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Understanding Nitric Oxide and Its Role in Blood Pressure Control

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Blood pressure monitor on heart printout with red heart ball.

Nitric oxide (NO) is a crucial molecule that plays a fundamental role in cardiovascular health. This article explores the mechanisms through which NO is produced, its impact on blood pressure regulation, and the role of supplements and medications in enhancing its effects.

Nitric Oxide Production Pathways

Nitric oxide is synthesized in the body through two primary pathways: the amino acid pathway and the food-based nitrate pathway.

Amino Acid Pathway

1. L-Arginine: This semi-essential amino acid serves as the primary substrate for nitric oxide synthase (NOS) enzymes. NOS enzymes convert L-arginine into nitric oxide and citrulline. This process occurs primarily in endothelial cells lining blood vessels and is essential for vascular health.

2. L-Citrulline: Another amino acid, L-citrulline, can be converted into L-arginine in the kidneys and other tissues. This conversion process helps maintain adequate levels of L-arginine for nitric oxide production, particularly when arginine availability is limited.

3. Taurine: While less directly involved than arginine and citrulline, taurine—a sulfur-containing amino acid—has also been implicated in nitric oxide production pathways, contributing to cardiovascular health.

Grape Seed Extract and Nitric Oxide Preservation

Grape Seed extract contains potent antioxidants, such as proanthocyanidins, which help preserve nitric oxide levels in the body. Nitric oxide, once synthesized, can be vulnerable to degradation by reactive oxygen species (ROS) and oxidative stress. Grape Seed extract’s antioxidant properties neutralize ROS, protecting nitric oxide from breakdown and supporting prolonged beneficial effects on vascular function.

We created a product to support the production of nitric oxide through the amino acid pathway. 

It also contains grape seed extract. We call this product, Vessel Support. 

Food-Based Nitrates

Found in foods like leafy greens (e.g., spinach, lettuce) and root vegetables (e.g., beets), dietary nitrates are converted into nitric oxide via the nitrate-nitrite-NO pathway. This alternative pathway becomes significant under conditions of increased physiological demand or limited L-arginine availability.

Nitric Oxide Enhancing Pharmaceuticals

In addition to natural pathways, pharmaceuticals like Viagra (sildenafil) and similar medications belong to a class known as phosphodiesterase type 5 (PDE5) inhibitors. These drugs enhance nitric oxide levels through a different mechanism. They inhibit the enzyme PDE5, which normally breaks down cyclic guanosine monophosphate (cGMP)—a signaling molecule that mediates the effects of nitric oxide in the body. By inhibiting PDE5, these medications increase cGMP levels, leading to prolonged vasodilation and improved blood flow.

Clinical Implications and Benefits

Nitric oxide’s role in cardiovascular health is profound and multifaceted:

– Blood Pressure Regulation: NO’s primary function is vasodilation, which reduces peripheral resistance and lowers blood pressure.

– Endothelial Health: Healthy endothelial cells are essential for nitric oxide production and maintaining vascular integrity.

– Antioxidant Properties: NO also acts as an antioxidant, protecting against oxidative stress—a significant contributor to endothelial dysfunction and hypertension.


Understanding the dual pathways—amino acid metabolism and dietary nitrates—through which nitric oxide is produced underscores its importance in cardiovascular health. Whether through natural means like amino acids and dietary nitrates or pharmaceutical interventions like PDE5 inhibitors, enhancing nitric oxide levels offers significant benefits for blood pressure regulation and overall cardiovascular function.

By incorporating nitric oxide-supportive nutrients, such as L-arginine, L-citrulline, and dietary nitrates, into daily dietary practices and considering supplements like grapeseed extract, individuals can potentially improve vascular health and reduce the risk of cardiovascular diseases associated with hypertension. Additionally, pharmaceuticals like Viagra demonstrate how medical advancements leverage nitric oxide pathways to treat conditions like erectile dysfunction and pulmonary hypertension.

Ultimately, optimizing nitric oxide levels through a balanced approach of nutrition, supplementation, and, when necessary, pharmaceutical intervention represents a proactive strategy for enhancing cardiovascular health and well-being.


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Dr. Keith Smigiel is a regenerative medicine physician and pain management specialist. He takes an integrative approach to medicine, focusing on customized solutions tailored to individual needs. Using advanced, non-surgical treatments, Dr. Smigiel stimulates your body’s ability to naturally heal itself.

Dr. Smigiel helps people suffering from conditions such as chronic pain and erectile dysfunction, to hair loss and weight gain. Combining treatments such as PRP Therapy, Ozone, Neural Prolotherapy, and IV Infusions with functional rehabilitation, he helps you look and feel better.

He heals the body, instead of just treating the symptoms!

With his professional qualifications as a certified family nurse practitioner, a doctor of chiropractic, and a fellow of the International Academy of Medical Acupuncture, Dr. Smigiel offers patients comprehensive care from a broad perspective of conventional and alternative medicine. He also has extensive experience in functional rehabilitation and chronic pain management.

Dr. Smigiel is married to Angela and has two children, Sophia and Larz. When he’s not busy helping patients, he enjoys hiking, mountain biking, motocross, and boating.

About Dr. James Kneller, M.D., Ph.D., FHRS

Dr. James Kneller, M.D., Ph.D., FHRS

Dr. James Kneller is one of the nation’s leading heart rhythm specialists. Dr. Kneller is certified by the American Board of Internal Medicine (ABIM) in Clinical Cardiac Electrophysiology, Cardiovascular Disease, and Internal Medicine.

As a Fellow of the Heart Rhythm Society (FHRS) and Certified Cardiac Device Specialist (CCDS), Kneller provides comprehensive patient care, combining best medical practice with invasive procedures using state-of-the-art technologies to treat heart rhythm disorders.

Beyond guideline-directed therapies, Kneller is passionate about optimized personal health. With a deep interest in complimentary alternative medicine (CAM), he strives to reduce the need for pharmaceuticals, invasive procedures, and exposure to harmful radiation. With Natural Heart Doctor, he strives to help each and every client to Live Well, Eat Well, and Think Well to attain their 100-year heart!

About Dr. Lauren Lattanza NMD, FACC

Dr. Lattanza Office Visit with Patient

As a Naturopathic Physician, I am trained to treat the whole person and get to the root cause of disease.

I went to Arizona State University where I graduated with a bachelor’s degree in psychology with a depth in physiology and minor in Spanish. After my undergraduate degree I was working on prerequisite classes towards medical school, which is when I came to learn that my values identified best with the principles of naturopathic medicine. I knew that I wanted to help patients identify the causes of disease and be able to offer treatments which would improve their health rather than simply treating symptoms.

I dedicated the next 4 years to the Southwest College of Naturopathic Medicine in Tempe, Arizona where I attained my Doctorate of Naturopathic Medicine. I served as Class President all 4 years, Board of Trustees – Student Trustee, spoke as the Club President for our branch of Toastmasters, and was voted by my peers and attending physicians to earn the Outstanding Leadership Award for the Class of 2020. Throughout medical school I took it upon myself to work alongside MDs, DOs, chiropractors, and functional medicine practitioners in addition to naturopathic physicians.

As a Spanish speaking student, I was able to volunteer with community clinics around Phoenix and provide free healthcare to low-income families. Due to this combined exposure, I came to find my passion in treating cardiometabolic and digestive disorders that are all too common, yet largely preventable. I took the opportunity to learn the broad spectrum of healthcare so I can ensure that I am able to provide my patients with the best options.

About Dr. Jack Wolfson DO, FACC

Dr. Wolfson Office Visit with Patient

Dr. Jack Wolfson is a board-certified cardiologist, Amazon best-selling author, husband, father, and the nation’s #1 Natural Heart Doctor.

For more than two decades, more than one million people have enjoyed the warmth, compassion, and transformational power of his natural heart health courses and events.

Dr. Wolfson is the founder of Natural Heart Doctor Scottsdale, his heart health practice in Arizona, and Natural Heart Doctor, an online resource center with natural health information. Doctors from across the globe reach out to Dr. Wolfson for training and education in holistic health practices.

He has been named one of America’s Top Functional Medicine Doctors and is a five-time winner of the Natural Choice Awards as a holistic M.D. Dr. Wolfson’s work has been covered by more than 100 media outlets, including NBC, CNN, and the Washington Post. His book “The Paleo Cardiologist: The Natural Way to Heart Health” was an Amazon #1 best-seller.

Dr. Wolfson and his wife Heather have four children and are committed to making the world a better place to live. They provide for those in need (including animals) and support natural health causes through their philanthropic efforts.


Our chiropractor is an expert at adjustments and holistic chiropractic care and works closely in conjunction with the other health care experts at Natural Heart Doctor.

Call (480) 535-6844 for details and scheduling.

IV Therapy

We use specially formulated natural vitamins and minerals that are injected into a vein to prevent or treat dehydration. Ideal for people in Arizona.

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Stimulate your body’s natural healing abilities and promote physical and emotional well-being with acupuncture at Natural Heart Doctor.

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Health Coaching

Our health coaches use evidence based skillful conversation, clinical interventions, and strategies to engage you actively and safely in health behavior changes.

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Cardio Tests

We use the most advanced testing in the world to assess heart health and to identify the root cause of your health issues.

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Office Visits

Schedule an office visit with one of our cardiologists, holistic physicians, chiropractor, or health coaches.

Call (480) 535-6844 for details and scheduling.

Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

Click here for  Natural Heart Doctor Health Coach.

Alternatively, you can email A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

Is my medical and payment information secure?

Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.