Nitrates are chemical compounds formed from nitrogen and oxygen (NO₃⁻) and can be classified as inorganic (NO₃⁻), which occur naturally in foods such as leafy green vegetables and beetroot, or organicnitrates, which are medicines used primarily to treat cardiovascular conditions such as angina and heart failure [1].
Nitrates can also be classified by origin as natural nitrates that occur naturally in vegetables and fruit, or added nitrates used as food additives (e.g., E251: sodium nitrate; E252: potassium nitrate), which are common in cured meats, cold cuts and processed products to preserve them and prevent bacterial growth [2]. In this respect, their health effects differ according to their source: naturally occurring nitrates have positive effects, whereas added nitrates are potentially harmful. This is because, under certain conditions such as the stomach's acidic pH and the presence of amines, added nitrates can form nitrosamines, potentially carcinogenic substances [3]. Consumption of nitrates associated with processed meat and cooking methods such as frying or smoking should therefore be reduced.
How Can Natural Inorganic Nitrates Improve Cardiovascular Health?
Inorganic nitrates naturally present in foods such as beetroot, spinach and arugula are associated with better cardiovascular health. In the body, they are converted into nitrites and then into nitric oxide. Nitric oxide (NO) is one of the body's main vasodilator molecules and a molecule with numerous metabolic functions [4]. Dietary inorganic nitrates therefore increase nitric-oxide bioavailability through the nitrate-nitrite-nitric oxide pathway.
In preclinical models, nitrates have also been associated with less lipid accumulation and liver inflammation, improved regulation of blood glucose in the pancreas and skeletal muscle, greater mitochondrial efficiency and reduced in oxidative stress [4].
What Does the Evidence Say About Natural Nitrate Intake and Cardiovascular Health?
Human observational studies have linked greater dietary nitrate intake to a lower incidence of ischemic cardiovascular disease and lower mortality from atherosclerotic vascular disease [5].
A recent systematic review with meta-analysis demonstrated a dose-dependent relationship between dietary nitrate intake and circulating levels of both nitrates and nitrites [6], which can subsequently be converted into nitric oxide.
Evidence from clinical trials and meta-analyses also shows that inorganic nitrate intake reduces blood pressure, improves endothelial function (increased flow-mediated dilation), reduces arterial stiffness and reduces platelet aggregation, all relevant factors in cardiovascular-disease prevention [5–11]. The effect on endothelial function is clinically relevant, with improvements of more than 1% in flow-mediated dilation, which is associated with lower cardiovascular risk [7]. Some studies also suggest that the positive blood-pressure-lowering effects are more pronounced in people with hypertension than in normotensive individuals [6].
Although more research is needed, preclinical evidence from cell and animal models suggests that dietary nitrate may have beneficial antidiabetic effects and could reverse metabolic syndrome [4].
What Is the Recommended Dose?
Current clinical evidence indicates that the recommended dose of nitrate supplementation for improving cardiovascular health —blood pressure, endothelial function and other risk factors—is in the range of 6 to 12 mmol/day of inorganic nitrate, equivalent to approximately 370-740 mg of nitrate per day [6,8]. This dose can be obtained through nitrate-rich foods, such as beetroot juice (250-500g of beetroot) or leafy green vegetables (e.g., 100-200g of spinach), or through supplements.
Conclusion
In conclusion, the benefits of nitrates depend greatly on their source. Nitrate intake from natural foods such as vegetables may have beneficial effects on cardiovascular health by helping prevent and manage parameters such as blood pressure, among others.
NITRATES 600 + CITRULLINE SHOT GEL
AUTHOR
Lucas Jurado Fasoli – PhD in Biomedicine (UGR). Dietitian-Nutritionist. Researcher at the Joint University Institute for Sport and Health and Assistant Professor in the Department of Physiology, University of Granada.
References
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[9] Bondonno CP, Blekkenhorst LC, Liu AH, Bondonno NP, Ward NC, Croft KD, et al. Vegetable-derived bioactive nitrate and cardiovascular health. Mol Aspects Med 2018;61:83–91.
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[11] Velmurugan S, Gan JM, Rathod KS, Khambata RS, Ghosh SM, Hartley A, et al. Dietary nitrate improves vascular function in patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled study. Am J Clin Nutr 2016;103:25–38.
