Transcription
You have to get rid of fluoride. Buy fluoride-free toothpaste, eliminate fluoride in your drinking water, and remove it from your home water system. If you're using an acid, you have to stop. For people who are unfamiliar with nitric oxide, what is it, and what role does it play in the body?
Well, I think it's been maybe a couple of years since we last spoke—not since we last spoke, but since we were on the podcast. I've seen it at several conferences. Yeah, but nitric oxide is one of these fascinating molecules. It's a gas produced naturally in the human body. The older we get, the less we make, and that's what's responsible for age-related disease. You call it a signaling molecule; it tells cells in the body to communicate. Its most common or known function is in vasodilation. It's produced by the lining of the blood vessels, diffuses into the smooth muscle, and leads to smooth muscle relaxation and vasodilation. It controls blood flow and circulation to every organ, tissue, and cell in the body. When we lose the regulation of blood flow, bad things happen as the earliest event in chronic disease.
Wow, and it plays a role in all kinds of chronic disease conditions, right? Like type 2 diabetes, hypertension, even dementia and Alzheimer's disease, where vascular dysfunction plays a role for sure. If you look broadly, I've been in academic medicine now for 25 years, and we understand what causes human disease. We know how to diagnose it, and we know how to fix it. The fact that we don't have a treatment for Alzheimer's and cardiovascular disease, to me, is unacceptable. The problem is not that we don't know the science; it's that we haven't been able to communicate the science to healthcare practitioners and then teach them how to teach their patients.
When we look at chronic disease, there are four hallmarks of every single chronic disease. It doesn't matter if it's Alzheimer's, cardiovascular disease, diabetes, or autoimmune disease. What are they? There's decreased blood flow to the organ, inflammation, oxidative stress, and immune dysfunction. Nitric oxide controls and mitigates all four of those. It improves blood flow. Some of my patients are on methods of reducing inflammation. We know we shut down the fires of inflammation; it prevents oxidative stress and mitigates the immune dysfunction occurring in those diseased tissues. So it's really the Holy Grail in terms of cardiovascular medicine.
When we look at the first signs and symptoms of nitric oxide deficiency, the first sign is usually erectile dysfunction. That makes sense because when you lose the ability to dilate blood vessels, which you need to dilate the sex organs to get engorgement and achieve an erection in both men and women, you fail to get vasodilation. It's the fundamental basis for erectile dysfunction. If you have ED, that's not just a sexual dysfunction; it's what we call the canary in the coal mine. If you have vascular dysfunction in the sex organs, you have vascular dysfunction in the heart, brain, liver, and kidneys. It's a systemic disease.
If you don't recognize that as a serious sign and symptom and take steps to correct it, you're now on a very slippery slope to cardiovascular disease, the number one killer of men and women, insulin resistance, vascular dementia, Alzheimer's—every single age-related chronic disease can be traced back to a lack of nitric oxide. Wow, so erectile dysfunction is like the major red flag. Are there others?
Typically, if your blood pressure starts to creep up, you know nitric oxide's fundamental role is in regulating vascular tone, keeping your blood vessels soft and compliant, and being able to dilate upon need. When you lose the ability to make nitric oxide, that's the primary vasodilator. The vessels become chronically constricted, and you're now pumping the same volume of blood through a thinner hose, so you develop high blood pressure. That leads to damage of the blood vessels, which leads to plaque deposition, atherosclerosis, heart attack, and stroke. Two out of three Americans have an unsafe elevation of blood pressure, so it's a huge problem. It's the number one risk factor for the number one killer of men and women worldwide, which is cardiovascular disease.
You mentioned one that's near and dear to your heart: dementia and Alzheimer's. We know fundamentally what causes dementia and Alzheimer's—it's a lack of cerebral blood flow and insulin resistance. It's referred to by many as type 3 diabetes. What does nitric oxide do? It dilates the blood vessels, we can perfuse the brain, and it improves insulin signaling, potentiating glucose uptake. We reverse the entire metabolic phenotype of dementia and Alzheimer's. Wow, and in fact, we have a drug now going into clinical trials specifically for Alzheimer's.
That's incredible. Erectile dysfunction is something that, just going back to that for a minute, is fairly obvious to observe if you're a male, right? But what about in women? Heart disease is still the number one killer in women, and women are at twice the risk of developing Alzheimer's compared to men. So what is one of those early red flags that women could look out for?
I think it's the same thing. When you look at sexual function in women, in order for women to become aroused, stimulated, and have an orgasm, you have to have an increase in blood flow. That leads to an increase in intralabial pressure. That's what leads to orgasm. All of that increase in pressure is due to vasodilation from nitric oxide. If you can't make nitric oxide, you don't get dilation, you don't get the increased pressure, and women become anorgasmic and develop sexual dysfunction.
In women, you know, men are somewhat simple creatures; it's typically just a vascular problem. In women, it's hormonal, psychological, vascular, and physiological. There are a number of different contributing factors, but the underlying problem is still vascular dysfunction. You can do hormone replacement therapy, but if you don't fix nitric oxide production in the lining of the blood vessels, then you're only correcting half the problem.
Wow, so what are the primary causes of this decline in nitric oxide? You know, one of the fundamental questions I've asked in my research lab for the past 25 years is how does the human body make nitric oxide? What goes wrong in people that can't make it? What are the clinical consequences, and how do we fix it?
To answer the second question—what goes wrong in people that can't make it—we have to understand how the human body normally makes it. There are two primary pathways. There's an enzyme in the lining of the blood vessels that makes nitric oxide. It's a very complex process called a five-electron oxidation of L-arginine, which is a semi-essential amino acid. That enzyme becomes dysfunctional with age and time. There are some genetic predispositions that cause it to become dysfunctional, but a lot of it is due to diet and lifestyle. Poor diet and a sedentary lifestyle render that enzyme dysfunctional.
We know how to correct that; we know how to recouple the enzyme and restore its function. What's the name of the enzyme? It's called nitric oxide synthase. It's found in the lining of the blood vessels, in our immune cells, and in neurons. Wow, so it's part of the neuro-signaling and action potentials by neurons and the cell signaling. It's called a presynaptic or retrograde messenger; it's how these neurons talk to one another.
Can we also have it? Aren't our sinuses enriched with nitric oxide synthase? There's a high concentration of this enzyme in our epithelial cells. In fact, it's the basis for the blood pressure-lowering effects of deep breathing. Wow, so mouth breathers bypass this. That's one of the reasons why mouth breathing is so detrimental because you're bypassing a fundamental nitric oxide production cascade.
But if you have a dysfunctional enzyme in the endothelial cells, then that enzyme is dysfunctional in the epithelial cells. You can do nasal breathing or deep breathing exercises, but if we don't fix that enzyme and make it functional, you're not going to get any nitric oxide produced when you do breathing exercises. So that's what people have failed to recognize: what's the enzymopathy in that enzyme, and how do you fix it? Because that's really the Holy Grail in cardiovascular medicine.
So that's one way we become nitric oxide deficient. The other is kind of the "aha" moment for most people. About 20 years ago, we recognized that there's a salivary circuit. The mechanism of action of certain dietary patterns—whether it's a plant-based diet, a Japanese diet, or a Mediterranean diet—involves consuming a lot of inorganic nitrate. This molecule is inert in humans, so humans cannot process this molecule. We're 100% dependent upon the bacteria.
There are bacteria on the surface of the tongue that metabolize nitrate into nitrite and nitric oxide. If you don't have the right oral microbiome, you can consume these vegetables, but you don't get the nitric oxide benefits from them. Here's where the problem comes in: mouthwash. Two out of three Americans use mouthwash, and two out of three Americans have an unsafe elevation in blood pressure. We published, I think in 2015, that this is causal for hypertension.
When you eradicate these essential commensal nitrate-reducing bacteria, it causes an increase in blood pressure. The other problem is fluoride. Fluoride is an antiseptic; it kills the bacteria. Most people put fluoride in their toothpaste or use fluorinated toothpaste. There's fluoride in municipal water. Fluoride is an antiseptic; it's a neurotoxin, and it kills your thyroid function. Yikes! So we have to get rid of fluoride.
Yeah, I mean, it is a serious toxin. Dude, you are the one who turned me on to this whole mouthwash thing. I had the privilege of getting to go on The Joe Rogan Podcast and talk about it because since you brought it up on my podcast, it was a rabbit hole that I was happy to go down because it's just so fascinating.
So just make it, like, if you can—I mean, you've already made it so clear—but just walk us through this again. How can mouthwash, something as benign, right? It's sold over the counter, right? Can over-the-counter mouthwash have this effect?
Absolutely. So here's what happens, and the advertisements are correct: it kills 99.99% of the bacteria when you use it, and that's the problem. I mean, the bacteria that live in and on the human body outnumber our human cells 10 to 1, right? This is an entire ecology. We call this symbiosis—these bacteria providing metabolic benefits to the human host that we can't do. One of those is the production of nitric oxide.
When you eradicate these bacteria, there's an entire ecology from the mouth all the way down to the anus, right? It's the microbiome. A lot of people focused on the gut microbiome years ago; we focused on the oral microbiome. What we found was that the more diverse the microbiome, the better cardiovascular health and blood pressure management.
So when you eradicate this with mouthwash, we saw, I think the first paper was in maybe 2009, that you take normal tens of patients, you just put them on mouthwash twice a day for seven days, and you see an increase in blood pressure. Damn! Now, this drove cardiologists and vascular biologists crazy because they thought we had a pretty good understanding of vascular biology and maintenance of systemic blood pressure.
So how, by killing oral bacteria, are we affecting systemic blood pressure and vascular tone? We figured out, well, it's through the production of nitric oxide. So yeah, alcohol-based mouthwash does this. The chlorhexidine prescription mouthwash is very effective at killing it. The good news is, and we published this in 2019, if you use mouthwash, we certainly see an increase in blood pressure.
In 2020, I was on The Doctor Show, and we revealed that if you use mouthwash, you actually lose the protective benefits of exercise. So think about this: if you're trying to do all the right things—you're eating a good balanced diet, you're getting exercise—but if you're using mouthwash, you lose the entire cardiovascular benefits of everything you're doing.
The good news is, four days after we stop using it, blood pressure normalizes, and the bacteria completely repopulate. This is a resilient community; just let them do their job, leave them alone. You know, there's a reason we don't take an oral antibiotic every day for the rest of our lives. There are known systemic effects of this, right?
So it doesn't make any sense to use an oral antiseptic every day for the rest of our lives. Yet two-thirds of Americans wake up every morning and use mouthwash. Shocking! To me, it's no wonder why Americans are the sickest population on the planet. But they'll sometimes market these mouthwashes for people with diabetes, right? But that seems to be misguided.
It's counterintuitive and misguided, and yeah, making it worse, as you suggested, if nitric oxide plays a role in insulin signaling. We have to look back and think about historically what caused this, right? What caused medicine to do the things they're doing today? Most of the time, there was good reason.
Fifty or sixty years ago, there was a recognition of an oral-systemic link, right? Patients who have periodontal disease or gingivitis have a higher incidence of heart attack and stroke. They immediately assumed that it was the pathogens in the gums that translocated and caused vascular inflammation, plaque instability, plaque rupture, heart attack, and stroke.
Then the thought was, well, if that's the case, then we need to kill these bugs, kill the pathogens. But that was long before we understood the entire microbiome. When I ask dentists this all the time, and I speak at a lot of dental events, I ask, "Why do you still use fluoride rinses, and why are you still prescribing chlorhexidine or mouthwash to your patients?" They think, "Well, that's just the way we've always done it."
Well, you know, in medicine, years ago, we used to use leeches for exsanguination. We don't do that anymore because we have better methods, and we know the science. The science advances, so we have to be able to apply the innovations in basic science and translate that into clinical medicine. The only way to do that is to take this new information, pivot, and realize that maybe what we were doing wasn't working because people aren't getting better going to physicians and taking medicine. In fact, they're getting worse.
From a scientific standpoint, we understand the mechanism of disease today, and we can fix every single chronic disease. Also, medicine is known for taking this reductionist approach, where the different organ systems of the body are siloed off and studied unto themselves. But if there's anything that the microbiome has shown us, it's that everything is connected.
The knee bone is connected to the hip bone, right? The heart is connected to the mouth, to the lungs, to the sex organs. I mean, we're all connected through the cardiovascular system, and when that fails, you get end-organ disease, and the human body fails.
So what happens when we eat a meal or a dish, a bowl of dark leafy greens, for example, rich in these inorganic nitrates, like your favorite—what, kale? Your favorite kale? Oh my God, people always pick on me for enjoying kale. It's not the only dark leafy green that I like; I like arugula, I like mixed organic greens.
So what's happening? Walk us through this process. What's happening as we lift a forkful of kale to our mouths? This pathway was first discovered in the 1970s. These were cancer biologists trying to understand the etiology of oral cancers. At that time, it was thought that nitrate would form nitrosamines, which would intercalate DNA, cause mutations, and lead to cancer.
Then they recognized that the human body actually concentrates, intentionally concentrates, nitrate in our salivary glands. The kidneys reabsorb it and concentrate it in our salivary glands. The body doesn't make mistakes, right? Why would we intentionally reabsorb a molecule and then concentrate it in our salivary glands?
They thought, okay, that's contributing to certain oral cancers. Fast forward 30 years, and now we recognize that the salivary glands secrete nitrate so that the bacteria living on the surface of the tongue can metabolize this. These are facultative anaerobes, so when there's no oxygen around, they respire on nitrogen in the form of nitrate.
This two-electron reduction forms nitrite in our saliva. So now, when we swallow our own saliva, we get a burst of nitric oxide in the lumen of the stomach. We've evolved a pathway to feed the bacteria right in our own mouth. Yeah, it's a prebiotic—it's an endogenous prebiotic made to recycle and reproduce nitric oxide on a continual basis.
This pathway is dependent upon, number one, getting enough nitrate from the diet; number two, the presence of the right oral bacteria; and number three, the presence of stomach acid. So when you use stomach acid blockers, you completely shut down nitric oxide production. Under normal conditions, if you're healthy, if you're eating a good balanced diet in moderation, you have the right bacteria, and you have stomach acid production, when we consume that meal, it takes 90 minutes.
If we eat a salad, whether it's spinach or any nitrate-containing food, 90 minutes after we consume that, we can start seeing secretion of nitrate in our salivary glands. For the next 6, 8, or 10 hours, each time we salivate and swallow our own saliva, we get a burst of nitric oxide in the lumen of the stomach.
That nitric oxide produced in the stomach kills things like H. pylori, the ulcer-causing bacteria. If you've got some E. coli or salmonella or some pathogen on your salad or greens, it'll kill that. It enhances gastric mucosal blood flow, enhances nutrient absorption, and prevents ulcers from chronic NSAID use. I mean, it's a fundamental physiological process that we interrupted at our own demise.
Now we find that people who have been on acid blockers for three to five years have a 40% higher incidence of heart attack and stroke. That's not increased risk; that's actual events. Wow! A study out two weeks ago showed that people who have been on proton pump inhibitors for four years had a 40% increase in dementia and rapid onset of Alzheimer's.
So these drugs really should have a black box warning on them. These drugs were never approved by the FDA for long-term use; they were only approved for acute use for gastroesophageal reflux. But now you can buy them over the counter. People have been taking them every day for 5, 10, 15 years, and the consequences are deadly.
These are very dangerous drugs that should not be used. I mean, antacids also block B12 absorption. Without stomach acid, you can't absorb iron, you can't absorb B vitamins, you can't absorb magnesium, you can't absorb iodine, and you can't absorb selenium or chromium. So we become nutrient deficient, interrupt cell signaling, insulin signaling, become insulin resistant, shut down nitric oxide production, and develop autoimmune disease.
Without stomach acid, you can't break down proteins into amino acids. We get peptide fragments absorbed across the gut, and we develop antibodies against them. It's autoimmunity, and it's all caused by a lack of stomach acid production. Wow!
How do we increase stomach acid production? I get this question quite a bit, actually. Well, as a biochemist, we look at reactions, right? What is the chemical reaction in the parietal cells that make hydrochloric acid? That chemical reaction is very well elucidated. We need iodine, we need betaine hydrochloride, we need zinc, and we need B vitamins. You need carbon dioxide, and the parietal cells make carbon dioxide or make hydrochloric acid.
But if you're on acid blockers, you can't absorb iodine, you can't absorb zinc, and you can't absorb B vitamins. So there's no way that your body can make stomach acid if you're on acid blockers because you don't have the nutrients to fuel that reaction.
So what we have to do is supplement the body. The whole paradigm I work on is called restorative physiology. Whether it's drug development or product development, give the body what it needs and get out of the way. The body's a lot smarter than we are, and the body heals itself.
Most people are deficient in iodine, zinc, and B vitamins. Now the parietal cells have what they need to secrete hydrochloric acid, and you overcome all the problems of nutrient deficiencies and nitric oxide production. I had no idea about iodine's role in stomach acid production. I mean, I was familiar with its role in thyroid hormone production, but when you're deficient in iodine, you get thyroid dysfunction, you develop autoimmune issues, and you develop achlorhydria in the stomach and everything that occurs thereafter.
What are some sources of iodine? Kelp, seaweed—you can't get enough iodine from iodized salt to fuel everything you need to convert T4 to T3, the active thyroid hormone. There's not enough iodine, and really, Americans are deficient in iodine. We found that the Japanese diet is probably the only population diet out there that's getting enough nitrate from their food supply.
That's why I supplement with iodine every day—12 to 12.5 milligrams—because the American diet and the food we eat in America is basically devoid of any iodine. Yeah, I mean, unless you're eating a ton of sea vegetables. That's right, or fermented foods. Or fermented foods, yeah. I mean, I know egg yolks contain some, but I don't know how much that is.
It's really good to know because people sometimes ask me—they have difficulty digesting animal products, for example. My go-to response, my sort of cookie-cutter or default response, is usually, "You should check out your stomach acid." You know, that's a big issue. But somebody who has, for example, been on a low-meat diet for some time probably is not regularly getting adequate amounts of zinc, iodine, and B vitamins.
So it creates this vicious cycle, right? You don't eat a lot of animal products, so then the machinery to digest animal products winds down. That's right! Our body adapts to what we give it, right? If you hit your body with something it's not used to seeing, it's going to take a while for it to adapt. So we have to give the body what it needs and heal it.
I tell people my response is to take some apple cider vinegar before a meal. That's acetic acid—one tablespoon is enough. It'll acidify the lumen of the stomach. Now you're acidic, and you can break down proteins into amino acids, you can properly digest food, you can properly absorb nutrients, and it fixes a lot of the problems until your body is able to secrete stomach acid on its own.
Wow, that's incredible! Yeah, so I tell you, nitric oxide is foundational, but if you're deficient in stomach acid and iodine, nitric oxide is foundational, but it's not a silver bullet. It's not going to fix these other problems. But I think what we're finding is the body cannot and will not heal without nitric oxide production, improving blood flow, and reducing inflammation.
But you still have to address the other deficiencies, the other problems, the other toxins that you may be exposed to, and the other nutrient deficiencies. So this is just kind of like laying the groundwork for the body to heal, but the physicians and practitioners still have to do the investigative work and figure out what exactly is causing this particular patient's problems.
Yeah, but I mean, when you acknowledge that the gut starts in the mouth, I mean, this is just really, really empowering information. One area where you blew my mind—I mean, every time you come on, you have all this incredible information to deliver—but one area in particular that I found fascinating about our first chat was we talked a bit about nitrites in processed meat, right? Because processed meat is very controversial. Some people believe it to be like the devil incarnate, and others will regularly use it for the valuable source of protein that it is.
But one chemical that does seem to have more agreement than not is sodium nitrate, which is added as a preservative in processed meats. A lot of people tend to avoid that as a compound, but you've argued, you've published papers suggesting that this isn't actually the dietary boogeyman that it's often made out to be.
It is a cure—it's an actual cure to curing agent to me, and it cures the human being of disease. Okay, this is fascinating and highly controversial. Well, let's go back historically again. There's a reason for the way things were done. If you go back thousands of years, long before refrigeration, when early humans were hunters and gatherers, they killed the buffalo, they killed the deer—there was no refrigeration.
So they had to preserve the meat to get them through winter. What they found way back when, thousands of years ago, was that they would preserve it with sea salt. They thought that the salt was just reducing the moisture content of the meat and preventing spoilage. Well, come to find out, the sea salt actually had nitrate and some nitrite in it—it's a natural salt, potassium nitrate, what we call saltpeter today—and that led to the curing.
You would cure the meat; there would be bacteria that were naturally on the meat. Then those bacteria would reduce nitrate to nitrite, and you would get nitric oxide that binds to the hemoglobin or the myoglobin of muscle, creating the nitrosyl hemichrome pigment that causes the pink color in cured meat. So when it preserved the meat, it prevents spoilage, prevents bacteria overgrowth, and prevents foodborne illnesses.
It's absolutely essential for ready-to-eat meats and any processed meats. In fact, for decades now, the meat industry has been trying to figure out how to get rid of nitrite because of the misinformation by the media, and you cannot live without it. I mean, if you took nitrite out of cured and processed meats, then you would have more Americans dying from salmonella, E. coli, and botulism than ever before.
So then the question was, fast forward to the '50s and '60s, when nutritional epidemiology came about. Nutritional epidemiologists take observations from populations of people and look at their incidence of certain diseases. They found that people who eat more cured meats than others have a higher incidence of gastrointestinal cancers, like colon cancer and stomach cancer.
So these are observations, and they're associations, but associations are not causation. There are a series of steps you have to go through to establish causation. One of those is that there's an observation, and by the way, it's a very small increased risk. So relative risk is different from absolute risk, and it's a statistical kind of deception.
Can you give us an example of that? Sure! Let's say you have a clinical trial, and you say that in the control group that was eating cured meat, let's say a thousand patients, and in that thousand patients, 998 people developed—or two out of those thousand developed stomach cancer. In the control group, only one out of a thousand developed stomach cancer.
So the absolute risk is 0.001, right? But if you take the relative risk, there's a 100% increase in risk because that group went from two that had cancer in the cured meat group to only one in the control group. It's a 100% increase, and that makes headlines!
Otherwise, the absolute risk of 0.001 is within the noise. There are so many other confounding factors. That's the problem with nutritional epidemiology and relative risk reporting. This is relative risk; it's a deception. So you have to look at absolute risk, and actually, what we look at is the number needed to treat—how many people would you need to treat or intervene to actually see a reduction in the disease process.
So that's a whole other subject matter that people don't understand. They just read the headlines, and those are headline-grabbing numbers. But the next step in that was, what's a biologically plausible mechanism to see that observation to establish causation?
In the '50s, it was recognized that nitrite can form nitrosamines, and nitrosamines can cause cancer. So that was their established biologically plausible mechanism. But then in the 1980s, it was recognized that the body actually produces nitrate and nitrite. This was one of the first observations that led to the discovery of nitric oxide.
Wow! So if nitrate and nitrite were carcinogenic, why would the human body naturally produce them? That starts shooting holes in their whole hypothesis. Then the other observation was from vegetarians. People who eat a plant-based diet have a tenfold reduction in risk of cancer and cardiovascular disease.
So if nitrate and nitrite in cured and processed meats cause cancer, vegetarians would have a tenfold higher rate of cancer than meat eaters. In fact, we see pretty much the opposite. Wow! Because 85% of the nitrate and nitrite we get from our diet comes from green leafy vegetables.
Right, so 5% comes from cured and processed meat, and the other 10% comes from swallowing our own saliva. You're saying that if this is true, then we would expect to see dramatically higher rates of these kinds of GI cancers in vegetarians and vegans who are ingesting a lot more inorganic nitrate.
That's right! Super interesting! Yeah, so it goes back to the fact that this may be surprising: the media is not always honest with this. Right? Very shocking! We're getting a lot of misinformation.
So this whole story of nitrate, nitrite, nitrosamines, and cancer has completely fallen apart over the past 30 years, and it was really the discovery of nitric oxide that these compounds are actually nitric oxide precursors. In fact, I've argued for the past 20 years that these are indispensable nutrients that we need—nitrate and nitrite.
So I tell—and I've consulted Kraft, Oscar Mayer, and tried to figure out ways how to do this—I go, "Look, you shouldn't be running away and creating these nitrite-free bacon, nitrite-free hot dogs. You should lead with it, advertising it. I'm developing this compound as a drug; we're developing these as functional nutrition products."
In fact, we've measured this, and we published this in 2009: nitrite-free bacon has five times more nitrite than bacon with sodium nitrite added to it. Whoa! Where does it come from? The celery powder, whatever.
So here's the game: to get a no-nitrite label, you just can't add sodium nitrate. So what do they do? They use celery salt, which is high in nitrate, and then they put a starter culture of bacteria called Staphylococcus carnosus on that broth, and the bacteria reduce the nitrate to nitrite.
So it's the nitrite that comes from nitrate that cures the meat, but they didn't add nitrite directly. So now you've got a problem with the variability of the bacterial reduction. You still have some bacteria present in that food, and the shelf life isn't as long.
So it's not a better product; it's a more expensive product, but it's certainly not a better product. So I tell people, save your money. Don't spend the extra $2 a pound or whatever it is now to buy no-nitrite or organically cured or whatever they're calling it now.
But what is the process, then, by which these nitrites become nitrosamines in the body? Like, don't when you fry bacon that has sodium nitrate in it at high temperatures—I'm not a chemist, but isn't there some kind of reaction that converts these compounds to nitrosamines?
Yeah, here's the chemistry: you've got to have a certain set of conditions or reactants present for this to occur. It's not nitrosamines in general; it's only secondary amines. This is a certain type of low molecular weight amine. Primary amines typically rearrange to alcohols; they're non-reactive. Tertiary and quaternary amines have too much steric hindrance for the nitrite to react, so they don't worry about those.
The only thing we worry about are secondary amines because they're small, they're low molecular weight, and nitrite can react to form nitrosamines. There are only a handful of these that are known carcinogens and mutagens that cause cancer. I don't dispute the fact that nitrosamines are bad.
So what we have to understand is, is there endogenous formation of nitrosamines in the food we eat? So number one, you have to have nitrite. Number two, you have to have the presence of secondary amines, which there typically are none in meat products. I mean, you can add dimethylamine and form nitrosodimethylamine, which is a huge liver carcinogen, but that's not naturally present.
The other thing, once they realized this chemistry, was that vitamin C, polyphenols, and vitamin E are potent inhibitors of nitrative chemistry. So even if you have a secondary amine around and you've got nitrite, if you've got a certain amount of ascorbic acid or vitamin E or polyphenols, it completely inhibits that reaction—100% inhibits it.
So you don't get any nitrosamine formation. I believe it was 1972 when the Code of Federal Regulations changed so that any nitrite-cured meat product had to add ascorbic acid to prevent any potential nitrosative chemistry.
So now they use ascorbic acid; you'll see ascorbic acid on bacon and hot dogs. That's kind of the—we call it an accelerant because it accelerates the one-electron reduction of nitrate to nitrite to nitric oxide, which is the actual curing agent, and it prevents any nitrosative chemistry.
So now there's no cause whatsoever. You're getting efficient nitric oxide production, you're getting efficient curing, and really, there's no residual nitrite left in a cured meat product. It's the nitrite that's bound to the heme of myoglobin in the meat muscle itself. There's hardly any residual nitrate.
Wow! Sodium nitrite, actually, you're saying, is a cure. Very interesting! So do we see a reduction of—do we see any of the benefits that we would see from an acute boost of nitric oxide after the consumption of processed meat, for example?
With nitrite, no, because there's so little in there. It's all reacted in the form of nitrosyl bound to myoglobin in the meat muscle. So it's a complex matrix, right? You've got proteins, you've got fat, you've got a lot of extracellular material in meat muscle. So it's a complex food to digest, but you don't get enough nitrite or nitric oxide in cured and processed meats to really provide any therapeutic benefit.
I think that's the reason that we should eat a balanced diet in moderation. Historically, I've written about this: the societal norms are that you eat your salad before you eat your steak. Why is that? Well, the salad's providing the nitrate, so by the time we're digesting the protein from the steak, we've had 90 minutes, and we've got the nitric oxide being produced to protect the vasculature from the postprandial inflammation and oxidative stress.
The French do it the opposite way, right? It explains the French paradox. I don't know, but the French paradox is interesting. It's not as paradoxical as we once thought it was, right? They eat a lot of cheese, they eat a lot of saturated fats, but saturated fats that are bound to what's called the milk fat globule membrane, which we're seeing is actually benign from a cardiovascular standpoint.
They have pristine heart health, and they smoke a lot. Yeah, and they exercise a lot, right? They walk everywhere. Yes! So I think we have to move; we have to exercise. In America, we go to our restaurant, we engorge ourselves, we drive home, and we never walk, and we go to bed full.
There are a lot of pre-workout supplements on the market that claim to boost nitric oxide. Is there any merit to those claims in your typical pre-workout product? For people that do like to lift—your boy being one of them—what is a good way to boost nitric oxide pre-workout?
Well, again, let's go back to '98 when the Nobel Prize was awarded. That's when nitric oxide really hit kind of mainstream. In '92, it was recognized as the molecule of the year by Science magazine, so it was gaining some momentum in terms of the scientific community, but still very little public awareness around it.
Then in '98, a Nobel Prize was awarded, and then people got excited about it. It was recognized that there's an enzyme called nitric oxide synthase that converts arginine to nitric oxide. The market was flooded with arginine-based products; they called it nitric oxide.
The problem with these products is that arginine is a semi-essential amino acid, right? Meaning that it's produced within the human body through the urea cycle, and then we get arginine from our diet—from plant proteins, animal proteins. It's part of the amino acids that make up proteins.
So when we eat a protein diet, we get arginine. When we have normal urea cycling and flux through the urea cycle, we make arginine. The body is never deficient in arginine, so it doesn't make sense to supplement arginine. In fact, now there's clinical data out showing that if you supplement high-dose arginine to patients that had a previous heart attack or peripheral disease, they get worse.
In post-infarct patients, it killed more patients than the placebo. Wow! So arginine should not be recommended for patients with endothelial dysfunction. If you don't have endothelial dysfunction—which well-trained athletes have good endothelial function—there's some evidence out there that if you give a certain dose of arginine, you can kind of push a little bit of nitric oxide and get some out.
But again, arginine is never the rate-limiting step in nitric oxide production; it's the function of the enzyme that converts it to nitric oxide. So those products don't work. Those were big for probably 15 years. Then in 2012, in the London Olympic Games, it was recognized that people were drinking gallons of beetroot juice, right?
In fact, the UK Olympic team won more gold medals than any time in the history of the Olympics, and they attributed it to drinking their beet juice. Wow! So then the market was flooded with beetroot products, and now there are hundreds of beetroot products out there that are sold as pre-workouts.
I've tested probably all of them. 99% of them do nothing but turn your pee and your poop pink and cause a lot of anxiety. Interesting! I wonder if it's because you're drinking it, and it's just like, you know, right down the gullet.
Those products aren't allowed time. Well, here's the thing: the companies that are marketing these don't understand the science. They just think beet juice, they go out and buy the cheapest dehydrated beetroot product they can and sell it for $10, $15, $20. You have to have sufficient nitrate in it, you have to have the right bacteria, and you have to have stomach acid.
As we've already elucidated, most people don't have the right bacteria, and most people are on acid blockers, so they're not going to get a nitric oxide benefit. In fact, most of these beet products don't have any detectable nitrate or nitrite in them. Wow! Damn! So there's no way they can work.
Wow! It's just creative marketing. Fascinating! So we understood the science, and back in 2012, I recognized this and developed my own fermented beet powder. What we do is we convert it; we don't rely on the human body to convert it because everybody would have a differential response.
I'm not interested in bringing a product to market that only works on a third of the people. We have to maintain the integrity of the science and provide safe and effective products that everybody's going to get the same effect. So we pre-convert our beetroot product into a bioactive nitric oxide.
When you put it in water, we generate nitric oxide gas. When you consume it, we're liberating nitric oxide systemically. Wow! We're not dependent upon the bacteria; we're not dependent upon your ability to produce stomach acid. We generate nitric oxide for you.
Wow! And what's the product that you gave me that has—it's like literally sodium nitrate and vitamin C and all this stuff, and it's like swallow your saliva after? I've been taking it pre-workout.
So that's our lozenge. Okay, cool! So that was the first product that I brought to market, and that came from my first Eureka moment in science. In 2007, we published the first paper showing that nitric oxide was a hormone.
If you're deficient in other hormones, like testosterone or estrogen, what do you do? We have to take it. Same thing with nitric oxide. If you're deficient in nitric oxide production, we have to give you nitric oxide, and we have to fix your body's ability to make it on its own.
So that was the whole basis for me developing a product technology that, number one, if your body can't make nitric oxide, we have to do it for you. As I mentioned earlier, we understand the enzymology and the biochemistry that we can fix the enzyme in the lining of the blood vessel.
Now we know how to repopulate these bacteria, so I developed this orally disintegrating tablet that you put in your mouth. It dissolves over five minutes; you just move it around, and we're providing nitric oxide gas. So as it's dissolving, we're generating about 30 parts per million of nitric oxide gas.
Whoa! It's not giving you—you're hoping your body can convert it. We can detect it, we can quantify it, we can verify it. The other important thing is we recouple the NOS enzyme, so we see about a 15% improvement in your body's ability to make it four hours after the lozenge.
Then we're repopulating the good bacteria in your mouth. Wow! So it's just the opposite. Theoretically, people would need less and less of my product over time because as we're fixing your body's ability to make it, the less you need supplemental.
Interesting! You said it takes about 90 minutes for a high-nitrate meal. That's right! Is that the same time frame that it takes for one of these lozenges?
The lozenge is immediate. Wow! Yeah, because I've been taking it literally as I walk into my gym. So we can see—if we use an ultrasound to measure your artery when you put that lozenge in your mouth, within 12 seconds, we can see your coronary artery dilate.
Whoa! So it's immediate dissolution; it's immediate vasoactivity, and you get systemic effects. Is nitric oxide the answer to hypertension? I mean, it's like we're seeing such staggering rates of metabolic illness.
Yeah, one in two people—one in two adults today have hypertension. Two out of three have either prehypertension or hypertension. Wow! So yeah, I think there are different causes for hypertension, right? If you look at different classes of drugs for antihypertensive medication, the first kind of effective drugs on the market were affecting what's called the renin-angiotensin system.
So there are ACE inhibitors, which are angiotensin-converting enzyme inhibitors, and that is part of a kidney problem related to hypertension. If you inhibit the conversion of angiotensin-converting enzyme in the lungs, you can prevent the production of a vasoconstrictor.
Hypertension is really just an imbalance in the vasodilatory versus vasoconstrictive molecules. Nitric oxide is the primary vasodilator. So ACE inhibitors, ARBs, calcium channel antagonists, and then diuretics correct fluid imbalances.
Wow! But there's something called resistant hypertension, right? So 50% of the people that have high blood pressure that are put on prescription medication don't respond with better blood pressure. So why is that?
It's because the root or the cause of their hypertension isn't related to their kidneys, isn't related to angiotensin, it's not related to calcium flux imbalance, and it's not related to fluid imbalance. What we've published on is that hypertension, in many cases, is a sign of oral dysbiosis.
Yeah, so if you're using mouthwash, stop! Your blood pressure normalizes when you restore the ecology of the oral microbiome. Your blood pressure normalizes. What about just drinking alcohol? People who just enjoy imbibing every once in a while—does drinking alcohol, vodka, tequila, or whatever—can that disrupt the oral microbiome?
No, I'm a scotch drinker. You are? I'm a social scotch drinker. In fact, I love my scotch. Here's the issue: if you were to drink alcohol—vodka, scotch, or whatever—and you hold it in your mouth for 60 or 90 seconds, as you would an antiseptic, yeah, I mean, maybe because these are 40%.
Right? In the actual—but I mix mine with water, so probably what I'm drinking is maybe 10% alcohol. Well, if there's anything I remember from 2020 in the whole COVID hygiene theater, it's that you want your alcohol percentage to be 60% or higher for it to be antiseptic or something. Did I just butcher that?
Yeah, no, I think that's probably right. So what we're drinking—even if we were to hold the alcohol in our mouth for 30 seconds like we would a mouthwash—it's probably not going to get effective killing. But you know, during COVID, everything they were telling us to do was basically making people more susceptible to co-infection.
Crazy! Like the antiseptic hand sanitizers and using all—I mean, you're making the patient more susceptible to COVID infection. Wild! Yeah, that was a crazy time, and there was just that review published in, it was like Exercise Physiology, one of these journals, where they said that exercise literally is like the ultimate, most ideal first-line defense.
For sure! Look, when I feel like my body is getting weak and I feel like I've got an onset of an illness coming, the last thing I want to do is go to the gym, but the first thing I do is go to the gym. Wow! And I exercise; I do 30 minutes of cardio, and then I go sit in a sauna for 30 minutes. I haven't been sick in more than 20 years.
Sauna boosts nitric oxide, does it not? Yeah, certain—I mean, red light—there are certain wavelengths of light that will stimulate nitric oxide production. Red light? So I have a red light device. Is that boosting nitric oxide when I use that?
So what's happening is there's what we call photolabile stores of nitric oxide that you can activate. When nitric oxide is produced, it has certain cellular targets; it can bind to metals, it can bind to cysteine thiols. Infrared light will actually liberate nitric oxide bound to metals, and then if you look at infrared or ultraviolet light, it'll cleave NO bound to cysteine thiols on proteins.
So when you get exposure to sunlight, you're getting both UV and infrared, and you're releasing nitric oxide. Wow! But the problem is if you're deficient in nitric oxide, you're deficient in these photolabile stores of nitric oxide.
So if you've got a sick patient who can't make nitric oxide, red light therapy—there's no nitric oxide to release. So what we do is we try to titrate up the nitric oxide. So either take our lozenge or our beet powder and then expose it to red light therapy. Now we're going to potentiate the effects of red light therapy; you're going to potentiate the blood pressure-lowering effects of sunlight or exposure to different light sources.
Wow! But if your oral microbiome is intact and healthy and you regularly eat dark leafy greens, then there's a synergistic effect. Absolutely! That you get in terms of nitric oxide synthesis with red light exposure, sun exposure, etc.
Yeah, you need nitrate, you need bacteria, and you need stomach acid. Wow! Without either of those three, if one of those is missing, you don't get the effects. Do you think the carnivore diet is a terrible idea?
No, look, I think different people respond to different diets. I'm not a big fan of extreme diets perpetually. I think you can make some changes in human physiology and metabolism by these drastic changes. So I'm not a big fan of a straight vegan diet; I'm not a big fan of a carnivore diet forever.
I think you can do intermittent changes in this and see the benefits, but from what I know about science and agronomy and nutrient assimilation in vegetables and nutrient assimilation in animal proteins, we get many nutrients and minerals that we need from a balanced diet, from a diverse diet.
I think that's how we as humans have evolved; we get our nutrients from many different dietary sources. Well, it's like they're not getting these inorganic nitrates. There's really not—I mean, I think we published on this in 2015. There's very little residual nitrite or nitrate in animal meats, in meat products.
And so the animals we eat are vegetarians, right? So they're assimilating the nitrate from the grass and the vegetables they're eating into their own muscle tissue. So even non-cured meat, non-processed meats, like a ribeye steak or things that are unprocessed, have some nitrate and nitrite.
It's very little. Wow! But it's there, and it's delicious! Ribeyes are my love language. Yeah, mine too! Yeah, love them! There's also, correct me if I'm wrong, a role for some of these co-factors, like CoQ10, in terms of recycling nitric oxide so it can make a little go a longer way, hypothetically.
Well, there are a number of kinds—there's the human body is redundant by nature, right? So there's enormous redundancy in the human body. In fact, if there was only one way to make nitric oxide, then probably humans would become extinct. So there have to be numerous ways to make this critical molecule, and there are different ways to recycle it and extend its biological half-life.
That's kind of what we've harnessed in our therapeutic program and in our product development. Once nitric oxide is produced, it's gone in less than a second. In fact, the half-life of nitric oxide in the human body is 2 milliseconds. Whoa!
But we can extend the biological half-life of this by understanding the metabolic hierarchy of nitric oxide: where does it go, what does it become, and what does it do? If we can capture that in the form of a product technology or therapeutic, then we can extend the biological half-life from 2 milliseconds out to tens of minutes and hours.
We can do this through giving sulfur compounds like glutathione, polyphenols—you mentioned CoQ10. CoQ10 is extremely important for mitochondrial function. Nitric oxide is what controls and regulates mitochondrial ATP production, maintains the electrical potential across the mitochondria so it can generate ATP and produce less superoxide and oxidative stress.
Nitric oxide is what controls mitochondrial biogenesis. So again, we can induce all these pathways, but if you don't have enough CoQ10 and all these mitochondrial co-factors, then the mitochondria are going to be dysfunctional.
So in that case, it's not a nitric oxide deficiency; it's a mitochondrial issue. So again, we have to give the body what it needs. The body incorporates what it needs and does its job. Beyond cardiovascular health, are there other areas of well-being that nitric oxide influences, like immune function, for example, inflammation?
So we learned a lot. There's a rich literature on nitric oxide and immune function. In fact, one of the first discoveries of nitric oxide was in macrophages. This whole reaction of arginine to nitric oxide to nitrate was back in the mid-'80s. Our immune cells make nitric oxide, and the whole purpose of this is when we're exposed to a pathogen, whether it's a virus or a bacteria, our immune cells recognize that, and our cardiovascular system mobilizes an immune response.
We get the immune cells to the site of attachment or infection, and then these immune cells surround that and generate a ton of nitric oxide. Wow! This nitric oxide binds to the iron-sulfur centers of bacteria, shuts down their respiration, kills the bacteria, and prevents the virus from replicating.
So even if we're exposed to a virus, if our immune system is strong and it generates nitric oxide, we don't get sick from the virus. Wow! This was what we recognized in probably March of 2020 with COVID—that the people who were getting sick and dying from COVID were the people who couldn't make nitric oxide.
Wow! So who was this? The elderly, people with a prior heart attack, diabetes, African Americans, people with pulmonary hypertension, or smokers—these were the people that if they got exposed to COVID, it was a very predictable sequence of events. Within three days, they were sick; within four to five days, they were hospitalized from low blood oxygen saturation; five to six days later, they were put on mechanical ventilation; and ten days later, they were dead.
I mean, this was very predictable. So that's what initiated us to start our drug trial for COVID. We had a nitric oxide drug in phase three clinical trials for COVID. Wow! We filed our investigational drug application in June, the FDA approved it in July, and we started enrolling patients in December of 2020.
We were making people better, but at that time, COVID changed, right? The hospitals weren't overrun with patients. These newer strains that evolved were less virulent, and people weren't going to the hospital. So our trial design was to reduce hospitalization by 20%.
We were enrolling high-risk patients and seeing if we could create an early treatment to keep them out of the hospital, keep their blood oxygen saturation up, and prevent the virus from replicating. We did this, but the problem was in the patients that we were enrolling, no one was going to the hospital, even the ones on the placebo, because they were getting the milder form of the disease.
But here's what we've learned, and I'm probably the best example. Since March of 2020, I've been on an airplane probably every week for the past four years. At one time, we had 26 COVID clinics around the U.S., so we would go in and enroll patients. I didn't wear a mask; I was almost thrown off airplanes for not wearing a mask. I didn't get the jab. I've never had COVID.
You've never had COVID? Never had COVID. Wow! In fact, I haven't been sick from any infection or sickness since 2001 when I got the flu vaccine when I was at Boston Medical Center. Damn! So it's not that I'm not exposed to these pathogens; I'm exposed every day.
Yeah, but my immune system is robust. I make a lot of nitric oxide, and if I'm exposed, we shut it down at the source of infection, we prevent it from replicating, and we prevent people from getting sick. Wow! Fascinating!
And what about just for—I mean, a lot of people today struggle with generalized low-grade chronic inflammation. Well, if you look at it, so mechanistically, what I—in terms of inflammation, it's very well defined in science. Most people just think, "Well, you're inflamed," right? They say it as the silent killer, which has been known for many decades.
So there are different markers of inflammation. One is high-sensitivity C-reactive protein that you can measure in the blood. In fact, one of my patents in our nitric oxide is a method of reducing C-reactive protein. Wow!
So nitric oxide—we published on this in 2009—that nitric oxide reduces the inflammatory response, reduces C-reactive protein. When we look at inflammation, the earliest stages of inflammation are called microvascular inflammation. When the blood vessels become like sticky, platelets stick, monocytes, neutrophils stick, and then they infiltrate into the intima, they develop oxidative stress, immune dysfunction, and you get plaque development.
The plaque ruptures, leading to heart attack and stroke. The sequence of events physiologically is very well defined. If you can inhibit that early microvascular inflammation, you can inhibit the onset and progression of cardiovascular disease. Wow! And that's what nitric oxide does.
That's the reason it's so effective in COVID. You know, whether you give inhaled nitric oxide—and there were a number of clinical studies that showed that nitric oxide prevents the upregulation of adhesion molecules. The spike protein binds to the ACE receptor. If you're nitric oxide deficient, you get an upregulation of the ACE receptor, so there's more targets for the spike protein to bind to.
That causes further vascular inflammation, platelets start sticking, and you get an elevation in D-dimer and microclots. Everything we know about COVID and long COVID and the systemic disease of COVID can be traced back to a lack of nitric oxide. Wild!
Is there a risk from bumping your nitric oxide too high? Yes, as with everything, it's dose-dependent. Too little NO is bad; too much can be bad. There's only two signs of toxicity: one is low blood pressure. If you take too much nitric oxide, you get systemic vasodilation, and you'll lose perfusion pressure.
So is it safe to say that somebody with, for example, POTS could potentially have too much nitric oxide? I think that's an autonomic disorder, not necessarily related to the overproduction of nitric oxide. It's an autonomic nervous system disorder where they lose the ability to control blood pressure upon sitting and standing.
Yeah, it's an autonomic nervous system issue. The only time you see—and again, if you go back 20 years, people thought that when you get sepsis, right, when you get systemic infection and septicemia, that the reason people die from sepsis is hypoperfusion of organs.
It was thought that when you have an active infection, the immune cells are generating too much nitric oxide, and you're getting systemic vasodilation, leading to loss of perfusion pressure, end-organ failure, and death. So in 1998, they developed a clinical trial to give a nitric oxide inhibitor to septic patients with very good reasoning.
Right? If you're making too much nitric oxide, if you inhibit it, can you prevent the loss of blood pressure and save people's lives? Well, a very unpredictable occurrence happened: when they gave a NOS inhibitor, it killed more people than the placebo.
So that told the scientific medical community that death from sepsis and septicemia is not due to an overproduction of nitric oxide. Now we struggle with trying to find a natural physiological condition where there's an overproduction of nitric oxide, and I don't think that exists.
But certainly, you can take too much NO, and you'll lose your blood pressure, or you develop what's called methemoglobinemia. So you'll oxidize the iron in hemoglobin of the red blood cells, and then you lose the oxygen-carrying capacity of the red blood cell, and you become cyanotic. You'll get blue around the lips, and you'll lose color.
But that's a whopping dose you'd need. I know it's typically 100 to 1,000 times higher than what you would ever get from a diet or from any product. Yeah, and you will lose—you will develop low blood pressure long before you develop any methemoglobin formation.
Most of the people today—the problem facing most Westerners is hypertension; it's high blood pressure, not the inverse. Well, there are people with low blood pressure, and that's typically a thyroid issue. You know, hypothyroidism causes low blood pressure.
So then you've got to fix—and the good thing about our product technology, and we tested this early on, is if you have low blood pressure and you take one of our lozenges, does it further reduce your blood pressure, causing syncope and lightheadedness? The answer is no.
So my blood pressure is typically, you know, 115 over 72 at any given time, and I take a lozenge; it doesn't change it. We've done 24-hour ambulatory blood pressure, and it doesn't—if you have normal or low blood pressure, it doesn't change your blood pressure. If you have high blood pressure, it'll normalize it.
So that's one of the remarkable things about delivering nitric oxide at the right dose over the right amount of time. It's regulatory by nature. Man, you take one of those lozenges before sex—what happens?
Well, we improve perfusion, right? I mean, we're leading to not only dilating the resistance arteries but opening up the microcirculation. In the sex organs, it's spongy tissue with a lot of small blood vessels. So when we can improve the perfusion and open up that microcirculation in small blood vessels, we get better perfusion, better engorgement, and better erections.
Have you—are there clinical trials? I mean, how would it work in comparison to a drug like Viagra, for example? Well, again, let's go back and talk about how Viagra was discovered and put into clinical practice. These drugs early on were developed for patients with pulmonary hypertension and for ischemic heart disease.
So the whole rationale is—these drugs are called phosphodiesterase inhibitors. Nitric oxide, once it's produced, causes an increase in a second messenger called cyclic GMP, and Viagra prevents the breakdown of the second messenger. So now, like, nitric oxide turns the switch on, and Viagra keeps it on.
That's the reason you're warned against the four-hour erection and headaches and loss of vision—all these side effects. But 50% of the men that are given Viagra don't respond with better erections. Interesting!
So it's been on the market for 25 years—a multi-billion dollar a year drug that only works in less than 50% of the men. I thought it worked in everybody. No, no! 50% efficacy in men with ED or symptoms of BPH, benign prostate hypertrophy.
So mechanistically, we understand why that is because you need nitric oxide for Viagra to work, and if you can't make nitric oxide, there's no increase in cyclic GMP. So there's no substrate for these drugs to work on. Got it!
We did a clinical trial years ago where we took non-responders to PDE5 inhibition therapy. We were using, I think, patients who were on 5 milligrams of Cialis once a day for either erectile dysfunction or BPH, and those that were non-responsive, we actually made them responsive by giving them the nitric oxide.
Damn! So you take one of your lozenges and a Viagra, and you're just ready to party! Yeah, be careful, though! Damn! You can overdo it!
Yeah, so the whole point is if you understand mechanistically what causes vasodilation and what causes improvement in sexual function and erections, then you get to the root cause of it. You don't need phosphodiesterase inhibitors to improve sexual function.
What we're finding is if you just improve nitric oxide production, all the downstream signaling aspects of that take care of themselves. You generate nitric oxide, you activate guanylate cyclase, you increase cyclic GMP, you get vasodilation, and you get an erection.
Is that—and as you mentioned earlier in the episode, it benefits women as well, right? Yeah, look, they need engorgement and erections as well. It's a clitoral erection instead of a penile erection, but the anatomy is a little bit different; the physiology is exactly the same.
Yeah! Damn! More nitric oxide for everybody! I feel like the world would be a better place; we'd all be happier. Well, we're working on that!
Working on it! And thanks to you, we're going to educate more people on the importance. Yeah, man, my mind is always blown whenever I get to sit down and chat with you.
I failed to mention this earlier in the episode, but I actually quote you in my third book, Genius Kitchen, as well, in the section about mouthwash. Yeah!
Now that's always the "aha" moment for people because people have good intents, I think. You know, they see the adverts on TV, they go to their dentist, and they think, "Well, I need to have clean breath, fresh-smelling breath." But they don't understand the collateral damage it's causing.
Yeah, it's like dropping an atomic bomb in your mouth. You're killing the bad guys, but you're killing the good guys too. And not only that, but the good guys probably police the bad guys to promote good breath. It's the whole ecology.
There are different communities of bacteria on the gingival tissue, on the tongue; there are biofilms, different layers. As long as you have a good, healthy, diverse oral microbiome, the good guys keep the bad guys at bay. When you disrupt that, you cause chaos. Then the bad guys take over, and now the inmates are leading the asylum.
Damn! All right, so let's just do a recap because I feel like there's so much incredible information here. People should definitely go and follow you on the socials and check out your products and everything because, I mean, this is really groundbreaking science that you're sharing.
But for those interested in optimizing their nitric oxide levels, let's just, in a sort of cliff notes format, recap what actionable steps or advice you would recommend.
You got to do two things; it's very simple: stop doing the things that disrupt it and start doing the things that promote it. So what is that? Stop using mouthwash. I mean, the evidence is abundantly clear.
For me, everything's about risk-benefit. What are the risks versus the benefits? Mouthwash? There's really no benefits. The risks? High blood pressure, loss of the protective benefits of exercise, and probably ED and the whole sequela of things that happen with nitric oxide deficiency.
You have to get rid of fluoride. Buy fluoride-free toothpaste, get rid of fluoride in your drinking water and your home water system. If you're using an acid, you have to stop. So those are three biggies: fluoride, mouthwash, and acid blockers.
You have to completely get off those because that's inhibiting the body's ability to make nitric oxide on its own. Then there's no need for product technology unless you're not doing the other. So if you stop doing those three things and you just get 20 to 30 minutes of physical exercise a day, it can be a brisk walk.
Then more green leafy vegetables or a nitrate source. I recommend a balanced diet in moderation, and then sunlight—whether red light therapy or you know, you get broad-spectrum, full-spectrum from sunlight.
So I'm a big fan of sitting 20 to 30 minutes out in the sun a day. Then when all else fails, then we have products that do it for you. Love it! Super useful!
With regard to oral care, are you a fan of hydroxyapatite, like some of these fluoride replacements? I think there's a spot for that. Again, everybody's different, right?
So hydroxyapatite is kind of like a substrate that helps build strong teeth and bones. There are a lot of things we don't know still. You know, people ask me all the time about oil pulling, essential oils, and different oral hygienic practices.
In 2019, we published that if you tongue scrape, people who did tongue scraping seemed to have a higher diversity of the oral microbiome, which seemed to be a good thing, and they had better blood pressure management.
But if you tongue scrape and use mouthwash, those were the people we saw the highest increase in blood pressure. Wow! So I think tongue scraping alone is probably good. I just don't know about things like hydroxyapatite and how they're affecting the microbiome.
We don't have any data on things like essential oils or oil pulling, but I think as long as they're not antiseptic, then it's probably going to be fine. You have to support the ecology of the oral microbiome and let these bugs do their job.
Great advice! Nathan Bryan for president! Not yet! You got other work to do! I know you do! Yeah, there's a lot of work that needs to be done.
But fascinating stuff, man! Thank you so much for coming back! Thank you, Max!
Hey, if you liked that video, you need to check out this one here, and I'll see you there! [Music]