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How Nitric Oxide Combats COVID-19


I’ve written many articles reviewing all kinds of therapies demonstrated or hypothesized to have a constructive affect on SARS-CoV-2 an infection and COVID-19 illness development. Now, we are able to add nitric oxide (NO) to the record — to not be confused with nitrous oxide (N2O, a sedative also known as laughing fuel). In keeping with Åke Lundkvist, a professor at Uppsala College who led the research1 in query:2

“To our data, nitric oxide is the one substance proven to date to have a direct impact on SARS-CoV-2. Till we get a vaccine that works, our hope is that inhalation of NO could be an efficient type of therapy. The dosage and timing of beginning therapy most likely play an essential half within the end result, and now must be explored as quickly as attainable.”

What Is Nitric Oxide?

Nitric oxide (NO) is a soluble fuel frequently produced from the amino acid L-arginine inside your cells. Whereas NO is a free radical, it’s additionally an essential organic signaling molecule that helps regular endothelial operate and protects your mitochondria — the little “energy stations” in your cells that produce a majority of your physique’s vitality within the type of ATP.

It’s saved within the lining of your endothelium (blood vessels), and will be triggered both by way of train or dietary means. NO is a potent vasodilator, serving to loosen up and widen the diameter of your blood vessels.

Wholesome blood circulation in flip permits for environment friendly oxygenation of tissues and organs, and aids within the elimination of waste and carbon dioxide. Importantly, NO infuses into areas which might be hypoxic, which means in want of oxygen, and each your coronary heart and mind3,4 are heavy oxygen customers. NO additionally:

Improves your immune operate, making your physique higher outfitted to combat off international pathogens

Has highly effective antibacterial potential

Protects your mitochondrial well being

Helps preserve physiological homeostasis — For instance, in your intestine, NO regulates mucosal blood circulation, intestinal motility and the thickness of mucus

Performs an essential function within the homeostasis of reactive oxygen species, which may have a big affect on metabolic pathways5

Helps suppress irritation

Promotes angiogenesis, the formation of recent, wholesome blood vessels6

Helps enhance your bodily health — For instance, uncooked beets have been proven to spice up stamina throughout train by as a lot as 16% on account of the rise in NO manufacturing7

Improves mind neuroplasticity by bettering oxygenation of the somatomotor cortex, a mind space that’s typically affected within the early levels of dementia8,9

Helps reverse metabolic syndrome10 and has antidiabetic results11,12

NO Successfully Inhibits SARS-CoV-2 Replication

As talked about, NO is thought to have broad-spectrum antimicrobial results, and Swedish researchers have now demonstrated that NO successfully inhibits the replication of SARS-CoV-2 in vitro by concentrating on the SARS-CoV-2 foremost protease. The research13 in query was printed within the October 2020 situation of Redox Biology. As defined in numerous sections of this paper:14

“Nitric oxide (NO) is a broad-spectrum antimicrobial and a potent vasodilator that has proved to be efficient in decreasing SARS-CoV replication and hypoxia in sufferers with extreme acute respiratory syndrome …

NO has been demonstrated as an efficient antiviral towards SARS-CoV in vitro and in vivo by inhalation in very low concentrations in a small scientific trial.

Moreover, inhaled NO improved arterial oxygenation in hypoxemic sufferers by redistributing blood circulation within the lung to raised ventilated areas, and counteracted blood clotting, each results being of significance for COVID-19 sufferers.

The function of NO-inhalation within the prevention and therapy of COVID-19 has been proposed, however no scientific information has but been reported. Within the current research the antiviral impact of NO on SARS-CoV-2 contaminated cells was examined in vitro …

The NO-donor S-nitroso-N-acetylpenicillamine (SNAP) had a dose dependent inhibitory impact on SARS-CoV-2 replication … SNAP (NO donor), however not NAP (NO-lacking model of SNAP) confirmed a dose dependent discount of SARS-CoV-2 viral RNA copy numbers, which proves that NO has an antiviral impact towards SARS-CoV-2 and possibly in the same method as beforehand described for SARS-CoV and different viruses …

Though the viral replication was not fully abolished (at 200 μM and 400 μM), SNAP delayed or fully prevented the event of viral cytopathic impact in handled cells, and the noticed protecting impact correlated with the extent of inhibition of the viral replication.”

The picture beneath compares and contrasts the cytopathic results over time (24-hour intervals) between cells handled with SNAP (a NO donor) at 200 μM and 400 μM, and untreated controls. The cells are magnified 100 instances.

cytopathic effects over time

SARS-CoV-2 Essential Protease Is an Engaging Drug Candidate

The SARS-CoV-2 foremost protease is a key enzyme within the virus’ life cycle,15 which makes it a beautiful goal for drug growth.16 As defined in a single Science paper,17 the SARS-CoV-2 foremost protease enzyme “cuts the polyproteins translated from viral RNA to yield useful viral proteins.”

By concentrating on this enzyme, researchers consider you possibly can successfully fight SARS-CoV-2, and that’s exactly what NO does. In keeping with the Swedish researchers:18

Primarily based on this research and former research on SARS-CoV in vitro, and in a small scientific trial, we conclude that NO could also be utilized for scientific use in the therapy of COVID-19 and different human coronavirus infections.”

The best way to Enhance NO Manufacturing Naturally

Whereas the Swedish researchers counsel utilizing NO inhalation remedy — which is already used for circumstances resembling hypoxic respiratory failure in adults19 and respiratory failure in neonates20 — you can additionally increase your resilience towards the virus by implementing way of life methods that enhance your pure NO manufacturing.

For readability, these methods wouldn’t be of rapid assist if you happen to come down with a SARS-CoV-2 an infection. Fairly, by rising your physique’s manufacturing of NO on a common foundation, the virus could also be much less more likely to achieve a foothold if you happen to’re uncovered to it. That stated, three methods that may enhance NO manufacturing in your physique embrace:

  1. Blood circulation restriction coaching (BFR)21
  2. Getting wise solar publicity on massive parts of your physique, as NO is launched into your bloodstream when daylight hits your pores and skin22,23
  3. Consuming nitrate-rich plant meals24,25,26 resembling arugula and purple beets. NO manufacturing will be additional magnified by combining these meals with probiotics27

BFR Boosts Vascular Operate by Rising NO

To offer you some extra particulars about these methods, BFR has been proven to enhance your vascular operate, and one of many methods by which it does that is by rising NO manufacturing. As defined in a 2012 research printed within the Worldwide Journal of Vascular Medication:28

“… after a number of minutes of arterial cuff occlusion at proximal or distal portion in any artery, for instance, brachial and popliteal artery, rapid cuff deflation can result in enhance shear stress induced by reactive hyperemia and activate endothelial nitric oxide (NO) synthase (eNOS).

This activation results in a shear-stress-mediated augmented NO manufacturing in endothelial cells … NO bioavailability within the endothelial cell … is a crucial issue and predictor in defending towards heart problems.”

The native muscle hypoxia introduced on by BFR train additionally considerably will increase vascular endothelial development issue (VEGF), which act like “fertilizer” to your blood vessels. The medical time period for this growth of recent blood vessels is angiogenesis. Angiogenesis, in flip, enhances NO bioavailability.

The next graph illustrates the vascular adjustments that happen in response to BFR. To study extra about BFR, together with how one can carry out it correctly, see “What You Need to Know About Blood Flow Restriction Training.”

vascular changes that occur in response to BFR

Complete Physique UVA Irradiation Triggers NO Launch

Subsequent up: Solar publicity. It doesn’t get any simpler than this, actually. All it’s essential do is expose as a lot pores and skin as attainable to shiny daylight. As at all times, you’ll need to be sure to don’t keep out too lengthy. Sunburn is counterproductive as it would solely hurt your pores and skin. As soon as your pores and skin turns the lightest shade of pink, transfer into the shade or placed on clothes and a hat.

Ultraviolet A (UVA) and the near-infrared gentle spectrum each enhance NO, so that you’re getting that profit from each ends of the sunshine spectrum. As defined in a 2009 paper29 in the journal Circulation Analysis, if you expose your physique to daylight, photolabile NO derivates such as nitrite and S-nitroso thiols decompose and type vasoactive NO. (Photolabile means the compounds are altered or endure chemical adjustments in response to gentle).

Eat a Nitrate-Wealthy Eating regimen

Lastly, the dietary element. Dietary nitrates are transformed into nitrites by oral micro organism throughout chewing. As soon as the nitrites are swallowed and are available into contact with abdomen acid, they get transformed into NO. You will discover extra in-depth particulars about this conversion in “Top 9 Reasons to Optimize Your NO Production.” Nitrate-rich meals that may increase your NO stage embrace:30,31,32


Crimson beets / fermented beets



Butter leaf lettuce

Spring greens like mesclun combine


Oak leaf lettuce

Swiss chard

As talked about, taking a probiotic can optimize the NO manufacturing when consuming nitrate-rich meals. The rationale for it is because intestine micro organism are concerned in step one of the NO metabolism chain. Probiotic micro organism resembling Lactobacillus scale back nitrate to nitrite, the latter of which turns into a substrate for NO. So, by including probiotics, you enhance the NO substrate, which permits for greater ranges of NO to be generated.

Other than the various advantages already listed, NO has additionally been proven to enhance muscle contractions in your diaphragm, thereby bettering respiration. This, beside its antiviral results, can have a direct profit for COVID-19.

For the research,33 researchers break up outdated mice into two teams. (For reference, the mice used within the research have been 24 months outdated, which is equal to about 70 years of age in people.) One group was given ingesting water that contained sodium nitrate day by day for 14 days. The opposite group was given plain water.

After the research interval, they measured the isometric power and peak energy of the diaphragm muscle groups within the mice and located that each considerably elevated within the nitrate group. This enhance in power and energy translated to improved contraction of the diaphragm muscle, which may then enhance lung operate and respiration.

The elevated energy within the diaphragm might additionally assist older individuals clear their lungs extra successfully, which can assist scale back the danger of growing infections. Your physique’s means to provide NO declines with age, so it’s essential to take steps to extend your NO manufacturing as you become older. Respiratory muscle operate additionally declines with age, contributing to respiration troubles, impaired airway clearance and a decreased high quality of life.

Since nitrates can enhance muscle operate of the diaphragm, it might assist enhance the outlook for older populations with respiratory infections like COVID-19. Dietary nitrates additionally enhance oxygen uptake by dilating the blood vessels and permitting extra oxygen to be delivered to muscle groups, just like the diaphragm, and different cells.34

How Molecular Hydrogen Impacts NO Manufacturing

In conclusion, I’d like to handle the detrimental facet of NO, and the way this performs into COVID-19. As defined by Tyler W. LeBaron in a current video lecture featured in “How Molecular Hydrogen Can Help Your Immune System,” a lot of the destruction wrought by SARS-CoV-2 is thru reactive oxygen species (ROS) and systemic irritation.

And, as talked about earlier, NO is each a free radical and a signaling molecule. As such, it could possibly have both constructive or unfavourable results, relying on its ranges and what else is occurring.

ROS are molecules that trigger oxidative harm. Nonetheless, they’re not all dangerous on a regular basis. Neutrophils that produce ROS additionally produce NO and superoxide. Superoxide helps kill pathogens, however you additionally don’t need an excessive amount of of it, so it must be regulated. The identical goes for NO.

Whereas NO can inhibit viral replication and increase your immune system, you don’t need an excessive amount of, as a result of as ranges of superoxide and NO rise, they mix and type peroxynitrites, that are extraordinarily damaging. Peroxynitrites in flip type hydroxyl radicals, essentially the most cytotoxic ROS.

Usually, when superoxide has carried out its job, it’s transformed by superoxide dismutase into hydrogen peroxide, which in flip is transformed into water and oxygen. This course of is regulated by a transcription issue known as Nrf2/keap1.

When this transcription issue is activated, it triggers your physique’s pure antioxidants resembling glutathione and catalase. Nrf2 — which is concerned in part 2 cleansing — regulates greater than 200 protecting proteins and enzymes. The issue is that when ROS is overabundant and uncontrolled, the Nrf2 system is depleted and might not regulate the inflammatory course of.

Molecular hydrogen (H2 fuel) has the flexibility to activate the Nrf2/keap1 pathway, thereby replenishing your endogenous antioxidants. In so doing, H2 helps regulate and preserve homeostasis in the entire system, stopping the an infection from getting uncontrolled and inflicting cell dying.

H2 may also decrease extreme NO and superoxide manufacturing by downregulating NOX and NOS enzymes. In a situation resembling COVID-19, this could be good, as when these two molecules are excessively elevated they mix to create the pernicious peroxynitrite molecule.

Contemplating very excessive ranges of NO look like a part of the COVID-19 illness course of within the later levels, it appears NO inhalation remedy could be greatest suited within the early levels of an infection, not the extra superior levels when irritation is working wild.

As famous by the Entrance-Line COVID-19 Crucial Care (FLCCC) Alliance,35,36 peak viral replication takes place on the earliest indicators of signs, which embrace chilly/flu-like signs, lack of style and odor, myalgia (muscle ache) and common malaise.

Right now, the main focus needs to be on antiviral therapies — which is what NO inhalation remedy, on this case, might be designated as. As signs worsen, viral replication really diminishes mechanically, giving approach to immune dysregulation, so at this level, NO may trigger extra issues than it solves.

Nebulized Hydrogen Peroxide — A Extremely Efficient Dwelling Treatment

Whereas unrelated to NO, I consider one of the crucial efficient therapy choices out there is nebulized hydrogen peroxide. This can be a residence treatment I like to recommend everybody familiarize themselves with, as in lots of circumstances it could possibly enhance signs inside mere hours. It’s significantly efficient in those that are within the later levels of the sickness.

Dr. David Brownstein, who has efficiently handled over 100 COVID-19 sufferers with nebulized hydrogen peroxide, printed a case paper37 about this therapy within the July 2020 situation of Science, Public Well being Coverage and The Legislation. He additionally discusses its advantages in a recent interview I did with him.

In my April 2020 article, “Could Hydrogen Peroxide Treat Coronavirus?” I reviewed a few of the fundamental science of how hydrogen peroxide works, in addition to a few of the research assessing its therapeutic potential. Essentially the most related research38 was printed in March 2020 within the Journal of Hospital An infection. They studied 0.5% hydrogen peroxide, and located it killed human coronaviruses, together with the coronaviruses accountable for SARS and MERS.

Nebulized hydrogen peroxide is extraordinarily secure. Brownstein has used it for 25 years with no ailing results being discovered. It’s additionally extremely cheap, and you may administer it at residence, and not using a prescription. In my view, it is without doubt one of the very best therapies for viral infections like SARS-CoV-2 and even worse respiratory viruses that may doubtless be unleashed in the long run.

I strongly advocate shopping for a desktop nebulizer. It must produce a really superb mist, and desktop variations are stronger than handheld battery operated fashions. The one I exploit is the Pari Trek S Compressor Aerosol System with a face masks, (bought individually) not with the provided mouth piece.

It is very important purchase the tools and peroxide BEFORE you want it, as the earlier you deal with the an infection the higher your outcomes will likely be, though the testimonials are unbelievably spectacular even in late stage sickness. It isn’t essential to deal with your self preventively, however solely if you’re sick or uncovered to somebody who’s.

Whereas I’ve been utilizing a 0.1% dilution, Brownstein makes use of a fair decrease focus of simply 0.04%. Neither Brownstein nor I like to recommend utilizing industrial 3% hydrogen peroxide present in most grocery shops, because it has probably poisonous chemical stabilizers in it. For optimum advantages, use food-grade peroxide and dilute it appropriately, utilizing saline.

hydrogen peroxide dilution chart

To dilute 35% food-grade peroxide right into a 0.04% answer, first dilute it down to three% by mixing 1 half peroxide with 10 components sterile water, then take 3 cubic centimeters (CCs) of that 3% dilution and add it to a 250CC bag of regular saline. This brings it all the way down to a .04% hydrogen peroxide focus. Within the video above, I am going over the fundamentals of how one can do nebulized peroxide.


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