How Does The Body Make Nitric Oxide?
As the summer is coming to an end and kids are going back to school, adults try to get back into some sense of normalcy and routine. We have touched many people with information and education about the vital role of nitric oxide is for the human body. So important, in fact, that your body cannot live without it. The number one most popular questions I get, as I talk to people around the country are “how do I restore nitric oxide production if I am low?” Can I take supplements or change my diet? If so which supplements and what diet is best? I thought this month’s blog should address just that.
It is crucial to understand how the body normally makes nitric oxide and what goes wrong in people that cannot make it. If you don’t understand these two fundamental principles, then you can never effectively and efficiently restore your body’s nitric oxide production and as a result,
you cannot optimize your body’s performance and health.
How Does The Body Make Nitric Oxide?
There are two ways the body makes nitric oxide
- Through the eating and metabolism of inorganic nitrate found in green leafy vegetables and some root vegetables. Nitrate is absorbed in the gut and concentrated in our mouths, in our salivary glands. There are nitrate reducing bacteria that live in the crypts of our tongue that convert nitrate to nitrite and nitric oxide. Our saliva then becomes high in nitrite and when we swallow our own saliva, we get nitric oxide produced in the inside space of the stomach provided there is stomach acid. For this pathway to work, people must consume sufficient nitrate from their diet (300-400mg), must have the right oral bacteria and must have sufficient stomach acid production.
- Through an enzymatic reaction using L-arginine and the enzyme nitric oxide synthase (NOS). This enzyme is found throughout the body, but primarily in the cells that line all blood vessels. L-arginine is a semi-essential amino acid, meaning that your body makes it through normal metabolism in the urea cycle and it is also found in many proteins we eat. When we eat protein and the protein is broken down into amino acids, L-arginine is provided to the body. Unless you have an inborn error in metabolism (which is extremely rare), then your body will always make enough L-arginine to produce NO. The reaction to convert L-arginine to nitric oxide is complex and complicated and requires many different co-factors and substrates. For this pathway to work, the NOS enzyme must be active and functional.
What Goes Wrong In People That Can’t Make Nitric Oxide?
As part of the aging process we made less nitric oxide. This is because the enzyme NOS becomes dysfunctional and no longer converts L-arginine to nitric oxide. This is termed endothelial dysfunction. The other problem is that most Americans do not consume sufficient vegetables to get enough nitrate. The typical American diet only contains 150mg per nitrate per day. We know we need at least 300 mg of nitrate per serving to lead to any appreciable production of nitric oxide, provided the person has the right oral bacteria and stomach acid production.
We know that more than 200 million Americans wake up every day and use an antiseptic mouthwash. This represents over half of the US population. The antiseptic mouthwash does a good job killing bad breath but unfortunately it also kills the bacteria essential to nitric oxide production, If you use such a mouthwash, you receive no nitric oxide benefit from eating a diet enriched in dietary nitrate. To make things even worse, there are over 100 million prescription written every year for proton pump inhibitors which reduce stomach acid and even more for antibiotics that kill the good bacteria. Now, many of these antacid drugs can be purchased over the counter. Therefore, there may be another 100 million Americans that take antacids that are not reported by the prescription data. As a result of poor diets, the use of antiseptic mouthwashes, antibiotics and antacids the majority of Americans become nitric oxide deficient.
How Do I Find A Product That Works For Me?
There are literally hundreds of nitric oxide products on the market. Most of these date back to 1998 after the discovery of nitric oxide won the Nobel Prize in Medicine. These initial products contained L-arginine and/or L-citrulline. As described above, there is really never a condition where people are deficient in L-arginine. Therefore taking a L-arginine product will not lead to any improvement in NO production, especially in patients that have endothelial dysfunction. In people that are nitric oxide deficient, the NOS enzyme doesn’t work. Furthermore, at least two clinical trials have demonstrated that giving L-arginine can make things worse. (references:
https://www.ncbi.nlm.nih.gov/pubmed/16391217;
https://www.ncbi.nlm.nih.gov/pubmed/17592080)
Most recently, beet products have been popularized. However, most of the beet products on the market do not contain any detectable nitrate. Therefore they offer no benefit with regards to nitric oxide production. There are however a few beet root products that have known amounts of nitrate. There is also a product that contains potassium nitrate in a capsule that is sold as a nitric oxide product. These are not nitric oxide products, these are nitrate products that in most cases do not lead to any NO formation or restoration.
If you are using mouthwash, antibiotics, antacids and have poor oral hygiene, these products cannot and will not work for you. Statistically this is most of America. Despite the marketing hype, the best available science states that beet root does not equal nitrate does not equal nitric oxide.
There are 4 questions you must ask yourself when considering a nitric oxide product for your health and wellness.
- Does the actual product have any published clinical trials in humans? Clinical trials are expensive and risky so you must have confidence that your product works. Very few companies actually put their product to the ultimate test in clinical trials.
- Does the product have any issued patents? Innovation and product superiority can be distinguished by issued patents. Look for patents on products.
- Is the technology licensed from a reputable University or Medical School? This will ensure there was actually research and some intellectual property on the product or product technology. Any company can put ingredients together but it does not mean there is science or any valid research to back it. Is the formulator an expert in nitric oxide and have they published in the NO field?
- Is the company a reputable company? There are many companies making nitric oxide products since it is recognized nitric oxide is very important to health. Look for companies that are focused and centered on nitric oxide product technology. Most pharmaceutical companies have failed at making a safe and efficacious NO drug or product so highly unlikely that supplement companies can make an effective NO product.
You need to do your homework. Search the products’ websites. If you cannot find this information on the site, it probably does not exist and in my professional opinion, after more than 20 years of work in this field, you ought not purchase that product.
However, if the product passes these four fundamental questions, then you can feel confident that the product may work for you.
I have studied nitric oxide for two decades, published hundreds of peer reviewed studies and have dozens of issued patents on nitric oxide technology. My objective is not to sell you product but rather provide you with the right information and education so you can find a product that works for you.
Unfortunately there are many companies out there that are good at marketing but poor at science. There are clear deceptive trade practices and outright fraud by many of these companies. My goal is to educate enough people that these companies go away and the superior products and companies will remain.