Nitric oxide is the critical piece of your immunity that nobody is talking about. In this post we cover:
Many, if not most people have low levels of nitric oxide. Are you one of them?
The research that supports the hypothetical link between low nitric oxide and risk for infection and risk for severe covid-19 outcomes.
The research showing that supplementing with nitrates can lower how bad an infection might get.
The direct antiviral activity and general immune-supporting role of nitric oxide.
Other tips for staying healthy while staying in during (and beyond) the Covid-19 pandemic.
The FDA has not approved any nitric oxide based supplement for the treatment, prevention, or cure for Covid-19. This content is meant to help you understand why nitric oxide is essential for your immune system, how to boost your nitric oxide levels naturally, and how to eat and supplement to promote your health. Please see our full disclaimer at the end of this page and refer to the CDC and your local public health department for official Covid-19 related guidelines.
What Can I Do To Boost My Immune System?
If you’re staying in this weekend instead of risking it out in the world, we have some resources for you! Check out these other articles of ours:
If you want a video to describe some of the potential benefits nitric oxide and other antioxidants may have on Covid-19, head over to our informational video here. If you’re a health professional or researcher who wants every last detail, this article provides the educational information you are looking for.
Now let’s get into why nitric oxide is so important for a healthy immune system.
What is Nitric Oxide?
Nitric oxide (“N-O” for short”) is a simple molecule with profound effects. Doctors know how it makes blood vessels relax. Athletes know how it can decrease how much oxygen you need to exercise. It’s well-researched effects on your gut, your brain, and even the mitochondria that power your cells are relatively unknown in popular media.
Who Needs More Nitric Oxide?
Nitric oxide levels decline with age, cardiovascular diseases like high blood pressure and clogged arteries, lung diseases like asthma and COPD, diabetes, kidney disease, obesity, and other conditions involving chronic inflammation.
Use antibacterial mouthwash? You probably have low N-O levels. Use antacids like proton pump inhibitors (PPIs)? You probably have low N-O levels. Older, inflamed, have a chronic condition? Exposed to pesticides, pollution, disinfectants?
You get the picture. Even if you’re young, fit, and healthy, your nitric oxide might be lacking. Not only do all of these conditions hurt your nitric oxide, they also put you at risk for infection (Zirk-Sadowski et al. 2018) and other immune issues (Raubenheimer et al 2019).
Nitric Oxide, Covid-19, and Your Immune System
Take a look at that list again. Notice anything?
Almost every one of the conditions associated with poor nitric oxide is also linked to severe covid-19 (CDC). We talk about this in much more detail here. We don’t have much direct evidence, but there are a few Covid-19 research studies that suggestively link low nitric oxide with poor immune health and severe outcomes of Covid-19:
Nitric oxide levels are low in people with dysregulated arginine metabolism and with hypertension, a leading risk factor for Covid-19. Nitrates act outside of that pathway to reduce high blood pressure, which may be promising for lowering risk of severe covid-19 (Bahadoran et al 2017; Zhang et al 2020)
Nitric oxide levels are low in the lungs of people with acute respiratory distress syndrome ー the “worst case scenario” for those infected with the 2019-Coronavirus. Inhaled nitric oxide is a promising therapy that has been successfully researched for Covid-19 (Cho et al 2016).
Besides these indirect benefits of getting enough nitric oxide, there are direct immune-enhancing effects of nitric oxide.
Nitric Oxide and Your Immune System
How does your immune system effectively fight an invading pathogen? Reactive oxygen species (ROS) - usually thought about as a cause of inflammation and aging - are also what give your immune system its stopping power.
Instead of the rampant ROS situation seen in chronic disease, aging, and inflammation, when your immune system use ROS, your white blood cells use a targeted burst of damaging inflammation to fend off invaders. Nitric oxide is a main source for this attack (Bogdan 2001).
That’s all fine and well, if your body is able to create enough nitric oxide. You already know that many, if not most, people have a dysregulated nitric oxide system though. If you think you have low nitric oxide levels, your immune system might benefit from a nitrate supplement.
In fact, we even have a study to help show the positive effects a nitrates supplement can have on your immune system (Ritz et al 2019). Researchers gave an inactive placebo or beet juice (a common nitrate source, see our thoughts on that below) to college students with and without underlying chronic lung issues during a stressful finals season. They wanted to see if the supplement would reduce how bad the typical cold got.
Results? Supplementing with 400mg dietary nitrate daily was linked with 26% fewer symptoms. Better yet: those with asthma and those who produced more NO saw an even greater benefit!
Those results are good to know for the common cold, less deadly coronaviruses (Amarasinghe et al 2017), and other viruses (Liu et al 2017; Pertile et al 1996), but they don’t really tell us all that much about the 2019-Coronavirus.
What we do know is that other coronaviruses are genetically similar to SARS-CoV-2 (the virus that causes Covid-19), and three test tube studies show that they seem to be stopped in their tracks by nitric oxide donors (Akerström et al 2009, Akerström et al 2010; Keyaerts et al 2004).
This data has some limitations, but in the absence of solid evidence all we can do is take our best guess. What we know is that:
Nitric oxide is essential for your immune function
Supplementing to raise your levels can help you fight off other viruses like the cold
Cell culture studies show that nitric oxide can directly fight other coronaviruses.
How Do I Get More Nitric Oxide?
You may have heard of using arginine or citrulline supplements to boost your nitric oxide levels. I hate to break it to you, but these supplements only work for a small subset of people. In fact, according to research out of Norway, arginine supplements might not even work at all!
You can get nitrates to convert to nitric oxide from synthetic sources, too. Some of our competitors fluff their products with these synthetic nitrates, but we know that the research shows natural sources are far better.
Red beet root has been the industry standard for raising NO levels for a while. There’s nothing wrong with the tried and true, benefits from beet juice, but there’s a catch:
Nitrate levels in beets vary. A Lot! One batch can have 10 times the amount as another from the same farm! Depending on where and when they’re planted, how they’re grown, and how they’re stored and processed, you might get enough nitrates from beets to beat your personal record… or you might just be painting your plate red.
Frankly, the nitrate levels in beets hit like a lightweight compared to the heavy-hitting doses in red spinach and other sources. Check our list of the best sources here. You just don’t know how much of a benefit you’re getting when you down a couple pounds of roasted beets (yes, it takes the nitrates in about 2 or 3 beets to get the immediate benefits shown in research).
You can try beet juice as well, but you’ll have the same problems: concentrated doesn’t always deliver. Plus, the extra sugar in beet juices can spike your blood sugar and insulin. That’s not necessarily a big deal if you’re a high-performing athlete recovering from a big event, but definitely avoid it if you care about healthy, normal metabolism and longevity.
A standardized nitrate supplement ー one that guarantees a minimum level of nitrates per serving ー puts these issues to rest. Other supplements might provide a benefit, but going with a standardized and certified beet powder makes sure.
If you want a whole-foods approach to nitric oxide support, check out our guide to eating for NO levels here. But if you want the convenience and added benefit of a supplement, I can’t help but plug the product Resync is known for: Resync Recovery. A science based, third-party certified, whole-body support drink for recovering your fastest so you can perform your best.
Unconventional Ways to Get More Nitric Oxide
Taking care of your immune system during a pandemic with the right nutrients is a no-brainer. Your immune system is integrated with every other “system” though, so you might not even realize that there are other things you can do to keep your defenses optimized. Here’s our list of unconventional ways you can boost your nitric oxide levels and revamp your immune system:
Regular exercise raises nitric oxide levels, improves your antioxidant system, and helps you fight off infections.
Enough sunshine not only provides vitamin D, but it may also be an underappreciated factor in converting nitrate to nitric oxide.
Enough vitamin C, besides having immune-boosting effects, it’s the antioxidant that helps your cells recycle nitric oxide.
Change your diet to reduce heartburn instead of taking an antacid, and stop using antibacterial mouthwash. Both of these hurt your healthy bacteria and a healthy level of stomach acid is necessary to turn nitrite into nitric oxide.
Support your nitric oxide making genes. Turmeric doesn’t have any nitrates in it, but its active ingredient curcumin can still help boost nitrate-making processes in healthy adults. Besides being delicious, mango may provide circulation benefits by increasing nitric oxide genes.
Nitric oxide is important. Really, important. But it often goes unnoticed since it’s not on the average person’s mind. From underlying conditions that put people at risk for infections, to not eating enough red and green leafy vegetables or exercising enough, to seemingly harmless daily activities like mouthwash and antacids, hurting your nitric oxide levels hurts your immune system too. If you want to stay on top of your immunity, try our tips and let us know how they work for you!
We Want To Hear From You!
Want the practical details on how to eat and supplement to support your exercise, heart health, beauty, and energy? Subscribe to our feed and never miss our best content! If you want more, leave a comment or question below and we’ll get back to you!
While other companies try to sell you through clickbait and fake news, we back up what we say with hard data. We believe that when you have the right information, you are empowered to make the best decision possible. That’s why we break down complex science into practical takeaways you can use today.
Wishing you the best in your health and your safety,
The Resync Team
Akerström et al. NO Inhibits Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus.pdf. Dropbox. https://www.dropbox.com/s/k2ge1s1vo8w8q21/NO%20Inhibits%20Replication%20Cycle%20of%20Severe%20Acute%20Respiratory%20Syndrome%20Coronavirus.pdf. Accessed March 26, 2020
Akerström S, Gunalan V, Keng CT, Tan Y-J, Mirazimi A. Dual effect of nitric oxide on SARS-CoV replication: viral RNA production and palmitoylation of the S protein are affected. Virology. 2009;395(1):1-9. doi:10.1016/j.virol.2009.09.007
Amarasinghe A, Abdul-Cader MS, Nazir S, et al. Infectious bronchitis corona virus establishes productive infection in avian macrophages interfering with selected antimicrobial functions. PLoS ONE. 2017;12(8). doi:10.1371/journal.pone.0181801
Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A. The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis. Adv Nutr Bethesda Md. 2017;8(6):830-838. doi:10.3945/an.117.016717
Bogdan C. Nitric oxide and the immune response. Nat Immunol. 2001;2(10):907-916. doi:10.1038/ni1001-907
Cho Y-J, Moon JY, Shin E-S, et al. Clinical Practice Guideline of Acute Respiratory Distress Syndrome. Tuberc Respir Dis. 2016;79(4):214-233. doi:10.4046/trd.2016.79.4.214
Holliman, Graham, et al. “Ultraviolet Radiation-Induced Production of Nitric Oxide:A Multi-Cell and Multi-Donor Analysis.” Scientific Reports, vol. 7, Sept. 2017. PubMed Central, doi:10.1038/s41598-017-11567-5.
Jonvik KL, Nyakayiru J, Pinckaers PJ, Senden JM, van Loon LJ, Verdijk LB. Nitrate-Rich Vegetables Increase Plasma Nitrate and Nitrite Concentrations and Lower Blood Pressure in Healthy Adults. J Nutr. 2016;146(5):986-993. doi:10.3945/jn.116.229807
Keyaerts E, Vijgen L, Chen L, Maes P, Hedenstierna G, Ranst MV. Inhibition of SARS-coronavirus infection in vitro by S-nitroso-N-acetylpenicillamine, a nitric oxide donor compound. Int J Infect Dis. 2004;8(4):223-226. doi:10.1016/j.ijid.2004.04.012
Liu C, Wen L, Xiao Q, He K. Nitric oxide-generating compound GSNO suppresses porcine circovirus type 2 infection in vitro and in vivo. BMC Vet Res. 2017;13(1):59. doi:10.1186/s12917-017-0976-9
Pertile TL, Karaca K, Sharma JM, Walser MM. An antiviral effect of nitric oxide: inhibition of reovirus replication. Avian Dis. 1996;40(2):342-348.
Ritz T, Werchan CA, Kroll JL, Rosenfield D. Beetroot juice supplementation for the prevention of cold symptoms associated with stress: A proof-of-concept study. Physiol Behav. 2019;202:45-51. doi:10.1016/j.physbeh.2019.01.015
Sandbakk, Silvana Bucher, et al. “Effects of Acute Supplementation of L-Arginine and Nitrate on Endurance and Sprint Performance in Elite Athletes.” Nitric Oxide: Biology and Chemistry, vol. 48, Aug. 2015, pp. 10–15. PubMed, doi:10.1016/j.niox.2014.10.006.
Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. March 2020. doi:10.1007/s00134-020-05985-9
Zirk-Sadowski J, Masoli JA, Delgado J, et al. Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults. J Am Geriatr Soc. 2018;66(7):1332-1338. doi:10.1111/jgs.15385