What’s New?

The dilemma surrounding nitrates—considered harmful in additives and water but beneficial in vegetables—can be clarified by examining the entire food matrix.

Why This Matters

Plants high in nitrates are among the strongest allies in promoting cardiovascular health.

What You’ll Learn

Learn how to effectively use beetroot, the most researched nitrate source, to lower blood pressure, enhance heart health, and boost athletic performance, supported by my personal insights.

“Consumers often lack nutritional knowledge, leading to poor choices, especially concerning nitrates in food.”

This assertion isn’t mine; it reflects findings from a study published in the journal Foods. While the tone is gentler, the message remains clear:

“Consumers’ misunderstanding of nutrition and food safety results in inconsistent behavior; they fear nitrates in meats but accept them in vegetables and beet juice.”

At first glance, this seems counterintuitive. After all, a nitrate molecule consists of one nitrogen and three oxygen atoms, regardless of whether it comes from beet juice, bratwurst, or bottled water.

In this article, I will advocate for you, explaining why not all nitrates are equivalent and why your discernment is justified.

The Perplexing Health Guidance

In the US and EU, regulatory bodies set a maximum nitrate concentration for public drinking water at 44 and 50 mg/liter respectively, while advising a daily intake cap of 3.7 mg/kg of body weight (around 260 mg for an individual weighing 70 kg). Yet, they simultaneously endorse beetroot juice, which can contain up to 15 times that allowable limit for water.

If this seems contradictory, you are not alone.

Do these authorities find amusement in our confusion? I doubt it. While defending bureaucrats is not my usual stance, there is a rationale behind this inconsistency, though I question whether they fully grasp it.

The reason often mentioned in relation to nitrates is cancer—a term that frequently appears alongside it.

In the following section, we will explore the connection between nitrates and cancer, demonstrating how nitrates from plant foods benefit health, whereas nitrates as additives can have adverse effects. I will share how I incorporate beetroot (the leading nitrate-rich plant) into my routine for enhanced cardiovascular well-being, and why it may benefit you too.

The Nitrate-Cancer Link

I have previously detailed the relationship between nitrates and cancer, so here’s a brief overview.

During digestion, dietary nitrate initially loses one oxygen atom and later another, leaving behind nitric oxide (NO), which is responsible for its heart-protective properties. However, there is a critical juncture on the path from nitrate (NO3) to NO.

If NO3 takes an undesirable route, it may produce a group of harmful compounds known as nitrosamines, which can lead to cancer (noting that “can” does not imply “will”).

The exact mechanisms that lead dietary nitrate to this detrimental outcome are not fully understood, but it is clear that we can mitigate risks by sourcing nitrates from plants like beetroot or spinach.

Plants are rich in thousands of phytochemicals that seem to inhibit the nitrosamine formation pathway. In contrast, processed meats, such as bratwurst or beef jerky, contain high levels of nitrates but lack these protective compounds.

This explains the cautious guidance from health organizations: they aim to prevent the consumption of isolated nitrates that arrive without the protective benefits of the whole-food matrix, as seen in cured meats and sausages.

The preservation of meat often involves sodium/potassium salts of nitrate and nitrite (NO2), not to harm consumers, but to prevent spoilage and bacterial growth, and to maintain desirable flavors.

However, our focus here is on the advantages of beetroot.

How NO Provides Cardiovascular Protection

Nitric oxide is the most effective vasodilator known, meaning it relaxes and expands arteries. The innermost layer of the arteries, the endothelium, generates NO to ease the tension on the smooth muscle layer.

This is where the cardiovascular advantages of NO come into play: more flexible arteries lead to lower blood pressure, which reduces the heart's workload and wear over time.

Moreover, NO diminishes oxidative stress within arterial cells and LDL cholesterol, and it helps prevent blood clots that could obstruct small vessels and result in heart attacks or strokes.

In a healthy body, most NO is synthesized internally from the amino acids arginine and citrulline, rather than derived from dietary sources.

So, how does dietary nitrate from beetroot factor into this?

From Dietary Nitrate to Heart Health and Athletic Performance

Once dietary nitrate converts to nitrite, it becomes a backup resource in the bloodstream. In times of need, nitrite releases an oxygen atom, transforming into NO to provide support.

This emergency situation arises when there’s insufficient oxygen and excessive acidity, such as during an impending heart attack or when muscles are under strain from intense exercise. This is why athletes, including myself, often consume beetroot juice (BRJ) before rigorous workouts. The nitrite reserve enhances our muscles’ oxygen uptake and extends stamina. Clinical studies have confirmed these performance-enhancing effects.

The benefits of beetroot extend beyond these acute situations. Research indicates that beetroot supplementation can lower blood pressure, enhance endothelial function, and reduce the risk of heart attacks and strokes in both healthy and hypertensive individuals. However, it’s easy to undermine these health advantages, a topic rarely discussed.

How to Optimize the Nitrate Pathway to Health

Humans cannot initiate the first step in converting nitrate to NO; we depend on specific bacteria in our mouths for this process. However, using antiseptic mouthwash can eliminate these bacteria, particularly those with chlorhexidine.

Therefore, a crucial takeaway is:

> All the nitrates in your plant food are ineffective if you routinely eliminate those beneficial bacteria.

Assuming you do not use such mouthwash frequently, the nitrate in your food must navigate a longer route to become effective. The act of chewing and swallowing doesn’t allow sufficient time for the bacteria to act on the nitrates. However, once nitrates enter the bloodstream, the salivary glands retrieve and store them. They then release the nitrates into your mouth through saliva, providing the bacteria time to convert them into nitrite. When you swallow this nitrite, you create that reserve I mentioned earlier.

You need not memorize this process; just remember to use mouthwash sparingly.

Why Choose Beetroot and How to Supplement

Among all nitrate-rich plants, beetroot and spinach are the leading contenders, but beetroot boasts the most scientific backing.

This suits me well, as I prefer beetroot’s taste over that of spinach.

Additionally, beetroot juice has a higher nitrate concentration than the whole root, which is another advantage. However, there are other options available as well.

To achieve cardiovascular benefits or performance enhancements from dietary nitrate, you should consume over 350 mg. The relationship between dosage and effect is S-shaped, as illustrated in related studies.

Timing your intake is also crucial; the maximum bioavailability occurs about 90 minutes after consumption. Therefore, if you aim to maximize your output during exercise, drink your juice more than an hour before starting.

My Personal Journey with Beetroot Supplementation

My main motivation for consuming beetroot juice is cardiovascular protection. I typically drink about 500–600 ml daily, divided into three portions: one before my morning workout, one with breakfast, and one at midday.

This isn’t evenly distributed, but I compensate for the absence of beetroot in the evening with a far more enjoyable alternative: a glass of quality red wine.

One of my clients approached me regarding his hypertension and his desire to discontinue his medication. In his case, I viewed BRJ as a viable option. He consumed 250 ml twice a day, which significantly impacted his condition, allowing him to reduce his medication. Over a two-month self-experiment, we observed a net reduction of 9 mmHg in his daily blood pressure fluctuations.

While BRJ may not work for everyone with hypertension due to the condition's various causes, it’s worth exploring through trial and error, as BRJ is a nearly side-effect-free natural option within lifestyle medicine.

Conclusion and Key Takeaway

Contrary to the claims about “consumer illiteracy,” you and I are not acting irrationally by choosing whole-food nitrates over isolated ones devoid of the food matrix.

> This should be reassuring for all those unfamiliar with nitrates: we are not making foolish choices; we are simply prioritizing long-term health and longevity.

Cited References

[1] Bernardo P, et al. Foods 2021;10:1–18. [2] Bescos R, et al. Food Sci Nutr 2023;11:6376–83. [3] Olas B. Foods 2024;13. [4] Bryan NS, et al. Nitric Oxide Biol Chem 2023. [5] Rajendra A, et al. Food Funct 2022;13:12572–89. doi:10.1039/d2fo02427f. [6] Bondonno CP, et al. Am J Hypertens 2015;28:572–5. [7] Dos D, et al. Antioxidants;2020:960. [8] Da Silva DVT, et al. Food Nutr Res 2016;60:1–9.