What's in Your Beet Juice? Nitrate and Nitrite Content of Beet Juice Products Marketed to Athletes

Effects of an Isotonic Beetroot Drink on Power Output During Sprint Exercise and Jump Performance in Physically Active Individuals: A Randomized Crossover Trial

Exogenous nitrate ingestion can improve exercise performance. This study investigated whether an isotonic beetroot drink could improve jump and sprint performance in active individuals. Twenty-three physically active participants (17 males, 6 females) (mean ± SD; age: 26 ± 4 years; body mass index: 22.4 ± 1.9 kg/m2) completed a double-blind, randomized, cross-over study where they consumed 570mL of either beetroot juice drink (BR) or isotonic beetroot juice drink (ISO-BR) three hours before performing countermovement (CMJ) and standing broad jump (SBJ) tests and a 30-second all-out sprint on a cycle ergometer. Both drinks contained equal nitrate (12.9 mmol) and carbohydrate (6.1g per 100mL) content but differed in osmolality (BR: 420 mOsm/kg vs. ISO-BR: 315 mOsm/kg). Salivary total nitrate and nitrite concentrations (NOx) 3 hours post-ingestion were significantly higher after consuming ISO-BR than BR. ISO-BR significantly improved peak power output compared to BR by 3.9% (ISO-BR: 11.4 ± 2.5 W/kg vs. BR: 11.0 ± 2.3 W/kg, p = .04) but not time to peak power (ISO-BR: 2.8 ± 1.7 s vs. BR: 2.9 ± 1.6 s, p = .62) or mean power output (ISO-BR: 7.3 ± 1.5 W/kg vs. BR: 7.3 ± 1.5 W/kg, p = .37). There were no significant differences in CMJ or SBJ between trials (p > .05). Sensory evaluation indicated that ISO-BR was preferred by 91% (n = 21) of participants compared with BR (average score; ISO-BR: 5.52 vs. BR: 3.52, p < .05). An ISO-BR drink improved peak power output during sprint cycling but not jump performance compared with BR alone, potentially via increased NOx.

Dietary NO3- does not enhance endothelial dependent cutaneous vascular conductance in older women

Prior work has yet to determine whether the reduction of dietary nitrate (NO3-) to NO, via the enterosalivary pathway, may modify cutaneous vascular conductance (CVC) responses to local heating in older women. Changes occurring with the transition to menopause related to hormonal flux, increased adiposity, and/or decreased physical activity may further compound the negative influence of aging on nitric oxide (NO)-dependent CVC. Herein, we characterized changes in NO-dependent CVC following acute ingestion of 140 mL of NO3--rich beetroot juice in 24 older women (age: 65 ± 5 y, BMI: 31.2 ± 3.7 kg/m2). Red blood cell (RBC) flux was measured continuously via laser-Doppler flowmetry on the dorsal aspect of the forearm during local skin heating to 39 °C/44 °C before and 3 h after NO3- ingestion. NO-dependent changes in CVC were calculated as RBC flux/mean arterial blood pressure at 39 °C and normalized as a proportion of maximal CVC at 44 °C (%CVCmax). Changes (Δ) in fractional exhaled NO (FeNO) following NO3- ingestion were used an index of NO bioavailability. Despite increased FeNO (+81 ± 70 %, P < 0.001), %CVCmax at 39 °C was reduced (-16 ± 10 %, P < 0.001) following NO3- ingestion. A greater reduction in %CVCmax was weakly to moderately associated with higher body fat% (r = 0.45 [0.05-0.72], P = 0.029), central adiposity% (r = 0.50 [0.13-0.75], P = 0.012), neutrophil% (r = 0.42 [0.02-0.70], P = 0.041), and higher neutrophil to lymphocyte ratio (r = 0.49 [0.11-0.75], P = 0.016). These findings demonstrate a single dose of dietary NO3- does not promote CVC responses to local heating in sedentary older women with overweight and obesity. Correlation with multiple biomarkers suggest systemic inflammation may be involved.

Beetroot juice supplementation and exercise performance: is there more to the story than just nitrate?

This mini-review summarizes the comparative effects of different sources of dietary nitrate (NO3-), beetroot juice (BRJ) and nitrate salts (NIT), on physiological function and exercise capacity. Our objectives were to determine whether BRJ is superior to NIT in enhancing exercise-related outcomes, and to explore the potential contribution of other putatively beneficial compounds in BRJ beyond NO3-. We conducted a comparative analysis of recent studies focused on the impact of BRJ versus NIT on submaximal oxygen consumption (VO2), endurance performance, adaptations to training, and recovery from muscle-damaging exercise. While both NO3- sources provide benefits, there is some evidence that BRJ may offer additional advantages, specifically in reducing VO2 during high-intensity exercise, magnifying performance improvements with training, and improving recovery post-exercise. These reported differences could be due to the hypothesized antioxidant and/or anti-inflammatory properties of BRJ resulting from the rich spectrum of phytonutrients it contains. However, significant limitations to published studies directly comparing BRJ and NIT make it quite challenging to draw any firm conclusions. We provide recommendations to help guide further research into the important question of whether there is more to the story of BRJ than just NO3-.

Effects of Acute Beetroot Juice and Sodium Nitrate on Selected Blood Metabolites and Response to Transient Ischemia: A Crossover Randomized Clinical Trial

BACKGROUND

Modification of the nitrate (NO3)-nitrite (NO2)-nitric oxide (NO) pathway can be induced by oral intake of inorganic NO3 (NIT) or NO3-rich products, such as beetroot juice (BRJ).

OBJECTIVES

The primary aim of this study was to evaluate the plasma changes in betaine, choline, trimethylamine (TMA), trimethylamine N-oxide (TMAO), and NO3/NO2 (NOx) concentrations over 4 h after single oral ingestion of NIT or BRJ. The flow-mediated skin fluorescence (FMSF) method was applied to measure the changes in nicotinamide adenine dinucleotide reduced form (NADH) in response to transient ischemia and reperfusion. We hypothesized that various sources of NO3 may differently affect endothelial and mitochondrial functions in healthy human subjects.

METHODS

In a randomized crossover trial, 8 healthy young adults ingested 800 mg NO3 from either NIT or BRJ on 2 separate days with ≥3 d apart. Venous blood samples were collected every hour, and FMSF determination was applied bihourly.

RESULTS

Plasma betaine and choline concentrations peaked at 1 h after BRJ ingestion, and remained significantly higher than baseline values at all time points (P < 0.001 and P < 0.001, compared to preingestion values). Over time, BRJ was more effective in increasing NOx compared with NIT (fixed-trial effect P < 0.001). Baseline fluorescence decreased after both NIT and BRJ consumption (fixed-time effect P = 0.005). Transient ischemia and reperfusion response increased because of NO3 consumption (fixed-time effect P = 0.003), with no differences between trials (P = 0.451; P = 0.912; P = 0.819 at 0, 2, and 4 h, respectively).

CONCLUSIONS

Acute ingestion of BRJ elevated plasma betaine and choline, but not TMA and TMAO. Moreover, plasma NOx levels were higher in the BRJ trial than in the NIT trial. Various sources of NO3 positively affected endothelial and mitochondrial functions. This trial was registered at clinicaltrials.gov as NCT05004935.

Myocardial infarct size is reduced by nitrite and nitrate administration: a systematic review and meta-analysis of animal studies

Ischemic heart disease (IHD) is the leading cause of mortality worldwide and can be complicated by myocardial infarction (MI), leading to cardiac failure. Inorganic nitrite and nitrate, which release nitric oxide (NO), can protect the heart against myocardial injury. This animal systematic review and meta-analysis aims to assess whether the administration of nitrite/nitrate decreases myocardial infarct size. We systematically searched PubMed, Scopus, and Web of Science databases until October 2023; 15 eligible animal studies (35 study arms for in-vivo and 10 for in-vitro studies) published between 1989 and 2023 were included. In-vivo studies were conducted on rats, mice, cats, and dogs, and in-vitro studies on rats and mice with an overall exposure of 0.03 to 12713 mg/kg to nitrate/nitrite administrated before, after, or during ischemia mainly by intravenous single bolus or by oral over 270 days. All in-vitro studies used nitrite/nitrate before ischemia, with the concentration ranging between 0.34 to 201 μM. MI was induced by occlusion of the left anterior diagonal or left circumflex arteries in in-vitro studies and by isoproterenol in in-vivo studies. Infarct size was measured by direct staining of the sliced heart sections. In in-vivo studies, nitrite (overall effect size (ES)=-17.0 %, 95 % confidence interval (CI)=-21.3, -12.8, P<0.001) and nitrate (overall ES= -9.6 %, 95 % CI=-15.7, -3.4, P=0.002) reduced myocardial infarct size. In in-vitro studies, nitrite (overall ES=-15.8 %, 95 % CI=-25.5, -6.2, P=0.001) reduced the infarct size. Sensitivity analysis showed that the overall effect of nitrite on myocardial infarct size was unaffected by doses or health conditions in in-vivo and in-vitro studies. In conclusion, our meta-analysis showed that nitrite/nitrate administration can effectively reduce myocardial infarct size. However, these results should be approached with caution because of the limitations of animal studies and the existing high heterogeneity.

Nitric Oxide in the Field: Prevalence and Use of Nitrates by Dietitians and Nutritionists in Spanish Elite Soccer

Soccer players make frequent use of dietary supplements to improve performance. One of the most widely used strategies to optimize performance is to increase the bioavailability of nitric oxide through nitrates, as it could delay fatigue during physical exertion, among other benefits. This may be positive for performance in soccer, although there is almost no research in professional soccer. The aim of the study was to evaluate the use of nitrates and behaviours related to their consumption in Spanish elite soccer clubs. Dietitian-nutritionist representatives from 45 teams from the most important Spanish soccer leagues completed an online survey to determine if, when, how and why nitrates are prescribed to soccer players. Of the total sample, 55.6% indicated providing nitrates, always before matches, but only 36% in training. There was a wide variation and lack of consistency in the timing, dosage and form of administration of nitrates. The use of mouthwashes or the protocol of chronic nitrate intake was not taken into account in most cases. The present study indicates a lack of interpretation between scientific knowledge and its application in practice, highlighting the need for future research to better understand how to optimize the use of nitrates in professional soccer.

Content of nitrate and nitrite in commercial and self-made beetroot juices and the effect of storage temperature

Popularity of beetroot juice (BJ) is growing due to its high inorganic nitrate content NO 3 - and its potential physiological benefits. However, the content of NO 3 - is not indicated in most commercial BJs and it can be affected by seasonal changes and storage conditions. This study analyzed the content of NO 3 - and nitrite NO 2 - in five and two commercial and self-made BJs, respectively, that were purchased in the summer and winter periods. The effect of storage temperature (20°C, 4°C, and -20°C) and pH was also analyzed. In nonconcentrated BJs, the NO 3 - content was 34 ± 20% (p = .075) in the winter than in the summer. NO 3 - was fully degraded in self-made BJ after 3 days at 20°C. This effect was attenuated by 78% and 82% when it was kept at 4°C and -20°C, respectively. The addition of lemon juice (5%) to self-made BJ was another useful approach to avoid NO 3 - degradation for 3 days when it was kept at 20°C. Regarding NO 2 - , self-made BJ had higher concentration (0.097 ± 0.01 mg/mL) compared to commercial BJs (<0.1 mg/mL; p = .001). The pH of self-made BJ was higher (6.3 ± 0.1) compared to commercial BJs (4.5 ± 0.3; p = .001). These results suggest that the content of NO 3 - in nonconcentrated BJs can substantially differ across the year and this is an important factor to take into account when recommending BJs to promote some of its potential physiological benefits.

Short-term beetroot juice supplementation improves muscle speed and power but does not reduce blood pressure or oxidative stress in 65-79 y old men and women

We have previously demonstrated that acute ingestion of inorganic nitrate (NO3-)-rich beetroot juice (BRJ), a source of nitric oxide (NO) via the NO3- → nitrite (NO2-) → NO pathway, can improve muscle speed and power in older individuals. It is not known, however, whether this effect is maintained or perhaps even enhanced with repeated ingestion, or if tolerance develops as with organic nitrates, e.g., nitroglycerin. Using a double-blind, placebo-controlled, crossover design, we therefore studied 16 community-dwelling older (age 71 ± 5 y) individuals after both acute and short-term (i.e., daily for 2 wk) BRJ supplementation. Blood samples were drawn and blood pressure was measured periodically during each ∼3 h experiment, with muscle function determined using isokinetic dynamometry. Acute ingestion of BRJ containing 18.2 ± 6.2 mmol of NO3- increased plasma NO3- and NO2- concentrations 23 ± 11 and 2.7 ± 2.1-fold over placebo, respectively. This was accompanied by 5 ± 11% and 7 ± 13% increases in maximal knee extensor speed (Vmax) and power (Pmax), respectively. After daily supplementation for 2 wk, BRJ ingestion elevated NO3- and NO2- levels 24 ± 12 and 3.3 ± 4.0-fold, respectively, whereas Vmax and Pmax were 7 ± 9% and 9 ± 11% higher than baseline. No changes were observed in blood pressure or in plasma markers of oxidative stress with either acute or short-term NO3- supplementation. We conclude that both acute and short-term dietary NO3- supplementation result in similar improvements in muscle function in older individuals. The magnitudes of these improvements are sufficient to offset the decline resulting from a decade or more of aging and are therefore likely to be clinically significant.

Effects of dietary nitrate supplementation on peak power output: Influence of supplementation strategy and population

Increasing evidence indicates that dietary nitrate supplementation has the potential to increase muscular power output during skeletal muscle contractions. However, there is still a paucity of data characterizing the impact of different nitrate dosing regimens on nitric oxide bioavailability and its potential ergogenic effects across various population groups. This review discusses the potential influence of different dietary nitrate supplementation strategies on nitric oxide bioavailability and muscular peak power output in healthy adults, athletes, older adults and some clinical populations. Effect sizes were calculated for peak power output and absolute and/or relative nitrate doses were considered where applicable. There was no relationship between the effect sizes of peak power output change following nitrate supplementation and when nitrate dosage when considered in absolute or relative terms. Areas for further research are also recommended including a focus on nitrate dosing regimens that optimize nitric oxide bioavailability for enhancing peak power at times of increased muscular work in a variety of healthy and disease populations.

The Effects of Nitrate Supplementation on Performance as a Function of Habitual Dietary Intake of Nitrates: A Randomized Controlled Trial of Elite Football Players

Nitrates are an effective ergogenic supplement; however, the effects of nitrate supplements based on habitual dietary nitrate intake through diet alone are not well understood. We aimed to assess this in a group of 15 highly trained football players from Slovenian football's First Division. Participants underwent two separate Cooper performance tests either with nitrate supplementation (400 mg nitrates) or placebo while having their nutrition assessed for nitrate intake, as well as energy and macronutrient intake. Nitrate supplementation had a statistically significant positive effect on performance if baseline dietary nitrate intake was below 300 mg (p = 0.0104) in both the placebo and intervention groups. No effects of nitrate supplementation when baseline dietary nitrate intake was higher than 300 mg in the placebo group could be concluded due to the small sample size. Nitrate supplementation did not have a significant effect on perceived exertion. The daily nitrate intake of the participants was measured at 165 mg, with the majority of nitrates coming from nitrate-rich vegetables.

Efficacy of beetroot juice on reducing blood pressure in hypertensive adults with autosomal dominant polycystic kidney disease (BEET-PKD): study protocol for a double-blind, randomised, placebo-controlled trial

BACKGROUND

In autosomal dominant polycystic kidney disease (ADPKD) impaired nitric oxide (NO) synthesis, in part, contributes to early-onset hypertension. Beetroot juice (BRJ) reduces blood pressure (BP) by increasing NO-mediated vasodilation. The aim of this double-blind, randomised, placebo-controlled study is to test the hypothesis that BRJ reduces systolic and diastolic clinic BP in hypertensive adults with ADPKD.

METHODS

Participants with ADPKD and treated hypertension (n = 60) will be randomly allocated (1:1) to receive a daily dose of either nitrate-replete (400 mg nitrate/day) or nitrate-deplete BRJ for 4 weeks. The co-primary outcomes are change in mean systolic and diastolic clinic BP before and after 4 weeks of treatment with daily BRJ. Secondary outcomes are changes in daily home BP, urinary albumin to creatinine ratio, serum and salivary nitrate/nitrite levels and serum asymmetric dimethylarginine levels before and after 4 weeks of BRJ.

DISCUSSION

The effect of BRJ in ADPKD has not been previously tested. BRJ is an accessible, natural dietary supplement that, if effective, will provide a novel adjunctive approach for treating hypertension in ADPKD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05401409. Retrospectively registered on 27th May 2022.

Effects of dietary nitrate supplementation on muscular power output: Influence of supplementation strategy and population

Increasing evidence indicates that dietary nitrate supplementation has the potential to increase muscular power output during skeletal muscle contractions. However, there is still a paucity of data characterizing the impact of different nitrate dosing regimens on nitric oxide bioavailability its potential ergogenic effects across various population groups. This narrative review discusses the potential influence of different dietary nitrate supplementation strategies on nitric oxide bioavailability and muscular power output in healthy adults, athletes, older adults and some clinical populations. Areas for further research are also recommended including a focus individualized nitrate dosing regimens to optimize nitric oxide bioavailability and to promote muscular power enhancements in different populations.

Beetroot Juice Produces Changes in Heart Rate Variability and Reduces Internal Load during Resistance Training in Men: A Randomized Double-Blind Crossover

Beetroot juice (BJ) has been used as a sport supplement, improving performance in resistance training (RT). However, its effect on the modulation of the autonomic nervous system has not yet been widely studied. Therefore, the objective of this randomized double-blind crossover study was to assess the effect of acute BJ supplementation compared to placebo in blood pressure (BP), heart rate (HR), heart rate variability (HRV) and internal load during RT measure as Root Mean Square of the Successive Differences between adjacent RR intervals Slope (RMSSD and RMSSD-Slope, respectively). Eleven men performed an incremental RT test (three sets at 60%, 70% and 80% of their repetition maximum) composed by back squat and bench press with. HR, HRV and RMSSD-Slope were measured during and post exercise. As the main results, RMSSD during exercise decrease in the BJ group compared to placebo (p = 0.023; ES = 0.999), there were no differences in RMSSD post-exercise, and there were differences in RMSSD-Slope between groups in favor of the BJ group (p = 0.025; ES = 1.104) with a lower internal load. In conclusion, BJ supplementation seems to be a valuable tool for the reduction in the internal load of exercise during RT measured as RMSSD-Slope while enhancing performance.

Skeletal Muscle Contractile Function in Heart Failure With Reduced Ejection Fraction-A Focus on Nitric Oxide

Despite advances over the past few decades, heart failure with reduced ejection fraction (HFrEF) remains not only a mortal but a disabling disease. Indeed, the New York Heart Association classification of HFrEF severity is based on how much exercise a patient can perform. Moreover, exercise capacity-both aerobic exercise performance and muscle power-are intimately linked with survival in patients with HFrEF. This review will highlight the pathologic changes in skeletal muscle in HFrEF that are related to impaired exercise performance. Next, it will discuss the key role that impaired nitric oxide (NO) bioavailability plays in HFrEF skeletal muscle pathology. Lastly, it will discuss intriguing new data suggesting that the inorganic nitrate 'enterosalivary pathway' may be leveraged to increase NO bioavailability via ingestion of inorganic nitrate. This ingestion of inorganic nitrate has several advantages over organic nitrate (e.g., nitroglycerin) and the endogenous nitric oxide synthase pathway. Moreover, inorganic nitrate has been shown to improve exercise performance: both muscle power and aerobic capacity, in some recent small but well-controlled, cross-over studies in patients with HFrEF. Given the critical importance of better exercise performance for the amelioration of disability as well as its links with improved outcomes in patients with HFrEF, further studies of inorganic nitrate as a potential novel treatment is critical.

Acute effects of beetroot juice and caffeine co-ingestion during a team-sport-specific intermittent exercise test in semi-professional soccer players: a randomized, double-blind, placebo-controlled study

BACKGROUND

Beetroot juice (BJ) and caffeine (CAF) are considered as ergogenic aids among athletes to enhance performance, however, the ergogenic effects of BJ and CAF co-ingestion are unclear during team-sport-specific performance. This study aimed to investigate the acute effects of BJ and CAF co-ingestion on team-sport-specific performance, compared with placebo (PL), BJ, and CAF alone.

METHOD

Sixteen semi-professional male soccer players (age: 19.8 ± 2.2 years, body mass: 69.2 ± 6.1 kg, height: 177.3 ± 6.0 cm) completed four experimental trials using a randomized, double-blind study design: BJ + CAF, CAF + PL, BJ + PL, and PL + PL. Countermovement jump with arm swing (CMJAS) performance and cognitive function by Stroop Word-Color test were evaluated before and after the Yo-Yo Intermittent Recovery Test level 1 (YYIR1). Also, rate of perceived exertion (RPE), heart rate, and gastrointestinal (GI) discomfort were measured during each session.

RESULTS

No significant differences were shown between test conditions for total distance covered in YYIR1 (BJ + CAF: 1858 ± 455 m, CAF + PL: 1798 ± 422 m, BJ + PL: 1845 ± 408 m, PL + PL 1740 ± 362 m; p = 0.55). Moreover, CMJAS performance, cognitive function, and RPE during the YYIR1 were not significantly different among conditions (p > 0.05). However, the average heart rate during the YYIR1 was higher in CAF + PL compared to PL + PL (by 6 ± 9 beats/min; p < 0.05), and GI distress was greater in BJ + CAF compared to PL + PL (by 2.4 ± 3.6 a.u.; p < 0.05).

CONCLUSION

These results suggest, neither acute co-ingestion of BJ + CAF nor BJ or CAF supplementation alone significantly affected team-sport-specific performance compared to the PL treatment.

The Effect of Beetroot Ingestion on High-Intensity Interval Training: A Systematic Review and Meta-Analysis

Dietary nitrate supplementation has shown promising ergogenic effects on endurance exercise. However, at present there is no systematic analysis evaluating the effects of acute or chronic nitrate supplementation on performance measures during high-intensity interval training (HIIT) and sprint interval training (SIT). The main aim of this systematic review and meta-analysis was to evaluate the evidence for supplementation of dietary beetroot-a common source of nitrate-to improve peak and mean power output during HIIT and SIT. A systematic literature search was carried out following PRISMA guidelines and the PICOS framework within the following databases: PubMed, ProQuest, ScienceDirect, and SPORTDiscus. Search terms used were: ((nitrate OR nitrite OR beetroot) AND (HIIT or high intensity or sprint interval or SIT) AND (performance)). A total of 17 studies were included and reviewed independently. Seven studies applied an acute supplementation strategy and ten studies applied chronic supplementation. The standardised mean difference for mean power output showed an overall trivial, non-significant effect in favour of placebo (Hedges' g = -0.05, 95% CI -0.32 to 0.21, Z = 0.39, p = 0.69). The standardised mean difference for peak power output showed a trivial, non-significant effect in favour of the beetroot juice intervention (Hedges' g = 0.08, 95% CI -0.14 to 0.30, Z = 0.72, p = 0.47). The present meta-analysis showed trivial statistical heterogeneity in power output, but the variation in the exercise protocols, nitrate dosage, type of beetroot products, supplementation strategy, and duration among studies restricted a firm conclusion of the effect of beetroot supplementation on HIIT performance. Our findings suggest that beetroot supplementation offers no significant improvement to peak or mean power output during HIIT or SIT. Future research could further examine the ergogenic potential by optimising the beetroot supplementation strategy in terms of dosage, timing, and type of beetroot product. The potential combined effect of other ingredients in the beetroot products should not be undermined. Finally, a chronic supplementation protocol with a higher beetroot dosage (>12.9 mmol/day for 6 days) is recommended for future HIIT and SIT study.

Effect of dietary nitrate on human muscle power: a systematic review and individual participant data meta-analysis

BACKGROUND

Previous narrative reviews have concluded that dietary nitrate (NO3-) improves maximal neuromuscular power in humans. This conclusion, however, was based on a limited number of studies, and no attempt has been made to quantify the exact magnitude of this beneficial effect. Such information would help ensure adequate statistical power in future studies and could help place the effects of dietary NO3- on various aspects of exercise performance (i.e., endurance vs. strength vs. power) in better context. We therefore undertook a systematic review and individual participant data meta-analysis to quantify the effects of NO3- supplementation on human muscle power.

METHODS

The literature was searched using a strategy developed by a health sciences librarian. Data sources included Medline Ovid, Embase, SPORTDiscus, Scopus, Clinicaltrials.gov , and Google Scholar. Studies were included if they used a randomized, double-blind, placebo-controlled, crossover experimental design to measure the effects of dietary NO3- on maximal power during exercise in the non-fatigued state and the within-subject correlation could be determined from data in the published manuscript or obtained from the authors.

RESULTS

Nineteen studies of a total of 268 participants (218 men, 50 women) met the criteria for inclusion. The overall effect size (ES; Hedge's g) calculated using a fixed effects model was 0.42 (95% confidence interval (CI) 0.29, 0.56; p = 6.310 × 10- 11). There was limited heterogeneity between studies (i.e., I2 = 22.79%, H2 = 1.30, p = 0.3460). The ES estimated using a random effects model was therefore similar (i.e., 0.45, 95% CI 0.30, 0.61; p = 1.064 × 10- 9). Sub-group analyses revealed no significant differences due to subject age, sex, or test modality (i.e., small vs. large muscle mass exercise). However, the ES in studies using an acute dose (i.e., 0.54, 95% CI 0.37, 0.71; p = 6.774 × 10- 12) was greater (p = 0.0211) than in studies using a multiple dose regimen (i.e., 0.22, 95% CI 0.01, 0.43; p = 0.003630).

CONCLUSIONS

Acute or chronic dietary NO3- intake significantly increases maximal muscle power in humans. The magnitude of this effect-on average, ~ 5%-is likely to be of considerable practical and clinical importance.

Effects of Beetroot Juice Supplementation on Cognitive Function, Aerobic and Anaerobic Performances of Trained Male Taekwondo Athletes: A Pilot Study

Studies have shown that nitrate (NO₃⁻)-rich beetroot juice (BJ) supplementation improves endurance and high-intensity intermittent exercise. The dose–response effects on taekwondo following BJ supplementation are yet to be determined. This study aimed to investigate two acute doses of 400 mg of NO₃⁻ (BJ-400) and 800 mg of NO₃⁻ (BJ-800) on taekwondo-specific performance and cognitive function tests compared with a placebo (PL) and control (CON) conditions. Eight trained male taekwondo athletes (age: 20 ± 4 years, height: 180 ± 2 cm, body mass: 64.8 ± 4.0 kg) completed four experimental trials using a randomized, double-blind placebo-controlled design: BJ-400, BJ-800, PL, and CON. Participants consumed two doses of BJ-400 and BJ-800 or nitrate-depleted PL at 2.5 h prior to performing the Multiple Frequency Speed of Kick Test (FSKT). Countermovement jump (CMJ) was performed before the (FSKT) and PSTT, whereas cognitive function was assessed (via the Stroop test) before and after supplementation and 10 min following PSTT. Blood lactate was collected before the CMJ tests immediately and 3 min after the FSKT and PSST; rating of perceived exertion (RPE) was recorded during and after both specific taekwondo tests. No significant differences (p > 0.05), with moderate and large effect sizes, between conditions were observed for PSTT and FSKT performances. In addition, blood lactate, RPE, heart rate, and CMJ height were not significantly different among conditions (p > 0.05). However, after the PSTT test, cognitive function was higher in BJ-400 compared to other treatments (p < 0.05). It was concluded that acute intake of 400 and 800 mg of NO₃⁻ rich BJ reported a moderate to large effect size in anaerobic and aerobic; however, no statistical differences were found in taekwondo-specific performance.

Impact of Red Spinach Extract Supplementation on Bench Press Performance, Muscle Oxygenation, and Cognitive Function in Resistance-Trained Males

The purpose of this study was to assess the impact of short-term dietary nitrate supplementation, in the form of red spinach extract (RSE), on bench press performance, muscle oxygenation, and cognitive function in resistance-trained males. Ten resistance-trained males participated in this randomized, cross-over, placebo-controlled, double-blind investigation. Each participant completed 7 days of either RSE (2 g; 180 mg NO₃⁻) or a maltodextrin placebo (PL) in a counterbalanced fashion with a 14-day washout between treatments. During experimental visits, participants were provided their 8th and last dose of RSE or PL 40 min before completing 5 sets of the barbell bench press exercise to failure at 75% of a predetermined 1-repetition maximum with 2 min rest intervals. Mean and peak power were recorded via a linear transducer. Near-infrared spectroscopy (NIRS) was implemented to estimate muscle oxygenation, a Stroop Test was used to assess cognitive function, and subjective performance ratings were obtained in relation to the acute resistance exercise sessions. Data were analyzed via separate repeated measures analyses of variance. There were no time by group interactions for bench press repetitions (p = 0.549), peak power (p = 0.061), or mean power (p = 0.877) across the 5 sets of bench press. Additionally, no significant differences (p > 0.05) were observed for any measure of muscle oxygenation, Stroop performance, or subjective performance ratings. It appears that 7 days of RSE supplementation did not alter performance, muscle oxygenation, nor Stroop scores during or following the bench press exercise in resistance-trained males.

Acute Beet Juice Supplementation Does Not Improve 30- or 60-second Maximal Intensity Performance in Anaerobically Trained Athletes

Research suggests that beet juice is beneficial during aerobic exercise. However, the impact of beet juice during primarily anaerobic exercise is equivocal. The purpose of this study was to determine the effects of acute beet juice supplementation on maximal intensity performance during 30-s and 60-s maximal-intensity cycling sprints. Using a double-blind, crossover-study design, 14 anaerobically trained male hockey players completed six Wingate cycling tests: familiarization trials of a 30-s and 60-s Wingate test, followed by 30-s Wingate placebo/beet juice trials, and 60-s Wingate placebo/beet juice trials. Repeated measures ANOVAs were used to compare the change in power between conditions over the duration of each trial. Paired t-tests were run to compare performance between conditions of various work and power variables. One-way ANOVAs were utilized to compare the change between conditions of the 30-s test to the change between conditions of the 60-s test. Beet juice supplementation yielded no statistical differences from placebo in any of the measured variables during the 30-s or 60-s tests (p > 0.05). The percent change for fatigue index was significantly different between the 30-s and 60-s tests (p = 0.032) suggesting less fatigue with beet juice supplementation. Overall, beet juice did not improve maximal intensity performance during 30-s or 60-s cycling sprint tests. Performance during the 60-s bout was not impacted to a greater extent than the 30-s bout after beet juice supplementation. These results suggest that beet juice supplementation does not improve short-duration exercise performance in anaerobically trained athletes.

Beetroot supplementation in women enjoying exercise together (BEE SWEET): Rationale, design and methods

Background

Postmenopausal women exhibit higher rates of disability and cardiovascular disease (CVD) with aging compared to men. Whereas habitual exercise training is a known strategy to enhance physiologic function in men and premenopausal women, exercise-related adaptations are often modest in postmenopausal women. We propose dietary nitrate (beetroot juice) administered prior to exercise training may be a feasible approach to improve mobility and cardio-metabolic health outcomes in postmenopausal women.

Methods

Our randomized, placebo-controlled study aims to determine preliminary effects sizes for changes in functional mobility and endothelium-dependent vasodilation across three study arms: exercise only (EX), exercise + placebo (EX + PL), and exercise + beetroot (EX + BR). Thirty-six postmenopausal women are recruited in small cohorts wherein group exercise is implemented to facilitate social support and adherence to an 8-week training progression. Participants are randomized to one of three study arms (n = 12 per group) following baseline assessments. Post-intervention assessments are used to determine pre-post changes in outcome measures including distance covered during a 6 min walk test, walking economy, muscle speed and power, and endothelial-dependent vasodilation as determined by flow-mediated dilation. Measures of feasibility include recruitment, retention, adherence to exercise prescription, perceived exercise session difficulty, and adverse event rates.

Discussion

Evidence-based, translational strategies are needed to optimize exercise training-related adaptations in postmenopausal women. Findings will inform larger randomized clinical trials to determine if pre-exercise consumption of beetroot juice is an efficacious strategy to promote mobility and attenuate CVD disease risk.

[Fraud in nutritional supplements for athletes: a narrative review]

Introduction

The use of nutritional supplements (NSs) is a widespread practice in both professional and amateur athletes. Their choice must be based on criteria of safety, legality, and effectiveness. There are several risks that some of these products can trigger, this being a reason for fraud to the consumer. By way of example, the presence of a legal substance in doses higher than its recommendation may cause unwanted side effects; on the other hand, its presence in quantities lower than necessary (effective threshold) may not have the effect expected or announced by the product. Therefore, the objective of this review was to describe the existence of fraud in relation to nutritional labeling and/or to the content of NSs intended for athletes. A narrative review was conducted through PubMed in which 16 studies met the inclusion criteria. The results show that nutritional labeling differs from the actual amounts of ingredients. This type of fraud has been found in protein powder supplements, pre-workout mixtures, creatine, and beverages containing vitamins and minerals, among others. Fraud due to errors in the labeling by omission of substances present in the product or by errors in the analysis or declaration of quantities, is high. This lack of transparency in the actual composition of labels can contribute to sports performance and/or health problems in the athlete. Therefore, an improvement of the legislation on NS is necessary to ensure their safety, effectiveness, and legality.

Dietary Nitrate Supplementation and Exercise-Related Performance

Over the last decade, there has been a growing interest in the utility of nitrate (NO3^-) supplementation to improve exercise-related performance. After consumption, dietary NO3^- can be reduced to nitric oxide, a free radical gas involved in numerous physiological actions including blood vessel vasodilation, mitochondrial respiration, and skeletal muscle contractile function. Emerging evidence indicates that dietary NO3^- supplementation has a small but nevertheless significant beneficial effect on endurance performance through the combined effects of enhanced tissue oxygenation and metabolic efficiency in active skeletal muscle. There is further evidence to suggest that dietary NO3^- exerts a direct influence on contractile mechanisms within the skeletal muscle through alterations in calcium availability and sensitivity. Response heterogeneity and sizeable variability in the nitrate content of beetroot juice products influence the effectiveness of dietary NO3^- for exercise performance, and so dosing and product quality, as well as training history, sex, and individual-specific characteristics, should be considered.

Effectiveness of beetroot juice derived nitrates supplementation on fatigue resistance during repeated-sprints: a systematic review

In recent decades, the search for non-doping substances that enhance sports performance has increased. Ergogenic aids such as beetroot juice (BRJ) and BRJ rich in nitrates (NO₃^-) are widely used to cause physiological benefits that may lead to physical improvements. Therefore, the purpose of this systematic review was to explore the knowledge reported to date on the NO₃^- derived from BRJ intake effect on fatigue resistance during repeated sprints. A digital search was conducted following systematic review guidelines, and 18 studies met inclusion criteria from a total of 209 articles. In a third of the selected studies, the consumption of beet juice rich in NO₃^- contributes to an increase in nitrites in plasma that led to the rise in peak power, mean power, number of sprint repetitions, total work and time to task failure, and causes a decrease in fatigue index and sprints times. Some different dose has been proposed for both chronic and acute protocols. It seems that a chronic intake of ∼5-6 mmol of NO₃^- in 70 ml of BRJ, twice a day, for a minimum of 3-6 days could lead to a fatigue resistance improvement during repeated sprints. Besides, acute intake of NO₃^- 2.5-3 h before physical exertion or a dose of 250 ml/d to 500 ml/d of BRJ could lead to similar effective results. This systematic review presents some improvements (1.2-5.38%) in fatigue resistance during repeated sprints when consuming BRJ derived NO₃^-. The in-field practical meaning of these results should be explored.

Acute Effects of Beetroot Juice Supplements on Resistance Training: A Randomized Double-Blind Crossover

The ingestion of beetroot juice (BJ) has been associated with improvements in physical performance in endurance sports, however the literature on resistance training (RT) is scarce. The aim of this study was to investigate the acute effects of BJ compared to a placebo (PLA) on muscular endurance and movement concentric velocity during RT. Twelve healthy men performed an incremental RT test (back squat and bench press) with three sets, at 60%, 70%, and 80% of their repetition maximum (1-RM). Movement velocity variables, total number of repetitions performed until concentric failure, blood lactate, and ratings of perceived effort post-training were measured. A higher number of repetitions were recorded with BJ compared to those with PLA (13.8 ± 14.4; p < 0.01; effect size (ES) = 0.6). Differences were found at 60% 1-RM (9 ± 10; p < 0.05; ES = 0.61) and 70% 1-RM (3.1 ± 4.8; p < 0.05; ES = 0.49), however, no differences were found at 80% 1-RM (1.7 ± 1; p = 0.12; ES = 0.41). A greater number of repetitions was performed in back squat (13.4 ± 13; p < 0.01; ES = 0.77), but no differences were observed in bench press (0.4 ± 5.1; p = 0.785; ES = 0.03). No differences were found for the rest of the variables (p > 0.05). Acute supplementation of BJ improved muscular endurance performance in RT.

Acute Ingestion of A Novel Nitrate-Rich Dietary Supplement Significantly Increases Plasma Nitrate/Nitrite in Physically Active Men and Women

Background: Dietary supplements purported to increase circulating nitric oxide are very popular among consumers. We determined the acute impact of two novel dietary supplements on plasma nitrate/nitrite (NOx) and nitrite alone. Methods: 20 men and women (age: 24 ± 5 years) ingested two different nitrate-rich supplements (Resync Recovery Blend at 7.5 g and 15 g; Resync Collagen Blend at 21 g), or placebo, on four different days. Fasting blood samples were obtained before and 75 min following ingestion and analyzed for NOx and nitrite. Results: Nitrite was not differently impacted by treatment (p > 0.05). The NOx response for men and women was very similar, with no sex interactions noted (p > 0.05). Condition (p < 0.0001), time (p < 0.0001), and condition x time (p < 0.0001) effects were noted for NOx. Values increased from baseline to post-ingestion for the Resync Recovery Blend at 7.5 g (11 ± 9 to 101 ± 48 µM) and at 15 g (9 ± 5 to 176 ± 91 µM), as well as for the Resync Collagen Blend (9 ± 9 to 46 ± 21 µM), while values for placebo remained stable (9 ± 7 to 8 ± 5 µM). Conclusion: While nitrite alone was not impacted by treatment, both Resync products result in an increase in plasma NOx, with the increase proportionate to the quantity of “nitric oxide blend” ingredients contained within each product. Future studies are needed to determine the physiological implications of the increased NOx, as pertaining to exercise performance and recovery, in addition to other aspects of human health.

Physiological Effects of Beetroot in Athletes and Patients

Dietary supplementation with beetroot juice (BRJ), a naturally rich source of nitrate, is an area of considerable interest to elite athletes as well as recreational exercisers. Nitrate and nitrite have previously been thought of as mainly final elimination products of nitric oxide (NO), but this view has been challenged and evidence indicates that these compounds can be converted to NO in vivo. We conducted a narrative review summarizing the literature regarding evidence of beetroot used as dietary supplement and its effects on training physiology and athletic performance in healthy and diseased populations. The databases PubMed and Web of Science were used to obtain articles. It was evident that BRJ supplementation had an effect on oxygen cost and consumption during exercise by more efficient adenosine triphosphate (ATP) production in combination with lower ATP consumption. However, the effect seems to be dependent on dose and duration. Effect on exercise performance is conflicting, time to exhaustion seems to increase but its effect on time-trial performance needs further elucidation. Ergogenic benefits might depend on individual aerobic fitness level, where individuals with lower fitness level may gain higher benefits regarding athletic performance. Dietary nitrate supplementation appears to have some effect on training performance in patients with peripheral artery disease, heart failure, and chronic pulmonary obstructive disease. However, larger randomized controlled trials are necessary to determine the overall utility of beetroot as a dietary supplement.