Circulation problems can show up as blood pressure imbalances, forgetfulness, impaired vision, or could take the fun out of romantic nights with someone special. If a person has bleeding gums, they are even more likely to struggle with the signs that blood is not flowing smoothly through the body. Tissues may be starving for much-needed oxygen. The solution? A tiny gas called nitric oxide, known for its role in healthy blood pressure levels. You can leverage the good bacteria in your mouth to help you make more nitric oxide. When you eat certain prebiotic foods like beets, celery, parsley, or leeks, you are feeding your oral microbiome, which helps convert the nitrate in these foods to naturally increase nitric oxide. The result is wide open vessels that can move blood and oxygen around freely, nourishing the heart, brain, and sex organs for a healthier and better quality of life. Clinicians and consumers, optimize oral health and heart health by eating prebiotic nitrates, taking prebiotic chewing gum, and using oral microbiome tests to measure nitrate-reducing bacteria. By building up beneficial bacteria in the mouth that help promote nitric oxide, you can leverage the oral-systemic link and get two benefits at once: a healthier mouth and a cardiovascular system that will keep going for years to come.

We are grateful to Calroy Health Sciences for making this blog possible.

Calroy Health Sciences is known for innovative nutritional formulas and a high bar for scientific evidence. Vascanox HP and Oral Microbiome Gums use natural strategies to enhance nitric oxide and allow blood and oxygen to flow freely through vessels. Arterosil HP nourishes the lining of vessels, known as the endothelial glycocalyx. I highly recommend Calroy’s products for cardiovascular health.

Mouth Bacteria Help Us Make Heart-Healthy Nitric Oxide

The friendly bacteria in your mouth- especially on your tongue- can lower your blood pressure.

Good bacteria in the mouth work together with you to transform nitrate, found in certain vegetables, into a heart-healthy substance called nitric oxide. These helpful bacteria are called nitrate-reducing bacteria. When you have good levels of these bacteria in the mouth, they can boost your levels of nitric oxide gas. When you don’t have these friendly bacteria, you are more likely to have an unhealthy mouth and more risk of cardiovascular problems. By feeding these good oral bacteria with what they like most (known as prebiotics), you can create healthier vessels and a heart that gets plenty of blood and oxygen.

What are the prebiotics that nitrate-reducing bacteria want the most? Why, nitrates of course! Nitrate (NO3) is a simple molecule made of nitrogen and oxygen. It’s found in plants, animals, and soil. If you eat whole foods and vegetables, you are already eating prebiotic nitrates. We get 80% of nitrate from dietary vegetables. Nitrates are high in lettuce and beetroot, for example. Scroll to the end of this blog to find a full list of nitrate-rich foods.

We depend on nitrate-loving friendly bacteria to help us make heart-healthy nitric oxide. That’s because we cannot take plant nitrates and turn them into nitric oxide by ourselves. However, nitrate-reducing mouth bacteria can take dietary nitrates from vegetables like lettuce and turn them into nitrites (NO2), which are molecules that we can then work with to make that wonderful little substance, nitric oxide.

When it was discovered over 30 years ago, nitric oxide made a huge splash in the scientific community because it is a key molecule that lowers blood pressure. It tells your blood vessels to relax so blood can flow more smoothly. Healthy levels of nitric oxide give you good blood pressure and lower your risk of heart attacks and strokes. Certain medications target this same mechanism-  they raise nitric oxide so that the heart can get more blood and oxygen.

The bacteria living on your tongue contribute up to 25% of your total daily needs of this blood-pressure-balancing superstar, nitric oxide. When people kill off their oral microbes with antiseptic mouthwash, their blood pressure skyrockets.¹ This is one of the main reasons some holistic and biological dentists warn against antiseptic mouthwash; because it kills good bacteria in the mouth that are trying to help your circulation. It also shows definitively that mouth bacteria are tied to heart health, a well-established relationship called the oral-systemic link, which we will discuss later.

The system for making nitric oxide is so critical that the body even has a way of recycling one-fourth of unused nitrate from the gastrointestinal tract by sending it back to the mouth for… guess what? More production of nitric oxide!

Image from Grant, M.M. and Jonsson, D. “Next Generation Sequencing Discoveries of the Nitrate-Responsive Oral Microbiome and Its Effect on Vascular Responses” J Clin Med. 2019 Jul 26;8 (8):1110.

Nitrates are the New Oral Microbiome Booster

Even if you haven’t heard of nitrates before, there is a lot of good research showing that they do wonderful things for the mouth and the heart.

Here are the Three Main Benefits of Dietary Nitrates:

• Oral microbiome balance
• Oral health
• Heart health

Nitrates encourage a healthier oral microbiome balance by growing the good bacteria and pushing out bad bacteria.² When the oral microbiome is more balanced, it wards off oral health problems, such as gingivitis and bad breath. It prevents cavities by making the pH in the mouth more basic, producing ammonia, and burning up lactic acid.²

Drinking high-nitrate beet juice boosts beneficial oral bacteria.³ If beet juice isn’t your drink of choice, lettuce juice decreases gum inflammation and increases good oral bacteria.⁴ Specifically, nitrate helps to increase beneficial Rothia and Neisseria species.⁵ It wards off microbes that cause dysbiosis or harm, such as Porphyromonas, Fusobacterium, Prevotella, Leptotrichia and Alloprevotella.²

In a peer-reviewed publication, Calroy Health Sciences’ prebiotic nitrate chewing gum decreased bad bacteria and promoted good bacteria involved in nitric oxide balance.⁶

Whether you have a healthy mouth or not can even be traced back to these bacteria that act on nitrates. Healthy people seem to have high levels.⁶ People with unhealthy gums have low levels, but after their gums are treated, the nitrate-loving bacteria increase.⁷ People who have inflammatory dysbiosis (or imbalance) of their oral microbiomes also are depleted in these nitrate-reducing friendly bacteria.⁶

Dietary Nitrates Help Lower Blood Pressure

Nitrates support cardiovascular health by providing the building blocks for nitric oxide. They enhance vascular function, which means they promote wide-open veins and arteries so that blood can flow freely.³ Nitrates from plant foods are so critically important to cardiovascular health,⁸ they have been proposed as conditionally essential nutrients, meaning that they are essential for human health.

Dietary nitrates are good foods for heart health and circulation since they are natural sources of nitric oxide. The research supports this. Drinking high-nitrate beet juice every day helped the inner lining of blood vessel walls function better (in scientist-speak, it improved endothelial function).³ Nitrate-rich beet juice also increased blood nitrite and reduced blood pressure.⁵ Eating more dietary nitrates has even been suggested as a strategy to prevent plaque build-up on artery walls.³

Prebiotic Nitrates Have Health Benefits For:

• Blood pressure⁵
• Blood sugar regulation⁸
• Brain function⁸
• Cardiovascular health⁵ and circulation⁶
• Erectile dysfunction⁹
• Eye health⁸
• Gingivitis⁴
• Oral bacteria balance⁵
• Gum inflammation⁶
• Muscle function⁸
• Oral dysbiosis (such as cavities)⁵
• Periodontal health⁶

*Note: Not all nitrates are healthy. Nitrates from plant foods that help to regulate nitric oxide are distinct from these nitrate sources: cured and processed meats; agricultural fertilizers; and the nitrates found in drinking water (from animal and human waste). The latter, non-vegetable sources of nitrates may pose health risks.⁸

What is the Oral Microbiome and Why Does it Matter?

The oral microbiome is the collection of microorganisms that live in the mouth. You’ve probably heard of the gut microbiome, which houses huge numbers of microorganisms. The oral and gut microbiomes are the most biodiverse ecosystems in our bodies, and they play a huge role in whether we are healthy or sick. These microbes are involved in digestion, absorption, metabolism, immune health, inflammation, and they protect us from pathogenic infections.

What are Prebiotics and Probiotics Anyway?

Prebiotics are the food for good bacteria. They help good bacteria stick in the body and do their good deeds. Prebiotics are usually hard-to-digest carbohydrates, such as dietary fiber.

The #1 value of prebiotics is they help build up good bacteria, increasing their growth and activity.¹⁰ The benefits of having strong levels of good bacteria are countless, but crowding out pathogens (or bad bugs) is one of the most important ones. By boosting good bacteria, prebiotics improve the immune system.¹¹ Good bacteria help to calm inflammation, detoxify waste products, improve digestion and absorption, and tune the metabolism.

Prebiotics and probiotics go hand-in-hand. When building up a strong and healthy microbiome, most integrative and functional medicine practitioners recommend taking both prebiotics and probiotics. Probiotics are beneficial bacteria encapsulated in pills, or lozenges, that can promote good health. There are also probiotic foods like yogurt or sauerkraut that help supply the body with good microbes.

Nitric Oxide May Be at the Center of the Oral-Systemic Link

Overwhelming research suggests that cardiovascular problems are more common in people who have gum disease.¹² This is known as the oral-systemic connection. There are many ways the mouth influences cardiovascular health, and I have written about some of them in previous blogs. Certain pathogenic bacteria in the mouth can contribute to heart disease; pathogens can also increase systemic inflammation, and a weak barrier in the mouth lining (“leaky gums”) may disrupt immune balance. In this blog, we explore yet another mechanism that could explain the relationship between oral health and systemic disease: good bacteria in the mouth are a critical player in making nitric oxide. That means a healthy oral microbiome is necessary for proper cardiovascular function, so blood vessels can open wide and let blood pass smoothly. Since nitrate-reducing bacteria are absent in gum disease, but grow back after it is treated, some researchers propose that oral bacteria and nitric oxide production could be the explanation for the oral-systemic connection.¹² There is still more to learn on this topic!

Harness the Power of the Oral Microbiome for a Healthy Heart

If you struggle with unhealthy blood pressure, poor memory, or if you aren’t having much fun in the bedroom, then you may not have proper circulation, meaning that oxygen cannot reach all the places it should. It is surprising to learn that bacteria in the mouth are key players in helping oxygen and blood flow smoothly throughout the body. The way they do this is through a famous tiny molecule called nitric oxide, which opens up and relaxes blood vessels, letting blood and oxygen flow freely. In this blog, we talk about the unsung heroes of the oral microbiome – the friendly mouth bacteria that promote health in the mouth and the cardiovascular system. Both practitioners and consumers can use this information to increase nitric oxide naturally. We covered the best prebiotic foods to boost these good oral bacteria, a prebiotic chewing gum, and tests to help you harness the power of the oral microbiome for a healthy heart and cardiovascular system.

Take These Steps to Boost Your Oral Microbiome and Cardiovascular Health

• Eat a whole foods diet with colorful veggies and fruits, healthy fats, proteins, nuts, seeds, and very low in sugar and refined carbohydrates.
• Eat High-Nitrate Foods That Promote Healthy Blood Pressure:
  • • Beets
    • Celery
    • Cress
    • Chervil
    • Chinese cabbage
    • Endive
    • Fennel
    • Kohlrabi
    • Leek
    • Lettuce
    • Parsley
    • Rocket (rucola)
    • Spinach
• Chew your prebiotic nitrate foods slowly and for more time so your oral microbiome can soak up the benefits.
• Consider Calroy’s Oral Microbiome Gum, a prebiotic nitrate chewing gum.
• Brush, floss, and stay on top of your dental health visits.
• Test your oral microbiome with Bristle’s Oral Health Test to find out about your levels of nitrate-reducing bacteria.

At Calroy, we translate breakthrough science into products without parallel. Through rigorous research and formulation, we develop transformative new solutions for foundational health.* Our mission is to advance science and enhance health for the benefit of healthcare practitioners and their patients.

References

1. Petersson J, Carlstrom M, Schreiber O, et al. Gastroprotective and blood pressure lowering effects of dietary nitrate are abolished by an antiseptic mouthwash. Free radical biology & medicine. Apr 15 2009;46(8):1068-75. doi:10.1016/j.freeradbiomed.2009.01.011
2. Rosier BT, Buetas E, Moya-Gonzalvez EM, Artacho A, Mira A. Nitrate as a potential prebiotic for the oral microbiome. Scientific reports. Jul 30 2020;10(1):12895. doi:10.1038/s41598-020-69931-x
3. Velmurugan S, Gan JM, Rathod KS, et al. Dietary nitrate improves vascular function in patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled study. Am J Clin Nutr. Jan 2016;103(1):25-38. doi:10.3945/ajcn.115.116244
4. Jockel-Schneider Y, Goßner SK, Petersen N, et al. Stimulation of the nitrate-nitrite-NO-metabolism by repeated lettuce juice consumption decreases gingival inflammation in periodontal recall patients: a randomized, double-blinded, placebo-controlled clinical trial. Journal of clinical periodontology. Jul 2016;43(7):603-8. doi:10.1111/jcpe.12542
5. Vanhatalo A, Blackwell JR, L’Heureux JE, et al. Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans. Free radical biology & medicine. Aug 20 2018;124:21-30. doi:10.1016/j.freeradbiomed.2018.05.078
6. Green J, Green SJ. Topical prebiotic nitrate: can extending the ‘hang-time’ in the mouth improve oral-vascular health outcomes? NPJ Biofilms Microbiomes. Jul 18 2024;10(1):57. doi:10.1038/s41522-024-00527-3
7. Simpson A, Johnston W, Carda-Dieguez M, et al. Periodontal treatment causes a longitudinal increase in nitrite-producing bacteria. Molecular oral microbiology. Dec 2024;39(6):491-506. doi:10.1111/omi.12479
8. Pinaffi-Langley A, Dajani RM, Prater MC, et al. Dietary Nitrate from Plant Foods: A Conditionally Essential Nutrient for Cardiovascular Health. Adv Nutr. Jan 2024;15(1):100158. doi:10.1016/j.advnut.2023.100158
9. Bryan NS, Ahmed S, Lefer DJ, Hord N, von Schwarz ER. Dietary nitrate biochemistry and physiology. An update on clinical benefits and mechanisms of action. Nitric Oxide. Mar 1 2023;132:1-7. doi:10.1016/j.niox.2023.01.003
10. Nunpan S, Suwannachart C, Wayakanon K. Effect of Prebiotics-Enhanced Probiotics on the Growth of Streptococcus mutans. Int J Microbiol. 2019;2019:4623807. doi:10.1155/2019/4623807
11. Mohd Fuad AS, Amran NA, Nasruddin NS, Burhanudin NA, Dashper S, Arzmi MH. The Mechanisms of Probiotics, Prebiotics, Synbiotics, and Postbiotics in Oral Cancer Management. Probiotics and antimicrobial proteins. Sep 1 2022:1-14. doi:10.1007/s12602-022-09985-7
12. Sanchez-Orozco NY, Rosier BT, Ruiz-Gutierrez A, et al. The blood pressure lowering effect of beetroot juice is impaired in periodontitis and recovered after periodontal treatment. NPJ Biofilms Microbiomes. Jan 9 2025;11(1):10. doi:10.1038/s41522-024-00622-5