Nitric oxide is a significant signaling molecule that plays a role in relaxing blood vessels and supporting healthy blood circulation. Its various actions in different body tissues may contribute to overall health. A lack of nitric oxide might be associated with certain health challenges and signs of aging. Dietary and lifestyle habits can influence nitric oxide production in the body. This article will explore some potential health benefits of supporting nitric oxide levels and ways to do so.

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What is Nitric Oxide?

Nitric oxide (NO) is an important gaseous signaling molecule made of one nitrogen and one oxygen atom. The discovery in 1998 by three scientists that NO is the endothelial-derived compound responsible for relaxing and dilating arteries won them the Nobel Prize that year, after NO was already named "Molecule of the Year" in 1992.

The body produces NO through two primary pathways; each contributes about half of the total body NO production. The first pathway involves the enzyme Nitric Oxide Synthase (NOS), which converts L-arginine to NO. The second pathway is the Nitrate-Nitrite-NO pathway, where dietary nitrates are converted into nitrite by oral bacteria and then to NO through various biochemical processes. (1)

What is Nitric Oxide's Role in the Body?

NO has many roles in the body, notably supporting endothelial function and cardiovascular health. However, NO's effects can extend beyond the vascular system, depending on the NOS isoform that is expressed. Three NOS isoforms exist: neuronal NOS (nNOS), endothelial NOS (eNOS), and inducible NOS (iNOS). nNOS supports brain and neuronal communications; eNOS is involved in vasodilation, glucose uptake, and muscle energy utilization; and iNOS is associated with inflammatory responses. (2)

Within the vasculature, NO supports vasodilation, helps manage platelet aggregation, and maintains endothelial cell function. NO generated by neurons acts as a signaling neurotransmitter. NO produced by macrophages may support the body's defense mechanisms. Due to its wide range of actions, NO is considered important for cardiovascular health and may play a role in energy metabolism, muscular performance, glucose control, and antioxidant pathways. (3-5)

Nitric Oxide Health Benefits

Below are some potential benefits associated with nitric oxide in the body.

Supports Healthy Blood Pressure

Clinical studies have shown that poor vasodilation and arterial stiffness are common in individuals with hypertension (high blood pressure). Research suggests that decreased NO may be linked to impaired endothelial function and hypertension. As a vasodilator, NO supports arterial vasodilation, which may help maintain healthy blood flow and blood pressure. (6, 7)

Supports Blood Sugar Regulation

NO may play a role in insulin signaling and secretion. If NO levels are low, it might be associated with insulin resistance and challenges in glucose uptake by cells. (8-10)

May Enhance Physical Performance and Recovery

Due to its role in supporting blood flow, oxygen delivery to muscles, and metabolism, NO is considered important for athletic performance and recovery. Studies indicate that NO-precursor L-citrulline may support nitric oxide production, and some evidence suggests that NO-supporting supplements could enhance endurance exercise and recovery. (11-13)

May Support Sexual Health

Vasculogenic erectile dysfunction (ED) is often related to vascular issues that affect blood flow. Some pharmacologic agents prescribed for ED work by enhancing the effect of NO to support blood flow. Supplements containing NO-supporting ingredients like L-arginine, L-citrulline, and French maritime pine bark extract have shown potential in supporting sexual function. (14)

Supports Wound Healing

Adequate blood supply is important for wound healing, as it delivers oxygen and nutrients and removes waste products. Nitric oxide plays roles in the wound healing process, including supporting the initial inflammatory response, cell proliferation, collagen formation, and new blood vessel formation. Additionally, nitric oxide may help manage microbial presence at the wound site. (15, 16)

Nitric Oxide Considerations

For most people, using NO-supporting supplements is generally considered safe. Side effects are uncommon and usually mild, potentially including diarrhea, stomach pain, headache, heart palpitations, and nausea.

Because of its potential effects on blood sugar and blood pressure, individuals on related medications or supplements should be cautious of hypoglycemia and low blood pressure. Symptoms can include irregular heart rate, fatigue, changes in appetite, trouble concentrating, and dizziness.

Additionally, those taking supplements containing arginine should be aware that arginine may influence herpetic reactivation. (17)

It is always advised to speak with a healthcare provider about the safety of a new supplement before starting it.

How to Test Nitric Oxide Levels

Certain symptoms like muscle/joint pain, cognitive changes, and others might suggest a need to explore NO levels. Testing NO levels can be done using salivary indicator strips, which measure the amount of nitric oxide recirculated through saliva. The indicator strip's color reflects the total bioavailable NO in the system at the time of the test.

How to Support Nitric Oxide Levels Naturally

Aging, diet, oral hygiene, and exercise habits can influence NO levels. Here are some tips that may help support nitric oxide levels naturally.

Diet

Since dietary nitrate can be converted to nitric oxide in the body, consuming foods rich in nitrates may help support nitric oxide levels. Approximately 80% of dietary nitrates come from vegetables like spinach, broccoli, cabbage, celery, lettuce, beets, and spinach.

Foods rich in nitric oxide precursors L-arginine and L-citrulline can also support endogenous nitric oxide production (18). L-citrulline is found in watermelon; L-arginine is present in protein-rich foods like meat, beans, nuts, and dairy.

Exercise

Moderate physical exercise may stimulate NO production. One study found that regular exercise performed 30 minutes three days a week for four weeks can increase the basal release of endothelium-derived NO. (19)

Oral Hygiene

A healthy oral microbiome and normal stomach acid levels are important for the bacterial conversion of dietary nitrates to NO. Bacterial species like Actinomyces, Corynebacterium, Haemophilus, Kingella, Neisseria, Rothia, and Veillonella express a nitrate reductase enzyme responsible for this conversion. When swallowed, the nitrites in saliva are then converted to NO in the stomach's acidic environment. Proton pump inhibitors, antacids, and mouthwash can all affect this NO conversion pathway. (20)

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Summary

Supporting nitric oxide levels can be a helpful approach in maintaining cardiovascular health and managing inflammation. Eating a diet rich in nitrates, staying physically active, and maintaining a healthy microbiome and gastrointestinal function are all important in naturally supporting nitric oxide levels. If you think nitric oxide levels may be affecting your health, consider discussing testing and supplement options with a healthcare provider.