Nitric Oxide and Oral Health

What was named “Molecule of the Year” in 1992? And in 1998, the topic that awarded three pharmacologists the Nobel Prize for furthering our understanding of how it impacts cardiovascular health?

Nitric oxide. It rarely captures the spotlight, but it should. If you’re interested in reducing inflammation or improving your digestion, sleep quality, immunity, memory, and behavior, then you need to know about nitric oxide, and how your oral health determines whether your body can produce enough of it.

Think that good oral health is all about sterilizing the mouth? Wrong. Without a healthy balance of bacteria in the mouth, your body will not be able to produce enough nitric oxide.

As a dentist, the most common culprits I see interfering with the oral microbiome and nitric oxide production: antibacterial mouthwash, mouth breathing, and even essential oils.

What Is Nitric Oxide’s Role in the Body?

Nitric oxide is most known for its role in heart health for being a potent vasodilator and regulator of blood pressure, making your blood vessels supple and flexible which allows them to withstand pressure changes. It just so happens that the blood vessels in the gums, along with blood vessels in the kidney, are among the smallest and most fragile in the body, making them susceptible to high blood pressure.

Nitric oxide is involved in a variety of systems and processes in the body such as:

• Impacting memory and behavior, via nerve cells in the brain
• Enhancing immunity by protecting against bacteria and cancer cells
• Decreasing inflammation
• Improving sleep quality
• Enhancing endurance and strength
• Enhancing gastric motility
• Insulin signaling
• Proper erectile functioning for men (medications used to treat erectile dysfunction work to increase the amount of nitric oxide, therefore allowing more blood flow and improved erections)

Nitric oxide is not to be confused with the “nitrate free” sticker on your deli meats. Nitrates and nitrites get a bad rap because of a certain form that’s added to preserve processed meats like bacon and hot dogs, which, during cooking, can form harmful compounds called nitrosamines that are known to cause cancer. This compound is also commonly confused with the nitrous oxide gas used at the dentist office for anxiety—these things aren’t related whatsoever!

Nitrates are naturally found in plants, taken up through the soil and used as the primary source of nitrogen for plants, essential for their growth. They tend to be higher in vegetables than fruits and particularly rich in beets, celery, and leafy greens like arugula and swiss chard. It is a molecule produced by the endothelial cells lining the arteries and acts as a biological messenger involved in a variety of cellular activities.

Worried About Heart Disease or High Blood Pressure?

I continue to be amazed by our mouth bacteria’s role in overall health.

Your oral bacteria can help you prevent cardiovascular disease and high blood pressure—IF you nourish it. This 2016 review summarizes the literature on epidemiological and clinical studies done on how dietary nitrates lower blood pressure.

High blood pressure is a big deal. It’s estimated to account for close to 10 million deaths worldwide, ranking higher than tobacco use, high blood glucose, physical inactivity, overweight and obesity for leading global risks for mortality.

The connection between your oral health and whether your body can produce adequate nitric oxide is part of a system known as the enterosalivary circuit. This circuit is highly important to your blood pressure, cardiovascular health and systemic health.

The solution? Nourish your oral and nasal bacteria.

Getting Enough Nitric Oxide? Check Your Gut Health

Nearly 100% of the nitrates we consume get absorbed through the gut wall. About 25% of this nitrate gets concentrated in the salivary glands and released into the oral cavity. It is here that friendly bacteria interact with nitrate, reducing it to nitrite which gets swallowed and absorbed through the intestines. With the help of specific enzymes, this nitrite gets reduced further to the bioactive form, nitric oxide (NO). In order for the enterosalivary circuit to be performing optimally, the gut and oral microbiome must be healthy, and your beneficial bacteria must be in good supply.

So you don’t want to kill bacteria or sterilize the mouth, as we’ve been told by advertising. Those bacteria are essential to heart health! This is why protecting the oral microbiome is so important.

My number one tip to you is this: Avoid using antibacterial mouthwashes.

That 2016 review mentioned earlier also references a 2008 study showing that nitrite levels in the body didn’t rise when antibacterial mouthwash was administered, eliminating the important bacterial conversion of nitrate to nitrite in the oral cavity.

It’s estimated that close to 60% of the US population regularly uses antibacterial mouthwash.

See also: 6 All-Natural Mouthwashes to Help You Break Your Listerine Habit

How to Boost Your Body’s Nitric Oxide Production

1. Protect the Enterosalivary Circuit: Eat a real foods-based diet. Include plenty of probiotic and fiber rich foods, healthy fats from plants and animals and eat an abundance of nitrate-rich vegetables like leafy greens and root vegetables like beets.
2. Mouth Tape:  Nitric oxide has a very short half life in the body, (we’re talking just a few seconds), and must be continually supplied.  It’s the reason why I began taping my mouth at night. Twenty-five percent of overall nitric oxide is produced in the nasal passages, and it’s imperative that they are kept moist through nose breathing.
3. Include L-arginine and L-citrulline rich foods: The amino acids L-arginine and L-citrulline are made in our bodies and found in certain foods.  L-citrulline, (primarily found in watermelons) is a precursor to L-arginine (found mostly in meats like turkey, pork and chicken, lentils, and nuts like pumpkin seeds and walnuts).  L-arginine with the help of an enzyme called nitric oxide synthase (or NOS), produces nitric oxide. (See my l-arginine containing oil pulling chews recipe.)
4. Exercise: Exercising your muscles signals release of oxygen and nutrients and triggers endothelial nitric oxide to be released, resulting in relaxed arteries and increased blood flow.  Exercise regularly to maintain nitric oxide levels.
5. Eat Chocolate: Researchers demonstrated that eating dark chocolate showed an increase in nitric oxide levels and a decrease in systolic blood pressure. Make sure it’s dark and low in sugar though…the darker the better, as it contains more of the beneficial polyphenols known as epicatechin, which act to stimulate higher levels of nitric oxide.
6. Use Nasal Spray: I use a nasal spray that contains xylitol, which helps stabilize the nasal microbiome and to keep the nasal passages moist—helping nitric oxide production. Xlear is the name of the one I use, and I use it once or twice daily or whenever I feel like my nasal passages are dry (especially when spending time at high altitude). Try using it for 6-8 weeks, twice a day, to see if you get some benefit—you should notice better breathing. The good thing about using a nasal spray like Xlear like this is you prevent the need for steroids; a lot of people wait until they feel a cold coming on to to use a nasal spray, but you can use something like Xlear preventatively.

Are you using any dental products with essential oils in them? Be aware that essential oils can interfere with the microbiome and nitric oxide production because they’re bactericidal.

Should I Take a Nitric Oxide Supplement?

Supplementation is futile if the oral microbiome foundation is not healthy. Consider taking a probiotic formulated specifically for oral health (I supplement with this one.) Make sure your oral health routine is something that nourishes your oral microbiome, i.e. you’re avoiding anything that’s bactericidal in the mouth (no antibacterial mouthwash or toothpastes) and eating a microbiome-friendly diet.

I’m a big proponent of food first rather than supplementation, as nature delivers nutrients, vitamins and antioxidants in packages in a way that’s difficult to reproduce in a laboratory.  Plus, the science on supplementation is not strong yet. There seems to be good scientific evidence suggesting using L-arginine for heart disease and peripheral vascular disease, but less so for things like erectile dysfunction, diabetes and athletic enhancement.

So, in honor of getting these nutrients from food, I’ll leave you with this delicious nitrate-rich beet and watermelon salad, perfect for capturing the freshness of summertime on your plate and for boosting your nitric oxide levels. It contains some bonus L-citrulline and L-arginine too!

And in the next few months, stay tuned, I’ll share with you my DIY recipe for mouthwash that doesn’t harm your oral microbiome, or the bacteria in your enterosalivary circuit!

How do you get your nitric oxide? Do you use a supplement or do you have a diet that includes nitric oxide rich foods? Let me know your favorites in the comments below.

To your health (and some very beneficial bacteria),

Dr. Mark Burhenne

Beet and Watermelon Salad

Servings2 people

Ingredients

Salad

• 4cups Arugula
• 1 Beetlarge, steamed and cut into 1/2 inch pieces*
• 2cups Watermelonchopped, seeded, and cut into 1/2 inch pieces
• 1tbsp Dillfresh, chopped
• 1/3cup Walnutstoasted, chopped*

Dressing

• 2tbsp Avocado Oil
• 1/2 Orangejuiced
• 1dash Sea SaltHimalayan or Celtic

Toppings

• 2oz Goat Cheese

Instructions

1. Place arugula in a medium sized salad bowl.
2. Add beets, watermelon, dill, and walnuts.
3. In a separate small bowl, whisk together oil, orange juice and salt.
4. Pour on salad and toss to combine.
5. Top with pieces of goat cheese.

Recipe Notes

*Notes:
To steam a beet:  Peel and cut beet into ½ inch pieces.  Place in a steamer basket and saucepan filled with 2 inches of water.  Bring water to a simmer and add beets.  Cover and steam for about 15-20 minutes, or until beets are tender when pierced with a fork.

To toast walnuts: Heat a dry skillet on medium-low heat and place walnuts in pan.  Stir often to prevent from burning.  Cook for about 3-5 minutes until they are golden brown and have a pleasant aroma.  Remove from heat and transfer to a plate to prevent burning, chop once cool.

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