Adverse effects associated with arginine α-ketoglutarate containing supplements

Abstract

<jats:p> The athletic performance supplement industry is a multibillion-dollar business and one popular category claims to increase nitric oxide (NO) production. We report three patients presenting to the emergency department with adverse effects. A 33-year-old man presented with palpitations, dizziness, vomiting, and syncope, after the use of NO<jats:sub>2</jats:sub> platinum. His examination and electrocardiogram (ECG) were normal. The dizziness persisted, requiring admission overnight. A 21-year-old man with palpitations and near syncope had used a "nitric oxide" supplement. He was tachycardic to 115 bpm with otherwise normal examination. Laboratory values including methemoglobin, and ECG were unremarkable. He was treated with 1 L of saline with no change in heart rate. He was admitted for observation. A 24-year-old man presented after taking NO-Xplode with palpitations and a headache. His examination, laboratory values, and ECG were normal. He was discharged. The purported active ingredient in these products is arginine α-ketoglutarate (AAKG), which is claimed to increase NO production by supplying the precursor L-arginine. The symptoms could be due to vasodilation from increased levels of NO, though other etiologies cannot be excluded. AAKG containing supplements may be associated with adverse effects requiring hospital admission. </jats:p>

Influence of Xpand Nitric Oxide Reactor, L-Arginine Alpha-Ketoglutarate, and Caffeine Supplementation on Calf Muscle Re-Oxygenation During and after Acute Resistance Exercise

“…Moreover, there were no significant differences between subjects for each of these measures ( Table 1). In addition, three subjects reported side effects such as itchy skin, nausea, tachycardia, and flushed face, which has also been previously reported [24]. Subjects reported that these symptoms distracted them mostly during the 45 minute pre-exercise period (since they were required to sit still), and that they were hardly noticeable during the exercise and did not adversely affect their exercise performances.…”

Acute L-arginine alpha ketoglutarate supplementation fails to improve muscular performance in resistance trained and untrained men

“…In this regard, a recent paper reported that individuals had experienced adverse side effects following ingestion of nitric oxide stimulator supplements [39]. However, other investigators (as in the current study) have reported that acute ingestion of AAKG ingestion appears to be safe and well tolerated in healthy subjects [13].…”

Renal Failure in a Soldier Taking N.O.-Xplode

“…Since 2009 there have been several reported cases of adverse outcomes linked to N.O.-Xplode, including a case series of 12 patients with mild to moderate hepatitis, 6 one case of ischemic colitis, 7 and one case of palpitations and headache. 8 The patient presented here is the first documented case of renal failure in someone taking N.O.-Xplode. Even after a pattern of adverse outcomes, N.O.-Xplode remains available to the public and carries no safety warnings.…”

“…The previous cases associating N.O.-Xplode with side effects or organ dysfunction focused on nitric oxide and its precursors, L-arginine and arginine ␣-ketoglutarate, because of their vasodilatory effects and effect on hemodynamics. 7,8 While supplemental nitric oxide may have caused palpitations, headache, and ischemic colitis in previous cases, it probably cannot be blamed for renal failure. Rather, nitric oxide is thought to be renally protective.…”