Increase Nitric Oxide, Improve Health

Increase Nitric Oxide, Improve Health

Julian Whitaker, MD

We knew about the health benefits of nitric oxide (NO) long before scientists were aware of its presence in the human body. Nitroglycerin, a drug that works on NO pathways, was adopted as a medical therapy for angina and high blood pressure in the 1880s, but another century passed before anyone had an inkling of why it worked.

The discovery of NO and its biological activities was so astounding that the 1998 Nobel Prize was awarded to the three pharmacologists who identified and furthered our understanding of this dynamic molecule. Let’s take a look at NO and how you can increase its production to improve multiple aspects of health.

Multiple Roles of NO

NO is a key signaling molecule throughout the body. Produced by the endothelial cells lining the arteries, it penetrates the underlying smooth muscles and acts as a potent vasodilator that relaxes the arteries. Therefore, NO plays a critical role in blood pressure and overall circulation. It also keeps the endothelium in shape by curbing inflammation and oxidative stress. Unfortunately, atherosclerosis, the underlying cause of heart disease and other vascular disorders, is characterized by endothelial dysfunction and a limited capacity to produce NO. It’s a vicious cycle. Diseased arteries can’t generate enough protective NO. In turn, low NO sets the stage for further damage, hypertension, and increased risk of cardiac events.

This explains why nitroglycerin is such an effective therapy for angina. It triggers NO production, which dilates narrowed coronary arteries, improving circulation and delivering much-needed oxygen to the heart muscle. Restoring NO availability also lowers blood pressure and improves erectile dysfunction (ED). In fact, the popular ED drugs Viagra, Cialis, and Levitra block the enzyme that degrades NO, allowing blood vessels in the penis to dilate and substantially improving erections.

This essential compound is also generated in the brain, where it’s involved in neurotransmission and protects against dementia and other neurodegenerative disorders. NO is synthesized in the white blood cells as well and is used as a weapon against bacteria, fungi, parasites, and aberrant cancer cells. (See page 5 to read about its antimicrobial effects.) In the gastrointestinal tract, it relaxes smooth muscle cells and helps regulate intestinal peristalsis and mucus and gastric acid secretion. NO is also involved in insulin signaling, bone remodeling, respiratory function, ATP (energy) utilization, and mitochondrial biogenesis, or the production of new cellular “energy factories.”

Because of the wide range of health benefits that NO provides, it makes sense for all of us to boost our production of this essential compound.

Boost NO Production With Diet

Because NO is synthesized from the amino acid arginine, dietary recommendations for boosting NO often include protein-rich meats and the like. However, recent research suggests that vegetables may be your best bet. Plant foods, particularly beets and leafy greens like kale, Swiss chard, arugula, and spinach, are rich in dietary nitrates and nitrites—compounds that stimulate the production of NO in the body. Coupled with its abundance of protective potassium, it’s not surprising that a plant-based diet is associated with lower blood pressure and reduced risk of stroke, heart attack, diabetes, and a variety of other health concerns.

In addition to eating more dietary nitrates, I suggest you consider drinking beet juice. Studies have shown that two cups a day, which contain about 1,400 mg of nitrates or six times the typical daily intake, lower blood pressure, increase stamina during exercise, and, in older people, boost blood flow to the frontal lobes of the brain. I also recommend increasing your intake of tea, cocoa, onions, grapes, and other foods that contain protective flavonoids, which help preserve NO by shielding against free radical damage. You should also be aware that high-fat, high-carb diets tend to increase blood levels of asymmetric dimethylarginine (ADMA), a naturally occurring inhibitor of NO production.

Exercise and Supplements Also Help

Exercise also stimulates NO generation in the vascular endothelium. How? Exercising muscles require extra oxygen and nutrients, and this prompts endothelial NO release, which relaxes the arteries and increases blood flow. Habitual physical activity keeps these mechanisms in shape and protects against disease and aging of the vascular system. Conversely, people with advanced atherosclerosis have a hard time exercising, due in part to the poor health of their arteries and impairments in NO release.

Nutritional supplements can also increase NO production and expression. L-arginine, which is a precursor to NO, is an option; however, recent studies suggest that it isn’t particularly beneficial for older people with cardiovascular disease. Another option is L-citrulline, an amino acid that is converted in the body into arginine and then into NO. Antioxidants are also extremely important because they protect the endothelium and guard against NO degradation. In addition to an antioxidant-rich daily multivitamin, consider taking spirulina. This blue-green algae contains a compound that is particularly effective in quelling oxidative stress and supporting optimal NO production.

EECP Raises NO

Finally, I want to tell you about an NO-boosting therapy we use at Whitaker Wellness that’s a godsend for anyone with vascular disease: enhanced external counterpulsation (EECP). In a study published last year, researchers enrolled patients with symptomatic coronary artery disease and treated them with EECP or a placebo therapy. Compared to the placebo, EECP increased nitric oxide levels by 36 percent, improved endothelial function by 51 percent, lowered C-reactive protein (CRP) by 32 percent, and reduced angina by 62 percent.

Unfortunately, conventional physicians, Medicare, and many insurance companies limit EECP to patients who have either been failed by bypass or angioplasty or are otherwise considered “unsuitable” candidates. This is absurd. Instead of a last resort, why not try this “natural bypass” first and allow patients to sidestep these costly, risky interventions? I’ll tell you why. It’s all about protecting the huge, profitable invasive cardiology industry. Given the choice, who wouldn’t opt for a safe, effective, noninvasive therapy that can be done in a doctor’s office and costs less than the sales tax on bypass surgery?

Even without Medicare reimbursement, thousands of patients have come to Whitaker Wellness, paid for EECP out of pocket, and are healthier and happier for it. Many of them presented with severe chest pain, an inability to climb stairs or walk more than a block or two, and/or a recommendation for angioplasty or bypass. After treatment, most were able to reduce or discontinue their drugs, avoid invasive procedures, and return to an active, productive lifestyle.

Whether you’re concerned about heart disease, hypertension, erectile dysfunction, or any of the other problems we’ve discussed, or you’re simply interested in preventing these and other challenges down the road, I encourage you to take steps to increase your NO levels and get on the road to optimal health.


  • For more about receiving EECP therapy at the Whitaker Wellness Institute, click here, or call (866) 944-8253.
  • To stimulate nitric oxide (NO) production, eat a low-fat, low-glycemic diet with lots of nitrate- and nitrite-rich leafy greens, beets, and other vegetables, along with tea, dark chocolate, onions, and other items abundant in flavonoids. You should also consider adding one or two cups daily of fresh or dehydrated beet juice, which is sold in health food stores.
  • Take a daily multivitamin that contains high doses of antioxidants. Recommended doses of L-arginine or L-citrulline are 5-6 g per day, taken in divided doses between meals. Because spirulina requires a large dose, we use a powdered product at the clinic called Chocolatl Verde, which contains 15 g of spirulina, along with cocoa and other protective flavonoids. 


  • Austin SA, et al. Endothelial nitric oxide modulates expression and processing of amyloid precursor protein. Circ Res. 2010 December 2. 107(12):1498-1502.
  • Braith RW, et al. Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study. Circulation. 2010 Oct 19;122(16):1612-1620.
  • Gielen S, et al. Exercise-induced modulation of endothelial nitric oxide production. Curr Pharm Biotechnol. 2011 Jan 11.
  • Presley TD, et al. Acute effect of a high nitrate diet on brain perfusion in older adults. Nitric Oxide. 2011 January 1;24(1):34-42.

Modified from Health & Healing with permission from Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.

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