Neuropathy, Oxidative Stress, and Inflammation

​In recent years, products containing L-Citrulline and L-Arginine have deluged the market. They entice individuals looking to ramp up their nitric oxide levels. But how effective are these supplements? Recent research shows they don’t do much and can even negatively impact patients with diabetes and peripheral neuropathy. 

This knowledge leads to a conundrum for pharmacists and convenient care clinicians. How do you assist patients in boosting nitric oxide levels? Begin by helping patients say “no” to L-Arginine and L-Citrulline supplements. 

But what should patients replace these supplements with? Keep reading for the inside scoop on high-quality nitric oxide supplementation.

Nitric Oxide Supplementation and Neuropathy
Customers with peripheral neuropathy struggle with extreme inflammation and oxidative stress. As a result, some turn to supplements like L-Arginine and L-Citrulline to ramp up nitric oxide levels. They erroneously assume that L-Arginine and L-Citrulline stimulate the enzyme nitric oxide synthase (NOS). They believe enhanced NOS leads to healthier levels of nitric oxide. Unfortunately, this conclusion could be hurting their health.  

Oxidative stress prevents nitric oxide production by uncoupling NOS in the body. In other words, instead of working as a nitric oxide producer, NOS transforms into a superoxide generator. The Physiology Review explains, “These reactions trigger cellular responses ranging from subtle modulations of cell signaling to overwhelming oxidative injury.” Increased oxidative stress contributes to the uncoupling of more NOS, resulting in a vicious cycle.
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The Risks Associated With L-Arginine and L-Citrulline Supplementation
Diabetic patients must combat oxidative stress. For this reason, Beth Shirley, RPh, CCN, cautions against L-Arginine supplements for patients suffering from diabetes and peripheral neuropathy. She argues that supplementation “may even increase ADMA, which is associated with all-cause mortality.” 

Asymmetric dimethylarginine (ADMA) represents an endogenous analog of L-Arginine. It cripples the activity of the enzyme NO synthase in the body. And it leads to dysfunction in the endothelial system. The International Journal of Molecular Sciences reports, “Type 2 diabetes (T2D) is characterized by a reduced endothelium-dependent vasodilation and increased ADMA levels.” 

For this reason, high ADMA levels and micro- and macrovascular diabetic disorders go together. So, your patients need to work on keeping their ADMA levels low. This approach will lower the risks of all-cause mortality. How can we make this claim? Because cardiovascular disease accounts for between 12 and 17 percent of all-cause death. Diabetes results in 30 to 52 percent of these fatalities, according to Diabetes Journals. In other words, L-Arginine is a poor choice for improving the body’s natural nitric oxide production. L-Citrulline proves no better because it converts to L-Arginine in the body.
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Your Customers Need to Know About Nitric Oxide Supplementation
High-quality nitric oxide supplements offer better solutions for patients with peripheral neuropathy. These products permit customers to increase nitric oxide levels effectively and directly. Increasing nitric oxide intake assists the body with NOS recoupling. The results include increases in nitric oxide and decreases in oxidative stress. 

Are you interested in other ways to help your patients achieve healthy nitric oxide levels? As a pharmacist or convenient care clinician, educate your customers about the importance of nitric oxide as a part of their treatment plan. Next, complement this nutritional therapy with the NeuropaCalm Care Program. 

The NeuropaCalm Care Program ensures the best possible outcome. Learn more about how your pharmacy or clinic can partner with us to bring the best therapeutic offerings to your customers. ​