What is Nitric Oxide?

Nitric oxide is one of the most important molecules produced naturally in the human body.  This molecule is so important that in 1998 three scientists won a Nobel Prize for discovering Nitric Oxide as a miracle molecule. Nitric oxide (NO) is a gas composed of one atom of nitrogen bonded to one atom of oxygen. It serves as a critical signaling molecule in the cardiovascular and circulatory system. Our bodies cannot function as intended without proper circulation. This means that NO affects absolutely every function in our bodies.

NO is made by the blood vessel’s lining called the endothelium. Nitric oxide expands the blood vessels, increasing blood flow and decreasing plaque growth and blood clotting.

Why is NO important in our bodies?

The loss of NO is recognized as the earliest onset of most, if not all, chronic diseases including the #1 killer of men and women, cardiovascular disease. Starting in your 30’s nitric oxide production begins to decline by 20% every 10 years. Most over the age of 65 have lost 85% of their ability to make NO. Factors influencing the decline in natural production of NO include aging, oxidative stress, lack of exercise, poor nutrition, diabetes and smoking.

NO is a vasodilator that helps keep arteries open and prevents plaque buildup. Reduced NO availability is often used as an early marker for various cardiovascular diseases.

Who needs NO?

• Men experiencing sexual dysfunction
• Anyone looking to support healthy blood pressure
• Anyone over the age of 30
• Anyone with low energy
• Diabetics
• Anyone suffering from issues with circulation
• Anyone diagnosed with vascular dysfunction

How do we get more NO?

• Start exercising regularly – Not only does exercise improve your ability to produce NO, the NO in return improves your ability to exercise. Moderate intensity exercise has been proven to yield the best results in enhancing endothelium vasodilation and increase production of NO. Research shows the best benefits come from 150 minutes a week of moderate intensity such as a brisk walk or 75 minutes a week of vigorous exercise like running, biking, or swimming laps.  The key is to get your heart rate above resting and to break a sweat.
• Stop using mouthwash or fluoride toothpaste. These products kill the good NO creating bacteria in your mouth.
• Re-evaluate if you are taking daily antacids, NSAIDS (ibuprofen, aspirin) and statin drugs which all block the production of NO.
• Eat your vegetables – Vegetables rich in nitrate and nitrate can be converted into NO. Foods rich in NO include green leafy vegetables (kale, arugula, spinach), beets, radish, and cabbage.
• Stop smoking. Smoking blocks your ability to make NO and causes your blood vessels to constrict, reducing blood flow to every cell and tissue in the body.

(https://drnathansbryan.com/nitric-oxide-science/)

How to supplement NO?

Restoring NO production can lead to better vascular production and reduce the risk of cardiovascular disease. Nitric oxide supplements are easy to order online and over the counter but NOT all are created equal. Supplements often market “increase blood flow to the muscles” or use as a pre-workout to “get blood flowing”.  Although the marketing on the outside seems appealing, the ingredients on the inside are often misleading and do not increase production of NO. Most OTC supplements include L-Arginine or L-Citrulline. The pathway to make more NO requires L-Arginine along with OTHER molecules. If supplements do not include the other molecules, supplementing L-Arginine can actually make things worse. According to research by the American Heart Association, “Long term administration of L-Arginine does not increase nitric oxide synthesis or improve the ability of blood vessels to widen.”

Other products often include beet root extract or kale but that doesn’t mean they have sufficient nitrates to create more NO. These vegetable sources are not all equal and are subject to growth conditions, chemicals, processing, heat and packaging.

How to pick a NO supplement?

Read the research. If a product has no published clinical trials in humans, stay away. Clinical trials are expensive but prove that a product does what it says. Very few companies go through this test to prove the quality of their product. At Victory Men’s Health our staff and medical providers have done extensive research on the best products on the market and only use clinically tested NO supplements.

Nitric Oxide and Erectile Dysfunction

The leading cause of erectile dysfunction is poor blood flow to the erectile tissue. Nitric oxide dilates blood vessels which in turn can increase blood flow to the penis. The key to getting and maintaining erections revolves around continuous activation of NO. Men often use medications like Viagra, Cialis, Levitra to assist in maintaining erections. These medications let NO go to work and stay at work. Here is the science in action behind the scenes. First, NO binds to the receptors of an enzyme called guanylyl cyclase. Second, this binding process boosts levels of CGMP (cyclic guanosine monophosphate), which leads to widening of arteries in the penis. Third, more blood flows into the penis, filling the corpus cavernosum, which is the spongy tissue that expands to form an erection. Fourth, Viagra, Cialis, and Levitra work by blocking the compound of PDE5 (phosphodiesterase type 5), which in turn dissolves cGMP.

For more information on NO supplements please contact our medical providers.

Clinical references:

• Bryan PHD, Nathan “How to boost the body’s miracle molecule to prevent and reverse chronic disease.”  The Nitric Oxide (NO) Solution, 2010.
• Bryan PHD, Nathan “Nitric Oxide Science.” https://drnathansbryan.com/nitric-oxide-science/
• Woolford, Andrea. “Nitric Oxide Study Guide”. 2020. Cardiology Institute.

Illinois Location:
O: 618.632.9000
F: 618.589.3448
1405 N. Green Mount Rd,
Suite 240 O’Fallon, IL  62269

Missouri Location:
O: 314.833.9000
F: 618.589.3448 1036
Town & Country Crossing Dr
Town & Country, MO 63017

Editors note: This article has been re-published from an original article at InBody USA

Consider the following three statements:

• “I’m not working out to get huge; I just want to build strength and put on five pounds of lean muscle.”
• “My goal is to workout more and put on a healthy five pounds of muscle mass before next season.”
• “I’m going to add more protein to my diet and hopefully gain 5 pounds of lean body mass by the end of the month.”

In each one, someone wants to gain five pounds of something but is using three different terms.  Are these three ways of saying the same thing? Can they be used interchangeably? Or are they different?

Let’s get one thing out of the way: “lean muscle” is a bit of a misnomer.  Although there are indeed different types of muscle, from a biological point of view, there is no such thing as “lean muscle”. The word “lean” is usually meant to suggest the absence of body fat.  But here’s the truth: all muscle is “lean muscle”.

What about Lean Body Mass and Muscle Mass?  Both of these exist. However, they are two very different parts of your body composition, and in order to understand your weight, health, and fitness goals properly, you’ll need to understand the differences between them.  Let’s take a look below.

Lean Body Mass Vs Muscle Mass

Lean Body Mass (also sometimes known as simply “lean mass,” likely the source of the word “lean muscle”) is the total weight of your body minus all the weight due to your fat mass.

Lean Body Mass (LBM) = Total Weight – Fat Mass

LBM includes the weight of:

• Organs
• Skin
• Bones
• Body Water
• Muscle Mass

Unlike lean muscle, Lean Body Mass correctly uses the word “lean” as it describes the entire weight of your body minus fat.  This is why it is also known as “Fat-Free Mass.”

Because your Lean Body Mass comprises so many parts, any change in the weight of these areas can be recorded as changes in LBM. Keep in mind, the weight of your organs will not change much. Bone density will decrease over time, but it won’t significantly affect the weight of your LBM.

Two major areas to focus on with Lean Body Mass is body water and muscle mass.

When people talk about gaining muscle by eating more protein or muscle building workouts, what they’re really talking about is gaining or building their Skeletal Muscle Mass.  This is because of the three major muscle types – cardiac, smooth, and skeletal – skeletal muscle mass is the only type of muscle that you can actively grow and develop through proper exercise and nutrition.

But Skeletal Muscle Mass is one part of your Lean Body Mass. Another major influencer is water and this can be a problem when people use muscle gain and “lean gains” interchangeably.

The Problem with “Lean Gains”

Because an increase of Skeletal Muscle Mass is an increase of Lean Body Mass, people will lump them together as “gaining lean mass” or “lean gains.”

However, it doesn’t work the other way: an increase of Lean Body Mass is not always an increase in muscle.  That’s because body water makes up a significant portion of your Lean Body Mass. To illustrate this point, here’s a body composition analysis of a 174.1-pound male.

98.1 (Total Body Water) + 35.5 (Dry Lean Mass) = 133.6 Lean Body Mass

Water made up more than 70% of the total body weight, which is normal for healthy adult males.

Notice how from a body composition standpoint, Lean Body Mass is made up of three components, two of which are water.  Everything else is grouped together in what’s called your “Dry Lean Mass,” which includes your bone minerals, protein content, etc.

Muscle gains definitely contribute to LBM gains, but so does water, which can fluctuate throughout the day. For instance, this means that if you were to drink a significant amount of water, enough to raise your body weight by one pound, this weight would technically be a “gain” of lean mass.

It’s also important to note that muscle itself contains water – a lot of it.  According to the USGS, muscle can contain up to 79% water content.  Research has also shown that resistance training promotes the increase of intracellular water in both men and women.

All of this points to two main problems when talking about “lean gains”:

1. Big Lean Mass gains, when it occurs quickly, are largely increases in body water
2. It’s difficult to say with any certainty how much any gain in Lean Body Mass is due to Skeletal Muscle Mass without using the right tools

Since there’s a significant difference between Lean Body Mass and Skeletal Muscle Mass, how is it possible to know how much of each you have?

Let’s start with what not to do: do not try to use a scale to calculate changes in Skeletal Muscle Mass.

It’s a popular method to estimate muscle gain using a combination of the number on the scale and advice from fitness magazines.

The problem with using a scale to estimate progress is there are so many factors that can influence an increase in body weight, a few of which include:

• An undigested meal or drink
• Water retention due to glycogen
• Water retention due to sodium
• Body Fat gain due to being in a caloric surplus

There is only one way to calculate what is happening to your Lean Body Mass: getting your body composition analyzed.  Without testing your body composition, there will be no way to know what any gain or loss in your body weight is due to.

Most methods of body composition analysis will at the minimum divide your body into Lean Body Mass (this may be referred to as Fat-Free Mass) and Fat Mass.  These methods include:

• Skinfold calipers
• Hydrostatic Weighing
• Air displacement plethysmography

Each of these has their pros and cons, and accuracy may vary depending on a number of factors unique to each testing method.

For more in-depth body composition analysis, you would need to look to two more sophisticated methods: dual-energy X-ray absorptiometry (DEXA) and Direct Segmental Multi-Frequency bioelectrical impedance analysis (DSM-BIA). Not only will these methods tell you how much fat you have, but they will differentiate your skeletal muscle mass from your lean body mass.

So, Lean Body Mass, Muscle Mass, Lean Mass, Which Is it?

Back to our originally three statements: which is correct to say?  Let’s review:

• Lean Muscle: You should stop using this term because it is misleading.  All muscle is “lean muscle,” and it is a confusing mix of two real terms: Skeletal Muscle Mass and Lean Body Mass.
• Muscle Mass (or Skeletal Muscle Mass): Yes, it is likely true that if you’re performing resistance training/weight lifting workouts and adding enough protein to your diet, a percentage of the change is likely due to muscle mass development. But remember that skeletal muscle mass is part of LBM. Things get tricky when you start putting numbers on your muscle mass gains. Everyone’s body composition is different, and the proportion of your skeletal muscle mass to Lean Body Mass will not be the same as someone else’s. This makes accurate estimations even harder unless you have access to sophisticated tools that can differentiate between LBM and SMM.
• Lean Mass (lean body mass):  This is probably the best and safest term to use to describe your gains.  When you use this term, you’re telling people that you have gained weight from muscle and water, not body fat.

However, that’s all you can really say.  Because of the nature of Lean Body Mass, it is very hard to say how much of the gain is due to water and how much is due to muscle (which is largely water to begin with). A gain of 5 pounds of LBM is not 5 pounds of pure muscle,

When it comes to tracking your muscle gain (or fat loss), it all comes down to what tools you’re using to measure your progress.  If all you are working with is a weight scale, then all you will ever know for sure is your weight is increasing or decreasing. It would be hard to differentiate the weight gain from water, muscle, or body fat. If you are serious about accurately measuring your muscle gain and assessing your health, go get a body composition analysis. Then – and only then – can you tell people that you gained five pounds of muscle with confidence.

Let’s face it: cortisol gets a bad rap these days.

“I have high cortisol.”

“I have low cortisol.”

“My cortisol is out-of-whack.”

You’ve no doubt heard this all before or said it yourself.

The human body is unable to differentiate between legitimate, perceived, positive or negative stress. That means worrying and excitement casts the same stress hormone response as an actual stressor.

What is cortisol?

Cortisol is popularly known as “the stress hormone” and is released by the adrenal glands which are located on top of the kidneys. Its primary role is to increase blood sugar for fuel. Other benefits include macronutrient absorption, blood pressure regulation, decreased inflammation, sleep, mood, and motivation.

Cortisol levels gradually decline throughout the day, being highest in the morning and lowest at night. An important point is if you think primitively, just like the sun, cortisol rises in the morning as we prepare for the busiest part of our day. By the end of the day, we can settle down, go to sleep, just like the sun setting and that is when cortisol should be at its lowest. Over time we have changed cortisol from an acute hormone to a chronic hormone.

How to maintain healthy Cortisol levels:

Lifestyle and everyday behaviors such as sleep schedules, balanced diet, exercise, perceived stress, and stress management heavily influence this rhythm.

What is meant by “perceived stress” is that our brains do not know the difference between perceived reality or what we can imagine and what is actually true.  It is important to always focus on what you want.  Many people struggle with that because people are inherently  negatively wired.

Unhealthy cortisol levels:

Elevated cortisol at night interferes with the anabolic output of hormones such as testosterone, growth hormone, and melatonin. When we don’t sleep as well, we don’t recover as easily and cannot fully repair tissues and our cells. Over time cell reproduction slows down and we have more toxins in our system.

With cortisol being so important for maintenance of the body’s basic regulatory systems, chronic stress can lead to unhealthy levels of cortisol causing a number of serious health risks:

• Breakdown of muscle tissue
• Consistent fatigue
• Weight gain due to increased appetite
• High glucose levels
• Increased visceral fat – fat surrounding organs
• Hormone imbalances

Common lifestyle factors that attribute to unhealthy levels of cortisol include:

• Irregular sleep schedule
• Rotating shift work
• Sedentary lifestyle
• Overstimulation from electronic devices
• Diet consisting of high amounts of sugar and processed foods
• Stressful activity
• Sleeping with the TV on
• Blue light

The fast-paced, high-demand, technology-driven expectations of the 21^st century make managing stress a difficult task. Although challenging, it is crucial in achieving optimal health. Understanding the role of cortisol and how our bodies respond to stress and is a great first step in the pursuit of a healthy lifestyle.

As we head into the summer months, everyone is excited for a little extra Vitamin D. Despite your tan skin, you may not be getting enough of the “sunshine vitamin”. According to a study published in The American Journal of Clinical Nutrition, Vitamin D levels in Americans have significantly declined in the past few decades. In fact, in the United States, 41% of the total population are Vitamin D deficient. 

The body does produce high amounts of Vitamin D when skin is directly exposed to the sun, however, excess sun exposure may increase the risk of skin cancer. Additionally, few foods contain Vitamin D and our ability to produce it declines as we age. Not the ideal circumstances, which is why doctors often prescribe a daily supplement.

WHAT IS VITAMIN D?

Vitamin D is a fat-soluble vitamin, meaning that it dissolves in fats and oils and can be stored in your body for a long duration. There are two main forms of Vitamin D:

•   Vitamin D3 (cholecalciferol): Found in animal foods like fatty fish and eggs.
•   Vitamin D2 (ergocalciferol): Found in plants such as mushrooms and yeast. 

Vitamin D3 is found to be twice as effective at increasing blood serum levels than Vitamin D2.

HOW IS VITAMIN D USED IN THE BODY?

Despite its name, Vitamin D isn’t technically a vitamin. Vitamin D is a potent steroid hormone responsible for switching our genes on and off. It has a similar molecular structure to testosterone, cholesterol and cortisol, all of which your body makes naturally.

Vitamin D is responsible for cell to cell communication making Vitamin D important for muscle health, mood and well-being, memory, heart function, and more, explains Arti Lakhani, M.D., Director of Integrative Oncology at AMITA Health Cancer Institute in Illinois.

VITAMIN D DEFICIENCIES

Vitamin D deficiency is one of the most common nutrient deficiencies and a silent epidemic. Some symptoms are subtle and may take years to surface, however signs may be detectable early on.  A blood test is the only true gauge of a Vitamin D deficiency but be on the watch for a few of these signs and symptoms:

•   Getting sick often
•   Bone density declines
•   Great risk for heart attacks
•   Increased body fat & loss of muscle mass
•   Fatigue, depression, and mood disorders

BEST SOURCES OF VITAMIN D

The sun is an excellent source of Vitamin D, but it is hard to quantify how much Vitamin D you get from time in the sun and the risk of skin cancer may outweigh the benefits.  Other factors affect the skin’s ability to produce Vitamin D, including season, time of day, latitude, air pollution, cloud cover, sunscreen, body parts exposed, color and age.

Geographic location plays a large part in your ability to get Vitamin D from sunshine. Harvard Health found that outside of the summer months, there’s little chance of getting enough Vitamin D if you live in the midwest.  

VITAMIN D IN FOOD

Vitamin D is naturally present in few foods.  Most people assume drinking milk helps to keep adequate levels, however the average milk is fortified with only 100 IU of Vitamin D per cup. At that rate you would need to drink 50 glasses per day to reach recommended dosage. Food manufacturers are fortifying other foods, such as yogurt, cereal, and orange juice to help consumers fill the nutrient gap in their diets. Although fatty fish like salmon, mackerel, swordfish, trout, tuna, and sardines are decent sources, you would have to eat them almost every day to get enough.  

Supplementing Vitamin D with a daily tablet can be a very cost-effective option to ensuring you are getting adequate levels. When looking for Vitamin D, choose the D3 gel capsule or liquid form for better absorption. It’s recommended to take Vitamin D supplements with a meal to enhance absorption. Quality supplementation is also critical due to over the counter supplements often contain fillers and may not contain the amount of Vitamin D needed. Elect for a medical grade, FDA regulated supplement to ensure efficacy and absorption. 

• According to one study in 17 people, taking Vitamin D with the largest meal of the day increased Vitamin D blood levels by about 50% after just 2–3 months.
• In another study in 50 older adults, consuming Vitamin D alongside a fat-heavy meal increased Vitamin D blood levels by 32% after 12 hours compared to a fat-free meal. 

HOW MUCH VITAMIN D DO I NEED?

In July 2011, the Endocrine Society Practice Guidelines published recommendations for the evaluation, treatment and prevention of Vitamin D recommending an upper limit of 10,000 IU/day.

The Vitamin D council states that those who rarely get sunlight need to supplement with 5,000IU per day. This would equate to 50 glasses of fortified milk a day or 10 multivitamins.

The Endocrine Society Practice Guidelines, as well as many laboratories and experts recommend a minimum Vitamin D blood level of 30 ng/ml as an acceptable level.

VITAMIN D AND TESTOSTERONE

Researchers found that Vitamin D deficiency, defined by levels less than 20ng/ml, was independently associated with testosterone deficiency. Men with Vitamin D deficiencies were 2.65 times more likely to have testosterone deficiency compared to those with levels above 20 ng/ml. 

Vitamin D affects the production of natural and free testosterone along with formation of male sperm cells. Supplementation with Vitamin D has been associated with higher levels of testosterone and sex hormone binding globulin.

If you are experiencing signs or symptoms of low Vitamin D, talk to your doctor about testing your blood serum levels of Vitamin D and adding a supplement to your routine. 

HCG – HCG stands for Human Chorionic Gonadotropin, and it is a natural hormone that has been found to mimic the effects of Luteinizing Hormone (LH) in males. LH plays a vital role in the synthesis and secretion of testosterone. When HCG is utilized to treat male infertility or hypogonadism, it gets to work on mimicking the effects of LH. This, in turn, means that it stimulates the natural production of testosterone from within the testes.

HCG injections are approved by the U.S. Food and Drug Administration (FDA) to treat specific medical conditions in both women and men.  In men, hCG injections are FDA-approved for a type of hypogonadism in which the body doesn’t adequately stimulate the testes to produce the sex hormone testosterone.  HCG is incredibly safe, so during the treatment, the male in question will likely not suffer from any adverse side effects at all.

HCG is sometimes used during testosterone replacement therapy because testosterone replacement therapy can lower sperm production due to the feedback loop on both the hypothalamus and pituitary gland.  In men still wanting to have children hCG therapy can help preserve sperm production by maintaining intra-testicular testosterone levels. Not only will hCG help to restore your fertility and sperm production, but it can reduce the testicle shrinkage.   Using hCG with TRT can restore your testicles to their normal, healthy size and function.

Studies have shown that in healthy normal testosterone men selected to undergo TRT, it was shown that their intra-testicular testosterone levels dropped by 94% while on therapy. However, in those who received HCG injections along with TRT, their intra-testicular testosterone levels only dropped 7%. Additionally, in men who received TRT and a higher dose of hCG every other day, had an increase in intra-testicular testosterone by 26% from baseline was observed. This proved that co-administering low dose hCG could maintain intra-testicular testosterone in those undergoing TRT. It was later shown that not only is intra-testicular testosterone increased with co-administration hCG but the sperm count is preserved as well at one year follow up.

According to the American Urological Association, HCG is appropriate for those men with testosterone deficiency who also desire to maintain fertility.  Some of the main uses and benefits of hCG injections include:

• Correcting undescended testes.

• Regulating testosterone production.

• Recovering from diseases or medical conditions that affect the body’s testosterone production.

• As a part of hormone replacement therapy.

• Weight loss, as increasing testosterone levels can help with exercise.

• Maintaining your testicular size.

• Repairing sexual dysfunction. Male sexuality is heavily linked to testosterone levels.

It is important to note that injectable medication provides a more reliable delivery than other drug administration methods of HCG on the market.  HCG drops or supplements are NOT a viable alternative to medical-grade HCG.  An HCG injection is injected subcutaneously into the fat tissue in the lower stomach or the fat pad of outer glute with a small insulin syringe.  Injectable hCG is available through prescription only. 

Thanks to the testosterone replacement therapy & HCG therapy, you may experience normal intra-testicular testosterone production, leading to increased fertility and overall health!