Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

I have recently been interested in NITRIC OXIDE, an important gas (produced in the lining of  your arteries) that is especially good for heart health. Three hundred years ago a famous English physician, Dr. Thomas Sydenham said “A man is as old as his arteries.” I firmly believe that to be true. So, let’s take a deeper dive into Nitric Oxide. 


Nitric Oxide 


Like I said in the intro, Nitric Oxide is a gas produced in the lining of all your arteries. It has much to do with how long you live, and how healthy you are (i.e., how you breathe, how your brain functions, etc). For example, Nitric Oxide relates to whether or not you’re going to have a heart attack or lose quality of life in some way, shape or form. 

Your life depends on Nitric Oxide in many ways. Just like our hormones, Nitric Oxide decreases as you age, and as you age you actually need more of it. At the end of this Note, we’ll talk about how to increase your own nitric oxide production, which will hopefully make you feel better, and live healthier longer. 


Nitrates, Nitrites, and Nitric Oxide 


To understand Nitric Oxide you need to know some of the fundamentals of biochemistry. Nitric oxide really starts with nitrates, which you get mostly from your food, i.e. vegetables. Nitrates are also produced inside your arteries. Nitrate has three oxygen molecules (NO3) that degrades to Nitrite (which has two oxygen molecules (NO2)), which then degrades to Nitric Oxide (where the money is). 

Note: Nitrous oxide is laughing gas, which has nothing to do with what we’re talking about here. 

Nitric Oxide is good, but when nitrites degrade to nitrosamines, that’s bad. A good example of this is cooking meat at high temperatures. Note: Don’t burn your meat. Hydrocarbons and heterocyclic amines can also be released when you burn your meat. These things are very carcinogenic. 


How To Increase Your Nitric Oxide 


People obtain nitric oxide in two ways. Number one: FOOD (mostly vegetables). Nitric Oxide is ingested through the action of an enzyme called nitric oxide synthase which catalyzes L-Arginine to produce nitric oxide

When you get Nitric Oxide from your food, the nitrate is reduced to nitrite by bacteria in your mouth. Over the course of several hours, this salivary pathway allows the nitrite to further reduce to nitric oxide in the gut. 

This is important because when you exercise and lactic acid builds up in your muscles, nitric oxide improves the contraction of your muscles and generates energy by your mitochondria. This improves oxygenation. It also dilates blood vessels, which improves everything in life. 

So we’re talking about (1) mitochondrial health, which produces energy and (2) vasodilation of your blood vessels. Think about the things that do that. If you went to the ER with chest pain, they give you nitroglycerin. That’s what this is! Nitroglycerine dilates your coronary arteries and can prevent you from dying of a heart attack. This is also what Viagra and Cialis do. They promote the release of nitric oxide to dilate the vessels in the genitals, which helps with erectile dysfunction. 

Nitric oxide is actually the most potent anti-inflammatory in the body. It’s important that you think about how to increase your nitric oxide. There are several ways to do this. Like I said above, food is the first way. The second way, NUMBER TWO: how it’s produced in your own endothelium (the lining of your arteries). You can mess that up (for sure) by poor lifestyle habits!

Nitric oxide is a very unstable gas. It degrades quickly in the bloodstream and needs to be constantly replenished. To stabilize that nitric oxide, you need antioxidants that will neutralize the free radicals that break it down. This means eating a lot of green leafy vegetables, taking Vitamin C, Vitamin E, polyphenols, and glutathione (the mother of all antioxidants). 

What you don’t want is the sodium nitrates that act as preservatives in food, and/or color preservatives that are in bacon, cold cuts, and hot dogs, etc. Sodium nitrates form nitrosamin, and you don’t want that. 

People that workout often take L-Citrulline or L-Arginine to vasodilate their arteries, which can improve their workout. Note: if I was choosing between the two, L-Citrulline is a much better choice, because L-Arginine breaks down quickly in your digestive system before it gets to your blood. Turns out, BEETROOT is the best one of them all to produce nitric oxide, but you have to get the right source. 


Supplementing Nitric Oxide 


Most of the information I am giving you in this Note comes from Dr. Nathan Bryan, a PhD scientist who’s been studying nitric oxide for about 20 years. Dr. Bryan is well known in the nitric oxide world and was recently a featured speaker at our integrative medical conference in Florida. He has some good products and good information about why most supplements for nitric oxide don’t work well (by themselves at least)

Dr. Bryan mentioned that when erectile dysfunction drugs (like Viagra and Cialis) don’t work (which is about half the time), it’s because they’re not producing enough nitric oxide upstream. Viagra and Cialis work downstream. So, in this case, you need to work upstream (precursors) by taking supplements for the downstream products, like Cialis and Viagra, to work.

Note: When a man comes in to see me for erectile dysfunction, I always pursue a heart workup, because the two are closely related (i.e vasodilation and blood flow). 

The best way to boost your nitric oxide production is by eating right, exercising, and getting good sleep. Fair warning, in today’s world there’s a lot of things working against you with nitric oxide production. The most common one is mouthwash. Two hundred million people use mouthwash on a daily basis. This actually destroys the good bacteria in your saliva that converts into nitric oxide that you get from food. 

Mouthwash is something that you definitely want to avoid. 

Other things that can decrease nitric oxide production: 

  • Antacids (especially PPIs)
  • Smoking
  • Antibiotics 
  • Sedentary lifestyle
  • Obesity

The good news is that there are supplements that can help you. In a study done this year out of Indiana University, there was a double blind, placebo controlled trial using BEETROOT JUICE. Beetroot juice is one of the major forms of Nitric Oxide production. 

In this fairly large study, they gave athletes beetroot juice without anything else. At the end of it, they determined that the athletes who used beetroot juice had a 5% increase in muscle power and even a greater increase in aerobic exercises, like cycling. That’s an amazing jump for athletes. 

For older adults, it’s even more amazing what it can do for you. BEETROOT JUICE helps with  everyday tasks, recovery, muscle soreness, and brain function. This is in addition to taking it for heart health. 

Supplements that the international olympic committee says can (a) boost performance, (b) are legal, and (c) no way to really track are: 

  • Beets 
  • Caffeine
  • Creatine
  • Beta Alanine
  • Sodium bicarbonate 

All of these are recognized as having performance enhancing properties that are legal, even for olympic athletes. 


What Can You Do? 


There’s a couple key points I want to make, plus a few supplement recommendations. One supplement that I like is from Berkeley Life. They have capsules that you can take a couple times a day, with a pretty long half life. The second is Circ02 lozenges. 

I personally take the Circ02 lozenges. I like the Circ02 lozenge because it has: 

  • Nitric oxide 
  • Sodium nitrite 
  • Magnesium
  • L-Citrulline
  • High dose of beetroot 
  • Vitamin C
  • B12
  • Hawthorne 

Most supplements don’t have enough beetroot juice to make a difference. These do. You can find both companies, Berkeley Life and Circ02, online. 

If you’re young and healthy, you won’t notice a huge difference when you take these supplements, but if you’re aging (or an athlete that will notice any small change in your body) you will!

There’s a lot of advantages to increasing your Nitric Oxide. It helps with running, cycling, and/or lifting weights. For older people, it protects your heart, keeps you active, and helps if you have ED or breathing problems.

You can measure your nitric oxide level directly by a salivary test strip. You can also measure blood markers (like CRP, Triglycerides), or O2 sats to see how you’re improving by taking these supplements. 

The main reason you want to increase your nitric oxide production is to protect your arteries because your arteries are your health. It’s not just your heart, but blood supply to all your organs and your brain. 

Think about nitric oxide. It’s very important for your health and longevity.