Before Trying Viagra, a Nitric Oxide Expert Asks Men 5 Questions. The First Two Are About Their Toothpaste and Mouthwash

Dr. Nathan Bryan has spent 25 years uncovering something that might make you rethink your entire morning routine.

The cardiovascular physiologist and nitric oxide researcher says millions of Americans are unknowingly sabotaging their heart health with products sitting in their bathroom cabinets right now.

His research reveals a startling connection between everyday products like mouthwash and fluoride toothpaste and serious cardiovascular issues, from high blood pressure to erectile dysfunction.

Even more surprising: the solution might not be another prescription, but rather removing certain products from your daily routine.

The Mouthwash Mystery: Killing Bacteria to Save Your Smile, Harming Your Heart?

For decades, Americans have been told that killing bacteria in the mouth is essential for good health. But Bryan’s research tells a dramatically different story.

“Two out of three Americans wake up and use mouthwash every single day, sometimes multiple times a day,” Bryan explains. “And then 98% of Americans are using fluoride-based toothpaste.”

The problem? Both products are antiseptics that destroy the oral microbiome—the collection of bacteria living in our mouths that perform crucial functions our bodies can’t do alone.

In a 2019 study Bryan conducted, researchers gave antiseptic mouthwash to healthy dental students for just seven days. The results were dramatic.

We just give them mouthwash for 7 days. Their blood pressure goes up. In some cases, 26 millimeters of mercury.

When researchers stopped the mouthwash after seven days, blood pressure normalized within four days. The bacteria that disappeared when blood pressure spiked reappeared when it returned to normal.

The Nitric Oxide Connection: Your Body’s Miracle Molecule

At the center of this story is nitric oxide, a gas produced in blood vessel linings that regulates blood flow and oxygen delivery to every organ, tissue, and cell.

Bryan describes nitric oxide’s wide-ranging effects throughout the body.

This one molecule regulates everything we know about human optimization, disease prevention and longevity. It dilates the blood vessels, mobilizes our own stem cells so we can repair and replace dysfunctional cells, and activates the efficiency of the mitochondria.

The discovery was significant enough to earn a Nobel Prize in 1998. But here’s the catch: good bacteria in your mouth are responsible for producing it.

When antiseptic mouthwash kills these beneficial bacteria, nitric oxide production plummets. Blood vessels can’t dilate properly, blood pressure rises, and the cardiovascular system suffers.

Why Erectile Dysfunction Is Your Body’s Early Warning System

Bryan calls erectile dysfunction “the canary in the coal mine” for cardiovascular disease. And the connection is simpler than most people realize.

If you have erectile dysfunction, then you have coronary dysfunction. You have cerebral dysfunction. If the blood vessels of the sex organs can’t make nitric oxide, then you’re not making nitric oxide in any vascular bed.

The mechanism is straightforward: achieving an erection requires blood vessels to dilate, which depends entirely on nitric oxide production. When that system fails in one area, it’s failing everywhere.

For women, the signs are different but equally telling: low libido, vaginal dryness, inability to reach orgasm, or painful intercourse can all signal vascular problems related to nitric oxide deficiency.

Other early warning signs include cold hands and feet, slow wound healing, and exercise intolerance—all pointing to inadequate blood flow.

The Viagra Revelation: Why Half of Users See No Results

Andrew Huberman recently suggested that men over 40 should consider daily low-dose Cialis (tadalafil) for cardiovascular benefits. Bryan has a different take.

50% of the people that are given PD5 inhibitors don’t respond with better blood flow, don’t respond with better erections. And why is that? Because mechanistically you need nitric oxide.

PD5 inhibitors like Viagra and Cialis don’t create blood flow on their own. They work by preventing the breakdown of cyclic GMP, a molecule produced only when nitric oxide is present.

Without nitric oxide, there’s no cyclic GMP to preserve. The drug becomes useless, which explains the 50% failure rate despite billions in annual sales.

Bryan’s philosophy: fix the root cause—nitric oxide production—rather than masking symptoms with drugs that may carry long-term risks.

Antacids: The Hidden Danger Lurking in Medicine Cabinets

If mouthwash is concerning, proton pump inhibitors (PPIs) like Prilosec, Prevacid, and Nexium are downright alarming according to Bryan.

Antacids are killing people. It’s making people sick. These drugs should be taken off the market. They’re dangerous.

Originally FDA-approved for short-term use during acid reflux (3-5 days), these drugs are now available over-the-counter, with many people taking them for years or even decades.

A 2015 study from Methodist Hospital in Houston examined tens of thousands of patients. Those who had been on PPIs for three to five years showed approximately 40% higher incidence of heart attack and stroke compared to age-matched controls.

The mechanism? PPIs shut down stomach acid production, which is essential for nitric oxide generation when we swallow saliva. They also increase asymmetric dimethylarginine, a compound that directly inhibits nitric oxide production in blood vessels.

Additional risks include osteoporosis, hip fractures, H. pylori infections, kidney disease, and autoimmune conditions—because without stomach acid, proteins can’t be broken down properly.

Fluoride: The “Wellness” Ingredient That Might Be Making You Sick

Perhaps most controversial is Bryan’s stance on fluoride, found in 73% of U.S. municipal water supplies and 98% of toothpastes.

We’re bathing in it, we’re cooking in it, we’re drinking it. It’s killing the bacteria in and on our body, and it’s causing human disease.

Fluoride is an antiseptic that destroys oral bacteria indiscriminately, eliminating the beneficial species responsible for nitric oxide production along with harmful ones.

Bryan estimates that 92% of Americans cannot utilize nitrate from diet or supplements because they lack the proper oral bacteria—killed off by fluoride and antiseptic products.

He’s been using non-fluoridated toothpaste for 25 years and has developed what he calls a “nitric oxide microbiome-friendly” toothpaste using hydroxyapatite instead of fluoride.

The Right Way to Care for Your Mouth

So what should you do instead? Bryan’s recommendations are surprisingly simple.

Tongue scraping is beneficial—an ancient Ayurvedic practice that improves oral microbiome diversity. But there’s a critical caveat.

People who did the tongue scraping and then used antiseptic mouthwash had the greatest increase in blood pressure. Tongue scraping alone is a good thing because it’s almost like tilling the soil before you plant the seeds. But if you’re doing tongue scraping and using antiseptic mouthwash, you get more effective killing.

His protocol for optimal oral health:

• Use fluoride-free toothpaste (preferably hydroxyapatite-based)
• Practice daily tongue scraping
• Avoid all antiseptic mouthwashes (anything advertising it kills 99.9% of bacteria)
• Consider oil pulling or essential oil-based rinses that aren’t antiseptic
• Limit sugar and high-carbohydrate foods that lower salivary pH

The goal isn’t sterility—it’s creating conditions where beneficial bacteria can thrive and keep pathogenic bacteria in check naturally.

The Organic Food Paradox

Bryan’s research team made a surprising discovery about so-called “superfoods” for nitric oxide production.

They purchased identical vegetables from five U.S. cities and analyzed nitrate content. The variation was staggering: 50 to 100-fold differences in nitrate levels depending on location.

If you lived in Dallas or Los Angeles, you could eat four to five stalks of celery, get enough nitrate, if you had the right bacteria, produce nitric oxide, and normalize your blood pressure. If you lived in New York, you’d have to eat 60 or 70 stalks of celery.

The difference? Soil nitrogen content, growth season, and farming practices.

Even more surprising: organic vegetables have significantly less nitrate than conventionally grown ones because organic certification restricts nitrogen-based fertilizers.

Bryan’s solution: grow your own vegetables with soil analysis to determine what nutrients need replenishing, or support local farmers who use regenerative practices and can answer questions about their methods.

Breathing, Cold Plunges, and Daily Habits That Move the Needle

Beyond eliminating harmful products, Bryan practices specific habits to optimize nitric oxide production.

Nasal breathing is crucial, especially at night. The highest concentration of nitric oxide synthase (the enzyme that produces nitric oxide) is found in upper airways.

The mouth is part of the digestive system. It’s not part of our respiratory system. The nose is our respiratory system. When we do nasal breathing, deep breathing, it’s activating these mechanoreceptors, turning nitric oxide on.

Mouth breathing during sleep fully oxygenates the mouth, disrupting the oral microbiome and preventing proper tissue repair. Bryan uses mouth tape when traveling to ensure nasal breathing throughout the night.

His daily non-negotiables include:

• 18-hour daily fasts (eating window from noon to 6-7 PM)
• 24-hour fast once weekly
• 48-72 hour fast once quarterly
• 25-30 minutes of high-intensity interval training each morning
• Daily sauna (3 minutes at 170°F) followed by cold plunge (3 minutes at 37-40°F)
• Deep nasal breathing exercises
• High protein, good fats, limited low-glycemic carbohydrates

The contrast therapy of sauna and cold plunge creates what Bryan calls “exercising your blood vessels”—alternating dilation and constriction that maintains vascular flexibility.

Why Sugar Is More Dangerous Than You Think

Bryan considers sugar potentially more dangerous than proton pump inhibitors for nitric oxide production.

Sugar is sticky, right? It’s sticky inside our cells and blood system. Anything that you do that causes an increase in blood sugar is completely shutting down your nitric oxide production in the lining of the blood vessels.

When sugar sticks to proteins like hemoglobin, it prevents the conformational changes needed to deliver oxygen and pick up carbon dioxide. This explains why diabetics experience poor wound healing, macular degeneration, and peripheral neuropathy.

Sugar also glycates the nitric oxide synthase enzyme itself, rendering it dysfunctional and unable to produce nitric oxide.

Additionally, sugar lowers salivary pH, creating an acidic environment where pathogenic bacteria thrive and beneficial bacteria struggle—further decimating nitric oxide production.

Interestingly, Bryan published research in 2011 showing that providing nitric oxide can overcome insulin resistance, suggesting that diabetes itself may be a symptom of nitric oxide deficiency rather than solely a glucose metabolism problem.

The Cardiovascular Disease Solution Hiding in Plain Sight

Bryan’s perspective on heart disease is refreshingly simple: maintain nitric oxide production, and cardiovascular disease becomes nearly impossible.

The entire process for the onset and progression of cardiovascular disease, heart attack, and stroke can be explained by nitric oxide. If your blood vessels make sufficient nitric oxide, it downregulates the adhesion molecules. You don’t get any plaque deposition, plaque instability or plaque rupture.

When blood vessels lose the ability to produce nitric oxide, a cascade begins: adhesion molecules increase, monocytes and neutrophils stick and migrate through vessel walls, immune responses create foam cells, smooth muscle proliferates, plaques form and eventually rupture, causing heart attacks or strokes.

Maintaining endothelial function—the ability of blood vessel linings to produce nitric oxide—keeps arteries soft, compliant, and free from obstruction.

This may explain mysterious cases like LeBron James’ son’s cardiac event: healthy young athletes using fluoride toothpaste, antiseptic mouthwash, or antacids could be unknowingly destroying their nitric oxide production despite excellent cardiovascular fitness.

Simple Steps to Restore Your Body’s Natural Balance

Bryan’s core message is about removing obstacles rather than adding interventions.

Start by eliminating:

• Antiseptic mouthwash (anything claiming to kill bacteria)
• Fluoride toothpaste and fluoridated water when possible
• Proton pump inhibitors and chronic antacid use
• High sugar and refined carbohydrate consumption
• Supplement gummies (which contain sugar/glycerin that disrupts oral pH)

Then support your body’s natural nitric oxide production:

• Practice daily tongue scraping
• Switch to nasal breathing, especially during sleep
• Eat locally grown, nutrient-dense vegetables when possible
• Incorporate intermittent fasting
• Engage in high-intensity interval training
• Consider contrast therapy (sauna/cold exposure)

For those whose oral microbiome has been devastated by years of antiseptic use, Bryan has developed nitric oxide supplements and probiotic formulations designed to repopulate beneficial bacteria.

The promise is compelling: people with high blood pressure unmanaged by prescription medications have seen their blood pressure normalize simply by eliminating fluoride, stopping mouthwash use, and allowing beneficial bacteria to repopulate.

If we give the body what it needs, remove from the body what it doesn’t need, there’s no need for prescription medication. We’re starting to get people off prescription high blood pressure medicine because we’re targeting the bacteria that are producing nitric oxide.

Bryan’s philosophy represents a fundamental shift: from symptom suppression through pharmaceutical intervention to restoration of the body’s natural systems through strategic removal of modern products that disrupt ancient biological pathways.

The irony is profound—products marketed for health and hygiene may be silently sabotaging the very systems that keep us alive.

Sources

• Nobel Prize in Physiology or Medicine 1998 – NobelPrize.org: https://www.nobelprize.org/prizes/medicine/1998/summary/
• Mouthwash use and blood pressure – Free Radical Biology and Medicine (2019): https://pubmed.ncbi.nlm.nih.gov/31255702/
• Oral bacteria and nitric oxide production – Nitric Oxide Journal (2013): https://pubmed.ncbi.nlm.nih.gov/23178815/
• Proton pump inhibitors and cardiovascular risk – PLOS ONE (2015): https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124653
• PPI use and dementia risk – JAMA Neurology (2016): https://jamanetwork.com/journals/jamaneurology/fullarticle/2487379