l-carnitine fatty acid transport mitochondria Carnitine shuttle system and beta oxidation of acids Mitochondrial protein promotes carnitine synthesis

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The amino acids L-citrulline and L-arginine both serve as food for NOS to produce NO from (see Figure), with L-citrulline being a precursor to L-arginine.[30],[31] In fact, a 2017 study found that lower serum levels of L-arginine and L-citrulline were more common in men having ED that was vasculogenic in nature.[32] Higher levels of arginine intake have been shown to be associated with higher serum levels of nitrite and nitrate.[33] Supplementation of L-arginine in combination with L-citrulline has been shown to have a greater impact on plasma L-arginine levels than either alone,[34] likely due in part to L-arginines extensive metabolism in the gut.[35] A 2019 systemic review and meta-analysis of randomized controlled trials concludes that supplementation with L-citrulline has a significant effect of lowering both diastolic and systolic blood pressure, with a greater effect in those with a baseline blood pressure of greater than 130/85 mmHg.[36] Studies of L-citrulline supplementation in athletes have shown a positive effect on performance with ongoing supplementation