Nitric Oxide and AO+Mist Skin Probiotic at the Perfect Health Retreat

Our May Perfect Health Retreat begins on Saturday, and we’re thrilled to announce a new partner: AOBiome.

In January I blogged (“UBiome and the May 2015 Perfect Health Retreat”) about our partnership with UBiome has contributed two gut microbiome sequencing kits for each guest, and we’re sequencing gut microbiomes pre-retreat and at the end of the retreat to see if a week together in a PHD-optimized environment causes microbiomes to converge to a “Perfect Health Diet” pattern.

Now, AOBiome is donating a four week supply of their AO+Mist skin probiotic to each guest. To see why I’m excited about this, I have to say a little about nitric oxide.

Nitric Oxide and Health

Nitric oxide is a gaseous signaling molecule with powerful effects on blood vessels, nerves, the immune system, gut and skin. It has proven to be such an important molecule that the three pharmacologists who established its role in relaxing blood vessels were awarded the Nobel Prize for Medicine in 1998.

Nitroglycerin, the explosive which turned out to be an effective remedy for heart failure, works by increasing nitric oxide levels.

A list of health conditions that may be improved through better nitric oxide status would be too long to attempt, but here is a brief sampling of Pubmed links. Nitric oxide may be helpful for high blood pressure and cardiovascular disease, gut conditions like constipation and impaired gut barrier integrity, obesity and diabetes, immunity against infections, dementia, lung dysfunction / COPD, and kidney disease. Nitric oxide has been reported to improve reaction time and exercise performance. It’s been proposed that nitric oxide may slow aging.

How do we obtain nitric oxide? It is a gas so you can’t eat it. Rather, we eat green leafy vegetables and beets to obtain nitrates; nitrates and bacteria-generated derivatives like nitrites are stored in the body, especially the skin; and then sunshine on the skin, among other processes, generates NO.

Here is dermatologist Richard Weller explaining why nitric oxide may be the reason sunshine is so good for our hearts, and why Scotsmen die so young despite the benefits of malt whisky:

Ammonia-Oxidizing Bacteria

Unfortunately, most of us don’t eat enough spinach to optimize our nitrate status. It would be wonderful if there were another way to obtain nitric oxide precursors.

David Whitlock, the scientist-founder of AOBiome, realized that there is. He was wondering why horses and other animals wallow in the mud, and realized that they might be obtaining probiotic bacteria for the skin from the soil.

Investigation revealed that a class of bacteria called ammonia-oxidizing bacteria are present in soil and, when they colonize the skin, can transform ammonia excreted in sweat to nitrite which can be re-absorbed by the body. These “AOBs” not only improve nitric oxide status, they improve body odor by eliminating ammonia. But they are destroyed by soaps and chlorinated water. Since most people use soap, take chlorinated showers, and rarely wallow naked in the mud, we lack these AOBs.

So AOBiome came up with the idea of a skin probiotic – some AOBs dissolved in water that you spritz on your skin after a morning shower, to re-colonize your skin each morning.

AOBiome has a variety of information on their web site if you’d like to read more: information about the skin microbiome in general, how modern lifestyle has changed it, why having a healthy skin microbiome is an important part of health, and the basics about the bacteria in the AO+ Mist.

Thank You, AOBiome

The Perfect Health Retreats represent our best effort to develop natural ancestral healing methods based on diet, lifestyle, and a healthful environment. Microbes are an important part of our environment, and managing our microbial environment has the potential to significantly improve health.

AO+Mist has not been tested in clinical trials, and there is no direct evidence that it will be beneficial to health. But the mechanisms seem logical, and I’m delighted that our guests will have a way to obtain ammonia-oxidizing skin bacteria without nakedness or mud. Thank you, AOBiome!

You don’t have to attend the retreat to benefit from AOBiome’s generosity. For readers of our blog, AOBiome is offering a 25% discount. Go here to purchase AO+Mist and use the coupon code phd25 for your discount.

Leave a comment ?


  1. I saw this product at Paleo FX last weekend. Looks interesting. Anyone with experience or do I need to buy it to find out? I mentioned it to them but I’m curious to see what impact it’d have on allergies, since it’s thought that’s where early allergan exposure occurs in people at risk.

    • Hi Uri,

      One of the functions of the retreat is to test natural healing methods and see what we can cure. AOBiome is curious about those questions also. This is a new frontier and only time and experience will tell us what conditions it may help with.

      Best, Paul

  2. Hello,

    How long is this coupon code good for?

  3. NO is supposedly produced in the nose too. I’m looking at you mouth breathers!

  4. But are there any double blind studies proving any quantitative effect on nitric oxide levels?

    Nice idea in any case….

  5. I was an AO biome “early adopter” as I think the concept is fabulous. I have eczema and psoriasis and overall temperamental skin. I have not really seen benefits from the mist yet, and spraying on liquid isn’t super convenient for my dry skin. Looking t their website pretty much all products kill this bacteria so it feels like a losing battle for me. AO, figure out how to make a lotion with bacteria and I’m your girl!

    • I’ve been working with it for the past few weeks. I have eczema which has returned in the past few years (perimnopause) anyway I wanted to say that I read on John Douillard’s blog that the Ayurvedic process of using oils on the skin (coconut and sesame) were good for another reason, not just as emolients, the oils were “food” for the good bacteria. I wrote to AO Mist and they confirmed that Coconut oil was fine. I use rosehip oil (tried coconut again and it’s nto so good for me). Im assuming that if the bacteria can handle coconut, they can handle other natural vege oils. If I spray the mist on while my skin is still damp (have a Vit C shower to try to remove the chlorine impact) and then apply oil while it’s still damp too I kind of make my own “probiotic lotion” as the oil emulsifies a little on the skin with the water.

  6. Nice. I’d been on the edge of buying this for months, ever since it was available in limited quantities. So I just used the discount for a 3 month supply!

    I love that our mirobiomes are getting more attention and research. Is anyone researching the lung microbiome?

  7. I’ve been using AOBiome since I read about it in the Times Magazine. My facial skin was already good (now even better) but I bought the spray because I had been struggling with a case of bacterial vaginosis that I developed when I was pregnant. I tried everything you’re supposed to do to cure this annoying condition and nothing worked until I discovered AOBiome.

    It occurred to me to try the spray for this purpose because BV is characterized by an ammonia odor (I know, UGH!!!) and I thought since these bacteria oxidize ammonia I am going to try this and see if it works and I am thrilled to report that it has. BV is one of those conditions that is notoriously difficult to treat and tend to recur despite women’s best efforts so you can imagine my happiness that after six years I finally discovered something that works.

    • that’s amazing K, if you don’t mind me asking, where did you spray it? How long did it take and how much did you use?

      • Hi Sally,

        I sprayed two sprays directly onto my groin . It worked in TWO days. It was so fast. I did notice that when I did two sprays twice a day that I got an itch that felt like a yeast infection. So it’s clearly powerful stuff that will alter your flora — once a day turned out to be right for me. Hope that’s helpful!

        • thanks for the reply K.

          Lactulose is recommended for use vaginally by naturopaths for BV, and it is an ammonia scavenger.

          • That’s really interesting, Sally — and makes sense. I never tried Lactulose, but it seems like clearing ammonia is a generally good strategy for BV.

            A side note — I do have the MTHFR mutation and one of the possibilities with this mutation (or the one I have) is that you don’t clear ammonia well because BH4 and nitric oxide are low. Not that these things are definitive — but it’s worth knowing predispositions. Pregnancy put a burden on my methylation that I hadn’t experienced before because I always ate well and exercised a lot and was young and always healthy, etc.

  8. Peggy Mandell

    Good luck at the May Retreat. Wish we could be there! Warmly, Peggy and Herb

  9. Straight Takin


    Arginine contains four times more nitrogen than most other amino acids, so it is the source for the nitrogen used by the body to make nitric oxide (NO). The enzyme eNOS produces a small amount of NO, which dilates blood vessels and lowers blood pressure, and is essential for a healthy cardiovascular system. Similarly, neuronal NO is essential for a healthy brain.

    NO, which is a highly reactive free radical, is also induced in large amounts by the inflammatory immune system, where it is a major player in the inflammatory immune response. This is critical to fight infections. However, in excess, NO combines with free radicals, generated from the inflammatory immune response or from toxins, to make peroxynitrite. NO also inactivates the vital CP450 enzymes.71 This inhibits the metabolism of toxins and drugs, via the formation of bile. It also inhibits these enzymes: conversion of cholesterol to sex hormones, cortisol, and activated vitamin D. NO also inhibits release of dopamine and norepinephrine, thus reducing alertness and activity.74 Hence, nitric oxide can be the lady, or the tiger.

    Peroxynitrite is a major free radical that damages tissues, plus it constricts blood vessels, which raises blood pressure.54 Lysine lowers inflammatory NO, preventing the formation of peroxynitrite.73 It does this by breaking down its source: arginine. Lysine also increases natural killer cells, which efficiently destroy viruses, bacteria and parasites. Then, once these pathogens are destroyed, the inflammatory immune system is turned off, thus limiting the damage from NO and peroxynitrite.

    Alcohol increases inflammatory NO production, and researchers have suggested that a low arginine (low NO) diet would enable people to stop smoking.42 Elevated ammonia levels also increase inflammatory NO production (see Urea, Ammonia and Metabolic Acidosis below).

    Membrane permeability is a major problem in many diseases. In excess, a growth factor that is induced by NO (VEGF and its receptor, VEGFR-1) has a “detrimental role” on membrane permeability.57 Accordingly, arginine supplements were found to increase intestinal permeability.61 This may be why side effects of arginine supplements include worsening of allergies and bloating. VEGF expression is also high in type 2 diabetes, asthma and cancer.68 The receptor, VEGFR-1, is elevated in autism, and greater intestinal permeability enables undigested gluten and casein to enter the blood stream.72 This is a major problem for people with autism as well as many others who are sensitive to these foods.

    Excess inflammatory NO is found in many diseases: leaky gut-blood-brain barrier, MS, rheumatoid arthritis, COPD, mental illness, inflammatory bowel disease, schizophrenia, insulin-dependent diabetes, cataracts, constipation, asthma, osteoarthritis. The widely used drugs Prednisone and Minocycline, as well as vitamin B12, lower NO. Production of excess NO thus uses extra B12 and may cause a deficiency. Damage from peroxynitrite is a “crucial pathogenic mechanism” for heart problems, diabetes, autoimmune, shock, neurodegeneration, cancer. Excess NO also increases fatality with heart attack and sepsis, and lysine is suggested as a therapy for sepsis. Similarly, interference with arginine metabolism “holds great promise for the treatment of cancer (and) autoimmunity”.6,7,8,9,11,18,19, 31,32,44,49,53,55,56,57,58,59,61,70

    ALS patients are advised by Stem Cell Therapies: “For the sole purpose of not contributing to excess nitric oxide production, you would at a minimum want to choose mostly from foods with a ratio of more lysine than arginine.”10

    Lysine, combined with aspirin, was effective treating rheumatoid arthritis and neuralgia. Lysine also controlled symptoms in schizophrenia, a case of IBS.20,21,22,23,45

    Regular lysine supplementation also controlled symptoms in a case of Raynaud’s.21 Raynaud’s is found in a number of diseases, so the cause is complicated, but the problem of numbness may be worsened by arginine in the diet. The vasodilating action from arginine’s NO dilates blood vessels, which is the body’s way of losing heat and lowering its temperature. In contrast, constriction of blood vessels conserves heat and raises temperature. In this way, excess vasodilation would cause low body temperature and cold fingers, such as occurs with Raynaud’s.62 Then, when the finger temperature is too low, the reaction of a vasospasm (constriction of blood vessels) occurs to conserve heat, and the fingers go numb. Lysine supplementation would decrease NO, lessening the initial excessive heat loss and, thus, the numbness. A lysine salt was also found to protect against diabetic neuropathy, which is induced by a vasospasm.63,64

    People who have Raynaud’s often suffer from migraine headaches as well. NO can induce migraine, as well as tension headaches, because it dilates blood vessels, and NO inhibitors prevent both kinds of headaches.43 Lysine plus niacin has been found to be effective against migraines.65

    The body also produces arginine to maintain proper blood pressure. This is done via the hormone arginine vasopressin (AVP) and via nitric oxide (produced by the arterial wall). AVP raises blood pressure by narrowing blood vessels and retaining water, plus it enhances blood clotting. In contrast, NO lowers blood pressure by dilating blood vessels (vasodilation). Arginine retailers claim that arginine helps heart disease. However, arterial NO is induced only when the collagen (from lysine) in arterial walls are intact. Arginine was recommended to heart attack patients until, in a study, the only study participants who died of a second heart attack were those taking arginine.60 Arginine also prolongs the usual rise in insulin levels that amino acids induce, which can lead to damaged arteries.37,38

    AVP also plays a key role in long term memory, aggression, depression, fear, and anxiety, and is elevated in eating disorders and OCD.36,24,41,69 In addition, AVP induces cortisol and sexual arousal, and males have more AVP receptors, so arginine is marketed as a “prosexual nutrient”.17 Notably, arginine is widely taken by bodybuilders and athletes, including teens. Oxytocin, the female “love and parenting hormone”, balances these AVP effects. It is interesting that all of the common drugs-caffeine, alcohol, and marijuana-inhibit AVP. Thus, excess AVP may cause cravings for these drugs. Lithium, a mood elevator which treats neurological disorders and addictions, also inhibits AVP.

    Thus, the heart-healthy effect of NO from arginine depends on the presence of lysine, both as acetylcholine and as collagen. This is the classic case of “the lady, or the tiger” because, although we hope that arginine will produce arterial NO, in excess, it can lead to many problems. On the other hand, beets, which contain an important component of methylation, have been found to increase arterial NO, so they are included in the high lysine diet.50

  10. Catherine H.

    I would be interested and deeply gratified if you would be so kind as to post a reply to Jimmy Moore’s May 2nd post about your Perfect Health Retreat.

  11. michael goroncy

    Many years ago I read a book by Louis Ignarro (who shared a ‘Nobel prize’) for his work in the field of ‘Nitric Oxide’.
    Having CHD for nearly 30 years, I have combined his formula (which I term the ‘Cardiac Combo’) which I have consumed for the past decade.

    Basically the ‘Protocol’ is:

    (1) L-Arginine (I use the AAKG) x6 grams
    (2) L-Citrulline x 1 gram
    (3) Alpha Lipoic Acid x 100 mg
    (4) Vitamin C x 1-2 grams

    Ignarro claims the ‘Synergistic effects’ create that magical short spark.

    How effective it is….I am uncertain, although I have not experienced any adverse effects.

    • I took L-Arginine and L-Citrulline in massive doses, and neither of these affected my nitric oxide levels, as measured by nitrite test strips in saliva. The only thing that budged my nitrite levels was nitrate rich foods. So don’t assume your therapy has the effect you think it does. Test.

      Alpha Lipoic Acid is shown in research literature to move mercury out of the blood and into the brain and deep tissues. I wouldn’t take it, and I especially would not take it if you eat large fish like tuna or have mercury amalgam fillings.

  12. michael goroncy

    “So don’t assume your therapy has the effect you think it does”.
    I didn’t assume anything……I shared a protocol from a ‘Nobel laureate’

    “measured by nitrite test strips in saliva “….Phff

    You did not bother to mention…..what you were treating?
    You sound like a ‘earth mother’ who is clueless regarding ALA and mercury amalgam fillings.

    • Michael, I had a serious and sudden onset of fatigue in Dec 2014. I tested very low on nitrites and wanted to see how affecting my nitric oxide levels might affect that. In general I feel better on a high nitrate diet but it doesn’t cure whatever the underlying problem is.

      I’m just sharing the empirical result that Arginine and Citrulline – in extremely high doses approaching 20 grams/day – did nothing to budge my nitrite levels. There are good articles online explaining why this is a common result.

      It’s worth nothing that my chronic fatigue started one month after I started high dose alpha lipoic acid. Once I discovered the research showing the mercury issue I went off ALA, and my symptoms get about 2% better each month. It’s a slow and aggravating recovery.

      • Michael Goroncy – I would like to ask you a few questions. I have recently begun Linus Pauling’s protocol because of a couple episodes of amaurosis fugax. I will see my GP this coming week and will go for carotid artery ultrasound, etc. But two years ago I had a heart scan and my calcium score was in the “moderate” range. My LDL remains high. So, probably a good idea to deal with things. Pauling’s protocol calls for high doses of lysine. He has an anti-aging protocol that calls for high doses of arginine. I’m concerned about creating problems of throwing my amino acids way out of balance. Do you have thoughts on this?


  13. Correction: It’s worth noting that my chronic fatigue…

  14. Paul,
    I have a question about uBiome — how does their testing (say the basic stool test) differ from a dr-ordered metabolic panel — i.e. something like Genova’s GI Effects?

    Do they test different things? Can you do one without the other?

    I’m finally truly incorporating all of your amazing advice on diet, but now I’d also like to heal gut issues.

    many thanks

    • hi ellk,

      this is a good question,
      i suggest you post this question on Paul’s official PHD Facebook Group,

      It should hopefully get more attention there, from some very knowledgeable group members.

      It’s a closed group, so you will need to request to join.

      If you do not have a facebook account, just create one, you do not have to use your real name.

  15. Damn!:sad: They don’t ship to Australia.

  16. Paul is it possible that the bacteria in sauerkraut/fermented veggie juice may have a similar effect?

  17. Just a n=1 comment: I’ve been using the AO-biome spray and subjectively haven’t noticed a difference in anything at all (other than feeling a bit stupid for forking out so much money 😉 ) I was hoping that maybe it could help me transition away from using deodorant (use mineral deodorant right now) or help my skin feel less dry etc. As far as my experience goes, there might as well have been tap water in the bottle. That is not to say that there might not be some changes in ten microbiome of the skin, but unless they are subjectively noticeable in any way, I think this product is a hard sell.

  18. Hi Paul,

    I was wondering if there are any articles where you have broached personal care products, such as the use of deodorants, cleansers, shampoos etc?



    • No, I’m afraid I don’t know much about personal care products.

    • Hi Claire,
      Your post is a year old, but I have information that may be useful to you. I won’t go into great detail, as I can get far too wordy.

      I discovered that deodorants, “natural” or otherwise, that contain benzoic acid or sodium benzoate caused me severe, and I do mean SEVERE eye irritation. I learned much in the process of sorting this out:
      –benzoic acid ingested in foods (berries, fruits, etc)goes to the liver where it is processed and sent to the kidneys for excretion
      –the underarm is the second most efficient skin transport region on a woman’s body; meaning if you want something in your body without sending it to the liver, applying it to your underarms is a good choice.
      –once my system was saturated with benzoic acid from my deodorants (both of them “natural”) I became sensitive to everything that contained it, even foods. A simple serving of blueberries sent me into wild eye discomfort.
      –doctors, including ophthalmologists, know nothing of this issue and will prescribe antibiotics and prednisone, without exploring the possibility of a reaction to something. Certainly not a reaction to a deodorant!

      So, what to do? I spent a year using a homemade deodorant, which was pretty effective, but contained baking soda and, eventually, created redness and itching.

      Now, I have what may be the answer. Milk of magnesia. One can use it straight from the bottle, but it is drippy and messy. Keeping a bottle in the shower and applying right after toweling is one possibility. But now, I shake it well and pour into tiny canning jars, which I leave on the bathroom counter to evaporate over a few days. Eventually, it is reduced to a creamy consistency. (Too long will ruin it as it becomes dry and granular, so watch it daily.) At this point I put the lids on the jars and I’m set for a quite awhile. Apply with fingers. Works great! Don’t expect it to last more than a day, however. Apply everyday, and after a shower, as it washes off.

      Hope this is useful for you.

      • Hi lana,

        Just a note – AOBiome’s AO+Mist is pretty good as a deodorant. The bacteria consume ammonia which is a major component of body odor and return it to the body as nitrite which is nourishing. It is good for vascular health as well as body odor. I would stop deodorants and just use that.

        Best, Paul

        • AO+Mist works excellent. I use a regular deodorant maybe once a month, if that.

        • Thanks, Paul. 🙂 On a different note, do you have thoughts on my concern about messing with my amino acids by taking large amounts of lysine as I start the Pauling protocol?

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