Strenuous Exercise

Following strenuous exercise glutamine levels are depleted approximately 20% resulting in immunodepression (Castell 2003, Castell & Newsholme 1997, Rogero et al 2002). The provision of glutamine after exercise has been shown to improve immune status (Castell & Newsholme 1997). In a study of 200 elite runners and rowers given a glutamine or placebo drink immediately after and again 2 hours after strenuous exercise, 1 51 participants returned questionnaires reporting the incidence of infection over the subsequent 7 days. The percentage of athletes reporting no infections was considerably higher in the glutamine group (81%, n = 72) compared to the placebo group (49%, n = 79, P < 0.001) (Castell et al 1996).

A trial assessing the possible ergogenic effects of glutamine supplementation (0.03 g/kg) to improve high-intensity exercise performance in trained males was unable to determine a beneficial effect (Haub et al 1998).

Clinical note — Total parenteral nutrition l-glutamine is not very soluble or stable in solution, especially upon heating for sterilisation. As a result, until recently it was not included in TPN, resulting in compromised glutamine status in patients for whom reduced immune status and increased intestinal permeability could potentially increase the risk of morbid infection and mortality. The more soluble and stable synthetic glutamine dipeptides (l-alanyl-l-glutamine (Ala-Gin) and glycyl-l-glutamine (Gly-GIn)) have now been developed as delivery forms of L-GIn for use in TPN. The dipeptide forms can also be used orally and have demonstrated a potential for greater bioavailability than glutamine alone (Macedo Rogero et al 2004).

Numerous studies have now been conducted using glutamine dipeptides in TPN and have shown benefit in preventing deterioration of gut permeability and preserving mucosal structure (Hall et al 1996, Jiang et al 1999, PDRHealth 2006a, van der Hulst et al 1993). In addition, animal studies suggest that glutamine-enriched TPN may attenuate the suppression of CYP3A and CYP2C usually associated with TPN (Shaw et al 2002).

In a meta-analysis of European and Asian RCTs in elective surgery patients, 13 studies (pooled n = 355) met inclusion criteria and demonstrated a significant

reduction in infectious complication and length of hospital stay (weighted mean difference of 3.86 days) (Jiang et al 2004)._

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