If you want to reduce your risk of heart attack and stroke and significantly improve your overall vascular health, today’s newsletter on nitric oxide (NO) is for you!
This week we’re taking a deep dive into this miracle molecule to help you understand why it matters and how a few simple hacks can radically help you increase its production.
What happens when we don’t produce enough nitric oxide?
Erectile dysfunction (ED), cognitive decline, Alzheimer’s, infertility, cardiovascular disease, and even sleep disorders have all been linked to low NO production.
So, what’s the link? How does this tiny little molecule have such a profound impact on our health? What is it doing inside our bodies to keep us healthy and protect us from disease?
We’re covering all that and more in this week’s newsletter.
Nitric Oxide: Why It’s Important
NO is very unstable, meaning it doesn’t stick around in the body for very long once it’s been produced. Because NO is such a short-lived molecule, it took a long time for researchers to identify it in the body. In 1998, Dr. Louis Ignarro and his colleagues were awarded the Nobel Prize in Physiology or Medicine for discovering the role of NO as a signaling molecule in the cardiovascular system.
Dr. Ignarro and I discussed the many roles of NO and why we want more of it in our bodies on my podcast, which sparked the excitement and inspiration behind this newsletter, in addition to the work of James Nestor, author of the New York Times bestselling book, Breath: The New Science of a Lost Art.
In his book and in our conversation together, Nestor talks about how many of our issues with metabolism, sleep, fertility, and brain health can all be traced back to losing the ability to breathe through our noses due to a lack of NO production, among other factors.
Before we can better understand the role of NO in promoting health and preventing chronic disease, let’s first get a general understanding of where NO is primarily produced in the body.
Where Nitric Oxide Is Produced
Breathing through your nose stimulates the production of NO, a gaseous molecule that dilates our blood vessels.
Our nose is one of the primary places NO is produced. When we breathe through our nose, the cells in our sinuses produce NO, which travels directly to our lungs; and because NO dilates our blood vessels, it relaxes our trachea and bronchioles, which allows us to take in more oxygen—that’s a good thing!
In addition to our nose, our endothelial cells (the cells that line the inside of our heart and blood vessels) are another main site of NO production. The NO that’s made by our endothelial cells relaxes our blood vessels, enhancing circulation and the delivery of oxygen and nutrients to our tissues.
How Nitric Oxide Protects the Body
When our endothelial cells produce NO, our arteries relax. This keeps our blood moving and our blood pressure normal, which prevents blood clots and plaque buildup.
Having enough NO is essential for cardiovascular health. It reduces our risk of heart attack and stroke—but not having enough NO does the opposite.
NO protects against stroke by increasing blood flow to the brain. This enhanced delivery of blood to the brain is accompanied by oxygen and nutrients, as well, which is why having sufficient NO levels is associated with better learning, cognition, and memory.
Additionally, this circulation to the brain helps flush out toxins and plaques that can lead to neurodegenerative diseases like Alzheimer’s and dementia (1).
Another crazy important function of NO is that it’s antimicrobial, which means it can help fight off viral and bacterial infections. Our nose is our first line of defense when we come in contact with airborne pathogens, but that’s only if we’re using it!
Breathing through our mouths doesn’t produce NO, so we are missing out on that first step of sterilizing whatever microbe is around and instead breathing it directly into our throat and lungs.
The Role of Nitric Oxide and Covid-19
Studies show that pre-intubation with NO could be an effective treatment approach for severe Covid-19 patients because it can reduce viral replication and allow more oxygen and blood to flow into the lungs, which helps oxygenate our tissues (2). One study found that NO administration early on reduced the need for mechanical ventilators, the duration of time spent in the hospital, and mortality. More research is needed but the results are promising (3).
Covid was a crisis situation, and practitioners and public health officials did the best they could with the information that they had at the time; however, knowing this now gives me hope that we will respond differently to future respiratory pandemic situations.
Signs of NO Deficiency
Believe it or not, one of the earliest warning signs of NO deficiency is erectile dysfunction (ED). Everyone’s heard of the little blue pill known as Viagra that’s prescribed to treat ED, but understanding the mechanism behind how it works can help connect the dots as to why it’s been such a blockbuster drug.
Viagra works by upregulating NO production. Pharmaceutical companies were quick to jump on the development of a drug for ED after Ignarro and his colleagues discovered NO and its role in vascular health. They took his findings and successfully applied them to create a drug designed to upregulate NO production for arousal and libido purposes. Based on the success of this drug, we can infer that ED is, in part, driven by a lack of NO and can be corrected by upregulating NO production (4).
To connect the dots even further, ED in men and low libido in women could be a warning sign of poor vascular health and a canary in the coal mine for more life-threatening situations like a heart attack or stroke. Other signs of NO deficiency are: poor cardiometabolic health (i.e., high blood pressure, insulin resistance, high blood sugar, and heart disease), obesity, mouth breathing, getting sick frequently, cognitive decline, and sleep disorders like sleep apnea or snoring.
What’s Driving NO Deficiency?
One of the leading causes of NO deficiency is insulin resistance. Insulin resistance puts the body in a state of inflammation and oxidative stress that damages our arterial walls, resulting in endothelial dysfunction and a reduced ability to produce NO. With American adults consuming approximately 60 pounds of added sugar annually and one in three having prediabetes, this explains why ED is so common today, affecting 40 percent of males over age 40 and a whopping 70 percent of males over age 70 (5–7)!
It also explains the rise of infertility in both men and women and why cardiovascular disease and sexual dysfunction are so intimately connected—they share the same common denominator, insulin resistance.
Another contributor to NO deficiency is mouth breathing. Mouth breathing doesn’t stimulate NO production the same as breathing through your nose does. In addition to James Nestor, Functional Dentists like Dr. Mark Burhenne and Dr. Steven Lin talk a lot about the impact mouth breathing has on our sleep, oral microbiome, and cardiometabolic health.
With the rise of obesity, people are using their mouths to breathe today more than ever, especially while they’re sleeping, which not only leads to sleep disorders like sleep apnea, but it also means lower levels of NO and the risks associated with it.
This week’s protocol is all about simple, low-cost strategies for how to boost your NO levels. But before we jump into my suggestions, I want to give some love to today’s sponsor, ButcherBox.
Sponsor: ButcherBox
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And now let’s get back to today’s newsletter.
Now before we get into simple, low-cost strategies for how to boost your NO levels, let’s get an idea of how our body makes NO so we can understand how to upregulate our production.
How Is Nitric Oxide Made inside the Body?
To make NO, we need help from an amino acid called L-arginine. L-arginine is a nitrogen-rich amino acid that binds to an enzyme called NO synthase. NO synthase borrows nitrogen from L-arginine and combines it with oxygen and water through a series of reactions to make NO and L-citrulline, an amino acid that can be recycled and turned back into L-arginine for additional NO production.
Now that we know the building blocks we need to make NO, let’s jump into my first tip for boosting NO production.
Try This:
I. Mouth taping at night. By far one of the best ways to start increasing your body’s natural ability to make NO is by making sure you are breathing through your nose at night. Many people who suffer from undiagnosed sleep apnea or a chronically stuffy nose breathe through their mouth, which results in a lack of oxygen and directly inhaling dust or allergens. Mouth taping is a simple and effective strategy to ensure you are breathing through your nose.
Believe me, when I first heard of mouth taping I thought the idea was crazy weird, but I gave it a chance and now I’m a huge mouth taping fan. My wife is addicted to using it at night and has seen incredible improvements in her deep sleep.
I can’t go into all the ins and outs of mouth taping in this newsletter, but Dr. Mark Burhenne (aka Ask the Dentist) has written a fantastic article on it here.
In terms of what mouth tape to use, you can go super basic with this 3M micropore tape, or you can get fancier with Somnifix.
II. Superfoods: Some fruits and vegetables naturally contain nitrates (NO3) and nitrites (NO2) that are enzymatically converted into nitric oxide in the body. This is one of the many reasons why eating a plant-rich diet can be good for cardiovascular health—because it boosts NO production.
Leafy green vegetables such as cabbage, spinach, and arugula (one of my favorite lettuces) are rich in nitrates. Garlic increases NO synthase and the bioavailability of NO, so using it with nitrate-rich vegetables can increase NO production even further (8).
Beetroot contains the most NO of any food and has been shown to significantly increase blood flow and circulation. It can also help improve cognitive function, blood pressure, and athletic performance (9–11).
My favorite way to eat beets is fermented, because you’re getting a “two for the price of one” deal: you get vascular benefits from the beets and probiotic, gut-health benefits from the fermentation. Fermented beets are super easy to add to a salad, and because I’m only having a couple of bites here and there a few times a week, I’m not worried about its blood sugar impact. In other words, the pros outweigh the cons!
III. Stop using traditional mouthwash. Yes, you read that right. Unfortunately, mouthwash can’t select against bad bacteria. It kills the good bacteria in our mouth, too—the bacteria that helps convert nitrates and nitrites into NO (12).
New research shows a link between using oral antiseptics and having elevated blood pressure due to its impact on our oral microbiome. Antiseptics like mouthwash can sterilize bacteria species that are integral in converting dietary nitrates and nitrites into NO (13). What’s even scarier is that mouthwash is also linked to insulin resistance.
We need NO to help regulate insulin activity and energy absorption after a meal— reduced NO means an impaired insulin response. One study found that those who used mouthwash two or more times a day had a 55-percent increased risk of prediabetes and diabetes compared to less frequent users and those who didn’t use mouthwash at all (14).
IV. Exercise: Daily movement is incredibly important for maintaining good cardiovascular health. A significant portion of the heart-healthy benefits we get from exercise comes from its ability to improve endothelial function and natural production of NO. As if that wasn’t enough to want to get moving, the insulin-sensitizing, mood-boosting, energizing, and metabolic health impact of engaging in regular physical activity—even if it’s just for 20-30 minutes a few times per week—can dramatically improve your health and overall quality of life.
Exercise doesn’t have to look a certain way either. It’s important to find some form of movement that you love, even if that means something quirky or unconventional. You have to enjoy whatever form of exercise you choose to want to keep at it consistently. Try to do a mixture of aerobic and resistance exercises for maximum muscle, respiratory, and vascular benefits.
Conclusion:
Based on the information we covered today, it’s safe to say that making enough of this tiny little molecule is pretty darn important when it comes to our vascular, respiratory, and metabolic health.
If we know the signs and symptoms of low NO (high blood pressure, cognitive decline, ED, low libido, mouth breathing, and chronic respiratory infections) and what influences our NO levels, we can remove what’s causing damage or dysfunction and add in what’s going to repair it.
No supplement or drug can do what improving your metabolic health can, so you want to make sure you’re avoiding or removing the factors that damage your endothelial cells and impair your ability to make NO—foods like refined flour, sugar, and inflammatory oils that cause insulin resistance.
And finally, remember to use the diet, lifestyle, and nose-breathing strategies outlined in my protocol to support your body’s natural ability to produce NO.
For the full list of references cited here and all of my previous Try This newsletters, head on over to my blog.
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Here’s to your health,
Dhru Purohit