BCAA metabolism may improve muscle net ammonia removal by supplying carbon skeletons for formation of alfa-ketoglutarate that combines with two ammonia molecules to become glutamine
Muscle becomes the primary mode of NH3 metabolism in liver cirrhosis. The authors here propose that it is via an increase in muscle mass rather than specifically lowering NH3. In fact, there is an early increase in NH3 production.
BCAA improve NH3 metabolism. This is via muscle metabolism as reported in other studies. This study highlighted the differences in BCAA supplementation. One caveat is that high glutamine is the result from glutamate and this can increase hepatic encephalopathy.
BCAA are low in patients with liver cirrhosis due to increased glutamate production from glutamine. The addition of BCAA in these patients is not without side effects--increased NH3 production. The addition of alpha ketoglutarate should alleviate this risk.
Elevated ammonia depletes glutamate and BCCA in muscle and plasma. A decrease in BCCA is through an up regulation of glutamine in an attempt to eliminate ammonia.
