Pipette adding fluid to one of several test tubes

Nitric Oxide Test Strips: Interview with Dr. Bryan

All us middle-aged and senior men owe Dr. Nathan Bryan of Neogenis a lunch or two.  Dr. Bryan came up with an inexpensive saliva test to measure my second most favorite molecule – nitric oxide.  (Yes, testosterone is #1.)

I’ve had a lot of fun, being a certified health geek, using the strips and have found them to be quite revealing and accurate. I get emails and forum posts quite often from men wondering if their erectile dysfunction problems are testosterone-related or nitric oxide-related. Of course, testing for testosterone is only a blood draw away and now, thanks to Dr. Bryan, you can easily check your NO levels as well. (Amazon now carries these as Nitric Oxide Diagnostic Test Strips for those interested.)

Of course, when you use the strips on a regular basis, a number of practical questions come to mind.  Dr. Bryan was gracious enough to answer some of these for me below:Q. These work by measuring the nitrate on the tongue, right?

The strips measure nitrite and nitric oxide in the saliva, not nitrate.

Q. Are there any cases where this will not translate as well to your actual cardiovascular nitric oxide levels? In other words, are theire circumstances where a saliva test would not correspond to actual plasma levels?

Yes, we have found that in cases of severe periodontal disease and active infections in the mouth, the saliva test does not translate well into actual cardiovascular NO levels but is a result of the infection in the mouth. Interestingly, although salivary levels may be high in this particular case, we have evidence that this overproduction of NO iin the mouth may actually shut down NO production throughout the rest of the body, causing systemic problems from a local oral infection.

Q. What if your nitric oxide levels look good on the test strips and yet your blood pressure is hypertensive? What could this mean?

Hypertension is the result of insufficient NO production throughout the blood vessels in the body. This is referred to as endothelial dysfunction. What we are measuring in the salivary strips is the amount of NO bioactivity that is recycled through the salivary glands. This activity is a reflection of what is produced by the blood vessels and what is consumed through the diet from nitrate rich vegetables. Eating a high nitrate meal such as a spinach salad will cause a temporary increase in salivary nitrite and NO 3-4 hours after the meal. So in this case, although the test strip may indicate normal, this is a short term spike and does not really reflect true steady state levels. That is why we recommend testing after a 6-8 hour fast.

Q. What if someone eats spinach or takes Neo40 and shows up consistently as depleted or low on your test strips an hour or two later? Does this mean a heavily damaged endothelium or could there be other explanations?

This typically means their body is really depleted and deficient in total body NO availability. The conversion of spinach nitrate requires adequate digestion and absorption. People who take proton pump inhibitors, antibiotics and/or antiseptic mouthwash will not be able to properly digest, absorb and utilize the nitrate from spinach to make nitric oxide. What we are measuring in the saliva is what is recycled from what the body has not used. If your body is using all the NO that we provide through the Neo40, there is none to recycle to show up in the saliva. Consider filling up an empty barrel. It takes time to fill the barrel depending on how low the levels was. We only know the barrel is full, when it starts to run over. The runover we are measuring in the body is what shows up in the saliva.

Q. What if your nitric oxide reading is good and you have erectile dysfunction? I assume you’d advise looking for low T, venous leakage, nerve damage, etc.?

More times than not, ED is a result of NO deficiency. However, there are also other causes of ED than just a vascular problem such as anxiety issues, hormonal problems etc that may be unrelated to NO.

Q. Nitric oxide is a fairly volatile molecule? Does this mean you need to test daily for a few days and take a rolling average?

NO has a very short half life but since we are measuring more stable endproducts of NO metabolism, we get a better sense of NO production/availabilty. We recommend testing 1-2 times weekly first thing in the morning for the most accurate readings.Q. I know that most modern toothpastes actually have a rather harsh chemical in them specifically designed to kill the bacteria on teeth. Does this mean that results on the test strips could be skewed after brushing? And do you think that these toothpastes could be somewhat lowering nitric oxide levels by killing the good bacteria in your mouth along with the bad?

Many bacteria on the teeth and tongue are responsible for converting nitrate to nitrite and NO so anything that removes or kills these good bacteria will affect the test strips and NO production. In fact we think this may be the link between oral health and cardiovascular disease.

Q. I know you can improve your nitric oxide during the day through exercise, certain foods and various supplements. But let s say you want to establish a baseline nitric oxide reading to find out your unassisted endothelial function. Would this potentially be a valuable measurement? If so, is first thing in the morning upon waking a good time to do this?

Great question and we are currently attempting to determine how endotheliail function correlates with the salivary test strip. We think this will be a very valuable measurement. The most accurate test is first thing in the morning before brushing, before drinking anything so that this reflects a fasted state and a period of rest and no exercise.

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