Ask the Pros Q&A

Q: What is Nitric Oxide (NO)

and what role does it play in our health?

You may be thinking “what the heck? I’ve never heard of nitric oxide. This must not apply to me.” Most people don’t know what it is otherwise they may say “Hey doc, what are my nitric oxide levels?”. Well, I urge you to stick with me because scientific and medical professionals recognize nitric oxide (NO) as one of the most important molecules produced in humans.  Unfortunately, there are no commercial labs that will test for this and no recognized drug therapies are on the market to improve it, which is possibly why we do not hear much about this from health professionals.

So what is nitric oxide? NO is produced in the lining of the blood vessels – the endothelial cells, where it regulates blood flow and oxygen delivery and is responsible for maintaining normal blood pressure. NO is also a neurotransmitter, so it’s an important part of our nervous system. In addition to that, it helps the immune system fight off invading pathogens. Dr. Caldwell Esselstyn states “Our endothelial cells are the “life jacket” of our blood vessels that line the innermost part of the artery – to make the nitric oxide which protects the heart. Esselstyn called it a “magic molecule that keeps the blood flowing like Teflon, rather than sticky like Velcro”.  He says functioning endothelial cells and the nitric oxide they produce are the ultimate guardians of our blood vessels. The problem is that many Americans have spent a lifetime of ingesting harmful foods which have totally overwhelmed and destroyed their endothelium to an extent where it is unable to protect them.

What happens to our body’s ability to create NO?  NO is found in endothelial cells, and, unfortunately, the production of NO decreases with age. We lose about 10 to 12% of NO production per decade. So, by the time we’re 40 or 50 years old, we only have about 50% of the nitric oxide we had when we were younger. Other things that decrease production of NO include smoking, eating an inflammatory diet, processed foods, sedentary lifestyle – all of the things that cause endothelial dysfunction – decrease production of this important molecule.

What can we do to increase our own NO production? Eat more plants – meaning eat a whole food plant-based diet (rich in fruits, vegetables, whole grains, and legumes). You can really boost production by focusing on dark leafy greens such as kale, spinach, swiss chard, collard greens, arugula, broccoli, brussels sprouts. They are the real powerhouses helping our bodies to increase NO production. Dr. Esselstyn recommends steaming the veggies and drizzle some vinegar (such as balsamic vinegar) to boost absorption. What should we avoid? Avoid meat, dairy and processed foods because these are highly inflammatory and full of fat and oil. Oils should be avoided because they almost immediately lower your nitric oxide levels. Also stay well hydrated by drinking lots of water every day. Data shows that even those with a strong family history of vascular disease are protected when eating a plant-based diet. Family history loads the gun, but lifestyle pulls the trigger.



Esselstyn CB. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017;14(5):317-320. doi:10.11909/j.issn.1671-5411.2017.05.004

Contributing Writer: Erin Sinnaeve APN, FNP-C

Erin Sinnaeve is a Family Nurse Practitioner, a member of the American College of Lifestyle Medicine, and owns her own private health coaching business Thrive Plant Life. She also works in Allergy/Immunology at Advocate Aurora Health.

Erin received her BSN from University of Nebraska, her MS from Creighton University, and her DNP from Chamberlain University. She is an instructor at Chamberlain University, a Food Over Medicine instructor and a member of the Physicians Committee for Responsible Medicine.