Scientific Appraisal of Men’s Health Magazine’s Article: “Here’s the Truth About Nitric Oxide Supplements”

Men’s Health balances credible Information with hollow claims, but the message lands flat due to an inconsistent message.

Men’s Health Magazine may be a go-to source for the latest health and wellness trends for men, but maybe you should not expect fully accurate appraisal of the science when reading their articles. Let’s break down one of their piece on nitric oxide supplements to see what they get right and where they should have left the experts to do more of the talking.

I’ll leave out any further mention of the poor editorial oversight in this article.  Repeated words, the use of “nitric” and “nitrous” interchangeably, and unclear sentence structure suggest right off the back that this article was hastily written. Look deeper into the contradictory statements and the lack of fact checking, and you’ll start to see the deeper flaws in the reporting on this topic.

Is there anything you can trust in this article???

Let’s go line by line through each factual issue the Resync team noticed from an off-hand reading of this article. This may seem painstaking, but trust me, once you see how the authors laid a poor foundation in the beginning, you’ll see that the whole house of cards falls.

 

1. "If you're ingesting nitrate or L-arginine, the idea is that it's supposed to stimulate the synthesis of nitric oxide in the endothelial cell. So the more substrates there are, the more NO can be produced," explains Jenkins.

 

The act that the author’s use a reputable source, Professor Nathan Jenkins, hides the seemingly harmless omission of specific data that leaves you, the reader, with a misconception right off the back. The first sentence, that taking NO boosters is hypothetically meant to increase NO levels, is true. How could it not be?

The second line though, is true in some cases but not others. Of the many ways that your body is able to make nitric oxide, amino acid substrates like L-arginine and L-citrulline, and natural inorganic nitrate sources get the most attention in the supplement industry.  The problem with saying that “the more substrates there are, the more NO can be produced”, is that it hides the fact that your body makes NO from these sources in different ways.

Making NO from amino acids is an enzymatically rate-limited step.  What does that mean? Just because you pump more L-arginine into your system, doesn’t mean you’re going to see higher NO levels and a greater pump in your workout. In fact, when using L-arginine, levels cap out relatively quickly. Using L-citrulline is a way around this, as your body is able to hold onto L-citrulline better than L-arginine, but it still has to be converted to L-arginine and then on to nitric oxide, and thus it is still subject to the same limited rate of conversion that L-arginine is.

Inorganic nitrates on the other hand, do not appear to be enzymatically rate-limited in the same way. Nitrates are reduced to nitrites by your gut bacteria, and then they’re turned into nitric oxide via a number of different enzymatic and non-enzymatic steps.

What does this mean for you? If you take an amino acid based nitric oxide booster, you might experience some nitric oxide boost, but overall it’s a limited process. Boost your nitric oxide with nitrates, however, and you'll be able to get a real nitric oxide boost that matches the dose you take.

 

2. "OK, but do nitric oxide supplements actually work? Honestly, we don't really know. There's simply not enough evidence to suggest that they do.

 

Not enough evidence, eh? The search terms: "Nitric oxide" and (nitrates or arginine or citrulline) produce more than 44,000 results in pubmed, the principal source for reputable biomedical research in the U.S. and the world. Select clinical trials done in humans, and you’ve still got more than 1500 results. Narrow it down even further to performance applications, and you’ve still got almost 486 research studies (as of July 7, 2020) to look at. You don’t have to spend the next year reading every one of those articles to know that there’s no lack of evidence on this topic.

  

3. "[The idea is that these supplements] will increase NO, and then because of that, it'll cause vasodilation, and then the downstream effect of vasodilation would be this massive increase in blood flow, which leads to increased exercise performance and enhanced recovery," says Richard Bloomer, Ph.D., dean of the School of Health Studies and The Center for Wellness and Fitness at the University of Memphis. "But most, if not all, of [these purported benefits] have not been supported by available evidence."

 

With all due respect to professor Bloomer, a collaborator with Resync on one of our recent research studies, we see ample evidence humans that each step in this process works as suspected. The most recently published study on Resync products showed that, indeed, Resync causes a massive increase in nitrate in your blood. Then, we know that nitrate is converted to nitrite by gut and mouth bacteria and then to nitric oxide. Following on that, supplements that actually do boost nitric oxide then cause vasodilation, hence their blood pressure lowering effect. The caveat here is that you only see the vasodilating, blood pressure lowering effect when looking at people with baseline high blood pressure or when you’re looking at someone’s blood pressure during exercise, especially anaerobic exercise. Then there are so many research studies showing that nitrates can help increase endurance exercise performance and enhance recovery that we’ll link to a review article with 79 references by a leader in the field, Dr. Andy Jones, rather than list out every one of them. These and hundreds of other studies clearly show that nitrates most likely work the way we think they do in performance applications.

 

4. "A review of 42 studies related to the effects of dietary ingredients linked with NO and exercise performance found mixed results: the review concluded that while NO supplements may "improve tolerance" to aerobic and anaerobic exercise in people who either aren't in shape or are moderately trained, there seems to be no benefit in highly trained people." (review linked here)

 

 This is a clear misrepresentation of the science. “Improve tolerance” is the simple way of saying “increases the ventilatory threshold”, which means that you can do more work using less oxygen. This phenomenon has been seen in people with heart disease, sub-elite athletes, and most people in between.

As can be seen in the lively discussion among researchers, coaches, and athletes on the benefits of nitric oxide among the world’s best athletes, the message that “there seems to be no benefit in highly trained people” is not so clear cut as the authors make it seem.  Some research shows benefits and some show no benefit of a nitrate supplement in elite athletes; there is no consensus.

Besides that, according to the author’s definition, who really falls into the category of highly trained people? Not anybody reading Men’s Magazine, that’s for sure! Elite refers to olympic and other world-class athletes. So even if you’re a nationally-ranked athlete or perform well in your regional tournaments, it stands to reason that you’re probably still going to benefit from a quality nitrate supplement.

  

5. “Beets are the highest dietary source of nitrates, which are converted into nitric oxide in the body."

 

Wrong. So wrong.

I’ll take care of this fallacy alongside all the other references to which vegetables weigh in as heavyweight nitrate sources. The authors state elsewhere that, “"[nitrate] is also found in leafy greens and other vegetables, just in smaller amounts" and "As for vegetables with the highest nitrite content, beets are top of the list, as well as celery, chard, watercress, lettuce, spinach, and arugula. The next group with the greatest amount includes cucumber, celeriac, Chinese cabbage, endive, fennel, kohlrabi, leeks, and parsley."

All of these statements are wrong. Red spinach extract made from red spinach leaf (also known as amaranth) is by far the most concentrated source of natural inorganic nitrates. Here’s our list, crafted from reading actual research articles (here, here, here, and here), not just hearsay. 

Although sources differ in the exact content, and food sources are immensely variable and unstandardized nitrates, the very best whole-food nitrate sources are:

 

1. Red Spinach Extract made from red spinach leaf (a type of amaranth)

2. Arugula

3. Spinach, the regular kind

4. Bok Choy

5. Rhubarb

6. Beet Juice (too bad it’s not consistent)

7. Cilantro & Parsley, but you probably don’t eat all that much at a time...

8. Lettuce, the red leafy kind (sorry no iceberg here)

9. Carrots and carrot juice

10. Basil

11. Spring greens

12. Beet Greens

13. Collard greens, just not with bacon unfortunately

14. Chinese Cabbage

15. Chard

16. Cole (aka cabbage and kale)

17. Beetroot

18. Fennel

19. Leek

20. Aronia berry (aka chokeberry)

 

 

 

 

Looks like there are better options than beets or beet juice out there; that’s one reason why we made Resync in the first place. Beets are not that great of a source, and beet juice supplements are notoriously variable (not to mention their exceedingly high sugar content). That’s why we use combinations combinations of nitrate sources that are standardized to a minimum level of nitrate like the one in red spinach, and we combine them with red beets, and aronia berries. 

 

6. "That said, if you're prone to hypotension (or low blood pressure), you might want to skip them, as they could leave you feeling lightheaded or dizzy." 

 

At last, some bit of information that is spot on. If you take a nitrate supplement and experience light headedness or dizziness, consider taking a smaller dose and talk with your healthcare provider about your symptoms. Alternately, if this a problem you experience, you might get some success avoiding taking it on an empty stomach.

 

7. "Jenkins also notes that high dosages of NO supplements could put your kidney function at risk, particularly if you already have a nitrate-heavy diet. In such cases, "it might actually cause a reduction in performance, because your kidneys are stressed out and trying to process all this extra nitrate," says Jenkins. To be on the safe side, don’t take anything more than what’s instructed on the package." 

 

We had to dig into the research to get to the bottom of this statement. We had never heard of this, and we love reading research!

The source of this statement appears to be in the association of nitric oxide levels with advanced liver disease combined with lowered kidney function.  While nitric oxide was being considered as a marker for liver function, kidney function was also associated with increased nitric oxide, suggesting that there may be an association. That said, an association is no grounds for causation - this was just an exploratory study in very, very sick patients.

Alternately, that statement might just be referring to the sodium in synthetic sodium nitrate supplements. That’s why Resync never uses artificial fillers, that, it turns out, don’t even work as well as whole-food sources.

In fact, studies that give nitric oxide boosters to patients and measures their kidney function show that if anything, supplemental nitric oxide may IMPROVE kidney function in patients with high blood pressure and chronic kidney disease.

Before you start downing scoop on scoop of nitric oxide boosters, there are some negative consequences of getting too much nitrate. We recommend staying within a sensible range, one or two servings of Resync Recovery has been shown safe in multiple research studies.

That said, we haven’t read every single article out there. If you know of an instance where natural nitrates actually did hurt the kidneys, let us know - we’d love to hear about it!

 

8. "Most notably, beetroot juice is full of nitric oxide, and there is research to show that drinking it before competition can help with performance."

 

Did I mention that different beetroot juices are so variable in their nitrate content? Check out this research study to see how some of the most popular sources stack up to one another. Don’t gamble on what’s in your beet juice, and choose a quality certified and tested supplement like Resync Recovery.

  

9. "Regular use of antibacterial mouthwash actually kills the bacteria that aid in production of nitric oxide from nitrates" And…

 

Another thing the authors got right! In addition, using antacids like the PPI omeprazole impairs nitric oxide. Older age, sedentary lifestyle, obesity, chronic kidney disease, inflammatory lung disease (e.g. asthma, COPD), hypertension, and almost all kinds of heart disease, plus, being male all lower nitric oxide levels.

  

10. "The research on beet juice and beet powder shows the best success in improving exercise performance and heart health with daily consumption of at least 2 weeks, explains Jones."   

 

This is probably your best strategy, just to give you some wiggle room.  Keep in mind though, that some studies show that you can get a benefit in just 3 days. It probably depends on your individual nitric oxide metabolism, so experiment and see what works for you.  For blood pressure lowering effects, it may be best to take it continuously to get the constant benefit.

There you go, 7 fundamental flaws and 3 things the authors got partially right. Men’s health offers some easy reading and some interesting opinions, but if you’re looking for a truly objective, and evidence-based source for supplement science, we recommend that you spend a little bit more time viewing the actual scientific facts before you draw your conclusions. 

Check out our blog, where we take a hard look at the science of supplementing and discuss it in an easy to understand way.