A Narrative Review on Dietary Strategies to Provide Nitric Oxide as a Non-Drug Cardiovascular Disease Therapy: Beetroot Formulations—A Smart Nutritional Intervention

Abstract

Beetroot is a remarkable vegetable, as its rich nitrate and bioactive compound contents ameliorate cardiovascular and metabolic functions by boosting nitric oxide synthesis and regulating gene expressions or modulating proteins and enzyme activities involved in these cellular processes. Dietary nitrate provides a physiological substrate for nitric oxide production, which promotes vasodilatation, increases blood flow and lowers blood pressure. A brief narrative and critical review on dietary nitrate intake effects are addressed herein by considering vegetable sources, dosage, intervention regimen and cardioprotective effects achieved in both healthy and cardiovascular-susceptible individuals. Compared to other nitrate-rich vegetables, beets were proven to be the best choice for non-drug therapy because of their sensorial characteristics and easy formulations that facilitate patient adherence for long periods, allied to bioaccessibility and consequent effectiveness. Beets were shown to be effective in raising nitrate and nitrite in biological fluids at levels capable of promoting sustained improvement in primary and advanced hemodynamic parameters.

Urinary Nitric Oxide Levels Are Associated with Blood Pressure, Fruit and Vegetable Intake and Total Polyphenol Excretion in Adolescents from the SI! Program

“…In the same line, plasma nitrate/nitrite levels increased significantly in overweight or obese adolescents after 1 h of intake and after a week of daily intake of 50 g of freeze-dried strawberry powder [ 44 ]. Likewise, a reduction in BP and an increase of NO were observed after the consumption of beetroot, spinach, or rocket leaf [ 2 , 8 ], all good sources of nitrates and nitrites, like many other fruits and vegetables [ 8 , 45 , 46 ]. Conflicting results were found in studies with postmenopausal women, or adults with prehypertension or hypertension, in which a daily intake of 150–400 mg nitrate over periods ranging from 10 days to 12 weeks increased NO (measured by nitrate in urine or plasma) but did not reduce SBP or DBP [ 47 , 48 , 49 , 50 ].…”

“…As a consequence, a diet rich in fruits and vegetables could result in an increase of nitrate, nitrite, and antioxidant, which could contribute to improve cardiovascular health [7,11,12]. Some studies have evaluated the relationship between NO and nitrate intake in adult populations, showing a reduction in blood pressure after a dose of nitrate whether in concentrated solutions or in the form of vegetable-based products [2,8]. However, scarce studies have examined the association between a healthy diet (i.e., fruit and vegetable intake) and urinary NO.…”

“…In fact, approximately 80% of nitrate intake comes from vegetables, mainly beets and green leaves such as raw spinach, rucola, celery, etc. [ 5 , 7 , 8 ], and the best sources found in fruits include melon, strawberries, and banana [ 7 ].…”

“…Some studies have evaluated the relationship between NO and nitrate intake in adult populations, showing a reduction in blood pressure after a dose of nitrate whether in concentrated solutions or in the form of vegetable-based products [ 2 , 8 ]. However, scarce studies have examined the association between a healthy diet (i.e., fruit and vegetable intake) and urinary NO.…”

Nitrites in Cured Meats, Health Risk Issues, Alternatives to Nitrites: A Review

“…Since the middle of the 1980s, research has shown that nitrite is a major chemical with substantial impacts on human health. Vegetables are a great source of dietary nitrates, and they have been proven to be an important source of endogenous nitrite as well as nitric oxide (NO) in the human body [ 14 ]. Nitric oxide (NO), produced through enzymatic synthesis, regulates blood pressure, wound healing, immunological response and neurological processes in the human body [ 15 ].…”