A new study titled “Ageing modifies the oral microbiome, nitric oxide bioavailability and vascular responses to dietary nitrate supplementation” by Anni Vanhatalo et al. (2025) reveals how older adults (67–79 years) respond differently to nitrate-rich beetroot juice than young adults (18–30 years), and why age-related changes in oral bacteria influence blood pressure and vascular health .
The research employed a double-blind, placebo‑controlled crossover design with three two-week phases (nitrate-rich beetroot juice, placebo juice without nitrate, antiseptic mouthwash), separated by wash‑outs. They compared 30 older adults with 39 younger adults, analyzing oral microbiome composition, plasma nitrite, blood pressure, and flow-mediated dilation (FMD) responses
Key Findings
Oral Microbiome Shifts Differ by Age
In both groups nitrate juice changed oral bacteria significantly—but older adults showed more dramatic shifts. Notably, they had decreases in Prevotella (linked to inflammation) and increases in Neisseria (a beneficial nitrate-reducing genus)
Blood Pressure Benefits in Older Subjects
At baseline, older participants had a mean arterial pressure (MAP) of 95 ± 9 mmHg, vs 87 ± 7 mmHg in younger adults. After two weeks of beetroot juice, older adults experienced a ~4 mmHg drop in brachial MAP. The younger group showed no significant decline Nitric Oxide
Bioavailability Correlates with Vascular Impact
In the older group, the decrease in blood pressure correlated with increased plasma nitrite levels, which in turn correlated with reductions in Prevotella abundance—a microbiome-mediated mechanism enhancing nitric oxide (NO) availability
Vascular Markers: FMD and Mouthwash
FMD changes weren’t significant in older adults, but the younger group showed differences between antiseptic mouthwash and nitrate-rich conditions, suggesting microbial disruption by mouthwash impaired FMD – highlighting the essential role of oral bacteria in supporting vascular responses to dietary nitrate
Why This Research Matters to N¹O¹ Users
This study reinforces the importance of oral nitrate‑reducing bacteria, especially genera like Neisseria, in converting dietary nitrate to nitrite, which eventually becomes nitric oxide in circulation. This is central to the nitrate‑nitrite‑NO pathway, critical for vasodilation, lowering blood pressure, and preserving endothelial health
As we age, oral nitrite reductase activity declines, reducing NO bioavailability. Nutritional strategies like beetroot juice restore NO only if oral bacteria remain functional. The study found that antiseptic mouthwash blocked these benefits, underscoring the need to support oral microbial balance
N¹O¹ Lozenges: Bridging the Gap
N¹O¹ is an oral nitric oxide lozenge designed to generate NO directly in the mouth by releasing sodium nitrite, along with supporting ingredients like vitamin C and magnesium to enhance NO release and stability
By dissolving slowly over the tongue, N¹O¹ bypasses dependency on oral nitrate-reducing bacteria, making it effective even when microbiome activity might be low due to age or mouthwash use.
This delivery mechanism promotes rapid vasodilation, improved circulation, and a measurable drop in blood pressure—all within minutes to hours
For older individuals whose natural oral bacterial conversion is impaired, N¹O¹ offers a complementary or alternative approach to boost NO when dietary nitrate alone might be suboptimal.
Integrating Diet & Supplementation: A Two-Pronged Strategy
Dietary nitrate (From Beetroot, Greens) promotes oral microbial changes favoring NO production in older adults. Supports slow, sustained vascular benefits over days to weeks. Benefits may diminish if oral bacteria are disrupted (e.g. by antiseptic mouthwash)
N¹O¹ Lozenges (Nitrite-driven NO release) provides fast-acting, reproducible NO delivery regardless of microbiome variability. Especially useful for older adults, or those on antibiotics, antiseptic mouthwash, or with oral dysbiosis.
Practical Recommendations
For older adults seeking vascular health support, combining nitrate-rich foods (beetroot shots, leafy greens) with N¹O¹ lozenges may deliver complementary effects – longer‑term microbiome modulation and immediate NO bioactivity.
Avoid antiseptic mouthwash in the daytime around nitrate consumption. Use only minimally or at times not overlapping with dietary nitrate or N¹O¹ doses. Monitor blood pressure and expect modest improvements from dietary nitrates over weeks and quick BP effects after N¹O¹ within an hour. If using N¹O¹ twice daily (as recommended), place one dose mid‑morning and another mid‑afternoon, and consume dietary nitrate at mealtimes (avoiding direct overlap).
Why Age Matters
This study shows that older adults benefit more from nitrate-induced oral microbial shifts and corresponding vascular effects than younger individuals. That’s largely due to
- Reduced baseline nitric oxide synthesis with age, from enzymatic and microbial decline.
- Greater plasticity in their oral microbiome in response to nitrate supplementation.
- Room for improvement in blood pressure, since baseline MAP was higher.
- Therefore, for aging individuals, optimizing both microbiome function AND direct NO generation yields the best results.
The Vanhatalo et al. study brings clarity to how age interacts with oral microbiome and nitrate bioactivity, influencing vascular health. For older adults, dietary nitrate can lower blood pressure, but only if the oral microbial community is responsive. N¹O¹ lozenges offer a practical solution to bypass microbiome limitations, delivering nitric oxide directly and rapidly.
Author
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.
