Ergogenic Effect of Nitrate Supplementation: A Systematic Review and Meta-analysis

Senefeld, Jonathon W.; Wiggins, Chad C.; Regimbal, Riley J.; Dominelli, Paolo B.; Baker, Sarah E.; Joyner, Michael J.

doi:10.1249/mss.0000000000002363

Cited by 86 publications

(152 citation statements)

References 125 publications

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“…Notwithstanding, the available evidence does not rule out the possibility that prolonged consumption of NO 3 − above the ADI could harm health. Currently, at least with short to medium term intakes, research suggests that doses exceeding the ADI are needed to optimise vascular health or exercise performance [ 17 , 48 ]. Because most human trials have only examined the acute health effects (< 4 weeks) of increased NO 3 − intake, the long-term safety of consuming NO 3 − in amounts that exceed the ADI is not well understood.…”

Section: Main Textmentioning

confidence: 99%

“…Likewise, NO 3 − has been identified as a potential prebiotic for the oral microbiome [35], with the potential to positively impact oral health [36]. Moreover, NO 3 − consumption has been demonstrated to improve performance during continuous [12,13,29,[37][38][39][40][41][42], intermittent [43][44][45] and strength-based [46,47] exercise, especially in untrained and recreationally active individuals [40,[48][49][50]. The mechanisms for the ergogenic effects of NO 3 − have not been fully resolved, but may include: 1) improvements in mitochondrial efficiency (reported by some [51], but not others [52]); 2) enhanced muscle contractile efficiency/ function [53][54][55][56]; and 3) augmented tissue blood flow, particularly to areas of low oxygen tensions such as type II muscle fibres (demonstrated in animal models [57,58], but with less convincing data in humans [59][60][61][62][63]).…”

Section: Introductionmentioning

confidence: 99%

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Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

Shannon

Easton

Shepherd

et al. 2021

BMC Sports Sci Med Rehabil

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Background Dietary inorganic nitrate (NO3−) is a polyatomic ion, which is present in large quantities in green leafy vegetables and beetroot, and has attracted considerable attention in recent years as a potential health-promoting dietary compound. Numerous small, well-controlled laboratory studies have reported beneficial health effects of inorganic NO3− consumption on blood pressure, endothelial function, cerebrovascular blood flow, cognitive function, and exercise performance. Translating the findings from small laboratory studies into ‘real-world’ applications requires careful consideration. Main body This article provides a brief overview of the existing empirical evidence basis for the purported health-promoting effects of dietary NO3− consumption. Key areas for future research are then proposed to evaluate whether promising findings observed in small animal and human laboratory studies can effectively translate into clinically relevant improvements in population health. These proposals include: 1) conducting large-scale, longer duration trials with hard clinical endpoints (e.g. cardiovascular disease incidence); 2) exploring the feasibility and acceptability of different strategies to facilitate a prolonged increase in dietary NO3− intake; 3) exploitation of existing cohort studies to explore associations between NO3− intake and health outcomes, a research approach allowing larger samples sizes and longer duration follow up than is feasible in randomised controlled trials; 4) identifying factors which might account for individual differences in the response to inorganic NO3− (e.g. sex, genetics, habitual diet) and could assist with targeted/personalised nutritional interventions; 5) exploring the influence of oral health and medication on the therapeutic potential of NO3− supplementation; and 6) examining potential risk of adverse events with long term high- NO3− diets. Conclusion The salutary effects of dietary NO3− are well established in small, well-controlled laboratory studies. Much less is known about the feasibility and efficacy of long-term dietary NO3− enrichment for promoting health, and the factors which might explain the variable responsiveness to dietary NO3− supplementation between individuals. Future research focussing on the translation of laboratory data will provide valuable insight into the potential applications of dietary NO3− supplementation to improve population health.

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Section: Main Textmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

Shannon

Easton

Shepherd

et al. 2021

BMC Sports Sci Med Rehabil

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“…Recent evidence suggests that at least 5 mmol of NO 3 -are needed to obtain exercise performance benefits (7). As the average intake of NO 3 -in a regular diet is within 1 and 2 mmol per day (8), several companies of dietary supplements have marketed supplements containing higher doses of NO 3 -via concentrated beetroot juice or powdered beetroot juice to facilitate the obtaining of this dosage.…”

Section: Introductionmentioning

confidence: 99%

“…To this regard, the International Olympic Committee has recently categorised beetroot juice as a dietary supplement with a good level of evidence to enhance endurance performance (9), and, hence, the use of beetroot juice and nitrate-rich dietary supplements has been gaining increasing importance in sport. However, while evidence supports the benefits of beetroot juice supplementation for prolonged submaximal exercise and for high-intensity short-duration (7,9)), little is known about the effects of beetroot juice supplementation to improve physical performance in intermittent sports (10,11).…”

Section: Introductionmentioning

confidence: 99%

Acute Beetroot Juice Supplementation Does Not Improve Match-Play Activity in Professional Tennis Players

Fernández-Elías

Courel-Ibáñez

Pérez-López

et al. 2020

Journal of the American Nutrition Association

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Beetroot juice is a source of dietary nitrate (NO3-) recognised as a potential ergogenic aid to enhance tolerance during endurance exercise of submaximal-to-maximal intensity. However, little is known about the effects of beetroot juice on exercise performance in intermittent sports such as tennis. The present study aimed to determine the effect of acute beetroot juice supplementation on movement patterns during a competitive tennis match in professional players. In a double-blind and randomised experiment, nine professional tennis players performed two experimental trials 3 h after ingesting either 70 mL of a commerciallyavailable concentrated beetroot juice (6.4 mmol NO3-) or placebo (0.005 mmol NO3-). In each experimental trial, players completed a 3-set tennis match and two performance tests (i.e., serve speed and isometric handgrip strength) before and after the match. Match-play running performance was recorded using wearable GPS and accelerometer units. In comparison to the placebo trial, the acute beetroot juice supplementation did not modify any match-play running performance (p= 0.178 to 0.997, d = 0.01 to 0.42). Furthermore, beetroot juice supplementation did not alter the pre-to-post match change in serve speed (p = 0.663, ηp2 = 0.03) or isometric handgrip strength (p = 0.219, ηp2 = 0.18). The current results indicated that acute ingestion of

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“…Despite being effective in animal models of T2DM, as it is summarized in Table 2 , all acute [ 67 ], mid-term [ 68 , 69 ], and long-term [ 70 , 71 , 72 ] oral dosing of inorganic NO 3 − and NO 2 − , either as pharmacological forms (i.e., KNO 3 , NaNO 3 , and NaNO 2 ) or food-based supplementation (i.e., NO 3 − -rich beetroot juice or powder) have failed to show beneficial effects on glucose and insulin parameters, including fasting and post-prandial serum glucose and insulin concentrations, insulin resistance indices, and HbA1c levels in patients with T2DM. However, ergogenic [ 73 , 74 ] and beneficial cardiovascular effects of inorganic NO 3 − and NO 2 − , e.g., reducing peripheral and central systolic and diastolic blood pressures [ 75 ], have been highlighted in non-diabetic subjects by several clinical studies.…”

Section: Effects Of Inorganic No 3 − and No 2 − In Type 2 Diabetesmentioning

confidence: 99%

Lost-in-Translation of Metabolic Effects of Inorganic Nitrate in Type 2 Diabetes: Is Ascorbic Acid the Answer?

Bahadoran

Mirmiran

Kashfi

et al. 2021

IJMS

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Beneficial metabolic effects of inorganic nitrate (NO3−) and nitrite (NO2−) in type 2 diabetes mellitus (T2DM) have been documented in animal experiments; however, this is not the case for humans. Although it has remained an open question, the redox environment affecting the conversion of NO3− to NO2− and then to NO is suggested as a potential reason for this lost-in-translation. Ascorbic acid (AA) has a critical role in the gastric conversion of NO2− to NO following ingestion of NO3−. In contrast to AA-synthesizing species like rats, the lack of ability to synthesize AA and a lower AA body pool and plasma concentrations may partly explain why humans with T2DM do not benefit from NO3−/NO2− supplementation. Rats also have higher AA concentrations in their stomach tissue and gastric juice that can significantly potentiate gastric NO2−-to-NO conversion. Here, we hypothesized that the lack of beneficial metabolic effects of inorganic NO3− in patients with T2DM may be at least in part attributed to species differences in AA metabolism and also abnormal metabolism of AA in patients with T2DM. If this hypothesis is proved to be correct, then patients with T2DM may need supplementation of AA to attain the beneficial metabolic effects of inorganic NO3− therapy.

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Ergogenic Effect of Nitrate Supplementation: A Systematic Review and Meta-analysis

Abstract: Supplemental digital content is available in the text.

Cited by 86 publications

References 125 publications

Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

Acute Beetroot Juice Supplementation Does Not Improve Match-Play Activity in Professional Tennis Players

Lost-in-Translation of Metabolic Effects of Inorganic Nitrate in Type 2 Diabetes: Is Ascorbic Acid the Answer?

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