Although nitric oxide or NO is considered one of the most important molecules produced in the human body with over 140,000 published papers in the scientific literature, still physicians do not always recognize which of their patients may be suitable for NO supplementation. Moreover, patients and consumers understand NO even less and don’t fully understand if or why they should take NO based products or supplements. Much of this stems from the fact that there are no labs or common tests that can determine NO production or NO status in patients. You can test your Vitamin D, Vitamin B or omega 3 fatty acid levels and if you are low, then it is easy to supplement with these products to restore normal levels. This concept is exactly the same for NO. People become low in NO and loss of NO production is considered one of the earliest events in the onset and progression of most if not all age related diseases [1-5], including cardiovascular disease, the #1 killer of men and women worldwide.
So how do you know if you need a safe and effective NO product? Functional changes in the blood vessels occurs years, sometimes decades, before the structural changes begin to occur  Therefore getting functional test that determine endothelial function is critical for determining NO production capacity and function before the onset and progression of symptoms or disease. There are several devices now on the market that can determine endothelial NO production, EndoPat, Vendys and MaxPulse are a few that are commonly used by many physicians and health care practitioners.
If you are unable to get functional measurements on endothelial NO production, there are now well validated biomarkers that appear in blood that mirror the progressive loss of NO production. The first phase of insufficient NO production is an increase in inflammation. The acute phase inflammatory marker hsCRP begins to increase. Subjects will also experience protein in the urine or microalbuminuria. The presence of protein is the urine is a very early marker of cardiovascular dysfunction.
Later stages once NO production is decreased by greater than 50%, there is heightened oxidative stress. This can be picked up by increase in myeloperoxidase (MPO) activity, oxidized lipoproteins (Lp-PLA2), increased excretion of F2 isoprostanes in the urine. If any of these biomarkers are increased or elevated, then you can be certain your body is not producing sufficient NO. As a result, since you are deficient in NO, then it is prudent to supplement NO and take steps to improve your body’s own ability to make NO. These labs are now common and most are covered by your insurance.
In this time of changing health care and the practice of medicine, it is time to be proactive in the control of our health instead of being reactive once we get sick or begin to show symptoms of disease. This is where NO supplementation can have the most profound impact on public health. The published literature reveals that age is the number one cause of loss of nitric oxide production [6-9]. This loss of endothelial function can be accelerated or decelerated by our diet and lifestyle. Taking measures to prevent the age related decline in NO production will ensure that your blood vessels remain healthy and responsive. The old saying, “an apple a day keeps the doctor away” may be even more true with NO. Daily moderate physical exercise and a diet enriched with green leafy vegetables is a great way to keep your NO levels up. For those that do not want to change diet or exercise, there are NO supplements and functional foods available to those. Whatever your choice, it is paramount that everyone keep their NO levels optimal for great health and well-being.
This article was originally published by Dr. Nathan S. Bryan, Ph. D.