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Research · Supplements

Dietary nitrate

Meta-analyses find nitrate, mostly as beetroot juice, extends time to exhaustion and lowers systolic blood pressure by about 4 mmHg in short trials. Artery dilation and recovery after muscle damage improved. Time-trial results did not change, and pooled trials in trained athletes found no effect. Tested beet juice products varied about 50-fold in nitrate.

Add to Bio HackChecked 2026-11-09
Status
Food and dietary supplement in the US.
Also called
beetroot juice, beet juice, beet shots, beet powder, inorganic nitrate, sodium nitrate, potassium nitrate, NO3, nitric oxide booster
Taken for
endurance, stamina, time to exhaustion, blood flow, nitric oxide, lower blood pressure, strength, recovery

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help5

Reported risks3

What people take it for, and what was found

Shown to help5

Strong

Endurance capacity and time to exhaustion

Shown to lengthen time to exhaustion in healthy adults, without improving time-trial performance.

The numbers and sources
Effect
Across 76 trials, time to exhaustion improved (ES 0.33, 95% CI 0.15 to 0.50); time trials (ES -0.10, 95% CI -0.27 to 0.06) and graded tests (ES 0.25, 95% CI -0.06 to 0.56) did not [1]. Across 73 studies (1,061 people), nitrate raised power output by 4.6 watts, time to exhaustion by 25.3 seconds and distance covered by 163.7 m, with no change in time-trial performance, work done or perceived exertion [2]. Across 38 studies (703 healthy adults), VO2max rose slightly (SMD 0.24, 95% CI 0.11 to 0.37), more in recreationally active people (0.38) than in highly trained athletes (0.07, 95% CI -0.09 to 0.23) [3].
Population
Healthy adults [1][2][3].
Sources
[1], [2], [3]
Caveats
Time to exhaustion tests are open-ended capacity tests, not races. Time trials, closer to competition, did not change in either analysis. The VO2max estimate shrank to 0.19 after adjustment for possible small-study bias [3].
Strong

Strength, muscular endurance and short sprints

Shown to improve muscular endurance and time to peak power slightly in healthy adults, with a trivial effect on strength.

The numbers and sources
Effect
Across 34 studies, nitrate had a trivial effect on strength (SMD 0.08) and a small effect on muscular endurance (SMD 0.31) [6]. In 23 studies of short, high-intensity efforts, nitrate improved time to peak power (SMD 0.75), mean power (SMD 0.20) and Yo-Yo test distance (SMD 0.17) [7]. An umbrella review of 20 meta-analyses (180 studies, 2,672 participants) found improved muscular endurance (SMD 0.48, 95% CI 0.23 to 0.74), peak power (SMD 0.25, 95% CI 0.10 to 0.39) and time to peak power (SMD -0.76, 95% CI -1.18 to -0.33) [8]. In 23 sprint trials (401 adults aged 18 to 40), beetroot juice shortened time to peak power (SMD -0.92, 95% CI -1.29 to -0.54) and raised handgrip strength (SMD 0.40), and did not change jump height, peak or mean power, or 10 m and 20 m sprint times [9].
Population
Healthy adults in resistance and sprint protocols [6][7][9]; trials pooled across published meta-analyses [8].
Sources
[6], [7], [8], [9]
Caveats
Effects are trivial to small. Most reviews in the umbrella analysis were rated low to critically low quality [8]. Certainty was low to very low in the sprint review [9].
Strong

Blood pressure

Shown to lower systolic blood pressure by about 4.4 mmHg in mostly healthy adults over short trials. Diastolic pressure did not change significantly.

The numbers and sources
Effect
In 16 crossover trials (254 participants), nitrate and beetroot juice lowered systolic pressure by 4.4 mmHg (95% CI -5.9 to -2.8); diastolic fell 1.1 mmHg (95% CI -2.2 to 0.1), not significant [10]. In 75 RCTs (1,823 participants), each additional mmol of nitrate lowered medium-term systolic pressure by 0.48 mmHg (95% CI -0.71 to -0.25) and improved pulse wave velocity and flow-mediated dilation [11].
Population
Adults, mostly healthy, in trials from 2 hours to 15 days [10]; acute to medium-term trials [11].
Sources
[10], [11]
Caveats
The 2013 analysis covers short trials only. Neither tests long-term cardiovascular events.
Strong

Recovery from muscle damage

Shown to speed strength and jump recovery after damaging exercise with beetroot juice, in small trials. The reviews disagree on creatine kinase.

The numbers and sources
Effect
In 6 pooled studies, beetroot juice sped isometric strength recovery at 72 hours (SMD 0.54) and countermovement jump recovery at 24 to 72 hours (SMD 0.75 to 1.32), and raised pressure pain threshold at 48 and 72 hours. Creatine kinase and oxidative stress did not change; C-reactive protein was higher than placebo at 48 hours (SMD 0.55) [12]. In 7 trials, beetroot juice lowered creatine kinase by 98.67 IU/L (95% CI -122.14 to -75.21, I² 74.2%) and improved recovery of isometric strength (8.93%, I² 81.2%), jump height (4.72%) and pressure pain threshold (7.22%) against placebo. CRP, IL-6 and TNF-α did not change [13].
Population
Adults after damaging exercise [12][13].
Sources
[12], [13]
Caveats
Both reviews pooled 6 or 7 small, overlapping trials, and heterogeneity was high for creatine kinase and strength [13]. The two disagree on creatine kinase. All pooled trials in [12] had some concerns for risk of bias and used beetroot juice rather than isolated nitrate, so other juice compounds cannot be ruled out [12].
Strong

Blood flow and blood vessel function

Shown to raise flow-mediated dilation, a measure of artery widening, by about 1.5% in adults, more after single doses.

The numbers and sources
Effect
In 13 studies, inorganic nitrate raised flow-mediated dilation, a measure of artery widening, by 1.48% (95% CI 0.70 to 2.27) over control, more after single doses (1.93%) than with longer use (0.90%) [14]. In 75 RCTs, nitrate improved flow-mediated dilation and pulse wave velocity, a measure of arterial stiffness [11].
Population
Adults with and without health conditions, dietary and non-dietary nitrate [14]; acute to medium-term trials [11].
Sources
[14], [11]
Caveats
Heterogeneity was 98.2% [14]. These are measures of vessel function, not heart attacks or strokes.

Not shown to help1

Strong

Performance in trained athletes

Not shown to improve performance in trained athletes, while non-athletes improved slightly, most in long open-ended tests.

The numbers and sources
Effect
Across 53 placebo-controlled studies, nitrate improved performance in non-athletes (ES 0.25, 95% CI 0.11 to 0.38), most in long open-ended tests (ES 0.47), but not in athletes (ES 0.04, 95% CI -0.05 to 0.15) [4]. In 45 RCTs of 659 athletes at tier 2 or higher, none of six outcomes (peak power, mean power, VO2max, heart rate, lactate, perceived exertion) changed overall [5].
Population
Athletes and non-athletes [4]; trained and elite athletes [5].
Sources
[4], [5]
Caveats
The authors of [5] write that an absent pooled effect is not proof of no effect in individuals.

Doses studied

A product analysis describes about 5 mmol of nitrate per serving as the apparent minimum for a performance effect in most individuals; only 5 of 24 tested products consistently delivered that much [15]. Blood pressure effects scaled with dose, at 0.24 to 0.48 mmHg systolic per mmol depending on duration [11]. Earlier blood pressure trials lasted 2 hours to 15 days [10]. Bulk beet juice in studies was often dosed at 500 mL [15].

Risks

Reported risks3

Moderate

Variable nitrate content in products

Nitrate varied about 50-fold between beet juice products and by 30% between lots, and only 5 of 24 products reliably gave 5 mmol per serving.

The numbers and sources
Effect
Across 45 lots of 24 beet juice products from 21 companies, nitrate varied between lots of the same product by a mean 30% (range 2% to 83%) and about 50-fold between products. Only 5 products consistently provided 5 mmol or more per serving. Nitrite was usually 0.5% or less of nitrate, but two products had 10% and 14% [15].
Population
Product testing, not people [15].
Sources
[15]
Caveats
US products tested before 2019. NIH-funded [15].
Limited

Antibacterial mouthwash blocks the effect

One small study found antibacterial mouthwash blocked nitrate's conversion to nitrite in saliva in 7 healthy adults.

The numbers and sources
Effect
In 7 healthy volunteers, a chlorhexidine mouthwash before a sodium nitrate load (10 mg per kg) abolished conversion to nitrite in saliva and markedly blunted the rise in plasma nitrite [16].
Population
7 healthy adults, crossover [16].
Sources
[16]
Caveats
One small mechanistic study. Performance and blood pressure were not measured.
Limited

Cancer and other disease associations

Linked to higher thyroid cancer risk with high nitrate intake, and to higher glioma, bladder and stomach cancer with high nitrite, in observational studies of diet.

The numbers and sources
Effect
In 41 observational studies covering 13 cancer sites, high nitrate intake was associated with higher thyroid cancer risk (OR 1.40, 95% CI 1.02 to 1.77) and lower kidney and bladder cancer risk. Higher nitrite intake was associated with higher glioma (OR 1.12), bladder and stomach cancer risk [17]. A 2025 systematic review of 267 human studies of nitrate and nitrite from food and drinking water found the most consistent patterns of higher risk for urinary tract, bladder and kidney cancer, prostate and thyroid cancer, type 2 diabetes and birth defects [18]. In a 5-week randomized trial in 231 adults with mild hypertension, 300 mg a day of nitrate from potassium nitrate or leafy vegetables did not change urinary N-nitrosamines, the carcinogens nitrate is suspected of forming [19].
Population
Observational cohorts and case-control studies of diet [17]; human studies of food and water exposure [18]; adults with mild hypertension [19].
Sources
[17], [18], [19]
Caveats
Sources disagree on kidney and bladder cancer [17][18]. The authors of [17] state these compounds are consumed mainly through processed food. The observational studies did not test beetroot supplements, and associations are not causal estimates. The trial measured a urine marker over 5 weeks, not cancer [19].

Claims tested and not found

  1. That nitrate improves race times. Time-trial performance did not change in two meta-analyses [1][2].
  2. That nitrate helps trained athletes in general. Pooled effects were absent in athletes across two meta-analyses [4][5].

Sources

  1. McMahon NF, Leveritt MD, Pavey TG. The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Sports Medicine. 2016. https://doi.org/10.1007/s40279-016-0617-7
  2. Gao C, Gupta S, Adli T, et al. The effects of dietary nitrate supplementation on endurance exercise performance and cardiorespiratory measures in healthy adults: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2021. https://doi.org/10.1186/s12970-021-00450-4
  3. Qin G, Kim S. Effects of beetroot juice supplementation on maximal oxygen uptake during aerobic exercise: a systematic review and meta-analysis. Frontiers in Nutrition. 2026. https://doi.org/10.3389/fnut.2026.1858216
  4. Campos HO, Drummond LR, Rodrigues QT, et al. Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis. British Journal of Nutrition. 2018. https://doi.org/10.1017/s0007114518000132
  5. Xie Y, Han Y, Du Q, et al. Dietary Nitrate Supplementation and Exercise Performance in Athletes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports. 2026. https://doi.org/10.3390/sports14100466
  6. Alvares TS, Oliveira GV, Volino-Souza M, et al. Effect of dietary nitrate ingestion on muscular performance: a systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2021. https://doi.org/10.1080/10408398.2021.1884040
  7. Alsharif NS, Clifford T, Alhebshi A, et al. 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. Antioxidants. 2023. https://doi.org/10.3390/antiox12061194
  8. Poon ETC, Iu JCK, Sum WMK, et al. Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses. Sports Medicine. 2025. https://doi.org/10.1007/s40279-025-02194-6
  9. Eroglu MN, Pancar S, López-Torres O, et al. The Effects of Beetroot Juice Supplementation on Performance and Fatigue During Single and Repeated Sprints: A Systematic Review and Meta-Analysis. Nutrients. 2026. https://doi.org/10.3390/nu18152513
  10. Siervo M, Lara J, Ogbonmwan I, et al. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. Journal of Nutrition. 2013. https://doi.org/10.3945/jn.112.170233
  11. Norouzzadeh M, Hasan Rashedi M, Ghaemi S, et al. Plasma nitrate, dietary nitrate, blood pressure, and vascular health biomarkers: a GRADE-Assessed systematic review and dose-response meta-analysis of randomized controlled trials. Nutrition Journal. 2025. https://doi.org/10.1186/s12937-025-01114-8
  12. Jones L, Bailey SJ, Rowland SN, et al. The Effect of Nitrate-Rich Beetroot Juice on Markers of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Human Intervention Trials. Journal of Dietary Supplements. 2021. https://doi.org/10.1080/19390211.2021.1939472
  13. Beba M, Dehghani E, Gholizadeh M. The effect of beetroot juice (BRJ) supplementation on exercise-induced muscle damage (EIMD): a systematic review and dose-response meta-analysis of randomized controlled trials. Annals of Medicine & Surgery. 2026. https://doi.org/10.1097/ms9.0000000000005231
  14. Celik B, Muriuki E, Kuhnle GGC, et al. The Impact of Inorganic Nitrate on Endothelial Function: A Systematic Review of Randomized Controlled Trials and Meta-analysis. Nutrition Reviews. 2025. https://doi.org/10.1093/nutrit/nuaf132
  15. Gallardo EJ, Coggan AR. What Is in Your Beet Juice? Nitrate and Nitrite Content of Beet Juice Products Marketed to Athletes. International Journal of Sport Nutrition and Exercise Metabolism. 2019. https://doi.org/10.1123/ijsnem.2018-0223
  16. Govoni M, Jansson EÅ, Weitzberg E, et al. The increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash. Nitric Oxide. 2008. https://doi.org/10.1016/j.niox.2008.08.003
  17. Said Abasse K, Essien EE, Abbas M, et al. Association between Dietary Nitrate, Nitrite Intake, and Site-Specific Cancer Risk: A Systematic Review and Meta-Analysis. Nutrients. 2022. https://doi.org/10.3390/nu14030666
  18. Christensen KY, Bommarito PA, Shaffer RM, et al. Systematic review of adverse human health effects following oral exposure to inorganic nitrate and nitrite. Journal of Toxicology and Environmental Health, Part B. 2025. https://doi.org/10.1080/10937404.2025.2559344
  19. Bondonno CP, Sundqvist ML, Shinde S, et al. A clinical study examining the effects of dietary nitrate on urinary N-nitrosamines. The American Journal of Clinical Nutrition. 2026. https://doi.org/10.1016/j.ajcnut.2026.101239

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