NO More Heart Disease: How Nitric Oxide Can Prevent--Even Reverse--Heart Disease and Strokes by Louis Ignarro

This is a simul-post of a review on Amazon.

I bet most people have no idea who Dr. Ignarro is, but know the drug of which he is the father - Viagra. Ignarro won the 1998 Nobel Prize in Physiology or Medicine shared with two other scientists for his discovery of the signaling properties of nitric oxide (NO).

The journeys of Nobel Laureates usually are fascinating and inspiring, and Ignarro's is no exception. A son of an immigrant carpenter, he started to have an intense interest in chemistry at a very early age leading to his career in pharmacology. His focus, persistence and tenacity paid off eventually. The biography part is very short because this book is primarily about a personal health program centered on NO.

I am glad to see the author frankly describing the difficulty in getting his discovery to be accepted. This is fairly common in the scientific community which, contrary to what many lay people think, is often resistant to new ideas except if they are from big names or labs. He discovered the vasodilation effect of nitric oxide (NO). When he presented his work showing that endothelium-derived relaxing factor (EDRF), discovered by his co-laureate Robert Furchgott, is actually NO at a conference, the conference attendees treated the work as a joke. His paper was rejected by multiple major scientific journals. He had difficulty in obtaining fund from the NIH for his research in NO for a long time.

Though I did not expect this book to be a scholarly text, I was still surprised by the shortage of rigor in this book. After all, Ignarro is prominent scientist, so I expected he would make claims cautiously, and substantiate every claim with solid evidences.

For books written by prominent scholars like Ignarro, laypeople may be afraid of too much / too deep scientific information for them to comprehend. This book, in my opinion, is the opposite - too little scientific data while too many big statements. The book claims NO is regarded as the most significant molecule in the body. I am not sure in what sense NO is the most significant. More significant than H2O? The book has a long list of the benefits of NO. I thought Chapter 3. The Science of NO would be the most important chapter, and provide the mechanism and evidence to support these benefits. To my surprise, it is the shortest chapter providing nothing but some statements and most superficial account of NO. The book frequently uses selected testimonials from NO supplement customers; this gives a strong commercial taste.

I am wondering if some statements are backed by research data. For example, a major claim of the book is that NO fights atherosclerosis, but it does not provide any studies showing how NO does it.

The book cites many studies, but often omits important numbers. For example, it mentions a small study of Mayo Clinic on the benefit of L-arginine for coronary artery disease. It is disappointing, and somewhat disturbing that the citation does not mention how significant the improvement is (e.g. the percentage of disease reduction).

His use of garden hose as an analogy of the vascular system to explain high blood pressure could confuse people. It explains only the systolic pressure. Many hypertensions are due to high base pressures (i.e. diastolic pressures). A better analogy is a balloon filled with water. The pressure is determined by the amount of the water and the elasticity of the balloon. Our body adjusts the amount of blood via the kidney to control our blood pressure. This is also how diuretics lower the blood pressure.

The mission of the book is advocating Ignarro's three-part program: 1.NO boosting supplements; 2. NO boosting nutrition; 3. NO boosting fitness. The latter two parts are consistent with common sense. The key part is the supplements - L-arginine and L-citrulline.

The essence of how the supplements work is L-citrulline => L-arginine => NO. NO is unstable, and can be toxic if administered directly. L-arginine is stable, and can be converted to NO in the body safely. The book says: "L-citrulline combines with L-arginine to create a synergistic effect, and it is therefore critical for you to include L-citrulline in your supplement program.", but it does not substantiate this claim with scientific studies. Some have questioned the significance of L-citrulline in this supplement regimen. L-citrulline is converted to L-arginine in the body. If this is all L-citrulline does, there is little reason to include L-citrulline.

Though the book mentions repeatedly a few well known sources of supplements, it does briefly and clearly promotes the author's invention as the best option - Nite-works that has all the supplements in the right proportion.

Though I applaud Dr. Ignarro's effort to educate people about NO and advocate fitness and balanced nutrition, I would not recommend this book to anyone who does not tend to read critically.