Glutamine: Supplements 101

Leah 0:00

Welcome to episode 38 of the cancer pod. In this episode, we're talking about Alta. What is it? What is it used for? Is it safe for cancer patients to take answers to these questions and more are coming up? So stick around.

Tina 0:16

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:20

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:24

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:28

But we're not your doctors

Tina 0:30

This is for education entertainment and informational purposes only

Leah 0:34

do not apply any of this information without first speaking to your doctor

Tina 0:39

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:45

Welcome to the cancer pod

Introduction

Leah 1:03

Good morning, Tina. Hi, Leah. I sounded so professional. Good morning, Tina.

Tina 1:08

I know that's awfully formal. I know I was

Leah 1:10

trying to mix it up a bit. So today we're talking about

Tina 1:13

glutamine. Yeah. Glutamine, the amino acid.

Leah 1:16

It's something that I think a lot of people have heard of Cancer patients ask about it a lot. Mm-hmm and it could be kind of

Tina 1:25

controversial. Yeah. You've heard about it. You've read about it and now we're gonna discuss it. Oh, that's perfect.

Leah 1:30

I'm gonna copy that for my intro. L glutamine. So like you said, it is an amino acid and what are amino acids? Those are building blocks

Tina 1:39

for protein. Yep. I always describe it. If a protein was a train, then each amino acid is a container. So they link together. The only difference is it actually in the body folds upon itself and becomes more of a 3d thing. So if you took a model train and bald it up, I suppose it would look like a protein. There

Leah 1:59

are essential amino acids and there are conditional amino acids. And then non-essential amino acids. Mm-hmm so glutamine,

Tina 2:09

what are you? Glutamine is considered. Conditionally essential amino acid. Yep. Much like arginine is conditionally essential as well. Those two are probably the number one amino acids that we give to people as a supplement that are conditionally essential. When they say conditionally essential, it means there are scenarios in which the body. Requires it to be taken in orally when everything is good and you're healthy. It's non-essential but let's just say you underwent a severe injury that required a lot of repair of tissue burns are classic example. Someone gets burned in a large amount of their body. Then glutamine becomes essential. Meaning those people. Need to take it in orally. So people do

Leah 2:50

use it in like non kind of severe conditions. You can find glutamine in like post workout supplements. Mm-hmm you know, cuz it helps with muscle repair because it's most abundantly found in skeletal muscle. It is found in digestive formulas. Things that help, repair the intestinal lining Harper type of supplement formulas or else do people take glutamine that's outside of oncology. I mean, I've had patients just taking it because they heard it was good for you. And I'm like, oh, maybe not like, maybe you shouldn't just take it will. And Neely I'm saying will and nilly again. I was gonna leave that with neuropathy, but no, I'm bringing it to this

Tina 3:30

episode. Let's just keep willy-nilly as part of our, uh, vocab here. That's gonna be our thing. That's gonna be a T. Willie nilly let's make this as simple as possible. Should I, or shouldn't I take this Willie nilly. Mm-hmm and we'll just kind of go down the list. Yeah. In the case of glutamine, you don't wanna just take it Willy nilly? No, cuz you're getting it in

Leah 3:49

your diet. I mean it's, it's in it's in any sort of protein. It makes up protein. So you're getting it, whether you're eating plants, whether you're eating animals, you're getting more of it. If you're eating animals because it's

Tina 4:02

inside of skeletal muscle. Right. So the muscle of any animal you eat would be a lot of glutamine, cuz that's where we store most of ours as well. Yeah.

Leah 4:11

so yeah, it does. It, it tests depend if you're going to like prime rib night, you know, are you getting like the, the super giant, I don't know, 24 ounce prime rib versus like the six ounce prime rib. So yeah, that, that kind of varies as. How much glutamine you're getting.

Tina 4:29

Yeah. I call those giant portions. Bam, bam. Remember on the Flintstones? Yeah, they'd put down a, like half of a dinosaur rack of ribs on the plate.

Leah 4:37

I think of it as, um, once after seeing the greeny Packers play in Lambo, we went to the Brett Farve steakhouse and they have like the biggest servings. I mean, they had different sizes of servings of prime rib, but then like they had like this super. Grande. I mean, it was massive. It was like, yeah, no human could really eat that whole thing without getting a bad

5:01

case

Tina 5:01

of meat sweats. I don't even know what meat sweats are and I don't think I

Tangent-Mediterranean diets

Tina 5:05

want to know, but, um, I think this, this reminds me just of this moment. You just don't see this in Europe. I mean, They just don't serve the portions we serve of meat here ever. No, I mean, I think that's one of the reasons Mediterranean diets and stuff. I mean, we talk about the contents of it, but we really should talk about proportions. And when we talk about comparisons of diets, because a small amount of meat is probably perfectly fine. It's the fact that we eat half a plate or whole plate. Right.

Leah 5:33

We're not eating a three to four ounce survey. We're eating like a 30 ounce serving,

Conditionally essential amino acids

Leah 5:38

but

Tina 5:38

yet we digress anyways.

Leah 5:40

Anyways. so yeah, there are times, like you said, there are times when there is a higher need, after surgery, in cases of burns, definitely higher need for ILU intake.

Tina 5:52

Mm-hmm also in the case of pregnancy, women have to get adequate protein when they're pregnant. Yeah. That's what makes it conditional that's overall?

Leah 6:00

Yes. Uh, protein, not just specifically

Tina 6:03

glutamine, no. Glutamine is conditionally essential for the pregnant woman is what I'm saying, because it's

Leah 6:07

part of the protein or glutamine specifically because

Tina 6:10

pregnancy in the grand scheme is a major stressor on the body. So it is conditionally essential, when we say conditionally essential, the conditions are major need for glutamine, but that's not a

Leah 6:23

time that one would supplement with it.

Tina 6:25

No, no, but that's when protein needs go higher, partly because glutamine. Needs to be eaten at that moment or for those

Leah 6:32

months. And there are congenital glutamine, deficiencies, but babies don't live that long

Tina 6:39

So, yeah. And yeah. Okay. So for the biochemistry aspect, just to geek out for a moment,

We can make glutamine

Tina 6:45

we all have an enzyme called glutamine synthetase and glutamine syntase is what allows us to make glutamine from ammonia, for example, so we can make GTA. In our bodies with glutamine synthesize, but we can't keep up with the body's needs during pregnancy, during major burns, maybe during major surgery, recovery. right. So the, the conditions are major stressors on the body when the need of glutamine is high. Or of course, if someone has a glutamine Synthes, the taste that doesn't work. But like you mentioned, if it doesn't work completely, that's something that

Leah 7:17

that's not, yeah. That's not a viable, I mean,

Tina 7:20

right. That's an inborn error of metabolism, which means that the baby will not survive that unless it's, I guess, unless it's caught extremely early. I don't know. I,

Leah 7:30

yeah, I don't think that it's surviv. anyway, is it

Tina 7:34

any who any way or anyways? Any who? Any who, so we

Leah 7:37

kind of covered glutamine basics. Oh, I guess like foods.

Cabbage, a good source?

Leah 7:41

Um, the one vegetable I think of with glutamine is cabbage. I don't know why I think cuz we're kind of taught that that's really like a good source

Tina 7:49

of glutamine. I think that's exactly why. Yeah. Part of our education. Yeah. Yeah. you like blend cabbage and

Leah 7:56

drink it. If you've got GI disorders. I don't remember something that, that sounds vaguely familiar in.

Tina 8:01

No, you're right. That's exactly it. I mean, we were glutamine is as far as vegetables go higher in cabbage and I think a traditional use of cabbage was to juice it and use it for upper GI issues. That's

Leah 8:13

right. It was juicing it mm-hmm, not blending it. It was juicing the cabbage. Yeah. All right. Well, let's just, let's take a quick little musical break and come back and we will talk about, the uses of GTAM. In oncology. And if there's research to back it up and then we'll talk about, cautions contraindications, those kinds of things.

Glutamine in cancer care

Tina 8:36

All right. So glutamine is an amino acid and it is offered as a supplement. And so let's talk about when we use it as a supplement. In cancer care.

Leah 8:46

It's one of those things that it can be used in chemotherapy, radiation surgery, and it's even used in parental nutrition formulas, which is the IV nutrition. Someone will get if they need bowel rest or they need, to get a nutrition because there's some sort of obstruction it's often administered through report and glutamine is included in

Tina 9:11

there as. So the Al nutrition goes into the port or directly into the bloodstream. And then there's the tube feedings that go directly into the GI tract, either the stomach or the small intestines. And those two will have glutamine added sometimes because again, it's conditionally essential. So if someone's critically ill in any way, For whatever reason, there's enough metabolic stress on the body, it becomes required. Okay. So when we're talking about glutamine being conditionally essential, we're talking about enough in the diet to make sure someone's not depleted. When we're applying it for chemotherapy, radiation, or surgery, it can be in that sense where we're just giving enough or it can be in very large doses. So let's talk about that. And let's start with, with chemo specifically.

High doses used with certain chemo

Tina 9:57

Yeah.

Leah 9:58

And for all of the large doses that we're talking about, it's not IV, we're talking. This is oral intake only as a supplement. So chemotherapy. We touched on this, on our neuropathy episode, but neuropathy is one of the reasons that we. Would recommend high dose glutamine

Tina 10:18

mm-hmm mm-hmm it's probably the number one reason. Do you think, like, of doing it really high dose as in 30 grams a day kind of dose?

Leah 10:25

Yeah. With chemo. Yeah. Yeah, definitely. Definitely. It's been studied with paclitaxel and with oxaliplatin

Tina 10:34

well, the, I think the oxaliplatin and the taxane drugs in general, paclitaxel, docetaxel, I. That those are the ones where it has been shown to work. So those are the ones we tend to remember. So each one in our neuropathy episode, you and I went into this in detail, but they each, each drug that causes neuropathy has a different mechanism So one agent that works for one chemotherapy induced Peripheral neuropathy will not necessarily work for another chemotherapy

Leah 11:01

agent because they're not all the same. Yeah. They're not all the same. Yes. Targets of the drug on the nerve. Yeah. I've

Mouth sores

Leah 11:08

used it in lower doses for the mouth source, the mucositis dermatitis that can happen too.

Tina 11:16

And for lower doses, I would say that's somewhere between one and three grams as a supplement. What's your low dose?

Leah 11:22

Um, I do 10. I don't have them

Tina 11:24

swallow. Oh, you mean swish and spit for their mouth source? Yeah. Swish and

Leah 11:28

spit. I usually say 10 mm-hmm but yeah. Yeah.

Tina 11:32

I will often have people take a little bit of powder, one to two grams, put it in some water, swish it. And I would say I have them swallow it more often than spit it myself. Um, when I recommend it to patients, cuz I make an assumption they have inflammation of the mucosa or there's any mucositis in the mouth, it may be farther down as well. So I just have. ahead

11:51

and

Leah 11:51

swallow. I guess I have them do both. I mean, I think I have them do, you can swallow and then you can switch and spit, you know, like you can. because it's not like one, one mouthful is gonna be that high of a dose. Mm-hmm what I think is interesting is it's often recommended to be put in water or juice and then it's recommended to swish. But if somebody puts it in juice, I don't really like them to swish. Mm,

Tina 12:15

good point. I don't think you should swish juice in your mouth. no, no. And juices are always acidic. Yeah.

Leah 12:21

And just, you know, the, the fact that your teeth are at higher risk of compromise during treatment anyways, but, and then glutamine can also be.

Diarrhea

Leah 12:28

Recommended for people who have diarrhea. And again, I don't think the juice is a great form of delivery for that because it's so high in sugar that it can. Actually aggravate

Tina 12:39

diarrhea. Mm-hmm I think they say juice because that way People are not taking it with an amino acid, another amino acid, cuz for absorption's sake, it's not competing.

Leah 12:50

Oh, interesting. I thought it was just because the taste

The taste of glutamine

Leah 12:53

and I didn't find it had a taste, but there are people who do report it, having a taste, which I think is interesting. I don't know if that's like the whole cilantro type thing,

Tina 13:02

but I, you know what I think it's brand. I think some of it's cleaner than others out there. We're talking about a purified amino acid in a powder form. And when I had patients take the one that I would recommend in office that is professional line and very clean, they didn't taste anything, but if they went to GNC or whatever, store Costco or wherever, and they get a powder, they would report that it tasted bad. And I saw this over time enough that I was. You are welcome to try the other one, but this is my experience. So, um, you know what we should do? Uh what should we do, Tina? We should get a few brands and do a taste test blindfolded. Well, I

Leah 13:42

thought that I had,

Tina 13:44

wait a second. You're not taking me up or you're not taking no,

Leah 13:47

I know. I really don't know. You know what? I once did a taste test. A patient said that a supplement powder tasted really bad. It was. modified citrus pec in, and they were like, this is really gross. And they brought it in and I tasted it and I didn't think it was that gross. So I think part of it is if you have taste changes from chemotherapy, are you picking something up in the glutamine powder? Sure. Again, I took it. The thing I found the hardest was the fact it would not dissolve. And you have to keep adding liquid and doing the, I don't know, it's like a cocktail swirl. What is that swirl like as if you're you're wine tasting and you're swirling your glass, you have to keep doing that because it just doesn't

Tina 14:23

dissolve. So you want them to take it, shake, and not stirred or stirred, not shaken.

Leah 14:27

You could shake it, you could stir it. Just kind of get it. So it's, it's floating around in there. Yeah.

Tina 14:32

My, my taste does in single patients and of one kind of. I think the same person trying two different brands clearly showed a differential between brands out there. So, um, yeah. So it'd be interesting to see if someone doesn't like

Leah 14:45

the taste if they switch a brand. No, that's a good idea. Yeah. Yeah. Cuz people do like to pick it up cuz they see it at, at, stores where they're really pushing those workout formulas, post workout formulas, I should say. Yeah. So that that's how

Tina 14:58

most people know it. Yeah. Unfortunate truth is supplement. Quality is not regulated to the point of purity. We would like, I always tell people don't buy the cheapest thing. Right. It's cuz you can guarantee they didn't spend the money on quality

Some caveats to big doses

Tina 15:12

assurance. And we should

Leah 15:13

mention that glutamine at 30 grams, that's not something you do in capsules. I have had patients who've gone out and bought capsules and that is a heck of a lot of capsules cuz Capsules are usually about 500 to a thousand milligrams. Mm-hmm and so you could do the math from there. A lot to take, if you're trying to use it to reduce your risk of neuropathy mm-hmm

Tina 15:35

yeah. And again, the reason we say these large doses for neuropathy from a taxine or from Oxil platinum specifically is because that's how studies were done. Studies used 30 grams um, we're not making that up is my point. These aren't numbers that we're just pulling out of the air or from our own experience. They're not Willy nilly. this is not being said, Willy nilly. This is

Leah 15:56

not Willy nilly dose.

Radiation

Leah 15:58

Okay. Uh, radiation is the other time when we use the really high dose. And that is for patients with head and neck cancer who are undergoing. Chemo radiation. If people are getting radiation to their GI tract

Tina 16:14

in any way mm-hmm Yeah, because glutamine is a, it's a preferred fuel source for the actual cells lining the intestines. So the mucosal cells, the small intestinal cells, all of these cells like to use glutamine for their own energy pathways and their own health. We'll just leave it at that. And so when. Taking a small amount of glutamine in, I have people do it in a more constant stream when I'm treating their GI tract. So I'll have 'em dissolve it and then kind of sip it throughout the day or drink it three different times in a day. I'm doing the

Leah 16:46

finger quotes, dissolve it. Yeah. I then dissolve you have to shake it, but yes. Yeah. So you do. I've even had. Patients just kind of put it all in a bottle of water. Mm-hmm yeah. Is that what you mean? Like you just have that all get mixed up in a bottle and then you carry that bottle with you and three times a day.

Tina 17:04

Drink it down vigorously, shake it, slurry it up. Yep. Mix it up and then take it. Mm-hmm throughout the day. Yeah. And that way the, the small intestinal cells, the cells lining your whole GI tract take in a little bit. It really doesn't reach your bloodstream if it's not a large dose, because The first cells that sees take it into their cells. They don't let it go through the cell. They don't let it go around the cell. They want it. So they take in the glutamine for their own health and their own benefit, which is great because we want those cells to be repairing. We want them to take the glutamine in. So that's when we do a kind of slow and steady dose throughout the day for the GI tract is how I think of it.

Leah 17:38

And that would be constant throughout radiation.

Dosing is specific during chemo

Leah 17:41

Mm-hmm so what we didn't talk about was that there's a very specific regimen on how many days you use. The Al glutamine powder mm-hmm when you're receiving chemotherapy. So for paclitaxel, you start taking it 24 hours after your infusion and you continue it for four days. Mm-hmm and then for oxaliplatin, you start taking it the day of infusion and you continue it for seven

Tina 18:06

days. Yeah. Yeah. And in that particular trial, they did a Soli platin every two weeks. So they were on the glutamine. Every other week in that trial that we're talking about with high dose, LG glutamine and neuropathy, which would

Leah 18:19

be like a FOLFOX regimen.

Tina 18:21

Is that every case. Yeah. Yeah. I think it was part of a full Fox in that case. And it, what was interesting, it wasn't just neuropathy. They, they had benefits across the board. and we refer to these studies cuz like in that study, for example, they also saw the response rate to the chemotherapy was no different between the groups.

Leah 18:40

Right. Right. And that's the really important

Tina 18:42

part. Mm-hmm. Yeah, because the, that is the perfect natural or complimentary intervention, something that lowers a side effect improves your quality of life in real time. And doesn't interfere with the chemotherapy while you're getting it. So that's, that's the trifecta. That is the trifecta. That's what we're looking for in natural agents. And any agent, I don't care if it's natural or, or prescriptive or whatever, but that's the ideal. Agents. And that's why, when we talk about these items, we don't discuss things that are not clinically proven to not interfere because we could give a lot of different things that might lower neuropathy, because there's plenty in the natural realm and in the plant kingdom that work on nerves, but we don't assume that they're safe. We have to see that they're proven to be safe alongside. So I'm just being really clear that we're picky because. We don't wanna interfere with the chemo. And we just assume everything that could benefit in lower side effect may interfere with chemo unless proven otherwise. Right? Because

Leah 19:38

there are also natural agents that people can take during radiation that may lessen the mucositis, the mouth source that they get. But again, is that interfering with their radiation. So glutamine has been shown to be safe.

Surgery

Tina 19:53

That's what's important. I mean, finally

Leah 19:55

surgery is the other. Where glutamine can be used, you know, post surgical actually it's in that formula that I mentioned in, was it collagen where I talked about Juvan Juvan is a powder that can be taken twice a day, leading up to certain surgeries, and then you continue it for, I believe it's two weeks after surgery as well. And each packet contains seven grams of glutamine in it. So you're getting a dosage of 14 grams a day. That is where I've seen glutamine used most around surgery. If somebody is going through, especially some sort of abdominal surgery, okay. Uh, Juven can be recommended to help with wound healing. And then I also recall seeing studies where they were using it to decrease the risk of postoperative Ilias.

Tina 20:47

Yeah. Cuz Ilias could be severe cuz Ilias is stoppage of the flow of the contents of the bowels. So it can be a severe, uh, after effect of, of surgery. So yeah, anything that can prevent that is, high on the list of todos,

Leah 20:59

which is why I think, I think that's why the Juven was recommended at the previous hospital where I worked mm-hmm um, to kind of just improve all those kinds of possible outcomes. Mm-hmm

21:09

all

Tina 21:09

right. So, so far we have Glu. In lower doses when there's a major stress on the body of any kind, major stress being a physical stress, I'm not talking about psychological stressors here. I'm talking about a major physical stressor on the body, whether it's a burn, yes, pregnancy, that's a high stress on the body, and surgery, and maybe even radiation when it covers a large area or even chemotherapy. So think of glutamine as an amino acid being essential in times of major. Stress. If you're otherwise healthy in your post-treatment, you should be able to get plenty in your diet. There's no need for it. And then we use it in high dose in certain scenarios where it's been proven to be useful. Damage from radiation and neuropathy and prevention of diarrhea in certain cases, that kind of thing. Right.

Leah 21:56

And I do know that it, that glutamine has been used in high dose

Stem Cell transplants

Leah 22:00

in patients receiving stem cell transplants. Mm-hmm um, the study, I think of offhand is the one where. Patients with multiple myeloma mm-hmm Um, and because it can decrease mucositis, but wasn't, it also used in pediatric oncology to reduce mucositis dermatitis. And I wonder if

Tina 22:17

this just goes onto the whole heading of conditionally essential, right? I mean, stem cell transplants are a massive assault on the body and so recovery, I can see. How it could be beneficial as a conditionally essential amino acid, given the massive stress on the body,

Leah 22:33

and glutamine also is fuel for immune

Tina 22:37

cells. Yeah. And that's why it's conditionally essential. Like our body will prioritize functions, whether it is heart, brain liver. the functionality of the body is prioritized. So the enzymes that are working to make glutamine will prioritize the use of glutamine in those systems over wound healing. So for wound healing or any kind of damage to the body may not get the required glutamine because the glutamine is being used in more essential systems of the body.

Leah 23:08

But I think that's a good segue for us to then talk about cautions contraindications interactions. Of

Tina 23:15

L-glutamine. So let's take a break and then we'll come back and talk about that. Alrighty.

When not to take L-glutamine

Leah 23:25

Okay. Tina, when do you not recommend L-glutamine?

Tina 23:32

I am careful with L-glutamine post-treatment in general for people. And one of the things after treatment we always think about is sometimes there's still cancer present and we know that, right. So in cases of people. Metastatic cancers. And it's gonna be more of a chronic condition that we're treating. They might not be getting active treatment. They get a period of time that they're not getting any conventional treatment maybe, or they're on a maintenance. An oral medication or something. I'm really careful when I know cancer is present because glutamine is second only to glucose in basically what cancer cells like to use for their own fuel and their own proliferation. So it's the preferential diet. It is a preferential diet. So among the amino acid, there's a few of them that cancers like, but glutamine is high up on that list. Now that said just like glucose, you cannot be without GTA. It's not conducive to living. So you can't take it down to zero. You can't deprive yourself of glutamine because your body will just go and get it from muscle. There will always be plenty of glutamine in the body, but that said, I will not give large doses. Like to me, large doses are any dose over three to five grams at once. I will do five grams over the course of a day, knowing that it won't go in the bloodstream. That way I would not give higher doses than five grams at one time. That's where I have the cutoff. When people have cancer active or a likely, you know, a cult cancer that might

Tina's soapbox- glutamine for neuropathy?

Tina 25:01

be still in their body.

Leah 25:02

And that's important to point out. Because, as we mentioned in the neuropathy episode, people are sometimes taking L-glutamine powder for residual neuropathy. After treatment has ended, you're making a face because you've seen this.

Tina 25:22

Yeah, I've seen it too. And it's, it's the classic extrapolation of information without knowing where it came from. So if you don't know the, the start of the information it's because these clinical trials showed using it short term, right around chemo worked, There's nothing about glutamine that should ameliorate neuropathy by itself. So there's no reason to take it. There's no benefit even theoretically. Yeah. And

Leah 25:45

that's, that's a pet

Tina 25:46

peeve, right? Because you it's, it's all risk, no benefit. Even if the risk, even if we're just talking in theory and not proven these there's at least a theoretical risk of. In air quotes, feeding the cancer, what it wants while there is no use. And there's, there's not even a premise for helping with neuropathy at high doses or even, you know, adequate doses. I mean, we have to remember even on the grand spectrum of deficiency to megadosing glutamine deficiency, doesn't show up as neuropathy either. Right? So there's no, there's nowhere in the spectrum of neuropathy that glutamine would be applied to say it would ameliorate symptoms except during chemotherapy. Where it's been proven. She's stepping off her soapbox now. Yeah, I'm done now.

Leah 26:30

mic drop.

Contraindicated in pancreatic cancer

Leah 26:31

So I avoid, um, I avoid using LG glutamine powder in patients who have been diagnosed with pancreatic cancer. because I worked with a medical oncologist who his focus was on GI cancers and. He wasn't comfortable with it because both glucose and glutamine. Dependent pathways are important for pancreatic cancer cells. Mm-hmm And so he was just like, don't use glutamine because of what you were saying in terms of it being part of a cancer cells, preferential diet mm-hmm diet is in quotes. It's in finger quotes, but yeah, it's a, the same reason. Patients with pancreatic cancer, it's important for them to regulate their blood sugar. Mm-hmm all patients, all cancer patients. It's important. Maintain an even steady blood sugar, um, level. Yeah. But I think especially with pancreatic

Bodily distribution of L-glutamine

Leah 27:28

cancer. Yeah.

Tina 27:29

And how glutamine is treated by the entire body like bio organ systems and how it's distributed is different when there is cancer present, as opposed when there's not cancer present. So I'd like to in our, on our webpage, I'm gonna put up a picture that kind of shows how the glutamine switches, how glutamine. Trafficking around the body makes it sound like a drug drug trafficking, no glutamine trafficking around the body. Meaning which organs take it up the most and which ones donate it to the cause of metabolism. So the cancer long story short takes up a lot of glutamine if it's available. So I think pancreatic cancer is one of those. I mean, it might, it might take up more than even other types of tumors. Yeah.

Leah 28:10

I mean, that's, I, I tried to see if I could find this study that, you know, was the. The trigger for him saying don't use this. And I, I don't remember if it, what it was specifically mm-hmm um, also caution with patients who have leukemia or lymphoma. Okay. At

Leukemia/Lymphoma

Leah 28:27

high doses. Mm-hmm because of the fact that we said that glutamine is a fuel for

Tina 28:31

immune system cells. That makes perfect sense. Yeah. Yeah. Since I, I do it across the board, so I, I would include those in my recommendations to people to not do high dose and

Leah 28:41

then liver disease and kidney disease. Is a, is a caution to take the really high doses. glutamine is a source of nitrogen mm-hmm And so high nitrogen is not good in, in those conditions.

Tina 28:56

Yeah. because ammonia is involved here, the body makes ammonia and we have to release it and remove it. And if we have compromised liver function, sometimes we have trouble getting rid of ammonia. Um, and that can lead to some severe side effects and The ammonia has effects on the brain that can have effects on. Someone's actions. So you can, you can have anxiety, you can have anger, you can have, a dullness. Um, you can have cognitive difficulties. Well, and then even

Leah 29:22

hepatic encephalitis. Mm-hmm. exactly. That's what my dad had. And that was, oh, he did? Yeah, because of his liver cancer. Mm-hmm so, yeah, that's from high. It can be from a high ammonia level. So yeah, you don't wanna, you don't wanna mess with that. Right. Um, glutamine also is

Neurotransmitters

Leah 29:41

what makes up neurotransmitters mm-hmm because of that, it can be excitatory in some people. I remember initially learning, not to use glutamine in patients who have bipolar disorder. Or to use caution. Okay. When using it in patients with bipolar disorder and it may actually increase seizures in some people mm-hmm

Glutamine becomes glutamate

Tina 30:05

yes, it can be in high doses. It's. Transfers over to glutamate very easily. So glutamine to glutamate is a very easy pathway in the, in the body. And generally that's an equilibrium. And so if you give a lot of glutamine, you're gonna have as a result, plenty of glutamate glutamate in the brain is what we call an excitatory neurotransmitter. So glutamate can be. Something that in, in adequate levels helps you focus and be alert. But for some people with certain conditions like bipolar or in some people who are more sensitive, high amounts of glutamate in the brain can be counterproductive, can actually be harmful. So

MSG

Tina 30:45

a classic example of glutamate that people might be familiar with, that they take in and maybe they even avoid is MSG. It's monosodium glutamate. And some people, when they take an MSG, they get a headache or they feel jacked or whatever. They can have side effects of that. So if you're sensitive to MSG, for example, you might be someone who's very careful about taking high doses of glutamate, cuz you may have a similar reaction.

Leah 31:06

I was gonna ask you that was gonna be my question for you.

Tina 31:10

Oh, that's okay. That's cause we've been talking so long and we're, you know, we chat so much. I already know what you're gonna ask me. Maybe I already knew that, oh

Leah 31:17

no, next comes finishing my sentences. But yeah, no, I was gonna ask that because I think that that's a, that's a really. That's a big question. Mm-hmm that, that people wanna know, um, like, is this the same as monosodium glutamate? And you know, for some people, it doesn't, they're not affected by MSG mm-hmm because it can be in very low doses, but it's when that, like you're saying that glutamate is in a really high dose that you would be concerned.

Tina 31:50

Yeah. I'm one of those people. I get massive headaches from MSG. I do too.

Leah 31:53

I do. I, I get, um, it feels like a vice is on my. and I've experimented too. Cuz I was like, maybe this is, this isn't really what's happening, but oh, it happens with me. Mm-hmm.

Tina 32:05

Yes, I, yes, I've gotten that headache and then looked back and went, oh right. That's probably what happened. I had that bento bowl or ramen noodle dish or whatever, when you're out and about. They'll put MSG in some things like that. And it's not the

Leah 32:18

fact that they just put in MSG it's that they put in copious amounts of MSG.

Tina 32:23

Yeah. So again, I'm sure it's dose dependent. Yeah. See, look at that. Oh

Leah 32:28

my God. Jinx, show me a Coke. Stop, stop. Um, I did see that there were a couple

Glutamine-drug interactions

Leah 32:35

of interactions, supplement drug interactions. One was with Lalo, uh, which I've seen it most used as a laxative mm-hmm and the interaction doesn't matter if you're using it just as a laxative, but glutamine can reduce the ammonia lowering effect of lack Chilo, which is what's given When somebody has hepatic encephalopathy because of high ammonia levels glutamine, because it is a nitrogen donor

Methotrexate potentiation

Leah 33:04

can counter that. The other time is G glutamine may increase. Tumor retention of methotrexate, which would increase its therapeutic efficacy according to Memorial Sloan Kettering. So I would never use it for that. I would never use it to increase.

Tina 33:21

I have never, yeah, I've never applied it in that sense. Yeah.

Leah 33:25

And it's not something that I would necessarily, you know, consider using it for. I don't see a lot of patients getting methotrexate anyways, but,

Tina 33:33

well, it's, it's an interesting, that would be interesting. I, I wanna. More about that. Cuz I know intravenous methotrexate as a single agent is used at times with primary CNS central nervous system lymphomas. And because it's being used as a curative treatment, the key is getting enough into the tumor to actually take all of it out. Like literally. You got one shot, you go through that course of treatment. And if you recur after you get that, then you're gonna be rec recurring. if you come out the other side and you don't recur, then it looks curative. So because you're kind of, aiming for the fences with that particular treatment, um, yeah. Glutamine alongside it. If it potentiates that treatment without any other untoward effects, it might be something to look at. Well,

Leah 34:18

I'll put the link in the bio that I found through Memorial Sloan kitting. And again, If you wanna start taking something, talk to your, talk to your medical oncologist, talk to your, talk to your

Tina 34:30

doctor. Yeah. And that's what the links are for that. We leave in our show notes and on our website is so that people can go from there and. Begin their own research or take that right to your medical oncologist and have a conversation, you know? So these are supposed to be spurring conversations and thoughts because we're

Leah 34:50

not your doctor. I, we haven't said that in a while, so I feel like I had to say it anyways. Anything else? Any other tidbits notes

Tina 34:58

aside? Nope. I'm fresh out of ideas on

Wind down

Tina 35:01

ALG glutamine. So technically this is our first amino acid, a whole episode on one amino. Right, right, right.

Leah 35:06

Of, of all of the supplements we have not done an amino acid yet. Are there others

Tina 35:11

that we would cover? No, we probably would do a few in one, so we could do like branch chain amino acids. So there'd be three in that episode. Yeah, but yeah, you don't, you're not very excited about that idea.

Leah 35:21

I don't typically recommend branch branch chain acids. Should I be we'll find out to do an episode tune in and find out. So as always leave us a review, let us know what you're thinking.

Tina 35:36

Oh yes. You mean some feedback that we. Email and stuff. Mm-hmm yeah.

Leah 35:41

Yeah, we're continuing, um, with the, with the supplements 1 0 1, I think people really like to know about supplements so you can write in and. Say, Hey, this is a supplement I wanna know more about that's how we chose glutamine was because I had a couple people saying, Hey, can you guys talk about glutamine? Mm-hmm and here we are, you ask. And we, we

Tina 36:02

deliver we're like, we're like DJs, we take requests. We take

Leah 36:05

requests, but not all

Tina 36:07

requests. this is the love line. Do you have any requests out there tonight?

Leah 36:11

oh, I was thinking like at a, like at a, you know, at a party or at a club, you know, I have friends who are DJs and people would come up and would ask for them to play stuff. And like, they're like, I wouldn't even have that record.

Tina 36:24

Oh, well we're not so snooty as your DJ friends. Oh,

Leah 36:27

I'm totally as snooty as my DJ friends. They're my friends. anyways. Um, On that note. I'm Dr. Lea

Tina 36:36

Sherman and I'm Dr. Tina Caer. And this is the cancer pod until next.

Leah 37:25

Chop this like a salad.