Abstract
This paper provides an overview of the current literature and scientific evidence surrounding inorganic nitrate (NO3−) supplementation and its potential for improving human health and physical performance. As indicative of the ever-expanding organic and natural food consumer market, athletes and health enthusiasts alike are constantly searching for ingredient-specific “super foods” and dietary supplements capable of eliciting health and performance benefits. Evidence suggests that NO3− is the viable active component within beetroot juice (BRJ) and other vegetables, responsible for health-promoting and ergogenic effects. Indeed, multiple studies support NO3− supplementation as an effective method to improve exercise performance. NO3− supplementation (either as BRJ or sodium nitrate [NaNO3−]) has also demonstrated modest benefits pertaining to cardiovascular health, such as reducing blood pressure (BP), enhancing blood flow, and elevating the driving pressure of O2 in the microcirculation to areas of hypoxia or exercising tissue. These findings are important to cardiovascular medicine/exercise physiology and suggest a possible role for NO3− supplementation: (1) as a low-cost prevention and treatment intervention for patients suffering from blood flow disorders; and (2) an effective, natural ergogenic aid for athletes. Benefits have been noted following a single bolus, as well as daily supplementation of NO3−. While results are promising, additional research is needed to determine the impact of NO3− supplementation on anaerobic exercise performance, to identify principle relationships between isolated nitrate and other ingredients found in nitrate-rich vegetables (e.g., vitamin C, polyphenols, fatty acids, thiocyanate), to explore the specific dose-response relationships needed to elicit health and ergogenic benefits, to prolong the supplementation period beyond a relatively short period (i.e., >15 days), to determine if more robust effects can be observed with longer-term treatment, and to fully examine the safety of chronic NO3− supplementation, as this continues to be a concern of some.
Highlights
Lifestyle behaviors such as dietary intake, physical activity, and sleep patterns are perhaps the strongest influencing factors related to human health and athletic performance
Supplementation on anaerobic exercise performance, to identify principle relationships between isolated nitrate and other ingredients found in nitrate-rich vegetables, to explore the specific dose-response relationships needed to elicit health and ergogenic benefits, to prolong the supplementation
The analysis demonstrated a minor yet statistically insignificant favorable outcome on performance for time trials (ES = 0.11, 95% CI: −0.16–0.37) and graded exercise performance tests
Summary
Lifestyle behaviors such as dietary intake, physical activity, and sleep patterns are perhaps the strongest influencing factors related to human health and athletic performance. The theory proposed by many companies who market “NO-stimulating supplements” is that by elevating NO, the flow of oxygenated blood to working skeletal muscle tissue may be enhanced, aiding exercise performance and recovery. These human physiological conditions are characterized by a largely deoxygenated venous circulation, and effectively maximize nitrite’s potency as a vasodilator in the systemic circulation, thereby producing NO in body regions of most need Because these conditions may persist in active, exercising skeletal muscle, diet manipulation via NO3−-rich sources may provide an effective means to enhance blood flow during exercise. Supplementation has shown to improve one’s tolerance to exercise [30,37,47] These studies effectively demonstrate a health and performance-enhancing role for dietary NO3−. This review includes studies involving both normal environments and those of hypoxic conditions
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