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The dose question

Arginine And Citrulline: How Much Is Enough?

Both amino acids have a respectable trial literature and almost none of it runs on milligrams. Reading a label that carries them means keeping the dose in view at every step, and this post sets six published amounts beside the seven printed on one bottle.

The supplier's how-it-works graphic for ProstaFlow
The supplier's own diagram describes a routine rather than a mechanism. The amounts below come from the published trials instead, which is the comparison this post exists to make.
The short version
  • Arginine trials in this literature ran at 1,500 to 5,000 mg a day, and the blood-pressure work at four to 24 grams.
  • The citrulline trial that found something used 1.5 grams a day for a month.
  • Only the largest arm of the pharmacokinetic study moved a marker, and no arm improved flow-mediated dilation.
  • This label carries about 333 mg of arginine and under 200 mg of citrulline salts.
  • Every encouraging arginine result in the urinary literature involves a pine bark extract alongside it, and this panel has none.

Why both are on one panel

Nitric oxide is not swallowed. It is made on demand inside the cells lining every blood vessel, from arginine and oxygen, by an enzyme family called nitric oxide synthase. A supplement aiming at that system has exactly one lever: supply more of the raw material.

There are two ways to pull it. Swallow arginine, and accept that an enzyme in the liver converts a substantial part of it into ornithine and urea before it reaches general circulation. Or swallow citrulline, which the kidney converts into arginine after the liver, bypassing that toll entirely.

A panel carrying both is covering both routes. That is a coherent design decision and it is the reason this formula reads as deliberate rather than random. The question the rest of this post answers is what happens when you put an amount against it.

What the trials actually used

Six records, each with the substance, the amount and the endpoint. The amounts are the column to read.

StudySubstance and doseHow longWhat it measured
2019 meta-analysis, 10 trials, 540 menL-arginine, 1,500 to 5,000 mg a dayVaried by trialAn erectile endpoint, with an adverse-effect rate of 8.3 per cent against 2.3 on placebo.
Blood-pressure meta-analysis, 11 trials, 387 peopleL-arginine, four to 24 grams a dayVaried by trialAbout 5 mmHg off systolic pressure and 2.7 off diastolic.
Pharmacokinetic crossover, 20 volunteersArginine and citrulline, six regimensOne week per armPlasma arginine, the arginine to ADMA ratio, urinary nitric oxide markers and flow-mediated dilation.
Single-blind trial, 24 menL-citrulline, 1.5 grams a dayOne monthA self-reported hardness score, which the authors called less effective than a prescription drug.
2018 review, five pooled interventionsL-citrulline, variousVariedNo significant effect on brachial or aortic blood pressure.
Open-label trial, 40 men460 mg a day of L-arginine with 40 mg of PycnogenolSixteen weeksA standard urinary symptom questionnaire. Both arms improved, and there was no placebo group.

Six records. Five measured something other than urinary symptoms, and the sixth measured urinary symptoms on a combination product rather than on arginine alone.

The pattern is hard to miss once the table is laid out. Every amount in the second column is measured in grams or in thousands of milligrams. The one entry that is not, the sixteen-week urinary trial, used 460 mg a day of arginine bundled with something else, and that bundle is the subject of a section below.

What the adverse-effect figure says

The erectile meta-analysis is worth reading for its safety column as much as its result. An adverse-effect rate of 8.3 per cent on arginine against 2.3 on placebo, none of them severe, at doses between 1.5 and 5 grams a day. Gram-scale amino acids draw water into the gut and loosen stools; milligram-scale ones do not, which is one small advantage of a low dose.

Why citrulline raises arginine better

This is the counter-intuitive part and it is settled rather than theoretical. A six-arm crossover in 20 volunteers tested arginine and citrulline at several amounts for a week each, and citrulline raised plasma arginine more efficiently than arginine itself did.

The mechanism is the liver. Hepatic arginase gets first refusal on anything swallowed as arginine. Citrulline uses a different gut transporter, passes the liver untouched, and is converted in the kidney, so more of it arrives where the enzyme is.

That finding is the honest basis for putting citrulline on a panel of this kind. It is also the finding most often quoted without its second half, which is the next section.

Where the ceiling sits

The same study that showed citrulline wins on efficiency also showed where the effect stops.

Only its largest arm, three grams of citrulline twice a day, moved the arginine to ADMA ratio and the urinary markers of nitric oxide production. And no arm at all improved flow-mediated dilation, which is the standard physiological readout for whether a blood vessel is behaving differently.

Six grams a day is thirty times the total citrulline salts on this label, and it did not move the physiological measure. That is not a reason to think the ingredient is useless; it is a reason to be exact about what the published evidence does and does not demonstrate at any given amount.

Two different claims

Raising plasma arginine and changing what a blood vessel does are separate things, and a study can show the first without showing the second. Most marketing in this area quotes the first and implies the second.

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The pine bark problem

There is one study in this whole literature that measured urinary symptoms on an arginine product, and it deserves to be stated exactly rather than gestured at.

A 2017 open-label Japanese trial randomised 40 men between 320 mg a day of saw palmetto extract and four tablets a day of a combination product. Each tablet carried 10 mg of Pycnogenol, 115 mg of L-arginine and 92 mg of aspartate, so the combination arm took 40 mg of Pycnogenol and 460 mg of L-arginine a day for sixteen weeks. Scores on the standard symptom questionnaire improved in both arms.

Three things about that design decide how far it travels. Twenty men took the arginine arm. There was no placebo group and the study was open-label, which is exactly the arrangement in which both arms improve whether or not either treatment does anything. And the nitric oxide donor in that product was the pine bark extract rather than the amino acid.

That last point is the one that matters for any bottle without pine bark in it. Every positive arginine result in this specific area follows the same shape: arginine paired with Pycnogenol, tested as a pair, reported as a pair. A panel carrying the amino acid alone is not carrying the thing that was tested.

What a dose comparison cannot settle

Setting a label amount beside a trial amount answers a question about arithmetic. It says nothing about whether a supplement is the right thing for one particular set of symptoms, which is a clinical question and belongs to somebody who can examine you.

What this label carries, resolved

Taking the four amino acid rows apart gives a smaller set of numbers than the panel does, and the smaller numbers are the ones to compare against the table above.

On this labelPrintedAmino acid inside itNearest trial amount
L-Arginine (base)200 mg200 mg of arginine1,500 mg a day, the bottom of the pooled range
L-Arginine AKG 2:1200 mgAbout 133 mg of arginineThe same
Arginine, combined400 mg of rowsAbout 333 mgBetween a fifth and a twentieth of the range
L-Citrulline HCl100 mgA little under 100 mg1,500 mg a day
L-Citrulline Malate100 mgLeft open by the label1,500 mg a day
Citrulline, combined200 mg of saltsUnder 200 mgAbout an eighth of the trial amount

The third column is arithmetic on the printed label rather than an assay. The AKG row can be resolved because it prints its ratio; the malate row cannot, because it does not.

So the position, stated plainly: about 333 mg of arginine against a pooled trial range starting at 1,500 mg, and under 200 mg of citrulline salts against the 1.5 grams used in the trial that reported something. Between a fifth and a twentieth on the first, about an eighth on the second.

There is one thing this label does that most in its category do not, and it is the reason the table above could be built at all. It prints the 2:1 ratio on the arginine AKG row, which lets a reader calculate the arginine inside it. Very few panels volunteer that, and a companion post is about exactly this skill.

What it does not do is print a ratio on the citrulline malate row, so that one row's contents cannot be derived. The honest reading is to treat those 100 mg as the weight of the salt and leave the amino acid content unstated.

How to compare any amino acid label

Five questions, in order, that work on any pack carrying arginine, citrulline or both.

  1. Is there a number against each row? A blend total cannot be compared with anything.
  2. Is it the free base or a salt? A free base weight is the amino acid. A salt weight includes a passenger.
  3. Is the ratio printed? Without one, a salt's contents are not derivable. With one, the arithmetic takes ten seconds.
  4. How does the resolved amount compare with grams? The trial literature runs in grams. That is the comparison, and it is usually unflattering.
  5. Is the donor that carried the positive results in the bottle? In the urinary literature that means pine bark extract, and most panels in this category do not have it.

Run those five on any pack and most of the marketing falls away. What is left is a weight, a form and a distance from a published amount, which is a much easier thing to think about than a paragraph about circulation.

The ingredients page runs the same five on every row of this panel, and the mechanism page follows the arginine from the mouth to the smooth muscle for anybody who wants the chain in order.

References

  1. Rhim HC, Kim MS, Park YJ, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med. 2019;16(2):223-234. PMID 30770070. https://pubmed.ncbi.nlm.nih.gov/30770070/
  2. Dong JY, Qin LQ, Zhang Z, et al. Effect of oral L-arginine supplementation on blood pressure: a meta-analysis of randomized, double-blind, placebo-controlled trials. Am Heart J. 2011;162(6):959-65. PMID 22137067. https://pubmed.ncbi.nlm.nih.gov/22137067/
  3. Schwedhelm E, Maas R, Freese R, et al. Pharmacokinetic and pharmacodynamic properties of oral L-citrulline and L-arginine: impact on nitric oxide metabolism. Br J Clin Pharmacol. 2008;65(1):51-9. PMID 17662090. https://pubmed.ncbi.nlm.nih.gov/17662090/
  4. Cormio L, De Siati M, Lorusso F, et al. Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction. Urology. 2011;77(1):119-22. PMID 21195829. https://pubmed.ncbi.nlm.nih.gov/21195829/
  5. Mirenayat MS, Moradi S, Mohammadi H, Rouhani MH. Effect of L-Citrulline Supplementation on Blood Pressure: a Systematic Review and Meta-Analysis of Clinical Trials. Curr Hypertens Rep. 2018;20(11):98. PMID 30284051. https://pubmed.ncbi.nlm.nih.gov/30284051/
  6. Yagi H, Sato R, Nishio K, et al. Effects of a supplement combining Pycnogenol and l-arginine aspartate on lower urinary dysfunction compared with saw palmetto extract. J Tradit Complement Med. 2017;7(1):117-120. PMID 28053897. https://pubmed.ncbi.nlm.nih.gov/28053897/
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