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Move to the ‘Beet’ of Nitric Oxide

Often, the smallest, simplest molecules have the greatest importance. Nitric oxide (NO) is made up of one atom of nitrogen and one atom of oxygen. It is one of the most important molecules able to influence metabolic activities and have diverse effects throughout the body. Previously, it was thought that the main pathway by which NO was produced in the body was from the amino acid arginine, which is what made arginine such an attractive workout supplement for gym-goers, athletes and even heart patients. However, scientists now understand that NO is produced even more effectively through the consumption of nitrates and nitrites found in
foods such as beets, spinach, lettuce, bok choy, celery and so many of the healthiest vegetables in the world. In fact, researchers think that higher NO production through increased nitrate and nitrite consumption may be in large part responsible for the health benefits attributed to diets such as the Mediterranean diet and the DASH diet (the Dietary Approaches to Stop Hypertension) which exceeds the acceptable daily intake for nitrate set by the World Health Organization by 550%.1 Vegetarian diets and the newer trend of a vegan diet are also known to produce lower blood pressures and hence better cardiovascular function and exercise endurance.2

The Age Factor

NO production in the body decreases after the age of 30, and blood vessel production of NO is almost totally compromised between the ages of 60-80.3,4,5 But the ability of the blood vessels to respond to NO doesn’t change. So while dietary nitrate and nitrite consumption can benefit younger, recreationally active people during exercise and at rest (in fact, most of the athletic performance studies have used healthy male subjects in their 20s, and most have found benefits), it may hold even greater benefits for middle-aged and elderly people. In fact, a small study noted that older adults around the age of 70 did not even actually absorb nitrate from nitrate-rich foods but did so from nitrate supplements, making supplementing with nitrates even more important as you age.6

Exercise and Your NO Levels

If you exercise, then you are already doing one of the best things you can to protect yourself against the age-related decline in NO production in your blood vessels and against arterial stiffness.3 But exercise also increases the responsiveness of the blood vessels to NO! A study on healthy older adults aged 60-72 years found that the blood vessels of those who exercised, burning the equivalent of calories to walking 1 hour a day, were almost 10% more responsive to nitroglycerin (an NO source given orally) than those who were less active.7

NO and Your Fitness Levels

NO helps regulate many different functions in the body including sleep, immunity, bone health, multiple aspects of cardiovascular health such as the blood pressure, blood clotting, cholesterol, and more. Of course, all of these influence health and fitness. But more specifically, NO can benefit exercise capacity, fitness and athletic performance in several interlinked ways.

NO has come to be known as the “endothelial-derived relaxation factor”. What this means is that NO is produced by cells lining the blood vessels, and it signals the blood vessels to relax or widen. This reduces blood pressure and improves blood flow. As a result, more oxygen and nutrients get delivered to the muscles and the heart, allowing them to function better at the same exercise intensity. This is called improving your VO2, or the amount of oxygen you need to use at a given exercise intensity, and is one of the main goals and outcomes of endurance training. The fitter an endurance athlete is, the harder and longer they can work with less oxygen at a given exercise intensity.

The presence of NO seems to increase energy production efficiency. Supplementing with a nitrate source causes muscles to use less energy during contractions, do more work, and delay fatigue during exercise. Supplemental nitrates have also been shown to allow mitochondria to produce more energy more efficiently by enhancing their function.8 This is especially important for people with disorders related to mitochondrial dysfunction and during aging since mitochondrial damage accumulates with age and is thought to be related to a host of common age-related diseases (including vascular dysfunction or hypertension.

Beetroot Juice Studies

Most beetroot juice studies have been done on cycling, walking and running, and with the exception of some elite, highly trained athletes, they have all found improved performance.9,10 A clinical study compared the effects of beetroot juice versus a placebo on exercise in recreationally active men between 20 and 40 years of age.11 During moderate exercise, the beetroot juice group had lower oxygen consumption in both the lungs and the muscles, and during intense exercise their fatigue was delayed over the placebo group. A second similar study was done on healthy men and women around 25-35 years of age. It showed that VO2 was 4% lower after 2.5 hours of steady state exercise after just 5 days of supplementation, with this effect lasting until the end of the study which was 15 days long.12 Just to be sure that the authors were correct in assuming that the nitrate in the beetroot juice was responsible for these benefits, a study compared the effects of nitrate-rich beetroot juice against nitrate-depleted beetroot juice on exercise.13 They were right: the nitrate-rich beetroot juice lowered blood pressure, improved performance at all exercise intensities (both walking and hard running), and delayed fatigue during intense exercise after just 6 days of supplementing while the nitrate-depleted beet juice did not. Finally, a similar group of authors decided to see what the optimal dose of nitrate was that would have these effects.14 Their findings were very interesting (on page 19), but ultimately they found that while a dose of juice containing 1040 mg of nitrate increased the efficiency of oxygen usage during moderate exercise more than 520 mg of nitrate did, there was no extra benefit in taking the higher dose for delaying fatigue. A recent study even showed that athletes in intermittent interval type sports could benefit from nitrate supplements.15 Young men involved in recreational team sports underwent a test meant to simulate short bursts of intense activity with brief breaks in between like in hockey, soccer and other such sports. Just 30 hours of supplementing with a nitrate-rich beet juice improved test performance by over 4%. Based on other findings, the authors suggest that the improvements were due to increased NO levels, better glucose use and better muscle contractility.

People with arterial or cardiovascular diseases are no exception. Studies have shown that people with peripheral arterial disease get the same benefits from beetroot juice during exercise as mentioned above.16

Supplemental Nitrate Studies

Since nitrate is the active component in beet juice, some studies have used sodium nitrate as a direct supplement and have found similar benefits as those using nitrate-rich beet juice. If beet juice is not your thing, you can opt for a nitrate supplement. Since NO also increases circulation and the delivery of blood, oxygen and nutrients to the muscles, NO could potentially be a vital addition to a post- workout supplement regimen or snack to make sure your muscles are getting the most nutrients possible for growth and repair.

Combining Nitrate with Other Supplements

Panax ginseng has been documented to help with physical stress as well as mental stress. It has been shown to help improve cognitive skills such as better focus, calmness and reduced mental fatigue in situations requiring a greater cognitive load or those causing mental stress.17 This is important for athletes in competition or during difficult drills, since mental stamina is just as important as physical stamina.

Studies have found that Panax ginseng can help improve exercise capacity.18 In one study, 1350 mg per day of a Panax ginseng supplement taken over 30 days improved time to exhaustion, and lowered blood pressure and required oxygen intake during endurance exercise. Panax ginseng also has ergogenic properties in facilitating recovery from exhaustive exercise, reducing exercise-induced muscle damage and inflammatory responses and supporting muscle repair.18,19,20 Panax ginseng has also been shownto help regulate blood sugar, possibly by improving insulin sensitivity and improving glucose usage by the body.17,21

In COPD patients, all measures of lung function as well as maximal exercise capacity were increased when Panaxginseng was administered for three months with no side effects whatsoever.22 In a mouse and in vitro study investigating the effects of Panax ginseng on nitric oxide production by blood vessels, the ginseng was found to protect the blood vessels, increase their responsiveness and improve impaired vascular function by increasing nitric oxide signaling.23 These findings make Asian ginseng a suitable supplement for the elderly, those with compromised exercise capacity or those with blood vessel or lung disorders as well as athletes who want to be on top of their game.

It’s easy to see why nitric oxide is so popular in research and in the media recently. Not only is consuming adequate nitrates and nitrites through a healthy diet important for producing nitric oxide, but other nutrients that support NO’s production and function in the body may be very useful for the young and old alike.

What You Need to Know

Due to their ability to produce nitric oxide (NO) in the body, nitrate-rich beet juice or isolated nitrate supplements have been shown to improve physical performance and delay fatigue by reducing the body’s oxygen requirements, improving the body’s energy production and usage and enhancing mitochondrial function, particularly in recreational athletes, people who are trying to become more active and in older adults. Cyclists, runners, walkers and those involved in intermittent high-intensity activities/sports have been shown to perform better after consuming nitrates. Middle-aged people, the elderly and those with compromised exercise capacities due to lung or cardiovascular complications can greatly benefit from nitric oxide-enhancing supplements.


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