Table of contents

Recent updates

Outline of regime

The assumption is that base nutrition (macro and micro), is already optimised, protein intake is above 1.6g / kg body weight, supplementation with vitamin D, creatine and all electrolytes and minerals are all already in place. Tools such as Cronometer for food tracking and Nutrient Optimiser are useful for this and so this subject is out of scope for this article

The 5 most useful supplements for help with (muscoskeletal) injury are Glutamine, Arginine, Citruline, and HMB, Fish Oil / Omega 3

A brief summary of effects comes to:

  • Arginine
    • Increase of growth hormone and IGF (either IV or high single dose empty stomach intake)
    • Release of NOx
  • Citrulline
    • Release of NOx (note that using citrulline and arginine together may be synergistic as they are proessed in the same pathway and converted between each other - no studies referenced here yet)
  • HMB
    • Not in itself useful for injury recovery
    • Prevents loss of muscle mass
  • Glutamine
    • Conditionally essential amino acid used extensively in wound repair
    • Increased requirements for glutamine pull it from the gut

Effective dosages:

Supplement Minimum effect seen at Intermediate Optimal Maximum Effective Toxicity seen at
Arginine 100 mg / kg 9 g / day 17 g / day > 20 (unknown) None seen
Citrulline ? 2 to 5 g / day ? ? None seen
Glutamine ? 10 to 20 g / day ? ? None seen
HMB ? 1 to 3 g / day ? None seen
Omega-3 ? 0.1 mg / kg bw 0.3 mg / kg bw ? None seen

Also referenced:

A good summary of arginine and glutamine: Arginine and glutamine in wound healing

Example regimes

Empiral example 1

While the individual pieces of dosage are derived from various studies, this combination hasn`t been studied, and instead is a personal use log. Two of these ingredients taste pretty damn awful, so the fish oil was taken as Nordic fish oil and the arginine can combined with psyllium husk (one tablespoon) to cut the taste. In addition, the 6g dose of arginine may cause digestive distress, so it's often good to start with 2g (in the same amount of water) and increase to as high as you can tolerate. Also note that as per the studies referenced below, minimum efficacy starts at 9g / day, and 17g and upwards (considered high dose) had the greates results

Timing Supplement list Notes
Morning Arginine 6g in 750 ml water First thing upon waking, then wait at least an hour before eating after
Breakfast Protein shake 40g (USN Diet Fuel), glutamine 10g, creatine 10g, citrulline 2g, Potassium Gluconate 1g Ensure at least 1 hour break
Breakfast HMB 1000mg Listed separately as it is taken as capsules
Breakfast Fish Oil 15 ml Listed separately as it is taken as liquid
Lunch Glutamine 10g Dissolved in water, taken before lunch
Lunch HMB 1000mg Listed separately as it is taken as capsules
Late afternoon / dinner Protein shake 40g (USN Diet Fuel), glutamine 10g, creatine 10g, citrulline 2g, Potassium Gluconate 1g Protein powder/potassium can be excluded if not necessary for getting protein/electrolytes up
Late afternoon / dinner HMB 1000mg Listed separately as it is taken as capsules
Pre bed time Arginine 6g in 750 ml water At least an hour after dinner
Pre bed time Fish Oil 15 ml Listed separately as it is taken as liquid

Arginine and Omega-3 Fish Oil

See summary at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217020/ NB: Do not substitute plant based Omega-3. Fish oil only, and preferably fresh not capsules. Reference to follow Key quotes:

Both arginine and fish oils have independent benefits, but the combination appears to be much more effective. Arginine is a normal dietary ingredient that can be given in oral doses of 2–3 times the normal dietary intake without evidence of significant toxicity. When given orally, arginine is absorbed quickly, varying between 21% and 68% with a half-life of 1.5–2 h after an oral dose of 6 g. Arginine supplementation is, perhaps, best known for its beneficial effect on the healing of cutaneous wounds,11 but it also improves the healing of fractures (see Oral arginine for wound healing) - " Radiographs showed significantly more healing in the treatment groups (2 weeks, 10/15; 4 weeks, 11/15) than in the control group (3/14). The mechanical energy necessary for femur failure was significantly higher in the 4-week treatment group than in the control group (P < 0.05)"

Arginine effective doses recorded in studies referenced from this review

Dosage Study Additional Notes
4.5g twice daily Leigh et al Also at 9g twice daily
17g daily Hurson et al Elderly populations
17g daily Kirsten Hurson et al Arginine stimulates wound healing and immune function in elderly human beings.
20g [High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial)[https://www.ncbi.nlm.nih.gov/pubmed/19694342/] the length of postoperative stay was shorter (24.3 days vs. 36.1 days, p=0.036)

Omega 3 Fish oils

Dosage Study Additional Notes
0.1 and 0.2 g/kg/day Heller et al The amount of fish oil infused as Omegaven® (Fresenius-Kabi), had a significant inverse relationship with mortality, reducing mortality, infection rates and length of stay when administered in doses between 0.1 and 0.2 g/kg/day. The least antibiotic demand was seen in patients receiving 0.15–0.2 g/kg/day of the fish oil.

Additional notes n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis

Additional references

Nutrition in Wound healing Arginine supplementation and wound healing Arginine: an essential amino acid for injured rats Oral arginine for wound healing Arginine: a thymotropic and wound-healing promoting agent Dose response: A minimum of 100mg/kg bw was effective in rats Dose-effect of dietary L-arginine supplementation on burn wound healing in rats.

References

Arginine

Glutamine

HMB

Citrulline