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Be All the Man You Can Be
Discover the Secret of Optimum Cellular Health and Maximum Male Vitality
Your Cellular Health Handbook and Definitive Guide to:
Nitric Oxide Assessment and Supplementation
Lasting Solutions for ED and Cardiovascular
Disease
NO and Improved Athletic Performance
0| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Hold Harmless Notice
The assessments and interpretations obtained through this program are intended only for informational purposes as a hormonal health and/or general wellness screen. As such, any results and interpretations are NOT intended for diagnosis, mitigation, treatment or prevention of any disease. And because this is a wellness screen and not a medical service, the user understands that he is fully responsible for all related costs and there is no insurance reimbursement.
The assessments obtained through this program are not a medical test kits or device. They are only collection materials for assessments which will be performed by an independent clinical laboratory. All responsibility for the sample and the lab evaluation is the lab itself.
We are not responsible for providing a diagnosis or recommending treatment for any results. Since results outside of the normal hormonal reference range may indicate a condition that requires medical attention, it is the user’s personal decision whether to pursue additional testing or medical advice.
The information in this program is my own intellectual, private property. The viewer may for his/her own personal use my material as examples to aid him/her in his/her particular situation, but he/she may not copy and distribute my material to anyone without my prior, written permission, nor can he/she receive economic gain from my material. I have put forth my best effort in generating sample, educational instruments that might help the viewer in his/her particular situation; however, I cannot guarantee that any of the information will be effective for the viewer's own particular situation.
The user of this program assumes all risks of injury that may result, and do hereby hold harmless and release, acquit, and forever discharge Richard Cohen, M.D., Palladium Health LLC, their agents, employees, and representatives, for any damages or injuries that might result from interpretation of results or use of the information in this program. If this is not acceptable, then do not use my material.
Any challenges to any portion of the above notice/agreement, or to any portion of my information or results presented, or to me, must be placed before the justices of the Constitutional County Court for the People at the county of Deschutes, State of Oregon for a determination on the merits of such challenges.
1| Be All the Man You Can Be with NO by Richard Cohen, M.D.
The Power of Cellular Health
How would you like to experience true VITALITY?
And I don’t just mean sexual vitality. I mean the boundless energy to do ALL the things you want to do. I mean the unlimited ability to act spontaneously, stay focused, motivated, and alert; to enjoy peak physical performance and quicker, more complete recovery.
While these benefits sound strikingly similar to those that come from achieving and maintaining a high, balanced level of testosterone, there’s another piece to the male performance puzzle that most men—and their doctors—miss.
That missing piece is optimum CELLULAR HEALTH.
Deep inside your body, there are trillions of different cells carrying out more than 200 specialized functions. And in order for the systems of your body to work efficiently, these cells must be able to communicate with each other well. If your cellular health is poor, your physical (and mental) systems will decline regardless of how high your testosterone level is.
Testosterone is an important hormone, but hormones are simply messengers that tell your cells what to do. The beneficial effects you experience from testosterone are dependent upon the health of your cells. And the health of your cells is dependent upon how well their basic, biological needs are being met.
1. Your cells need support. Because they are constantly dividing and growing, your cells need a steady supply of raw materials to work with. Just as you could not build a strong house without adequate amounts of wood, concrete, and nails, you cannot build a healthy cell without adequate amounts of essential amino and fatty acids, which must be derived from cholesterol and saturated fats. That’s right—the RIGHT kinds of fat are actually GOOD for you! Without sufficient amounts of these critical building blocks, your cells will be weak, function poorly, and make mistakes when attempting to communicate with each other.
2. Your cells need to be nourished with a wide spectrum of nutrients including vitamins and minerals. If these are deficient, the functional capacity of each individual cell will suffer. Just as you cannot fuel a car with water, you cannot fuel your cell with nutritionally-deficient foods.
3. Your cells need to eliminate waste. The human body is approximately 70% water, which is used as a transport mechanism by each and every cell. Drinking an adequate amount of pure, clean water is essential as it will allow your cells to rid themselves of metabolic waste.
2| Be All the Man You Can Be with NO by Richard Cohen, M.D.
4. Your cells need to be protected. In order to protect themselves from the damaging effects of free radical activity (the inevitable end result of any metabolic process), your cells need antioxidants. If left unchecked and unaddressed, excessive free radical activity will result in reduced cellular energy and pre-mature aging.
5. Your cells need to be kept clean. You wouldn’t walk into your house wearing a pair of shoes coated in mud or toxic waste, but many of us don’t think twice about exposing our bodies (and our cells) to toxins. While we all know that chemicals, metals, radiation, and medications can be harmful to the body, it’s easy to forget that the toxic load we carry can include excessive physical and mental stress; and a variety of commonly-ingested substances we mistakenly call food—artificial sweeteners, chemical additives, processed fats, hybridized grains, refined sugars, and genetically modified foods such as soy, corn, and canola.
6. Your cells need to be properly fueled. Even if everything else is in your physiological house is in order, your cells must have the necessary energy to carry out their tasks. Their most basic source of energy is oxygen. You can live without water for a week and without food for more than a month, but you cannot live without oxygen for more than 15 minutes.
And this is where the big picture story of optimal cellular and maximum male health both begin—with oxygen and a simple, yet relatively secret, gas molecule called Nitric
Oxide (NO). Nitric Oxide is the key player responsible for delivering oxygen-rich blood to every cell, tissue, and organ system in your body.
As you read on, you will discover how this male vitality secret
can greatly increase your health and performance by directing more oxygen to every cell in your body.
Just a few of the functional benefits of NO supplementation include:
Better circulation
Improved lung capacity
A stronger, more powerful heart
More energy and greater endurance
Improved mental capacity
More youthful, on-demand sexual function.
3| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide: The Miracle of Life
In the 1970’s, medical researchers made a Nobel Prize winning discovery: the existence of a short-lived gas called Nitric Oxide (NO) that acts as a powerful, messenger molecule inside the body. Because NO diffuses rapidly across cellular membranes, it is involved in virtually all physiological (and pathological) processes in the body. Learn more about the 1998 Nobel Prize award here.
The idea that a short-lived gas (50% of NO disappears less than a
second after it’s released) plays such a pivotal role in virtually every physiological function took the scientific community by surprise. And the realization that such a molecule is being produced within our bodies, acting as a cell to cell communication agent, has revolutionized scientific and medical reasoning.
Now, almost 15 years after the Nobel Prize award and more than 120,000 scientific papers later, we are finally beginning to appreciate the foundational role NO plays in both health and disease—and the critical importance of having enough of this vital compound in your body.
The effects of Nitric Oxide are fleeting but powerful.
When created and released, this gas quickly and easily penetrates nearby membranes and cells, initiating its myriad signals. Most notably, it relaxes the smooth muscle lining of the blood vessels, promoting better blood flow (and therefore more oxygen) to the cells.
It also acts as powerful antioxidant by neutralizing the free radical superoxide and promoting the formation of glutathione, a critical antioxidant. It facilitates the transmission of messages between nerve cells contributing to improved memory and learning capacities, better sleep, and a more positive mood. It supports the immune system by helping the body fight off infections and the potential development of cancer cells.
And as bodybuilders have known for years, it contributes directly to glucose uptake, muscle velocity, power output, gene expression, and muscle growth.
4| Be All the Man You Can Be with NO by Richard Cohen, M.D.
The Famous Three
NO was first discovered by Dr. Robert Furchgott in 1980 as a substance produced by the cells lining our blood vessels, or endothelial cells, that allows our arteries to vasodialate (relax and open). He first described the substance as an “endothelium derived relaxing factor” or EDRF. Dr. Louis Ignarro later discovered that EDRF was actually a gas molecule—Nitric Oxide. Doing further research, Dr. Ferid Murad confirmed that the life-saving heart medication Nitroglycerin actually works through the release of NO.
Nitroglycerin relieves chest pain via Nitric Oxide
In atherosclerosis, plaques that form reduce blood flow in the arteries. This reduced blood flow decreases oxygen supply to the heart muscle causing chest pain. For more than a century, we have known that Nitroglycerine reduces this pain by dilating the vessels and increasing blood flow.
With the discovery of NO came the knowledge that Nitroglycerin acts as Nitric Oxide donor, causing the affected blood vessels to dilate in nanoseconds.
5| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide: The Key to Unlocking Your Personal Health Potential
Take control of your health and well- being. Assess and optimize your Nitric Oxide level!
Nitric Oxide plays a vital role in the functional health of virtually every cell, tissue, and organ system in the human body. And because of this, diminished NO levels will lead to a wide variety of physical, mental, and sexual problems.
It’s most powerful effects are on protecting and strengthening your heart and vascular system.
To protect yourself from heart disease, you need more Nitric Oxide. NO will:
• Reduce and prevent high blood pressure
• Keep your arteries young and flexible
• Prevent or reverse artery-clogging plaque
• Stop the formation of artery-clogging blood clots • Reduce internal inflammation
But the benefits of NO don’t stop there. This life-enhancing substance will:
• Improve penile erections and enhance both male and female sexual sensitivity • Reduce the risk of diabetes and diabetic complications.
• Promote a healthy immune system as it attacks and kills unwanted bacteria
• Improve your digestion
• Limit the swelling and pain of arthritis
• Calm the inflammation of asthma
• Enhance wound healing
• Protect your bones from osteoporosis
• Allow for an easier adaption to low oxygen at high altitudes • Limit skin damage from over exposure to the sun
• Promote deeper, more restful sleep
• Improve your mood and memory
• Act as a powerful antioxidant regenerator.
6| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide: The Proven Performance Edge
Increased NO levels have been scientifically shown to enhance athletic performance and endurance—even among athletes who were already fit and healthy.
This makes sense given that Nitric Oxide contributes directly to blood flow, oxygen delivery, glucose uptake, muscle velocity, power output, and muscle growth; it’s really only logical that increased NO levels will enhance an athlete’s overall performance.
Studies on foods rich in nitrates (especially red beets and kale), which enable NO production, have shown that Nitric Oxide can increase an athlete’s endurance capacity by at least 16%. (Murphy M, et al. J Acad Nutr Diet. 2012;4:548-52)
Other studies have shown that the use of NO-enhancing supplements have reduced the oxygen cost of moderate-intensity exercise and extended athletes’ time to exhaustion during high-intensity exercise. (Bailey SJ, et al. J Appl Physiol. 2010;109(5):1394-403)
Increases in Nitric Oxide also explain, at least in part, the benefits in performance seen by endurance athletes living and training in high altitudes.
Your Nitric Oxide level will increase in low oxygen content locations in order to improve oxygen delivery to your cells. This natural, physiological response is the reason why Tibetans living at high altitudes have ten times the amount of NO in their blood compared to those living at sea level.
7| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide: Production Pathways
Our bodies continuously produce NO from specific amino acids, oxygen, vitamins, various enzymes, and certain foods. Although Nitric Oxide is manufactured by many cells in the body, the greatest area of its production occurs in the single layer of cells lining your blood vessels (the endothelium) and from the conversion of the nitrates found in certain foods.
There are two primary pathways the human body uses to produce NO.
In the classical eNOS pathway, NO is produced from L-arginine (an amino acid) found in the healthy endothelium (the tissue that forms a single layer of cells lining various organs and cavities of the body) under the direction of an enzyme called endothelial Nitric Oxide Synthetase (eNOS).
Production of NO in the eNOS pathway declines with age, and when the endothelial lining becomes damaged due to cardiovascular disease. Moderate physical activity, regular exposure to sunlight (or vitamin D3 support), antioxidants, and an anti-inflammatory diet rich in omega 3 fats can be very powerful in protecting the endothelium and raising
NO production. In addition, in many men, supplementation with an L-Arginine Cocktail (described later) will also raise NO levels.
A second, more recently-discovered nitrate-NO pathway operates independently from eNOS. This production pathway relies on the health bacteria in your mouth to convert the naturally- present nitrates found in certain foods to Nitric Oxide. This pathway is now known to produce the majority of NO found in the body. The nitrate-NO pathway confirms the importance of eating
foods rich in nitrates—dark green vegetables, red beets, berries, wine, and dark or raw chocolate.
Production of Nitric Oxide in the nitrate-NO pathway will decline for a number of reasons, including poor oral and stomach health. In addition to improving your oral and gastro-intestinal health, the consumption of vegetables rich in nitrates such as kale, chard, spinach, and arugula and in polyphenol-rich foods such as red beets, pomegranates, blueberries, grapes, and chocolate will help support this pathway. Supplementation with a natural, nitrate-rich NO lozenge can also greatly enhance the conversion of nitrates to NO.
8| Be All the Man You Can Be with NO by Richard Cohen, M.D.
The Nitrogen Cycles
Nitrogen is used in many ways by life on our planet. In order for the nitrogen cycle to work properly, both the Earth and its inhabitants convert nitrogen into many different organic forms that are then used and recycled on a continuous and repetitive basis.
The Environmental Nitrogen Cycle
Our atmosphere consists of over 75%
nitrogen gas (primarily N2). It is this gaseous nitrogen that serves as the precious resource all life on Earth depends upon.
Through a multi-step process that involves precipitation, lightening, solid waste, and soil bacteria, nitrogen is naturally recycled into formats that plants can use and incorporate into their own, living matter. It is this form of nitrogen that fuels the NO production process.
The Human Nitrogen Cycle
Through a multi-step process that involves healthy bacteria in your mouth, salivary glands, stomach acid, and gastrointestinal absorption, dietary nitrates from plants are first converted to nitrites, then to NO which directly supports all cellular health and function.
This short-lived gas (which is produced either from dietary nitrates or from L-arginine in the cell lining) is physiologically converted back to nitrate, which either re-enters the circulatory system or is excreted in the urine.
9| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide Production: Age is the Enemy
Do you frequently feel fatigued? Find yourself falling asleep in the afternoon? Losing your car keys or your interest in sex? Do you want to have a stronger, more resilient immune system? Are you concerned about the health of your heart, blood pressure, or blood sugar?
Then you are probably getting older—both chronologically and biologically. And the older you are, the more difficult it becomes for your body to produce adequate amounts of NO.
An adequate amount of oxygen is an essential requirement for optimum physiological health; powered by Nitric Oxide, your arteries are responsible for transporting it. When you are young, your body produces large amounts of NO in the endothelial lining of your internal organs which keep your arteries supple and expandable (to accommodate variable blood flow requirements).
While NO levels decline for a variety of reasons including endothelial damage, a lack of dietary nitrates, low stomach acid, imbalanced mouth bacteria, insufficient physical activity, and excessive physical and mental stress, the greatest threat to your NO level is your age. As your NO production begins to decline after the age of 40, your cardiovascular health and health risks exponentially increase.
The aging process interferes with the body’s ability to make enough Nitric Oxide.
By the age 40, your body will produce half the NO it did at the age of 20. By the time you reach 70, it will be capable of producing only 25% of the Nitric Oxide it needs. That means your NO level will be at its lowest right when you need it the most!
Reduction in blood flow and nitrate levels in younger versus older athletes, after the same exercise stimulus.
The amount of nitrite found in your body following physical exercise is a reliable predictor of your overall fitness capacity.
With age, the amount of NO your body can generate after exercise is reduced. This is why older athletes lose their responsiveness to training; they have to work harder in order to derive the same training-related benefits.
10| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide and Cardiovascular Health
Over the past two decades, it has become evident that decreased levels of bioavailable, endothelial NO (produced from endothelial NO synthase or eNOS) play a large role in the development and progression of atherosclerosis. Medical science now recognizes that the dysfunctional eNOS pathway as one of the most important cellular imbalances and a powerful indicator of future cardiovascular disease and many other health disorders.
Endothelial dysfunction is a disruption of the normal biochemical processes carried out by the endothelium—the cells that line the inner surface of the body’s internal organs including the heart, arteries, and veins.
Experimental and clinical studies provide evidence that endothelial dysfunction is linked to every major cardiovascular risk factor. It is now considered a reliable predictor of both atherosclerotic disease and its progression. (Schachinger, Britten et al. 2000; Halcox, Schenke et al. 2002; Bugiardini, Manfrini et al. 2004; Lerman and Zeiher 2005)
Loss of NO-related endothelial function is associated with a number of cardiovascular disorders including atherosclerosis, resulting from decreased NO production and/or utilization. (Davignon and Ganz 2004)
NO Concentrations and Endothelial dysfunction:
The average plasma nitrate and subsequent NO response is directly related to conventional, vascular disease risk factors including high lipid levels, high blood pressure, and age.
11| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Optimizing your NO level will protect your endothelial lining and dramatically reduce your risk of cardiovascular disease.
While there are many factors that contribute to the onset of cardiovascular disease, the health of your entire vascular system depends upon healthy endothelial function and an adequate NO supply. Nitric oxide deficiency will lead to reduced blood flow and tissue oxygenation and lead to increased inflammation and free radical activity which will injure the cells, damage the endothelium and further reduce Nitric Oxide production.
Over time, the effects of internal inflammation (caused by stress and poor dietary and lifestyle choices) injure the inner, arterial walls. This damage is the underlying cause of atherosclerosis.
Despite what you might have read or been told, cholesterol is only an innocent by- stander; it does not cause heart disease.
If your approach to cardiovascular health has been cholesterol-centered and does not address your endothelial health and Nitric Oxide status, you will lose the battle.
Instead, you must adopt an anti-inflammatory diet—primarily, grass-fed meats, fresh vegetables, and HEALTHY FATS including those that come from wild fish, olive, coconut, avocado, and grass-fed dairy products. You must also reduce or eliminate your intake of most grains, processed sugars and fats; make more positive lifestyle and fitness choices; and supplement your diet with food-based micronutrients and antioxidants. Finally, you must optimize your NO, vitamin D3 and omega 3 fatty acid levels.
12| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Nitric Oxide and Sexual Health
Erections are naturally triggered by the body’s release of NO.
When you are sexually stimulated, Nitric Oxide is produced in the penis to signal the blood vessels in the corpus cavernosum to dilate in order to accommodate an increase in blood flow. It is this increased blood flow that causes engorgement and a sustained erection. Without sufficient NO production, there is poor circulation which results in either no erection or a poor erection that cannot be sustained. The same applies to women. Without proper blood flow to the clitoris, women cannot have orgasms or experience enhanced sexual sensitivity.
You need both testosterone and NO.
As men and women age, their sexual performance and enjoyment often suffers. It is important to understand that it is only through the combination of testosterone and NO signaling working together that the natural vasodilation required for erections and sexual sensitivity will occur.
So if your eNOS and/or nitrate-NO pathways are impaired, even if you have adequate hormonal and dopamine triggers, you will not have a strong erectile response. On the other hand, you can still have a good erectile response, even if your testosterone levels are declined if your NO pathways are healthy.
Note: Your testosterone and dopamine levels (the brain chemical responsible for drive and passion) will be at the highest upon waking, which is what causes your morning erections. Both testosterone and dopamine influence the release of Nitric Oxide.
New research shows that, for many men, erectile dysfunction (ED) is an early warning sign of cardiovascular disease (CVD), cancer, Alzheimers disease, diabetes, and other chronic illnesses.
Over 50% of those who suffer a heart attack have no traditional risk factors for heart disease. Quite often, their first sign of heart disease is a heart attack!
If you are suffering from ED, be forewarned: Sexual dysfunction is linked to an NO insufficiency, which contributes to the onset of heart disease. In a 10-year study, men who had ED at the beginning of the study were 80 percent more likely to develop CVD by its end.
13| Be All the Man You Can Be with NO by Richard Cohen, M.D.
The Age of Viagra
ED drugs such as Viagra, Levitra, and Cialis capitalize on NO function to increase blood flow and enhance erections in men and sexual responsiveness in women.
Interestingly, Viagra was initially designed to be a heart medication. But instead of having its strongest effect on the heart, researchers discovered that it
improved blood flow more dramatically in other areas of the body.
Viagra and other ED drugs improve blood flow by binding to an enzyme called PDE-5 that is involved in the breakdown of NO in the body. By blocking this enzyme, NO is metabolized much less rapidly, causing its levels to accumulate more slowly—even when Nitric Oxide production is low do to an unhealthy endothelium.
As with any medication that functions by inhibiting an intricate natural function in the body, the PDE-5 inhibitors are ineffective for some and can create serious problems for others.
Let’s look at why PDE-5 inhibitors are NOT your long-term solution to Erectile Dysfunction:
1. They are ineffective in many people whose NO levels are too low.
2. Their effects diminish over time; they become ineffective for over 50% of all users after
three years.
3. There are a number of side effects associated with their use. These can range from minor (light-headed, headaches, and back pain) to troublesome (chest pain, vision, and hearing problems) to dangerous (increased risk of heart attacks and blood clots). Too much NO is the main cause of these side effects! Excessive Nitric Oxide is converted into a free radical called peroxynitrate, which causes circulatory and other systemic damage.
4. They are a temporary band-aid that does nothing to improve NO production and/or blood flow.
A better solution to sexual dysfunction is the restoration of healthful Nitric Oxide production. By taking the proper steps, your endothelial cells can naturally and consistently produce more NO!
14| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Are your NO Levels Low?
Take inventory of your current health status.
If you answer “yes” to two or more of the questions below, your NO levels are probably less than optimal.
Are you over the age of 40?
Do you eat very few green vegetables and/or red beets?
Do you lead a sedentary lifestyle?
Do you suffer from erectile dysfunction?
Are your testosterone levels low?
Do you have circulation problems and/or fluid retention issues?
Do you suffer from heart disease or high-blood pressure?
Are you hypoglycemic, diabetic, or pre-diabetic?
Do you suffer from memory lapses and/or mild cognition disorders?
Do you suffer from internal inflammation, abnormally high CRP, or an autoimmune dysfunction? Do you suffer from frequent infections, viral, fungal, or bacterial?
Do you suffer from hair loss?
Have you been diagnosed with asthma, bronchitis, or a lung disease?
Do you have any kidney problems?
Find out for sure: Assess your Nitric Oxide level!
Until very recently, there was no way to easily assess your NO level. Testing required costly blood work or a complicated procedure called Flow Mediated Dilation, which indirectly predicted NO levels by measuring the rate of blood flow in the arm after the application of pressure.
Fortunately, recent advances in laboratory testing technology now make it possible for you to easily measure and regularly monitor your NO levels in the comfort and convenience of your own home with nothing but a simple test strip and a drop of saliva.
15| Be All the Man You Can Be with NO by Richard Cohen, M.D.
Assessing your Salivary Nitric Oxide
Despite its deceptive simplicity, a salivary assessment is a powerful tool that will allow you to measure and monitor how your NO level change with your diet, lifestyle, training, stress, and the use of supportive supplements. By assessing your NO level the first thing in the morning, after consuming nitrate-rich foods and/or taking supportive supplements, Nitric Oxide assessment strips can be used to quantify your body’s ability to produce and maintain an optimal amount of NO.
Important: While it is helpful to maintain an awareness of any improvements in your NO-related symptoms, the salivary test strips should be the objective foundation for determining improvements in your NO level.
How do the NO strips work?
The reagent on the strip will react with the nitrates present in your saliva and change color based on its amount. This change is a very good indicator of your body’s Nitric Oxide supply, derived from both the eNOS pathway (that which is created by the endothelium by NOS) and nitrate-NO pathway (that which comes from your dietary intake of nitrate rich foods).
The NO assessment strips are easy to use.
Simply place a drop of saliva on the end of the strip and compare the resulting color to the chart on the package. If the strip turns dark pink, your NO levels are strong. If the test strip only turns a pale pink or is entirely without color, you need more Nitric Oxide.
You should initially assess your NO level at least twice a week (the first thing in the morning) so that you will be able to note how fluctuations or definitive changes in your activity, lifestyle, and/or diet affect your results. Once a consistently-optimal Nitric Oxide level is achieved, you can assess your sal
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