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Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway.

Abstract

The discovery that dietary (inorganic) nitrate has important vascular effects came from the relatively recent realization of the 'nitrate-nitrite-nitric oxide (NO) pathway'. Dietary nitrate has been demonstrated to have a range of beneficial vascular effects, including reducing blood pressure, inhibiting platelet aggregation, preserving or improving endothelial dysfunction, enhancing exercise performance in healthy individuals and patients with peripheral arterial disease. Pre-clinical studies with nitrate or nitrite also show the potential to protect against ischaemia-reperfusion injury and reduce arterial stiffness, inflammation and intimal thickness. However, there is a need for good evidence for hard endpoints beyond epidemiological studies. Whilst these suggest reduction in cardiovascular risk with diets high in nitrate-rich vegetables (such as a Mediterranean diet), others have suggested possible small positive and negative associations with dietary nitrate and cancer, but these remain unproven. Interactions with other nutrients, such as vitamin C, polyphenols and fatty acids may enhance or inhibit these effects. In order to provide simple guidance on nitrate intake from different vegetables, we have developed the Nitrate 'Veg-Table' with 'Nitrate Units' [each unit being 1 mmol of nitrate (62 mg)] to achieve a nitrate intake that is likely to be sufficient to derive benefit, but also to minimize the risk of potential side effects from excessive ingestion, given the current available evidence. The lack of data concerning the long term effects of dietary nitrate is a limitation, and this will need to be addressed in future trials.

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  • Authors+Show Affiliations

    ,

    King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas' Hospital, London, UK.

    Source

    MeSH

    Beta vulgaris
    Blood Pressure
    Blood Vessels
    Cardiovascular Diseases
    Cardiovascular System
    Diet
    Humans
    Nitrates
    Nitric Oxide
    Nitrites
    Plant Leaves
    Risk Factors
    Vegetables

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22882425

    Citation

    Lidder, Satnam, and Andrew J. Webb. "Vascular Effects of Dietary Nitrate (as Found in Green Leafy Vegetables and Beetroot) Via the Nitrate-nitrite-nitric Oxide Pathway." British Journal of Clinical Pharmacology, vol. 75, no. 3, 2013, pp. 677-96.
    Lidder S, Webb AJ. Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway. Br J Clin Pharmacol. 2013;75(3):677-96.
    Lidder, S., & Webb, A. J. (2013). Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway. British Journal of Clinical Pharmacology, 75(3), pp. 677-96. doi:10.1111/j.1365-2125.2012.04420.x.
    Lidder S, Webb AJ. Vascular Effects of Dietary Nitrate (as Found in Green Leafy Vegetables and Beetroot) Via the Nitrate-nitrite-nitric Oxide Pathway. Br J Clin Pharmacol. 2013;75(3):677-96. PubMed PMID: 22882425.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway. AU - Lidder,Satnam, AU - Webb,Andrew J, PY - 2012/02/20/received PY - 2012/08/05/accepted PY - 2012/8/14/entrez PY - 2012/8/14/pubmed PY - 2013/8/7/medline SP - 677 EP - 96 JF - British journal of clinical pharmacology JO - Br J Clin Pharmacol VL - 75 IS - 3 N2 - The discovery that dietary (inorganic) nitrate has important vascular effects came from the relatively recent realization of the 'nitrate-nitrite-nitric oxide (NO) pathway'. Dietary nitrate has been demonstrated to have a range of beneficial vascular effects, including reducing blood pressure, inhibiting platelet aggregation, preserving or improving endothelial dysfunction, enhancing exercise performance in healthy individuals and patients with peripheral arterial disease. Pre-clinical studies with nitrate or nitrite also show the potential to protect against ischaemia-reperfusion injury and reduce arterial stiffness, inflammation and intimal thickness. However, there is a need for good evidence for hard endpoints beyond epidemiological studies. Whilst these suggest reduction in cardiovascular risk with diets high in nitrate-rich vegetables (such as a Mediterranean diet), others have suggested possible small positive and negative associations with dietary nitrate and cancer, but these remain unproven. Interactions with other nutrients, such as vitamin C, polyphenols and fatty acids may enhance or inhibit these effects. In order to provide simple guidance on nitrate intake from different vegetables, we have developed the Nitrate 'Veg-Table' with 'Nitrate Units' [each unit being 1 mmol of nitrate (62 mg)] to achieve a nitrate intake that is likely to be sufficient to derive benefit, but also to minimize the risk of potential side effects from excessive ingestion, given the current available evidence. The lack of data concerning the long term effects of dietary nitrate is a limitation, and this will need to be addressed in future trials. SN - 1365-2125 UR - https://www.unboundmedicine.com/medline/citation/22882425/full_citation L2 - https://doi.org/10.1111/j.1365-2125.2012.04420.x DB - PRIME DP - Unbound Medicine ER -