when taking orally, and will probably switch to suppertime for l-arginine and pycnogenol.

[newguy]

So, I'm calling it 11 hours when taking orally, and will probably switch to suppertime for l-arginine and pycnogenol.

Do you think it's important to take l-arginine before food? I take so many supplements that on occasion when is best to take them all becomes a bit of a blur

Is it recommended to take l-arginine with pentox?

Also it seems that pycnogenol can up the effectiveness of l-arginine.  Anyone taking both of these?  Is it worth it?  Dosages.

Ahhh so many questions  

It's hard to be sure of its importance but animal studies point towards it being useful, and some urologists also suggest it as part of the PAV cocktail (pentox, l-arginine, viagra). Adding pynogenol to l-arginine seems to improve erections compared to just l-arginine on its own.  

[Ashen]

what's the "usual" dosage of both?

[newguy]

what's the "usual" dosage of both?

Penile erection requires the relaxation of the cavernous smooth muscle, which is triggered by nitric oxide (NO). We investigated the possibility of overcoming erectile dysfunction (ED) by increasing the amounts of endogenous NO. For this purpose, we orally administered Pycnogenol, because it is known to increase production of NO by nitric oxide syntase together with L-arginine as substrate for this enzyme. The study included 40 men, aged 25-45 years, without confirmed organic erectile dysfunction. Throughout the 3-month trial period, patients received 3 ampoules Sargenor a day, a drinkable solution of the dipeptide arginyl aspartate (equivalent to 1.7 g L-arginine per day). During the second month, patients were additionally supplemented with 40 mg Pycnogenol two times per day; during the third month, the daily dosage was increased to three 40-mg Pycnogenol tablets. We obtained a sexual function questionnaire and a sexual activity diary from each patient. After 1 month of treatment with L-arginine, a statistically nonsignificant number of 2 patients (5%) experienced a normal erection. Treatment with a combination of L-arginine and Pycnogenol for the following month increased the number of men with restored sexual ability to 80%. Finally, after the third month of treatment, 92.5% of the men experienced a normal erection. We conclude that oral administration of L-arginine in combination with Pycnogenol causes a significant improvement in sexual function in men with ED without any side effects.

- http://www.ncbi.nlm.nih.gov/pubmed/12851125

Here's a study involving the two supplements. It's not a bad starting point and there are no fixed adeas about how much people should tae. I tend to take about 4-5g of l-arginine spread over the day, and maybe 100mg of pycnogenol

[despise]

What's a good source to buy pyconegol and l-arginine? Sorry if im a bit off topic but I am trying to save money because I can't afford to waste. I would normally go to The Vitamin Shop but I think that would probably be a foolish idea if you could get a great deal over the internet. Can anyone help me out eh eh? =P

[slowandsteady]

Pycnogenol and l-arginine.

[cowboyfood]

Pycnogenol and l-arginine.

Also, good deals at puritans pride; usually buy 1 get 1 for a total of 2, and buy 2 get 3 for a total of 5.

L-arginine http://www.puritan.com/arginine-501/l-arginine-1000-mg-007888?NewPage=1

Pycnogenol http://www.puritan.com/pycnogenol-519/pycnogenol-60-mg-002171?NewPage=1

CF

[Ashen]

I ordered 100mg tablets of Pycnogenol.  Seems like everyone else is linking to 60mg.  Is this going to be a problem with the 100mg?  Should I order the 60mg bottle?

[despise]

Ouch! They definitely aren't cheap! =/ Would you guys recommend that I get the L-arginine and pycnogenol? Or should I just get one of them? Gah I wish I had a lot of cash! Would just buy this stuff on the spot.

[skunkworks]

I remember not too long ago someone posting that Lysine supplementation might in fact make the condition worse, something to do with collagen maybe. I will try to find the post.

[nemo]

I know my dermotologist who specializes in Vitiligo told me to stop taking Arginine as it is an oxidant and could contribute to the skin condition Vitiligo.  She said she's seeing more men with V than ever before and a lot of men are taking Arginine as a bodybuilding supplement, ect., so she's putting two and two together.  She may be right, she may be wrong - I know my V started somewhere in proximity to my starting Arginine, I just can't say for sure whether it started before Arginine or not, so I'll never know for sure.  

Nemo

[slowandsteady]

I remember not too long ago someone posting that Lysine supplementation might in fact make the condition worse, something to do with collagen maybe. I will try to find the post.

This one by Hawk?

[nemo]

Alex, where are you getting that there's "some evidence out there that vitiligo is viral"?  I've never heard that ...

Nemo

[George999]

Alex, where are you getting that there's "some evidence out there that vitiligo is viral"?  I've never heard that ...

Nemo

Nemo,  There is an old theory often espoused by natural medicine people that "auto-immune" syndromes are really caused by pathogens, viruses or bacteria that infest tissue in a way that causes ongoing damage to those tissues.  They dispute the traditional theories of inappropriate immune responses otherwise known as auto-immune syndromes.  This may or may not be what Alex is referring to.  My thoughts on this are that when the immune system is unable to suppress pathogens, that indicates a problem with the immune system just as much as an auto-immune response would.  But it seems obvious to me that Alex is trying to challenge the theory that auto-immune issues are behind Peyronie's even though there is established evidence that they are.  In this case, he seems to be applying that same logic to vitiligo.  - George

[Ashen]

Well last night I took 500mg of l-arginine right before bedtime.  I did notice an improvement in nocturnal erections.  I have some Pycnogenol that I know is recommended to pair with the l-arg but it's 100mg tablets and most people seem to take just 60mg.  Not sure if that would really matter or not.

[Ashen]

Found this on webmd about Pycnogenol, not sure how it may apply to Peyronies being though by some as an immune problem.

"Auto-immune diseases" such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), or other conditions: Pycnogenol might cause the immune system to become more active, and this could increase the symptoms of auto-immune diseases. If you have one of these conditions, it's best to avoid using pycnogenol.

[alexk]

Alex, where are you getting that there's "some evidence out there that vitiligo is viral"?  I've never heard that...

http://www.google.com/search?q=vitiligos+virus turned up some information about vitiligo and hepatitis C. And by that, I only mean "some information," before somebody here gets all bent out of shape (haha) I am not proposing some vague theory, just trying to point out existing research.

If you search on PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for 'vitiligo virus' (not as a phrase, as separate keywords), you'll also bring up more research. Again, this is just FYI to possibly help you with the condition.

George999, I wasn't really saying that vitilogo was autoimmune in nature, just a potential side effect or direct effect of a virus. You are right to say that I'm skeptical of an autoimmune origin for Peyronie's. A much more plausible theory is that the penis, probably the most highly vascularized organ in the human body, will show signs of cardiovascular disease earlier than other organs. But I don't want to be accused of thread hijacking again, if you want to take time, please send me some autoimmune info through a PM. I know that what I've read on the forum in the past was not convincing.

[Skjaldborg]

l-arginine at bedtime seems to be beneficial for me as well. Good for the ole morning glory, as it were.

On another topic, the cardiovascular disease theory of Peyronie's doesn't make sense. Peyronie's is likely due to a number of factors including genetics, trauma and the body's response to injury. If Peyronie's was a barometer for cardiovascular disease, then we happy few, we band of brothers, wouldn't be skulking around the anonymity of the internet. Instead, millions upon millions of men would be complaining of bent ding dongs on Oprah and you'd have Pentox commercials during Monday Night Football and NASCAR. Heart disease is very common; Peyronie's is not.

I have Peyronie's, not heart disease.  My erectile functioning is great. My blood flow is great. My resting heart rate is very low because I'm a runner and I'm in good shape. I am 30 years old and I got this from an injury (with my genetic history as a possible contributing factor, darned Dutch, Dane and English ancestry!). Indeed, some men with heart disease or very poor circulation due to diabetes may get Peyronie's or corporal fibrosis, but correlation does not equal causation.

[George999]

I have Peyronie's, not heart disease.

There is NOT ONE study linking Peyronie's to heart disease.  The research instead links Peyronie's to diabetes.  Heart disease IS linked to ED, NOT to Peyronie's.  This is what you learn when you actually read through the research rather than just come up with ideas.  - George

[jackp]

George

In my case I can directly relate coronary artery disease (CAD)  to ED.

Jackp

[Brewpunk]

My 2 cents, I've been taking l-arginine at bedtime for a while. Since I have, I've noticed that I usually wake up with a decent "morning wood". It seems also that this is the only time my erections don't have some degree of pain or soreness to them. I highly recommend l-arginine at bedtime! Actually, I take it 2 hours before bedtime to be exact along with Pentox. Directly before bed, I've been taking 8 oz. of diluted food grade hydrogen peroxide *delivers oxygen direct to your body's cells allegedly*.
The reasoning behind this regime the l-arginine & pentox should be taken with food & you should wait 2 hours after eating to put the food grade h2o2 in your system. Been doing this for a week & 1/2. I'll post progress reports. Most definitely improves the morning wood & that can't be a bad thing!    

[sunsetsonfire]

Hi Everybody,

As I'm still new to the peyronies situation (started 7/09), I'm in the process of putting together a proper plan of action to combat it (having learned from this forum that my urologist's advice of "Vitamin E and wait and see" was NOT in my best interest if i wanted to get a handle on this condition early before later calcification could occur.  

I've already decided on the 3 cylinder VED approach for exercising and stretching the region.  

Now I wish to add some kind of "internal" plan, as well.  And reading the posts I can see lots of various suggestions, but I'm sort of confused in terms of narrowing down the choices for what would be best for my own particular condition.

For me, pain and/or discomfort has never been an issue from day one, so a "pain" treatment is not necessary.  Just one day in early July, Mr. Happy decided to bend at a 45 degree sharp angle, and I guess I lost about an inch of elasticity  

Indentation along the sides of where the bend is seems fairly minor, and the "plaque" really can't be seen or felt as a lump, just where it bends I fees the tissue is a bit harder internally in that spot.  

Problems with ED aren't major, and I think when I've had them it's been due to the psychological issue, since when I'm alone and relaxed and reading an erotic story I can have no problems.  But I have a prescription for Levitra anyway, which I take a quarter pill when with my wife just so my mind doesn't have to worry about "will he or won't he".  

Sorry if that all comes across as TMI, but I figured it best to narrow down the best choices for oral treatments for treating my own particular infliction.  

Now for the questions:
I can see that Pentox seems to be a very popular recommendation as a blood thinner.  As my urologist put me on high doses of Vitamin E (another blood thinner), would Pentox work better in that area?

Frequent erections are also highly recommended.  I see l'arginine brought up a lot to help with nocturnal erections (when taken at night).  I've also seen where someone brought up the usage of trazodone.  Apparently this drug is normally prescribed to treat depression or sleeplessness when used in dosages of 100mg - 400mg, but has the side effect of nocturnal erections and can achieve that in dosages of 25mg at night... enough for the side effect but too low a dose to cause problems.   Is one better than the other?  

Anything else that one can recommend for breaking up plaque or just general circulatory health?  I should mention that improving my circulation might be a good idea overall as I've always felt my circulation was awful (I'm like a reptile, when the weather is even SLIGHTLY cold my hands and feet are like icebergs, even if I wear gloves and socks an inch thick).  

Sorry for this long post, but I just wanted to try to narrow down the best options of all the various drugs, and advice from those more experienced will be appreciated.  Then the next step will be to arm myself with info for the drugs that need a prescription and lobby my uro hard, and order the over the counter ones as soon as possible to get the ball rolling.

Thanks very, very much!

[George999]

Now for the questions:
I can see that Pentox seems to be a very popular recommendation as a blood thinner.  As my urologist put me on high doses of Vitamin E (another blood thinner), would Pentox work better in that area?

There is research based evidence that Pentox is effective against Peyronie's.  There is exactly zero credible evidence that Vitamin E is effective against Peyronie's.  The problem is that few physicians are aware of the very successful use of Pentox to treat Peyronie's, and since that use is off-label, that is the drug is not FDA approved for Peyronie's, most physicians refuse to prescribe it.  But the reality is, Pentox is the best drug out there at this time for Peyronie's.  Vitamin E is not even on the list.  Both ALC and Potaba (the one FDA approved Peyronie's drug) run rings around Vitamin E in terms of effectiveness.  Don't waste your time on Vitamin E.  Its not going to help you significantly.  - George

[newguy]

For me, pain and/or discomfort has never been an issue from day one, so a "pain" treatment is not necessary.  Just one day in early July, Mr. Happy decided to bend at a 45 degree sharp angle, and I guess I lost about an inch of elasticity  

No pain = a good sign. It doesn't mean that there is zero low level inflammation, but some members battle pain for many months, so you're in a better position than some in that regard.

Now for the questions:
I can see that Pentox seems to be a very popular recommendation as a blood thinner.  As my urologist put me on high doses of Vitamin E (another blood thinner), would Pentox work better in that area?

If forced to make a choice between pentox and vitamin E I would absolutely, without hesitation go with Pentox every single time. I do think that the benefits of vitamin E for peyronie's sufferers are very limited or perhaps even nonexistent though some studies have used pentox and alpha-tocopherol (vit e). 'Perhaps' in combination with proven treatments (I feel confident in saying that pentox has been proven to be useful [click1] [click2] [click 3]) it adds slightly to its effectiveness. That's debatable though.

Frequent erections are also highly recommended.  I see l'arginine brought up a lot to help with nocturnal erections (when taken at night).  I've also seen where someone brought up the usage of trazodone.  Apparently this drug is normally prescribed to treat depression or sleeplessness when used in dosages of 100mg - 400mg, but has the side effect of nocturnal erections and can achieve that in dosages of 25mg at night... enough for the side effect but too low a dose to cause problems.   Is one better than the other?  

A few of the top urologists prescribe what is known as the PAV cocktail: Pentoxifylline, L-Arginine and Viagra . Pentox has been shown to be useful. L-arginine helps with erections, boosts nitric oxide production etc. Viagra is a phosphodiesterase type 5 inhibator, again increasing bloodflow to the penis. The PAV cocktail as a package, especially in combination with mechanical treatments (esp. the VED) help to keep the penis healthy. Assuming that the side effects are not as issue for you, perhaps Cialis is preferable to Viagra due to its increased halflife. I like to have supplements/drugs always working for me. There is some evidence that adding pycnogenol to l-arginine increases the strength of erections, though as your erections are already good, I probably wouldn't recommend adding it to the PAV approach.

I don't see l-arginine and trazodone as an either/or. If both have uses for you then take both. If however you have no problem obtaining night time eections, then there is probably no point in taking trazodone. I wouldn't apply that same measure to the PAV cocktail at this stage though (meaning that if you have no trouble with daytime erections, i'd still give the PAV cocktail a try for a good few months - preferably 6 months minimum).

Anything else that one can recommend for breaking up plaque or just general circulatory health?  I should mention that improving my circulation might be a good idea overall as I've always felt my circulation was awful (I'm like a reptile, when the weather is even SLIGHTLY cold my hands and feet are like icebergs, even if I wear gloves and socks an inch thick).  

I wonder if you have Raynauds (http://en.wikipedia.org/wiki/Raynaud's_phenomenon). If so, all the more reason to make sure that you do everything you can to increase circulation. There are several avenues to go down regarding what helps and what doesn't. There are typically so many factors at play, that it's hard to seperate the useful from the useless at times. We do tend to go with the science though, not always peyronie's studies (since they are thin on the ground) but related issues and processes, to try to form a rounded and all encompassing approach to the condition. Again, for some no treatment appears to help, for others a combination of supplements and use of mechanical treatments (VED, traction) has really made all the diference. At worst, it IS the right approach to take, and it's all about doing what you can in a tough situation. If you don't get good results, there is always surgery once the condition is stable, and the success rate there is high.

In addition to the PAV cocktail I'd recommend:

Taurine and Niacin

Vitamin D

Acetyl-l-carnitine (ALC)

and possibly:

N Acetyl Cystein (NAC)

Biotin

Curcumin (dissolved in coconut oil)

Resveratrol

Potaba (PABA)

----

Potaba is quite an old treatment and can be tough for some people to tolerate (while others are fine). Since it's old there is probably a temptation to say that it's useful, but if you find that you can tolerate it, I don't see why it shouldn't be considered. A guy here was on the PAV cocktail with potabo replacing the pentox, and in combination with the VED he experienced some success.

[sunsetsonfire]

Wow, thanks Newguy and George999.  Very useful information indeed!  I appreciate the time spent replying.

Looks like the Pentox is a "must", and will be my main push with my urologist.  In another thread there are links to studies that look very favorably upon the Pentox as helping with Peyronies, and I will show those to him.

I didn't realize that the l'arginine was over the counter.  Doing a google search I see where I can go around the corner tomorrow and pick some up from Walgreens.  Conversely, the trapozone I mentioned seems to do basically the same thing (nocturnal erections), but would - like the Pentox - require a prescription.  And since I'm already going to be pushing for the Pentox, I don't think I should have a list of things I want him to prescribe for me (unless he seems open to a lot of these things).  I might be easier to push for one thing at a time to not overwhelm him, so I'll go with the l'arginine.

The potaba sounds interesting in that its description mentions its use for peyronies and how it softens plaque.  But it would be important to go over my meds with the doc as it seems to have a tendency to interact with stuff.

Thanks for the advice!

[George999]

The potaba sounds interesting in that its description mentions its use for peyronies and how it softens plaque.  But it would be important to go over my meds with the doc as it seems to have a tendency to interact with stuff.

You would be able to easily get a prescription for Potaba from your doctor.  It IS the FDA approved treatment for Peyronie's.  It is also:

1)  Far MORE expensive than Pentox.
2)  Far MORE difficult to take than Pentox.
3)  Far MORE prone to side effects than Pentox.
4)  Far MORE prone to serious adverse reactions than Pentox.
5)  Far LESS effective than Pentox.

The choice should be obvious.  Fight for Pentox.

- George

[alexk]

Heart disease is very common; Peyronie's is not.

First of all, how can you say that for sure? The statistics don't necessarily present a true picture of prevalance, because many men refuse to go to the doctor for anything, much less a big dent in their you-know-what.

Second, heart disease is just one manifestation of cardiovascular disease. Perhaps the semantics are getting confused here. If you look at everyone's favorite website, Wikipedia (http://en.wikipedia.org/wiki/Cardiovascular_disease) you will see some familiar issues: high levels of fibrinogen and inflammation, leading to buildup of plaque.

All I mean by the term "cardiovascular disease" is that something has gone wrong with the blood vessels. That doesn't have to happen everywhere in your body at once. Some people get lesions in their brain, some get them in their heart, others get them between the legs.

What I'm proposing is that Peyronie's is atherosclerosis of the penis. The descriptions of many people on this board, who refer to encircling fibrotic lesions that run circumferentially around the shaft, match up pretty closely with a diagram of the penile arteries that I posted on another thread. If you have many lesions it's possibly because the upstream vasculature is compromised.

The many metabolic markers for cardiovascular disease play into this theory: if you get an injury and you already have a compromised vasculature, and you don't have the raw materials needed for repairing blood vessels property, the wound will heal imperfectly as a big mass of fibrin and scar tissue. This is the body's version of duct tape.

[alexk]

Anything else that one can recommend for breaking up plaque or just general circulatory health?  I should mention that improving my circulation might be a good idea overall as I've always felt my circulation was awful (I'm like a reptile, when the weather is even SLIGHTLY cold my hands and feet are like icebergs, even if I wear gloves and socks an inch thick).

I wonder if you have Raynauds (http://en.wikipedia.org/wiki/Raynaud's_phenomenon). If so, all the more reason to make sure that you do everything you can to increase circulation.

Or it could be http://en.wikipedia.org/wiki/Peripheral_vascular_disease, another type of cardiovascular disease. Coincidence?

In my case I can directly relate coronary artery disease (CAD)  to ED.

[alexk]

If forced to make a choice between pentox and vitamin E I would absolutely, without hesitation go with Pentox every single time.

The good thing is that you don't have to decide between these two, you can take both (as long as you're taking full-spectrum vitamin E, anyway).

In this study, you can find more references to the efficacy of Pentox alone versus Pentox + vitamin E (see the Discussion section):

Complete healing of severe osteoradionecrosis with treatment combining pentoxifylline, tocopherol and clodronate
http://bjr.birjournals.org/cgi/content/full/75/893/467

Here's a finding that Vitamin E was more effective than Pentox alone; although they did have a synergistic effect, "pentoxifylline itself had limited efficacy, which was not statistically significant" (I wouldn't take my chances, personally):

Vitamin E protects against the development of radiation-induced pulmonary fibrosis in rats
http://www.ncbi.nlm.nih.gov/pubmed/17433970

And what do you know, here's an article on successful treatment of rodent heart disease with Pentox and Vitamin E:

Studies on Pentoxifylline and Tocopherol Combination for Radiation-Induced Heart Disease in Rats
http://linkinghub.elsevier.com/retrieve/pii/S0360301608038613

Many of the Pentox studies are based on radiation-induced fibrosis... they're treating heart disease and fibrosis with the same oral agents... the results are the same... they couldn't be connected, could they?

[newguy]

The thread appears to have gone off track somewhat. Perhaps any future posts not relating specifically to ' l-arginine at bedtime' should be posted elsewhere. I've moved my latest post here to a new thread.

Alex - Maybe you can create a vitamin E thread in the oral treatments board, as there are your thoughts are very valid. Also, a circulation baed thread in the general section would be useful.

[George999]

[What I'm proposing is that Peyronie's is atherosclerosis of the penis. The descriptions of many people on this board, who refer to encircling fibrotic lesions that run circumferentially around the shaft, match up pretty closely with a diagram of the penile arteries that I posted on another thread. If you have many lesions it's possibly because the upstream vasculature is compromised.

Alex,  You can propose this as many times as you like.  But until you come up with some solid medical evidence for it beyond your own speculation, it is not going to carry a lot of weight with most of us around here.  Where is the research that shows this to be the case?  There IS research showing abnormal TGF-beta1 activity associated with Peyronie's via dissections.  TGF-beta1 is not a circulatory factor, its an immune system factor.  And Pentox just coincidentally inhibits TGF-beta1 which is why many doctors believe it is so effective.  Where are the dissections showing vascular disease?  Where is one published expert opinion showing vascular disease?  There have been a lot of research studies on Peyronie's involving tissue analysis.  Where is the hard evidence?  - George

[Skjaldborg]

Heart disease is very common; Peyronie's is not.

First of all, how can you say that for sure? The statistics don't necessarily present a true picture of prevalance, because many men refuse to go to the doctor for anything, much less a big dent in their you-know-what.

http://www.mayoclinic.com/health/heart-disease/DS01120:
The term "heart disease" is often used interchangeably with "cardiovascular disease" — a term that generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as infections and conditions that affect your heart's muscle, valves or beating rhythm also are considered forms of heart disease.

Heart disease is the No. 1 worldwide killer of men and women, including in the United States. For example, heart disease is responsible for 40 percent of all the deaths in the United States, more than all forms of cancer combined. Many forms of heart disease can be prevented or treated with healthy lifestyle choices and diet and exercise.

So, since one out of every three Americans will die from heart/cardiovascular disease, it is therefore very common. Regarding Peyronie's disease, no studies have linked it to heart disease. If it were linked with heart disease, then thousands of men would be diagnosed with Peyronie's symptoms. Even if many of those men were reluctant to speak up, you would still have many, many, many more men diagnosed with Peyronie's than the current estimate of 5%-9%. Furthermore, we do know that Peyronie's is linked to Dupuytren's contracture and Lederhose's disease. Therefore, if cardiovascular disease caused Peyronie's, we would see huge spikes in Dupuytren's and Lederhose's disease because men would report these.

And for emphasis: I have Peyronie's. I do NOT have cardiovascular disease.  Cardiovascular disease does not even run in my family (all grandparents lived past 80, my maternal grandma lived to be 96). I am 30 years old, 5' 11'' tall, weigh 156 pounds, run 4-5 days a week and eat healthy. I have normal blood pressure and a very low resting heart rate. I have good erectile functioning, which is not common with severe heart disease. Plaque in the blood vessels is different from scar tissue in the tunica. The biological mechanisms that occur in each case are very different. Also, Peyronie's lesions are concentric circles in many cases because they follow the shape of the tunica, which is cylindrical. They don't "match up" to the blood vessel structure as you claim.

With all due respect alexk, unless you are an MD or a medical researcher with access to information that we are not privy to, I don't believe you have a good grasp of the facts.

-Skjald

[Jackieo]

Skjaldborg:
Well written, well presented information.  I, too, considered the fact that heart disease and Pyronie's were related...to the point that I had an EBT (Heart Scan) last year.  My EBT score was 39.  That puts me at the low-end (2 percentile) for a heart event (I am 57, 180#, 6'-0", and like you I run 4 to 5 times a week).
My partner, OTO, has a EBT score of 600+ which is 93%+ on the heart event scale.
We are on the Healthy Heart Diet and are thankful to both the PDS Forum as well as the Track-Your-Plaque Forum.
I happen to think that, regardless of the relation between various plaques, it appears that lifestyle is key to healthy living:  diet (food and supplements) and exercise.
JackieO

[newguy]

A couple of years old, but of interest.

AIMS
Oral L-arginine supplementation has been used in several studies to improve endothelium-dependent, nitric oxide (NO)-mediated vasodilation. L-Arginine treatment is hampered by extensive presystemic elimination due to intestinal arginase activity. In contrast, L-citrulline is readily absorbed and at least in part converted to L-arginine. The aim of our study was to assess this metabolic conversion and its subsequent pharmacodynamic effects.

 
METHODS
In a double-blind, randomized, placebo-controlled cross-over study, 20 healthy volunteers received six different dosing regimes of placebo, citrulline, and arginine. Pharmacokinetic parameters (Cmax, Tmax, Cmin, AUC) were calculated after 1 week of oral supplementation. The ratio of plasma L-arginine over asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase (arginine/ADMA ratio), urinary cyclic guanosine monophosphate (cGMP) and nitrate excretion rates, and flow-mediated vasodilation (FMD) was measured to assess pharmacodynamic effects.

 
RESULTS
L-Citrulline dose-dependently increased AUC and Cmax of plasma L-arginine concentration more effectively than L-arginine (P < 0.01). The highest dose of citrulline (3 g bid) increased the Cmin of plasma L-arginine and improved the L-arginine/ADMA ratio from 186 ± 8 (baseline) to 278 ± 14 [P < 0.01, 95% confidence interval (CI) 66, 121]. Moreover, urinary nitrate and cGMP were increased from 92 ± 10 to 125 ± 15 µmol mmol−1 creatinine (P = 0.01, 95% CI 8, 58) and from 38 ± 3.3 to 50 ± 6.7 nmol mmol−1 creatinine (P = 0.04, 95% CI 0.4, 24), respectively. No treatment improved FMD over baseline. However, pooled analysis of all FMD data revealed a correlation between the increase of arginine/ADMA ratio and improvement of FMD.

 
CONCLUSION
Our data show for the first time that oral L-citrulline supplementation raises plasma L-arginine concentration and augments NO-dependent signalling in a dose-dependent manner.

[Tim468]

Do you have a title or NHLBI reference?

Thanks, Tim

[newguy]

Do you have a title or NHLBI reference?

Thanks, Tim

http://cat.inist.fr/?aModele=afficheN&cpsidt=19984543


Plus I found some more interesting studies:

Cardiovasc Drug Rev. 2006 Fall-Winter;24(3-4):275-90.
Therapeutic use of citrulline in cardiovascular disease.
L-citrulline is the natural precursor of L-arginine, substrate for nitric oxide synthase (NOS) in the production of NO. Supplemental administration L-arginine has been shown to be effective in improving NO production and cardiovascular function in cardiovascular diseases associated with endothelial dysfunction, such as hypertension, heart failure, atherosclerosis, diabetic vascular disease and ischemia-reperfusion injury, but the beneficial actions do not endure with chronic therapy. Substantial intestinal and hepatic metabolism of L-arginine to ornithine and urea by arginase makes oral delivery (or l-arginine) very ineffective. Additionally, all of these disease states as well as supplemental L-arginine enhance arginase expression and activity, thus reducing the effectiveness of L-arginine therapy. In contrast, L-citrulline is not metabolized in the intestine or liver and does not induce tissue arginase, but rather inhibits its activity. L-citrulline entering the kidney, vascular endothelium and other tissues can be readily converted to L-arginine, thus raising plasma and tissue levels of L-arginine and enhancing NO production. Supplemental L-citrulline has promise as a therapeutic adjunct in disease states associated with L-arginine deficiencies.
http://www.ncbi.nlm.nih.gov/pubmed/17214603

A study in humans has shown that oral administration of L-citrulline at 3.8 g/m2 body
surface, resulted in a 227% peak increase in plasma L-arginine levels at 4 h, compared
with a 90% peak increase with the same dose of L-arginine (43). Furthermore, the area
under the curve plot of L-arginine plasma concentration vs. time was 3 fold larger for L-
citrulline, and the elevation in L-arginine levels was more persistent following L-citrulline
administration. Thus, acute oral administration of L-citrulline appears to be considerably
more efficient raising plasma levels of L-arginine than L-arginine itself. Additionally, a
recent study in children and young adults showed that five oral doses of L-citrulline every
12 hours (1.9 g/m2/dose) for a total dose of 9.5 g/m2 resulted in 57 and 85% increases in
mean plasma levels of L-arginine and L-citrulline, respectively (78). - http://jtcs.ctsnetjournals.org/cgi/reprint/132/1/58.pdf

For the final study, I found the text above and ha to search for the actual study. The pdf is a fairly large document called "Nitric oxide precursors and congenital heart surgery" and it appears to backup the above claims.

[Iceman]

so what does this mean with larginine for those of us who are not doctors and who dont fully understand that document - do we keep taking it or what? ive just ordered another 4 bottles of it

[newguy]

so what does this mean with larginine for those of us who are not doctors and who dont fully understand that document - do we keep taking it or what? ive just ordered another 4 bottles of it

I have loads of l-arginine too . I'm just toying with the prospect that l-citrulline may be as, if not more useful at raising NO levels. By all means keep taking the l-arginine you have.

[Tim468]

Well, the studies show that L-arginine will raise the levels of serum arginine too. However, the question is does it stimulate arginase, and by that collagen products and by-products. That seems to be the implication. Since L-Arginine has dual fates (arginase to collagen and proline; versus NO synthase to NO - a BIG difference in fate!), I think the more important factoid is that it "does not induce tissue arginase".

Right now I have about 500 gm of L-arginine sitting on my shelf.

Tim

[newguy]

Well, the studies show that L-arginine will raise the levels of serum arginine too. However, the question is does it stimulate arginase, and by that collagen products and by-products. That seems to be the implication. Since L-Arginine has dual fates (arginase to collagen and proline; versus NO synthase to NO - a BIG difference in fate!), I think the more important factoid is that it "does not induce tissue arginase".

Right now I have about 500 gm of L-arginine sitting on my shelf.

Tim

Yes, perhaps the safer option would be to take l-citrulline. Either that or with l-arginine be sure to take Norvaline to block arginase activity.  

[newguy]

L-Arginine Supplementation in Peripheral Arterial Disease

No Benefit and Possible Harm
Andrew M. Wilson, MBBS, PhD; Randall Harada, MD; Nandini Nair, MD, PhD; Naras Balasubramanian, PhD; John P. Cooke, MD, PhD From the Division of Cardiovascular Medicine (A.M.W., R.H., N.N., J.P.C.) and Department of Biostatistics (N.B.), Stanford University School of Medicine, Stanford, Calif.

Correspondence to John P. Cooke, MD, PhD, Division of Cardiovascular Medicine, Stanford University Medical Center, Falk Cardiovascular Research Institute, 300 Pasteur Dr, Stanford, CA 94305. E-mail john.cooke@stanford.edu

Received December 20, 2006; accepted May 3, 2007.

Background— L-Arginine is the precursor of endothelium-derived nitric oxide, an endogenous vasodilator. L-Arginine supplementation improves vascular reactivity and functional capacity in peripheral arterial disease (PAD) in small, short-term studies. We aimed to determine the effects of long-term administration of L-arginine on vascular reactivity and functional capacity in patients with PAD.

Methods and Results— The Nitric Oxide in Peripheral Arterial Insufficiency (NO-PAIN) study was a randomized clinical trial of oral L-arginine (3 g/d) versus placebo for 6 months in 133 subjects with intermittent claudication due to PAD in a single-center setting. The primary end point was the change at 6 months in the absolute claudication distance as assessed by the Skinner-Gardner treadmill protocol. L-Arginine supplementation significantly increased plasma L-arginine levels. However, measures of nitric oxide availability (including flow-mediated vasodilation, vascular compliance, plasma and urinary nitrogen oxides, and plasma citrulline formation) were reduced or not improved compared with placebo. Although absolute claudication distance improved in both L-arginine- and placebo-treated patients, the improvement in the L-arginine-treated group was significantly less than that in the placebo group (28.3% versus 11.5%; P=0.024).

Conclusions— In patients with PAD, long-term administration of L-arginine does not increase nitric oxide synthesis or improve vascular reactivity. Furthermore, the expected placebo effect observed in studies of functional capacity was attenuated in the L-arginine-treated group. As opposed to its short-term administration, long-term administration of L-arginine is not useful in patients with intermittent claudication and PAD.

- http://www.ncbi.nlm.nih.gov/pubmed/17592080

Hmm, this one isn't too promising.

[newguy]

Br J Nutr. 2008 Apr;99(4):855-62. Epub 2007 Oct 22.Click here to read Links
Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: the Citrudose pharmacokinetic study.

Previous experimental studies have highlighted that citrulline (CIT) could be a promising pharmaconutrient. However, its pharmacokinetic characteristics and tolerance to loading have not been studied to date. The objective was to characterise the plasma kinetics of CIT in a multiple-dosing study design and to assess the effect of CIT intake on the concentrations of other plasma amino acids (AA). The effects of CIT loading on anabolic hormones were also determined. Eight fasting healthy males underwent four separate oral loading tests (2, 5, 10 or 15 g CIT) in random order. Blood was drawn ten times over an 8 h period for measurement of plasma AA, insulin and growth hormone (Gh). Urine samples were collected before CIT administration and over the next 24 h. None of the subjects experienced side effects whatever the CIT dose. Concerning AA, only CIT, ornithine (ORN) and arginine (ARG) plasma concentrations were affected (maximum concentration 146 (sem to 303 (sem 11) micromol/l (ARG) and 81 (sem 4) to 179 (sem 10) micromol/l (ORN); time to reach maximum concentration 1.17 (sem 0.26) to 2.29 (sem 0.20) h (ARG) and 1.38 (sem 0.25) to 1.79 (sem 0.11) h (ORN) according to CIT dose). Even at high doses, urinary excretion of CIT remained low ( < 5 %). Plasma insulin and Gh were not affected by CIT administration. Short-term CIT administration is safe and well-tolerated. CIT is a potent precursor of ARG. However, at the highest doses, CIT accumulated in plasma while plasma ARG levels increased less than expected. This may be due to saturation of the renal conversion of CIT into ARG

- http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1789836

This could start to give us an idea of potential dosing of l-citrulline.

[despise]

I am currently on lexapro, a ssri for depression and anxiety. Would taking trazadone with this effect my medication because it is another anti depressent? What's better, trazadone or l-arginine for nocturnal errections? I have noticed that I don't have nocturnal erections when I obviously should =P So I'm trying to figure out what would be the best way to go, any help would be greatly appreciated!

[Skjaldborg]

Despise,

I would really recommend speaking with your prescribing physician or pharmacist. They are the ones who have the training and knowledge regarding mixing medications. You have to be very careful when it comes to prescription drugs.

Best,

Skjald

[despise]

Despise,

I would really recommend speaking with your prescribing physician or pharmacist. They are the ones who have the training and knowledge regarding mixing medications. You have to be very careful when it comes to prescription drugs.

Best,

Skjald

Ok thank you =] Do you know how big of a doze of trazadone I should get if its safe? I remember hearing you want to get only a small dose because the side effects of erections still occurs. I'm still not sure what has produced stronger errections for most people, trazadone or l-arginine, I think I remember hearing trazadone gave excellent benefits.

[Bart2]

Hey guys,

I also asked this in a pentox thread so I am repeating this here. For those on L-ARG or on it before, how much did you guys pay for monthly prescriptions? Or how much did it cost over the 6 month span for you?

I would also like to ask here for those who could also comment the same thing about pentox I would greatly appreciate it as these are my two prescriptions which I have not purchased yet and just would like to ballpark how much I would need to pay for them. Thanks,

Bart