How Poor Mouth Health Silently Raises Blood Pressure

Nitric oxide is the molecule that keeps your blood vessels relaxed and your blood pressure under control. Part of the system that produces nitric oxide is hidden in your mouth. You can eat all the beetroot and arugula you want to try to make nitric oxide, but if your antiseptic mouthwash disrupts your oral microbiome, you're blocking most of the production of nitric oxide. Now, it's not entire nitric oxide production that gets reduced by doing that, but it's potentially enough to affect your blood pressure. So in this video, I'm going to talk about how the food that you eat gets converted into nitric oxide, which mouthwash blocks this process, and how to protect your nitric oxide production for healthier blood pressure and blood vessels. Nitric oxide is a tiny gas with a lifespan of only seconds, but it controls several things that determine vascular health. It tells the smooth muscles surrounding your arteries to relax. This widens the blood vessel and lowers resistance to blood flow. But nitric oxide does more than lower blood pressure. It also helps inhibit platelet activation, reduces white blood cell adhesion to the artery wall, and helps maintain a healthier endothelium, this delicate inner lining of your blood vessels. All of this helps to lower the risk of atherosclerosis and heart disease. Nitric oxide activates soluble guanylate cyclase, which increases cyclic GMP inside the vascular smooth muscle to produce vasodilation, the relaxation of the blood vessels. It also inhibits platelet activation and leukocyte adhesion. When nitric oxide levels decline, you get endothelial dysfunction. Blood vessels become less responsive, more inflammatory, and more prone to vasoconstriction, the constriction of the arteries. This makes it more likely that ApoV-containing particles enter the artery wall, which is central to plaque formation. That's why nitric oxide has been seen to have such an important role in preventing plaque buildup. It improves blood flow and keeps the arteries more supple, whereas stiff arteries increase your blood pressure and increase the risk of plaque formation. Your body has two nitric oxide pathways. Pathway number one is the conventional enzymatic pathway. Your blood vessels normally make nitric oxide from the amino acid L-arginine, an enzyme called endothelial nitric oxide synthase, ENOS, converts arginine into nitric oxide. L-citrulline can raise arginine availability and support this pathway. That's why citrulline and arginine don't depend upon the bacteria in your mouth to make nitric oxide. Pathway number two is the nitrate to nitrite into nitric oxide pathway. It begins with nitrate from vegetables like arugula, spinach, and beetroot. After you absorb them, your salivary glands pull roughly 25% of the circulating nitrate back into your mouth and concentrate it in the saliva up to 10 to 20 times above the levels in your blood. Bacteria living in the grooves of the back of your tongue, especially strains like villonella, actinomyces, and rothia, then convert nitrate into nitrite. After you swallow it, the nitrite can become nitric oxide in the stomach, blood, and the muscles. Unlike the ENOS pathway, this conversion becomes more active under the acidic, low oxygen conditions of intense exercise, which produces nitric oxide where blood flow is needed the most, mostly the muscles that are being exercised. This is an important distinction. If you consume antiseptic mouthwash, you can disrupt the nitric oxide pathway in the mouth by disrupting the oral microbiome, but it doesn't eliminate all the nitric oxide producing pathways. In a 2013 study on 19 healthy volunteers who used chlorhexidine mouthwash for seven days reduced oral nitrite production by 90%, plasma nitrite by 25%, and the blood pressure rose by 2 to 3.5 points. That study shows the mechanism very clearly. There's fewer nitrate reducing bacteria, less nitrite, and a subsequent rise in blood pressure because of the reduced nitric oxide production. Another 2015 study found the same results. Three days of antibacterial mouthwash impaired oral nitrate and raised blood pressure. Now not all the studies find the same results. A 2024 meta-analysis of five crossover trials found that mouthwash increased blood pressure by 1.59 points, but these results weren't statistically significant. So the mechanism and the effect is real. Is mouthwash going to be enough to give you hypertension or increase your risk of atherosclerosis? Probably not. I wouldn't consider it in the top 10 list of things that matter for that, but it's still useful to keep this in mind. And if you're trying to improve your oral health as well as your cardiovascular health, which you should, then you should just keep this in mind. We do have evidence that periodontal disease and periodontal pathogens in the mouth are associated with cardiovascular disease and even dementia. That's because the teeth are connected to your rest of the body and inflammation in the mouth causes inflammation in the rest of the body. So the mouth has a role in atherosclerosis. There's not enough evidence that it would cause atherosclerosis, but it is true that the mouth and the oral microbiome participate in your vascular system and they affect your vascular function through nitric oxide production. In the scope of this video, we're focusing mostly on the oral nitric oxide pathway through dietary nitrates. A quick word from today's sponsor, BonCharge. One of the things I use for skin health is red light therapy and there are actually some pretty interesting clinical trials behind it. 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That's because these wavelengths of light reach deeper into the skin, unlike other wavelengths of light that hit the surface layer, such as blue or green light. So the wavelengths of the device actually matter. I personally use the BonCharge LED face mask, which gives you red and near-infrared light in an easy mask you can use at home. If you want to check it out, head to boncharge.com forward slash seamlunt and use the code SEAM for 15% off. So let's go through the journey of how nitric oxide gets produced from your mouth to the arteries. Step one, eat nitrate-rich vegetables. The process begins with nitrate-rich foods such as arugula, spinach, lettuce, celery, and beetroot. The exact nitrate content of these vegetables varies between the plant, growing conditions, season, and storage. Step two is absorb the nitrate. After you swallow nitrate-rich vegetables, nitrate is absorbed through the digestive tract into your blood. Your salivary glands then pull roughly a quarter of it back out of the circulation and concentrate it in your saliva, which delivers it to the bacteria on the back of your tongue. Step three, the tongue bacteria activate it. Bacteria living in the deep groves of the back of your tongue use nitrate-reductase enzymes to convert the relatively inactive nitrate into nitrite. The important nitrate-reducing bacteria include species from valenilla, actinomyces, and rothia. Step four, nitrate becomes nitric oxide. You then swallow the nitrite. Some of it becomes nitric oxide in the acidic stomach, while some enters the circulation, and it can be converted by deoxygenated hemoglobin, myoglobin, and other proteins. This conversion becomes more favorable when your oxygen levels are low, such as when you're doing exercise. That makes it the perfect backup to the ENOS pathway, which requires oxygen. Because the oral microbiome is highly adaptable and is always changing, you need to cultivate and maintain these nitric oxide-boosting bacteria with food. In a 2016 human crossover trial, drinking beverages with nitrate-rich beetroot, arugula, and spinach increased plasma nitrate and nitrite, as well as reduced blood pressure acutely. Now, this was only on 18 people, and the drink contained quite a high amount of nitrate, 800 milligrams. Another 12-week trial on 77 adults found that about 350 to 400 milligrams of nitrate daily from vegetables lowered their daytime systolic blood pressure compared to the control group. Now, you can get very obsessed with the exact numbers of nitrate and the stuff like that you consume. I think the practical takeaway is to just eat a lot of these foods that contain nitrate, things like beetroot, arugula, spinach, etc. However, the more important thing to focus on is to stop destroying the bacteria that produce nitric oxide in your mouth. And I'm talking about antiseptic mouthwash, mostly. Chlorhexidine is useful when a dentist prescribes it for a specific oral infection or procedure, but if you're using a strong antiseptic rinse twice every day simply because it feels healthy, you might be doing more harm than good. The key is whether the mouthwash is antiseptic or not. Chlorhexidine, CPC, hydrogen peroxide, povidone-iodine, and broad spectrum essential oil blends can all suppress oral bacteria. If you want to preserve nitrate-reducing bacteria, choose a simple saline or dry mouth rinse without added antiseptics. Here's a table with the ingredients that are safe and the ones that are not safe for the nitric oxide-producing bacteria that you could use. You don't really need any mouthwash to have perfect oral health. Just brushing your teeth and flossing regularly is enough. The rest of your oral health is determined by the quality of your diet, your overall metabolic health, and systemic inflammation. Toothpaste does not harm your oral microbiome, so you shouldn't skip that. Gentle tongue-scraping might also be useful. A small 2019 study of 27 healthy adults found that regular tongue-cleaning was actually associated with a more favorable community of nitrate and nitrite-metabolizing bacteria. However, people who cleaned their tongues twice a day experienced the largest disruption to microbial diversity when they added chlorhexidine mouthwash. So it might be that tongue-cleaning and tongue-scraping are useful as long as you're not using antiseptic mouthwash. But the tongue-scraping leaves your oral microbiome more vulnerable whenever you add the mouthwash. Lastly, it's important to pay attention to hydration and nasal breathing. Saliva is required to transport nitrate, so if you have a severely dry mouth, it could impair this process. Stay normally hydrated and avoid a persistently dry mouth. Nasal breathing also helps with nitric oxide production, whereas mouth breathing leads to a dry mouth. Your mouth isn't the only place where you produce nitric oxide, but the bacteria in your mouth are able to do something that other cells of your body aren't able to do. They activate the dietary nitrate, which can be converted into nitric oxide. So the main message is to feed them the dietary nitrates that you get from certain vegetables, avoid unnecessarily sterilizing your mouth with antiseptic mouthwash, have good oral and dental health, as well as breathe through the nose and stay hydrated. Alright, thanks for watching. If you want to discover your health percentage and get your roadmap to top 1% of health, then join the community using the link in the description. I'll see you there.