How To Improve Nitric Oxide Levels (& Why You Should)
"Nitric oxide is the most important molecule produced by the human body for cardiovascular health."
—Dr. Janet Zand, L.Ac., O.M.D.
Nitric oxide (NO) gained acclaim as the "Molecule of the Year" in 1992 and received the Nobel Prize in Physiology or Medicine in 1998 for its vital role in biological signaling, particularly within the cardiovascular system. This versatile molecule is synthesized in various cells throughout the body and regulates essential physiological processes such as blood flow, immune response, and inflammation. Its ability to promote vasodilation helps regulate blood pressure and enhance cardiovascular health, while its anti-inflammatory properties aid in tissue repair and combatting infections.
Beyond its cardiovascular role, NO influences diverse aspects of health, including cognitive function, sexual health, and exercise performance. It’s also involved in a variety of health conditions such as hypertension, erectile dysfunction, atherosclerosis, pulmonary hypertension, gout, diabetes mellitus, COPD, inflammatory bowel disease (IBD), and sepsis.
Therefore, maintaining a delicate balance of NO levels is crucial. Lifestyle factors such as regular exercise and a diet rich in nitrate-containing foods can support NO production and promote overall health. The good news is that we have a lot of control over our NO levels and it doesn’t involve expensive meds or treatments.
Let’s dive in.
What Is Nitric Oxide?
Nitric oxide (not to be confused with the laughing gas nitrous oxide) is a tiny molecule that does big things in our bodies. It's like a messenger, sending signals to different parts of our body to help them work properly. Made inside our body by a special enzyme called nitric oxide synthase (NOS), NO has a gaseous form and is made up of nitrogen and oxygen.
Why Is Nitric Oxide Important?
Nitric oxide is super important because it helps keep our body running smoothly. In our heart and blood vessels, it acts like a natural blood vessel opener, making sure blood flows well and our blood pressure stays in a healthy range. In our brain, it helps with memory, learning, and mood. Plus, research has shown that it helps our immune system stay strong, fighting off infections. It's also crucial for our body's functions like controlling blood flow and helping muscles work during exercise. One review of 42 studies found that supplements might help people who aren't used to exercising, but they might not be as helpful for those who already exercise a lot.
Here are some of the pathways that NO is involved within the human body:
Regulation of blood vessel tone
Neurotransmission
Immune function
Oxygen delivery
Muscle function
Wound healing
Erectile function
Mitochondrial function
Neuroprotection
Antioxidant defense
When nitric oxide isn't working right, it can cause problems. It's been linked to diseases like heart disease, Alzheimer's, and inflammation. So, making sure our body has enough nitric oxide is key for staying healthy and feeling good.
As we age, our body's production of nitric oxide significantly decreases, with levels declining by as much as 50% by the age of 40 and only 15% remaining by age 60.
Symptoms of Low and High Nitric Oxide Levels
Symptoms of Low Nitric Oxide Levels
Hypertension (high blood pressure)
Erectile Dysfunction
Poor Exercise Tolerance
Cognitive Dysfunction
Slow Wound Healing
Headaches
Depression
Digestive Issues
Symptoms of High Nitric Oxide Levels:
Hypotension (low blood pressure)
Headaches
Gastrointestinal Disturbances
Fatigue
Gout
Nausea
How Do You Know Your Nitric Oxide Levels?
While there isn't a direct, widely available test specifically for measuring nitric oxide levels in the body, several indirect methods can offer valuable insights into NO activity. A normal range for nitric oxide levels in the bloodstream typically falls between 25-50 parts per billion (ppb).
Saliva Testing: Some laboratories offer saliva tests that measure nitrite levels, which can indirectly reflect nitric oxide production. However, these tests may not provide a comprehensive assessment of NO levels.
Blood Pressure Monitoring: Since nitric oxide plays a crucial role in regulating blood vessel tone, monitoring blood pressure levels can offer indirect clues about NO activity. Low blood pressure may suggest insufficient NO production, while high blood pressure could indicate excessive NO levels.
Endothelial Function Testing: Endothelial cells lining blood vessels produce nitric oxide, so assessing endothelial function through techniques like flow-mediated dilation (FMD) can offer insights into NO bioavailability.
Symptom Assessment: While not a direct measure, paying attention to symptoms associated with NO dysregulation can provide clues about potential imbalances.
How To Improve Nitric Oxide Levels
The good news is that we have a lot of control over our nitric oxide levels. Much of our impact cones through various lifestyle modifications, dietary interventions, and targeted supplementation strategies.
Exercise Regularly: Engaging in regular physical activity, particularly aerobic exercises like running, cycling, or swimming, stimulates nitric oxide production. Exercise boosts blood flow and oxygen delivery to tissues, leading to the release of nitric oxide, which helps dilate blood vessels and improve circulation.
Consume Nitrate-Rich Foods: Incorporate nitrate-rich foods into your diet, such as leafy green vegetables (spinach, kale, arugula), beets, celery, and radishes. These foods contain compounds that the body converts into nitric oxide, promoting vasodilation and cardiovascular health.
Get Sufficient Vitamin C: Vitamin C acts as a cofactor for the enzyme nitric oxide synthase, which catalyzes the production of nitric oxide from L-arginine. Include vitamin C-rich foods in your diet, such as citrus fruits, berries, bell peppers, and kiwifruit, to enhance nitric oxide synthesis.
Maintain Healthy Blood Sugar Levels: Elevated blood sugar levels can impair nitric oxide production and endothelial function. To support optimal nitric oxide levels, aim for balanced blood sugar levels by limiting refined sugars, refined carbohydrates, and processed foods in your diet.
Optimize Vitamin D Levels: Vitamin D deficiency has been associated with impaired nitric oxide production and endothelial dysfunction. Ensure adequate vitamin D intake through sun exposure, fortified foods, and supplements, as appropriate, to support nitric oxide synthesis and cardiovascular health. Shoot for at least 15–30 minutes of sun exposure on your skin daily, particularly arms and face, at least once a day. Getting sun through clouds counts (although you’ll have to stay outside longer to reap the rewards) and getting it through a window does not count (because the glass blocks UVB rays). Use a SAD lamp or red light therapy panel, particularly during winter months or in environments with limited sunlight exposure. I supplement with vitamin D from October to March due to shorter days and a lower angle of the sun.
Consume Omega-3 Fatty Acids: Omega-3 fatty acids, found in fatty fish (salmon, mackerel, sardines), flaxseeds, chia seeds, and walnuts, have been shown to enhance nitric oxide production and improve endothelial function. Include omega-3-rich foods in your diet, or supplement with a high-quality fish oil, to promote cardiovascular health and nitric oxide activity.
Dark Chocolate Consumption: Dark chocolate contains flavonoids, which have been shown to stimulate nitric oxide production and promote endothelial function. Enjoying moderate amounts of high-quality dark chocolate with a high cocoa content (70% or higher) can support nitric oxide activity and cardiovascular health. A great, high-quality brand is Hu Chocolate Bars.
Prioritize Quality Sleep: Adequate sleep is crucial for maintaining optimal nitric oxide levels and cardiovascular function. Poor sleep quality or insufficient sleep duration can impair nitric oxide synthesis and contribute to endothelial dysfunction. Aim for 7-9 hours of quality sleep per night to support nitric oxide production.
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Limit Conventional Mouthwash Use: Some commercial mouthwashes contain antimicrobial agents that can disrupt the oral microbiome and reduce nitric oxide production in the mouth. Limiting the use of alcohol-based mouthwashes and opting for alcohol-free alternatives can help preserve oral nitric oxide levels and support oral health. We use hello mouthwash which is made without alcohol, fluoride, sulfates, or artificial sweeteners. Lean more here: Mouthwash Health Concerns: Should You Stop Using Mouthwash?
Manage Your Stress: Chronic stress can negatively impact nitric oxide production and endothelial function. Engaging in stress-reducing activities such as meditation, breathwork exercises, yoga, or spending time in nature can help lower stress levels and support nitric oxide activity. If you're more of a black and white thinker like me then consider tracking your stress level through the use of heart rate variability (HRV).
Maintain a Healthy Weight: Excess body weight, particularly abdominal fat, has been associated with impaired nitric oxide synthesis and endothelial dysfunction. Check out this article for how to measure and lower your body fat for improved nitric oxide production and cardiovascular health.
Hum. Humming significantly increases nasal nitric oxide levels compared to quiet exhalation, as demonstrated in a study involving ten healthy subjects where nasal NO output increased 15-fold during humming, facilitating greater gas exchange between the paranasal sinuses and the nasal cavity. This happens because humming makes the air move around in your sinuses, allowing more of this gas to come out.
Great graph on this: Humming caused a 15-fold increase (range, 8–21) in nasal NO compared with quiet exhalation (Figure 1)
Consider Supplements: Certain supplements, such as beetroot powder, citrulline, and arginine, may help boost nitric oxide levels when taken as part of a balanced diet. However, it's essential to consult with a healthcare professional before starting any new supplements to ensure safety and efficacy, especially if you have underlying health conditions or are taking medications.
Beet supplements: Eating beets or consuming beet-based products like juice, powder, or capsules can boost nitric oxide (NO) levels in the body. You can eat regular old beats or get them in other forms such as juice, powder, or capsules. A 2014 study found that “dietary nitrate supplementation appears to represent a promising new approach for enhancing aspects of the physiological response to exercise, such as muscle efficiency and oxygenation, which might augment performance.” Basically, you might feel less tired during workouts and might even perform better.
Recommended brand: humanN Super Beet Heart Chews
Dosage: Here are dosages taken from the literature
70-140 mL of beetroot juice before exercise daily
200 grams of baked beetroot ~75 minutes before exercise
50 mg of beetroot concentrate, twice daily for ~6 days.
L-citrulline supplements: L-citrulline is an amino acid that your body can use to produce nitric oxide. It's found naturally in watermelon, cucumbers, and cantaloupe. In supplement form, research has shown that taking L-citrulline may improve vascular health, reduce blood pressure, enhance muscle function, improve exercise performance, and potentially mitigate age- and lifestyle-related diseases by increasing nitric oxide synthesis and promoting beneficial metabolic effects.
Recommended brand: Nutricost L-Citrulline Tablets (500mg)
Dosage: A review of the literature on citrulline malate found that 8g "has been the most common approach" in studies.
L-arginine supplements: L-arginine is another amino acid that can increase nitric oxide production in the body. It's found naturally in foods like poultry, fish, seeds, and legumes. In supplement form, research has shown that taking L-arginine can improve blood flow, which can have various health benefits including better exercise performance, lower blood pressure, a reduced risk of diabetes, enhanced muscle pump during workouts, faster wound healing, and potentially improved erectile function in men.
Recommended brand: Nutricost L-Arginine Tablets (1.00mg)
Dosage: A 2018 study found that up to 30g per day of l-arginine is safe for most adults.
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