The nitrate-nitrite-nitric oxide pathway: Its role in human exercise physiology

Malate or Not? Acute Effects of L-Citrulline Versus Citrulline Malate on Neuromuscular Performance in Young, Trained Adults: A Randomized, Double-Blind, Placebo-Controlled Crossover Trial

L-citrulline (CIT) supplementation seems to improve resistance training performance; yet, whether malate has additive ergogenic effects when combined with CIT is unknown. This randomized, double-blind, placebo-controlled crossover trial aimed to compare the acute effects of CIT versus citrulline malate (CMA) supplementation on neuromuscular performance and exertion and emotional perceptions in young, trained men and women. 43 (21 women; 24.2 ± 3.7 years) participants ingested a placebo, CIT (5.3 g of CIT), or CMA (5.3 g of CIT, 2.7 g of malate) 45 min before three experimental sessions in a counterbalanced manner. We evaluated the upper and lower limb maximal neuromuscular and ballistic performance through the two-point method and countermovement jump. Strength-endurance was assessed across three sets of 10 repetitions in the squat and bench press exercises. Exertion and emotional perceptions were evaluated before and after the assessment and during the strength-endurance assessment. CIT and CMA supplementation did not enhance maximal neuromuscular performance (all p ≥ .061, ηp2≤.066), or ballistic strength (all p ≥ .348, ηp2≤.025). Neither CIT nor CMA supplementation improved strength-endurance as observed in the total number of repetitions (all p ≥ .590, ηp2≤.013), repetitions before reaching velocity loss threshold (all p ≥ .623, ηp2≤.010), mean velocity (all p ≥ .792, ηp2≤.004), mean velocity decline (all p ≥ .293, ηp2≤.029), and mean velocity maintenance (all p ≥ .393 ηp2≤.022), or exertion and emotional perceptions (both p ≥ .306, ηp2≤.028). In conclusion, CIT and CMA supplementation may not increase the neuromuscular performance during low- to moderate-volume resistance training sessions in young, trained adults. This trial was registered at ClinicalTrials.gov (No. NCT05183893).

Overview of mechanisms related to citrulline malate supplementation and different methods of high-intensity interval training on sports performance: A narrative review

Regular exercise is a practical non-pharmacological approach to maintaining physical and mental health through rehabilitation and prevention of chronic diseases due to its cardiovascular, cardiorespiratory, neurological, and neuromuscular benefits. Despite awareness of the benefits of exercise, a "lack of time" has proven to be the most common impediment to regular activity. Thus, a time-efficient and potentially enjoyable training modality with growing popularity is high-intensity interval training (HIIT). HIIT incorporates intermittent bouts of work and recovery intervals performed at an intensity close to maximal oxygen consumption (VO2max). HIIT is considered to have equivalent or superior benefits compared to moderate-intensity continuous training (MICT). This narrative review focuses on the mechanisms of Citrulline Malate (CM) supplementation and various modes of HIIT on exercise performance. CM serves as a nitric-oxide enhancer leading to improved aerobic and anaerobic exercise performance by increasing muscle adenosine triphosphate (ATP) production, vasodilation, and blood flow to the active musculature and boosting work capacity. This article reviews the mechanisms related to CM supplementation and different modes of HIIT on exercise performance. Even though a single, acute 8 g dose of CM has been recommended, its mechanism of action remains to be seen due to the synergistic impact of both components (citrulline and malate). Moreover, the limited evidence for the standard level of supplement use and source of purchase results in athletes' self-prescription of supplements. Therefore, to reduce the risk of accidental doping or toxicity, further studies should continue to investigate the optimal dose, timing, mechanism of action, as well as reliable sources of purchase for CM consumption.

Muscle Oxygen Saturation Dynamics During Upper-Body Resistance Exercise

Research examining the changes in muscle oxygen saturation across multiple sets of resistance exercise is limited. The purpose of this study was to describe the physiological response of muscle oxygenation parameters during upper-body resistance exercise and examine the differential effects of relevant participant characteristics on resistance training performance and muscle oxygen saturation dynamics. Sixty-one recreationally trained men (n = 44; 21.8 ± 2.6 years) and women (n = 17; 20.2 ± 1.8 years) completed five-repetition maximum sets of barbell bench presses at a load equal to 75% 1-RM with a 2 min rest interval. Muscle oxygen saturation (SmO2) dynamics within the anterior deltoid were monitored using a portable near-infrared spectroscopy sensor. The percent change in SmO2 (∆%SmO2), the muscle oxygen re-saturation rate (SmO2RecSlope), and the highest measured SmO2 value during recovery periods (SmO2Peak) were measured. Two-way (sex [men, women] x time [sets 1-5]) repeated measures analyses of variance (ANOVA) were performed on muscle saturation variables. To examine the effect of relevant controlling variables, separate analyses of covariance (ANCOVA) with repeated measures were also performed. No differences were seen with ∆%SmO2 across sets. The main effects for sets occurred for SmO2RecSlope, whereby a decline was noted on sets 4 and 5 (p = 0.001) compared to set 1. Additionally, SmO2Peak was the lowest on set 5 (p < 0.001) compared to all other sets. Moreover, body mass (p = 0.013), diastolic blood pressure (p = 0.044), and mean arterial pressure (p = 0.033) for ∆%SmO2 were the only significant covariates noted amongst the muscle oxygenation variables. In conclusion, no sex differences and only a few set differences in muscle oxygen saturation dynamics were seen without employing any covariates. Body mass, diastolic blood pressure, and mean arterial pressure were identified as factors that could influence observed responses.

Effects of Supplementation with Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Antioxidant Vitamins, Combined with High-Intensity Functional Training, on Exercise Performance and Body Composition: A Randomized, Double-Blind, Placebo-Controlled Trial

The aim of this study was to investigate the effects of a supplement rich in ω-3 and ω-6 polyunsaturated fatty acids (PUFAs) and antioxidant vitamins on physical performance and body composition following a period of high-intensity functional training (HIFT). Nineteen healthy young adults (nine males, ten females) underwent an 8-week HIFT program (3 days·week-1) where they were randomized 1:1 into either the supplement group (SG)-n = 10, receiving a 20 mL daily dose of a dietary cocktail formula (Neuroaspis™ PLP10) containing a mixture of ω-3 and ω-6 PUFAs (12,150 mg), vitamin A (0.6 mg), vitamin E (22 mg), and γ-tocopherol (760 mg)-or the placebo group (PG)-n = 9, receiving a 20 mL daily dose of virgin olive oil. Body composition, cardiorespiratory fitness, muscle strength, and muscle endurance were assessed before and after the training period. Body mass did not change, but muscle mass increased by 1.7 ± 1.9% or 0.40 ± 0.53 kg in the SG (p = 0.021) and decreased by 1.2 ± 1.6% or 0.28 ± 0.43 kg (p = 0.097) in the PG, compared with baseline. VO2max, vertical jump, squat 1RM, bench press 1RM, and muscle endurance increased similarly in both groups. The effects of HIFT on physical performance parameters, muscle damage, and inflammation indices were not affected by the supplementation. In conclusion, HIFT combined with high doses of ω-3 and ω-6 PUFAs and antioxidant vitamins resulted in a small but significant increase in muscle mass and fat reduction compared with HIFT alone.

n-3 Polyunsaturated Fatty Acids Are Associated with Stable Nitric Oxide Metabolites in Highly Trained Athletes

BACKGROUND

The aim of this study was to investigate the relationships between levels of n-3 essential polyunsaturated fatty acids (n-3 PUFAs) and stable nitric oxide (NO) metabolites in the plasma of athletes.

METHODS

Highly trained cross-country skiers (males, n = 39) were examined. The fatty acid profile of the total plasma lipids was determined by gas chromatography. The plasma NO level was studied by a colorimetric method via reaction with Griess reagent.

RESULTS

A widespread deficiency of essential n-3 PUFAs in the plasma of athletes (more than 80% of the subjects) was demonstrated in association with an imbalance in the levels of nitrates (NO3) and nitrites (NO2). A lower value of n-3 linolenic acid in the plasma (0.21 mol/%) was associated with a NO3 level below the normal range (n-3 C18:3 and NO3 Rs = 0.461; p = 0.003). Higher levels of n-3 eicosapentaenoic acid (0.8 mol/%) were associated with a concentration of NO2 above the normal value (n-3 C20:5 and NO2 Rs = 0.449; p = 0.004).

CONCLUSION

For the first time, the participation of essential n-3 PUFAs in the nitrite-nitrate pathway of NO synthesis in highly trained skiers was demonstrated.

Erythrocyte metabolism

Our aim is to present an updated overview of the erythrocyte metabolism highlighting its richness and complexity. We have manually collected and connected the available biochemical pathways and integrated them into a functional metabolic map. The focus of this map is on the main biochemical pathways consisting of glycolysis, the pentose phosphate pathway, redox metabolism, oxygen metabolism, purine/nucleoside metabolism, and membrane transport. Other recently emerging pathways are also curated, like the methionine salvage pathway, the glyoxalase system, carnitine metabolism, and the lands cycle, as well as remnants of the carboxylic acid metabolism. An additional goal of this review is to present the dynamics of erythrocyte metabolism, providing key numbers used to perform basic quantitative analyses. By synthesizing experimental and computational data, we conclude that glycolysis, pentose phosphate pathway, and redox metabolism are the foundations of erythrocyte metabolism. Additionally, the erythrocyte can sense oxygen levels and oxidative stress adjusting its mechanics, metabolism, and function. In conclusion, fine-tuning of erythrocyte metabolism controls one of the most important biological processes, that is, oxygen loading, transport, and delivery.

A review on nitrates' health benefits and disease prevention

Dietary nitrates (NO3-) are naturally occurring compounds in various vegetables, especially beetroot, which is mainly supplemented in the form of BRJ. Dietary nitrates (NO3-) play a crucial function in human physiology. On consumption, nitrates (NO3-) undergo a conversion process, producing nitric oxide (NO) via a complex metabolic pathway. Nitric oxide (NO) is associated with many physiological processes, entailing immune modulation, neurotransmission, and vasodilation, enabling blood vessel dilation and relaxation, which boosts blood flow and oxygen delivery to tissues, positively influencing cardiovascular health, exercise performance, and cognitive function. There are various analytical processes to determine the level of nitrate (NO3-) present in dietary sources. The impact of dietary nitrates (NO3-) can differ among individuals. Thus, the review revisits the dietary source of nitrates (NO3-), its metabolism, absorption, excretion, analytical techniques to assess nitrates (NO3-) content in various dietary sources, and discusses health effects.

Effects of citrulline on endurance performance in young healthy adults: a systematic review and meta-analysis

BACKGROUND

Citrulline is a popular dietary supplement, primarily thought to exert ergogenic effects on exercise performance through the enhancement of nitric oxide (NO) synthesis and ammonia buffering. However, recent findings surrounding citrulline's effect on endurance performance have been inconsistent. A systematic review and meta-analysis of the relevant literature have yet to be undertaken.

AIM

To determine if acute ingestion of citrulline has an ergogenic effect on endurance performance in young healthy adults.

METHODS

A systematic search of three databases was undertaken to find peer-reviewed randomized controlled trials (RCTs) published in English investigating the effects of citrulline supplementation on endurance performance in young healthy adults. Two independent investigators completed a three-phased screening procedure against pre-determined eligibility criteria. Included studies evaluated loading or bolus dosage regimes of citrulline in participants aged 18 or over that were at least recreationally active. Outcome measures focused on time-to-completion (TTC) or time-to-exhaustion (TTE) in continuous submaximal intensity exercise. Cochrane's Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in individual studies. Meta-analysis was conducted using a fixed-effects model to pool the weighted estimate of standardized mean differences (SMD) across studies. A chi-squared test assessed heterogeneity between studies. This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Nine studies (n = 158 participants) met the eligibility criteria; five reported TTE outcomes (I² = 0%, χ² = 0.37, df = 4, P = 0.99) and four reported TTC outcomes (I² = 0%, χ² = 0.46, df = 3, P = 0.93), both with a low between-study heterogeneity. The results of the meta-analyses showed no significant difference in the endurance performance measures, TTE (pooled SMD = 0.03 [-0.27, 0.33]) and TTC (pooled SMD = -0.07 [-0.50, 0.15]), after acute ingestion of citrulline supplementation or a control in young healthy adults.

DISCUSSION

The current evidence suggests no significant benefit of citrulline supplementation for endurance performance. However, the small evidence base requires further research to fully evaluate this topic. Recommendations include a focus on female populations; higher continuous doses of citrulline over seven days; and TTC outcome measures over longer distances to simulate competition.

The effects of L-Citrulline and Glutathione on Endurance performance in young adult trained males

BACKGROUND

Citrulline may amplify the effects of L-arginine and nitric oxide concentration, which may augment vasodilation and blood flow, thereby enhancing aerobic exercise performance. The purpose of this randomized, double-blind, placebo-controlled crossover study was to investigate effects of L-citrulline + Glutathione on aerobic exercise performance and blood flow in well-trained men.

METHODS

Twenty-five males (Mean ± SD; Age: 22.2 ± 2.4 yrs; Height: 177.0 ± 4.8 cm; Weight: 75.3 ± 6.9 kg) were randomly assigned to the L-citrulline + Glutathione (Setria Performance Blend: SPB; L-citrulline [2 g] + glutathione [200 mg], 6 capsules) or placebo (PL; 3.1 g cellulose, 6 capsules) group. Participants performed a maximal oxygen consumption treadmill test to determine peak velocity (PV) and returned after eight days of ingesting either PL or SPB. Three timed treadmill runs to exhaustion (TTE) were performed at 90%, 100%, and 110% PV. Brachial artery blood flow and vessel diameter were assessed using ultrasound at 1-hr prior to exercise (1hrPrEX), after each exercise bout, immediately post-exercise (immediate PEX), and 30 minutes post exercise (30minPEX) at visits 2 and 4. Blood analytes were assessed via venous blood draws at visit 1, visit 3, and 1hrPEX, immediate PEX, and 30minPEX at visits 2 and 4. After a 14-day washout, participants repeated the same procedures, ingesting the opposite treatment. Separate repeated measures ANOVAs were performed for TTE, vessel diameter, blood flow, and blood analytes.

RESULTS

Blood flow was significantly augmented 30minPEX (p = 0.04) with SPB in comparison with PL. L-citrulline and L-arginine plasma concentrations were significantly elevated immediately PEX (p = 0.001) and 30-minPEX (p = 0.001) following SPB in comparison to PL.

CONCLUSION

Acute ingestion of SPB after eight days may enhance blood flow, L-citrulline, and L-arginine plasma concentrations after high-intensity exercise, which may enhance performance.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/ct2/show/nct04090138], identifier [NCT04090138].

A synergistic blend of Garcinia mangostana fruit rind and Cinnamomum tamala leaf extracts enhances myogenic differentiation and mitochondrial biogenesis in vitro and muscle growth and strength in mice

Background

A proprietary combination of Garcinia mangostana fruit rind and Cinnamomum tamala leaf extracts (LI80020F4, CinDura®) improved the physical performance and muscle strength of resistance-trained adult males.

Objective

This study assessed the underlying mechanisms of the ergogenic potential of LI80020F4 in in vitro and in vivo models.

Methods

The individual extracts and their combination (LI80020F4) were assessed for nitrite production in EAhy926 human endothelial cells. Subsequent experiments evaluated the effect of LI80020F4 in myotube formation in C2C12 mouse myoblasts, expression of mammalian target of rapamycin (mTOR) signaling proteins, myogenic factors, and mitochondrial functions in L6 rat myoblasts.Moreover, adult male ICR mice were randomly assigned (n = 15) into vehicle control (G1), exercise alone (G2), oxymetholone-16 mg/kg body weight (bw) (G3), and 75 (G4)-, 150 (G5)-, or 300 (G6) mg/kg bw of LI80020F4, orally gavaged for 28 days. G1 and G2 mice received 0.5% carboxymethylcellulose sodium. Following completion, muscle strength and physical performance were assessed on forelimb grip strength and forced swimming test (FST), respectively. Gastrocnemius (GA), tibialis anterior (TA) muscle weights, muscle fiber cross-sectional area (CSA), levels of muscle, and serum protein markers were also determined.

Results

LI80020F4 increased nitrite production in EAhy926 cells in a dose-dependent manner. LI80020F4 induced C2C12 myotube formation, increased mitochondrial biogenesis, upregulated the expressions of activated mTOR and other mitochondria and myogenic proteins, and mitigated H2O2-induced mitochondrial membrane depolarization in the myoblast cells. In the animal study, 75, 150, and 300 mg/kg bw LI80020F4 doses significantly (P < 0.05) increased the animals' forelimb grip strength. Mid- and high-dose groups showed increased swimming time, increased muscle weight, CSA, muscle growth-related, and mitochondrial protein expressions in the GA muscles.

Conclusion

LI80020F4 increases nitric oxide production in the endothelial cells, mitochondrial biogenesis and function, upregulates skeletal muscle growth-related protein expressions and reduces oxidative stress; together, it explains the basis of the ergogenic potential of LI80020F4.

Effects of Dietary Nitrate Supplementation on Performance during Single and Repeated Bouts of Short-Duration High-Intensity Exercise: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Inorganic nitrate (NO₃^-) has emerged as a potential ergogenic aid over the last couple of decades. While recent systematic reviews and meta-analyses have suggested some small positive effects of NO₃^- supplementation on performance across a range of exercise tasks, the effect of NO₃^- supplementation on performance during single and repeated bouts of short-duration, high-intensity exercise is unclear. This review was conducted following PRISMA guidelines. MEDLINE and SPORTDiscus were searched from inception to January 2023. A paired analysis model for cross-over trials was incorporated to perform a random effects meta-analysis for each performance outcome and to generate standardized mean differences (SMD) between the NO₃^- and placebo supplementation conditions. The systematic review and meta-analysis included 27 and 23 studies, respectively. Time to reach peak power (SMD: 0.75, p = 0.02), mean power output (SMD: 0.20, p = 0.02), and total distance covered in the Yo-Yo intermittent recovery level 1 test (SMD: 0.17, p < 0.0001) were all improved after NO₃^- supplementation. Dietary NO₃^- supplementation had small positive effects on some performance outcomes during single and repeated bouts of high-intensity exercise. Therefore, athletes competing in sports requiring single or repeated bouts of high-intensity exercise may benefit from NO₃^- supplementation.

The Effect of Acute Pre-Workout Supplement Ingestion on Basketball-Specific Performance of Well-Trained Athletes

A pre-workout supplement's (PWS; 200 mg caffeine, 3.3 g creatine monohydrate, 3.2 g β-alanine, 6 g citrulline malate and 5 g branched chained amino acid (BCAA) per dose) acute effects on the alactic (jumping, sprinting, agility), lactic (Running-Based Anaerobic Sprint Test, RAST) and aerobic performance (Yo-Yo Intermittent Recovery Test Level 1, Yo-Yo IRL1 VO_2max) of well-trained basketball players was investigated in this double-blind placebo-controlled study. Thirty players (age 18-31 years, height 166-195 cm, weight 70.2-116.7 kg, body fat 10.6-26.4%) were allocated to pre-workout (PWS, n = 15) or placebo (PL, n = 15) groups. Half of the participants in each group performed the evaluations without PWS or PL, while the rest consumed PWS or PL 30 min before the assessments (1st trial) and vice versa (2nd trial). Significant improvements in counter-movement jump (CMJ) (PWS: 4.3 ± 2.1%; PL: 1.2 ± 1.0%), agility (PWS: -2.9 ± 1.8%; PL: 1.8 ± 1.7%), RAST average (PWS: 18.3 ± 9.1%; PL: -2.2 ± 2.0%), minimum power (PWS: 13.7 ± 8.9%; PL: -7.5 ± 5.9%), and fatigue index (PWS: -25.0 ± 0.9%; PL: -4.6 ± 0.6%) were observed in the PWS group vs. the PL group (p < 0.05). No differences were found regarding sprinting, aerobic performance, and blood lactate concentrations. Thus, although players' alactic and lactic anaerobic performance could be improved, peak power, sprinting and aerobic performance are not.

Highly Sensitive Graphene-Based Electrochemical Sensor for Nitrite Assay in Waters

The importance of nitrite ions has long been recognized due to their extensive use in environmental chemistry and public health. The growing use of nitrogen fertilizers and additives containing nitrite in processed food items has increased exposure and, as a result, generated concerns about potential harmful health consequences. This work presents the development of an electrochemical sensor based on graphene/glassy carbon electrode (EGr/GC) with applicability in trace level detection of nitrite in water samples. According to the structural characterization of the exfoliated material, it appears as a mixture of graphene oxide (GO; 21.53%), few-layers graphene (FLG; 73.25%) and multi-layers graphene (MLG; 5.22%) and exhibits remarkable enhanced sensing response towards nitrite compared to the bare electrode (three orders of magnitude higher). The EGr/GC sensor demonstrated a linear range between 3 × 10^-7 and 10^-3 M for square wave voltammetry (SWV) and between 3 × 10^-7 and 4 × 10^-4 M for amperometry (AMP), with a low limit of detection LOD (9.9 × 10^-8 M). Excellent operational stability, repeatability and interference-capability were displayed by the modified electrode. Furthermore, the practical applicability of the sensor was tested in commercially available waters with excellent results.

Supplementation with Nitric Oxide Precursors for Strength Performance: A Review of the Current Literature

Nitric-oxide-stimulating dietary supplements are widely available and marketed to strength athletes and weightlifters seeking to increase muscle performance and augment training adaptations. These supplements contain ingredients classified as nitric oxide (NO) precursors (i.e., "NO boosters"). Endogenous NO is generated via a nitric oxide synthase (NOS)-dependent pathway and a NOS-independent pathway that rely on precursors including L-arginine and nitrates, with L-citrulline serving as an effective precursor of L-arginine. Nitric oxide plays a critical role in endothelial function, promoting relaxation of vascular smooth muscle and subsequent dilation which may favorably impact blood flow and augment mechanisms contributing to skeletal muscle performance, hypertrophy, and strength adaptations. The aim of this review is to describe the NO production pathways and summarize the current literature on the effects of supplementation with NO precursors for strength and power performance. The information will allow for an informed decision when considering the use of L-arginine, L-citrulline, and nitrates to improve muscular function by increasing NO bioavailability.

Influence of Beetroot Juice Ingestion on Neuromuscular Performance on Semi-Professional Female Rugby Players: A Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE

Beetroot juice (BRJ) is considered an ergogenic aid with good to strong evidence for improving human performance in sport modalities with similar demands to rugby. However, most of the studies were realized in male athletes with limited evidence in female athletes. Thus, the aim of this study was to explore the acute ingestion of BRJ in female rugby players.

METHODS

Fourteen semi-professional female rugby players (25.0 ± 3.7 years) belonging to a team from the First Spanish Female Rugby Division participated in this study. Participants were randomly divided into two groups that realized a neuromuscular battery after BRJ (140mL, 12.8 mmol NO₃^-) or placebo (PLAC, 140 mL, 0.08 mmol NO₃^-) ingestion on two different days separated by one week between protocols. The neuromuscular test battery consisted of a countermovement jump (CMJ), isometric handgrip strength (i.e., dominant), 10-m and 30-m sprint, agility t-test and Bronco test. Afterwards, participants reported a rate of perception scale (6-20 points) and side effects questionnaire associated with BRJ or PLAC ingestion.

RESULTS

Statistically significant improvements were observed in CMJ (7.7%; p = 0.029; ES = 0.62), while no differences were reported in dominant isometric handgrip strength (-1.7%; p = 0.274; ES = -0.20); 10-m and 30-m sprint (0.5-0.8%; p = 0.441-0.588; ES = 0.03-0.18); modified agility t-test (-0.6%; p = 0.503; ES = -0.12) and Bronco test (1.94%; p = 0.459; ES = 0.16).

CONCLUSIONS

BRJ ingestion could improve neuromuscular performance in the CMJ test, while no differences in sprint (10-m and 30-m sprint test), agility, isometric handgrip strength and endurance performance (i.e., Bronco test) were reported.

Consumption of water contaminated by nitrate and its deleterious effects on the human thyroid gland: a review and update

Nowadays, the nitrates have been established as carcinogenic components due to the endogenous formation of N-nitroso compounds, however, the consumption of water contaminated with nitrates has only been strongly related to the presence of methemoglobinemia in infants, as an acute effect, leaving out other side effects that demand attention. The thyroid gland takes relevance because it can be altered by many pollutants known as endocrine disruptors, which are agents capable of interfering with the synthesis of hormones, thus far, it is known that nitrates may disrupt the amount of iodine uptake causing most of the time hypothyroidism and affecting the metabolic functions of the organism in all development stages, resulting in an important health burden for the exposed population. Here, this review and update highlighted the impact of consumption of water contaminated with nitrates and effects on the thyroid gland in humans, concluding that nitrates could act as true endocrine disruptor.

Maternal Dietary Nitrate Supplementation Lowers Incidence of Stillbirth in Hyper Prolific Sows under Commercial Circumstances

The objective of the current experiment was to investigate whether or not maternal dietary nitrate supplementation, a nitric oxide (NO) precursor, could reduce piglet losses under commercial circumstances. In the current experiment, 120 hyper prolific gilts and sows (Landrace x Yorkshire: Danbred) on a commercial farm in Denmark received either a control lactation diet or a lactation diet containing 0.1% of calcium nitrate (containing 63.1% of nitrate) from approximately 5 days pre-farrowing until day 4 of lactation. The number of piglets born total, alive, and stillborn, as well as birth weights, weights after cross-fostering (approximately 1 day of age), 24 h after cross-fostering, day 3 of age, and at weaning was recorded. Placentas of sows were collected after expulsion and scored on redness. No effect of nitrate supplementation was found on piglet weight, piglet growth, placental redness score, and pre-weaning mortality during lactation. Maternal dietary nitrate supplementation decreased stillbirth percentage with 2.5% (9.9 vs. 7.4%; p = 0.05). It can be concluded that maternal dietary nitrate supplementation shows the potential to decrease the incidence of stillbirth in hyper prolific sows.

Potential effect of beetroot juice supplementation on exercise economy in well-trained females

This study examined if acute dietary nitrate supplementation (140 mL beetroot juice, BRJ) would reduce oxygen consumption (V̇O2) during cycling at power outputs of 50 and 70% maximal oxygen consumption in 14 well-trained female Canadian University Ringette League athletes. BRJ had no effect on V̇O2 or heart rate but significantly reduced ratings of perceived exertion (RPE) at both intensities. Individually, 4 participants responded to BRJ supplementation with a ≥3% reduction in V̇O2 at the higher power output. Novelty: Acute BRJ supplementation did not improve exercise economy in well-trained females, but significantly reduced RPE. However, 4/14 subjects did respond with a ≥3% V̇O2 reduction.

Marching to the Beet: The effect of dietary nitrate supplementation on high altitude exercise performance and adaptation during a military trekking expedition

PURPOSE

The aim was to investigate the effect of dietary nitrate supplementation (in the form of beetroot juice, BRJ) for 20 days on salivary nitrite (a potential precursor of bioactive nitric oxide), exercise performance and high altitude (HA) acclimatisation in field conditions (hypobaric hypoxia).

METHODS

This was a single-blinded randomised control study of 22 healthy adult participants (12 men, 10 women, mean age 28 ± 12 years) across a HA military expedition. Participants were randomised pre-ascent to receive two 70 ml dose per day of either BRJ (~12.5 mmol nitrate per day; n = 11) or non-nitrate calorie matched control (n = 11). Participants ingested supplement doses daily, beginning 3 days prior to departure and continued until the highest sleeping altitude (4800 m) reached on day 17 of the expedition. Data were collected at baseline (44 m altitude), at 2350 m (day 9), 3400 m (day 12) and 4800 m (day 17).

RESULTS

BRJ enhanced the salivary levels of nitrite (p = 0.007). There was a significant decrease in peripheral oxygen saturation and there were increases in heart rate, diastolic blood pressure, and rating of perceived exertion with increasing altitude (p=<0.001). Harvard Step Test fitness scores significantly declined at 4800 m in the control group (p = 0.003) compared with baseline. In contrast, there was no decline in fitness scores at 4800 m compared with baseline (p = 0.26) in the BRJ group. Heart rate recovery speed following exercise at 4800 m was significantly prolonged in the control group (p=<0.01) but was unchanged in the BRJ group (p = 0.61). BRJ did not affect the burden of HA illness (p = 1.00).

CONCLUSIONS

BRJ increases salivary nitrite levels and ameliorates the decline in fitness at altitude but does not affect the occurrence of HA illness.

Acute Effect of Citrulline Malate on Repetition Performance During Strength Training: A Systematic Review and Meta-Analysis

Citrulline malate (CitMal) is a dietary supplement that is suggested to enhance strength training performance. However, there is conflicting evidence on this matter. Thus, the purpose of this meta-analysis was to determine whether supplementing with CitMal prior to strength training could increase the total number of repetitions performed before reaching voluntary muscular failure. A systematic search was conducted wherein the inclusion criteria were double-blind, placebo-controlled studies in healthy participants that examined the effect of CitMal on repetitions to failure during upper body and lower body resistance exercises. The Hedges's g standardized mean differences (SMD) between the placebo and CitMal trials were calculated and used in a random effect model. Two separate subanalyses were performed for upper body and lower body exercises. Eight studies, including 137 participants who consisted of strength-trained men (n = 101) and women (n = 26) in addition to untrained men (n = 9), fulfilled the inclusion criteria. Across the studies, 14 single-joint and multijoint exercises were performed with an average of 51 ± 23 total repetitions during 5 ± 3 sets per exercise at ∼70% of one-repetition maximum. Supplementing with 6-8 g of CitMal 40-60 min before exercise increased repetitions by 3 ± 5 (6.4 ± 7.9%) compared with placebo (p = .022) with a small SMD (0.196). The subanalysis for the lower body resulted in a tendency for an effect of the supplement (8.1 ± 8.4%, SMD: 0.27, p = .051) with no significant effect for the upper body (5.7 ± 8.4%, SMD: 0.16, p = .131). The current analysis observed a small ergogenic effect of CitMal compared with placebo. Acute CitMal supplementation may, therefore, delay fatigue and enhance muscle endurance during high-intensity strength training.

S-nitrosothiols, and other products of nitrate metabolism, are increased in multiple human blood compartments following ingestion of beetroot juice

Ingested inorganic nitrate (NO₃⁻) has multiple effects in the human body including vasodilation, inhibition of platelet aggregation, and improved skeletal muscle function. The functional effects of oral NO₃⁻ involve the in vivo reduction of NO₃⁻ to nitrite (NO₂⁻) and thence to nitric oxide (NO). However, the potential involvement of S-nitrosothiol (RSNO) formation is unclear. We hypothesised that the RSNO concentration ([RSNO]) in red blood cells (RBCs) and plasma is increased by NO₃⁻-rich beetroot juice ingestion. In healthy human volunteers, we tested the effect of dietary supplementation with NO₃⁻-rich beetroot juice (BR) or NO₃⁻-depleted beetroot juice (placebo; PL) on [RSNO], [NO₃⁻] and [NO₂⁻] in RBCs, whole blood and plasma, as measured by ozone-based chemiluminescence. The median basal [RSNO] in plasma samples (n = 22) was 10 (5–13) nM (interquartile range in brackets). In comparison, the median values for basal [RSNO] in the corresponding RBC preparations (n = 19) and whole blood samples (n = 19) were higher (p < 0.001) than in plasma, being 40 (30–60) nM and 35 (25–80) nM, respectively. The median RBC [RSNO] in a separate cohort of healthy subjects (n = 5) was increased to 110 (93–125) nM after ingesting BR (12.8 mmol NO₃⁻) compared to a corresponding baseline value of 25 (21–31) nM (Mann-Whitney test, p < 0.01). The median plasma [RSNO] in another cohort of healthy subjects (n = 14) was increased almost ten-fold to 104 (58–151) nM after BR supplementation (7 × 6.4 mmol of NO₃⁻ over two days, p < 0.01) compared to PL. In conclusion, RBC and plasma [RSNO] are increased by BR ingestion. In addition to NO₂⁻, RSNO may be involved in dietary NO₃⁻ metabolism/actions.

•

Human ingestion of NO₃⁻-rich beetroot juice caused increased plasma S-nitrosothiol levels compared with baseline.

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Beetroot juice ingestion also caused increased S-nitrosothiol and NO₂⁻ levels in red blood cells compared with baseline.

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RSNO formation may contribute to the physiological effects of dietary NO₃⁻.

Effects of acute dietary nitrate supplementation on cold-induced vasodilation in healthy males

PURPOSE

Cold-induced vasodilation (CIVD) is a paradoxical rise in blood flow to the digits that occur during prolonged cold exposure. CIVD is thought to occur through active vasodilation and/or sympathetic withdrawal, where nitric oxide (NO) may play a key role in mediating these mechanisms. Beetroot juice (BRJ) is high in dietary nitrate (NO₃^-) which undergoes sequential reduction to nitrite (NO₂^-) and subsequently NO. Using a double-blind, randomized, crossover design, we examined the effect of acute BRJ supplementation on the CIVD response in 10 healthy males.

METHODS

Participants had a resting blood pressure measurement taken prior to ingesting 140 mL of nitrate-rich BRJ (13 mmol NO₃^-) or a NO₃^--free placebo (PLA). After 2 h, participants immersed their hand in neutral water (~ 35 °C) for 10 min of baseline before cold water immersion (~ 8 °C) for 30 min. Laser-Doppler fluxmetry and skin temperature were measured continuously on the digits.

RESULTS

Compared to PLA (100 ± 3 mmHg), acute BRJ supplementation significantly reduced mean arterial pressure at -30 min (96 ± 2 mmHg; p = 0.007) and 0 min (94 ± 2 mmHg; p = 0.008). Acute BRJ supplementation had no effect on Laser-Doppler fluxmetry during CIVD (expressed as cutaneous vascular conductance) measured as area under the curve (BRJ: 843 ± 148 PU mmHg^-1 s; PLA: 1086 ± 333 PU mmHg^-1 s), amplitude (BRJ: 0.60 ± 0.12 PU mmHg^-1; PLA: 0.69 ± 0.14 PU mmHg^-1), and duration (BRJ: 895 ± 60 s; PLA: 894 ± 46 s).

CONCLUSION

Acute BRJ supplementation does not augment the CIVD response in healthy males.

Influence of Sex and Acute Beetroot Juice Supplementation on 2 KM Running Performance

Purpose: To assess the effect of acute nitrate-rich (BJ) and nitrate-depleted (PL) beetroot juice ingestion on 2 km running performance in amateur runners, and to what extent the ergogenic effect of BJ supplementation would be influenced by the sex of the participants; Methods: Twenty-four amateur long-distance runners (14 males and 10 females) performed a 2 km time trial (TT) on an outdoor athletics track 2.5 h after ingesting either 140 mL of BJ (~12.8 mmol NO3−) or PL. After the tests, blood [lactate] and ratings of perceived exertion (RPE) related to the leg muscles (RPEmuscular), cardiovascular system (RPEcardio) and general overall RPE (RPEgeneral) were assessed; Results: Compared to PL, BJ supplementation improved 2 km TT performance in both males (p < 0.05) with no supplement × sex interaction effect (p > 0.05). This improvement in 2 km running performance was a function of improved performance in the second 1 km split time in both males and females (p < 0.05). Supplementation with BJ did not alter post-exercise blood [lactate] (p > 0.05) but lowered RPEgeneral (p < 0.05); Conclusions: acute BJ supplementation improves 2 km running performance in amateur runners by enhancing performance over the second half of the TT and lowering RPEgeneral by a comparable magnitude in males and females.

Pharmacokinetics of Nitrate and Nitrite Following Beetroot Juice Drink Consumption

BACKGROUND

Nitrate (NO₃ ^-)-rich beetroot (BR) juice supplementation has been shown to improve cardiovascular function via reduction to nitrite (NO₂ ^-) and then to the bioactive molecule nitric oxide (NO). However, limited research exists for the role of inorganic NO₂ ^- that is contained naturally within BR.

OBJECTIVE

As BR juice can naturally contain both NO₃ ^- and NO₂ ^- the objective of this study was to evaluate the individual effects of NO₃ ^- and NO₂ ^- consumed from BR on plasma [NO₃ ^-]/[NO₂ ^-] and their subsequent effects on various cardiovascular measures.

DESIGN

In four separate treatments, 11 healthy adults consumed 250 mL of BR containing one of the following: (i) high NO₃ ^-, low NO₂ ^- (HL; 572 mg NO₃ ^-, 32 mg NO₂ ^-); (ii) medium NO₃ ^-, medium NO₂ ^- (MM; 280 mg NO₃ ^-, 237 mg NO₂ ^-); (iii) low NO₃ ^-, medium NO₂ ^- (LM; 43 mg NO₃ ^-, 262 mg NO₂ ^-); (iv) placebo (PL; low NO₃ ^-, low NO₂ ^-: 8 mg NO₃ ^-, 5.8 mg NO₂ ^-). Plasma [NO₃ ^-]/[NO₂ ^-], blood pressure, heart rate, mean arterial pressure (MAP), cardiac output and stroke volume were measured at baseline and every hour or second hour for 6 h post-BR consumption.

OUTCOMES

Ingestion of the HL and MM BR increased plasma [NO₂ ^-] and [NO₃ ^-] after 2 h, with both remaining elevated after 6 h (p < 0.05). LM increased plasma [NO₃ ^-] (p < 0.05) but did not increase plasma [NO₂ ^-] compared to PL (p = 0.177). MAP was lower following the consumption of HL at 4 h and LM at 6 h (p < 0.05).

CONCLUSION

Inorganic NO₃ ^- consumption is the critical factor in elevating plasma [NO₃ ^-] and [NO₂ ^-]; however, both NO₂ ^- and NO₃ ^- show potential to reduce MAP. The known reduction of systolic blood pressure (SBP)/diastolic blood pressure (DBP) following NO₃ ^- supplementation was not observed, making it unclear if NO₂ ^- contributes to a reduction in SBP/DBP alongside NO₃ ^-.

Nitric Oxide Production in Professional Skiers During Physical Activity at Maximum Load

The purpose of this study is to assess the production of nitric oxide in professional cross-country skiers with normotensive and hypertensive responses to physical activity at maximum load. The observation group included professional cross-country skiers (22.2 ± 7.1 years, = 107) who were current members of the national team of the Komi Republic. All the examined athletes performed the exercise test on a cycle ergometer “until exhaustion.” The following parameters were determined for each participant while they were sitting at rest, while at their anaerobic threshold level, during peak load, and during the recovery period (5th min): systolic blood pressure, diastolic blood pressure, heart rate, and the level of stable nitric oxide metabolites (nitrites, nitrates) in capillary blood samples. According to the blood pressure results, the cross-country skiers were divided into two groups. Group I included athletes with a normotensive response to stress. Group II was composed of individuals with a hypertensive response to stress. During the performance of the test “until exhaustion,” a significant (p < 0.05) increase in the amount of stable metabolites of nitric oxide was observed in the group of athletes with a normotensive response to the load compared with the group with a hypertensive response to the load. In athletes with a normotensive reaction to the load during exercise at maximum load and in the early recovery period, nitrate was prioritized in the regulation of vascular tone. The exercise test on a cycle ergometer “until exhaustion,” combined with the assessment of the levels of stable nitric oxide metabolites in plasma, can be considered a test for the early diagnosis of endothelial dysfunction in professional athletes.

Contrast-enhanced ultrasound for determining muscular perfusion after oral intake of L-citrulline, L-arginine, and galloylated epicatechines: A study protocol

INTRODUCTION

The market for dietary supplements in the sports sector has been growing rapidly for several years, though there is still lacking evidence regarding their claimed benefits. One group is that of nitric oxide increasing supplements, so-called "NO-boosters," which are claimed to improve the supply of oxygen and nutrients to the muscle by enhancing vasodilation.The aim of this study was to investigate 3 of these supplements in healthy male athletes for their muscle perfusion-enhancing potential using contrast-enhanced ultrasound (CEUS).

METHODS

This placebo-controlled, double-blind, randomized cross-over trial will be carried out at the Center for Orthopedics, Trauma Surgery and Spinal Cord Injury of the University Hospital Heidelberg. Three commercial NO enhancing products including 300 mg of the specific green tea extract VASO6 and a combination of 8 g L-citrulline malate and 3 g L-arginine hydrochloride will be examined for their potential to increase muscular perfusion in 30-male athletes between 18 and 40 years and will be compared with a placebo. On each of the 3 appointments CEUS of the dominant biceps muscle will be performed at rest and after a standardized resistance training. Every athlete receives each of the 3 supplements once after a wash-out period of at least 1 week. Perfusion will be quantified via VueBox quantification software. The results of CEUS perfusion measurements will be compared intra- and interindividually and correlated with clinical parameters.

DISCUSSION

The results of this study may help to establish CEUS as a suitable imaging modality for the evaluation of potentially vasodilatory drugs in the field of sports. Other supplements could also be evaluated in this way to verify the content of their advertising claims.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS), ID: DRKS00016972, registered on 25.03.2019.

Nitric oxide-related markers link inversely to blood pressure in black boys and men: the ASOS and African-PREDICT studies

Nitric oxide plays an important role in maintaining endothelial function, while increased oxidative stress may lead to nitric oxide inactivation and cardiovascular disease. If nitric oxide biosynthesis/bioavailability is already suppressed early in life, it may potentially predispose an individual to the early development of cardiovascular disease. We therefore aimed to identify differences in nitric oxide-related markers (urinary nitrate, nitrite and the nitrate-to-nitrite ratio (U_NOxR)) between young black and white individuals, and whether these markers are associated with blood pressure and carotid intima media thickness. We included black and white healthy boys (n = 80; aged 6-8 years) and men (n = 510; 20-30 years) and measured blood pressure and carotid intima media thickness, along with urinary biochemical markers including nitrate and nitrite. The black boys and men had lower nitrate and U_NOxR (all p ≤ 0.003) than their white counterparts. In single and multiple regression analyses, we found an inverse association of diastolic blood pressure in the black boys (adj. R² = 0.27; β = -0.32; p = 0.030), and systolic blood pressure in black men (adj. R² = 0.07; β = -0.13; p = 0.036) with nitrate. Carotid intima media thickness associated inversely with U_NOxR in the black men (adj. R² = 0.02; β = -0.14; p = 0.023), but not in the boys. Lower urinary nitrate in black boys and young men was associated negatively with blood pressure, suggesting that potentially lower nitric oxide bioavailability in young black individuals may contribute to hypertension development in later life.

No effect of beetroot juice supplementation on exercise economy and performance in recreationally active females despite increased torque production

This study investigated the effects of acute and chronic beetroot juice (BRJ) supplementation on submaximal exercise oxygen uptake (VO₂), time trial (TT) performance, and contractile properties of the plantar flexors in females. Study 1: Using a double blind, randomized, crossover design, 12 recreationally active females using hormonal contraceptives supplemented acutely (2.5 h) and chronically (8 days) with 280 mL BRJ/d (~26 mmoles nitrate [NO3−]) or a NO3−‐free placebo (PLA). On days 1 and 8, participants cycled for 10 min at 50% and 70% VO_2peak and completed a 4 kJ/kg body mass TT. Plasma [NO3−] and nitrite ([NO₂⁻]) increased significantly following BRJ supplementation versus PLA. There was no effect of BRJ supplementation on VO₂ at 50% or 70% VO_2peak, or TT performance. Study 2: 12 recreationally active females (n = 7 from Study 1) using hormonal contraceptives participated in a baseline visit and were supplemented acutely (2.5 h) and chronically (8 days) with 280 mL BRJ/d. Maximum voluntary strength (MVC) of the plantar flexors was assessed and a torque‐frequency curve performed. BRJ had no effect on MVC, voluntary activation, peak twitch torque, time to peak torque, or half relaxation time. Following both acute (46.6 ± 4.9% of 100 Hz torque) and chronic (47.2 ± 4.4%) supplementation, 10 Hz torque was significantly greater compared to baseline (32.9 ± 2.6%). In summary, BRJ may not be an effective ergogenic aid in recreationally active females as it did not reduce submaximal exercise VO₂ or improve aerobic TT performance despite increasing low frequency torque production.

Nutritional Recommendations for Physique Athletes

The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.

The Efficacy of Administering Fruit-Derived Polyphenols to Improve Health Biomarkers, Exercise Performance and Related Physiological Responses

Polyphenols are secondary metabolites involved in a myriad of critical processes in plants. Over recent decades, special attention has been paid to the anti-oxidative role of fruit-derived polyphenols in the human diet, with evidence supporting the contribution of polyphenols in the prevention of numerous non-communicable disease outcomes. However, due to the low concentration in biological fluids in vivo, the antioxidant properties of polyphenols seem to be related to an enhanced endogenous antioxidant capacity induced via signaling through the nuclear respiratory factor 2 pathway. Polyphenols also seem to possess anti-inflammatory and antioxidant properties and have been shown to enhance vascular function via nitric oxide mediated mechanisms. Consequently, there is rationale to support fruit-derived polyphenol supplementation to enhance exercise performance, possibly via improved muscle perfusion. Fruit-derived polyphenol supplementation in exercise studies have included a variety of fruits, e.g., New Zealand blackcurrant, pomegranate, and cherry, in the form of extracts (multicomponent or purified), juices and infusions to varying degrees of benefit. For example, research has yet to link the health-related benefits of black elderberry (Sambucus nigra L.) ingestion to exercise performance in spite of the purported health benefits associated with black elderberry provision in vitro and in vivo models, which has been attributed to their high antioxidant capacity and polyphenol content. This review summarizes the existing evidence supporting a beneficial effect of fruit-derived polyphenols on various biological processes and outlines the potential for black elderberry ingestion to improve nitric oxide production, exercise performance, and the associated physiological responses before-, during- and post-exercise.

Comparison of the Effectiveness of High-Intensity Interval Training in Hypoxia and Normoxia in Healthy Male Volunteers: A Pilot Study

Aims

The study investigated the effect of high-intensity interval training in hypoxia and normoxia on serum concentrations of proangiogenic factors, nitric oxide, and inflammatory responses in healthy male volunteers.

Methods

Twelve physically active male subjects completed a high-intensity interval training (HIIT) in normoxia (NorTr) and in normobaric hypoxia (HypTr) (FiO₂ = 15.2%). The effects of HIIT in hypoxia and normoxia on maximal oxygen uptake, hypoxia-inducible factor-1-alpha, vascular endothelial growth factor, nitric oxide, and cytokines were analyzed.

Results

HIIT in hypoxia significantly increases maximal oxygen uptake (p=0.01) levels compared to pretraining levels. Serum hypoxia-inducible factor-1 (p=0.01) and nitric oxide levels (p=0.05), vascular endothelial growth factor (p=0.04), and transforming growth factor-β (p=0.01) levels were increased in response to exercise test after hypoxic training. There was no effect of training conditions for serum baseline angiogenic factors and cytokines (p > 0.05) with higher HIF-1α and NO levels after hypoxic training compared to normoxic training (F = 9.1; p < 0.01 and F = 5.7; p < 0.05, respectively).

Conclusions

High-intensity interval training in hypoxia seems to induce beneficial adaptations to exercise mediated via a significant increase in the serum concentrations of proangiogenic factors and serum nitric oxide levels compared to the same training regimen in normoxia.

No longer beeting around the bush: a review of potential sex differences with dietary nitrate supplementation

Over the last decade there has been substantial interest in the health and athletic performance benefits associated with acute and chronic dietary nitrate (NO3–) supplementation. Dietary NO3–, commonly found in leafy green and root vegetables, undergoes sequential reduction to nitrite and nitric oxide (NO) via the enterosalivary circulation. Importantly, NO has been shown to elicit a number of biological effects ranging from blood pressure reduction to improved exercise economy and athletic performance. However, a common absence within biological research is the lack of female participants, which is often attributed to the added complexity of hormonal fluctuations throughout the menstrual cycle. Despite mounting evidence supporting significant anthropometric, metabolic, and physiological differences between the sexes, this problem extends to the field of dietary NO3– supplementation where women are underrepresented as research participants. This review examines the existing dietary NO3– supplementation research with regards to dietary NO3– pharmacokinetics, resting blood pressure, exercise economy and performance, and mechanisms of action. It also provides evidence and rationale for potential sex differences in response to dietary NO3– supplementation and future directions for this field of research.

Novelty Dietary NO3– supplementation has been shown to have positive impacts on health and athletic performance in generally male populations. However, women are underrepresented in dietary NO3– supplementation research. The present evidence suggests that sex differences exist in response to dietary NO3– supplementation and this review highlights avenues for future research.

Acute Supplementation with Nitrate-Rich Beetroot Juice Causes a Greater Increase in Plasma Nitrite and Reduction in Blood Pressure of Older Compared to Younger Adults

Nitrate-rich beetroot juice supplementation has been shown to improve cardiovascular and cognitive function in younger and older adults via increased nitric oxide production. However, it is unclear whether the level of effects differs between the two groups. We hypothesized that acute supplementation with nitrate-rich beetroot juice would improve cardiovascular and cognitive function in older and younger adults, with the potential for greater improvements in older adults. Thirteen younger (18–30 years) and 11 older (50–70 years) adults consumed either 150 mL of nitrate-rich beetroot juice (BR; 10.5 mmol nitrate) or placebo (PL; 1 mmol nitrate) in a double-blind, crossover design, 2.25 h prior to a 30-min treadmill walk. Plasma nitrate and nitrite concentrations, blood pressure (BP), heart rate (HR), cognitive function, mood and perceptual tests were performed throughout the trial. BR consumption significantly increased plasma nitrate (p < 0.001) and nitrite (p = 0.003) concentrations and reduced systolic BP (p < 0.001) in both age groups and reduced diastolic BP (p = 0.013) in older adults. Older adults showed a greater elevation in plasma nitrite (p = 0.038) and a greater reduction in diastolic BP (p = 0.005) following BR consumption than younger adults. Reaction time was improved in the Stroop test following BR supplementation for both groups (p = 0.045). Acute BR supplementation increased plasma nitrite concentrations and reduced diastolic BP to a greater degree in older adults; whilst systolic BP was reduced in both older and younger adults, suggesting nitrate-rich BR may improve cardiovascular health, particularly in older adults due to the greater benefits from reductions in diastolic BP.

Acute Supplementation with Nitrate-Rich Beetroot Juice Causes a Greater Increase in Plasma Nitrite and Reduction in Blood Pressure of Older Compared to Younger Adults

Nitrate-rich beetroot juice supplementation has been shown to improve cardiovascular and cognitive function in younger and older adults via increased nitric oxide production. However, it is unclear whether the level of effects differs between the two groups. We hypothesized that acute supplementation with nitrate-rich beetroot juice would improve cardiovascular and cognitive function in older and younger adults, with the potential for greater improvements in older adults. Thirteen younger (18-30 years) and 11 older (50-70 years) adults consumed either 150 mL of nitrate-rich beetroot juice (BR; 10.5 mmol nitrate) or placebo (PL; 1 mmol nitrate) in a double-blind, crossover design, 2.25 h prior to a 30-min treadmill walk. Plasma nitrate and nitrite concentrations, blood pressure (BP), heart rate (HR), cognitive function, mood and perceptual tests were performed throughout the trial. BR consumption significantly increased plasma nitrate (p < 0.001) and nitrite (p = 0.003) concentrations and reduced systolic BP (p < 0.001) in both age groups and reduced diastolic BP (p = 0.013) in older adults. Older adults showed a greater elevation in plasma nitrite (p = 0.038) and a greater reduction in diastolic BP (p = 0.005) following BR consumption than younger adults. Reaction time was improved in the Stroop test following BR supplementation for both groups (p = 0.045). Acute BR supplementation increased plasma nitrite concentrations and reduced diastolic BP to a greater degree in older adults; whilst systolic BP was reduced in both older and younger adults, suggesting nitrate-rich BR may improve cardiovascular health, particularly in older adults due to the greater benefits from reductions in diastolic BP.

Pomegranate Extract Improves Maximal Performance of Trained Cyclists after an Exhausting Endurance Trial: A Randomised Controlled Trial

The efficacy of pomegranate (Punica granatum) extract (PE) for improving performance and post-exercise recovery in an active population was equivocal in previous studies. In this study, a randomised, double-blinded, placebo-controlled, balanced, cross-over trial with two arms was conducted. Eligibility criteria for participants were as follows: male, amateur cyclist, with a training routine of 2 to 4 sessions per week (at least one hour per session). The cyclists (n = 26) were divided into treatment (PE) and placebo (PLA) groups for a period of 15 days. After physical tests, the groups were exchanged after a 14-day washout period. Exercise tests consisted of endurance bouts (square-wave endurance exercise test followed by an incremental exercise test to exhaustion) and an eccentric exercise drill. The objective was to assess the efficacy of PE in performance outcomes and post-exercise muscular recovery and force restoration after a prolonged submaximal effort. Twenty-six participants were included for statistical analysis. There was a statistically significant difference in total time to exhaustion (TTE)(17.66–170.94 s, p < 0.02) and the time to reach ventilatory threshold 2 (VT2)(26.98–82.55 s, p < 0.001), with greater values for the PE compared to the PLA group. No significant results were obtained for force restoration in the isokinetic unilateral low limb test. PE, after a prolonged submaximal effort, may be effective in improving performance outcomes at maximal effort and might help to restore force in the damaged muscles.

Effects of maternal dietary nitrate supplementation during the perinatal period on piglet survival, body weight, and litter uniformity

The objective of this study was to evaluate effects of different dosages of dietary nitrate supplementation to sows from d 108 of gestation until d 5 of lactation on reproductive performance of sows and piglet performance from birth until weaning. Dietary nitrate supplementation leads to nitric oxide (NO) formation that can potentially increase blood flow to the fetuses (by the vasodilative effect of NO), leading to a decrease in the loss of potential viable piglets in the form of stillbirth and preweaning mortality. Three hundred and five gilts and sows were allocated to one of six diets from d 108 of gestation until d 5 of lactation, containing 0.00% (Control), 0.03%, 0.06%, 0.09%, 0.12%, or 0.15% of dietary nitrate. The source of nitrate used was calcium nitrate double salt. Calcium levels were kept the same among diets by using limestone. Gilts and sows were weighed and backfat was measured at arrival to the farrowing room (d 108 of gestation) and at weaning (d 27 of age). Data included number of piglets born alive, born dead, and weaned, as well as individual piglet weights at d 0, 72 h of age and weaning. Preweaning mortality was determined throughout lactation. Body weight d 0 (P = 0.04) as well as BW at 72 h of age (P < 0.01) increased linearly with increasing dosages of nitrate in the maternal diet. Litter uniformity (SD) at birth was not affected by maternal nitrate supplementation level (P > 0.10), but tended to be higher at 72 h of age in the control treatment than in all nitrate-supplemented treatments (P = 0.07), and SD decreased linearly (increased uniformity) at weaning with increasing dosages of nitrate (P = 0.05). BW at weaning (P > 0.05) and average daily gain of piglets during lactation (P > 0.05) were not affected by maternal nitrate supplementation. A tendency for a quadratic effect (P = 0.10) of the dosage of maternal dietary nitrate was found on preweaning mortality of piglets with the lowest level of mortality found at 0.09% to 0.12% of maternal nitrate supplementation. We conclude that the use of nitrate in the maternal diet of sows during the perinatal period might stimulate preweaning piglet vitality. Exact mode of action and optimal dose of nitrate still need to be elucidated.

The Effect of Branched-Chain Amino Acids, Citrulline, and Arginine on High-Intensity Interval Performance in Young Swimmers

High-intensity interval training has drawn significant interest for its ability to elicit similar training responses with less training volume compared to traditional moderate-intensity protocols. The purpose of this study was to examine the effect of co-ingestion of branched-chain amino acids (BCAA), arginine, and citrulline on 8 × 50 m high-intensity interval swim performance in trained young swimmers. This study used a randomized cross-over design. Eight male (age 15.6 ± 1.3 years) and eight female (age 15.6 ± 0.9 years) swimmers completed both amino acids (AA) and placebo (PL) trials. The participants ingested 0.085 g/kg body weight BCAA, 0.05 g/kg body weight arginine and 0.05 g/kg body weight citrulline before the swim test in the AA trial. The average 50 m time was significantly shorter in the AA trial than that in the PL trial. The AA trial was faster than the PL trial in the first, second, and the seventh laps. The AA trial showed significantly higher plasma BCAA concentrations and lower tryptophan/BCAA ratio. The other biochemical parameters and ratings of perceived exertion were similar between the two trials. The results showed that BCAA, arginine, and citrulline, allowed the participants to swim faster in a high-intensity interval protocol in young swimmers.

Beetroot supplementation improves the physiological responses to incline walking

PURPOSE

We investigated the effects of an acute 24-h nitrate-rich beetroot juice supplement (BR) on the energy cost, exercise efficiency and blood pressure responses to intermittent walking at different gradients.

METHODS

In a double-blind, cross-over design, eight participants were provided with a total of 350 ml of nitrate-rich (~ 20.5 mmol nitrate) BR or placebo (PLA) across 24 h before completing intermittent walking at 3 km/h on treadmill at gradients of 1, 5, 10, 15 and 20%.

RESULTS

Resting mean arterial pressure (MAP) was ~ 4.1% lower after BR (93 vs. 89 mmHg; P = 0.001), as well as during exercise (102 vs. 99 mmHg; P = 0.011) and recovery (97 vs. 94 mmHg; P = 0.001). Exercising (1227 vs. 1129 ml/min P < 0.001) and end-stage (1404 vs. 1249 ml/min; P = 0.002) oxygen uptake ([Formula: see text]O₂) was lower in BR compared to PLA, which was accompanied by an average reduction in phase II [Formula: see text]O₂ amplitude (1067 vs. 940 ml/min; P = 0.025). Similarly, recovery [Formula: see text]O₂ (509 vs. 458 ml/min; P = 0.001) was lower in BR. Whole blood potassium concentration increased from pre-post exercise in PLA (4.1 ± 0.3 vs. 4.5 ± 0.3 mmol/L; P = 0.013) but not BR (4.1 ± 0.31 vs. 4.3 ± 0.2 mmol/L; P = 0.188).

CONCLUSIONS

Energy cost of exercise, recovery of [Formula: see text]O₂, MAP and blood markers were ameliorated after BR. Previously-reported mechanisms explain these findings, which are more noticeable during less-efficient walking at steep gradients (15-20%). These findings have practical implications for hill-walkers.

Performance and Health Benefits of Dietary Nitrate Supplementation in Older Adults: A Systematic Review

Supplementation with nitrate (NO₃⁻)-rich beetroot juice has been shown to improve exercise performance and cardiovascular (CV) responses, due to an increased nitric oxide (NO) availability. However, it is unclear whether these benefits are greater in older adults who have an age-related decrease in NO and higher risk of disease. This systematic review examines 12 randomised, crossover, control trials, investigating food-based NO₃⁻ supplementation in older adults and its potential benefits on physiological and cognitive performances, and CV, cerebrovascular and metabolic health. Four studies found improvements in physiological performance (time to exhaustion) following dietary NO₃⁻ supplementation in older adults. Benefits on cognitive performance were unclear. Six studies reported improvements in CV health (blood pressure and blood flow), while six found no improvement. One study showed improvements in cerebrovascular health and two found no improvement in metabolic health. The current literature indicates positive effects of dietary NO₃⁻ supplementation in older adults on physiological performance, with some evidence indicating benefits on cardiovascular and cerebrovascular health. Effects on cognitive performance were mixed and studies on metabolic health indicated no benefit. However, there has been limited research conducted on the effects of dietary NO₃⁻ supplementation in older adults, thus, further study, utilising a randomised, double-blind, control trial design, is warranted.

Ingestion of a Nitric Oxide Enhancing Supplement Improves Resistance Exercise Performance

Mosher, SL, Sparks, SA, Williams, EL, Bentley, DJ, and Mc Naughton, LR. Ingestion of a nitric oxide enhancing supplement improves resistance exercise performance. J Strength Cond Res 30 (12): 3520-3524, 2016-Studies have established that supplementation of nitrate increases nitric oxide which in turn improves exercise performance. The current study aimed to investigate the effects of nitrate ingestion on performance of bench press resistance exercise until failure. Twelve recreationally active (age, 21 ± 2 years, height, 177.2 ± 4.0 cm, weight, 82.49 ± 9.78 kg) resistance-trained men participated in the study. The study used a double-blind, randomized cross-over design, where participants ingested either 70 ml of "BEET It Sport" nitrate shot containing 6.4 millimoles (mmol·L) or 400 mg of nitrate or a blackcurrant placebo drink. Participants completed a resistance exercise session, consisting of bench press exercise at an intensity of 60% of their established 1 repetition maximum (1RM), for 3 sets until failure with 2 minutes rest interval between sets. The repetitions completed, total weight lifted, local and general rate of perceived exertion (RPE), and blood lactate were all measured. The results showed a significant difference in repetitions to failure (p ≤ 0.001) and total weight lifted (p ≤ 0.001). However, there were no significant difference between blood lactate over the 2 trials (p = 0.238), and no difference in Local (p = 0.807) or general (p = 0.420) indicators of fatigue as measured by RPE. This study demonstrates that nitrate supplementation has the potential to improve resistance training performance and work output compared with a placebo.