Dr. Conway McLean, Journal columnist

What is the buzz word of the day? Isn’t there always some hot topic the media is latching onto? It will haunt the news, circulating in the tabloids after the reputable news channels have let it go. Medical topics are of tremendous interest, especially some new and relevant discovery.

There have been many, from the tremendously popular penicillin to the fave of everyone who has had a “procedure”, local anesthetics. More recently, who can forget the wonders of organ transplant. Now that was a game changer.

I’m here to report on a new buzz word, which you probably have heard if you read almost anything. From specialized medical journals to the ‘tabloids’, the talk of the town is a substance only recently recognized for its complex and varied roles in health.

I refer now to the compound nitric oxide, which has a long and fascinating history of discovery and development. Because of the results of research to date, it has the potential to become one of the greatest discoveries in science and medicine in the last century.

Nitric oxide was once thought to be just another type of air pollutant, produced by both cars and factories. This was the prevailing belief until the ’80’s when the critical importance of the chemical compound was discovered. Nitric oxide (NO) is a widespread signaling molecule that participates in virtually every cellular and organ function in the body and appears to have many roles, maybe most important being its activity as a chemical messenger, one found in all mammals.

The importance of this compound is reflected by the awarding of the Nobel Prize for Medicine in 1998 for the discovery of NO’s role in the human body. There is much that has yet to be learned about how this substance works, though research is on-going. Early findings include its effects on the cardiovascular system, on how well our blood vessels and heart carry that essential fluid throughout the body.

But as studies continued, it became obvious that NO plays a significant role in numerous chemical reactions in the body. It is vital to the immune system, the nervous system (including the brain), and more. Conversely, abnormalities in NO play an important role in many chronic conditions and diseases such as chronic inflammation and cancer. As expected, research has focused on ways to use nitric oxide as a medical therapy.

Nitric oxide is a molecule that is produced naturally by your body, released by the inner layer of cells of our blood vessels. We exhale tiny amounts during normal respiration. One of the most critical functions of this compound is vasodilation of blood vessels, meaning it relaxes the muscles of blood vessels, in effect widening them.

NO keeps blood vessels flexible, allowing them to dilate. The cumulative effect is a boosting of blood flow. This allows the vessel to carry more blood, increasing circulation. Consequently, nitric oxide increases blood flow and lowers blood pressure.

It appears to have many other beneficial effects besides reducing blood pressure. These include improving platelet function and enhancing cerebral blood flow. Nitric oxide also has anti-inflammatory effects and helps prevent platelets and white blood cells from sticking to the lining of blood vessels.

Wider blood vessels help increase the delivery of nutrients and oxygen to working muscles during exercise, thus enhancing exercise performance. Nitrate, which can be converted in the body to nitric oxide, has been shown to improve exercise performance in cyclists, runners, swimmers, in several analyses. Hence the popularity amongst athletes and recreational gym-goers. This is where the marketing efforts have been directed of late, although the effects on performance of supplementation have been inconsistent.

Aging leads to stiffening of our arteries, contributing to hypertension, as well as the build-up of plaque inside our blood vessels, aka atherosclerosis, a critical component of cardiovascular disease. These changes, increased blood pressure and atherosclerotic changes, lead to higher levels of inflammation, all of which result in impaired functioning of NO.

Could nitric oxide therapy lessen the changes of aging, maybe even reverse them? Does it have the capacity to turn back the hands of time, and become the fountain of youth? Probably not, but then, we don’t know. Its discovery as an important substance in the functioning of the human body was made not that long ago. We are certain smoking interferes with the functioning of nitric oxide in the body, so quitting should result in improved blood pressure.

Studies have demonstrated clearly an impairment of NO production in those with type 2 diabetes. We know very well the problems diabetics have with reduced circulation. This type of vascular disease in diabetics can lead to conditions like high blood pressure, kidney disease and heart disease over time. Thus, supplements that increase nitric oxide may have important implications for the treatment and prevention of vascular disease in diabetics.

It would seem from all the information gathered to date, increasing our levels of this essential substance is beneficial to health. How does someone achieve this? Apparently, there are many natural ways to raise our levels of NO. Adding foods to our diet known to boost levels is a healthy option. Many foods have been found to increase nitric oxide in the body.

Vegetables, especially beets and leafy greens, contain nitrates. The consumption of nitrate, after conversion to NO, causes blood vessels to relax and dilate, lowering blood pressure. Apparently, beet juice lowers blood pressure in those with hypertension, an effect attributed to the ability of its nitrates to boost nitric oxide.

Flavonoids, found in almost all fruits and vegetables, are compounds known to be beneficial to immune function, having powerful antioxidant properties. They have also been shown to improve blood pressure, likely by increasing production of nitric oxide. Scientists believe they also decrease its breakdown, promoting higher levels overall. Another component of many plant foods is a group of compounds called polyphenols. These can increase nitric oxide production in the body via a variety of pathways. Polyphenols are found in larger amounts in certain fruits, chocolate, garlic, and red wine.

Arginine, an amino acid, is a substance used by cells to make nitric oxide. High-protein foods such as turkey, seafood, beans, nuts, and seeds supply arginine. One study found that higher dietary intake of arginine was strongly linked with higher blood levels of nitrates, which are a measure of nitric oxide production. Is supplementation with arginine a good idea? Apparently, according to research to date, arginine can indeed boost the body’s nitric oxide production. There is also some indication supplements can improve the function of blood vessels, enhance coronary blood flow, and lower blood pressure.

Nitric oxide is difficult to assess except in laboratories doing specialized, experimental research, so don’t bother to order a ten dollar home test. Currently, there is no valid, reliable method to determine your available nitric oxide. A better approach, knowing what you do now, is to eat healthy, meaning lots of fresh vegetables. This should result in improved blood vessel health and improved blood pressure. Of course, another proven means of improving cardiac health and blood vessel fitness, as well as better immune function, is to exercise more. Imagine that, improved nutrition and regular exercise as a prescription for health. Now where have I read that before?

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.