L-arginine in severe Covid-19 decreases the length of hospitalization | Hacker News Reader

L-arginine in severe Covid-19 decreases the length of hospitalization

sciencedirect.com

50 pointsdrocer8829 comments

Just wanted to say that this seems like really good data. Pre-registered RCT with a large n and a very significant measured effect.

I kind of wonder how necessary/effective this treatment would be in people who are already enough protein, they didn't include info on the diets of the patients involved.

For others who are curious, N=101 in the OP paper, which is a preliminary subset of the total subjects in the clinical trial (N=290, according to the registration).

To your second point, arginine supplementation can still be helpful for otherwise healthy individuals who are undergoing physiological stress due to illness. FWIW there are some supporting references on the Wikipedia page.

I'm not sure, the data seems oddly and unnecessarily skewed in terms of the group breakdown.

- The placebo group was almost 10 years older on average. You might think that this would be fine, or even make the effect demonstrated even larger than the study suggests, except 8 patients were removed from the placebo group due to being moved to the ICU before the start of the study. This introduces a massive amount of selection bias into the data when you only had 48 in the placebo group to start with.

- The placebo group had about half as many women as a %

Of course there is an attempt to remove these confounding factors in some of the data, but the big results appear to be un-adjusted numbers (number of days in hospital being reduced, reduction of the need for oxygen, etc).

There is also an odd coincidence that they selected 53 patients for the Placebo group, and 48 for the L-Arginine group, and the groups lost 8 and 3 patients to the ICU respectively, so the final groups were both 45. Is this normal in these types of studies? Why wouldn't they have made the intention to treat population 50 for both cases?

already eating enough protein*

3.2g of arginine in a day doesn't sound like a lot. There's around 2g in most meat/protein servings, and 1g on each egg yolk[0]. I wonder how much of the study outcome is just the result of changing dietary habits of the patients.

[0] http://www.dietandfitnesstoday.com/arginine.php

It's well known that elderly people have reduced ability to absorb protein through the gut. I'm just speculating here but could that be one of several reasons why elderly patients are at higher risk of COVID-19? Perhaps some of them are simply deficient in essential amino acids.

I think 500mg is a reasonable starting dose. It’s a vasodilator so too much would cause hypotension.

This seems consistent with the fact that Arginine is a conditionally essential amino acid. Our body can naturally make its own Arginine most of the time. When tissues are under increased stress (wound healing is a good example), Arginine becomes essential (the healing tissue can't make enough on its own and needs extra exogenous Arginine).

I'd be curious to see whether this effect is specific to COVID or if Arginine is also beneficial in non-COVID ARDS/Pneumonia.

Cited from the study: "20 days after randomization we failed to detect any significant difference in the primary outcome between the study arms" (p4). The fact that it has no difference in primary outcome (removal of respiratory support) makes me very skeptical of its secondary outcome claims (time to discharge).

This adds to the pile of evidence suggesting that most people with severe COVID symptoms are in that position due to their own health and diet choices. I am thinking of the studies showing the concurrence of obesity or vitamin D deficiency with COVID hospitalization.

For those without access: https://www.thelancet.com/pdfs/journals/eclinm/PIIS2589-5370...

Isn’t it easier to get vaxxed and reduce your chance of cytokine storm than to hope that there are existing compounds that can help repair lung damage once it’s already occurring? There are already immunosuppressants that are cheap and widely available that reduce damage, and the search is on for things that inhibit viral replication. I think there is also research for universal antibodies that attack regions that are rarely mutated.

Would be great if such last possibility treatments work as patients are usually post COVID by the time the lungs are shot. The course of other diseases would profit from lung repair, possibly even smoking damage.

It's not either / or. Vaccines aren't 100% effective so we still need treatments for breakthrough cases.

Also, not everyone can be vaccinated. Even now, no one under 13 years old is vaccinated.

It would be interesting if argenine supplementation reduced impact on those affected by side effects of vaccination. I don't know of any progress predicting who is (most) likely to experience side effects, or how severe they will be. Argenine supplementation is at worst perfectly safe, and cheap.

We should be able to discuss side effects, anyway, and try to eliminate them, without hysteria.

There has been some preliminary research on who is most likely to experience side effects from vaccination. Adolescent males seem to be at slightly elevated risk from heart inflammation. The absolute risk is still low, but they are also at minimal risk from the virus.

https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v...

https://www.gov.uk/government/news/jcvi-issues-updated-advic...

Under 12, not 13

While you're right, unproven cures have been hyped to magical levels in order to rationalize not getting vaccinated.

The science can’t stop, or be hidden, just because of that.

Arginine will boost your Nitric Oxide (NO) production abilities. It's often used as a simple ED treatment, for example. NO is a vasodilator.

This could align to recent NO-based nasal treatments against COVID.

This is yet another piece of compelling evidence showing that nutraceuticals can significantly reduce recovery time and improve health outcomes.

Combined with early treatment using widely available medicines, it’s clear we have a variety of tools at our disposal to mitigate this pandemic.

Unfortunately many people are unaware of the evidence supporting these types of treatments, partly because they receive such little attention in mass media.

As usual I’m ready for the downvotes - for some reason people here think this information is contentious or disagreeable.

I think your analysis is a little bit vague? There are an almost unlimited number of chemicals that might be tried to treat any given disease. You can't test all of them.

If you limit the chemicals to those available at a vitamin store (which is how I'm interpreting 'nutraceutical') seems like a terrible strategy for how to deploy research resources. Almost no diseases are treatable in an effective way with these chemicals, and when there are positive results in a study involving these chemicals it is almost always not reproducible or the effect of the chemical is insufficient to justify using it. The vitamins and nutrients which we have evidence there is a benefit to taking are already added to almost every food product you can buy.

The only people who seem to be motivated to push this strategy are the companies which profit from selling big plastic bottles covered with the most misleading claims they can legally make, and filled with what are basically placebo pills.

I'm going to go ahead and make a prediction: There is nothing you can find in a vitamin shop, taken in any amount, that will end up demonstrating sufficient benefit to the treatment of COVID that it is worth using.

Have you reviewed the studies on Vitamin D? Several have shown significant benefits and the costs are low.

https://vitamin-d-covid.shotwell.ca/

Upvoted. Here is a good breakdown of other contentious early Covid treatments.

COVID-19 early treatment: real-time analysis of 917 studies https://c19early.com/

Thanks for this, it's quite well done. It's a good model for tracking an evolving understanding of what may help as the situation (and the underlying disease) continues to evolve.

"a significant difference was not detected 20 days after randomization, most likely because most of the participants in the L-arginine arm had been already discharged from the hospital by this time"

If memory serves, isn't L-arganine a treatment for herpes as well?

No. People have tried lysine, but it is ineffective. If anything, argenine would worsen herpes.

But, on the subject, do be sure to get your shingles vaccination!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419779/

I used to eat 10g/d. Never made a lick of difference.

Reply on news.ycombinator.com