Recommendations

The ideal dose of glutamine is not known. This is a consistent statement among many published articles on glutamine. A wide variety of doses were used in the many clinical trials of glutamine supplementation. One systematic review of glutamine supplementation chose to compare the effects of low-dose (< 0.2 g/kg/d) versus high-dose (> 0.2 g/kg/d) supplementation and found that high-dose glutamine was associated with reduction in mortality, complication rates, and length of hospital stay. Low-dose glutamine, on the other hand, had no observable treatment effect [75]. The literature specifically addressing safety indicates that doses up to 0.3 g/kg as a single oral dose or 0.57 g/kg/d given intravenously for 30 d are safe [85]. Typical dietary consumption of glutamine is less than 10 g, but 20 to 40 g/d may be needed in catabolic states [69]. There are some studies available where much more than 40 g/d were used, and although safety was not a measured endpoint, there were no adverse effects reported [85].

In the absence of a large study delineating the optimal treatment dose, it is difficult to make any recommendation concerning the ideal dosing of glutamine. Most studies showing a benefit used doses of 0.6 g/kg or less. In light of these facts and in the absence of high-quality evidence, an easy-to-remember dose of 0.5 g/kg/d seems a reasonable supplemental dose of glutamine.

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