But from a health and long-term perspective of functional medicine and ageing, these problems that can apparently be separated from one another often seem to have a common denominator: declining blood vessel health.
Central to this process is the naturally-occurring molecule nitric oxide, which is responsible for circulation, metabolism, immune balance and healthy ageing.
Nitric oxide is a gas formed in the body that relaxes and widens the channels of blood vessels within the body – a process called vasodilation.
This basic action helps to ensure that oxygen and nutrients are delivered to all tissues in the body.
Even in very small amounts, nitric oxide has a huge impact on health.
It is typically considered in functional medicine to be a marker of vascular age as healthy blood vessels are crucial for determining how well the body functions over time.
Here is why nitric oxide matters to our health:
> Heart disease and high blood pressure
Heart disease remains a major cause of death in Malaysia.
Many people assume that high blood pressure or heart disease are just a consequence of advancing age or genetic fate.
In fact, one major contributor to these conditions is endothelial dysfunction, in which the lining of a blood vessel loses its ability to produce adequate nitric oxide.
When nitric oxide levels are low, our blood vessels become stiff and inflamed, causing the heart to work harder and blood pressure to eventually rise.
The longer this goes on, the more likely you are to experience complications like heart attack and stroke.
> Diabetes and metabolic syndrome
Nitric oxide also contributes to metabolic health, which has become an increasingly serious issue in Malaysia.
A sufficient level of nitric oxide assists in increasing cellular insulin sensitivity and aiding glucose to enter the muscles more effectively.
With decreased production of nitric oxide, insulin resistance and the occurrence of type 2 diabetes increases.
This vascular-metabolic connection explains why people with diabetes are at much higher risk for heart disease, and why the health of blood vessels is critical in long-term diabetes management.
> Ageing brains
Nitric oxide is crucial for brain health and cognitive longevity.
Reduced availability of nitric oxide is associated with impaired cerebral blood flow and a greater risk of neurodegenerative diseases, like Alzheimer’s disease.
The brain is exceptionally sensitive to changes in blood flow, and even small decreases in circulation can threaten memory, concentration and mental clarity.
From a lifelong perspective, sustaining healthy blood flow to the brain is the most critical means of preserving cognitive function and independence in old age.
> Energy and stamina
Nitric oxide is closely related to a person’s energy level and physical stamina.
A lot of middle-aged and elder Malaysians say that they are easily fatigued, have low exercise resistance or take longer to recover after playing sports.
Although such symptoms are frequently ascribed to ageing, they often indicate diminished nitric oxide generation instead.
When blood vessels do not dilate properly, muscles get less oxygen for activity, leading to mild tiredness and slower recovery.
Supporting pathways through nitric oxide helps to preserve mobility, strength and vitality – key elements of healthy ageing.
> Sexual health
Another important insight into nitric oxide status comes from sexual health.
Early indicators of the ageing of the vascular system often occur in men via erectile dysfunction and women via impaired sexual responsiveness.
Nitric oxide is critical for genital blood flow and normal sexual function, so trouble in that area often shows up years before more significant cardiovascular symptoms come about.
Thus, sexual health in functional medicine is conceptualised not just as an individual problem, but also as a window into overall cardiovascular and metabolic health.
> Living longer
Nitric oxide production naturally decreases with age due to several key factors.
Sadly, Malaysia’s modern lifestyle aspects – i.e. physical inactivity, consumption of refined carbohydrates and ultra-process-ed foods, chronic stress, poor sleep, smoking, and chronic metabolic disease – only exacerbate this decline.
When the amount of nitric oxide drops, blood vessels become stiffer, inflammation rises and the body’s capacity for coping with stress decreases.
This accelerates biological ageing and raises the risk of various chronic diseases.
From a functional medicine and longevity standpoint, the idea is to not just treat disease once it starts, but also preserve nitric oxide levels over the course of a lifetime by promoting early and consistent production.
It requires that the body’s natural nitric oxide pathways be supported by lifestyle and nutritional approaches, rather than relying only on drugs for the treatment of late stage disease.
Some examples of nitrate-containing vegetables in Malaysia include:
- Spinach (bayam)
- Water spinach (kangkung)
- Mustard greens (sawi)
- Lettuce
- Beetroot
- Ulam-ulam (pegaga, selom, daun ketumbar).
These vegetables help to fuel the nitrate to nitrite to nitric oxide pathway, which depends on healthful oral bacteria.
This pathway may be blocked by excessive use of antiseptic mouthwash.
Regular physical activity, adequate sleep, stress management and so on are also important to reduce chronic inflammation and oxidative stress, which quickly destroy nitric oxide and decrease blood vessel function.
> Ageing healthily
Nitric oxide, in the context of healthy ageing, is much more than a cardiovascular molecule.
It says everything about health as a healthy circulatory system serves all organs in the body.
Sufficient nitric oxide is related to higher energy metabolism, higher cognitive function, better metabolic control, healthier sexual function and resilience with ageing.
By boosting nitric oxide production, people aren’t just adding years to life, but are maximising the quality of those years.
Clinically, nitric oxide provides a valuable model of why many co-existing chronic diseases are often clustered in the same individual.
High blood pressure, diabetes, fatigue, erectile dysfunction and cognitive complaints are often treated independent of one another, but tend to stem from the same underlying problem: vascular dysfunction with a reduced availability of nitric oxide.
In a clinical setting, signs such as low exercise tolerance, chronic fatigue or sexual dysfunction should not be dismissed as standard ageing.
These findings are frequently early indicators of compromised endothelial function and increased risk of cardiometabolic disease.
Early intervention in nitric oxide pathways can help clinicians to prevent irreversible damage before it happens.
Do note however, that functional medicine does not replace medical treatment; it is an answer to root causes, not a substitute for clinical care.
Medications are often needed when necessary and life-saving, but improved long-term health happens when lifestyle problems, nutrition, metabolic state, sleep and stress are treated in parallel with pharmacological treatment.
Providing interventions to support nitric oxide production and utilisation by vascular systems provide an opportunity to enhance vascular resilience and potentially reduce the burden of future disease.
For patients, the real message is empowerment.
The many factors that affect nitric oxide – physical activity, diet, gut and oral health, sleep quality and stress – can be changed.
Even modest and consistent changes can lead to significant improvements in circulation, vitality and overall health.
Preserving nitric oxide is ultimately about protecting the body’s internal highways that connect oxygen, nutrients and signals to every cell.
When these are kept open and flexible, the body ages more slowly, recovers more efficiently and stays in use for longer.
This is what longevity-led, preventive care is about.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Informa-tion published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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