Ornithine alpha-ketoglutarate (OKG)

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • 2-Oxoglutaric acid, 2-oxopentanedoicic acid, 3-methylhistidine, AAKG, acétoglutarate (French), acide 2-oxoglutarique (French), acide a-cétoglutarique (French), acide alpha-cétoglutarique (French), AKG, alanine, alfa-cetoglutarato (Spanish), alpha keto glutarate, alpha ketoglutarate, alpha KG, alpha-cétoglutarate (French), alpha-cétoglutarate d’arginine (French), alpha-cétoglutarate de calcium (French), alpha-cétoglutarate de créatine (French), alpha-cétoglutarate de glutamine (French), alpha-cétoglutarate de L-arginine (French), alpha-cétoglutarate de L-leucine (French), alpha-cétoglutarate de taurine (French), alpha-cetoglutarate d’ornithine (French), alpha-ketoacid, alpha-ketoanalogs, alpha-ketoglutarate, alpha-ketoglutarate dehydrogenase (KGDHC), alpha-ketoglutarate-pyridoxine complex, alpha-ketoglutaric acid, alpha-ketoisocaproate, alpha-ketoisovalerate, alpha-ketomethylvalerate, ammonia, arginine, arginine alpha-ketoglutarate, arginine aspartate, calcium alpha-ketoglutarate (Ca-ket), cétoglutarate d’ornithine (French), Cetornan®, creatine alpha-ketoglutarate (creatine AKG), diarginine alpha-ketoglutarate, glutamate, glutamine, glutamine alpha-ketoglutarate, glycine, histidine, hydroxyproline, L-arginine, L-leucine alpha-ketoglutarate, L-lysine alpha-ketoglutarate reductase, L-ornithine alpha-ketoglutarate, L(+)-ornithine alpha-ketoglutarate, lysine, malate-oxalacetate, OAKG, OGO, OKG, Ornicetil®, ornithine, ornithine alpha-ketoglutarate, ornithine oxoglutarate, ornitina cetoglutarato (Spanish), oxoglutarate, phenylalanine, polyamines, proline, putrescine, pyridoxine AKG (PAK), pyruvate, pyruvic acid, spermine, spermidine, taurine alpha-ketoglutarate, tyrosine.

Background

  • Ornithine alpha-ketoglutarate (OKG) is not found naturally in the body. It is made from combining two amino acids, ornithine and alpha-ketoglutarate (AKG), which are thought to have important roles in metabolism.

  • OKG has been used for treating burns and wounds, to promote the production of muscle protein following trauma, stroke, or surgery, and to promote growth in children who are fed via intravenous tube for the long term (called long-term total parenteral nutrition, or TPN). It has been studied for recovery from major trauma or illness, as well as for brain disease. It is also often used to improve athletic performance or to build muscle, although more research is needed to confirm these effects.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Burns

Severe burn injury may lead to problems with metabolism, nitrogen imbalance, and low energy and protein reserves. Numerous studies suggest that OKG may help severe burn patients by regulating protein metabolism and maintaining nitrogen balance and nutritional status. Delivering OKG via a tube through the nose to the stomach may improve wound healing time and shorten the duration of tube feeding in burn patients.

Aging

Early studies suggest that OKG may benefit elderly people who are ill. More research is needed.

Chemotherapy side effects

Early studies suggest that OKG may prevent nausea and vomiting associated with chemotherapy, and that these benefits may equal those of the drug metoclopramide, in people who are treated with the cancer medications cisplatin or Adriamycin. More research is needed.

Coma

In early studies, OKG had a lack of effect on coma associated with liver disease. Further research is needed before conclusions can be made.

Critical illness

Research suggests that OKG therapy may help improve and balance nitrogen levels after an injury or trauma. OKG is known to enhance metabolism and improve cell immunity, as well as stimulate important hormones such as insulin and growth hormone. Further research is needed.

Encephalopathy

Early studies show that OKG had a lack of benefit on brain disorders and worsened the condition of patients. The information that is available comes from low-quality studies. More research is needed before conclusions can be made.

Growth

Early studies suggest that OKG may improve growth in children before puberty, but there is currently not enough evidence. More research is needed.

HIV support

There are a limited number of studies involving the use of OKG for improving nutrition and immune function in HIV-positive people. More research is needed before conclusions can be made.

Pressure ulcers

Early research suggests that OKG may benefit elderly people who have bedsores. More research is needed.

Recovery after surgery

Few studies have looked at the potential benefits of OKG on recovery after surgery. Limited evidence suggests that OKG may improve the production of muscle protein during the recovery period. However, more research is needed.

Stroke recovery

Few studies have looked at the effect of OKG in stroke recovery. There is some evidence that OKG may initially improve stroke recovery. More research is needed before conclusions can be made.

*Key to grades:

Tradition

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Ammonia toxicity, antioxidant, athletic performance, bacterial infections, cancer, cataracts, deficiency, diabetes, energy, fatigue, fungal infections, high cholesterol, immune function, intestinal problems, liver disease, loss of appetite, kidney disease, malnutrition, movement disorders, muscle strength, muscle wasting, nerve damage, nutrition supplementation, organ transplantation, osteoporosis / osteopenia (bone loss), sleep aid, stomach disorders, stomach ulcers, toxicity, weight loss, wound healing, wrinkle prevention.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • The use of OKG should be supervised by a physician.

  • To treat acute illness in elderly people, 10 grams of OKG has been taken by mouth once daily for two months.

  • To treat burns, 10 grams of OKG has been given via stomach tube 1-3 times daily for up to three weeks.

  • To improve nitrogen balance after illness, 20 grams of OKG has been given along with nutrition via stomach tube beginning 48-60 hours after injury and continuing for four days.

  • To aid recovery after surgery, 10 grams of OKG (Cetornan®) diluted in flavored water has been taken by mouth during lunch and dinner five days before and 10 days after surgery. A dose of 20 grams of OKG has been used in two divided doses daily for two months. A dose of 20 grams of OKG has been given via stomach tube daily for one month. A dose of 0.35 grams per kilogram of OKG has been given along with nutrition through the veins for three days after stomach surgery.

  • To treat pressure ulcers, 10 grams of OKG has been used daily for six weeks.

  • To aid recovery after trauma or injury, 25 grams of OKG has been given along with nutrition through the veins daily or taken by mouth along with feeding with a stomach tube.

  • To treat the side effects of chemotherapy, 10 grams per square meter of OKG has been given through the veins as a single dose.

  • To treat trauma or injury, 25 grams of OKG has been given along with nutrition through the veins daily, or taken by mouth along with feeding via stomach tube for a short period.

Children (under 18 years old)

  • The use of OKG should be supervised by a physician. To promote growth in children, 15 grams of OKG has been added to a solution through the veins for five months, along with supplemental nutrition infused over 12-14 hours at night.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid if allergic or sensitive to OKG.

Side Effects and Warnings

  • The use of OKG should be supervised by a doctor.

  • OKG may lower blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary. OKG may affect insulin levels.

  • Use cautiously in people who have stomach disorders. OKG may cause bloating, cramps, diarrhea, nausea, stomach pain, and vomiting.

  • Use cautiously in young children and in pregnant or breastfeeding women, due to a lack of safety data.

  • Use cautiously in people who have brain disorders or serious liver conditions, as OKG may worsen these conditions.

  • Use cautiously in people who have serious kidney disease, due to a lack of safety data.

  • Use cautiously in people who have mood disorders, as OKG may negatively affect mood.

  • Use cautiously in people who have skin conditions, as OKG may cause itching.

  • Avoid if allergic or sensitive to OKG.

Pregnancy and Breastfeeding

  • There is currently a lack of scientific evidence on the use of OKG during pregnancy or breastfeeding.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • OKG may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

  • OKG may also interact with agents that may affect the liver, agents that may affect the immune system, agents that may affect the nervous system, agents that may enhance muscle strength, agents that may treat HIV, agents that may treat skin conditions, agents that may treat stomach conditions, growth hormone, mood stabilizers, and wound-healing agents.

Interactions with Herbs and Dietary Supplements

  • OKG may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

  • OKG may also interact with amino acids, glutamine, herbs and supplements that may affect the liver, herbs and supplements that may affect the immune system, herbs and supplements that may affect the nervous system, herbs and supplements that may enhance muscle strength, herbs and supplements that may treat HIV, herbs and supplements that may stimulate growth, herbs and supplements that may treat skin conditions, herbs and supplements that may treat stomach conditions, mood stabilizers, ornithine, phenylalanine, proline, and wound-healing herbs and supplements.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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  3. Bruce M, Constantin-Teodosiu D, Greenhaff PL, et al. Glutamine supplementation promotes anaplerosis but not oxidative energy delivery in human skeletal muscle. Am.J.Physiol Endocrinol.Metab 2001;280(4):E669-E675. View Abstract
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  9. Karsegard VL, Raguso CA, Genton L, et al. L-ornithine alpha-ketoglutarate in HIV infection: effects on muscle, gastrointestinal, and immune functions. Nutrition 2004;20(6):515-520. View Abstract
  10. Meaume S, Kerihuel JC, Constans T, et al. Efficacy and safety of ornithine alpha-ketoglutarate in heel pressure ulcers in elderly patients: results of a randomized controlled trial. J.Nutr.Health Aging 2009;13(7):623-630. View Abstract
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  13. Rutten EP, Engelen MP, Schols AM, et al. Skeletal muscle glutamate metabolism in health and disease: state of the art. Curr.Opin.Clin.Nutr.Metab Care 2005;8(1):41-51. View Abstract
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  15. Zur Nieden HC, Pullen R, Fusgen I. Treatment of decubital ulcers in geriatric patients with ornithine- oxoglutarate – A randomized, double-blind pilot study. European Journal of Geriatrics. 1999;1:144-147.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.