5 Health Benefits of Nitric Oxide Supplements: Boost Performance and Wellness

Nitric oxide supplements have surged in popularity among health enthusiasts, athletes, and those seeking natural ways to improve cardiovascular health and physical performance. These supplements work by increasing the body’s production of nitric oxide, a crucial molecule that plays a vital role in numerous physiological processes.

Understanding how nitric oxide supplements work and their potential benefits can help you make informed decisions about incorporating them into your wellness routine. This comprehensive guide explores the science-backed health benefits of nitric oxide supplements and what you need to know before taking them.

What Is Nitric Oxide and Why Does It Matter?

Nitric oxide is a naturally occurring molecule produced by nearly every cell in the human body. It functions as a vasodilator, meaning it relaxes and widens blood vessels by relaxing the inner muscles of the vessel walls. This process is critical for maintaining healthy blood flow and regulating blood pressure.

The discovery of nitric oxide’s role in cardiovascular health was so significant that it earned researchers a Nobel Prize in Physiology or Medicine in 1998. Since then, scientific understanding of this molecule has expanded considerably, revealing its importance in various bodily functions beyond cardiovascular health.

While your body produces nitric oxide naturally, various factors can reduce production, including aging, poor diet, lack of exercise, and certain health conditions. This is where nitric oxide supplements come into play.

How Nitric Oxide Supplements Work

Nitric oxide supplements don’t actually contain nitric oxide itself because the molecule is a gas that’s unstable outside the body. Instead, these supplements contain precursor compounds that your body converts into nitric oxide. The most common ingredients include:

• L-arginine: An amino acid that serves as a direct precursor to nitric oxide
• L-citrulline: An amino acid that converts to L-arginine in the kidneys, then to nitric oxide
• Nitrate: Found in beetroot and leafy greens, converts to nitric oxide through a different pathway
• Plant extracts: Such as French maritime pine bark extract, which may enhance nitric oxide production

Now let’s explore the five key health benefits supported by scientific research.

1. Supports Treatment of Erectile Dysfunction

Erectile dysfunction (ED) affects millions of men worldwide and is characterized by the inability to achieve or maintain an erection sufficient for sexual intercourse. Nitric oxide plays a crucial role in erectile function because it’s essential for the relaxation of smooth muscles in the penis, allowing blood flow into the chambers that create an erection.

The L-Citrulline Connection

L-citrulline has shown promise in supporting men with mild to moderate erectile dysfunction. A study published in the journal Urology examined 24 men with mild ED who took L-citrulline supplementation. The results showed improvements in erection hardness and increased satisfaction with sexual intercourse.

Unlike prescription medications that work directly on specific enzymes, L-citrulline works by increasing the body’s natural nitric oxide production. While it may be less potent than pharmaceutical options, L-citrulline demonstrated a favorable safety profile with minimal side effects.

L-Arginine and Pine Bark Extract Combination

Research has also examined combinations of L-arginine with French maritime pine bark extract (Pycnogenol). Multiple studies have found that this combination may help improve sexual function in men experiencing ED. The pine bark extract appears to work synergistically with L-arginine to enhance nitric oxide production and improve blood flow.

If you’re considering nitric oxide supplements for erectile dysfunction, it’s essential to consult with a healthcare provider first. ED can sometimes signal underlying cardiovascular issues that require medical attention, and a doctor can help determine the most appropriate treatment approach for your situation.

2. May Reduce Muscle Soreness After Exercise

Delayed onset muscle soreness (DOMS) is a common experience among both athletes and casual exercisers. This discomfort typically peaks 24-72 hours after intense or unfamiliar physical activity and can interfere with subsequent training sessions and daily activities.

Citrulline Malate for Muscle Recovery

Citrulline malate, a specific form of L-citrulline bound to malic acid, has been studied for its potential to reduce muscle soreness. The proposed mechanism involves increased blood flow to working muscles, which may enhance nutrient delivery and accelerate the removal of metabolic waste products like lactate and ammonia that contribute to muscle fatigue and soreness.

In one notable study, participants who took 8 grams of citrulline malate before performing bench press exercises reported 40% less muscle soreness at 24 and 48 hours post-exercise compared to those who received a placebo. The supplement also enabled participants to perform more repetitions during their workout.

Mixed Research Results

However, it’s important to note that research on citrulline malate for muscle soreness has produced mixed results. Some studies focusing on lower-body exercises haven’t found the same benefits, and a systematic review of multiple studies showed that while citrulline may reduce muscle soreness at 24 and 48 hours, effects at 72 hours were less consistent.

The effectiveness may depend on several factors, including:

• Dosage and timing of supplementation
• Type and intensity of exercise performed
• Individual variation in response to the supplement
• Training status and adaptation level

More research is needed to establish optimal protocols for using citrulline malate to manage muscle soreness.

3. Helps Lower Blood Pressure

High blood pressure, or hypertension, affects nearly half of American adults and is a major risk factor for heart disease, stroke, and kidney disease. Research suggests that people with hypertension may have impaired nitric oxide production or utilization, contributing to reduced blood vessel flexibility and elevated blood pressure.

Dietary Nitrate and Blood Pressure

One of the most well-researched approaches to increasing nitric oxide involves dietary nitrate, particularly from beetroot juice and leafy green vegetables. When you consume nitrate, bacteria in your mouth convert it to nitrite, which is then converted to nitric oxide in the blood vessels and tissues.

Numerous studies have demonstrated that nitrate supplementation can lower blood pressure. A comprehensive review of 43 studies found that beetroot juice consumption reduced systolic blood pressure by an average of 3.55 mmHg and diastolic blood pressure by 1.32 mmHg. While these numbers may seem modest, even small reductions in blood pressure at the population level can significantly reduce cardiovascular disease risk.

Another systematic review focusing on older adults found that nitrate supplementation produced meaningful reductions in both systolic and diastolic blood pressure, which is particularly relevant since blood pressure tends to increase with age.

Flavonoids and Vascular Health

Flavonoids are plant compounds found abundantly in fruits, vegetables, tea, and cocoa. These antioxidant-rich compounds may support nitric oxide production and reduce its breakdown in the body, potentially contributing to healthier blood pressure levels.

Research on flavonoids and blood pressure has shown promising but somewhat mixed results. Some large observational studies have found associations between higher flavonoid intake and reduced risk of hypertension. However, intervention studies have produced varied outcomes, with some showing modest benefits and others showing no significant effects.

The inconsistency may relate to differences in flavonoid types, dosages, study populations, and baseline blood pressure levels. Overall, consuming a diet rich in flavonoid-containing foods appears to be a sensible approach for supporting cardiovascular health.

Important Considerations

If you have high blood pressure or are taking blood pressure medications, consult your healthcare provider before starting nitric oxide supplements. These supplements could potentially interact with blood pressure medications, and your doctor may need to adjust your treatment plan accordingly.

4. Enhances Exercise Performance

Athletes and fitness enthusiasts have shown considerable interest in nitric oxide supplements as potential ergogenic aids—substances that can enhance physical performance. The theoretical basis is compelling: by widening blood vessels, nitric oxide could increase oxygen and nutrient delivery to working muscles while accelerating waste removal.

Nitrate Supplementation and Athletic Performance

Dietary nitrate, particularly from beetroot juice, has emerged as one of the most effective nitric oxide precursors for improving exercise performance. Research has shown benefits across various athletic disciplines:

• Endurance performance: Studies in cyclists and runners have found that nitrate supplementation can improve time trial performance and time to exhaustion
• High-intensity intermittent exercise: Team sport athletes may benefit from enhanced repeated sprint ability
• Exercise efficiency: Nitrate supplementation may reduce the oxygen cost of exercise, allowing athletes to perform at a given intensity with less physiological strain

The performance benefits appear most pronounced in recreational athletes and those performing submaximal exercise. Elite athletes may experience smaller benefits, possibly because they already have highly efficient cardiovascular systems.

L-Citrulline for Performance

L-citrulline supplementation has also shown promise for enhancing exercise performance, though the evidence is somewhat less consistent than for nitrate. Some studies have found that L-citrulline can improve resistance training performance, increase time to exhaustion during endurance exercise, and enhance recovery between exercise bouts.

The typical effective dosage ranges from 6-8 grams of L-citrulline taken 60-90 minutes before exercise. Citrulline malate is often preferred over L-citrulline alone, though both forms appear effective.

L-Arginine: Less Effective for Performance

Despite being a direct precursor to nitric oxide, L-arginine has generally not proven effective for enhancing exercise performance in research studies. The likely reason is that much of the L-arginine consumed orally is broken down in the digestive system and liver before reaching the bloodstream in sufficient quantities to increase nitric oxide production.

This is why L-citrulline has largely replaced L-arginine in sports nutrition products—citrulline bypasses this first-pass metabolism and more effectively raises blood arginine and nitric oxide levels.

5. May Support Type 2 Diabetes Management

Type 2 diabetes is characterized by insulin resistance and impaired blood sugar control, affecting over 37 million Americans. Research indicates that people with type 2 diabetes often have reduced nitric oxide production, which contributes to the vascular complications commonly associated with the condition.

Nitric Oxide and Insulin Sensitivity

Nitric oxide plays important roles in glucose metabolism and insulin action. It helps regulate blood flow to muscles and tissues, facilitating glucose uptake. It also appears to directly influence insulin signaling pathways within cells.

A systematic review of studies examining L-arginine supplementation found that it could improve insulin sensitivity in some populations. One randomized controlled trial followed 144 people with impaired glucose tolerance—a pre-diabetic state—and found that L-arginine supplementation improved insulin sensitivity and blood sugar control, though it didn’t prevent progression to diabetes.

Inconsistent Evidence

However, research on L-arginine and other nitric oxide-boosting supplements for diabetes has produced inconsistent results. Some studies have found benefits for blood sugar control and insulin sensitivity, while others have found no significant effects or only modest improvements.

These mixed findings suggest that nitric oxide supplements shouldn’t be considered a standalone treatment for diabetes. Instead, they might serve as a complementary approach alongside established diabetes management strategies including:

• Dietary modifications emphasizing whole foods and controlled carbohydrate intake
• Regular physical activity
• Weight management
• Medical treatment as prescribed by a healthcare provider
• Regular blood sugar monitoring

If you have diabetes or pre-diabetes and are interested in nitric oxide supplements, discuss this with your healthcare team. They can help you integrate supplements safely with your current treatment plan and monitor for any effects on blood sugar control.

Potential Side Effects and Safety Considerations

Nitric oxide supplements are generally considered safe for most people when taken at appropriate dosages. However, as with any supplement, there are potential side effects and precautions to be aware of.

Common Side Effects

Most side effects from nitric oxide supplements are mild and dose-dependent:

• Gastrointestinal distress: High doses of L-arginine (above 10 grams) may cause stomach discomfort, nausea, or diarrhea
• Urine and stool discoloration: Beetroot-based supplements commonly cause harmless red or pink discoloration of urine and stool, which can be alarming if unexpected but is not medically concerning
• Low blood pressure: Since nitric oxide lowers blood pressure, excessive supplementation could potentially cause blood pressure to drop too low, leading to dizziness or lightheadedness

Who Should Exercise Caution

Certain groups should be particularly cautious with nitric oxide supplements:

• People taking blood pressure medications: Nitric oxide supplements could enhance the blood pressure-lowering effects of medications, potentially causing hypotension
• Those scheduled for surgery: Some healthcare providers recommend discontinuing L-arginine supplements at least two weeks before surgery as it may affect blood pressure control during and after procedures
• People with kidney disease: High protein intake, including amino acid supplements, may stress impaired kidneys
• Individuals with herpes virus: L-arginine may potentially trigger herpes outbreaks in susceptible individuals, as the virus requires arginine to replicate

Quality and Purity Concerns

The dietary supplement industry is less strictly regulated than pharmaceuticals, which means product quality can vary significantly between brands. When choosing nitric oxide supplements, consider:

• Looking for products that have been third-party tested for purity and potency
• Choosing reputable brands with transparent manufacturing practices
• Checking for certifications from organizations like NSF International, USP, or Informed-Sport
• Being wary of products making exaggerated or unsubstantiated claims

Choosing the Right Nitric Oxide Supplement

With numerous nitric oxide supplements on the market, selecting the right one can be challenging. Here are factors to consider based on your specific goals:

For Blood Pressure Support

Beetroot powder or beetroot juice supplements providing at least 300-500 mg of nitrate have the strongest evidence for blood pressure benefits. Look for products that standardize nitrate content.

For Exercise Performance

Either beetroot supplements (with standardized nitrate) or L-citrulline/citrulline malate (6-8 grams) taken 60-90 minutes before exercise appear most effective. Some pre-workout supplements combine multiple nitric oxide precursors.

For Erectile Dysfunction

L-citrulline (typically 3-6 grams daily) or combinations of L-arginine with pine bark extract have shown promise in research, though effects may take several weeks to manifest. Medical consultation is strongly recommended for persistent ED.

For General Cardiovascular Health

A combination approach including nitrate-rich foods (leafy greens, beetroot), along with moderate supplementation if desired, appears most sensible for general health maintenance.

Natural Ways to Boost Nitric Oxide

While supplements can be helpful, several lifestyle approaches can naturally enhance your body’s nitric oxide production:

Dietary Strategies

• Consume nitrate-rich vegetables: Arugula, spinach, kale, beetroot, and celery are excellent sources
• Eat antioxidant-rich foods: Antioxidants help protect nitric oxide from degradation, so consume plenty of berries, dark chocolate, and colorful fruits and vegetables
• Include L-citrulline-rich foods: Watermelon is a natural source of L-citrulline
• Don’t use antiseptic mouthwash excessively: Beneficial oral bacteria play a crucial role in converting dietary nitrate to nitrite, a process disrupted by antibacterial mouthwash

Lifestyle Factors

• Exercise regularly: Physical activity stimulates nitric oxide production in blood vessel walls
• Maintain a healthy weight: Obesity is associated with reduced nitric oxide availability
• Limit alcohol consumption: Excessive alcohol can impair nitric oxide production
• Manage stress: Chronic stress and elevated cortisol may reduce nitric oxide levels
• Get adequate sleep: Poor sleep quality is associated with endothelial dysfunction and reduced nitric oxide
• Spend time in sunlight: UV exposure on skin can trigger nitric oxide release from skin stores

The Bottom Line

Nitric oxide supplements offer several evidence-based health benefits, particularly for cardiovascular health, exercise performance, and blood pressure management. The most effective supplements include L-citrulline, dietary nitrate (from beetroot), and certain combinations like L-arginine with pine bark extract.

However, supplements work best as part of a comprehensive approach to health that includes a nutritious diet rich in vegetables, regular physical activity, adequate sleep, and stress management. They should complement, not replace, these fundamental lifestyle factors.

Before starting any new supplement regimen, especially if you have existing health conditions or take medications, consult with a healthcare provider. They can help you determine whether nitric oxide supplements are appropriate for your situation and guide you on proper dosing and potential interactions.

With proper use and realistic expectations, nitric oxide supplements may serve as a valuable tool in supporting your health and performance goals. The key is choosing quality products, following evidence-based dosing guidelines, and integrating supplementation into an overall healthy lifestyle.

Sources:

• National Institutes of Health – Nitric Oxide and Blood Vessel Health
• NIH – Nitric Oxide as Vasodilator
• NIH – Erectile Dysfunction Overview
• PubMed – L-Citrulline and Erectile Function
• PubMed – L-Citrulline Study on Erectile Dysfunction
• PubMed – Delayed Onset Muscle Soreness
• PubMed – Citrulline Malate and Muscle Soreness
• NIH – Citrulline Malate Mechanisms
• NIH – Nitric Oxide and Hypertension
• PubMed – High Blood Pressure and Heart Disease
• PubMed – Diet and Blood Pressure
• NIH – Dietary Nitrate Sources
• PubMed – Nitrate Supplements and Blood Pressure in Older Adults
• PubMed – Beetroot Juice and Blood Pressure
• PubMed – Nitrate and Exercise Performance
• NIH – Nitric Oxide and Type 2 Diabetes
• PubMed – L-Arginine and Insulin Sensitivity
• PubMed – L-Arginine in Diabetes Prevention
• PubMed – Safety of Nitric Oxide Supplements