The Effects of Dietary Nitrate (Beetroot Juice) Supplementation on Exercise Performance: A Review
American Journal of Sports Science
Volume 2, Issue 4, July 2014, Pages: 97-110
Received: Jul. 15, 2014; Accepted: Jul. 30, 2014; Published: Aug. 10, 2014
Views 4811      Downloads 723
Andreas Zafeiridis, Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
Article Tools
Follow on us
Nitric oxide (NO) is a potent vasodilator that increases blood flow and induces various intracellular actions such as increased mitochondrial and contractile efficiency. NO bioavailability may be increased by direct consumption of dietary nitrate and its sequential reduction to nitrite, a regulator of NO-induced hypoxic signaling. Dietary nitrate consumption reduces blood pressure, protects from ischemia-reperfusion injury, and improves endothelial dysfunction. Recently, the popularity of dietary nitrate as an ergogenic aid has been increased dramatically. Most exercise studies have administered dietary nitrate in the form of beetroot juice containing 5-8 mmol of nitrate and a few studies have used sodium and potassium nitrate (8-10 mg/kg). The most prominent and consistent effects of dietary nitrate supplementation is a reduction in the oxygen cost of exercise and an increase in exhaustion time at submaximal workloads. This effect was observed after either a single bolus (2-3 h prior to exercise) or a long-term (2-15 days) supplementation. The ergogenic effects of beetroot supplementation appear to be dose-dependent and are most often observed after long-term ingestion (approximately 6 days), at high exercise intensities and in less fit individuals. The ergogenic value of beetroot supplementation in endurance athletes is not clear; many studies have documented no improvements and a few studies an enhanced performance (0.4% to 3%) in time- and distance-trials. Clearly, more research is needed to document (i) the optimal dosage of beetroot ingestion for enhancing exercise performance in athletes, (ii) the effects of dietary nitrate consumption on training adaptations, (iii) the efficacy of beetroot supplementation in increasing exercise tolerance in individuals with chronic disease, and (iv) the safety of long-term beetroot consumption.
Dietary Nitrate, Nitric Oxide, Nitrite, Beetroot, Endurance, Exercise, VO2, Performance, Supplements
To cite this article
Andreas Zafeiridis, The Effects of Dietary Nitrate (Beetroot Juice) Supplementation on Exercise Performance: A Review, American Journal of Sports Science. Vol. 2, No. 4, 2014, pp. 97-110. doi: 10.11648/j.ajss.20140204.15
Stamler JS, Meissner G. Physiology of nitric oxide in skeletal muscle. Physiol Rev. 2001 Jan;81(1):209-37. PubMed PMID: 11152758. Epub 2001/01/12. eng.
Joyner MJ, Tschakovsky ME. Nitric oxide and physiologic vasodilation in human limbs: where do we go from here? Can J Appl Physiol. 2003 Jun;28(3):475-90. PubMed PMID: 12955873. Epub 2003/09/06. eng.
Ferreira LF, Behnke BJ. A toast to health and performance! Beetroot juice lowers blood pressure and the O2 cost of exercise. J Appl Physiol (1985). 2011 Mar;110(3):585-6. PubMed PMID: 21183624. Epub 2010/12/25. eng.
Lundberg JO, Weitzberg E. The biological role of nitrate and nitrite: the times they are a-changin'. Nitric Oxide. 2010 Feb 15;22(2):61-3. PubMed PMID: 19919855. Epub 2009/11/19. eng.
Miller GD, Marsh AP, Dove RW, Beavers D, Presley T, Helms C, et al. Plasma nitrate and nitrite are increased by a high-nitrate supplement but not by high-nitrate foods in older adults. Nutr Res. 2012 Mar;32(3):160-8. PubMed PMID: 22464802. Pubmed Central PMCID: PMC3319660. Epub 2012/04/03. eng.
Lundberg JO, Carlstrom M, Larsen FJ, Weitzberg E. Roles of dietary inorganic nitrate in cardiovascular health and disease. Cardiovasc Res. 2011 Feb 15;89(3):525-32. PubMed PMID: 20937740. Epub 2010/10/13. eng.
Gilchrist M, Winyard PG, Benjamin N. Dietary nitrate--good or bad? Nitric Oxide. 2010 Feb 15;22(2):104-9. PubMed PMID: 19874908. Epub 2009/10/31. eng.
Alexander J, Benford D, Cockburn A, Cravedi J, Dogliotti E, Di Domenico A, et al. Nitrate in vegetables. The EFSA Journal. 2008 (689):1-79.
Lidder S, Webb AJ. 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. 2012;75(3):677-96.
van Faassen EE, Bahrami S, Feelisch M, Hogg N, Kelm M, Kim-Shapiro DB, et al. Nitrite as regulator of hypoxic signaling in mammalian physiology. Med Res Rev. 2009 Sep;29(5):683-741. PubMed PMID: 19219851. Pubmed Central PMCID: PMC2725214. Epub 2009/02/17. eng.
Totzeck M, Hendgen-Cotta UB, Luedike P, Berenbrink M, Klare JP, Steinhoff HJ, et al. Nitrite regulates hypoxic vasodilation via myoglobin-dependent nitric oxide generation. Circulation. 2012 Jul 17;126(3):325-34. PubMed PMID: 22685116. Pubmed Central PMCID: PMC3410747. Epub 2012/06/12. eng.
Dreissigacker U, Wendt M, Wittke T, Tsikas D, Maassen N. Positive correlation between plasma nitrite and performance during high-intensive exercise but not oxidative stress in healthy men. Nitric Oxide. 2010 Sep 15;23(2):128-35. PubMed PMID: 20451646. Epub 2010/05/11. eng.
Gladwin MT, Kim-Shapiro DB. The functional nitrite reductase activity of the heme-globins. Blood. 2008 Oct 1;112(7):2636-47. PubMed PMID: 18596228. Pubmed Central PMCID: PMC2556603. Epub 2008/07/04. eng.
Casey DP, Beck DT, Braith RW. Systemic plasma levels of nitrite/nitrate (NOx) reflect brachial flow-mediated dilation responses in young men and women. Clin Exp Pharmacol Physiol. 2007 Dec;34(12):1291-3. PubMed PMID: 17973870. Epub 2007/11/02. eng.
Larsen FJ, Schiffer TA, Borniquel S, Sahlin K, Ekblom B, Lundberg JO, et al. Dietary inorganic nitrate improves mitochondrial efficiency in humans. Cell Metab. 2011 Feb 2;13(2):149-59. PubMed PMID: 21284982. Epub 2011/02/03. eng.
Larsen FJ, Schiffer TA, Weitzberg E, Lundberg JO. Regulation of mitochondrial function and energetics by reactive nitrogen oxides. Free Radic Biol Med. 2012 Nov 15;53(10):1919-28. PubMed PMID: 22989554. Epub 2012/09/20. eng.
Hernandez A, Schiffer TA, Ivarsson N, Cheng AJ, Bruton JD, Lundberg JO, et al. Dietary nitrate increases tetanic [Ca2+]i and contractile force in mouse fast-twitch muscle. J Physiol. 2012 Aug 1;590(Pt 15):3575-83. PubMed PMID: 22687611. Pubmed Central PMCID: PMC3547271. Epub 2012/06/13. eng.
Ferguson SK, Hirai DM, Copp SW, Holdsworth CT, Allen JD, Jones AM, et al. Impact of dietary nitrate supplementation via beetroot juice on exercising muscle vascular control in rats. J Physiol. 2013 Jan 15;591(Pt 2):547-57. PubMed PMID: 23070702. Pubmed Central PMCID: PMC3577528. Epub 2012/10/17. eng.
Bailey SJ, Fulford J, Vanhatalo A, Winyard PG, Blackwell JR, DiMenna FJ, et al. Dietary nitrate supplementation enhances muscle contractile efficiency during knee-extensor exercise in humans. J Appl Physiol (1985). 2010 Jul;109(1):135-48. PubMed PMID: 20466802. Epub 2010/05/15. eng.
Vanhatalo A, Fulford J, Bailey SJ, Blackwell JR, Winyard PG, Jones AM. Dietary nitrate reduces muscle metabolic perturbation and improves exercise tolerance in hypoxia. J Physiol. 2011 Nov 15;589(Pt 22):5517-28. PubMed PMID: 21911616. Pubmed Central PMCID: PMC3240888. Epub 2011/09/14. eng.
Rassaf T, Lauer T, Heiss C, Balzer J, Mangold S, Leyendecker T, et al. Nitric oxide synthase-derived plasma nitrite predicts exercise capacity. Br J Sports Med. 2007 Oct;41(10):669-73; discussion 73. PubMed PMID: 17496072. Pubmed Central PMCID: PMC2465183. Epub 2007/05/15. eng.
Totzeck M, Hendgen-Cotta UB, Rammos C, Frommke LM, Knackstedt C, Predel HG, et al. Higher endogenous nitrite levels are associated with superior exercise capacity in highly trained athletes. Nitric Oxide. 2012 Aug 15;27(2):75-81. PubMed PMID: 22609879. Epub 2012/05/23. eng.
Wilkerson DP, Hayward GM, Bailey SJ, Vanhatalo A, Blackwell JR, Jones AM. Influence of acute dietary nitrate supplementation on 50 mile time trial performance in well-trained cyclists. Eur J Appl Physiol. 2012 Dec;112(12):4127-34. PubMed PMID: 22526247. Epub 2012/04/25. eng.
Wylie LJ, Mohr M, Krustrup P, Jackman SR, Ermiotadis G, Kelly J, et al. Dietary nitrate supplementation improves team sport-specific intense intermittent exercise performance. Eur J Appl Physiol. 2013 Jul;113(7):1673-84. PubMed PMID: 23370859. Epub 2013/02/02. eng.
Larsen FJ, Weitzberg E, Lundberg JO, Ekblom B. Effects of dietary nitrate on oxygen cost during exercise. Acta Physiol (Oxf). 2007 Sep;191(1):59-66. PubMed PMID: 17635415. Epub 2007/07/20. eng.
Vanhatalo A, Bailey SJ, Blackwell JR, DiMenna FJ, Pavey TG, Wilkerson DP, et al. Acute and chronic effects of dietary nitrate supplementation on blood pressure and the physiological responses to moderate-intensity and incremental exercise. Am J Physiol Regul Integr Comp Physiol. 2010 Oct;299(4):R1121-31. PubMed PMID: 20702806. Epub 2010/08/13. eng.
Bond V, Jr., Curry BH, Adams RG, Asadi MS, Millis RM, Haddad GE. Effects of dietary nitrates on systemic and cerebrovascular hemodynamics. Cardiol Res Pract. 2013;2013:435629. PubMed PMID: 24455404. Pubmed Central PMCID: PMC3886243. Epub 2014/01/24. eng.
Bond V, Jr., Curry BH, Adams RG, Millis RM, Haddad GE. Cardiorespiratory function associated with dietary nitrate supplementation. Appl Physiol Nutr Metab. 2014 Feb;39(2):168-72. PubMed PMID: 24476472. Pubmed Central PMCID: PMC3909870. Epub 2014/01/31. eng.
Thompson KG, Turner L, Prichard J, Dodd F, Kennedy DO, Haskell C, et al. Influence of dietary nitrate supplementation on physiological and cognitive responses to incremental cycle exercise. Respir Physiol Neurobiol. 2014 Mar 1;193:11-20. PubMed PMID: 24389270. Epub 2014/01/07. eng.
Murphy M, Eliot K, Heuertz RM, Weiss E. Whole beetroot consumption acutely improves running performance. J Acad Nutr Diet. 2012 Apr;112(4):548-52. PubMed PMID: 22709704. Epub 2012/06/20. eng.
Fulford J, Winyard PG, Vanhatalo A, Bailey SJ, Blackwell JR, Jones AM. Influence of dietary nitrate supplementation on human skeletal muscle metabolism and force production during maximum voluntary contractions. Pflugers Arch. 2013 Apr;465(4):517-28. PubMed PMID: 23354414. Epub 2013/01/29. eng.
Kenjale AA, Ham KL, Stabler T, Robbins JL, Johnson JL, Vanbruggen M, et al. Dietary nitrate supplementation enhances exercise performance in peripheral arterial disease. J Appl Physiol (1985). 2011 Jun;110(6):1582-91. PubMed PMID: 21454745. Pubmed Central PMCID: PMC3119136. Epub 2011/04/02. eng.
Lansley KE, Winyard PG, Bailey SJ, Vanhatalo A, Wilkerson DP, Blackwell JR, et al. Acute dietary nitrate supplementation improves cycling time trial performance. Med Sci Sports Exerc. 2011 Jun;43(6):1125-31. PubMed PMID: 21471821. Epub 2011/04/08. eng.
Bescos R, Rodriguez FA, Iglesias X, Ferrer MD, Iborra E, Pons A. Acute administration of inorganic nitrate reduces VO(2peak) in endurance athletes. Med Sci Sports Exerc. 2011 Oct;43(10):1979-86. PubMed PMID: 21407132. Epub 2011/03/17. eng.
Cermak NM, Res P, Stinkens R, Lundberg JO, Gibala MJ, van Loon LJ. No improvement in endurance performance after a single dose of beetroot juice. Int J Sport Nutr Exerc Metab. 2012 Dec;22(6):470-8. PubMed PMID: 23212319. Epub 2012/12/06. eng.
Bescos R, Ferrer-Roca V, Galilea PA, Roig A, Drobnic F, Sureda A, et al. Sodium nitrate supplementation does not enhance performance of endurance athletes. Med Sci Sports Exerc. 2012 Dec;44(12):2400-9. PubMed PMID: 22811030. Epub 2012/07/20. eng.
Muggeridge DJ, Howe CC, Spendiff O, Pedlar C, James PE, Easton C. A single dose of beetroot juice enhances cycling performance in simulated altitude. Med Sci Sports Exerc. 2014 Jan;46(1):143-50. PubMed PMID: 23846159. Epub 2013/07/13. eng.
Peacock O, Tjonna AE, James P, Wisloff U, Welde B, Bohlke N, et al. Dietary nitrate does not enhance running performance in elite cross-country skiers. Med Sci Sports Exerc. 2012 Nov;44(11):2213-9. PubMed PMID: 22874535. Epub 2012/08/10. eng.
Muggeridge DJ, Howe CC, Spendiff O, Pedlar C, James PE, Easton C. The effects of a single dose of concentrated beetroot juice on performance in trained flatwater kayakers. Int J Sport Nutr Exerc Metab. 2013 Oct;23(5):498-506. PubMed PMID: 23580456. Epub 2013/04/13. eng.
Boorsma RK, Whitfield J, Spriet LL. Beetroot Juice Supplementation Does Not Improve Performance in Elite 1500-m Runners. Med Sci Sports Exerc. 2014 Apr 28. PubMed PMID: 24781895. Epub 2014/05/02. Eng.
Martin K, Smee D, Thompson KG, Rattray B. Dietary Nitrate Does Not Improve Repeated Sprint Performance. Int J Sports Physiol Perform. 2014 Jan 15. PubMed PMID: 24436354. Epub 2014/01/18. Eng.
Hoon MW, Jones AM, Johnson NA, Blackwell JR, Broad EM, Lundy B, et al. The Effect of Variable Doses of Inorganic Nitrate-Rich Beetroot Juice on Simulated 2,000-m Rowing Performance in Trained Athletes. Int J Sports Physiol Perform. 2014 Jul;9(4):615-20. PubMed PMID: 24085341. Epub 2013/10/03. eng.
Clementi E, Nisoli E. Nitric oxide and mitochondrial biogenesis: a key to long-term regulation of cellular metabolism. Comp Biochem Physiol A Mol Integr Physiol. 2005 Oct;142(2):102-10. PubMed PMID: 16091305. Epub 2005/08/11. eng.
Nisoli E, Falcone S, Tonello C, Cozzi V, Palomba L, Fiorani M, et al. Mitochondrial biogenesis by NO yields functionally active mitochondria in mammals. Proc Natl Acad Sci U S A. 2004 Nov 23;101(47):16507-12. PubMed PMID: 15545607. Pubmed Central PMCID: PMC534517. Epub 2004/11/17. eng.
Bailey SJ, Winyard P, Vanhatalo A, Blackwell JR, Dimenna FJ, Wilkerson DP, et al. Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans. J Appl Physiol (1985). 2009 Oct;107(4):1144-55. PubMed PMID: 19661447. Epub 2009/08/08. eng.
Lansley KE, Winyard PG, Fulford J, Vanhatalo A, Bailey SJ, Blackwell JR, et al. Dietary nitrate supplementation reduces the O2 cost of walking and running: a placebo-controlled study. J Appl Physiol (1985). 2011 Mar;110(3):591-600. PubMed PMID: 21071588. Epub 2010/11/13. eng.
Kelly J, Fulford J, Vanhatalo A, Blackwell JR, French O, Bailey SJ, et al. Effects of short-term dietary nitrate supplementation on blood pressure, O2 uptake kinetics, and muscle and cognitive function in older adults. Am J Physiol Regul Integr Comp Physiol. 2013 Jan 15;304(2):R73-83. PubMed PMID: 23174856. Epub 2012/11/24. eng.
Haider G, Folland JP. Nitrate Supplementation Enhances the Contractile Properties of Human Skeletal Muscle. Med Sci Sports Exerc. 2014 Mar 27. PubMed PMID: 24681572. Epub 2014/04/01. Eng.
Larsen FJ, Weitzberg E, Lundberg JO, Ekblom B. Dietary nitrate reduces maximal oxygen consumption while maintaining work performance in maximal exercise. Free Radic Biol Med. 2010 Jan 15;48(2):342-7. PubMed PMID: 19913611. Epub 2009/11/17. eng.
Kelly J, Vanhatalo A, Wilkerson DP, Wylie LJ, Jones AM. Effects of nitrate on the power-duration relationship for severe-intensity exercise. Med Sci Sports Exerc. 2013 Sep;45(9):1798-806. PubMed PMID: 23475164. Epub 2013/03/12. eng.
Masschelein E, Van Thienen R, Wang X, Van Schepdael A, Thomis M, Hespel P. Dietary nitrate improves muscle but not cerebral oxygenation status during exercise in hypoxia. J Appl Physiol (1985). 2012 Sep 1;113(5):736-45. PubMed PMID: 22773768. Epub 2012/07/10. eng.
Jones AM, Burnley M. Oxygen uptake kinetics: an underappreciated determinant of exercise performance. Int J Sports Physiol Perform. 2009 Dec;4(4):524-32. PubMed PMID: 20029103. Epub 2009/12/24. eng.
Jones AM, Grassi B, Christensen PM, Krustrup P, Bangsbo J, Poole DC. Slow component of VO2 kinetics: mechanistic bases and practical applications. Med Sci Sports Exerc. 2011 Nov;43(11):2046-62. PubMed PMID: 21552162. Epub 2011/05/10. eng.
Breese BC, McNarry MA, Marwood S, Blackwell JR, Bailey SJ, Jones AM. Beetroot juice supplementation speeds O2 uptake kinetics and improves exercise tolerance during severe-intensity exercise initiated from an elevated metabolic rate. Am J Physiol Regul Integr Comp Physiol. 2013 Dec 15;305(12):R1441-50. PubMed PMID: 24089377. Epub 2013/10/04. eng.
Cermak NM, Gibala MJ, van Loon LJ. Nitrate supplementation's improvement of 10-km time-trial performance in trained cyclists. Int J Sport Nutr Exerc Metab. 2012 Feb;22(1):64-71. PubMed PMID: 22248502. Epub 2012/01/18. eng.
Bond H, Morton L, Braakhuis AJ. Dietary nitrate supplementation improves rowing performance in well-trained rowers. Int J Sport Nutr Exerc Metab. 2012 Aug;22(4):251-6. PubMed PMID: 22710356. Epub 2012/06/20. eng.
Pinna M, Roberto S, Milia R, Marongiu E, Olla S, Loi A, et al. Effect of beetroot juice supplementation on aerobic response during swimming. Nutrients. 2014;6(2):605-15. PubMed PMID: 24481133. Pubmed Central PMCID: PMC3942720. Epub 2014/02/01. eng.
Smith TB, Hopkins WG. Variability and predictability of finals times of elite rowers. Med Sci Sports Exerc. 2011 Nov;43(11):2155-60. PubMed PMID: 21502896. Epub 2011/04/20. eng.
Christensen PM, Nyberg M, Bangsbo J. Influence of nitrate supplementation on VO(2) kinetics and endurance of elite cyclists. Scand J Med Sci Sports. 2013 Feb;23(1):e21-31. PubMed PMID: 23020760. Epub 2012/10/02. eng.
Puype J, Ramaekers M, Van Thienen R, Deldicque L, Hespel P. No effect of dietary nitrate supplementation on endurance training in hypoxia. Scand J Med Sci Sports. 2014 Mar 20. PubMed PMID: 24646076. Epub 2014/03/22. Eng.
Hopker J, Passfield L, Coleman D, Jobson S, Edwards L, Carter H. The effects of training on gross efficiency in cycling: a review. Int J Sports Med. 2009 Dec;30(12):845-50. PubMed PMID: 19941249. Epub 2009/11/27. eng.
Jungersten L, Ambring A, Wall B, Wennmalm A. Both physical fitness and acute exercise regulate nitric oxide formation in healthy humans. J Appl Physiol (1985). 1997 Mar;82(3):760-4. PubMed PMID: 9074960. Epub 1997/03/01. eng.
Schena F, Cuzzolin L, Rossi L, Pasetto M, Benoni G. Plasma nitrite/nitrate and erythropoietin levels in cross-country skiers during altitude training. J Sports Med Phys Fitness. 2002 Jun;42(2):129-34. PubMed PMID: 12032406. Epub 2002/05/29. eng.
Brand MD, Pakay JL, Ocloo A, Kokoszka J, Wallace DC, Brookes PS, et al. The basal proton conductance of mitochondria depends on adenine nucleotide translocase content. Biochem J. 2005 Dec 1;392(Pt 2):353-62. PubMed PMID: 16076285. Pubmed Central PMCID: PMC1316271. Epub 2005/08/04. eng.
Ferreira LF, Padilla DJ, Williams J, Hageman KS, Musch TI, Poole DC. Effects of altered nitric oxide availability on rat muscle microvascular oxygenation during contractions. Acta Physiol (Oxf). 2006 Mar;186(3):223-32. PubMed PMID: 16497201. Epub 2006/02/25. eng.
Ferguson SK, Hirai DM, Copp SW, Holdsworth CT, Allen JD, Jones AM, et al. Effects of nitrate supplementation via beetroot juice on contracting rat skeletal muscle microvascular oxygen pressure dynamics. Respir Physiol Neurobiol. 2013 Jul 1;187(3):250-5. PubMed PMID: 23584049. Pubmed Central PMCID: PMC3753182. Epub 2013/04/16. eng.
Ferguson SK, Hirai DM, Copp SW, Holdsworth CT, Allen JD, Jones AM, et al. Dose dependent effects of nitrate supplementation on cardiovascular control and microvascular oxygenation dynamics in healthy rats. Nitric Oxide. 2014 May 30;39:51-8. PubMed PMID: 24769046. Epub 2014/04/29. eng.
Hirai DM, Copp SW, Ferguson SK, Holdsworth CT, McCullough DJ, Behnke BJ, et al. Exercise training and muscle microvascular oxygenation: functional role of nitric oxide. J Appl Physiol (1985). 2012 Aug 15;113(4):557-65. PubMed PMID: 22678970. Pubmed Central PMCID: PMC3424059. Epub 2012/06/09. eng.
Hoon MW, Johnson NA, Chapman PG, Burke LM. The effect of nitrate supplementation on exercise performance in healthy individuals: a systematic review and meta-analysis. Int J Sport Nutr Exerc Metab. 2013 Oct;23(5):522-32. PubMed PMID: 24172997. Epub 2013/11/01. eng.
Wylie LJ, Kelly J, Bailey SJ, Blackwell JR, Skiba PF, Winyard PG, et al. Beetroot juice and exercise: pharmacodynamic and dose-response relationships. J Appl Physiol (1985). 2013 Aug 1;115(3):325-36. PubMed PMID: 23640589. Epub 2013/05/04. eng.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186