What is nitric oxide?

Nitric oxide is naturally found in your body and is important for blood vessel health.
People with type 2 diabetes have problems producing nitric oxide, so there are lots of claims that taking supplements that boost nitric oxide helps diabetes. These supplements don’t actually contain nitric oxide, but rather, ingredients that your body converts to nitric oxide.
It’s possible that these supplements might help manage diabetes, but more research is necessary.
Nitric oxide is a gas your body naturally produces. Certain enzymes called nitric oxide synthase break down an amino acid called arginine and produce nitric oxide.
This chemical reaction happens in almost every cell and tissue in your body and makes this small-molecule gas that easily gets into your cells. It’s important for your blood vessels and helps keep them flexible.
A hormone called insulin controls nitric oxide enzyme activity. Insulin helps get glucose into your liver, muscle, and fat cells where it can be used for energy. People with type 2 diabetes don’t respond to or process insulin properly, which causes problems making nitric oxide and affects blood vessels.
What does nitric oxide do in your body?
Nitric oxide does many things in your body. It is sometimes called a double-edged sword because it has lots of beneficial effects on the body, but it can also cause damage at high levels. A lot of the time, it’s helpful and acts on lots of cells and tissues, regulating lots of activities.
Relaxes blood vessels and smooth muscles
Nitric oxide is a vasodilator, which means it widens blood vessels. The NOS enzymes mostly make NO in the lining of your blood vessels. The gas flows easily into your cells, where it increases certain chemicals and sets off a cascade of changes that make your muscles and vessels relax. This helps control the tone of your blood vessels and keeps them flexible. It also helps the muscles in your lungs.
Regulates blood flow
Nitric oxide helps control blood flow and oxygen to tissues. With relaxed vessels, blood can move better through your body and bring oxygen and nutrients to your tissue.
Signals immune system
It’s not exactly clear how NO affects the immune system, but immune cells have high nitric oxide activity. Nitric oxide can increase or block inflammation and activate cells that attack and defend against infections and foreign microbes. NO gas is also toxic to microbes, so your body uses it to kill germs that could cause infection.
Involved in brain activities
Nitric oxide is active in almost every area of the brain. It interacts with brain cells and other brain chemicals and helps with cell-to-cell communication. It’s involved in lots of your brain and nervous system activities, like sleeping, pain, anxiety, learning, memory, moving, and feeding.
Regulates metabolism
Your body also uses nitric oxide in energy production. The gas interacts with your mitochondria (the energy centers of your cells) and makes them more efficient. Nitric oxide also stimulates your cells to take in glucose for energy and helps your body break down fatty acids.
Can nitric oxide supplements help type 2 diabetes?
Nitric oxide supplements usually contain l-arginine or l-citrulline amino acids. Your body breaks down arginine into citrulline and nitric oxide. Some have suggested that you can help your body make more nitric oxide if you give your body these precursors, and some research shows supplements might have benefits for those with type 2 diabetes, but it’s too early to know for sure.
Might lower blood pressure
People with type 2 diabetes have trouble making nitric oxide, which can affect blood vessels and blood pressure. Poor vessel health leads to high blood pressure and heart disease, which are common complications of diabetes. Nitric oxide supplements might help with blood pressure.
Scientists conducting a small study gave high blood pressure patients a lozenge made of vitamin C, citrulline, sodium nitrate, hawthorn berry, and beetroot extract. After 30 minutes, patients had significantly lower blood pressure. The study points out these natural supplements might be useful because you don’t build a tolerance to them. Other studies also show that supplements can help lower blood pressure in cases of diabetes.
Might improve insulin sensitivity
If you have diabetes, your body is resistant to insulin, which means it doesn’t respond well to or properly use this hormone. Since nitric oxide interacts with insulin, the theory is that supplements might help.
One study showed that arginine supplements increase nitric oxide in diabetes patients. The study compared two groups, one treated with diet and the other treated with diet plus arginine. The group who took arginine not only had higher nitric oxide production, but it also /increased insulin sensitivity or response to insulin, too.
A longer study conducted over 18 months showed that arginine supplements improved glucose metabolism, insulin sensitivity, and pancreas cell function in people with diabetes.
The pancreas is where your body makes insulin. While the arginine supplement doesn’t prevent diabetes, it might help with insulin response.
There is a debate about how nitric oxide affects insulin, though. While supplement treatments show promise, more research is necessary to understand how these supplements affect people with diabetes.
Make nitric oxide naturally
Overall, it’s not clear that nitric oxide supplements help manage type 2 diabetes. You also might not need these supplements. You can naturally increase your nitric oxide production by eating foods that convert to nitric oxide, including beets, watermelon, and spinach. While arginine and other nitric oxide supplements can cause side effects like nausea, bloating, and diarrhea, these healthy, nutritious foods generally don’t.
You can also naturally stimulate nitric oxide production with exercise and calorie restriction. These activities will help you maintain a healthy weight and become more sensitive to insulin.
Bottom line
Diabetes is a lifelong condition, and lots of people need medication to control it. Sometimes, you can push type 2 diabetes into remission with exercise, weight loss, and diet, but this can change as you get older and if you get sick. You usually need continuous treatment and long-term monitoring.
If you have type 2 diabetes and want to take supplements, talk to your doctor first.

SLIDESHOW
Diabetes: What Raises and Lowers Your Blood Sugar Level? See SlideshowAntioxidants and Redox Signaling: "Nitric Oxide in Health and Disease of the Nervous System," "Nitric Oxide in the Vasculature: Where Does It Come From and Where Does It Go? A Quantitative Perspective."
Brain and Neuroscience Advances: "Nitric oxide as a multimodal brain transmitter."
Cardiology: "Characterization of the Role of Nitric Oxide and Its Clinical Applications."
Department of Defense Dietary Supplement Resource: "Nitric Oxide Supplements."
Diabetes: "Nitric Oxide Synthesis Is Reduced in Subjects With Type 2 Diabetes and Nephropathy," "ON NO—The Continuing Story of Nitric Oxide, Diabetes, and Cardiovascular Disease."
Diabetes Care: "Long-Term Oral l-Arginine Administration Improves Peripheral and Hepatic Insulin Sensitivity in Type 2 Diabetic Patients."
Diabetes, Obesity, & Metabolism: "Effect of a long-term oral l-arginine supplementation on glucose metabolism: a randomized, double-blind, placebo-controlled trial," "Impact of nitric oxide on metabolism in health and age-related disease."
Diabetes UK: "Reversing Type 2 Diabetes."
Frontiers in Pharmacology: "L-Citrulline Supplementation Increases Plasma Nitric Oxide Levels and Reduces Arginase Activity in Patients With Type 2 Diabetes."
Harvard Medical School Harvard Health Publishing: "Type 2 Diabetes Mellitus."
Journal of Clinical and Diagnostic Research: "Nitric Oxide: Its Role in Immunity."
Journal of Clinical Endocrinology & Metabolism: "Insulin Resistance Is Associated with Impaired Nitric Oxide Synthase Activity in Skeletal Muscle of Type 2 Diabetic Subjects."
Journal of Clinical Hypertension: "Acute Effects of an Oral Nitric Oxide Supplement on Blood Pressure, Endothelial Function, and Vascular Compliance in Hypertensive Patients."
Mayo Clinic: "L-arginine."
Medscape: "Therapeutic Role for Nitric Oxide in Respiratory Disease."
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