Dr. Anne Truong explains how nitric oxide (NO) is critical for blood-vessel relaxation, sexual function, and cardiovascular health, and how common everyday habits lower NO and contribute to erectile dysfunction and heart disease. She describes the oral-to-gut pathway (dietary nitrate → salivary/nitrate conversion → stomach acid → nitrite → intestinal conversion → NO), notes age-related decline in NO (about 50% loss by age 40 and ~15% of 20s levels by age 60), and lists causes of decreased NO including smoking, antiseptic mouthwash, antibiotics, proton pump inhibitors, poor diet, sedentary lifestyle, inflammation, and diabetes. Practical recommendations: aim for ~300–400 mg dietary nitrate daily (~4 mg/kg/day), eat nitrate-rich greens (spinach, kale, broccoli, celery, cabbage, lettuce), avoid antiseptic mouthwash and unnecessary PPIs/antacids and fluoride-containing toothpaste, stop smoking, follow a Mediterranean or DASH diet, do moderate-to-vigorous exercise (targeting ~80% maximal heart rate for recommended bouts), consider infrared light/sauna, nitric oxide supplements, get ~30 minutes sunlight daily, and target ~7 hours of sleep nightly. The episode promotes Dr. Truong’s Modern Man Club for follow-up coaching.
Questions this episode answers
January 19, 2023.
Approximately 300–400 mg of nitrate per day (~4 mg per kg per day).
Around age 40 you lose about 50% of nitric oxide; by age 60 NO is about 15% of the level present in your 20s.
Prilosec, Prevacid, Nexium, Protonix, Dexilant.
Stop smoking; stop using antiseptic mouthwash; stop using fluoride-containing toothpaste (speaker framed fluoride toothpaste as antiseptic); avoid antacids/PPIs when possible; improve diet (stop high-carb/processed junk food).
Chapters
Well, stay tuned to this episode because I'm going to talk about the five common things that you're doing right now that could harm your erection. So we're going to dive into it. So I'll see you in the episodes. Well, hello there. Welcome back. I am Dr. Anne Truong. And today we're going to talk about five common things that you do every day that could really harm your sex life and eventually lead to ed. So let's dive in. At this point, you're going to be so amazed because this is just something that you do every day. And I will hope that you will learn something from today's episode as well. So we're going to talk about nitrous oxide. Nitrous oxide is a gas and it is critical component for the blood vessel because the blood vessel need nitrous oxide in order for it to relax and open up. So that way you have more increased blood flow. The endothelial cells and the cells that line inside the blood vessels are the one that produces nitrous oxide. Now, if you listen to my past episode, I discussed how the endothelial cells are prone to injury due to inflammation, smoking, poor diet, and even cholesterol. So when it's injured, it cannot produce nitrous oxide. So there are two ways that the body can make nitrous oxide is from the food that you eat and then it gets processed through the saliva. We'll dive deep into that a little bit later. And then an enzyme that is in your blood vessels that, that process the nitric to nitric oxide. Okay. Those of you that can see that on the video, at around the age 40, you lose 50% of your nitrous oxide. Yes, because nitrous oxide gets less and less and less as you get older. And by the time you're at the age 60, you're at about 15% nitrous oxide as you were when you were in your 20s. So that's a bummer. And that's why we see more cardiovascular or heart disease as you get older. And when you have decreased nitrous oxide. Nitrous oxide is what determines whether you have more blood flow or not. And that's why when you get older, you have ed, you have heart disease, Alzheimer's, stroke, heart attack. Nitrous oxide, when it's less and less, you have more a thickening of your artery, which is the blood vessel that brings in oxygenated blood to your cells. So when you have less nitrous oxide, the more severity, the more the stiffening of the artery. As you can see from this picture. So when you have less nitrous oxide around age 60 was about 15%, you get like plaque deposit that come from the cholesterol that gets sticky to the artery, and that's what lead to blockage and eventually poor blood flow. And you'll see it more in the sexual organs first, because the arteries to the sexual organs are the smallest one compared to the heart. And this is happening in both men and women. Now. I love this picture because this picture really shows clearly how we get nitrous oxide and what happen when we take it in as a food. So when you eat food that are high in nitrous oxide, such as green leafy vegetables like spinach, kale, broccoli, when you eat it, your saliva, which has bacteria in the mouth, actually processes the nitrate. So when the food goes into your mouth and it become nitrate, and then it goes to your stomach, and then in the stomach lining, the juice, the acid in the stomach lining, converted from nitrate to nitrite. And then when it goes to your intestine, it is converted from nitrite to nitric oxide. And then the nitric oxide goes to your blood vessels, and that's where the endothelial cells convert it to nitric oxide. So that way your cells get absorbed and you have increased more blood flow to organ. And just know that in the saliva in your mouth is involved in processing the nitrate to nitrite, and then the acid in your stomach process the nitrite to nitric oxide. So that's why when you start taking a certain medication, it affects the concentration of nitric oxide, because you will disrupt the bacteria that is present in your mouth as well as the acidity that is in your stomach. Now, what causes decreased nitrous oxide and eventually heart disease? Because when you have decreased blood flow, it not only affects just the sexual organ, but it also affects the heart as well, too. For instance, smoking, poor diet, a diet as high in carb and processed food, it inhibits the enzyme that make nitrous oxide, which is nitric oxide synthase, poor oral hygiene or oral infection. And then you take antibiotics that will decrease nitric oxide. A sedentary lifestyle, you don't exercise at all. Inflammation. Inflammation can cause from free radicals from the diet, well as from the environment. Drug therapy, we'll go over which type of medication that will affect nitric oxide and diabetes. And we know that in diabetic, they produce less nitric oxide in its perpetual cycle because the less nitric oxide will exacerbate diabetes as well. All of these conditions that I just mentioned all have decreased nitric oxide. Well, how much nitric oxide do you need in a day? You should be getting about 300 to 400 milligrams of nitrate. Remember, nitrate come from your mouth. Your mouth formed nitrate to nitrate, so that equals approximately 4 milligram per kilogram a day. And taking nitric oxide in that amount will actually lower your blood pressure. And a lot of the nitric oxide come from broccoli, cabbage, celery, lettuce, spinach, kale. Unfortunately, most of us can't get enough to meet our daily needs because we're going to have to eat large servings of those vegetables that I just mentioned. And interestingly, organic vegetables have less nitric oxide than non organic vegetables. The mouth bacteria actually help you convert the nitrate to nitrite. And so you want to be able to have a lot of bacteria that is in your mouth because that help increase the nitric oxide concentration. Because the studies have shown that in people that take antibiotic, they actually have less bacteria in their mouth and therefore less nitric oxide. And if once the antibiotics stop, then the bacterial colony is able to colonize the mouth again and the nitric oxide increases. So what to do to increase nitric oxide? Because we know that low nitric oxide, poor blood flow, right? Low nitric oxide, poor blood flow, high nitric oxide, good blood flow. All right, so things that disrupt or decrease nitric oxide production is antiseptic mouthwash. I do antiseptic mouthwash every day. Well, now I'm not going to do that anymore now that I find out that doing this will kind of kill the bacteria in your mouth. A bacteria in your mouth is the one that actually convert your food to nitrate. And then fluoride toothpaste. Fluoride toothpaste, also antiseptic. You want to use toothpaste that is non fluoride antacid. Common antacids, such as a Prilosec, Prevacid, Nexium, protonic dexalant, Those are all proton pump inhibitors. And what they do is that they prevent acid from being produced in your stomach, and that actually decreases the conversion of nitrite to nitric oxide. So you don't want that. All right? You want to have the acidity in the stomach. And. And then we know that eating a high carbohydrate and processed junk food actually inhibit the enzyme nitric oxide synthase from converting nitrite to nitric oxide. Also smoking. Smoking also decreases nitrous oxide as well. So five things that you want to stop doing is stop smoking, stop using mouthwash, stop using fluoride, toothpaste, antacid as much as you can and improve your diet as well. Things that promote or restore nitric oxide production is being on a Mediterranean or a DASH diet with lots of green vegetables and less processed carb. Moderate exercise, meaning getting your heart rate to at least 80% of maximal heart rate. I recommend either jogging or fast walking or even high intensity interval exercise, infrared light therapy or infrared sauna, increase nitric oxide and taking a nitric oxide supplement. Now, I will leave the link in the show note on nitric oxide supplements as well as a recommendation for infrared light therapy. It'll be a link down there as well as a link to the Mediterranean diet. Sunlight 30 minutes a day will actually help as well. And not only is sunlight help with nitric oxide production, but also kind of reset your circadian rhythm and help with sleep. And then that eventually lead to the last point. Sleep seven hours at night as much as possible because when you sleep, that's when your body heal physically and also psychologically as well. So to recap things that increase nitrous oxide are eat a Mediterranean diet or DASH diet, do moderate exercise, infrared light therapy or infrared sauna, nitric oxide supplement and sunlight at least 30 minutes a day and sleep at least seven hours as much as you can. And having said that, now you know the five things that you shouldn't be doing that you're probably doing every day that is really harming your sex life life. And you want to be able to restore and increase your nitrous oxide content so that way you have better blood flow. Not only will it help your performance in the bedroom, will also help your heart as well and also longevity. So having said that, if you want more content and you want to have an opportunity to ask me more questions, I encourage you to check out the Modern man club. The link will be down below the this is the club where I will be coaching you and assisting you on how to restore your erectile capacity again. I'll see you in the next episode.
