Alanylglutamine

Also called L-alanyl-L-glutamine, Ala-Gln, Sustamine (brand), alanyl-glutamine dipeptide.

Best grade B across 10 graded outcomes Amino acid Last checked Oct 21, 2026

The short answer

From 16 sources

Alanylglutamine is a two-amino-acid dipeptide that delivers glutamine more efficiently than free glutamine: plasma glutamine exposure was about twice as high at the same glutamine dose. Small sports studies suggest it may help endurance under dehydration. In undernourished children, 10 days at 3–24 g/day improved gut-permeability tests and weight gain.

Every graded outcome on this page

10 rows · line = participants

Grade BComplications and hospital stay after major abdominal surgery (intravenous dipeptide)Surgeryn 1,243
Grade BInfections, hospital stay and mortality in critically ill adults (intravenous dipeptide)Critical caren 842
Grade CGut permeability and growth in undernourished childrenGut barriern 140
Grade CIntestinal permeability and weight gain in children with poor growthGut barriern 107
Grade DIntestinal absorption in people with HIV/AIDSGut barriern 46
Grade DChemotherapy diarrhoea in colon cancer (intravenous dipeptide)Cancer caren 44
Grade DExercise capacity, lean mass and quality of life in chronic heart failure (with fish oil)Heart failuren 31
Grade DFluid retention (beverage hydration index)Hydrationn 19
Grade DReaction time and cognition after endurance runningReaction timen 12
Grade DTime to exhaustion during mild dehydrationEndurancen 10
7 more graded outcomes, in the evidence chapter

Key facts

Absorption: Plasma glutamine area under the curve 284 vs 127 µmol·h/L for the dipeptide vs free glutamine at equal glutamine doses³
Endurance: Longer time to exhaustion under mild dehydration at 0.05–0.2 g/kg in 10 men¹
Children's gut trials: 3–24 g/day for 10 days improved gut-permeability tests and weight gain in two Brazilian trials^5,6
Critical illness: Glutamine given by vein (as the alanyl-glutamine dipeptide) and by tube was linked to higher in-hospital and 6-month mortality in a 1,223-patient ICU trial^7,9

What it is

Alanylglutamine is a dipeptide of alanine and glutamine, used in sports drinks and clinical nutrition.

How it works

Proposed

The dipeptide is absorbed intact and split to release glutamine, giving a larger and longer plasma glutamine rise than free glutamine. In rats after resistance exercise it reduced signalling linked to muscle protein breakdown but did not boost synthesis signalling.^3,8

Forms, side by side

2 forms named in our sources. The rest show what our data holds, and say plainly where it holds nothing yet.

Alanylglutamine forms compared

2 forms

Alanylglutamine forms compared: 2 forms by 3 attributes. Empty cells are labelled No data yet, or Not graded in the evidence row.
2 forms	L-alanyl-L-glutamine powder (oral)	Intravenous alanyl-glutamine (hospital parenteral nutrition, e.g. Dipeptiven)
Absorption in people	At 89 mg/kg, plasma glutamine peaked at 30 minutes and stayed above baseline for up to 4 hours, with roughly twice the exposure of free glutamine.³	Given by vein as part of parenteral nutrition, so gut absorption does not apply.¹³
GI tolerance	Children tolerated 24 g/day in enteral formula for 10 days.⁶	Linked to higher mortality at high doses in ventilated ICU patients with multiorgan failure (REDOXS); guideline doses are 0.3–0.5 g/kg/day in stable patients without liver or kidney failure.^7,9,13
Studied for	Exercise hydration, reaction time, gut permeability in children and adults with HIV, heart failure (with fish oil)	Critical illness, major surgery and chemotherapy diarrhoea (hospital use only)

L-alanyl-L-glutamine powder (oral)
Absorption in people
At 89 mg/kg, plasma glutamine peaked at 30 minutes and stayed above baseline for up to 4 hours, with roughly twice the exposure of free glutamine.³
GI tolerance
Children tolerated 24 g/day in enteral formula for 10 days.⁶
Studied for
Exercise hydration, reaction time, gut permeability in children and adults with HIV, heart failure (with fish oil)
Intravenous alanyl-glutamine (hospital parenteral nutrition, e.g. Dipeptiven)
Absorption in people
Given by vein as part of parenteral nutrition, so gut absorption does not apply.¹³
GI tolerance
Linked to higher mortality at high doses in ventilated ICU patients with multiorgan failure (REDOXS); guideline doses are 0.3–0.5 g/kg/day in stable patients without liver or kidney failure.^7,9,13
Studied for
Critical illness, major surgery and chemotherapy diarrhoea (hospital use only)

What the human research says

Human trials only, one row per outcome. The form line shows what each trial actually tested. Grades follow our evidence-grading policy.

Trial map

10 graded outcomes, largest study first

10 graded outcomes: 6 improved, 4 mixed. The largest, a 2015 meta-analysis of 1,243 people on complications and hospital stay after major abdominal surgery (intravenous dipeptide), found mixed results.

By sizeTable

1Complications and hospital stay after major abdominal surgery (intravenous dipeptide)

Mixed · Grade B · Meta-analysis, 1,243 people, 2015

19 RCTs of elective major abdominal surgery (640 glutamine, 603 controls)

Dose, result and source

Every graded outcome on this page, largest study first
Outcome	Found	People	Study	Who was studied
Complications and hospital stay after major abdominal surgery (intravenous dipeptide)	Mixed	1,243	Grade B · Meta-analysis, 2015	19 RCTs of elective major abdominal surgery (640 glutamine, 603 controls)
Infections, hospital stay and mortality in critically ill adults (intravenous dipeptide)	Improved	842	Grade B · Meta-analysis, 2017	15 RCTs in critically ill adults without liver or kidney failure (major surgery, trauma, infection, organ failure)
Gut permeability and growth in undernourished children	Improved	140	Grade C · RCT, 2020	Children aged 2–60 months at risk of environmental enteropathy (Fortaleza, Brazil)
Intestinal permeability and weight gain in children with poor growth	Improved	107	Grade C · RCT, 2007	Children aged about 8 months to 7 years with low weight or height z-scores (northeastern Brazil)
Intestinal absorption in people with HIV/AIDS	Improved	46	Grade D · RCT, 2013	46 adults with HIV/AIDS in Brazil
Chemotherapy diarrhoea in colon cancer (intravenous dipeptide)	Improved	44	Grade D · RCT, 2022	44 patients with stage II–III colon cancer on mFOLFOX-6 chemotherapy in Egypt (22 per group)
Exercise capacity, lean mass and quality of life in chronic heart failure (with fish oil)	Mixed	31	Grade D · RCT, 2015	31 patients with chronic stable heart failure in New York
Fluid retention (beverage hydration index)	Mixed	19	Grade D · Crossover RCT, 2021	Healthy young adults at rest
Reaction time and cognition after endurance running	Mixed	12	Grade D · Crossover RCT, 2016	Male endurance athletes
Time to exhaustion during mild dehydration	Improved	10	Grade D · Crossover RCT, 2010	Physically active young men dehydrated to −2.5% body mass

Every graded row

10 rows

Form tested

Showing 10 of 10 outcomes. Human trials only.

Grade BComplications and hospital stay after major abdominal surgery (intravenous dipeptide)SurgeryMixedMeta-analysis
n 1,243 · 2015

Mixed Overall complications (RR 0.84, 95% CI 0.51 to 1.36) and infections (RR 0.64, 95% CI 0.38 to 1.07) did not fall significantly; hospital stay was 2.67 days shorter (95% CI -3.83 to -1.50).

Design: Meta-analysis, n = 1,243, 2015
Population: 19 RCTs of elective major abdominal surgery (640 glutamine, 603 controls)
Form: Intravenous glutamine dipeptide
Dose: Not stated in the abstract
Duration: Around surgery
Source: Reference 14 · PubMed 25584966 (opens PubMed)

Grade BInfections, hospital stay and mortality in critically ill adults (intravenous dipeptide)Critical careImprovedMeta-analysis
n 842 · 2017

Improved Fewer infectious complications, ICU stay 1.61 days and hospital stay 2.30 days shorter (95% CI -4.14 to -0.45), ventilation 1.56 days shorter and hospital mortality 45% lower (RR 0.55, 95% CI 0.32 to 0.94); ICU mortality did not change.

Design: Meta-analysis, n = 842, 2017
Population: 15 RCTs in critically ill adults without liver or kidney failure (major surgery, trauma, infection, organ failure)
Form: Glutamine dipeptide in parenteral nutrition
Dose: 0.3–0.5 g/kg/day by vein, with adequate nutrition
Duration: During ICU parenteral nutrition
Source: Reference 13 · PubMed 28361751 (opens PubMed)

Grade CGut permeability and growth in undernourished childrenGut barrierImprovedRCT
n 140 · 2020

Improved At the highest dose, urinary lactulose excretion improved modestly (0.19% to 0.17%, p = 0.05). Weight-for-height improved transiently in two groups at day 10 and weight measures in all groups at day 30. No effect on diarrhoea or fecal inflammation markers.

Design: RCT, n = 140, 2020
Population: Children aged 2–60 months at risk of environmental enteropathy (Fortaleza, Brazil)
Form: Alanyl-glutamine versus glycine placebo
Dose: 3, 6 or 12 g/day
Duration: 10 days, follow-up to 120 days
Source: Reference 5 · PubMed 32826717 (opens PubMed)

Grade CIntestinal permeability and weight gain in children with poor growthGut barrierImprovedRCT
n 107 · 2007

Improved Lactulose excretion improved with alanyl-glutamine but not with glycine, and weight-for-height and weight-for-age gains over 120 days were greater. Height-for-age did not change.

Design: RCT, n = 107, 2007
Population: Children aged about 8 months to 7 years with low weight or height z-scores (northeastern Brazil)
Form: Alanyl-glutamine-supplemented enteral formula versus glycine
Dose: 24 g/day
Duration: 10 days, follow-up to 120 days
Source: Reference 6 · PubMed 17325559 (opens PubMed)

Grade DIntestinal absorption in people with HIV/AIDSGut barrierImprovedRCT
n 46 · 2013

Improved Urinary mannitol excretion, a marker of absorption, rose in the alanyl-glutamine group (median 14.38% to 21.24%, n = 14, P = 0.0382); recent diarrhoea was linked to worse permeability at baseline.

Design: RCT, n = 46, 2013
Population: 46 adults with HIV/AIDS in Brazil
Form: Oral alanyl-glutamine versus glycine placebo
Dose: 24 g/day (placebo glycine 25 g/day)
Duration: 10 days
Source: Reference 11 · PubMed 23657308 (opens PubMed)

Grade DChemotherapy diarrhoea in colon cancer (intravenous dipeptide)Cancer careImprovedRCT
n 44 · 2022

Improved Diarrhoea was less frequent and less severe than on placebo, especially after cycles four and six; overall survival did not differ.

Design: RCT, n = 44, 2022
Population: 44 patients with stage II–III colon cancer on mFOLFOX-6 chemotherapy in Egypt (22 per group)
Form: Intravenous N(2)-L-alanyl-L-glutamine (Dipeptiven) versus placebo
Dose: 20 g in 100 mL by vein with each chemotherapy cycle (full text)
Duration: Every 2 weeks with chemotherapy
Source: Reference 15 · PubMed 35334570 (opens PubMed)

Grade DExercise capacity, lean mass and quality of life in chronic heart failure (with fish oil)Heart failureMixedRCT
n 31 · 2015

Mixed Muscle function, 6-minute walk, grip strength and echocardiography did not change and peak VO2 rose non-significantly; lean body mass increased and quality of life improved.

Design: RCT, n = 31, 2015
Population: 31 patients with chronic stable heart failure in New York
Form: L-alanyl-L-glutamine plus omega-3 fatty acids (placebo: safflower oil and milk powder)
Dose: 8 g/day alanyl-glutamine with 6.5 g/day omega-3 fatty acids
Duration: 3 months
Source: Reference 12 · PubMed 26269566 (opens PubMed)

Grade DFluid retention (beverage hydration index)HydrationMixedCrossover RCT
n 19 · 2021

Mixed The dipeptide drink retained more fluid than water at 240 minutes but did not differ from electrolytes alone or a carbohydrate-electrolyte sports drink.

Design: Crossover RCT, n = 19, 2021
Population: Healthy young adults at rest
Form: Alanyl-glutamine (2 g/L) plus electrolytes
Dose: 1 L of beverage
Duration: Single sessions, 4 hours
Source: Reference 4 · PubMed 34578811 (opens PubMed)

Grade DReaction time and cognition after endurance runningReaction timeMixedCrossover RCT
n 12 · 2016

Mixed Reaction-time measures were likely better with alanyl-glutamine than with no hydration; cognitive-test comparisons between conditions were mostly unclear.

Design: Crossover RCT, n = 12, 2016
Population: Male endurance athletes
Form: Alanyl-glutamine added to an electrolyte drink
Dose: 300 mg or 1 g per 500 mL
Duration: Single sessions
Source: Reference 2 · PubMed 25321847 (opens PubMed)

Grade DTime to exhaustion during mild dehydrationEnduranceImprovedCrossover RCT
n 10 · 2010

Improved Both doses gave significantly longer time to exhaustion at 75% VO2max than the no-rehydration trial. Inflammation, oxidative stress and hormone markers did not differ between trials.

Design: Crossover RCT, n = 10, 2010
Population: Physically active young men dehydrated to −2.5% body mass
Form: L-alanyl-L-glutamine (Sustamine) in rehydration water
Dose: 0.05 g/kg or 0.2 g/kg
Duration: Single sessions
Source: Reference 1 · PubMed 20181080 (opens PubMed)

What the numbers add up to

Each point is worked out from the data and the sources numbered on this page, with the arithmetic shown under it. It adds no new data and is not medical advice.

Most sports evidence compares against no drink

The endurance benefit was measured against no rehydration; against plain water or electrolyte drinks, differences were small or unclear.^1,4

Strongest data are paediatric

The largest trials studied gut permeability and growth in undernourished children, not athletes.^5,6

Studied doses

Doses used in research, shown against the official limits. They describe the studies, not a recommendation for you.

Studied doses in research, not advice. These are amounts used in research, not personal advice. Your clinician or pharmacist can say what fits you.

Doses studied in human trials

Doses studied in human trials ranged from 300 mg to 1 g per 500 mL of sports drink, or 0.05–0.2 g/kg, in single exercise sessions, to 3–24 g/day for 10 days in undernourished children and adults with HIV, and 8 g/day (with fish oil) for 3 months in heart failure. Intravenous hospital use (0.3–0.5 g/kg/day) is clinical nutrition. These are research doses, not recommendations.^{1,2,5,6,11,12,13}

Interactions and safety

Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.

What Alanylglutamine meets

0 cited rows 2 tested together

Medicines 0

No medicine rows in our sources.

Alanylglutamine0 medicines · 1 supplement

Supplements and foods 1

Tested together in a graded trial

Also cited: 2 tested together

Electrolytes and sodiumElectrolytes and sodium page
- Tested together
  Reaction time and cognition after endurance running. Graded on the Alanylglutamine page; tested together is not a claim that they work better together.
- Tested together
  Fluid retention (beverage hydration index). Graded on the Alanylglutamine page; tested together is not a claim that they work better together.

Interactions

0 agents

None found in our sources.

Check with what you take

Kept on this device only

Add what you take. We list every interaction our evidence profiles cite between Alanylglutamine and your picks, and between your picks.

Add a supplement or medicine

Most cited:

Add a supplement or medicine you take to check it against Alanylglutamine.

Starting from one medicine? The interaction checker rates how serious each pair is, on a curated list of 19 entries for 11 medicines. This cabinet has no severity rating: it lists every interaction row our supplement pages cite.

Who should be careful

4 groups

Critically ill people: In a trial of 1,223 ventilated ICU patients with multiorgan failure, high-dose glutamine given by vein (as the alanyl-glutamine dipeptide) and by tube (as alanyl-glutamine and glycine-glutamine dipeptides) was linked to higher in-hospital and 6-month mortality.^7,9
Children: Paediatric data come from supervised trials in undernourished children, not from routine supplement use.^5,6
Pregnancy and breastfeeding: No alanylglutamine trial enrolled pregnant or breastfeeding women, and LactMed has no entry for it. NCCIH notes that many dietary supplements have not been tested in pregnant women, nursing mothers or children.¹⁰
Liver disease: Alanylglutamine releases glutamine. LiverTox rates L-glutamine likelihood score E (unlikely cause of acute liver injury with jaundice), but notes that 10 to 20 g of glutamine raised blood ammonia and worsened hepatic encephalopathy measures in people with decompensated cirrhosis, so it should be avoided in advanced cirrhosis.¹⁶

Safety notes

2 notes

Short trials, one serious hospital signal.

Intensive care: Early glutamine plus antioxidants did not improve outcomes, and glutamine, given largely as alanyl-glutamine, was associated with higher mortality in critically ill adults with multiorgan failure.^7,9
Tolerance: Children tolerated alanyl-glutamine formula well in a 10-day trial.⁶

How to read the label

What to check on the Supplement Facts panel.

How to read the label

2 checks

Dipeptide vs free glutamine

Alanylglutamine contains less glutamine by weight than free glutamine: 89 mg/kg of the dipeptide matched 60 mg/kg of glutamine.³

Label dose vs studied dose

Sports drinks in trials used 300 mg–1 g per 500 mL; the children's trials used 3–24 g/day.^2,5,6

Have the bottle? Photograph its Supplement Facts panel and see each line, alanylglutamine included, beside the doses and forms the trials used in Label X-Ray.

Frequently asked questions

Short answers to common questions; the numbers link to the sources below.

Common questions

6 answers

Does it improve endurance?

In 10 men under mild dehydration, it lengthened time to exhaustion compared with no rehydration.¹

Does it help hydration?

A dipeptide-electrolyte drink retained more fluid than water at 4 hours but no more than electrolytes alone.⁴

Does alanylglutamine help after surgery or in intensive care?

Only as hospital nutrition by vein. A 2015 meta-analysis of 19 surgery trials (1,243 patients) found 2.67 fewer hospital days but no drop in complications; a 2017 industry-authored meta-analysis of ICU trials found fewer infections and deaths, but the 1,223-patient REDOXS trial linked high-dose glutamine to higher mortality.^14,13,7

Is it safe?

Short trials report good tolerance, but in critically ill ICU patients high-dose glutamine, given largely as alanyl-glutamine, was linked to higher mortality.^1,6,7,9

Is it better absorbed than glutamine?

In 8 men it produced about twice the plasma glutamine exposure of free glutamine at the same glutamine dose.³

What is alanylglutamine?

A dipeptide made of alanine and glutamine, used in sports drinks and clinical nutrition.³

Sources

16 sources: trial abstracts, NIH fact sheets and reference databases. Numbers in the text link here.

Sources cited on this page

16 sources

1Examination of the efficacy of acute L-alanyl-L-glutamine ingestion during hydration stress in endurance exercise.Crossover RCT J Int Soc Sports Nutr, 2010 · PMID 20181080
2Effect of acute L-Alanyl-L-Glutamine and electrolyte ingestion on cognitive function and reaction time following endurance exercise.Crossover RCT Eur J Sport Sci, 2016 · PMID 25321847
3L-glutamine absorption is enhanced after ingestion of L-alanylglutamine compared with the free amino acid or wheat protein.PK study Nutr Res, 2012 · PMID 22575040
4The Beverage Hydration Index: Influence of Electrolytes, Carbohydrate and Protein.Crossover RCT Nutrients, 2021 · PMID 34578811
5Intervention and Mechanisms of Alanyl-glutamine for Inflammation, Nutrition, and Enteropathy: A Randomized Controlled Trial.RCT J Pediatr Gastroenterol Nutr, 2020 · PMID 32826717
6Wasting and intestinal barrier function in children taking alanyl-glutamine-supplemented enteral formula.RCT J Pediatr Gastroenterol Nutr, 2007 · PMID 17325559
7A randomized trial of glutamine and antioxidants in critically ill patients.RCT N Engl J Med, 2013 · PMID 23594003
8L-Alanylglutamine inhibits signaling proteins that activate protein degradation, but does not affect proteins that activate protein synthesis after an acute resistance exercise.Animal study Amino Acids, 2015 · PMID 25837301
9Trial of Glutamine and Antioxidant Supplementation in Critically Ill Patients (REDOXS), NCT00133978Database ClinicalTrials.gov, 2013 · clinicaltrials.gov
10Using Dietary Supplements WiselyFact sheet National Center for Complementary and Integrative Health (NCCIH), 2019 · nccih.nih.gov
11Improvement of intestinal permeability with alanyl-glutamine in HIV patients: a randomized, double blinded, placebo-controlled clinical trial.RCT Arq Gastroenterol, 2013 · PMID 23657308
12Supplementation of l-Alanyl-l-Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Chronic Heart Failure.RCT Circ Heart Fail, 2015 · PMID 26269566
13Glutamine dipeptide-supplemented parenteral nutrition improves the clinical outcomes of critically ill patients: A systematic evaluation of randomised controlled trials.Meta-analysis Clin Nutr ESPEN, 2017 · PMID 28361751
14Effect of glutamine dipeptide supplementation on primary outcomes for elective major surgery: systematic review and meta-analysis.Meta-analysis Nutrients, 2015 · PMID 25584966
15Ameliorative Potential of L-Alanyl L-Glutamine Dipeptide in Colon Cancer Patients Receiving Modified FOLFOX-6 Regarding the Incidence of Diarrhea, the Treatment Response, and Patients' Survival: A Randomized Controlled Trial.RCT Medicina (Kaunas), 2022 · PMID 35334570
16L-GlutamineDatabase LiverTox (NCBI Bookshelf), 2021 · ncbi.nlm.nih.gov

What changed

Every dated change to this page: what changed, who made it and why.

Change log

4 entries

Dated changes to this page
Date	Change	Who and why
Oct 21, 2026evidence, forms, studied doses, who should avoid, FAQ, questions	Added two oral trials (46 adults with HIV, 24 g/day for 10 days; 31 heart-failure patients, 8 g/day with fish oil for 3 months) and three hospital-only rows for the intravenous dipeptide: a 2017 ICU meta-analysis (15 RCTs, 842 patients; industry authors noted), a 2015 surgery meta-analysis (19 RCTs, 1,243 patients) and a 44-patient chemotherapy-diarrhoea RCT. Added an intravenous form row, a pregnancy and breastfeeding note (no data; no LactMed entry), a liver note from LiverTox's L-glutamine chapter (likelihood score E; avoid in advanced cirrhosis), an FAQ item, page questions and links to the performance and gut goal hubs; widened studied doses to 3 months. Interactions checked in LactMed, LiverTox and NCCIH: none documented for alanylglutamine, so the list stays empty. Not added: a 2018 HIV cognition trial whose 'glutamine dipeptide' is not identified as alanyl-glutamine in the full text, and a 2026 colorectal surgery meta-analysis whose abstract does not name the glutamine form.	Writer: Kymata Health EditorialTrigger: A–Z audit against docs/supplements/AUDIT-STANDARD.md
Oct 18, 2026Goals	Added the Brain & focus goal (focus): the page already has a graded human row on a memory or thinking outcome (“Reaction time and cognition after endurance running”, Grade D). No evidence row, grade or text changed.	Writer: Kymata Health EditorialTrigger: Update
Oct 14, 2026all	Independent adversarial review: corrected the critical-illness caveat. The REDOXS trial's glutamine was given as the alanyl-glutamine dipeptide intravenously and as alanyl-glutamine and glycine-glutamine dipeptides by tube (ClinicalTrials.gov NCT00133978), so the earlier note that it was "not this dipeptide specifically" was wrong.	Writer: Kymata Health EditorialTrigger: review
Oct 14, 2026all	Initial editorial evidence review (first draft). Every PMID checked against NCBI E-utilities esummary (titles and years taken from the record) and the abstract read for each cited row. Studied doses are reported as research doses, not dosing advice.	Writer: Kymata Health EditorialTrigger: new page

Supplement & Nutrient Encyclopedia. Educational information only; it is not medical advice and does not replace a clinician. Dietary supplements are not intended to diagnose, treat, cure or prevent any disease. Statements about supplements have not been evaluated by the FDA.

Alanylglutamine

Medicines 0

Supplements and foods 1

Electrolytes and sodiumElectrolytes and sodium page