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Ihtresearch.com

NITROCUT SUBJECTS' INFORMED CONSENT
TITLE: Evaluation of the Safety and Efficacy of a Dietary Supplement ("Nitrocut" ) Designed to
Improve Strength and Lean Body Mass IRB PROTOCOL # _

SPONSOR: Nitrocut LLC, 4780 Ashford Dunwoody Road, A336, Atlanta. GA. 30338

INVESTIGATORS: Gilbert R. Kaats, PhDa; Harry G. Preuss, MDb; Larry K. Parker, Sr, MDc
aIntegrative Health Technologies, Inc. San Antonio, TX, 78209
bProfessor of Medicine, Departments of Biochemistry, Physiology, Medicine and Pathology,
Georgetown University Medical Center, Washington, D.C. 20057
cWomen's Total Healthcare, 315 East Mulberry Street, Angleton, TX 77515

SITE(S): Integrative Health Technologies, Inc., 5170 Broadway, Suites 1, 2 & 5, San Antonio, Texas 78209

STUDY-RELATED PHONE NUMBER(S): Gilbert R. Kaats, Ph.D., 210-824-4200
Mike Gale, (Study Coordinator): 210-824-4200, 210-275-9173 (24 hours)
The Purpose of this study. This study is designed to examine whether or not taking the four veggie
capsules a day of the dietary supplement "Nitrocut" described below will improve body composition
by increasing lean body mass (muscle and bone) without adverse effects or discomfort. Nitrocut is
considered a food supplement, is not a drug or pharmaceutical product and cannot prevent, militate,
mitigate or cure diseases. The main ingredient in Nitrocut is L-Arginine, a protein amino acid. The
Supplement Facts are provided below.
The individual daily serving amounts for the last four ingredients are as follows:

Fenugreek Extract (50% Saponin) (Trigonella foenum-gracum) (Seeds)….40 mg
Tribulus Terrestris (20% Saponis) (Puncture vine) (Fruit)……………….………40 mg
Tongkat Ali Extract (Eurycoma longifolia) (Roots)……………………………………10 mg
Oat Straw Extract 10:1 (Avena sativo) Straw)……………………….……………….10 mg
What is L-Arginine? L-arginine is often marketed as "nitro oxide" but, it is actually an amino acid that
is one of the building blocks of protein. It acts as a precursor of the gas nitric oxide produced by the
body for protein syntheses. This reaction occurs in neurons in the immune system where Nitric Oxide
acts as a defense mechanism in endothelial cells that line the blood vessels and arteries. Under normal
conditions, nitric oxide is released in blood vessels to allow more blood to flow through to the muscles
by relaxing the smooth muscle cells in the vessels—a process called vasodilation. It is thought that this
relaxation allows more protein in the blood to flow through the arteries to the muscles aiding in
workout and recovery, thus supporting the buildup of muscle tissue. (For more details, see Attach 8,9
and 10.)
If you participate, you will be required to complete the tests and questionnaires on the study days
indicated below and as described:
 DEXA Body Composition Test (Baseline & Ending) [Atch 1]
 48-Measurement Blood Chemistry Test (Baseline & Ending) [Atch 2]
 Self-reported Quality of Life Questionnaires (Baseline, & Ending) [Atch 3]
 Ankle-Brachial Blood Pressure Measurements (Baseline & ending) [Atch 4]
 Tracking/graphing program for daily step totals (daily) [Atch 5]
 IGRIP Isometric Upper-body Strength measurement (Baseline & Ending) [Atch 6]
 Hand Dynamometer Grip Strength Meter (Baseline and Ending) [Atch 7]
 How Clinical Research Studies Benefit Patients [Atch 8]
 Mayo Clinic on L-Arginine [Atch 9]
 Arginine: Heart Benefits and Side Effects [Atch 10]
 How Much Do You NO (Nitric Oxide)? [Atch 11]

Summary of Requirements: If you choose to enroll in the study, you agree to adhere to the procedures for
taking the dietary/food supplement on the product label and:
□ Complete all baseline and end-of-study tests described above, □ Wear the pedometer and record daily step totals as per instructions, □ Take the two capsules twice a day (two at least 45 minutes before workout), and □ Complete an end-of-study critique. Potential Risks: Although the ingredients used in this product are considered "generally regarded as safe"
(GRAS) by the U.S. Food and Drug Administration, there is always a chance of adverse reactions to the product.
Since this is a new and untested product, we have inadequate information about the potential risks, allergic or
other symptomatic reaction to product. Although we have no data suggesting taking L-arginine would cause
such common effects as nausea, headache, and stomach upset, these effects are sometimes
experienced with any change in diet. However, be very cautious about attributing these effects to the
product and ignoring other possibilities that your healthcare provider should address. Although you need
to check with your healthcare provider prior to your involvement in the study, it is unlikely he/she will have
sufficient knowledge of effects of an unknown and untested product. Therefore, to provide your healthcare provider with additional information and for your own knowledge, Atch 9-10 (see above) have been included. If you experience any allergic-like or other adverse effects at any time during this study, you should discontinue product use, notify the researchers, and contact your medical care provider immediately. We are asking you to check with your healthcare provider before participating in the study. However, it is unlikely that your healthcare provider will be familiar with the research on L-Arginine so we have attached reviews from the Mayo Clinic and Webb MD. and copies of other research studies should he/she or you wish further information on potential risks. Benefits:
□ You will receive a 60-day supply of the supplement (There are no placebos used in this study); □ You will receive two comprehensive blood chemistry tests—a total value of $900; □ You will receive two DEXA Body Composition Test—a total value of $400; □ You may be entitled to participate in future studies, including a possible extension of this study; □ Since the product is designed to improve body composition, your participation will provide important scientific information that may be beneficial to others [See Atch 8].
In order to participate, you must:
 be an English-speaking male or female at least 18 years of age;  agree to follow the requirements of the study as set forth in this Informed Consent;  agree to withdraw from the study if you become pregnant during the study You cannot participate if you:
 Do not speak English
 Are under 18 years of age
 Are pregnant or nursing
 Are diabetic
 Have uncontrolled hypertension
 Had major surgery two weeks prior to enrolling
 Are undergoing infertility treatment
 If you are a male with BPH
 Known cardiovascular disease
 Had a bypass or now have a stent
 Your physician recommends against participation
 Women who are on estrogen therapy.
NOTE: Since this is a new and untested product there may be other problems that would exclude your
participation about which we are unaware.

Study Procedures: A Checklist for Participation. If you meet the eligibility requirements for inclusion in the
study and wish to be a participant, PLEASE INITIAL each of the steps listed below in order to ensure you
understand requirements for participation.
1. I meet the inclusion/exclusion criteria set forth above 2. _ I have read this Informed Consent, the additional information on the website and have met with the research coordinator to ensure I understand what will be expected of me. 3. _ I acknowledge that I have had the opportunity to review this Informed Consent with my physician or healthcare provider to ensure that I have no medical conditions that would prevent my participation. 4. I am willing to participate in this study and acknowledge that upon signing this informed consent, I will be enrolled as a participant. 5. The study materials and supplement will be provided at no cost. 6. I will complete all required tests shown below. 7. No later than 3 days after the end of each study day, I will record my daily step totals for each day, how much product I took each day, and any adverse effects I think are attributable to the product. 8. I will visit the Research Center at the end of 60 days to complete all study questionnaires 9. I agree to fast for at least 10 hours prior to having my blood drawn at the Quest drawing station of my
choosing within 5 DAYS OF STARTING AND NO LATER THAN FIVE DAYS AFTER COMPLETING the study.
Payments for Testing: Upon completing all study requirements, you can receive up to $120 for recording your
product usage and daily step totals within 3 days after each study day.

Participant Time Involved: The total time required for the study is approximately 10 hours over the 60-day study
period. This time includes completion of the Informed Consent Form, meeting with the research coordinator,
completion of all of the required tests and questionnaires, on-line reporting, study critique, travel and wait
times.
Unknown effects: Although there are no known adverse effects from the supplement, you are asked to review
your participation with your personal physician to insure you have no medical conditions that would prevent
your participation. NOTE: Since this is a new and untested product there may be other effects about which
we are unaware. Therefore, if you have any adverse effects you should check with your healthcare provider
to see if your adverse effects are attributable to something else other than the product.
New Findings: During the study, you may be provided with any important new findings about the study
supplements. You may use this information in your decision to continue in the study.
Alternatives to Participation: This study is for research purposes only and your participation is voluntary.
In Case of Research Related Injury: Neither Integrative Health Technologies, Inc. nor the study sponsor will
provide medical services or financial assistance for injuries or other medical conditions that might occur because
you are taking part in this research.
Legal Rights: You do not waive any of your legal rights by signing this document.
Confidentiality: All data acquired in this study will be accorded the confidentiality as set forth in the Health
Insurance Portability and Accountability Act of 1996 for Research (HIPPA) Form, "Authorization (Permission)
to Use or Disclose (Release) Protected Health Information, that you are required to sign.
Whom to Contact: Contact Mike Gale at 210-824-4200 or 210-275-9173 (24 hours) if:
 you have any questions about your participation in this study,
 at anytime you feel you have had an adverse reaction to the study supplement,
 you have questions, concerns or complaints about the research
If you have questions about your rights as a research subject or if you have questions, concerns or complaints about the research, you may contact Solutions IRB. Solutions IRB is an OHRP approved board of medical and lay people who will conduct an independent review of this research to ensure the risks to which you will be exposed and the benefits you receive are explicitly stated and are not excessive. You may reach them ator call 1-855-226-4472 if the research staff cannot be reached or if you wish to talk to someone other than the research staff. Voluntary Participation: Your participation in this study is voluntary. You may decide not to leave the study at
any time. Your decision will not result in any penalty or loss of benefits to which you are entitled. If you have
any questions about the research study, tests, supplements, your rights as a participant, or if you wish to
withdraw from the study, contact Dr. Kaats or the research coordinator at (210) 824-4200. Your participation in
this study may be stopped at any time by your physician or healthcare provider without supporting information.
Participation may also be stopped by the study's principal investigator upon receipt of information that either
the product has unexpected adverse effects or that changes in the study protocol are inconsistent with
information provided to you in this Informed Consent. Notwithstanding these conditions, this Consent Form is
the sponsor's agreement to provide all services listed in this form including all tests and payment of the tracking
fees testing within 30 days of receipt of all ending test data.
HIPAA Authorization (Permission) to Use Protected Health Information (PHI) for Research
Study Title: Evaluation of the Safety and Efficacy of a Dietary Supplement ("Nitrocut" ) Designed to
Improve Strength and Lean Body Mass. Principal Investigator: Gilbert R. Kaats, PhD
1. What is the purpose of this form?
This form is required by the Health Insurance Portability and Accountability Act of 1996. Specifically the privacy regulation (HIPAA) permits the research investigators listed above to use and disclose health information about you for the research study identified above which has been approved by the Solutions Institutional Review Board. Researchers would like to use your protected health information for research. The elements of protected health information as defined by HIPAA are: Data Elements for Protected Health Information (PHI)
 Names  All geographic subdivisions smaller than a state (except for the first 3 digits of the zip code in some  All elements of dates (except year) for dates directly related to an individual (e.g., birth date, admission date, discharge date, date of death) and all ages over age 89 and dates indicative of that age  Telephone numbers  Fax numbers  E-mail addresses  Social security numbers  Medical record numbers  Health plan beneficiary numbers  Account numbers  Certificate/license numbers  Vehicle identifiers and serial numbers, including license plate numbers  Device identifiers and serial numbers  Web Universal Resource Locators (URL)  Internet Protocol (IP) addresses  Biometric identifiers, including finger and voice prints  Full face photos and any comparable images  Any other unique identifying number, characteristic, or code 2. What protected health information do the researchers want to use? The researchers want to use the
results of the tests that you will complete in conjunction with participation in this study. Personal identifiers will be removed from your test results which will not be released to anyone or any agency without your written permission.  information about other medical conditions that may affect your participation;  DEXA x-rays;  short-term information about your general health status and,  data derived from blood samples that will be collected from you. No informed consent will be shared with anyone without your written consent. 3. Why do the researchers want my protected health information? The researchers will collect your protected
health information and use it if you enter this research study.

4. Who will be able to use my protected health information? The researchers will use your health information
for research. All names and personal identifiers will be removed from any forms or tests you complete as part
of this research. Your personal data will not be provided to the Sponsor or anyone else without your written
permission.

5. How will information about me be kept private? The researchers will keep all patient information private to
the extent possible, even though the researchers are not required to follow the federal privacy laws. Only
researchers working with the study will have access to your information. The researcher will not release
personal health information about you to others without your written permission.
6. What happens if I do not sign this permission form? If you do not sign this permission form, you will not be
able to take part in the research study for which you are being considered.
7. If I sign this form, will I automatically be entered into the research study? No, you cannot be entered into
any research study without further discussion and separate consent. After discussion, you may decide to take
part in the research study. At that time, you will be asked to sign a specific research consent form. Treatment
by your physician will not be affected by whether you provide authorization for the requested use or
disclosure except if your treatment is related to research.
8. What happens if I want to withdraw my permission? You can change your mind at any time and withdraw
your permission to allow your protected health information to be used in the research. If this happens, you
must withdraw your permission in writing. Beginning on the date you withdraw your permission, no new
protected health information will be used for research. However, researchers may continue to use the
protected health information that was provided before you withdrew your permission. If you sign this form
and enter the research study, but later change your mind and withdraw your permission, you will be removed
from the research study at that time. To withdraw your permission, please contact the person below. He/she
will make sure your written request to withdraw your permission is processed correctly.
Contact Name:
Gilbert R Kaats, PhD Contact Address:
5170 Broadway San Antonio, TX 78209 Contact Phone and FAX:
210-824-4200 FAX:210-390-6142

9. How long will this permission last?
If you agree by signing this form that researchers can use your protected health information, this permission
has no expiration date. However, as stated above, you can change your mind and withdraw your permission at
any time.

10. What are my rights regarding access to my personal health information?
You have the right to refuse to sign this permission form. You have the right to review and/or copy records of
your protected health information kept by the researcher. The researchers will provide you with test reports of
all tests you complete during the study,
Consent: I have read the information in this consent form. All my questions about the study and my
participation in it have been answered. I freely consent to be in this research study. None of my medical
records are being requested for this study.
TITLE: Evaluation of the Safety and Efficacy of a Dietary Supplement ("Nitrocut" ) Designed to
Improve Strength and Lean Body Mass IRB PROTOCOL # _
THE NOTICE OF PRIVACY PRACTICES TELLS YOU HOW INTEGRATIVE HEALTH TECHNOLOGIES USES AND
DISCLOSES INFORMATION ABOUT YOU. WE ARE REQUIRED TO GIVE YOU A NOTICE OF OUR PRIVACY PRACTICES
FOR THE INFORMATION WE COLLECT AND KEEP ABOUT YOU.

I, (PRINT NAME) HAVE BEEN GIVEN A COPY OF INTEGRATIVE
HEALTH TECHNOLOGIES, INC.'S NOTICE OF PRIVACY PRACTICES (HIPAA)

INDIVIDUAL'S SIGNATURE DATE
Please select a user name and a password for on-line access for reporting our data.
Your Name (Please Print Clearly): _ User Name: Password: Mailing Address: _ Zip: _ Signature of Participant Date Telephone Contact
Consent Discussion. I confirm that the research study was thoroughly explained to the subject. I reviewed the
consent form with the subject and answered the subject's questions. The subject appeared to have
understood the information and was able to answer the following questions:
1. What is the purpose of this study?
2. If you decide to be in the study, what will you be asked to do? 3. What is the possible benefit of participating in this study? 4. What are the possible risks of participating in this study? 5. If you decide not to participate in this study, what options do you have? 6. Will participating in this study cost you anything? If so, what will you have to pay for? 7. Do you have to be in this study? 8. If you decide to be in the study, can you leave the study when you want to? 9. What do you need to do in order to be paid the tracking/reporting fees? 10. What options do you have if you decide not to continue in the study? Will you still be paid? Signature of Participant & Date Research Coordinator

Atch 1: DEXA Total Body Test

NOTE: The DEXA Total Body Test is considered the "gold standard" for the assessment of body
composition—Fat-free mass (mostly muscle), body fat and bone mineral density (BMD). This
attachment shows a picture of the measuring equipment, your print-out and the analysis of your fat-
free mass you will receive. A description of the test followed by a review of the safety considerations.

What is a Bone Density Scan (DEXA or DXA)?
Is There a Fracture in Your Future?
By Michael F. Roizen, MD & Mehmet C. Oz, MD
is often called the Rottweiler disease because it chews up your bones fast. And it's sneaky. You won't have a clue that your bones have been quietly getting brittle until you trip over the dog's water bowl and break your wrist or fracture your hip. Getting a clue early enough to do something about it is the whole point of having something called a bone mineral density test, which checks out the sturdiness of your skeleton. Who should have one of these, and when? Age, sex, family, and "it depends" are part of the answer. (Aren't they always?) If bones that snap like toothpicks run in your family (or if you're underweight or you overdo alcohol), you should get your
skeleton scanned by age 50 or earlier. If not, docs urge women to have the test around menopause and definitely by 65. Men
should get it by then, too; osteoporosis doesn't know from sexual discrimination.
No worries about the process. As medical tests go, this one's a gem: It's fast, painless, very safe, and doesn't cost the moon. Figure about 15 minutes for a DXA scan… (DXA or DEXA stands for Dual Energy X-ray Absorptiometry if you like to know these
things). DXA scans are the gold standard for assessing your bones' mineral content and bone density, the most frequently used
measure for bone strength. {NOTE: There are no charges or fees of any kind for subjects participating in this study.}
The following information has been reviewed by a physician with expertise in DEXA testing and was further
reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North
America (RSNA) by physicians with expertise in several radiologic areas.
Bone density scanning, also called dual-energy x-ray absorptiometry (DXA) or bone densitometry, is an enhanced form
of x-ray technology that is used to measure bone loss. DXA is today's established standard for measuring bone mineral
density (BMD). An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical
conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce
pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. DXA is
most often performed on the lower spine and hips. In children and some adults, the whole body is sometimes
scanned. Peripheral devices that use x-ray or ultrasound are sometimes used to screen for low bone mass. In some
communities, a CT scan with special software can also be used to diagnose or monitor low bone mass (QCT). This is
accurate but less commonly used than DXA scanning.
Benefits
 DXA bone densitometry is a simple, quick and noninvasive procedure.
 Considered the "gold standard" for the measurement of body composition (fat, lean and bone)  Provides total and regional measurements of all body composition measurements  Compares the patient's body composition measurements to the reference standard and same aged adults  No anesthesia is required.  The amount of radiation used is extremely small—less than one-tenth the dose of a standard chest x-ray, and less than a day's exposure to natural radiation.  DXA bone density testing is the most accurate method available for the diagnosis of osteoporosis and is also considered an accurate estimator of fracture risk.  DXA equipment is widely available making DXA bone densitometry testing convenient for patients and physicians alike.  No radiation remains in a patient's body after an x-ray examination.  X-rays usually have no side effects in the diagnostic range Risks There is always a slight chance of cancer from excessive exposure to radiation. However, the
benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose from this procedure
is about 0.01 mSv, which is about the same as the average person receives from background radiation
in one day. Women should always inform their physician or x-ray technologist if there is any possibility
that they are pregnant. No complications are expected with the DXA procedure.
A Word About Minimizing Radiation Exposure
Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals. State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure. What are the limitations of DXA Bone Densitometry?
A DXA test cannot predict who will experience a fracture but can provide indications of relative risk. Despite its effectiveness as a method of measuring bone density, DXA is of limited use in people with a spinal deformity or those who have had previous spinal surgery. The presence of vertebral compression fractures or osteoarthritis may interfere with the accuracy of the test; in such instances, CT scans may be more useful. Central DXA devices are more sensitive than pDXA devices but they are also somewhat more expensive. Disclaimer: This information is copied from the Radiology Info Web site (http://www.radiologyinfo.org)
which is dedicated to providing the highest quality information. To ensure that, each section is
reviewed by a physician with expertise in the area presented. All information contained in the Web site
is further reviewed by an ACR (American College of Radiology) - RSNA (Radiological Society of North
America) committee, comprising physicians with expertise in several radiologic areas. However, it is
not possible to assure that this Web site contains complete, up-to-date information on any particular
subject. Therefore, ACR and RSNA make no representations or warranties about the suitability of this
information for use for any particular purpose. All information is provided "as is" without express or
implied warranty. Please visit the RadiologyInfo Web site at http://www.radiologyinfo.org to view or
download the latest information. Note: Images are shown for illustrative purposes. Do not attempt to
draw conclusions or make diagnoses by comparing these images to other medical images, particularly
your own. Only qualified physicians should interpret images; the radiologist is the physician expert
trained in medical imaging. Copyright 2008 Radiological Society of North America, Inc. Send
comments via email to:
In addition to the bone density information discussed above, the Total Body DEXA scan is also
considered the gold standard for the assessment of body fat and fat-free, largely muscle, tissue. Your
test report will also include the following Analysis of your Fat-free mass and body fat.
Atch 2: 48-measure blood chemistry measurements
45 BLOOD CHEMISTRIES THAT WILL BE MEASURED
ABSOLUTE BASOPHILS ABSOLUTE EOSINOPHILS ABSOLUTE LYMPHOCYTES ABSOLUTE MONOCYTES CHOLESTEROL, TOTAL ABSOLUTE NEUTROPHILS NON-HDL CHOLESTEROL eGFR NON-AFR. OR AFR. AMERICAN PLATELET COUNT ALBUMIN/GLOBULIN RATIO EOSINOPHILS ALKALINE PHOSPHATASE RED BLOOD CELL COUNT BUN/CREATININE RATIO TSH W/REFLEX TO FT4 UREA NITROGEN (BUN) WHITE BLOOD CELL COUNT
Atch 3: Self-reported Quality of Life Inventory
Quality of Life Inventory (QOL)
Please report problems occuring over the last 30 days.
0=NOT a problem 1=a MINOR problem 2=a MAJOR problem 3=a SEVERE problem
1 Headaches
ijkl 30 Feeling weak
59 Sleepy throughout the day
2 Irritable bowel syndrome
ijkl 31 Eating too rapidly
60 Difficulty in making decisions
3 Arthritis
ijkl 32 Eating after being full
61 Feeling restless
4 Premenstrual syndrome
ijkl 33 Embarrassed about overeating
62 Getting more tired than usual
5 Recurring sinus infections
ijkl 34 Depressed over eating habits
63 Blaming myself too often
6 Tension fatigue syndrome
ijkl 35 Depressed about my weight
64 Causing problems for others
7 Recurrent anxiety
ijkl 36 Difficult to stop eating
65 Worrying about my faults
8 Recurrent depression
ijkl 37 Worrying about the future
66 Wondering if life is worth living
9 Insomnia
ijkl 38 Unable to concentrate
67 Suicidal thoughts and worries
10 Low self esteem
ijkl 39 Forgetfulness
68 Decreasing interest in people
11 Binge eating
ijkl 40 Bad temper or quick to anger
69 Decreasing interest in activities
12 Chronic tension
ijkl 41 Indigestion
70 Difficulty in sitting/standing still
13 Lack of energy
ijkl 42 Diabetes
71 Often fidgety
14 Food allergies
ijkl 43 Vomiting
72 More tired than usual
15 Feeling under stress
ijkl 44 Heartburn
73 Generalized depression
16 Cancer
ijkl 45 Esophageal reflux
74 Difficulty in finishing activities
17 Prostate problems
ijkl 46 Control over my appetite
75 Feeling sad too much of the time
ijkl 47 Ability to relax
76 Dieting too often
19 Stomach pain
ijkl 48 Heart disease
77 Difficulty in staying with a diet
20 Back pain
ijkl 49 Fibromyalgia
78 Difficulty in getting up in the morning
21 Pain in arms, legs, or joints
ijkl 50 Difficulty in falling asleep
79 Eating too much between meals
22 Menstrual pain or problems
ijkl 51 Awakening during the night
80 Eating too much during meals
23 Chest pain
ijkl 52 Feeling sad
81 Getting tired too often
24 Dizziness
ijkl 53 Waking up too early
82 Preoccupied with gloomy thoughts
25 Diarrhea
ijkl 54 Sleeping too much
83 Thinking too much about death
26 Irregular heartbeat
ijkl 55 Unintentional weight gain
84 Slowing down of my thinking
27 Shortness of breath
ijkl 56 Unintentional weight loss
85 Unhappy too much of the time
28 Constipation
ijkl 57 Inability to concentrate
86 Difficult to stop eating once I start
29 Stomach gas or indigestion
ijkl 58 Satisfied with my life

Atch 4: Ankle-brachial blood pressure index (ABI) and resting heart rate
The ankle brachial pressure index (ABPI is obtained by taking a resting blood pressure measurements of the subject's upper arm and just above the ankle. The ABI is the ratio of thin the ankle compared to the blood pressure in the arms. The ABI is calculated by dividing that the ankle by the systolic blood pressures in the arm to provide a measure of the health of the blood circulatory system. To enhance test-retest reliability, the ABPI will be obtained while you are still lying down on the scanning table after the 15-20 minutes needed to complete the DEXA test. Atch 5: IGRIP Isometric Upper-body Strength measurement

How it Works
While holding the grips in various poses to target specific muscles, apply (push or pull) force for 7 or
more seconds. The result is your body generates the same resistance as when lifting weights, resulting
in fast maturity of the muscle.
Incorporating a static contraction with the IGRIP eliminates the need to perform dozens of reps. The
range of motion is focused directly on the muscle.
Why it Works
Isometric exercise engages the primary muscle as well as secondary muscle fibers to help maintain
resistance during a contraction. Dramatic strength gains can be achieved with this form of exercise
because the force is focused directly on the muscle. This is why so many forms of exercise such as
Pilates, Yoga, Martial Arts, and Weight Lifting incorporate isometrics into their routine.
Atch 6: Hand Dynamometer Grip Strength Meter

Atch 7: Research-quality pedometers

Study participants will wear pedometers during their waking hours and will enter their daily step and
step-equivalent totals each day throughout the study using an on-line tracking/feedback program that
will produce the graphic representation shown below.
Atch 8: How Clinical Research Studies Benefit Patients
Newswise — Clinical research studies are the reason medical care has improved leaps and bounds in the past
few decades. Without these carefully-designed tests for new drugs, procedures or devices, treatments for
diseases would not progress. These studies should be viewed as opportunities, although some people may view
them negatively. "We need to change the view from researching on people to providing opportunities for
people to participate in research," associate dean of clinical research "Clinical research is necessary to advance medical care and is all about trying to further discoveries
to find the best cure for a diseases." Here is what the public should know about clinical studies:

Volunteers do not have to have a specific disease."You don't have to be sick to be in a clinical research study,"
said Terry Novchich, director of "We look for healthy volunteers for
various studies depending on where we are in the development stage of that drug." For example, Novchich said
a new drug may be given to healthy volunteers before it's given to individuals who have that particular disease
to test their reactions, or someone healthy could be studied to compare to someone with a disease.

Clinical studies offer crucial access for patients to cutting edge research. In addition to providing scientists with
information, clinical research studies often allow patients at academic medical centers like Penn State Hershey
access to new and developing therapies that are not otherwise available."A small percentage of the patients in
the United States are treated at places like Penn State Hershey," Thomas said. "A lot of things that we do here
are not offered at places that are not academic and don't have an active research program."

Not all studies are the same. Sometimes studies involve a medication, but others involve a device or new
therapy. Some may be merely observational. "We do a lot of research here where the patient never receives
anything," Thomas said. "They either just give information or they give samples of tissue or blood that allow
scientists to help discover why things happen and then try to target therapies to that specific reason."
A lot of the research studies conducted at the college are not trials at all but studies that lead to discovery.

There's a reason for the experiments. People may fear they or their loved one will be "experimented on."
Novchich and Thomas often hear potential study participants or their parents say they don't want to be a ‘guinea
pig.' "Part of our job is to explain that it's not experimenting on someone just to experiment. It really is trying to
find the best possible treatment for their specific disease," Thomas said. At a teaching hospital, each case is
looked at as a learning opportunity to advance treatment and care for the next patient. "A lot of people say even
if this won't help my child, if it could help the next generation of children that come through with this problem,
then it's worth it."
Safety of participants is paramount. According to Novchich, an independent institutional review board (IRB)
ensures human subject protection during all studies. Patients always must consent to being part of a study, a
process that is monitored locally by the Penn State Hershey IRB and overseen by federal regulations. The
potential risks and the benefits are outlined for each volunteer during a comprehensive consent process by
members of the study team prior to participating in the research study. Additionally, before a drug can be tested
on humans, it often goes through years of development and any studies have to be approved by the Food and
Drug Administration. "They can be assured that the research is being done to answer an important scientific
question and not being done just because we want to do research," Thomas said. "The overarching goal is to
improve the care of the patients that we treat, whether that's the individual patient who is recruited for the
research study or future patients with the same disease process."
Atch 9: Mayo Clinic on L-Arginine
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects. Allergies
Avoid with known allergy or sensitivity to arginine. Symptoms may include rash, itching, or shortness of breath. Arginine is likely safe when taken in levels normally found in foods. Arginine may increase the risk of bleeding. Caution is advised in people with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Arginine may change blood sugar levels. Arginine may cause hyperkalemia (abnormally high levels of blood potassium). Use cautiously in people with impaired kidney function or those at risk for hyperkalemia, including those with diabetes or using drugs that elevate potassium levels, such as potassium-sparing diuretics and potassium supplements. Use cautiously in children and in pregnant women, due to insufficient available evidence and safety data. Avoid with known allergy or sensitivity to arginine. Avoid in doses over 30 grams due to increased risk of toxic effects. Avoid in women with high-risk pregnancies, as, in women with multiple diseases, intravenous arginine resulted in premature delivery, pre-eclampsia, and death in two cases. Arginine may cause low blood pressure. Avoid use in those with low blood pressure or those using blood pressure-lowering agents. Avoid with nitrates and spironolactone as well as in people with pulmonary hypertension, cancer, and those at risk for or with a history of heart attack. Arginine may also cause bloating; diarrhea; hematuria (blood in urine), hives; hormonal changes; increased blood urea nitrogen, serum creatine, and serum creatinine; increased inflammatory response (in people with asthma or cystic fibrosis); leg restlessness, lower back pain; nausea, night sweats and flushing (with arginine withdrawal), numbness (with arginine injection); rash; reduction in hematocrit; severe tissue damage (with arginine injection); stomach and intestine discomfort; systemic acidosis; or venous irritation. In people with heart disease or heart transplants, arginine may cause high white blood cell counts, increased post-heart attack deaths, lack of energy and strength, vertigo, or increased blood pressure. Atch 10: Arginine: Heart Benefits and Side Effects
The below article was extracted from webmd. For more information go to:
L-arginine is POSSIBLY SAFE for most people when taken appropriately by mouth, administered as a shot, or applied to
the skin, short-term. It can cause some side effects such as abdominal pain, bloating, diarrhea, gout, blood abnormalities,
allergies, airway inflammation, worsening of asthma, and low blood pressure.
Special Precautions & Warnings:
Pregnancy and breast-feeding: L-arginine is POSSIBLY SAFE when taken by mouth appropriately for a short-term
during pregnancy. Not enough is known about using L-arginine long-term in pregnancy or during breast-feeding. Stay on
the safe side and avoid use.
Children: L-arginine is POSSIBLY SAFE when used by mouth in premature infants in appropriate doses. However, L-
arginine is POSSIBLY UNSAFE when used in high doses. Doses that are too high can cause serious side effects including
death in children.
Allergies or asthma: L-arginine can cause an allergic response or make swelling in the airways worse. If you are prone to
allergies or asthma and decide to take L-arginine, use it with caution.
Cirrhosis: L-arginine should be used with caution in people with cirrhosis.
Guanidinoacetate methyltransferase deficiency: People with this inherited condition are unable to convert arginine and
other similar chemicals into creatine. To prevent complications associated with this condition, these people should should
not take arginine.
Herpes: There is a concern that L-arginine might make herpes worse. There is some evidence that L-arginine is needed for
the herpes virus to multiply.
Low blood pressure: L-arginine might lower blood pressure. This could be a problem if you already have low blood
pressure.
Recent heart attack: There is a concern that L-arginine might increase the risk of death after a heart attack, especially in
older people. If you have had a heart attack recently, don't take L-arginine.
Kidney disease: L-arginine has caused high potassium levels when used by people with kidney disease. In some cases, this
has resulted in a potentially life-threatening irregular heartbeat.
Surgery: L-arginine might affect blood pressure. There is a concern that it might interfere with blood pressure control
during and after surgery. Stop taking L-arginine at least 2 weeks before a scheduled surgery.
 Medications for high blood pressure (Antihypertensive drugs) interacts with L-ARGININE L-arginine seems to decrease blood pressure. Taking L-arginine along with medications for high blood pressure might cause your blood pressure to go too low. Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.  Medications that increase blood flow to the heart (Nitrates) interacts with L-ARGININE L-Arginine increases blood flow. Taking L-arginine with medications that increase blood flow to the heart might increase the chance of dizziness and lightheadedness. Some of these medications that increase blood flow to the heart include nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat), and isosorbide (Imdur, Isordil, Sorbitrate).  Sildenafil (Viagra) interacts with L-ARGININE Sildenafil (Viagra) can lower blood pressure. L-arginine can also lower blood pressure. Taking sildenafil and L-arginine together might cause the blood pressure to go too low. Blood pressure that is too low can cause dizziness and other side effects. There are plenty of powerful new drugs to help prevent and treat chronic health problems. But we also know that certain may help, as well. Tak for example. Arginine has gotten lots of attention lately for its poten benefits. That's important because, today, about 85.6 million Americans have some form of Deficiencies of arginine are rare. It's abundant in many different types of foods, and your body can also make it. Arginine-rich foods include red meat, fish, poultry, wheat germ, grains, nuts and seeds, and dairy products. But what does arginine do for th and are there potential side effects? Why Do We Need Arginine?
Arginine, also known as L-arginine, is involved in a number of different functions in the body. They include:  Wound healing  Helping thremove waste products from the body  Maintaining immune and hormone function  Dilates and relaxes th As a naturarginine has garnered particular attention for its possible heart benefits. What Are Arginine's Heart Benefits?
In the body, the amino acid arginine changes into nitric oxide (NO). Nitric oxide is a powerful neurotransmitter that helps vessels relax and also improves circulation. Some evidence shows that arginine may help improvflow in the arteries of the heart. That may improve symptoms ofor and However, there currently is no data on how the long-term use of arginine affectsor Since arginine may help arteries relax and improve blood flow, it may also help with There are other potential health benefits with arginine, such as possible reduction ofin some people and improved walking distance in patients with intermittent leg cramping andknown as intermittent claudication. However, the scientific studies are not conclusive enough for experts to make any firm recommendations. Not all studies on arginine have been positive. A 2006 study showed that arginine was not helpful -- and may have been harmful -- for treatingin combination with standard treatment. Is Arginine Supplementation Safe?
In arginine has been used safely with minor side effects for up to three months. Possible side effects include nd and It may also cause a worsening of breathing in people with Arginine may interact with certainthat lower blood pressure. It may also interact with certain heart medications and drugs such as Viagra that treawomen and women who are nursing should not takwithout first talking to their doctor. The following doses have been studied in scientific research:
BY MOUTH:
 For congestive heart failure: doses range from 6-20 grams per day, as three divided doses.  For chest pain associated with coronary artery disease (angina pectoris): 3-6 grams three times per day for up to  For preventing the loss of the effectiveness of nitroglycerin in relieving pain in people with chest pain due to coronary artery disease (angina pectoris): 700 mg four times daily.  For organic erectile dysfunction (ED): 5 grams per day. Taking lower doses might not be effective.  For preventing inflammation of the digestive tract in premature infants: 261 mg/kg added to oral feedings daily for the first 28 days of life. Lis a chemical building block called "an amino acid." It is obtained from the diet and is necessary for the body to make proteins. L-arginine is found in red meat, poultry, fish, and dairy products. It can also be made in a laboratory and used as medicine. L-arginine is used foranvessel conditions includin(CHF), and-arginine is also used for recurrent pain in the legs due to blocked(intermittent claudication), decreased mental capacity in the elderly (sen,(ED), and male Some people use L-arginine for preventing thimprovinfunction after during(pre, improving athletic performance, boosting the immune system, and preventingof the digestive tract in premature infants. L-arginine is used in combination with a number of over-the-counter and prescriptionor various conditions. For example, L-arginine is used along witforwith conventiondrugs for with other amino acids for treatingin people with AIDS; and withand other for reducing infections, improving wound healing, and shortening recovery time after surgery. Some people apply L-arginine to the skin to speed wound healing and for increasingflow to cold hands and feet, especially in people with It is also used as a cream for sexual problems in both men and women. How does it work?
L-arginine is converted in the body into a chemical called nitric oxide. Nitric oxide causes blood vessels to open wider for improved blood flow. L-arginine also stimulates the release of growth hormone, insulin, and other substances in the body.  Chest pain (angina). Taking L-arginine seems to decrease symptoms and improve exercise tolerance and quality of life in people with angina. However, L-arginine does not seem to improve the disease itself.  (ED). Taking 5 grams of L-arginine by mouth daily seems to improve sexual function in men with ED. Taking lower doses might not be effective. However, there is some early evidence that adding 40 mg of Pycnogenol three times daily might improve the effectiveness of low-dose L-arginine for ED.  There is early evidence that taking L-arginine by mouth can reduce blood pressure in healthy people, people with high blood pressure, and people with slightly high blood pressure with or without diabetes.  Inflammation of the digestive tract in premature infants. Adding L-arginine to formula seems to prevent inflammation of the digestive tract in premature infants.  Nitrate tolerance. Taking 700 mg of L-arginine four times daily seems to prevent nitrate tolerance in people taking nitroglycerin for chest pain (angina pectoris).  Leg pain associated with poor blood flow (peripheral arterial disease). Research suggests that taking L-arginine by mouth or intravenously (by IV) for up to 8 weeks increases blood flow in people with peripheral arterial disease. However, long-term use (up to 6 months) does not improve walking speed or distance in people with peripheral arterial disease.  Improving recovery after surgery. Taking L-arginine with ribonucleic acid (RNA) and eicosapentaenoic acid (EPA) before surgery or afterwards seems to help reduce the recovery time, reduce the number of infections, and improve wound healing after surgery.  High blood pressure during pregnancy (pre-eclampsia). Although there are inconsistent results about the effects of L-arginine on pre-eclampsia, most research suggests that it can reduce blood pressure in women with this condition.  Kidney disease. Most early research suggests that taking L-arginine, either by mouth for up to 6 months or intravenously (by IV) for a short time, does not improve kidney function in people with kidney failure or kidney disease.However, taking 1.3 grams of L-arginine by mouth daily seems to improve kidney function and reverse anemia in elderly people with kidney disease-associated anemia.  Heart attack. Taking L-arginine does not seem to help prevent a heart attack. It also does not seem to be beneficial for treating a heart attack after it has occurred. In fact, there is concern that L-arginine might be harmful for people after a recent heart attack. Do not take L-arginine if you have had a recent heart attack.  Wound healing. Taking L-arginine does not seem to improve wound healing.  AIDS-related wasting. Taking L-arginine by mouth, together with hydroxymethylbutyrate (HMB) and glutamine, for 8 weeks seems to increase body weight and improve immune function in people with HIV/AIDS. However, taking 7.4 grams of L-arginine by mouth daily, together with omega-3 faty acids and a balanced nutritional supplement, for 6 months does not improve body weight or fat mass, energy intake, or immune function in people who are HIV-positive.  Altitude sickness. Early research suggests that L-arginine does not reduce altitude sickness.  Anal fissures. There is inconsistent evidence about that effects of L-arginine for treating anal fissures. Applying L- arginine to the skin twice daily for 3 months is less effective than surgery for treating anal fissures. However, applying a topical gel containing L-arginine five times daily for at least 12 weeks might heal anal fissures in people who do not respond to traditional care.  Breast cancer. Early research shows that taking L-arginine before chemotherapy does not improve the response rate in people with breast cancer.  Congestive heart failure. Taking L-arginine by mouth, together with conventional treatment, seems to improve kidney function in people with heart failure. However, it might not improve the ability to exercise, quality of life, or blood circulation. L-arginine should not be used in place of conventional treatment.  Clogged blood vessels (coronary artery disease). Early research suggests that taking L-arginine intravenously (by IV) before exercising can improve blood vessel function in people with coronary artery disease. However, it does not improve blood flow to the heart.  Critical illness (trauma). Research shows that taking L-arginine by mouth with glutamine, nucleotides, and omega- 3 fatty acids reduces the recovery time, need for ventilation, and risk of infections in people who are critically ill. However, it does not reduce the risk of death.  Memory loss (dementia). Early research suggests that L-arginine might improve memory loss related to aging.  Cavities. Early research suggests that using a sugarless mint containing an arginine complex (CaviStat) for one year reduces the number of cavities in molars of children compared with sugarless mints that do not contain arginine.  Sensitive teeth. Early research suggests that using a toothpaste containing arginine, calcium, and fluoride reduces tooth sensitivity when used twice daily.  Diabetes. Taking L-arginine by mouth for one month seems to improve blood sugar control in people with diabetes. L-arginine also seems to improve insulin sensitivity and blood pressure in people with type 2 diabetes.  Diabetic foot ulcers. Early research shows that applying L-arginine to the feet daily can improve circulation in people with diabetes, which might be helpful in preventing diabetic foot ulcers. However, if there is already an ulcer on the foot, injecting L-arginine under the skin near the ulcer does not seem to shorten healing time or lower the chance of needing an amputation in the future.  Nerve damage due to diabetes. Early research suggests that taking L-arginine daily for 3 months does not improve nerve damage related to diabetes.  Muscle problems in the esophagus. Early research suggests that receiving an L-arginine infusion and taking L- arginine by mouth for 6 weeks reduces the number and intensity of chest pain attacks in people with muscle problems in the esophagus and chest pain that is not related to the heart.  Exercise performance. There is inconsistent evidence about the effects of L-arginine on exercise performance. Some evidence shows that taking 6 grams of L-arginine in a drink increases exercise time. However, other evidence suggests that taking L-arginine, alone or together with antioxidants (Niteworks, Herbalife International, Inc), does not improve performance in male cyclists.  Head and neck cancer. Supplementing a feeding tube with L-arginine does not seem to improve immune function, reduce tumor size, or improve healing in people with head and neck cancer.  Coronary artery bypass graft (CABG) surgery. There is mixed evidence about the effects of L-arginine in protecting the heart during CABG. Early research suggests that administering L-arginine intravenously (by IV) helps maintain pressure in the arteries and blood flow in people undergoing CABG. However, it does not reduce complications after surgery or the amount of time spent in the hospital.  Heart transplant. Early research suggests that taking L-arginine by mouth for 6 weeks increases walking distance and improves breathing in people with a heart transplant.  Infertility. There is inconsistent evidence about the effectiveness of L-arginine for infertility. Some early research suggests that taking 16 grams of L-arginine daily increases egg counts collected in women undergoing IVF. However, it does not seem to improve pregnancy rates. Other research suggests that taking L-arginine does not improve semen quality in men with unexplained infertility.  Bladder inflammation. Taking L-arginine by mouth seems to reduce pain and some symptoms of bladder inflammation, although improvements may take 3 months to occur. However, L-arginine does not seem to reduce the need to urinate at night or improve the frequency of urination.  Poor growth of fetus during pregnancy. Early research suggests that taking L-arginine during pregnancy can increase the birthweight of babies who show poor growth while still in their mother's womb. However, L-arginine does not seem to increase birthweight or reduce the risk of the baby dying if the baby has extremely poor growth while in the womb.  Mitochondrial encephalomyopathies (a group of disorders that lead to muscle and nervous system problems). There is some interest in using L-arginine to improve symptoms associated with MELAS (myoclonic epilepsy with lactic acidosis and stroke-like episodes) syndrome. Early research suggests that administering L-arginine intravenously (by IV) within one hour of stroke-like symptoms improves headaches, nausea, vomiting, blindness, and the appearance of bright spots in people with this condition.  Migraine headache. Taking L-arginine by mouth along with the painkiller ibuprofen seems to be effective for treating migraine headache. This combination sometimes starts to work within 30 minutes. However, it is hard to know how much of the pain relief is due to L-arginine, since ibuprofen can relieve migraine pain on its own.  Ovarian disease (polycystic ovarian syndrome). Early research suggests that taking N-acetyl-cysteine and L- arginine daily for 6 months can improve menstrual function and reduces insulin resistance in people with polycystic ovarian syndrome.  Pressure ulcers. Taking L-arginine by mouth along with the painkiller ibuprofen seems to be effective for treating migraine headache. This combination sometimes starts to work within 30 minutes. However, it is hard to know how much of the pain relief is due to L-arginine, since ibuprofen can relieve migraine pain on its own.  Restricted blood flow (restenosis). Some evidence suggests that administering L-arginine during stent implantation followed by L-arginine supplementation by mouth for 2 weeks after stent implantation does not reduce the risk of restricted blood flow. However, other evidence suggests that administering L-arginine at the site of stent implantation may reduce artery wall thickening.  Kidney transplant. There is inconsistent evidence about the effects of L-arginine for people with kidney transplants. Early research suggests that taking L-arginine intravenously (by IV) improves kidney function. However, other evidence suggests that L-arginine does not improve kidney function. The inconsistencies may be due to other factors related to the transplant procedure.  Respiratory infections. Early research suggests that taking L-arginine by mouth for 60 days prevents the recurrence of respiratory infections in children.  Sickle-cell disease. Early research suggests that taking L-arginine for 5 days might be useful for people with sickle cell disease who have high blood pressure in the lungs.  Stress. Some early research suggests that taking a combination of L-lysine and L-arginine for up to 10 days reduces stress and anxiety in healthy people and those prone to stress.  Prevention of the common cold.  Female sexual problems. More evidence is needed to rate the effectiveness of L-arginine for these uses Atch 11: How Much Do You NO (Nitric Oxide)?
University of Michigan Medical School, Egbers, Rob, Kestrson, MD
One of the hottest athletic supplements available is L-arginine, marketed as Nitric Oxide. You can buy it as a pure supplement or as an additive in common mixtures such as BSN NO-Xplode, Xyience NOX-CG3, or any protein supplement. This article will be a beneficial read for anyone taking or considering an arginine supplement. Even if you aren't thinking about taking L-arginine, look at the supplements that you are currently taking and there is a good chance you will find it as an ingredient. The Basics
L-arginine is an amino acid that is found in high concentrations in nuts, seeds and raisins. It is used by the body for protein syntheses, wound healing and removing urea and nitrogen waste from the body. More recently, scientists discovered that L-arginine is the precursor for the gas nitric oxide (NO) produced in the body via the following reaction: This reaction occurs in neurons, in the immune system where NO acts as a defense mechanism, and in cells which line the blood vessels of your body (endothelial cells). As athletes, our primary concern is with NO's ability to dilate our arteries allowing more blood to flow to our muscles, which is called vasodilation. Under normal conditions, NO is released in blood vessels in response to an increased volume of blood trying to get through the vessels. These NO molecules then diffuse from the lining of blood vessels to the surrounding smooth muscle cells and allows them to relax. The idea with supplementation is that by taking more L-arginine your body will be able to produce more NO. This relaxation allows more blood filled with protein, oxygen and nutrients to flow through the arteries to your muscles, aiding in workout and recovery. What scientific data do we have to support these claims?
The human body is extremely complex and just because we can theorize how a supplement may help us it doesn't prove that you will be able to lift more weight or gain more muscle mass. Experiments with actual people need to be evaluated to determine the effectiveness of supplementation with L-arginine. So far, studies have shown contradictory evidence on the effects of L-arginine supplementation. L-arginine supplementation has been shown to increase blood flow in healthy individuals at rest [2,3] and in individuals with certain diseases such as heart failure [1], diabetes, smokers, high cholesterol and high blood pressure [13]. However, research finds no increase in blood flow with arginine supplementation in healthy individuals during exercise [2,3,4], even through NO production has been shown to increase during exercise [5,6]. It has been postulated that this is due to the multitude of other vasodilatory factors at work during exercise such as potassium, hydrogen ions, adenine and prostaglandins [4]. Also, and maybe more importantly, during exercise the production of NO may not limited by the substrate arginine [14]. This means that taking more L-arginine under exercise conditions wont increase the output of NO. On the other hand, L-arginine supplementation has been shown to have beneficial effects beyond those related to vasodilation. Some recent publications suggest L-arginine supplementation reduces plasma lactate, ammonia [7,9,10] and blood glucose [8,9,10]. Build-up of lactate and ammonia lead to fatigue during exercise. Increasing glucose clearance means more energy will be available inside muscle cells to finish a work out. It has been proposed that the increase in glucose clearance results from an increase in glucose uptake by muscle cells by glucose transporters rather than from vasodilation [8]. A current misconception associated with L-arginine is that it causes an increase in growth hormone release. Intravenously administered large quantities of arginine has been shown to increase growth hormone secretion (via inhibition of somatostatin). Orally administered arginine on the other hand has been shown not to increase growth hormone secretion in well trained athletes [11,12]. Part of the problem with orally administered arginine is palatability. Oral doses that do cause a slight increase in growth hormone in secretion in athletes cause diarrhea and stomach cramping. Growth hormone has anabolic effects to increase amino acid uptake, protein synthesis, fat mobilization and maintenance of blood glucose concentration. How safe is this product?
Systems in the human body do not operate in a vacuum. What you put in to your body could affect more than just the one or two types of cells where the effect is desired. People with herpes simplex virus should be aware that arginine can stimulate virus growth. Also a theoretical interaction exists with erectile dysfunction medications or nitroglycerine. Headache, nausea, diarrhea and weakness have been reported if taken in excess. Like with any other supplement you want to start, consult your doctor before taking. Is it worthwhile to take an L-arginine supplement?
It still isn't clear weather or not L-arginine supplementation will give you the increased blood flow you want to improve athletic performance. More research needs to be done on the subject. However, research has shown some other benefits of L-arginine supplementation. Based on the current available information, you should really think If you decide to take this product you should know that peak levels of orally administered arginine occur between 1-2 hours after ingestion. And authors suggested 4-5g of orally administered arginine to decrease plasma lactate and ammonia during exercise [7]. 1. Kanaya, Y., Nakamura, M., Kobayashi, N., Hiramori, K. Effects of lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure. Heart 1999; 81:512-517. 2. Hickner, R.C., Fisher J.S., Ehsani A.A., Kohrt W.M. Role of nitric oxide in skeletal muscle blood flow at rest and during dynamic exercise in humans. Am. J. Physio. 1997; 273:405-410. 3. Wilson, J.R., Kapoor, S. Contribution of endothelium –derived relaxing factor to exercise-induced vasodilation in humans. Am. J. Physio. 1993; 75:2740-2744. 4. Brett, S., Cockcroft, J., Mant, T., Ritter, J., Chowienczyk, P. Haemodynamic effects of inhibition of nitric oxide synthase and of L-arginine at rest and during exercise. J. Hypertension. 1998; 16:429-435. 5. Persson, M.G., Wiklund, N.P., Gustafsson, L.E. Endogenous nitric oxide in single exhalations and the change during exercise. Am. Rev. Resp. Dis. 1993; 148:1210-1214. 6. Bode-Boger S.M., Boger, R.H., Schroder E.P., Frohlich, J.C. Exercise increases systemic nitric oxide production in men. J. Cardiovascular Risk. 1994; 1:173-178. 7. Schaefer, A., Piquard, F., Geny, B., Doutreleau, S., Lampbert, E., Mettauer, B., Lonsdorfer, J. L-arginine reduces exercise-induced increase in plasma lactate and ammonia. 8. McConell, G.K., Kingwell, B.A. Does nitric oxide regulate skeletal muscle glucose uptake during exercise? Am. Coll. Sports Med. 2006; 34:36-41. 9. McConell, G.K., Hunh N.N., Lee-Young, R.S., Canny, B.J., Wadley, G.D. L-arginine infusion increases glucose clearance during prolonged exercise in humans. Am. J. Physio. 2006; 290:60-66. 10. Mendonca, J.R., Lancha, A.H. Jr, Curi, R. Effect of chronic diet supplementation of ornithine, citrulline and arginine. Med. & Sci. in Sports & Exercise. 1996; 28:82. 11. Moore, T.A., Switzer, B.R., McMurray, R.G., Hall, J.E. Growth hormone response to oral arginine supplementation. Med. & Sci. in Sports & Exercise. 1998; 30:18. 12. Chromiak, J.A., Antonio, J. Use of amino acids as growth hormone-releasing agents by athletes. 13. Wu, G., Meininger, C., Knabe, D., Baze, F., Rhoads, J. Arginine nutrition in development, health and disease. Curr. Op. Clin. Nutrition and Metabolic Care. 2000; 3:59-66. By using this site, you agree to the Terms & Conditions

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