Nitric oxide is a crucial molecule in the body responsible for various physiological processes, from regulating blood pressure, blood flow, cellular communication, and oxygen delivery to muscles.

This article discusses dietary guidelines, lifestyle advice, and supplements that help boost nitric oxide levels. 

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Understanding Nitric Oxide and Its Importance

Nitric oxide (NO) is involved in vasodilation in the cardiovascular system, immune response, neurotransmission, apoptosis, and oxygen delivery to tissues. NO production decreases in cardiovascular disease, normal aging, and poor nutritional status. Within the cardiovascular system, NO assists in vasodilation of blood vessels, platelet aggregation, myocardial function, and proper blood flow.

Improper production of NO results in endothelial dysfunction, atherosclerosis, thrombosis, and coronary artery disease. In regard to physical activity, NO helps boost mitochondrial oxygen consumption in cardiac cells promoting oxygen delivery and nutrients to the heart. Nitric oxide is a crucial signaling molecule that contributes to several physiological processes for health and well-being (2). 

Dietary Sources of Nitric Oxide Boosters

The following foods are the top dietary sources of Nitric Oxide boosters:

Beets and Beetroot Juice: 

Beets have gained attention for their ability to produce nitric oxide. Beetroot contains a molecule called nitrates, which has been shown to decrease lipid levels, glucose, and blood pressure. Nitrates get converted to nitrites, which then convert to nitric oxide (NO). Studies show that long-term intake of beetroot juice improves vascular performance through increasing vasodilation and reducing blood pressure. Beetroots also contain high levels of antioxidants which further assist in reducing atherosclerosis (12). 

Leafy Greens: 

Green leafy vegetables such as spinach, kale, mustard greens, arugula, and bok choy have high levels of nitrates and are thus a good source of nitric oxide for the body. Implementing a Mediterranean diet which is high in leafy greens is correlated with a decrease in cardiovascular disease and an increase in longevity. Green leafy vegetables also reduce the risk of developing a heart attack and stroke. Consumption of green leafy vegetables is an excellent source of nitric oxide and a good strategy for increasing NO in the body (21). 

Citrus Fruits:

Citrus fruits contain high levels of vitamin C which has been shown to increase nitric oxide production. Vitamin C is high in antioxidants and decreases oxidative stress. Studies show that intake of vitamin C improves endothelial cell function by stabilizing nitric oxide molecules and protecting them from reactive oxygen species (ROS). Long-term treatment of vitamin C has shown a decrease in atherosclerosis and an increase in vasodilation (11). 

Nuts and Seeds: 

Nuts and seeds contain high levels of L-arginine and L-citrulline. These two amino acids play a crucial role in nitric oxide synthesis. Arginine located in the plasma provides the necessary substrate for the synthesis of NO. Arginine gets converted to NO and L-citrulline. L-citrulline then gets converted back to arginine to maintain proper levels of arginine within the cell. Consuming nuts such as walnuts, hazelnuts, almonds, and Brazil nuts is an excellent source of these amino acids which help boost NO levels (2). 

Garlic: 

Garlic is a widely used remedy for the treatment of various health concerns. In regard to nitric oxide, garlic extract improves cardiovascular function through increasing NO availability. The sulfur compounds in garlic are responsible for inducing endothelial NO which results in smooth muscle cell relaxation and a decrease in blood pressure. Some even hypothesize that a sulfur deficiency may be responsible for the development of hypertension (25).

Exercise and Nitric Oxide Production

Participating in regular physical activity, especially aerobic and resistance training can stimulate the body’s own nitric oxide production. During exercise, our bodies respond to increased oxygen demand by activating the nitric oxide synthesis pathways which results in an increase in NO. This occurs because the body requires higher levels of oxygen and increased mitochondrial metabolism during exercise. The elevation of NO helps sustain physical activity by delivering oxygen to tissues, decreasing oxidative stress, and increasing blood flow to skeletal muscle. 

Both aerobic and resistance training have been shown to reduce mortality and enhance physical performance in both healthy patients and those with chronic heart failure. Incorporating exercise into your wellness plan is essential in promoting NO production (31). 

Lifestyle Factors Influencing Nitric Oxide Levels

The following lifestyle factors can help increase Nitric Oxide levels:

Sunlight Exposure: 

Sunlight exposure is one of the most important lifestyle factors in a healthy immune system. There has been increasing evidence showing that UV radiation from sunlight lowers blood pressure through interaction with nitrites in skin cells. This interaction can trigger the production of nitric oxide release through the skin (14). 

Managing Stress: 

Stress is a common experience that takes a toll on our physical, mental, and emotional health. When we experience chronic stress, it results in an elevation of cortisol. Cortisol has been shown to inhibit nitric oxide synthesis. Maintaining healthy stress levels through mind-body practices such as yoga and meditation can support healthy NO synthesis (33). 

Sleep: 

Sleep plays a crucial role in regulating nitric oxide levels and vascular function. Adequate sleep is associated with healthy endothelial function. Decreased sleep quality leads to impaired endothelial function resulting in decreased NO availability. This leads to increasing risk of cardiovascular disease. Prioritizing good sleep hygiene is crucial for overall well-being and proper NO synthesis (15). 

Supplementation to Support Nitric Oxide Levels

While dietary interventions are the preferred method for boosting nitric oxide levels, a few supplements have been shown effective in supporting NO synthesis. Supplementing with both L-arginine and L-citrulline has been shown to increase nitric oxide synthesis. L-arginine is effective because it gets directly involved in NO synthesis and L-citrulline serves as a precursor to L-arginine that is also converted to NO. Studies show that supplementing with L-arginine increases respiratory response and exercise capacity (20). 

Nitrate supplements have gained popularity as sports enhancement supplements. These supplements utilize inorganic nitrates sourced from vegetables and beetroot. Supplementation with concentrated nitrites has been shown to increase exercise tolerance and performance and decrease blood pressure (17). 

Safety Considerations and Potential Side Effects

It is important to be aware of side effects and contraindications when increasing nitric oxide levels through supplementation. Since NO promotes vasodilation and lowers blood pressure, it is not advised for those with low blood pressure to supplement due to the possibility of developing excessive vasodilation. Individuals with hypertension who are currently taking pharmaceutical anti-hypertensives should not supplement with arginine and citrulline due to the risk of blood pressure dropping too fast. Side effects reported from arginine and citrulline supplementation include nausea, vomiting, and diarrhea. It is important to consult a healthcare provider to assess individual medical needs and provide guidance on healthy ways to increase nitric oxide (13, 18). 

Furthermore, patients with the herpes virus should avoid taking arginine and citrulline supplements as these amino acids can cause herpes virus (HSV) to over-replicate (16). 

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Key Takeaways

Boosting nitric oxide through diet, lifestyle, and supplementation can help increase exercise performance, decrease blood pressure, and boost the immune system.

Eating a diet rich in leafy greens, beets, citrus fruits, and nuts/seeds is an excellent way to increase NO production.

Integrating aerobic and resistance training and practicing stress management techniques are excellent tools for those looking to improve vascular health.