From the Guidelines
Nitric oxide boosters, such as L-arginine and L-citrulline, can be effective in improving blood flow and exercise performance, but their use should be approached with caution and consideration of individual patient needs and health status, as evidenced by studies such as 1 and 1.
Key Considerations
- L-arginine and L-citrulline are amino acids that serve as precursors to nitric oxide production, with potential benefits for cardiovascular health and exercise performance, as suggested by 1.
- Beetroot juice or powder, containing approximately 250-500mg of nitrates daily, is another effective option for boosting nitric oxide levels, best consumed 2-3 hours before exercise for peak benefits.
- Foods rich in nitrates like beets, spinach, arugula, and celery can naturally boost nitric oxide levels when consumed regularly.
- Antioxidant-rich foods such as berries, dark chocolate, and green tea help preserve nitric oxide in the body.
- Regular exercise, which naturally stimulates nitric oxide production through increased blood flow to muscles, should be combined with these supplements for best results.
Evidence-Based Recommendations
- The use of nitrates in patients with heart failure with preserved ejection fraction (HFpEF) does not appear beneficial, as shown in the NEAT-HFpEF trial 1 and the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
- Phosphodiesterase-5 inhibition, which augments the nitric oxide system, did not show improvement in oxygen consumption or exercise tolerance in the RELAX trial 1.
- Patients with HFpEF and symptomatic coronary artery disease (CAD) may still receive symptomatic relief with nitrates, as noted in 1.
Clinical Implications
- The decision to use nitric oxide boosters should be made on a case-by-case basis, considering the individual patient's health status, medical history, and potential interactions with other medications.
- Healthcare providers should carefully monitor patients using nitric oxide boosters, particularly those with underlying medical conditions or taking medications that may interact with these supplements.
- Further research is needed to fully understand the effects of nitric oxide boosters on cardiovascular health and exercise performance, as well as their potential risks and benefits in different patient populations.
From the Research
Nitric Oxide Booster
- Nitric oxide boosters, such as beetroot juice, have been shown to have various health benefits, including improving cardiovascular function and exercise performance 2, 3, 4, 5, 6.
- The consumption of beetroot juice, which is rich in nitrates, can increase plasma nitrite concentrations and reduce blood pressure, particularly in older adults 3.
- Nitric oxide has a vasodilatory effect, which reduces blood pressure and increases oxygen- and nutrient delivery to various organs, indicating its potential applications in prevention and treatment of cardiovascular disease 2.
- Beetroot juice supplementation has also been shown to improve muscle speed and power in older individuals, although it may not reduce blood pressure or oxidative stress in this population 5.
- Dietary nitrates, found in vegetables such as beetroot, play a crucial function in human physiology, and their conversion to nitric oxide is associated with many physiological processes, including immune modulation, neurotransmission, and vasodilation 6.
Potential Health Risks
- While beetroot juice consumption has several benefits, there may also be potential health risks, such as increasing nitrate intake above the acceptable daily intake, which can stimulate the endogenous formation of N-nitroso compounds, a class of compounds known to be carcinogenic 2.
- The amount of data and literature on the negative effects of beetroot juice consumption is limited, and further research is needed to perform a balanced risk assessment 2.
Age-Related Effects
- Older adults may experience greater benefits from nitrate-rich beetroot juice supplementation, including increased plasma nitrite concentrations and reduced diastolic blood pressure, compared to younger adults 3.
- Short-term beetroot juice supplementation has been shown to improve muscle speed and power in older individuals, with similar improvements observed after acute and short-term supplementation 5.