For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
What is it?
What is it used for?
Glutamine is used to:
- Treat weakness and loss of muscle mass caused by cancer treatment
- Treat neuropathy (numbness or tingling hands and feet) caused by chemotherapy
- Treat nausea (feeling like you’re going to throw up), vomiting (throwing up), and diarrhea (loose, watery bowel movements) due to cancer treatments
- Help recovery after surgery by reducing your risk for infection
Glutamine also has other uses that haven’t been studied by doctors to see if they work.
Glutamine that you get from food is safe. Talk with your healthcare provider before taking glutamine supplements because they have higher amounts of glutamine.
Supplements can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.
What are the side effects?
What else do I need to know?
For Healthcare Professionals
Glutamine is an amino acid that can be absorbed from food and synthesized and stored, mainly in the muscles and lungs. It is the building block of protein and a major cellular fuel source. Although abundant in the body, patients with cancer and AIDS-related cachexia or those recovering from catabolic states such as surgery, sepsis, and intense exercise may need to increase intake. Parenteral supplementation is used in hospitals, but oral formulations are available as medical food products. Glutamine is also marketed as a dietary supplement to enhance muscle building, wound healing, and for intestinal and immune system health.
Despite its popularity, evidence is lacking to support the use of glutamine supplements for increasing muscle mass and strength (42).
In post-surgical or critically ill patients, glutamine may improve nitrogen balance, preserve intestinal integrity, maintain intracellular glutamine levels, and reduce hospital stay (3) (4) (12) (13) (40), but data on whether it can prevent infections are mixed (5) (40). In patients with irritable bowel syndrome, glutamine supplements reduced related symptoms (36). Among patients with sickle cell anemia, treatment with glutamine resulted in significantly fewer pain crises (35).
In oncology settings, studies suggest glutamine is useful against cachexia (11), peripheral neuropathy (14) (15), mucositis (16) (17) (18) (19) (46), and fluorouracil-induced GI toxicity (20). Intravenous glutamine also reduced chemotherapy-induced nausea, vomiting, and diarrhea in patients with gastric or colorectal cancer (21), and enteral nutrition that includes arginine , glutamine, and omega-3 fatty acids may improve short-term survival in stage IV gastric cancer patients (22). Preliminary data on a supplement containing HMB, L-arginine and glutamine suggest it may help prevent sorafenib-associated hand-foot skin reactions in patients with advanced hepatocellular carcinoma (39).
Other studies suggest glutamine may reduce radiation morbidity in breast cancer patients (23) and treatment-induced mucositis and dysphagia in patients with oropharynx and larynx carcinoma (37), and delay esophagitis onset in non-small cell lung cancer patients (38). However, meta-analyses report lack of strong evidence with glutamine for oral mucositis (43) or for radiation-associated gastrointestinal toxicity (47), a systematic review cited the need for well-designed trials (44), and conflicting data indicate no impact on postsurgical complications or infections in gastrointestinal cancer patients (25). Furthermore, findings suggest a role for glutamine in tumor cell growth and maintenance (26) (27). More research is needed to resolve these ambiguities.
Mechanism of Action
Glutamine is essential for the maintenance of intestinal mucosal integrity and function (1). It maintains immune function by serving as the principle metabolic fuel for cells, acts as a precursor for protein synthesis, and along with cysteine and glycine, is involved in glutathione (GSH) synthesis. Intravenous glutamine preserves liver and intestinal glutathione stores in animal models of oxidant damage. Glutamine is also involved in nitrogen exchange, as it neutralizes and eliminates excess ammonia formed during protein catabolism. As a nitrogen donor, it contributes to the synthesis of other non-essential amino acids, including the purines and pyrimidines, and is therefore essential for the proliferation of most cells (29). It also plays a supportive role during biochemical stress and sepsis. Reduced oxidative stress and sickle cell-related pain with l-glutamine is attributed to increased proportions of the reduced form of nicotinamide adenine dinucleotides in sickle cell erythrocytes (35).
Although the mechanism underlying benefits against cachexia is unclear, it is thought that glutamine, a modulator of protein turnover, enhances net protein synthesis (11). Clinical evidence suggests that total parenteral nutrition supplemented with glutamine improves nitrogen balance, maintains the intracellular glutamine pool, enhances protein synthesis, and prevents deterioration of gut permeability in post-surgery patients (12).
Glutamine prevented genotoxic and clastogenic damages caused by cisplatin in mice (30). It may also potentiate the tumoricidal effect of methotrexate (MTX) since polyglutamation of MTX impairs its efflux from tumor cells and reduces its accumulation in the gut (31). The supplemental intravenous form leads to increases of GSH in the gut, but not in tumors, in a sarcoma-bearing rat model.
However, other findings show that glutamine transporters are upregulated in tumor cells and that glutamine acts as a mitochondrial substrate and promotes protein translation. This indicates tumor cell dependence for growth and maintenance (26). In addition, glutamine helps cancer cells survive acidic stress through enzymatic deamidation rather than provide nutrition (27).
- Severe abdominal pain and scleral icterus: In a 35-year-old female athlete following consumption of glutamine powder for three weeks. Testing suggested hepatoxicity, but the patient recovered successfully after discontinuing glutamine (45).