Food sources of nitrates and nitrites: The physiologic context for potential health benefits
Open accessAbstract
The presence of nitrates and nitrites in food is associated with an increased risk of gastrointestinal cancer and, in infants, methemoglobinemia. Despite the physiologic roles for nitrate and nitrite in vascular and immune function, consideration of food sources of nitrates and nitrites as healthful dietary components has received little attention. Approximately 80% of dietary nitrates are derived from vegetable consumption; sources of nitrites include vegetables, fruit, and processed meats. Nitrites are produced endogenously through the oxidation of nitric oxide and through a reduction of nitrate by commensal bacteria in the mouth and gastrointestinal tract. As such, the dietary provision of nitrates and nitrites from vegetables and fruit may contribute to the blood pressure-lowering effects of the Dietary Approaches to Stop Hypertension (DASH) diet. We quantified nitrate and nitrite concentrations by HPLC in a convenience sample of foods. Incorporating these values into 2 hypothetical dietary patterns that emphasize high-nitrate or low-nitrate vegetable and fruit choices based on the DASH diet, we found that nitrate concentrations in these 2 patterns vary from 174 to 1222 mg. The hypothetical high-nitrate DASH diet pattern exceeds the World Health Organization's Acceptable Daily Intake for nitrate by 550% for a 60-kg adult. These data call into question the rationale for recommendations to limit nitrate and nitrite consumption from plant foods; a comprehensive reevaluation of the health effects of food sources of nitrates and nitrites is appropriate. The strength of the evidence linking the consumption of nitrate- and nitrite-containing plant foods to beneficial health effects supports the consideration of these compounds as nutrients.
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Nitrate dosing amounts (300-600 mg or 0.1 mmol/kg/day) appear to be well tolerated without significant alterations in hemodynamics or clinical boundaries of hepatorenal and muscle enzyme status.
“These dosing amounts appear to be well tolerated when consumed as both supplemental [587] and supplemental sources [588] without significant alterations in hemodynamics or clinical boundaries of hepatorenal and muscle enzyme status [478, 589].”
From ISSN exercise & sports nutrition review update: research & recommendations (2018) · cites this paper as [587]
The ‘Estimating Human Nitrate and Nitrite Exposure Levels’ section describes typical dietary exposure as apparently safe, and ‘Potential Contexts for Nitrate- and Nitrite-Associated Toxicities’ reports no methemoglobinemia in the cited human nitrate-exposure studies (page numbers unavailable). The paper does not establish that the stated 300–600 mg or 0.1 mmol/kg/day dosing was well tolerated without changes in hemodynamics or hepatorenal and muscle-enzyme measures. It also reports blood-pressure lowering from nitrite, rather than a general absence of hemodynamic effects. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThis may be due to greater responsiveness resulting from baseline NO deficiency.
“possibly due to greater responsiveness resulting from baseline NO deficiency [112,155,245].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [112]
In “Vascular Nitric Oxide Production,” the paper says nitrite can substitute for lost eNOS-derived nitric oxide in eNOS-deficient mice. “Quantifying the Nitrite Economy” likewise says nitrite may support vascular function when nitric oxide is limiting. These passages support a response under NO-deficient conditions, but do not establish greater responsiveness than in people or tissues without baseline deficiency; page numbers were not provided in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredOlder individuals may experience substantial improvements in blood pressure and endothelial function after consuming nitrates.
“clinical studies suggest that older individuals may experience substantial improvements in blood pressure and endothelial function after consuming nitrates”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [112]
The Introduction describes nitrate-derived compounds as a plausible means of lowering blood pressure, and the Nitric Oxide Production in Tissues section reports acute blood-pressure reduction with nitrite infusion in humans. The section on endogenous and diet-derived nitric oxide generation discusses an age-related impairment, but not a clinical study showing that older individuals improve their blood pressure and endothelial function after consuming nitrates. The copy also does not establish the claimed magnitude of improvement. (LLM, conf=0.84)
Experimental — accuracy not yet measuredRecent work proposed that the DASH diet's blood pressure benefits stem from the high nitrate content of certain foods it includes.
“recent research has suggested that the beneficial effects of the DASH diet on BP are related to the high inorganic nitrate content of some of the food products included in the DASH dietary plan (e.g., green leafy and root vegetables) (9).”
From Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis (2013) · cites this paper as [9]
Inorganic nitrate is present in numerous foodstuffs and is abundant in green leafy vegetables and beetroot.
“Inorganic nitrate is present in numerous foodstuffs and is abundant in green leafy vegetables and beetroot.”
From Dietary Nitrate Supplementation and Exercise Performance (2014) · cites this paper as [7]
Body stores of nitrate and nitrite can be increased exogenously through the diet, particularly through consumption of green leafy vegetables.
“In addition to its generation by means of the NOS system, body stores of nitrate and nitrite may also be increased exogenously through the diet, particularly through the consumption of green leafy vegetables such as lettuce, spinach, rocket, celery, cress, and beetroot”
From Dietary Nitrate Supplementation and Exercise Performance (2014) · cites this paper as [7]
Green leafy vegetables as well as root vegetables such as beets are known to contain the highest amounts of inorganic nitrate.
“Green leafy vegetables as well as root vegetables such as beets are known to contain the highest amounts of inorganic nitrate[36,161,370].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [161]
Estimates of average daily nitrate consumption in the U.S. and Europe reach only 40-100 mg and 30-180 mg, respectively.
“Unsurprisingly, estimates of average daily nitrate consumption in the U.S. and Europe, regions with high rates of CVD and vascular disease, reach only 40–100mg and 30–180mg, respectively[157,161,372].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [161]
A typical DASH-compliant diet is estimated to contain a range of nitrate from 174-1222 mg/day.
“with a typical DASH-compliant diet estimated to contain a range of nitrate from 174–1222mg/day[161].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [161]
Dietary intake of fruits and vegetables rich in nitrate/nitrite prevents insulin resistance and vascular endothelial dysfunction by increasing NO availability.
“Recently accumulated evidence has demonstrated that dietary intake of fruits and vegetables rich in nitrate/nitrite is an inexpensive and easily-practicable way to prevent insulin resistance and vascular endothelial dysfunction by increasing the NO availability”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [28]
A DASH diet can easily exceed 1,200 mg/day nitrate.
“according to a report by Hord [28], in which the daily nitrate and nitrite intakes were calculated based on the variations using the vegetable and fruit components of the DASH (Dietary Approaches to Stop Hypertension) dietary pattern [46], the level easily exceeds 1,200 mg/day nitrate.”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [28]
Dietary nitrate/nitrite improves features of lifestyle-related diseases by enhancing NO availability.
“dietary nitrate/nitrite improves the features of lifestyle-related diseases by enhancing NO availability, and thus provides potential options for prevention and therapy for these patients [28].”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [28]
A DASH diet containing 1200 mg nitrate exceeds the WHO ADI by more than five-fold and the US EPA level for a 60 kg individual by more than two-fold.
“This is more than five-fold higher than the WHO’s ADI of 3.7 mg nitrate/kg body weight/day, and more than two-fold the US Environmental Protection Agency’s level of 7.0 mg nitrate/kg body weight/day for a 60 kg individual [28].”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [28]
Nitrate and nitrite derived from vegetables and fruits are reduced to NO, followed by formation of S-nitrosothiols, rather than formation of nitrosamines, especially in the presence of reducing agents such as vitamin C and E in the stomach.
“Although it may be difficult to isolate the specific effects of these dietary nutrients, as discussed above, the nitrate and nitrite derived from vegetables and fruits are reduced to NO, which is followed by the formation of S-nitrosothiols [123], rather than the formation of nitrosamines especially in the presence of reducing agents such as vitamin C and E in the stomach [28,124].”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [28]
Beetroot juice (500 ml; 23 mmol nitrate) completely reduced endothelial dysfunction induced by ischaemic-reperfusion injury to the forearm and preserved the FMD response, whereas the FMD response was reduced by 60% in control subjects.
“Webb et al. (81) showed that beetroot juice (500 ml; 23 mmol nitrate) completely reduced endothelial dysfunction induced by ischaemicreperfusion injury to the forearm and preserved the FMD response, whereas the FMD response was reduced by 60 % in the control subjects.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
The peak effect in BP after beetroot juice occurred at 3 h after ingestion and was associated with an increase in plasma nitrite concentration.
“The peak effect in BP occurred at 3 h after ingestion and in association with an increase in plasma nitrite concentration, supporting the hypothesis that the delayed appearance of nitrite is due to the sequential bioconversion of nitrate to nitrite and further to NO in vivo.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
In most studies examined, peak reduction in BP compared with baseline occurred at 2-3 h after consumption of dietary nitrate, which is the same time at which peak plasma nitrite concentrations have been observed.
“In most of the studies examined, peak reduction in BP compared with baseline occurred at 2-3 h after the consumption of dietary nitrate, which is the same time at which peak plasma nitrite concentrations have been observed (81,82,86,87,89,92) ,”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
Ingestion of a single dose of beetroot juice (500 ml; 23 mmol nitrate) by fourteen healthy subjects reduced systolic BP and diastolic BP by 10 and 8 mmHg, respectively.
“In 2008, Webb et al. (81) showed that ingestion of a single dose of beetroot juice (500 ml; 23 mmol nitrate) by fourteen healthy subjects reduced systolic BP (SBP) and DBP by 10 and 8 mmHg, respectively.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
A few studies have found that dietary nitrate inhibits platelet aggregation.
“A few studies have found inhibitory effects of dietary nitrate on platelet aggregation, suggesting that inhibition of abnormal platelet aggregation may be partly responsible for the cardiovascular benefits of nitrate supplementation.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
Webb et al. (81) supplementation of healthy individuals with beetroot juice (550 ml; 23 mmol nitrate) had an inhibitory effect on ex vivo platelet aggregation in response to collagen and adenosine diphosphate.
“In a study by Webb et al. (81) supplementation of healthy individuals with beetroot juice (550 ml; 23 mmol nitrate) also had an inhibitory effect on ex vivo platelet aggregation in response to collagen and adenosine diphosphate.”
From The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies (2013) · cites this paper as [81]
A recent systematic review found the pooled effect for inorganic nitrate and beetroot juice supplementation to be a significant reduction of SBP of ~4-5 mmHg.
“A recent systematic review found the pooled effect for inorganic nitrate and beetroot juice supplementation to be a significant reduction of SBP of ~4-5 mmHg (6) .”
From High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women (2015) · cites this paper as [6]
Most of the study populations in the systematic review consisted of healthy, young men and may not be representative of the whole population.
“However, most of the study populations have consisted of healthy, young men and may not be representative of the whole population (6) .”
From High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women (2015) · cites this paper as [6]
Intake of nitrite from environmental sources occurs through contaminated ground water, commonly due to fertilizers, livestock and human excreta, which pose a potential hazard to health.
“Intake of nitrite from environmental sources also occurs through contaminated ground water, commonly due to fertilizers, livestock and human excreta, which pose a potential hazard to health [59, 65].”
From Inorganic nitrite therapy: historical perspective and future directions (2011) · cites this paper as [59]
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- Authors
- Hord, N. G., Tang, Y., & Bryan, N. S.
- Affiliations
- Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (US)
- Corresponding author
- Bryan, Nathan S
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 90
- Issue
- 1
- Pages
- 1-10
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2114325309
- Cited by
- 1,069
- References
- 105
- Citations by year
- 2026: 53 · 2025: 66 · 2024: 47 · 2023: 77 · 2022: 79 · 2021: 80 · 2020: 66 · 2019: 74 · 2018: 70 · 2017: 87 · 2016: 66 · 2015: 73 · 2014: 48 · 2013: 51 · 2012: 42
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Keywords
- dietary nitrate, dietary nitrite, vegetable consumption, fruit consumption, processed meat, DASH diet, blood pressure reduction, nitric oxide, commensal bacteria, methemoglobinemia, gastrointestinal cancer risk, acceptable daily intake, dietary habits
- MeSH terms
- Animals, Diet, Food Analysis, Food Handling, Fruit, Health, Humans, Meat, Nitrates, Nitric Oxide, Nitrites, Vegetables
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