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Lower blood pressure and more flexible arteries
There is a growing body of evidence suggesting that dietary nitrate may have a protective role in health, in particular vascular health, and in particular by lowering blood pressure.
Coronary heart disease (CHD), stroke, and heart failure are three of the leading causes of death globally. Cardiovascular Diseases (CVDs) are responsible for a significant (typically about 25%) of premature deaths, and the risk substantially increases with age.
For such a major public health problem, it is perhaps surprising that by simply improved our diet quality - by eating more vegetables - we can substantially reduce the risk of dying early.
For example, in a study of vegetable intake in Japan, China, and Hong Kong, confirmed the benefits. The study found dietary exposure to nitrate from raw vegetables was found to be up to 350% the average recommended daily intake (for high-vegetable consumers). Leafy greens, including spinach, bok choy, and Chinese cabbage, were associated with lower systolic and diastolic blood pressure.
Japanese meal patterns rely on a wide variety of vegetables, and it is believed that dietary nitrate may in part be responsible for the lower rates of cardiovascular disease in Japan.
More than just lower blood pressure
The cardioprotective effects of vegetable consumption within the context of cultural dietary patterns are also evident in the Mediterranean diet. In particular, rich sources include green leafy vegetables, beetroot, and celery, as nitrate tends to accumulate in the leaves, stems, and roots of plants.
The benefits are broader than just lower blood pressure.
A systematic review and meta-analysis investigating the short term effects of inorganic/dietary nitrate and CVD risk factors was recently published. The study found that inorganic/dietary nitrate intakes can significantly reduce arterial stiffness and reduce platelet aggregation (meaning a lower risk of stroke).
Why has it taken so long?
These benefits of dietary nitrate have only (relatively) recently come to light - within the last 20 years.
Traditionally, dietary nitrate has been considered to be biologically unnecessary or a potentially harmful component of the food and water supply. As a result, it is strictly regulated and is often not included as part of National food composition tables (as in Australia).
People are more likely to associate nitrates with carcinogenic properties than beneficial health outcomes. That's understandable as it can be confusing, and the fear of cancer is more likely to motivate people than living longer better.
There is a difference between nitrates and nitrites. A high intake of processed meats may increase the risk of cancer in the digestive tract.
On the other hand, nitrates and nitrites also occur naturally in vegetables, which may reduce the risk for some types of cancer and other diseases.
It's confusing - nitrites versus nitrates
No wonder people are confused.
The simple explanation is that Vitamin C and flavonoids, found in a wide variety of fruits and vegetables, inhibit the formation of the "bad nitrites", whereas heme iron, found primarily in red meat, enhances their production.
Therefore, the benefits of fruit and vegetable consumption, owing to their content of flavonoids and other nutrients may therefore mitigate the potentially harmful effects of the nitrites associated with processed and red meats.
In fact, epidemiological studies have shown high nitrate ingestion primarily from vegetables reduced the risk of gastric cancer. In contrast, other studies of nitrate and nitrite ingestion from processed meats found an increased risk.
Our body also produces nitrates and secretes them into saliva. This discovery was the major finding of the last 20 years, which changed our understanding of how nitrates are beneficial for health. Nitrates and nitrites circulate from the digestive system into the blood, then into saliva, and back into the digestive system.
This internal metabolism is the main natural pathway for our production of nitric oxide (NO) and the now ubiquitous promotion of beetroot juice as a potential feedstock for this process.
Although beetroot juice is promoted as a single source boost to raise NO levels in our system, the evidence is that dietary nitrate intakes produce more significant bioactive effects when consumed within the context of a healthy diet.
A diet rich in antioxidants and polyphenols enhances the potency and bioactivity of dietary nitrate. Some studies even found that dietary nitrates can help kill bacteria, such as Salmonella.
Your parents were right - eat your veggies, more of them
Vegetables are our the primary source of dietary nitrate, generally contributing about 80% of our total daily intake in western cultures.
The primary sources are all readily obtainable, and inexpensive:
Processed meats contributed very little to total dietary nitrate intakes, along with alcohol and dairy foods.
Processed beetroot juice may be beneficial, but it is expensive and will not make up for the deficiencies of an unhealthy diet.
The first step to boosting the cardiovascular benefits of nitrates is to eat more vegetables. The second - optional step - is to drink supplements.
While we may not fully understand the role of nitrates, we do know that eating a healthy mix of vegetables, and more vegetables is going to help us live better longer.
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