Nitric Oxide: A Key to Peak Athletic Performance

By Dr. Rick Cohen, MD
Creator of PureClean Performance

All athletes want to improve performance, so we optimize our training, get plenty of sleep, and focus on the foods we eat. Even so, there’s an important nutrient many athletes still don’t know enough about: nitrates. More specifically, it’s what your body can do with nitrates that should be of great interest to athletes.

Nitrates and Nitric Oxide

Only a few decades ago, scientists discovered the connection between nitric oxide and blood flow. In the presence of NO, blood vessels relaxed, which improved blood flow and reduced blood pressure. At the time, this led to great insights and developments in the treatment of cardiac patients and people with essential hypertension. As more research emerged, the scientific understanding of NO’s roles throughout the body grew.

Because NO is a gas that diffuses rapidly across cellular membranes, it’s involved in many physiological processes. When released inside the body, this gas quickly and easily penetrates cells, promoting optimal, physiological function.

NO is produced 3 ways in your body:

1. It is secreted by the cells in the inner lining (endothelium) of your blood vessels.
2. It is converted by oral bacteria from your intake of nitrates from the foods you eat.
3. It is created by bacteria on our skin when we are exposed to adequate amounts of sunlight.

NO enhances oxygen delivery and blood flow.

From an athletic perspective, nitric oxide’s primary role is to regulate the delivery of oxygen to muscles, It does this by relaxing and opening blood vessels, subsequently improving blood flow. Better blood flow not only translates into lower blood pressure, but a decreased demand on your heart and skeletal muscles. Better blood flow also supports a muscles’ ability to contract and transport metabolic by-products such as lactic acid. Because NO is responsible for delivering oxygen-rich blood to every cell, tissue, and organ system in the human body, it is now recognized by the scientific, medical, and athletic communities as a key, physiological performance variable.

And NO has even more benefits!

NO acts as powerful antioxidant neutralizing harmful, free radical activity and promoting the formation of glutathione, a critical antioxidant. NO facilitates the transmission of messages between nerve cells, contributing to improved memory and learning capacities, better sleep, and a more positive mood. And NO supports the immune system helping fight off infections.

NO can improve athletic performance

Given that NO contributes directly to blood flow, oxygen delivery, glucose uptake, muscle velocity, power output, and muscle growth; a higher NO level may enhance an athlete’s overall performance and endurance — even among athletes who were already fit and healthy.

In fact, a number of studies have shown boosting nitric oxide can reduce the oxygen cost of exercise and improve the function of energy-producing mitochondria, resulting in a lower perceived effort and easier breathing during exercise, in addition to reduced muscle soreness and faster recovery following hard, physical efforts.

Nitric oxide may even improve adaptation to altitude.

People who live at high altitude produce more NO than people at sea level, and populations that thrive at high altitude, like Tibetans, have been found to have NO levels several times those of sea level populations. If you’re planning a trip to a high-altitude location, then it would be wise to consider upping your nitric oxide level. Hypoxia reduces NO levels initially, and studies show that the consumption of dietary nitrates (for instance, red beets) or NO supplementation can improve the body’s adaptation to altitude by keeping NO levels from declining.

But… NO levels decline with age.  

NO levels can decline for a variety of controllable reasons including a lack of dietary nitrates, excessive physical and mental stress, low stomach acid, imbalanced mouth bacteria, anti-inflammatory medicines and arterial damage. But the one we can’t control, aging, is by fat the greatest threat to your NO level.

By the age of 40, your body will produce half the NO it did at the age of 20! By the time you reach 70, it will be capable of producing only 25% of the nitric oxide it needs! And as your body’s ability to generate NO after exercise is reduced, so does your responsiveness to training. To make matters worse, as NO production declines past the age of 40, the health risks from dysfunctional blood vessels rise significantly.

Determining your NO level

Until very recently, there was no easy way to assess your NO level. Testing required costly blood work or a complicated procedure called Flow Mediated Dilation, which indirectly predicted NO levels by measuring the rate of blood flow in the arm after applied pressure. Fortunately, recent advances in laboratory testing technology make it possible for you to easily and regularly measure your NO levels—anywhere, anytime—using nothing more than a test strip and a drop of saliva.

Even before – or in conjunction with – testing NO levels, you can start by assessing how you feel. Ask yourself the following questions. In my experience, if you answer “yes” to any two or more, your NO level is probably low.

• Are you over the age of 40?
• Do you rarely or occasionally eat green vegetables and/or red beets?
• Do you train at high-levels more than 10 hours a week?
• Are your hormone levels imbalanced?
• Do you use anti-inflammatory medications such as Motrin or Celebrex?
• Do you use antacids or suffer from indigestion?
• Do you frequently use an antiseptic mouthwash?
• Do you have gum disease or bad breath?
• Have you recently taken antibiotics?
• Do you suffer from any form of bowel distress?
• Do you have circulation problems, high blood pressure and/or fluid retention issues?
• Do you suffer from abnormally high CRP, or an autoimmune disease?
• Have you been diagnosed with asthma or bronchitis?

You don’t need to guess.

Over the past 10 years, I have found that almost everyone over the age of 40 and/or is an endurance athlete has less than optimal levels of NO. But, don’t take my word for it.

While it is always helpful to maintain a subjective awareness of any improvements in the way you feel and perform, salivary test strips provide an objective foundation for determining improvements in your NO level. Despite its deceptive simplicity, a salivary nitric oxide assessment is a powerful tool that will allow you to monitor how your NO level changes with dietary and lifestyle choices, training intensity, stress, and the use of nitrate-based supplements.

By using a nitric oxide assessment strip to periodically check your NO level first thing in the morning and an hour or two after consuming nitrate-rich foods and/or a nitric oxide supplement, you can accurately assess your body’s ability to produce and maintain an optimal amount of NO. In addition, by assessing your NO you can determine just how much and when you should be supporting it for maximum health and performance results.

How can you improve your NO levels?

Now that you know the importance of nitric oxide for health and performance and how to gauge your NO levels, the big question how can you improve your NO levels?

Well, since it’s hard to affect the behavior of bacteria in your mouth, or enhance the creation of NO on your skin from sun exposure, the most effective and proven method of optimizing your NO levels is through the use of dietary nitrates.

More on that in Part 2 (coming next week).

Disclosure: CTS has a partnership with PureClean Performance and CTS Coaches use PureClean Performance products during training and training camps.

About Dr. Cohen

Dr. Rick Cohen has worked as a specialist in nutritional medicine and sports performance for more than two decades, and developed a number of innovative treatment programs that have successfully helped patients enhance their sports performance as well as eliminate a variety of health problems.

He received his undergraduate degree with honors of distinction from Duke University in Durham, North Carolina, and received his medical degree from Hahnemann Medical University in Philadelphia, Pennsylvania. He is a proud member of several professional organizations including the American College for the Advancement of Medicine and the American Academy of Anti-Aging Medicine. Dr. Cohen is the creator of PureClean Performance.

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