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How to increase your Nitric Oxide levels and your performance. (Part II)

I know you were waiting for it….:Foods and Lifestyle Behaviors that Increase Nitric Oxide Levels
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By Dr. Rick Cohen, MD
Creator of PureClean Performance

In Part 1, I discussed how nitric oxide works to have a positive effect on health and performance, as well as how to assess your NO levels. In Part 2 I’ll show you how you can increase your NO levels through lifestyle adjustments, consumption of nitrate-rich foods, and supplementation.

Disclosure: CTS has a partnership with PureClean Performance and CTS Coaches use PureClean Performance products during training and training camps.

It’s all about the nitrates
Nitrates are naturally-occurring, inorganic compounds that are converted as part of the photosynthesis process by plants from the nitrogen in the air. Leafy greens such as arugula (rucola), red-leaf spinach, and celery have some of the highest concentrations of nitrates. Red beets offer both the largest amount of dietary nitrates per gram and the highest bioavailability, meaning you absorb a higher percentage of the nitrates present in the food.

When we ingest nitrate-rich plants our body converts these nitrates into nitric oxide. Enhancing your NO levels can help relax your arteries, which means improved delivery of oxygen to muscles and other tissues. For athletes, getting oxygenated blood to working muscles faster is a key to improving performance. Many athletes find they can do the same or more work with lower perceived exertion. A 2014 review study concluded that dietary nitrates represent a promising approach to enhancing physical response to exercise, and note that more research is necessary on the potential ergogenic effect.

We know NO levels can be optimized through a variety of methods (see below), but the most practical and effective method is through the use of dietary nitrates. This is especially important once we reach the age of 40 as the amount of nitric oxide produced by our arterial lining declines by 50% or more. So, while somebody in their 20’s and early 30’s with a youthful arterial lining can get by without eating a lot of dietary nitrates (although nitrates will still boost their performance) as we get older it is critical for our health and peak performance to regularly consume foods and whole-food supplement rich in nitrates.

Whole foods matter.
Ironically, until recently, nitrates (especially those used in processed meats as a preservative) were considered to be bad for your long-term health. But we now understand the problem isn’t the nitrates themselves; it’s the cooking and processing methods that are the underlying causes for concern. The important point to grasp here is that synthetic nitrates added to meats that are grilled are different than nitrates that occur naturally in fresh vegetables, which contain a host of additional compounds (minerals, vitamins and phytonutrient antioxidants) that may protect our health and further enhance the actions and benefits of dietary nitrates.

Benefits of nitrate-rich beets
Red beets improve adaptation to altitude.

People who live at high altitude produce more NO than people at sea level, and populations that thrive at high altitude, like Tibetans, have been found to have NO levels several times those of sea level populations. If you’re planning a trip to a high-altitude location, then it would be wise to consider upping your nitric oxide level. Hypoxia reduces NO levels initially, and studies show that the consumption of dietary nitrates (for instance, red beets) or NO supplementation can improve the body’s adaptation to altitude by keeping NO levels from declining.

Red beets improve blood pressure.

A 2015 study showed that just ½ cup of beet juice a day for 4 weeks led to a significant 8 point drop in blood pressure due to an increase in NO. Since NO relaxes blood vessels, healthier blood pressure is one of the most common benefits of the regular intake of beet nitrates.

Red beets improve oxygen efficiency.

In a one study, just a shot of beet juice helped free divers hold their breath for a half minute longer than usual. For people who have trained and spent years increasing their breath hold, that time is a huge benefit! For endurance athletes, this oxygen conserving effect may make more oxygen available for working muscles.

Red beets improve performance!

This is no longer a question of maybe. High quality beet juice powder really is “Fitness in a Jar.” and is now accepted by almost everyone right along with caffeine as a proven performance booster. There is a preponderance of studies that clearly show that both moderately fit and older athletes experience performance improvements. Some evidence has suggested the effects may be weaker for elite athletes, but a recent study showed that even elite-level athletes can experience the benefits, as long as they consume more.

In the end, what ultimately matters is whether beet nitrates can help your performance, so here a few studies that highlight the potential gains you could experience by optimizing your NO levels…

You’ll go faster with less perceived effort

In a double-blind, placebo-controlled study, 11 fit men and women were evaluated during two 5K treadmill time trials. 75 minutes prior to one trial, subjects ingested either 500mg of nitrate or a placebo. The findings were that the beet nitrate group‘s endurance capacity increased by at least 16%, their mean running velocity was higher, and during the last mile of the time trial, their running velocity was five percent faster. In addition, subjective feedback in the beet nitrate group indicated a lower perceived rate of exertion.

You’ll go longer and use less oxygen

In another study, beet juice-derived nitrates helped cyclists perform at the same intensity while consuming 19% less oxygen when compared to the placebo group. The riders then cranked up the intensity and those who took the beet nitrates extended their time to exhaustion from an average 9:43 to 11:15.This translates into greater endurance with less oxygen cost, which is quite handy when you’re looking for that slight edge to bring out your best performance in competition or training.

You’ll cycle farther in a time-trial.

In this study, cyclists’ heart rates and oxygen consumption levels were measured during a series of cycling tests given at sports performance laboratory during moderate as well as timed exercises. The two-week trial was then repeated. They found that after consuming nitrates and increasing nitric oxide levels, the cyclists used less oxygen when riding at a moderate pace. They also cycled a longer distance in a two-minute all-out time trial

Dietary and Behavioral Methods of Increasing Nitric Oxide Levels
Eat some form of nitrate-rich vegetables daily.

The foods highest in nitrate include beet roots and leafy greens such kale, arugula, chard, and spinach. Others include parsley, Chinese cabbage, leeks, celery, radishes, and turnips. Because bacteria in your mouth are one naturally occurring way of activating the NO production process, you may benefit from keeping nitrate-rich foods in your mouth longer. Make sure to chew your food well and consume liquids slowly. In order to increase your intake of these nitrate-rich vegetables, you can make vegetable juices or add steamed or roasted beets to a blended protein drink.

This is where Pureclean beet root supplements can be helpful. They are a convenient, economic and tasteful way (see below) to use a proven nitrate-certified, beet-based whole food support formula.

Eat foods that are rich in polyphenols.

Foods rich in polyphenols and flavonoids (which are potent antioxidants) encourage the endothelial cells in your arteries to produce more NO. These foods include dark chocolate, green tea beets, berries, cherries, and pomegranates.

Get adequate rest and recovery.

Don’t overlook the powerful, restorative effects of getting eight hours of sleep for healthy NO production and maintenance. Take time out for yourself each day. Listen to calming music, watch a comedy show, read a book, go for a walk and play. If you’re spiritual, dedicate a portion of each day to meditation or practicing your faith. Just five to ten minutes of silence a day can have a positive impact on your overall health and performance.

Breathe through your nose.

The sinuses produce NO when you breathe through your nose! As air travels from the nasal passages into the lungs, a portion of the available NO gas is used as a bronchial vasodilator. This process speeds oxygen delivery and promotes antibacterial activity. This is especially useful during physical activity when the NO production is amplified.

Get at least 20 minutes of exposure to sunlight, three times a week.

Sunlight activates beneficial bacteria on the skin, triggering the production of vitamin D3 — which drives nitric oxide production. Because full-body sun exposure is often impractical and ineffective, it may be important to assess your vitamin D3 level and supplement your diet for at least a portion of the year.

Load up on omega 3 fats

Eat plenty of omega 3 essential fatty acids (found in wild, cold-water fish, grass-fed meats, macadamia nuts, pumpkin seeds, hemp seeds, and chia seeds) on a regular basis. Reduce or avoid inflammatory omega-6 fats found in soy, corn, safflower, canola, and sesame oils, as well as the artificial trans-fats found in margarines and other processed foods. Assess your omega 3 levels to determine whether you need additional omega 3 supplements.

Avoid the use of antiseptic mouthwash and antacids

The effective conversion of dietary nitrates to nitric oxide requires an abundance of healthy bacteria in your mouth and high levels of digestive enzymes in your stomach. Antiseptic mouthwash reduces these essential oral bacteria, while antacids suppress the production of stomach acid, interfering with NO production. Watch this short video on why you shouldn’t use an antiseptic mouthwash.

Use an NO-rich supplement

All of the strategies above can promote higher nitric oxide levels without supplementation, and eating more fresh vegetables, getting out in the sunshine, getting plenty of sleep, and consuming enough omega 3 fatty acids are all good for athletes by themselves. That said, the dietary requirement is about 5-7 mmol (500mg) of nitrates daily to improve athletic performance, and that can be difficult to achieve, messy, expensive, unpalatable (for many) and less than gut friendly.

Many athletes – especially those over the age of 40 – may therefore benefit from supplementation. UNBEETABREWTM beet-infused instant coffee and BEET”UMSTM beet-infused chocolate chews are made with specially processed beet juice that is certified to have 4 to 5 times the nitrate levels of regular beet juice. We then combine the beet juice with synergistic foods (coffee, cacao, mango, pomegranate, mushrooms) that amplify nitric oxide production.

Take the NO Performance Challenge
I know you may be skeptical because I’m a firm believer in the effectiveness of nitric oxide supplementation and I produce supplements. I get it, but there is good research indicating NO can improve health and athletic performance, so I encourage you to give NO a try and see for yourself with the following protocol:

1. Establish Baseline Values

For 3 days, first thing in the morning record your morning blood pressure and NO level first thing in the morning. You will need salivary test strips to measure NO level.

Perform an endurance activity you can gauge either by time, power and/or heart rate. Record your performance metrics as well as how you felt subjectively.

2. Boost your NO
Drink 1 serving of UNBEETABREWTM twice daily. One of the servings should be consumed 45 minutes prior to physical activity. Consume 1 or 2 BEET’UMSTM on days you aren’t able to take a second serving of UNBEETABREWTM and/or as a treat anytime.

On 2 separate occasions, record your NO levels two hours after taking UNBEETABREWTM or BEET’UMSTM. (Do not eat anything and refrain from drinking water for 30 minutes prior to testing)

Record your morning blood pressure and NO levels every 3 to 4 days.

3. Reassess
When you have completed the bag of UNBEETABREWTM (15 to 20 days) perform your physical performance assessment again to compare the results.

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Nitric Oxide is a potent vasodilator that improves performance.

Even thought the article’s author, Dr. Cohen, is the creator of the product he is promoting- the science is good behind it.Nitric Oxide: A Key to Peak Athletic Performance
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By Dr. Rick Cohen, MD
Creator of PureClean Performance

All athletes want to improve performance, so we optimize our training, get plenty of sleep, and focus on the foods we eat. Even so, there’s an important nutrient many athletes still don’t know enough about: nitrates. More specifically, it’s what your body can do with nitrates that should be of great interest to athletes.

Nitrates and Nitric Oxide
Only a few decades ago, scientists discovered the connection between nitric oxide and blood flow. In the presence of NO, blood vessels relaxed, which improved blood flow and reduced blood pressure. At the time, this led to great insights and developments in the treatment of cardiac patients and people with essential hypertension. As more research emerged, the scientific understanding of NO’s roles throughout the body grew.

Because NO is a gas that diffuses rapidly across cellular membranes, it’s involved in many physiological processes. When released inside the body, this gas quickly and easily penetrates cells, promoting optimal, physiological function.

NO is produced 3 ways in your body:

1. It is secreted by the cells in the inner lining (endothelium) of your blood vessels.
2. It is converted by oral bacteria from your intake of nitrates from the foods you eat.
3. It is created by bacteria on our skin when we are exposed to adequate amounts of sunlight.

NO enhances oxygen delivery and blood flow.
From an athletic perspective, nitric oxide’s primary role is to regulate the delivery of oxygen to muscles, It does this by relaxing and opening blood vessels, subsequently improving blood flow. Better blood flow not only translates into lower blood pressure, but a decreased demand on your heart and skeletal muscles. Better blood flow also supports a muscles’ ability to contract and transport metabolic by-products such as lactic acid. Because NO is responsible for delivering oxygen-rich blood to every cell, tissue, and organ system in the human body, it is now recognized by the scientific, medical, and athletic communities as a key, physiological performance variable.

And NO has even more benefits!
NO acts as powerful antioxidant neutralizing harmful, free radical activity and promoting the formation of glutathione, a critical antioxidant. NO facilitates the transmission of messages between nerve cells, contributing to improved memory and learning capacities, better sleep, and a more positive mood. And NO supports the immune system helping fight off infections.

NO can improve athletic performance

Given that NO contributes directly to blood flow, oxygen delivery, glucose uptake, muscle velocity, power output, and muscle growth; a higher NO level may enhance an athlete’s overall performance and endurance — even among athletes who were already fit and healthy.

In fact, a number of studies have shown boosting nitric oxide can reduce the oxygen cost of exercise and improve the function of energy-producing mitochondria, resulting in a lower perceived effort and easier breathing during exercise, in addition to reduced muscle soreness and faster recovery following hard, physical efforts.

Nitric oxide may even improve adaptation to altitude.

People who live at high altitude produce more NO than people at sea level, and populations that thrive at high altitude, like Tibetans, have been found to have NO levels several times those of sea level populations. If you’re planning a trip to a high-altitude location, then it would be wise to consider upping your nitric oxide level. Hypoxia reduces NO levels initially, and studies show that the consumption of dietary nitrates (for instance, red beets) or NO supplementation can improve the body’s adaptation to altitude by keeping NO levels from declining.

But… NO levels decline with age.
NO levels can decline for a variety of controllable reasons including a lack of dietary nitrates, excessive physical and mental stress, low stomach acid, imbalanced mouth bacteria, anti-inflammatory medicines and arterial damage. But the one we can’t control, aging, is by fat the greatest threat to your NO level.

By the age of 40, your body will produce half the NO it did at the age of 20! By the time you reach 70, it will be capable of producing only 25% of the nitric oxide it needs! And as your body’s ability to generate NO after exercise is reduced, so does your responsiveness to training. To make matters worse, as NO production declines past the age of 40, the health risks from dysfunctional blood vessels rise significantly.

Determining your NO level
Until very recently, there was no easy way to assess your NO level. Testing required costly blood work or a complicated procedure called Flow Mediated Dilation, which indirectly predicted NO levels by measuring the rate of blood flow in the arm after applied pressure. Fortunately, recent advances in laboratory testing technology make it possible for you to easily and regularly measure your NO levels—anywhere, anytime—using nothing more than a test strip and a drop of saliva.

Even before – or in conjunction with – testing NO levels, you can start by assessing how you feel. Ask yourself the following questions. In my experience, if you answer “yes” to any two or more, your NO level is probably low.

Are you over the age of 40?
Do you rarely or occasionally eat green vegetables and/or red beets?
Do you train at high-levels more than 10 hours a week?
Are your hormone levels imbalanced?
Do you use anti-inflammatory medications such as Motrin or Celebrex?
Do you use antacids or suffer from indigestion?
Do you frequently use an antiseptic mouthwash?
Do you have gum disease or bad breath?
Have you recently taken antibiotics?
Do you suffer from any form of bowel distress?
Do you have circulation problems, high blood pressure and/or fluid retention issues?
Do you suffer from abnormally high CRP, or an autoimmune disease?
Have you been diagnosed with asthma or bronchitis?
You don’t need to guess.

Over the past 10 years, I have found that almost everyone over the age of 40 and/or is an endurance athlete has less than optimal levels of NO. But, don’t take my word for it.

While it is always helpful to maintain a subjective awareness of any improvements in the way you feel and perform, salivary test strips provide an objective foundation for determining improvements in your NO level. Despite its deceptive simplicity, a salivary nitric oxide assessment is a powerful tool that will allow you to monitor how your NO level changes with dietary and lifestyle choices, training intensity, stress, and the use of nitrate-based supplements.

By using a nitric oxide assessment strip to periodically check your NO level first thing in the morning and an hour or two after consuming nitrate-rich foods and/or a nitric oxide supplement, you can accurately assess your body’s ability to produce and maintain an optimal amount of NO. In addition, by assessing your NO you can determine just how much and when you should be supporting it for maximum health and performance results.

How can you improve your NO levels?
Now that you know the importance of nitric oxide for health and performance and how to gauge your NO levels, the big question how can you improve your NO levels?

Well, since it’s hard to affect the behavior of bacteria in your mouth, or enhance the creation of NO on your skin from sun exposure, the most effective and proven method of optimizing your NO levels is through the use of dietary nitrates.

More on that in Part 2 (coming next week).

Disclosure: CTS has a partnership with PureClean Performance and CTS Coaches use PureClean Performance products during training and training camps.

About Dr. Cohen

Dr. Rick Cohen has worked as a specialist in nutritional medicine and sports performance for more than two decades, and developed a number of innovative treatment programs that have successfully helped patients enhance their sports performance as well as eliminate a variety of health problems.

He received his undergraduate degree with honors of distinction from Duke University in Durham, North Carolina, and received his medical degree from Hahnemann Medical University in Philadelphia, Pennsylvania. He is a proud member of several professional organizations including the American College for the Advancement of Medicine and the American Academy of Anti-Aging Medicine. Dr. Cohen is the creator of PureClean Performance.

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