Cited by 451Cardiovascular and exercise physiologyExercise and Physiological ResponsesMuscle metabolism and nutrition

The DOI matches its Crossref record; 80 of the 80 references it cites were found in a registry or an index; 2 of the 162 sources its claims cite were checked for support.

Dietary Nitrate Supplementation and Exercise Performance

Open access
Jones, Andrew M.·2014·Sports Medicine

Abstract

Dietary nitrate is growing in popularity as a sports nutrition supplement. This article reviews the evidence base for the potential of inorganic nitrate to enhance sports and exercise performance. Inorganic nitrate is present in numerous foodstuffs and is abundant in green leafy vegetables and beetroot. Following ingestion, nitrate is converted in the body to nitrite and stored and circulated in the blood. In conditions of low oxygen availability, nitrite can be converted into nitric oxide, which is known to play a number of important roles in vascular and metabolic control. Dietary nitrate supplementation increases plasma nitrite concentration and reduces resting blood pressure. Intriguingly, nitrate supplementation also reduces the oxygen cost of submaximal exercise and can, in some circumstances, enhance exercise tolerance and performance. The mechanisms that may be responsible for these effects are reviewed and practical guidelines for safe and efficacious dietary nitrate supplementation are provided.

Overview

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TL;DR

Dietary nitrate supplementation increases plasma nitrite, lowers resting blood pressure, reduces the oxygen cost of submaximal exercise, and can improve exercise tolerance and time-trial performance in some settings. Effects are less consistent in highly trained endurance athletes and depend on factors such as training status, exercise intensity/duration, and supplementation duration.

Key findings

  • In early studies, sodium nitrate (0.1 mmol/kg body mass/day for 3 days) elevated resting plasma nitrite by 82%, reduced systolic and diastolic blood pressure by 8 and 6 mmHg, reduced the oxygen cost of submaximal exercise by 5%, and improved gross efficiency from 19.7 ± 1.6 to 21.1 ± 1.3% and delta efficiency from 22.1 ± 1.6 to 22.9 ± 1.9%.
  • Beetroot juice studies reported elevated plasma nitrite by 95%, reduced systolic blood pressure by 8 mmHg, reduced steady-state oxygen uptake by 5%, reduced the high-intensity slow component by 23%, and increased time to exhaustion by 16% (9.7 ± 2.4 to 11.3 ± 3.4 min) and by 25% in knee-extensor exercise (9.8 ± 1.3 to 12.2 ± 1.8 min).
  • Performance effects were mixed: acute beetroot juice improved 4-km and 16.1-km cycling time trials by 2.8% and 2.7%, and 6 days of concentrated beetroot juice improved 10-km time trial time (15.9 ± 0.3 vs. 16.1 ± 0.3 min) and power (294 ± 12 vs. 288 ± 12 W); however, several studies in highly trained endurance athletes (VO2max approximately 60–70 ml/kg/min) found no ergogenic effect, including no difference in a 50-mile time trial (136.7 ± 5.6 vs. 137.9 ± 6.4 min).
  • Mechanistic evidence includes a 19% increase in mitochondrial P/O ratio correlated with reduced whole-body oxygen uptake during submaximal cycling (r = −0.80), altered Ca2+ handling and contractile force in mouse fast-twitch muscle, and a 38% increase in muscle blood flow in nitrate-fed rats.

Methods

  • Narrative review of the evidence base for inorganic nitrate and exercise performance, focusing entirely on young, healthy, physically active individuals exercising in normoxia.
  • Synthesizes human and animal studies using varied protocols, including sodium nitrate (e.g., 0.1 mmol/kg body mass/day), beetroot juice (e.g., 0.5 L/day; 5.2–6.2 mmol nitrate), and approximately 5–9 mmol nitrate/day for 1–15 days.
  • No primary data collection, systematic search strategy, or meta-analysis is described.

Limitations

  • The paper states that the dose–response relationship has yet to be established, acute supplementation effects are inconsistent, and the precise conditions in which nitrate is ergogenic are not firmly established.
  • The paper states that whether longer-term nitrate supplementation supports, augments, or hinders training adaptations is unknown, and long-term safety of high-nitrate vegetable products is not established.
  • Evident from the text: this is a narrative review without a described systematic search or risk-of-bias assessment, and its scope is restricted to young, healthy, physically active individuals in normoxia, so findings may not generalize to older, clinical, or hypoxic-exercise populations.

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Integrity signals

Registry

Crossref · 10.1007/s40279-014-0149-y

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Pathways of NO production. NO is produced from the substrates l-arginine and oxygen in a reaction catalyzed by the NO synthases and is subsequently oxidized to nitrite and nitrate. Nitrate can be reduced to nitrite by xanthine oxidase and by anaerobic bacteria in the oral cavity, and nitrite can be further reduced to NO and other reactive nitrogen species, an effect that is accentuated when tissue oxygen availability is low. In this way, the products of NO production can be recycled. In addition to endogenous production, body stores of nitrate and nitrite can be increased through the consumption of foods that are rich in inorganic nitrate such as green leafy vegetables and some fruits. NO is important in several physiological processes that may support or enhance exercise performance. It is possible that the reliance on the nitrate–nitrite–NO pathway for NO production is increased during exercise. Dashed arrows show that NO can be oxidized to NO2 − and NO3 −. Ca 2+ calcium, NO nitric oxide, NO 3 − nitrate, NO 2 − nitrite, NOS nitric oxide synthase, SR sarcoplasmic reticulum
Fig. 1 Pathways of NO production. NO is produced from the substrates l-arginine and oxygen in a reaction catalyzed by the NO synthases and is subsequently oxidized to nitrite and nitrate. Nitrate can be reduced to nitrite by xanthine oxidase and by anaerobic bacteria in the oral cavity, and nitrite can be further reduced to NO and other reactive nitrogen species, an effect that is accentuated when tissue oxygen availability is low. In this way, the products of NO production can be recycled. In addition to endogenous production, body stores of nitrate and nitrite can be increased through the consumption of foods that are rich in inorganic nitrate such as green leafy vegetables and some fruits. NO is important in several physiological processes that may support or enhance exercise performance. It is possible that the reliance on the nitrate–nitrite–NO pathway for NO production is increased during exercise. Dashed arrows show that NO can be oxidized to NO2 − and NO3 −. Ca 2+ calcium, NO nitric oxide, NO 3 − nitrate, NO 2 − nitrite, NOS nitric oxide synthase, SR sarcoplasmic reticulumCC BY · PubMed Central
Fig. 2 Influence of acute and chronic dietary nitrate supplementation with 0.5 l/day of beetroot juice on a pulmonary oxygen uptake during submaximal exercise and b peak power output achieved during ramp incremental exercise. The nitrate condition is shown in filled symbols, the placebo condition is shown in open symbols, and the non-supplemented control condition is shown in grey symbols. The steady-state V˙O2 during moderate-intensity exercise was reduced 2.5 h after nitrate ingestion and this was maintained after 5 and 15 days of continued supplementation. The peak power output was higher than the other conditions after 15 days of supplementation. Values are mean ± SD. *Significantly different from the non-supplemented control condition (p < 0.05); #significantly different from the placebo condition (p < 0.05). BL baseline, V˙O2 oxygen uptake
Fig. 2 Influence of acute and chronic dietary nitrate supplementation with 0.5 l/day of beetroot juice on a pulmonary oxygen uptake during submaximal exercise and b peak power output achieved during ramp incremental exercise. The nitrate condition is shown in filled symbols, the placebo condition is shown in open symbols, and the non-supplemented control condition is shown in grey symbols. The steady-state V˙O2 during moderate-intensity exercise was reduced 2.5 h after nitrate ingestion and this was maintained after 5 and 15 days of continued supplementation. The peak power output was higher than the other conditions after 15 days of supplementation. Values are mean ± SD. *Significantly different from the non-supplemented control condition (p < 0.05); #significantly different from the placebo condition (p < 0.05). BL baseline, V˙O2 oxygen uptakeCC BY · PubMed Central
Fig. 3 Influence of dietary nitrate (black symbols) and placebo (white symbols) supplementation on 50-mile cycling time trial performance. The lines in the upper part of the figure show the ratio of power output to V˙O2 and the bars in the lower part of the figure show the split times taken to complete consecutive 10-mile splits. The power output to V˙O2 ratio was higher for the 20- to 30-mile (*p = 0.05) and 40- 50-mile (*p < 0.05) splits, and the 40- to 50-mile split was completed in a faster time (# p < 0.05) following nitrate supplementation compared with placebo. However, there was no significant difference in overall performance between treatments (beetroot juice 136.7 ± 5.6 vs. placebo 137.9 ± 6.4 min). Values are shown as mean ± SD. V˙O2 oxygen uptake
Fig. 3 Influence of dietary nitrate (black symbols) and placebo (white symbols) supplementation on 50-mile cycling time trial performance. The lines in the upper part of the figure show the ratio of power output to V˙O2 and the bars in the lower part of the figure show the split times taken to complete consecutive 10-mile splits. The power output to V˙O2 ratio was higher for the 20- to 30-mile (*p = 0.05) and 40- 50-mile (*p < 0.05) splits, and the 40- to 50-mile split was completed in a faster time (# p < 0.05) following nitrate supplementation compared with placebo. However, there was no significant difference in overall performance between treatments (beetroot juice 136.7 ± 5.6 vs. placebo 137.9 ± 6.4 min). Values are shown as mean ± SD. V˙O2 oxygen uptakeCC BY · PubMed Central

Verification

Claims the paper makes

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  • It may state two separate claims as one. 40
  • Probably not a substantial claim. 10
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  • The authors state this as an assumption.

    Other determinants of endurance exercise performance, such as maximal oxygen uptake and its fractional utilization, remain unchanged when muscle efficiency improves.

    “Assuming that the other factors remain unchanged, an improvement in muscle efficiency would be expected to enable a greater work output for the same energy cost and translate into improved exercise performance [37, 38].”
  • The authors state this as an assumption.

    Any harmful effect of nitrosation requires the presence of secondary amines in the saliva or stomach.

    “It is pertinent to note that any possible harmful effect of nitrosation (which assumes the presence of secondary amines in the saliva or stomach) is very effectively inhibited [77] by the antioxidants that accompany nitrate in vegetables [45].”
  • The paper relies on this without support.

    5–9 mmol nitrate can readily be consumed within the normal diet.

    “It should be emphasized that 5–9 mmol nitrate can readily be consumed within the normal diet and there is presently no evidence that additional nitrate intake produces greater benefits.”
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Metadata

Authors
Jones, A. M.
Affiliations
University of Exeter (GB)
Corresponding author
Jones, Andrew M.
Venue
Sports Medicine
Published
2014-05
Volume
44
Issue
S1
Pages
35-45
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
OpenAlex
W2012172244
Cited by
442
References
80
Citations by year
2026: 47 · 2025: 32 · 2024: 30 · 2023: 31 · 2022: 43 · 2021: 50 · 2020: 42 · 2019: 36 · 2018: 37 · 2017: 29 · 2016: 27 · 2015: 28 · 2014: 10
FWCI
8.62
Type
journal article
Language
en
Open access
Locations
  • Sports Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • PepsiCo
  • Gran Sasso Science Institute
Topics
  • Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
  • Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
Keywords
dietary nitrate, inorganic nitrate supplementation, exercise performance, nitric oxide, nitrite, beetroot, leafy vegetables, oxygen cost of exercise, exercise tolerance, blood pressure, sports nutrition
MeSH terms
Energy Metabolism, Humans, Nitrates, Oxygen Consumption, Exercise, Exercise Tolerance, Muscle, Skeletal, Dietary Supplements, Athletic Performance, Sports Nutritional Physiological Phenomena

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