Cardiovascular disease (CVD) is the leading cause of death globally. Over 11% of the United States population has diabetes. Alzheimer's disease is a neurodegenerative condition that was the third leading cause of death for Americans in 2019. Despite appearing unrelated, these conditions may all be linked to nitric oxide insufficiency.

Nitric oxide plays multifaceted roles in cardiovascular health, metabolic regulation, and neuronal function. Its deficiency has been implicated in endothelial dysfunction, impaired insulin sensitivity, and diminished cerebral blood flow. Optimizing nitric oxide through dietary interventions represents a promising avenue toward mitigating the development and progression of chronic diseases, offering hope for improved public health outcomes.

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Understanding Nitric Oxide and Its Health Benefits

Nitric oxide (NO) is a gaseous molecule produced naturally within the body. It is most notorious for its role as a vasodilator, meaning it relaxes the muscles of blood vessels to allow them to widen. But it also transmits messages within the cardiovascular, immune, endocrine, and nervous systems. Its actions have widespread effects on human health, and nitric oxide supplementation has been studied to treat high blood pressure, erectile dysfunction, physical endurance, insulin resistance, neurodegeneration, poor wound healing, and inflammation. (12) 

Two main pathways are responsible for NO production in the body.

The nitric oxide synthase (NOS)-dependent pathway involves the conversion of the amino acid L-arginine to NO by the enzyme NOS. There are three NOS isoforms:

1. Endothelial Nitric Oxide Synthase (eNOS): Found predominantly in endothelial cells lining blood vessels, eNOS produces NO to regulate vascular tone, blood pressure, and blood flow. It also plays a role in maintaining the integrity of the endothelium, preventing platelet aggregation, and inhibiting smooth muscle cell proliferation. (36) 
2. Neuronal Nitric Oxide Synthase (nNOS): Primarily located in nerve cells, nNOS generates NO for neurotransmission, synaptic plasticity, and neuroprotection. nNOS regulates functions like learning and memory. (16) 
3. Inducible Nitric Oxide Synthase (iNOS): iNOS produces NO as part of the immune response. While iNOS-derived NO can help combat pathogens and regulate inflammation, excessive or prolonged production may contribute to tissue damage in conditions like sepsis, cancer, and pain. (9) 

The NOS-independent pathway involves bacteria in our mouth and stomach. Oral bacteria take dietary nitrate and turn it into nitrite. The food bolus enters the stomach after swallowing, where some of the nitrite is converted into NO in the acidic environment.

Top 5 Foods to Boost Nitric Oxide Naturally

Symptoms of low nitric oxide levels include high blood pressure, high blood sugar, erectile dysfunction, muscle soreness, and slow wound healing. Consider incorporating the following foods into your diet to boost nitric oxide levels. 

#1 Beets: 

Beets have gained attention for their potential to boost NO synthesis due to their high nitrate content. Dietary nitrates act as the precursory molecule for NO synthesis via the NOS-independent pathway. Once NO has been synthesized in the stomach, it can enter the bloodstream and exert its various physiological effects.

Research suggests that dietary nitrate supplementation, such as with beetroot or beetroot juice, can elevate circulating levels of NO metabolites and positively impact cardiovascular and exercise-related outcomes.

#2 Garlic: 

Garlic, particularly aged garlic extract, can potentially reduce cardiovascular risk by lowering blood pressure, total cholesterol, and markers of systemic inflammation. 

These benefits are attributed to garlic's primary active constituent, allicin, which is broken down into various sulfur-containing compounds. One mechanism by which allicin is believed to confer cardioprotective effects is its ability to activate eNOS activity, which induces vasodilation and blood pressure reductions. 

#3 Leafy Greens: 

Approximately 80% of dietary nitrates are derived from vegetable consumption. Nitrate-rich green leafy vegetables include spinach, lettuce, kale, arugula, chard, and cabbage.

In an observational study, researchers examined data collected over 23 years from more than 50,000 people in Denmark who had participated in the Danish Diet, Cancer, and Health Study. They found that people who ate one cup of raw (or one-half cup of cooked) nitrate-rich vegetables daily had about 2.5 mmHg lower systolic blood pressure and a 12-26% lower risk of cardiovascular disease. (33) 

#4 Citrus Fruits: 

Reactive oxygen species (ROS) are major culprits of NO breakdown. Vitamin C, or ascorbic acid, is an antioxidant. Antioxidants scavenge and neutralize free radicals so that they can not degrade NO. (14) 

Additionally, tetrahydrobiopterin (BH4) is a cofactor required for the proper functioning of eNOS. Vitamin C helps regenerate BH4 to prevent deficiency, which is involved in NOS dysfunction. (17, 38) 

Several studies have demonstrated the potential of vitamin C supplementation or increased intake of vitamin C-rich foods, such as citrus fruits, in reducing blood pressure and vascular oxidative stress.

#5 Nuts and Seeds: 

Nuts and seeds are high in arginine, the amino acid that acts as the building block for NO in the NOS-dependent synthesis pathway. 

In a cross-sectional study involving over 2,700 men and women, researchers found that a higher intake of dietary arginine was associated with higher NO levels in the blood. Research has also shown that regularly eating nuts, particularly pistachios and sesame seeds, is correlated to lower systolic and diastolic blood pressure readings. 

Incorporating Nitric Oxide-Boosting Foods into Your Diet

Incorporating nitric oxide-boosting foods into your daily eating habits can be delicious and beneficial for your health. By following a plant-based, anti-inflammatory diet, you will inherently be adding NO-boosting foods to your diet. Here are some meal ideas to help you integrate these foods into your diet:

Smoothies

Blend banana, spinach, Greek yogurt, beet juice, and a splash of orange or grapefruit juice together for a nutrient-packed smoothie rich in vitamin C and nitrates. Add a tablespoon of flaxseeds or nut butter for an extra boost of fiber and arginine. 

Salads

Salads are a great side dish to add to any meal to meet your dietary requirements for leafy greens. One example is tossing fresh spinach and arugula together and topping with walnuts and sliced strawberries. Dress the salad with a simple vinaigrette dressing. 

Hummus

Hummus is a dip made from mashed chickpeas blended with tahini (sesame seed paste), lemon juice, garlic, and olive oil. Hummus is easy to make at home by combining all the ingredients in a food processor. You can even add cooked beets to the recipe to enhance its NO-boosting properties. Serve with your favorite crackers or veggie sticks. 

Other Lifestyle Factors Affecting Nitric Oxide Levels

In addition to mindful dietary choices, other lifestyle habits can help boost NO levels naturally.  

Exercise: 

During exercise, increased blood flow and oxygen delivery to tissues stimulate the release of eNOS. This elevated eNOS activity leads to higher levels of NO, promoting vasodilation, improving blood flow, and enhancing oxygen delivery to working muscles. (28) 

Exercise also increases antioxidant activity, inhibiting the breakdown of NO caused by free radicals. 

Engaging in a home-based exercise program of 30 minutes of aerobic exercise three days per week for four weeks can increase NO levels. 

Sunlight Exposure: 

When the skin is exposed to ultraviolet (UV) rays from sunlight, it triggers the conversion of stored nitrate and nitrite compounds in the skin into NO. UVA rays can upregulate iNOS in the skin to release enough NO to create a vasodilatory effect and reduce blood pressure. (19) 

Avoidance of Nitric Oxide Inhibitors: 

Just as certain compounds can upregulate NO production, some factors can diminish NO levels. Avoiding NO inhibitors will increase NO's bioavailability.

Smoking

Smoking tobacco inhibits NO production by inhibiting NOS enzyme expression. Tobacco smoke also contains ROS, which can further deplete NO levels. (7, 8)

For many reasons (including reducing the risk of heart disease, lung disease, and cancer), it is highly encouraged to quit smoking and avoid secondhand smoke. The CDC provides many resources for those who need support in quitting. 

Mouthwash

While antiseptic mouthwashes can kill oral bacteria responsible for causing dental and gum disease, they also kill the beneficial bacteria responsible for converting nitrates to nitrites for up to 12 hours after use. To maintain adequate NO production via the NOS-independent pathway, it is encouraged to limit your use of mouthwash.

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Key Takeaways

• Nitric oxide is a signaling molecule produced naturally in the body that plays important roles in blood flow, endothelial function, neurotransmission, and immune responses.
• Health conditions related to insufficient NO levels may include high blood pressure, cardiovascular disease, and neurodegenerative diseases.
• Mindful dietary and lifestyle choices can support NO levels to prevent diseases related to NO deficiency and maintain optimal wellness.