Nitric Oxide: Do “NO Boosters” Actually Help?

Written By Daniel Placik

Nitric oxide supplements have become popular in the wellness, fitness, and biohacking world.

You may see products marketed as:

  • Nitric oxide boosters

  • Beetroot powder

  • Beetroot juice

  • Nitrate supplements

  • Pre-workout endurance formulas

  • Cardiovascular support supplements

The claims usually sound impressive: better blood flow, lower blood pressure, improved endurance, better workouts, and healthier blood vessels.

Some of these claims are based on real science.

But, as usual, the details matter.

From a lifestyle medicine perspective, I usually prefer starting with whole foods first — especially vegetables — before jumping to supplements.

So the real question is not just whether nitric oxide matters.

It does.

The better question is:

What is the safest and most evidence-based way to support nitric oxide production?

What is nitric oxide?

Nitric oxide, often abbreviated as NO, is a gas naturally made by the body.

It plays an important role in blood vessel health.

One of its most important jobs is helping blood vessels relax and widen. This process is called vasodilation.

When blood vessels relax, blood can flow more easily.

That is why nitric oxide is important for:

  • Blood pressure

  • Circulation

  • Exercise performance

  • Endothelial function

  • Cardiovascular health

The endothelium is the thin inner lining of blood vessels. Healthy endothelial function is an important part of long-term heart and vascular health.

How does the body make nitric oxide?

The body can make nitric oxide in more than one way.

One pathway uses the amino acid L-arginine, which gets converted into nitric oxide by enzymes in the body.

Another important pathway comes from dietary nitrate.

This is where foods like beetroot, spinach, arugula, celery, and other leafy greens come in.

Dietary nitrate can be converted into nitrite by bacteria in the mouth. Then nitrite can be further converted into nitric oxide in the body.

This is called the nitrate-nitrite-nitric oxide pathway.

It is one reason vegetables rich in nitrate may support blood vessel health.

Why beetroot became popular

Beetroot is naturally high in dietary nitrate.

Because of this, beetroot juice and beetroot powder have been studied for blood pressure, exercise performance, and vascular function.

Many over-the-counter supplements use beetroot as a “natural nitric oxide booster.”

This is not just marketing. Beetroot really can increase nitrate availability and support nitric oxide production.

But the magnitude of benefit varies, and the strongest evidence is not that beetroot extends lifespan.

The strongest evidence is that dietary nitrate can modestly improve blood pressure and blood vessel function.

Potential benefit: lower blood pressure

The most consistent benefit of dietary nitrate supplementation is modest blood pressure reduction.

Studies have shown that nitrate-rich foods or supplements can lower systolic and diastolic blood pressure in some people.

The effect is usually not dramatic, but it can be meaningful.

For example, a few points of systolic blood pressure reduction may matter at the population level and may contribute to lower cardiovascular risk over time.

That said, beetroot juice is not a replacement for blood pressure medication when medication is needed.

If someone has hypertension, the foundation still includes:

  • Weight management

  • Exercise

  • Sodium reduction when appropriate

  • Potassium-rich foods

  • Alcohol moderation

  • Sleep apnea evaluation when indicated

  • Stress management

  • Medications when needed

Beetroot may be a helpful addition for some people, but it is not a cure.

Potential benefit: better endothelial function

Dietary nitrate may improve endothelial function.

This matters because endothelial dysfunction is an early sign of vascular aging and cardiovascular risk.

Some studies show that beetroot juice or inorganic nitrate can improve flow-mediated dilation, a research measure of how well blood vessels relax.

That is encouraging.

But flow-mediated dilation is still a surrogate marker. It is not the same as proving fewer heart attacks, strokes, or longer lifespan.

This is an important distinction in longevity medicine.

Improving a marker is promising, but we still need to know whether it changes long-term outcomes.

Potential benefit: exercise performance

Nitric oxide supplements are also popular among athletes and people trying to improve endurance.

Dietary nitrate may reduce the oxygen cost of exercise, meaning the body may perform certain types of activity more efficiently.

The benefits appear most relevant for moderate-to-high intensity endurance exercise.

Some people notice improved stamina, better exercise tolerance, or slightly better performance.

However, results vary.

Elite athletes may see smaller benefits because their nitric oxide pathways and training adaptations are already optimized. Recreational athletes or older adults may notice more benefit.

For a longevity-focused patient, the most important outcome may not be race performance.

It may be helping someone exercise more consistently.

If beetroot helps a person feel better during walks, cycling, strength training, or conditioning, that could indirectly support long-term health.

Potential benefit: healthy aging

The longevity argument for nitrate-rich foods is interesting.

Higher intake of nitrate-rich vegetables has been associated with lower cardiovascular disease risk and lower cardiovascular mortality in some observational studies.

This makes sense biologically because nitrate-rich vegetables may improve blood pressure, blood vessel function, and exercise capacity.

But there is a major caveat:

People who eat more nitrate-rich vegetables are usually eating more vegetables overall.

They may also have healthier diets, exercise more, smoke less, and have better overall lifestyle patterns.

So we cannot say that nitrate alone is responsible.

Still, it is reasonable to view nitrate-rich vegetables as part of a longevity-focused diet.

The evidence is much stronger for eating vegetables than for taking isolated nitric oxide supplements.

Food sources of nitrate

Many of the best nitrate sources are vegetables.

Examples include:

  • Beetroot

  • Spinach

  • Arugula

  • Celery

  • Lettuce

  • Swiss chard

  • Bok choy

  • Radishes

  • Parsley

  • Cilantro

A practical target may be as simple as eating about one cup of nitrate-rich leafy greens per day.

This is not complicated.

A salad with arugula and spinach, a beet salad, celery in a smoothie, or greens added to meals can all help.

This is why I prefer a food-first approach.

You get nitrate plus fiber, potassium, magnesium, vitamin C, polyphenols, and other compounds that work together.

That is different from taking an isolated supplement.

Nitrates from vegetables are not the same as processed meats

This is one of the most important points.

Many people hear “nitrates” and think of processed meats like bacon, hot dogs, ham, or deli meat.

But nitrate from vegetables is not the same context as nitrate or nitrite used in processed meats.

In vegetables, nitrates come packaged with:

  • Vitamin C

  • Polyphenols

  • Fiber

  • Potassium

  • Magnesium

  • Antioxidant compounds

These compounds may help reduce the formation of harmful nitrosamines.

In processed meats, nitrites and nitrates are often present with heme iron, high sodium, saturated fat, and high-temperature processing — a very different environment.

That is why processed meats are consistently associated with worse health outcomes, while nitrate-rich vegetables are generally associated with better health.

Source matters.

Food matrix matters.

What about cancer concerns?

Nitrate can be converted into nitrite, and under certain conditions, nitrite can contribute to formation of N-nitroso compounds, some of which may be carcinogenic.

This is the main reason people worry about nitrates.

But again, source matters.

The strongest concern is with processed meats and certain drinking water exposures, not with vegetables.

Plant-derived nitrate has not shown the same cancer risk signal in the literature. In fact, vegetable-rich dietary patterns are generally associated with lower risk of many chronic diseases.

This does not mean more nitrate is always better.

It means nitrate from vegetables appears to be much safer and more favorable than nitrate or nitrite from processed meat additives.

The mouthwash problem

Here is a practical point many people miss.

The nitrate-nitrite-nitric oxide pathway depends partly on oral bacteria.

Those bacteria help convert nitrate into nitrite in the mouth.

If someone uses strong antibacterial mouthwash frequently, it may reduce these helpful bacteria and blunt the nitric oxide benefit from nitrate-rich foods.

This does not mean no one should ever use mouthwash.

But daily use of strong antiseptic mouthwash may not be ideal unless there is a specific dental reason.

Oral health is connected to vascular health in more ways than most people realize.

Who might benefit from nitrate-rich foods?

Nitrate-rich vegetables may be especially useful for people focused on:

  • Blood pressure support

  • Cardiovascular prevention

  • Exercise endurance

  • Healthy aging

  • Endothelial function

  • Increasing vegetable intake

  • Replacing processed foods with whole foods

For most people, I would start with food:

  • Add arugula or spinach daily

  • Eat beets a few times per week

  • Add celery, greens, or herbs to meals

  • Use beetroot powder only if whole foods are not practical

The supplement should not replace the dietary pattern.

Who should be cautious?

Although nitrate-rich foods are generally safe for most people, certain situations require caution.

Be more careful if you have:

  • Low blood pressure

  • Frequent dizziness or fainting

  • Use of nitrates for chest pain

  • Use of PDE-5 inhibitors such as sildenafil or tadalafil

  • Advanced kidney disease

  • High oxalate kidney stone risk

  • Need for potassium restriction

  • History of beetroot triggering GI symptoms

  • Infants exposed to high-nitrate well water

Beetroot is also higher in oxalates, which may matter for people with calcium oxalate kidney stones.

Supplements can also be more concentrated than food, making dose harder to judge.

If someone is on blood pressure medication, adding high-dose beetroot or nitrate supplements could theoretically contribute to lower blood pressure, especially if they are already well controlled.

Beetroot supplements vs. whole vegetables

Beetroot supplements can be convenient.

They may be useful for someone who wants a pre-exercise nitrate boost or does not regularly eat nitrate-rich vegetables.

But they are not automatically better.

Whole vegetables provide a broader nutritional package.

Beetroot powder may provide nitrate, but it may not provide the same full matrix of fiber, water, minerals, and polyphenols as eating whole beets or leafy greens.

Also, supplement quality varies.

Some products may not clearly disclose nitrate content. Others may include added sugars, stimulants, or proprietary blends.

If using a beetroot supplement, I would look for:

  • Third-party testing

  • Transparent dosing

  • No stimulant-heavy blend

  • Minimal added sugar

  • Clear nitrate content if available

  • No exaggerated claims

What about L-arginine and L-citrulline?

Some nitric oxide supplements use amino acids instead of nitrates.

Common ingredients include:

  • L-arginine

  • L-citrulline

L-arginine is a direct precursor for nitric oxide, but oral arginine has variable absorption and metabolism.

L-citrulline may raise arginine levels more effectively in some cases and is commonly used in exercise supplements.

These may help certain people with exercise performance or blood flow, but they are not the same as nitrate-rich foods.

They can also interact with blood pressure medications or vasodilators and may cause GI side effects.

For general longevity and cardiovascular prevention, I would still prioritize vegetables over amino acid nitric oxide boosters.

My lifestyle medicine approach

As a lifestyle medicine physician, I am not against supplements.

But I want supplements to be used thoughtfully.

The question should not be:

“What pill can I take to boost nitric oxide?”

The better question is:

“How can I build a lifestyle that naturally supports vascular health?”

That includes:

  • Eating nitrate-rich vegetables

  • Exercising regularly

  • Improving blood pressure

  • Sleeping well

  • Avoiding smoking

  • Managing glucose and insulin resistance

  • Maintaining a healthy body composition

  • Improving ApoB and cardiovascular risk

  • Limiting ultra-processed foods

  • Supporting oral health

Nitric oxide is part of the picture.

But cardiovascular health is much bigger than one pathway.

Practical recommendation

For most healthy adults, I would recommend:

First: food

Aim for nitrate-rich vegetables most days.

Examples:

  • Arugula

  • Spinach

  • Beets

  • Celery

  • Lettuce

  • Swiss chard

  • Herbs

This gives you the nitric oxide support plus the broader benefits of a plant-forward diet.

Second: exercise

Exercise itself improves endothelial function and nitric oxide signaling.

A supplement cannot replace that.

Third: consider supplements only when appropriate

Beetroot juice or beetroot powder may be reasonable if:

  • You want a pre-workout endurance boost

  • You do not eat many nitrate-rich vegetables

  • You have mildly elevated blood pressure and want an adjunctive strategy

  • You tolerate it well

  • You are not at risk for low blood pressure or medication interactions

Fourth: avoid processed meat as a nitrate source

Do not confuse vegetable nitrates with processed meat additives.

Bacon is not a nitric oxide supplement.

Bottom line

Nitric oxide is important for blood vessel health, circulation, blood pressure, and exercise performance.

Dietary nitrates from vegetables — especially beetroot and leafy greens — can support nitric oxide production and have evidence for modest blood pressure reduction and improved endothelial function.

There is also observational evidence linking nitrate-rich vegetable intake with lower cardiovascular risk, though this likely reflects the broader benefits of a healthy diet.

The safest and most evidence-supported approach is not chasing a nitric oxide supplement.

It is eating more nitrate-rich vegetables as part of a whole-food, plant-forward diet.

Beetroot supplements may be useful for some people, especially for exercise performance or blood pressure support, but they should be viewed as optional tools — not replacements for lifestyle.

For longevity, the foundation remains the same:

Whole foods, regular exercise, good sleep, metabolic health, blood pressure control, and thoughtful prevention.

Daniel Placik
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