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A further disadvantage of ingesting L-Arginine directly is that it is metabolized in the liver by arginase in men with heart disease, arginase is upregulated or more active meaning that more Arginine is converted to the amino acid ornithine, which can potentially lead to herpes outbreaks and other issues

Conversion of biliverdin to bilirubin by biliverdin reductase contributes to endothelial cell protection by heme oxygenase-1-evidence for direct and indirect antioxidant actions of bilirubin

Electrophysiological disturbances may arise as a consequence of these structural and biochemical changes

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