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The Nitrate-Nitrite-Nitric Oxide Enterosalivary Pathway
Maintaining elastic, compliant blood vessels that expand seamlessly with each heartbeat is the cornerstone of cardiovascular longevity. While the body produces nitric oxide ($) via endothelial eNOS enzymes, modern cardiology has uncovered a powerful parallel pathway: the Enterosalivary Nitrate-Nitrite-Nitric Oxide Pathway, powered by dietary inorganic nitrates (^-$) found abundantly in Beetroots (Beta vulgaris), wild arugula (Roka), and dark leafy greens.
Enterosalivary Nitrate Nitrite NO PathwayFigure 1: The enterosalivary circulation: dietary nitrate swallowed, concentrated in saliva, and reduced by tongue bacteria to nitrite.
In this guide, we explore the symbiotic role of oral microbiome bacteria (Veillonella), explain why synthetic antibacterial mouthwashes destroy blood pressure regulation, and provide raw beetroot juice protocols.
1. The Enterosalivary Circulation & Oral Bacteria
Concentration in Salivary Glands:
- Dietary inorganic nitrate (^-$) from beets and greens is absorbed into the bloodstream, where salivary glands concentrate it 10-fold into saliva.
Oral Bacterial Nitrate Reductase:
- Commensal bacteria on the posterior tongue (Veillonella and Actinomyces) reduce nitrate (^-$) into nitrite (^-$).
Gastric Acid to Systemic Nitric Oxide:
- When swallowed into acidic stomach juice, nitrite converts to bioactive Nitric Oxide ($), dilating systemic blood vessels and reducing systolic blood pressure by 4 to 10 mmHg within 2 hours.
[!WARNING] Avoid Antiseptic Mouthwashes: Using chlorhexidine or alcohol-based mouthwashes eradicates oral nitrate-reducing bacteria, completely abolishing the blood pressure-lowering benefit of dietary beets and greens.
2. References & Academic Citations
Kapil, V., et al. (2015).Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension, 65(2), 320-327. [PubMed: 25421976]
Lundberg, J. O., et al. (2008).The nitrate-nitrite-nitric oxide pathway in physiology and therapeutics. Nature Reviews Drug Discovery, 7(2), 156-167. [PubMed: 18167491]
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