I Feel the Need, the Need for Nitric Oxide
Erectile dysfunction (ED) is a complicated condition involving many factors. Dozens of internal compounds and chemicals can influence your penile health and also impact other areas of your body.
One of those compounds is nitric oxide (NO). Keeping your NO levels healthy is a proven way to help prevent and treat ED.
"Nitric oxide appears to have a role in not only erectile dysfunction but also cardiovascular health and lung health," said Michael Ingber, M.D., a board-certified urologist with Garden State Urology in New Jersey.
What is nitric oxide?
Nitric oxide is a gas and a free radical, an unstable molecule that is a byproduct of chemical changes in a cell. NO has many functions in the body, such as dilating blood vessels, acting as a neurotransmitter, and relaxing the smooth muscles in the body's vascular system, including those in the penis.
Keeping your nitric oxide levels healthy is a proven way to help prevent and treat ED.
"[NO] is important for erection health because NO signals the surrounding vascular smooth muscle to relax, resulting in vasodilation and increased blood flow to the penis," said Josh Gonzalez, M.D., a sexual health and urology specialist with a clinic in Los Angeles.
Farah Naz Khan, M.D., an endocrinologist at the UW Medicine Diabetes Institute in Seattle and a writer for Fitness Savvy, explained further: "By dilating the inner muscles of the vessels [in the penis], it widens up the vascular lumen so that blood can easily flow through them."
NO's role in erection health
Nitric oxide's key part in the circulatory system means it also has a major influence over your ability to get hard.
"Penile erection is a parasympathetic reaction. It occurs when NO relaxes the penile corporal cavernosal smooth muscles, increasing the blood flow and [resulting in a] subsequent erection," Khan said.
NO helps your body stay relaxed enough for your penis to get erect. High levels of stress and anxiety can mess with your sexual response, and therefore interfere with erections.
"Without nitric oxide, erections wouldn't exist," said Sarah Melancon, Ph.D., a sociologist and clinical sexologist at SexToyCollective.com. "Healthy levels of nitric oxide lead to erections, vaginal engorgement and lubrication, and appear to also play a role in ejaculation."
How to maintain healthy NO levels
Since NO plays a vital role in erections, maintaining healthy levels can potentially aid or prevent ED. Medical professionals agree the best way to do this is to take care of your overall well-being.
"In general, take care of yourself: mind, body, emotions and spirit," Melancon said. "Keep your stress levels low and your fun, social connection and pleasure levels high."
Exercising regularly and eating healthy foods are the two most important steps you can take to maintain good NO levels. Regular exercise stimulates the endothelial cells of the blood vessels to release more nitric oxide, which dilates vessels for more blood flow, according to Khan. Focus on any kind of cardio exercise, such as running, swimming or biking.
Make sure your diet is high in fruits, vegetables and antioxidants, Gonzalez said. All of those, in concert with regular cardiovascular exercise, increase nitric oxide levels. If you want to follow a structured eating plan, the Mediterranean diet has been shown to help men with erectile function.
Additionally, try to avoid or limit substances that conspire to decrease nitric oxide levels, such as cigarettes, alcohol and many recreational drugs, Melancon said.
How you can get NO in your body
If you lack NO, supplements such as L-citrulline, L-arginine and citrulline malate can help increase NO levels in the body. Keep in mind, however, that supplements are not regulated or tested by the U.S. Food and Drug Administration, so the market is always a buyer-beware situation.
If you're leery of supplements, you don't have to take a pill to get L-citrulline, L-arginine and citrulline malate into your body. Ingber advises eating foods such as pomegranate, beets and beetroot, and green leafy vegetables like kale, all of which are rich in these compounds.
Before you buy a bunch of supplements or raid the produce aisle at your local grocery store, be careful about having too much NO in your system. Khan said the side effects of ingesting too much NO include:
- Headache
- Dizziness
- Confusion
- Low blood pressure
- Increased heart rate
- Breathlessness
- Tightness in chest
- Dark urine
- Unusual bleeding/bruising
- Blurred vision
You should always ask your doctor before adding new supplements to your regimen, because they can interfere with medications or exacerbate preexisting conditions.
Can you determine your NO levels?
Nitric oxide has a half-life of just a few seconds, so it can be challenging to measure how much is in your body to determine whether you have an adequate level or you're deficient and need supplements.
Gonzalez said there's no reliable blood test for measuring NO. One proven way is something not everyone needs but could potentially use.
"Asthma testing involves an exhaled nitric oxide test, where air is exhaled and the levels of nitric oxide are recorded," Melancon said.
NO's role in regulating your circulatory system means it's crucial to your penile health. Knowing how to maintain healthy levels of this compound will not only improve your sex life, but also lead to other important health benefits.
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