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Ketone Esters to assist body composition optimization

Protocol for optimizing nitric oxide bioavailability.

The primary pathway to generate nitric oxide is the nitric oxide synthase enzymes which utilize arginine. However, as we age, there is a reduction in nitric oxide synthase gene expression and a reduction in function of the nitric oxide synthase enzymes. This results in reduced bioavailability of nitric oxide.

Nitric oxide is critical for arterial health, mitochondrial health, immune system function, and balancing inflammation and oxidative stress. Optimizing nitric oxide availability can improve arterial health, mitochondrial function, blood pressure, sexual function, exercise performance, and immune system function.

Between the ages of 40 and 50, approximately 50% of people will experience impairment in their nitric oxide synthase enzymes. Over the age of 50, 85% of people will have impaired nitric oxide synthase enzymes. When the nitric oxide synthase system is biochemically decoupled, it can no longer create nitric oxide from arginine. In addition, if someone is using arginine or citrulline to try and front load the system, they will create superoxide instead of nitric oxide which increases oxidative stress.

The nitric oxide synthase genes can be evaluated to identify polymorphisms that impact overall robustness. Some individuals will need nitric oxide support at a younger age depending on their specific gene polymorphisms.

There is an additional pathway to improve nitric oxide bioavailability. This pathway involves taking dietary nitrates and converting them into nitrites which can then be used to create nitric oxide. If the body has an adequate nitrite reserve, it can continue to produce nitric oxide when needed.

If the NOS system has been decoupled, optimizing the nitrate to nitrite pathway can result in recoupling the NOS system and improving the availability of nitric oxide via that pathway.

You can assess nitrite status with a salivary test. If the individual is depleted, you can use nitrates to optimize this pathway. It’s important to note that individuals under age 40 may have a normal functioning NOS system and not need additional support. Presumably, they can still use arginine and citrulline supplementation to improve NO production for exercise. However, over the age of 40, it is most likely beneficial to make sure you have adequate nitrites in case the NOS system is not functioning as well.

It would be great if we could get the nitrates we need from our diet. However, it’s not possible at this time. Nitrate-rich foods include spinach, arugula, bok choy, and other dark leafy greens, as well as beets. You could get the nitrates by eating inorganic versions of these foods, but you’re also going to get a lot of toxicants which is not good for your health. If you choose organic versions of these foods, the lack of nitrogen-rich fertilizer results in a low nitrate concentration.

Therefore, the best way to optimize the nitrate to nitrite pathway is through supplementation.

One option is the nitrate capsules produced by Berkeley Life. These are long-acting capsules that contain approximately 500 milligrams of nitrates from spinach and beet sources. They work very well and are easy to take. The protocol is to take two capsules twice a day until you test at target. After that, you take two capsules once a day for maintenance. It can take two to three weeks to build up the nitrite reserve needed to test at target.

Another option is the Bionox products which include beet-based lozenges and a greens-based powder with nitrates. The lozenges work well, but they’re short-acting. You would have to use them multiple times a day to maintain adequate nitrite reserve. The greens powder works well, but the dose of nitrates is not as high as that of the Berkeley Life products.

I’ve included links to both companies at the bottom of this document. Most of my patients choose to use the Berkeley Life capsules, and they are typically able to reach target levels and maintain target levels with consistent use of two capsules daily. However, individuals can experiment with the Bionox products and dietary nitrate sources and monitor their response. The main thing is that they get to target and stay at target.

It’s also important to optimize glutathione status. You need optimized glutathione availability, nitric oxide availability, and thioredoxin availability. These all work in concert to maintain an optimal functioning human system.

There are different ways to try and improve glutathione availability. The primary method is to supplement with N-acetylcysteine, glycine, and making sure you’re meeting your selenium requirement. Whole food vitamin C is also important. However, as we age, this may not be sufficient. Liposomal glutathione works well, but it is consumed very quickly, and therefor, not effective for chronic oxidative stress issues. It can be helpful for focused use such as travel or when consuming alcohol.

Glutaryl is a patented topical nano glutathione product that works very well. It is applied to the skin and absorbs within 45-60 minutes. Glutaryl may maintain glutathione levels in the bloodstream for four to six hours for each application. This is probably the most effective way to optimize glutathione availability. This is my preferred method if someone is dealing with significant inflammation, autoimmune diseases, or infections. It is also my preferred method for those over age 40. If you choose to utilize the topical glutathione, you do not need to use N-acetylcysteine. However, it’s still important to get adequate amounts of glycine, overall protein, selenium, and whole food vitamin C.

The links I’m providing for these products are affiliate links. I’m sharing this information because I believe it’s important, not because I’m trying to get people to purchase through my links. Berkeley Life only works through physician links, so the product cannot be ordered directly by consumers. I have negotiated discounts with the providers of these resources. Again, I’m sharing this information because of how important it is for the health of our population. I am not trying to get people to buy products through my links.

Finally, remember, regardless of age, if someone is experiencing poor metabolic health or excess body weight, their NOS pathway is likely decoupled and not working effectively. In order to improve their metabolic health and lose weight, it is important to provide resources for nitric oxide and glutathione.


Berkeley Life links for testing strips and capsules

Practitioners Code: GVIC01

Discount Code: drvick10

Auro Wellness link for Glutaryl

Discount code  auro15