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Dot Connect: Viagra, L-Arginine, High BP, Heart Disease, ED, Covid, now Alzheimer’s Too

Did you know that Viagra was originally developed to treat angina?

During phase one clinical trials, where humans are given the drug for the first time to see what effects it may have, many of the volunteers were hanging on to their medication, rather than handing them back.

From a post I’ll formally credit later

Viagra jokes are prone to writing themselves. Here’s my try: “They developed Viagra for angina but ended up treating vagina.” Not bad?

  • My Viagra Experience
  • Much More Than A Hardening Drug
  • What Is L-Arginine And Who Cares?
  • My L-Arginine Experience
  • Viagra: The Drug For Everything?
  • 69% Fewer Alzheimer’s Cases With Viagra
  • Confounders And Prophylactic Doses
  • Final Observations

My Viagra Experience

If you wish to get over the social stigma of taking an ERECTILE DYSFUNCTION!!! drug, come to Thailand. I’m convinced that the ED-moniker, as well, IMPOTENCE!!! is gleefully tossed around as a belittling term because it’s principally for men, the gender with dicks. Do any of the drugs or hormones to treat women come with some [woman-equipment] DYSFUNCTION!!! naming convention? Not that I’m aware of. That would be misogynist.

My issues, if you could call them that, are part natural, part man-made.

The natural part is that I’m not 20 or 30-something anymore. I’ve had encounters in my younger life with varied partners of many languages and cultures around the world—that’s my thing. And just like with money, there’s a marginal value in the drive to have more—at least for lots of people. It’s not—for me—as though another partner or another dollar isn’t worth anything. It’s just less of an imperative than it was when I was young and poor. I’m neither sexless nor rich at 60, but the young desires, as driving imperatives, aren’t there in the same way.

The man-made problem is that I’m a whiskey drinker. It’s well known the effect that can have on actual sexual performance. Thankfully, for me, being inebriated does not typically correspond to perceiving girls as prettier as the evening wears on. Thank God and Buddha for that, at least! I really can’t recall an embarrassing situation next morning, ever.

So there’s one joke that’s not on me.

To cut to the chases, Thailand has its own Sildenafil, and so does India (it’s off patent). Both are obtainable at almost any of the ubiquitous mom & pop pharmacies in Thailand. They outnumber by huge multiples, the 9,000 Starbucks you have in the USA. Price? It’s expensive by Thai standards, but not ours. A couple of bucks a dose. Less than one of the total number of drinks that put you there. I believe the Kamagra jelly is about 25% less per dose than Sidegra.

When I caught wind of this within months of arrival 2 years ago, I learned that lots of guys use them, even young guys. Now and then, a guy will reach into his pocket to pull out some coinage and one of those gel packs gets caught up and drops to the ground.

It’s a recreational drug, here.

…Because, duh, you can get it cheap and you don’t need anyone’s permission—as is required in The Land of the Free!!!

It’s hilarious to do a bit of a Google tour, searching the names of both of these knock-offs, to see all the hand-wringing from all the Usual Suspects. Dire warnings about safety—when they could simply observe those living in Thailand and other places that take them OTC a lot, and see for themselves. They even go so far as to claim these off-patent products may not be effective. Excuse me, but a pretty specific and pronounced short-term result is expected and I’m pretty sure that while the placebo effect is real, it’s not that real for those taking it for actual problems with function. …Reminds me of that film once…with Steve Martin?…where the woman tells him that she faked all her orgasms and his quick retort was “yea, well so did I!

…So I tried it.

It works in 2 ways for me, at the age of 60:

  1. It often, not always, prolongs normal sessions. Double the time, twice the umph, thereabouts? I suppose it also takes some pressure off in terms of the psychological aspects—performance anxiety isn’t an on/off, it’s degrees from on, to off. So, relax and enjoy. Sildenafil’s got your back.
  2. It can make what could otherwise be a disappointment for your co-inebriated partner who’s aroused, into a genuine smile in the morning—rather than a polite smile and look away.

Much More Than A Hardening Drug

I have barely begun to scratch at the wonder-surface of this drug as a potentially population-changing thing. The double-edged sword of getting drugs to market is that while an abundance of caution is required—except for an emergency-experimental drug euphemistically called “vaccine” so the whole world has to take it—it’s that it’s typically for a specific use. I’m sure angina is not a pleasant experience, but it’s probably an a priori reality that ED was a bigger market by exponents. Viagra and other ED drugs were huge profit makers while still under patent.

Patent profits have dried up, and while I don’t know the ins-&-outs of getting an existing drug approved for uses other than its originally approved use(s), I’m sure it’s expensive and that the existing machinery was built for single-use drugs under patent. So good luck getting Pfizer to say “whoa, this shit helps in a bunch of other ways, so let’s charitably spend the hundreds of millions to get them approved for those uses.”

It’s tough to blame, them, frankly. That’s a certain means of getting a stock price to tank and have the entire amoral investment world pissed off at you.

Patents are the price of admission for the sport of FDA drug approval.

Before delving into the other things Viagra/Sildenafil does wonders for, let’s detour a bit to a rather related strange-bedfellow substance that does at least similar things and it’s already in much of your food.

But there’s a catch.

What Is L-Arginine And Who Cares?

I seriously never heard of it until Chris Masterjohn’s Time’s Square, NYC soapbox speech to the crowd a few months back. It’s item number 1 in this roundup post. The second item in that post talks about Chris’ revelation of a new study showing the amino acid, L-Arginine—at about 3 grams supplemented daily—was crazy effective in saving Covid patients already in dire straights.

Huh?

It’s an amino acid, one of 20-something humans use in total, one of hundreds in nature in total. It was a mystery to me until issue #40 of Dr. Eades’ The Arrow. In the particular section covering the foregoing, he describes how arginine works and to my eye-opening surprise, related it to Viagra (Sildenafil).

Are you beginning to see the dots, now?

Viagra works on the endothelium in a similar manner to arginine, which is why almost all the OTC versions of Viagra contain plenty of it. Viagra works through a different process, but it increases nitric oxide (NO), which allows arteries to dilate. […]

Arginine works by converting to nitric oxide (NO) and thus increasing the level of (NO) in the endothelium. NO stimulates the endothelium to relax the arterial wall so the arteries dilate, allowing more blood to flow through them.

It would seem then that throwing back a bunch of arginine that would end up converting to NO would solve the problem of endothelial dysfunction. And it sort of does, but in a way it took a while to figure out.

The typical arginine levels found in most people will completely saturate the NO synthesis pathways. Yet folks with obesity, diabetes, high blood pressure, and even aging get benefit from arginine supplementation even when their own blood levels of arginine are plentiful. Why?

It’s called the “arginine paradox.” […]

For most people with endothelial dysfunction, I would recommend from three to five grams per day taken in divided doses on an empty stomach for best absorption. You can read the paper linked above that describes a number of studies on various disorders that have used different doses. Nice thing about arginine is that you really can’t overdo it. Within reason.

That bold / italics is mine. I took note of it.

Taking note of it was driven home in issue #41, when Mike was challenged with the fact that there’s plenty of arginine in the foods we folks tend to eat (like steak & eggs).

What’s difficult is getting the arginine into the cells in large amounts. Arginine competes with other amino acids to get into the cells, so if you eat eggs or steak or whatever, you get a big load of arginine along with a lot of other amino acids, but all these other amino acids compete with arginine to get into the cells where we need it get if we’re to increase the synthesis of nitric oxide.

If we want to get a lot more arginine into the cells, we need to increase the level of arginine in the blood relative to the other amino acids. If you take a couple of grams of arginine alone on an empty stomach (as those subjects did in the study we discussed in last week’s Arrow), you will have a short term spike of arginine in your blood that you won’t have if you get the same amount of arginine in a steak or in eggs, which contain all kinds of other amino acids.

The spike of arginine then gets more arginine into the cells than when arginine is thrown in with all the other amino acids and there is no relative difference.

My L-Arginine Experience

I doubt these dots would have appeared for me to connect had I not already had the Viagra/Sildenafil experience. Mike relating it to that caused me to perk up.

So, knowing me, I got a big cheap bottle, and I took 5 1g horse pills one night before bed. Totally sober, 8 hours since anything but water. I went right off to sleep and about an hour later, woke up to a phenomenon that’s more typical in the morning. I was in that state for about 3 hours before I could sleep again. I think it’s useful to point out that libido wise, I considered just getting up and going out prowling.

…The true test was three nights ago when my girl flew in from Ubon Ratchathani to Phuket via a Bangkok layover. She was supposed to arrive at 20.40, but there were delays and she finally landed just as I arrived after an hour drive, at about 23.00. After a couple of stops, we get home about 00.30, and being stone sober and echo chamber for a stomach, I downed 5g of arginine.

I thought I was tired. By the time we caught up, she did the unpacking, showered, and donned proper attire, it was just after 02.00.

I got to sleep around 04.00…

Amazing stuff and the proper technique for its use. The empty stomach is key. You may need to adjust your playtime routines accordingly to account for that. Thank you Dr. Michael Eades!

I’ve since used it like that a third time, same results. Seems pretty damn real to me.

“More study is required.”

Viagra: The Drug For Everything?

Well, now, that’s a question, isn’t it? And, I don’t know why you ought not be able to take both that and Arginine per the empty-stomach method. Viagra is a phosphodiesterase type-5 inhibitor (PDE5i), while Arginine converts to nitric oxide. I suppose more study is required on that front as well…

The quote I opened this post with is from a post that Dr. Eades linked, to the UK Dr. Malcolm Kendrick. Many readers here will be familiar with him as the author of The Great Cholesterol Con, required reading back in the Paleo Daze.

Dr. Kendricks’ post is a whirlwind of the wonders of Viagra that go beyond its more pronounced use. And, it’s from 2017.

In truth, it is actually one of the best drugs ever. Not only does is treat ED, but it can also be used by mountaineers to prevent pulmonary oedema (fluid filling up in the lungs), which is one of the major symptoms of altitude sickness. It does this by reducing the blood pressure in the pulmonary vessels (blood vessels in the lungs). […]

Viagra is used to treat people who have pulmonary hypertension (high blood pressure in the blood vessels in the lungs) at sea level. It is sold under the name Ravatio, for this indication – but we know that it is just Viagra. In addition, Viagra can be used to treat Raynaud’s disease, where the small blood vessels supplying the fingers and toes constrict, leading to painful cold fingers.

So, here we have a drug that can treat angina, pulmonary hypertension, erectile dysfunction and Raynaud’s disease at the same time. Thus, you can have great sex at twenty thousand feet above sea level, not get chest pain, or breathless, and stay warm at the same time. What more could a man ask for?

How does it do all these things? The answer is that it increases Nitric Oxide (NO) synthesis in endothelial cells. When it does this in the penis, it stimulates erections. In the heart, it opens up coronary arteries. In the lungs, it dilates the blood vessels, in fingers and toes it opens up arteries. So, all of the many different effects, are all due to exactly the same process – increased NO synthesis. Viagra also lowers blood pressure – as you would expect.

https://drmalcolmkendrick.org/2017/03/17/what-causes-heart-disease-part-xviii/

Now, when a doctor shatters the cholesterol hypothesis—and a lot of conventional “wisdom” concerning heart disease cause—plus advocates meat and eggs, then goes on to tell you many drugs including statins are profiteering garage and potentially harmful, then turns around to say this drug is one of the best ever, take notice, because that’s knowledge, honesty, and integrity speaking.

Ha, and that’s not even all. Dr. Kendrick marches on.

Researchers at Manchester University, in the UK, studied the use of Viagra in people with diabetes – who often have erectile dysfunction. Here is what they found:

‘Viagra could prevent heart attacks, according to research. Patients taking the male impotence drug were found to have a lower risk of having a heart attack or dying from heart failure than those not on the medication. The lead scientist told the Daily Express the findings are “incredibly exciting”. […]

For those who don’t like their statistics quite as much as me (shame on you). I shall attempt to simplify.

Over a seven year period, those men taking PDE5is (Viagra Cialis and the like) had a 4.7% reduction in overall mortality – compared to men who did not.

Those taking Viagra were 38% less likely to have a myocardial infarction

If you did have a myocardial infarction, those who were taking PDE5is had a 25.7% death rate. Those who were not taking PDE5is had a 40.1% death rate. So, if you were unfortunate to have a heart attack, you were 14.6% less likely (absolute risk reduction) to die if you were taking PDE5is.

Whilst the first figure of a 4.7% reduction in overall mortality may not sound terrible exciting, it knocks all antihypertensives and cholesterol lowering medication into a cocked hat. Even if you add them together and multiply by two – on their best day. Because 4.7% is an absolute risk reduction. [Absolute mortality reduction in the Heart Protection Study (HPS), the most positive statin trial, was 1.8% over five years]

The benefits of Viagra are even more startling when it comes to having a heart attack (MI). The current ‘gold standard’ treatment of choice is Primary Percutaneous Coronary Intervention (PCI), which basically means popping a stent into a blocked coronary artery to open it up again.

It has been estimated that PCI results in a 2% absolute reduction in mortality. On the other hand, Viagra gives you, very nearly, a 15% reduction in overall mortality. Or, to put it another way, Viagra may be seven and a half times as effective as PCI.

https://drmalcolmkendrick.org/2017/03/17/what-causes-heart-disease-part-xviii/

Is that it? Buddha no!

But it does not end here. it was also found that men with heart failure were 36% less likely to die if they took a PDE5i.

‘In the other subgroups, there was an inverse association between PDE5i use and all-cause mortality. Those with a recorded history of congestive cardiac failure, TIA and PVD had 36%, 40% and 34% lower risk, respectively.’ [A TIA is a transient Ischaemic attack/small stroke. PVD is peripheral vessel disease.]

Congestive cardiac failure is usually shortened to heart failure. [This 36% is a relative risk reduction, and I could not work out what the absolute risk was from the paper. I am probably too thick].

The effect on heart failure is almost certainly because another benefit of increasing NO is that you increase ‘angiogenesis’, otherwise known as, ‘the creation of new blood vessels’. If a coronary artery does completely block, this often leads to heart failure, as not enough oxygen and other nutrients can get into the heart muscle downstream.

However, if collateral blood vessels develop, the blood will be directed around the blockage and back into the artery downstream, through these newly created blood vessels. Although collateral circulation is not as effective as a fully patent coronary artery, it will create a significant flow of oxygen and nutrients once more. Thus, heart failure will be greatly improved.

https://drmalcolmkendrick.org/2017/03/17/what-causes-heart-disease-part-xviii/

Are we finished, yet? Nope. In a subsequent post, Dr. Kendrick went at it again. This one has a striking chart.

This was a study on over forty-three thousand men over a six-year period, who had previously had a myocardial infarction (MI). Just over forty thousand did not have medication dispensed for erectile dysfunction (ED) (40,077), three thousand did (3,068). They were split into three groups: lowest number of ED scripts, medium and highest number.

For the sake of brevity here I am just looking at the highest script group.

To put it another way, this is 81% relative risk reduction in overall mortality. Compare this with statins, in secondary prevention (using best figures possible), statins achieved a 15% relative risk reduction in overall mortality.

https://drmalcolmkendrick.org/2017/07/29/what-causes-heart-disease-part-xxxiii/

69% Fewer Alzheimer’s Cases With Viagra

This one has actually been in the news lately. Alzheimer’s has to be amongst the most sadly devastating diseases of all time. Even with a wasting-away cancer, at least your loved-one is fully cognizant—and likely, at the top of their awareness in those last times, taking in as much as they can.

With Alzheimer’s it’s as though you have to go through all the motions, but there’s just nothing there.

I’m not betting on it, especially given the prevailing societal, political, institutional, media, and drug company general evil, but given the sorrow and devastation of this disease, perhaps something shakes loose and Sildenafil gets serious looks as to its wonder status one way, or another.

Viagra could be used to treat Alzheimer’s disease, study finds

Alzheimer’s disease, the most common form of age-related dementia, affects hundreds of millions of people worldwide. Despite mounting numbers of cases, however, there is currently no effective treatment.

Using a large gene-mapping network, researchers at the Cleveland Clinic integrated genetic and other data to determine which of more than 1,600 Food and Drug Administration-approved drugs could be an effective treatment for Alzheimer’s disease. They gave higher scores to drugs that target both amyloid and tau – two hallmarks of Alzheimer’s – compared with drugs that targeted just one or the other.

“Sildenafil, which has been shown to significantly improve cognition and memory in preclinical models, presented as the best drug candidate,” said Dr Feixiong Cheng, the study lead. Viagra is the brand name of sildenafil.

Researchers then used a database of claims from more than 7 million people in the US to examine the relationship between sildenafil and Alzheimer’s disease outcomes by comparing sildenafil users to non-users.

They found sildenafil users were 69% less likely to develop Alzheimer’s disease than non-sildenafil users after six years of follow-up. To further explore the drug’s potential effect on Alzheimer’s disease, researchers developed a lab model that showed that sildenafil increased brain cell growth and targeted tau proteins, offering insights into how it might influence disease-related brain changes. The findings were published in Nature Aging.

https://www.theguardian.com/society/2021/dec/06/viagra-could-be-used-to-treat-alzheimers-disease-study-finds

Typical of idiot “journalists” who don’t even understand what they’re writing. It’s an observational study showing people who’ve been using Viagra long term had a 69 (har har) percent less Alzheimer’s incidence. Touting it as a treatment is like saying that because non-smokers have less incidence of lung cancer, “non-smoking could be used to treat lung cancer, study finds.” Or, “baby aspirin could be used to treat stroke, study finds.”

Idiots.

And it doesn’t end there.

Prof Tara Spires-Jones, deputy director of the Centre for Discovery Brain Sciences at the University of Edinburgh, said there were several important limitations to consider. “While these data are interesting scientifically, based on this study, I would not rush out to start taking sildenafil as a prevention for Alzheimer’s disease.”

And here, let me finish that for her, “…especially since the chief side-effect of the drug is harder and longer-lasting erections, and enhanced sexual enjoyment.

OK, KAREN

It’s a drug that’s been around for 23 years, proven highly effective and actually liked by its customers. The list of side-effects are mostly shit you could feel on an average day of waking up a bit off, and a search for overdoses (why?) and death are damn few amongst billions of usage incidents.

But no matter what, there will be gate keeping, hand waving, and of course: grant whoring.

Dr Susan Kohlhaas, director of research at Alzheimer’s Research UK, said: “Being able to repurpose a drug already licensed for other health conditions could help speed up the drug discovery process and bring about life-changing dementia treatments sooner.

“Importantly, this research doesn’t prove that sildenafil is responsible for reducing dementia risk, or that it slows or stops the disease. The only way to test this would be in a large-scale clinical trial measuring sildenafil effect against the usual standard of care.”

Well, it looks like the “usual standard of care” gets you 69% more Alzheimer’s from the get-go.

You can see the worry in their words.

By this point, you might be welling up with solemn joy as am I, coming to the realization that the very mechanisms by which drug companies make such fortunes eventually results in a big mistake.

In their heart of hearts, are they interested in developing a drug that’s so damn good it wipes clean any need for many of their other drugs? To boot, this one is off-patent and is obliterating the need for many of their other drugs that are still in patent-monopoly, where they can bill your insurance company whatever they want. This is a correct angle on the nonsense you’ve heard from the 70s that they don’t want to cure cancer. What they want is to develop patented drugs for any market big enough to turn huge profits. But, they certainly don’t want to shoot themselves in those many feet by developing wide-sweeping drugs that cover multitudes of sins.

Confounders And Prophylactic Doses

The most obvious confounder is that none of these foregoing observational outcomes rigorously specify dose or periodicity and indeed, Viagra is an on-demand sort of drug (expensive, too), where you take it “when the time is right.” This is part of what makes it such a potentially deadly Trojan Horse for shattering a whole shit ton of pharma profits and other industries grown up around making billions by demonstrating a 1% improvement in shit that just perpetuates and gets worse by the year, all in league with the food-engineering industry, dietary industry, and others.

In terms of a daily dose to get all these benefits (50-100mg seems to be the effective dose for the desired pronounced results), I Googled around and found these:

On that last one, it’s worth pointing out that such a dose for infants less than 24 hours old is 2-4x what an adult would get by weight and frequency and did no harm to them against placebo.

For an average 80 Kg guy, seems to me that a daily dose of 50mg should sit about right, but I’m just estimating from what I see out there.

In terms of overdoses, this is interesting:

An Accidental Repetitive 10-Fold Overdose of Sildenafil in a Young Infant with Pulmonary Hypertension

Here, we present a young infant with congenital diaphragmatic hernia and PH who received an unintentional 10-fold overdose of oral sildenafil for 6 consecutive days. This overdose, compared to the therapeutic dose, resulted in increased plasma concentrations of sildenafil from 42 to 521 mcg/L and desmethylsildenafil from 81 to 393 mcg/L. However, the high exposure only led to diarrhea, without any other serious adverse events.

There’s one for all the forgoing gatekeepers, hand wringers, and grant whores.

Final Observations

I find it odd that after 23 years of a super-successful, safe, and effective drug—doubling as a veritable happy pill in a good way with nary a truly awful side-effect—it’s just now coming to some mainstream attention as anything but a drug exclusively for disgusting old men who just can’t get it up. I suppose it’s plausible that’s part of the reason in itself, and the associated stigma, but I doubt it.

Of course, Viagra isn’t the only drug like this out there, but just eyeballing their sales since inception, and it looks to be on the order of $40-50 Billion. I think it’s safe to say that they’ve been used by tens of millions of people over 23 years.

…And you mean to tell me that nobody had much of a clue in all this time, that the thing seems to provide other benefits? Lowered BP, for instance, is pretty damn obvious. In fact, I just tested that. Cut a 100mg in half, so 50mg, and 2 hours later my systolic was down 11 points and diastolic, down 15 points. Plus, I called my girl who’s down at the beach with her sister and told her to get home ASAP.

This 20-year anniversary piece in The Atlantic demonstrates it was about sex, only about sex.

But I get it. I too joked about it, because I thought it was only about that, the jokes write themselves, and I took the manly stance that you fix the underlying issues rather than treat symptoms of them. Had I even a hint of a clue of the wonder, I’d have been looking into this a long time ago.

…Imagine an alternate universe where Pfizer had gone ahead and got it approved for angina.

Side Effects May Include:

  • Lower blood pressure
  • Lessened pulmonary hypertension
  • Improved symptoms from Raynaud’s disease
  • Increased nitric oxide levels (shown to be protective of endothelial cells)
  • 4.7% reduction in overall mortality
  • 38% less likely to have a myocardial infarction
  • 14.6% less risk of death from a myocardial infarction
  • 36% less likely to die from heart failure
  • Increased angiogenesis (the creation of new blood vessels)
  • 81% relative risk reduction in overall mortality (for men with previous myocardial infarctions)
  • 69% less likely to develop Alzheimer’s disease
  • Harder and longer-lasting penile erections

If that’s not a wonder drug, then we have no clue what such a thing is.

As for me, I’ve just motorcycled 3 minutes over to one of the many closest pharmacies and got 3 boxes of Sidegra, the Thai-manufactured sildenafil. That’s twelve 100 mg blue pills, for 1,000 baht. About $30, $2.50 a pop. At 50 mg daily, that’s $1.25 per day. Pfizer sells Viagra, chemically identical, for $70 per pill and nobody says what the fuck? because they have HEALTH INSURANCE!!! so it’s FREE!!!

I’m going to do 100 mg daily, 1 pill, in 2 doses morning and evening for the first 4 days, then reduce to half that. I’ll monitor blood pressure. My “normal” has been 130/90 since I was a teen. Higher BP runs in my dad’s German side of the family, yet nobody has strokes or heart disease. I’ve had acute bouts of scary-high, so I began taking BP meds (Enalapril 5 mg and Amlodipine 10 mg, 1x daily in 2 doses; sets me back $4 for a 30-day supply) about 18 months ago, zero side-effects. During this Sildenafil trial, I’ll cease those meds, but monitor.

What I’m looking for there is a kill-two-birds thing where the Sildenafil replaces the BP meds and affords me all those other “side-effects.”

I’m still meandering about integrating L-Arginine into that, perhaps a 4 gram thing, 2 g morning and before bed, empty stomach.

As this is tangentially related to my series on testosterone, future reports and updates will be done there.

UPDATE:

Richard Nikoley

I'm Richard Nikoley. Free The Animal began in 2003 and as of 2021, contains 5,000 posts. I blog what I wish...from health, diet, and food to travel and lifestyle; to politics, social antagonism, expat-living location and time independent—while you sleep—income. I celebrate the audacity and hubris to live by your own exclusive authority and take your own chances. Read More

9 Comments

  1. Alan Andersen on December 14, 2021 at 11:06

    Interesting. I’ve been doing about 3 grams of L-Arginine once per day & just realized my naturopath gave me a scrip for sildenafil 20 mg three times per day. So he likes splitting a 60 mg dose into three 20 mg doses per day. But I weigh 125 kilos. I think I am going to double the sildenafil to 120 mg daily, just under 1 mg/kg, split into two doses, since taking it 3 times daily is a pain. Sounds like I won’t suffer much of an overdose effect at that rate. And I think I will up the L-Arginine to 5 grams daily divided into two doses. I am also taking 10 mg tadalafil per day. All of this for heart and lung issues. We shall see. Thanks again for the interesting hacks. I can’t remember why I started the L-Arginine but now I’m glad I have it, plus stumbling into the sildenafil scrip.

    • Alan Andersen on December 14, 2021 at 11:09

      PS. I also am taking a beta blocker, metoprolol, and and BP med, Losartan and even with those my BP has been around 145/93, but lately, after stopping the testosterone injections plus starting the L-Arginine, it’s now around 143/70. Weird drop in just the diastolic. We shall see.

  2. Lars Jonsson on December 14, 2021 at 16:51

    Great article. Wish it where as readily available in Sweden.

    Would love your take on a few other supplements said to be NO-raising.

    Beet root juice. (Mix with some apple juice for taste) nitrates (turn to NO via oral bacteria in saliva). Lots of research going on.

    L-citrulline (converts to L-arginine)

    Vitamin c

    Maritime pine bark extract -Pycnogenol

    Garlic (aged garlic increase conversion on L-arginine to NO). I remember reading you tried it for bp.

    Pomegranate juice (said to protect NO from oxidation)

  3. george phillips on December 14, 2021 at 18:40

    Thank you Richard, knowledge and laughs together, I love reading your posts !

    I’ve had some l’arginine powder ‘on stand by’ since last March to cope with any nasty cov symptoms. Not needed yet.

    Perhaps some little ‘blue’ pills are in order; die smiling, biting the pill !

  4. Todd Lambert on December 16, 2021 at 07:56

    Berberine is a nice arrow in the nitric oxide quiver. It also has other positive effects.

  5. MIne Derien on December 20, 2021 at 02:00

    Great post! I take a mix of arginine/citrulline, often mixed in with the rest of my stack, after a meal. I do however observe a difference over time. Not to be neglected either, nitrate rich food such as green veggies, beets, water melon (as close the the rind you can get).

  6. Greg on January 4, 2022 at 06:28
    • MIne Derien on January 4, 2022 at 19:49

      Now that V is sold mostly as generic, I predict Pfizer vill throw the drug under the bus, like Merks for Iver…

    • Greg on January 4, 2022 at 21:08

      I’m in mexico now. Ivermectin & Viagra both available at the pharmacies

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