Nutrition and Dietary Supplements Dove; 8 REVIEW Beetroot juice and exercise performance Michael | Ormsbee! Jon Lox! Paul J Arciero® "Department of Nutrition, Food, and Bearise Sciences, Human Performance Lab, Florida State Universe. Tallahassee, FL USA. Department of Heath and Exercise Sciences, Human Nutrition and Metaboliam Lab, Skidmore College, Saratoga Springs, NYUSA Correspondence Michael J Ormebee Department of Nutrition. Food. and Exercive Sdnces, Human Performance Bb, Florida State University, 120 Convocation Way, 436 Sandels Bling, Tallahassee FL 32316, USA ‘Tel-+1850 6444793 Fe +1 850 645 5000 Ell mormsbee@u.ed Abstract: Increased sales and consumption of organie and natural foods reflest consumers heightened interest in promoting heslth and improving athletic performance. Of these products, beetroot and its constituents have become inereasingly popular in the arena of exereise performance, mainly du tothe high concentrations of nitrate. Studies have indicated beetroot juice (BRI) may improve exercise time fo exhaustion, running performance, and increase museulareffcieney during moderate tensity exereise. The purpose of this review is to examine the efficacy of BRJ to serve as an ergogenic sid in athletic performance. It appears that BRJ may provide modest performance enhancement; however, more research is needed to clearly identify mechanisms of action and proper dosing patterns to maximize the performance benefits of BR Keywords: beetroot, nitrate, bot Introduction In the world of athletic competition, margins of victory are becoming smaller, and in some cases may literally come down t0 a fraction of a second or the ability to ‘contract a single motor unit one more time. Thus, athletes are constantly in pursuit Of any advantage to improve athletic performance, Some athletes may turn toward nutritional supplements, from both natural and organic sources, to provide this edge. Not surprisingly, during the period from 1999 to 2009, the US market for organie and natural foods experienced an inerease in annual growth rate from 22.5% to 31.1%, \whereas the supplement market had a decline in annual growth rate from 34,5% to 24.8%." In addition, the forecast for “Estimated Compound Annual Sales Growth” from 2010 to 2017 is projected to be 5% for supplements compared to 8% for natural and organic foods.' Given this trend for organic and natural food products, it is Particularly relevant to understand whether there isan added performance benefit due tothe ingredients within these food products acting additively, synergistically, or even negatively compared to a concentrated dose of the isolated bioactive ingredient from the whole food or product Currently, one of the more popular natural foods considered to help athletic performance is beetroot (Beta vulgaris), one of the most common varieties of beet in North America, Beetroot is an excellent source ofantioxidants and micro- nutrients, including (in descending order by weight) potassium, betaine, sodium, magnesium, vitamin C, and nitrate (NO,-) and contains 29 keal per 100 g.? The color of beetroot stems from its purple and yellow pigments (betaeyanin and betaxanthin, respectively), known collectively as betalains. These betalains have ‘Natron and Dietary Supplements 201355 27-35 7 (ES acc ett met ttt note So ercae Eh Mett spnateemnryenapcgoame nae me penrcley ee errs bts ape cpa td cere dns on hr ne (Circe mis anne tlpteciopn contoOrmsbee et Dove potential antioxidant capabilities." Interestingly, BRJ has been marketed on the Internet to support digestive and blood health, improve energy, be a natural cleanser, and increase levels of nitric oxide (NO) leading to increased blood flow. In addition, BRI has been indicated to pos- sess anticancer properties, can lower the risk of coronary events (stroke and peripheral vascular disease), lower blood pressure, and reduce inflammation.’ These claims have boosted the popularity of BRI. Several of the properties of BRJ mentioned above have been hypothesized to enhance athletic performance. For ‘example, betaine has been shown to favorably enhance performance outcomes.* However, the adlitve or synergistic effects of the constituents contained within BRI have not been extensively studied. Nevertheless, both anecdotal and scholarly evidence supports the use of BRJ to produce faster finish times, increase time to exhaustion,*" reduce stead state oxygen (O,) consumption,” increase peak power.” ‘and increase work rate at the gas exchange threshold (see Table 1). Therefore, this review will examine the impact 7 performance. ically of BRI, rather than each constituent, on athletic Beetroot, NO,,and NO Beetroot has a high NO, content (250 mg/100 g of fresh weight), among the highest assessed, and other foods high in NO, include spinach, celery, lettuce, and carrot juice." NO, can be reduced to nitrite via bacteria in the oral eav- ity and by specific enzymes (eg, xanthine oxidase) within tissues. There are several pathways to metabolize nitrite to NO and other biologically active nitrogen oxides." NO is a signaling molecule formed in the endothelium by the enzyme endothelium NO synthase, which triggers the vasculature to relax (vasodilatation) by interacting with vascular smooth muscle leading to increased blood flow.!5" NO facilitates increased blood flow at rest” and during exercise." Given these properties, NO has gained a lot of atention for possible exercise improvements including increased O. ‘glucose, and other nutrient uptake to better fuel working muscles. Bradley et al” and Balon and Nadler reported NO production contributed significantly to exercise-induced skeletal muscle glucose uptake, independent of skeletal muscle blood flow. Currently there is no means to provide NO supplementation through the diet, as itis a gas, thus BRJ and its high NO, concentration is used as @ means t0 ‘generate NO endogenously In fat, up until this point, much ‘of the support for NO use to improve exercise performance has relied heavily on “borrowed science” using amino acids such as L-arginine Much more impressive is the growing body of scientific data in support of whole food sources of inorganic NO, such as that found in BRJ, and improved athletic performance, BRJ, dietary NO,-, and exercise performance Aerobic exercise Lansley tal? examined whether the exereise performance benefits of BRI were attributed tits high NO, conten or its other potentially bioactive compounds. Nine healthy, physically active men consumed either 0.5 L of BRI (6.2 mmoliday of NO-) of 0.5 L of NO--depleted BRI placebo (0.0034 mmotiday of NO-) fr 6 days followed by ‘cute bout of submaximal and high-intensity (to exhaustion) running and incremental knee extension exercises. BRI consumption increased plasma nitrite by 105% and reduced the O, cos for constant workcrate moderate and severe-inten- sity runing by ~7% compared to placebo. In ation, time toexhaustion was increased during severe-intensity running by ~15% and incremental knee extension exercise by ~5¥% with BRJ compared to placebo.’ These findings suggest that the performance benefit (0, sparing and enhanced exercise tolerance) of consuming BRI is attributed to its high NO,- content, More recently, Murphy etal, using a double-blind placebo-controlled crossover trial, had eleven recreatonally fit men and women consume either baked bectrot (200 g ‘vith =500 mg NO) or an isocalrie placebo (cranberry relish) 75 minutes prior to performing a 5 km time trial (TT) treadmill no determine whether whole beetroot consump tion would improve running performance. They observed a nonsignificant, 41-second faster finishing time (12.3 = 2.7 versus [1.9 £ 2.6 kmyhour, respectively: P=0.06) following beetroot consumption compared to placebo. Interestingly. luring the last 1.1 miles (1.8 km) of the §km ran, running velocity was 5% faster (12,7 £ 3.0 versus 12.1 £ 2.8 km/ hour, respectively; P-0.02) and rating of perceived exer- tion was lower (13.0: 2.1 versus 13.7 1.9 respectively 'P-0.04) during the beetroot trial compared tothe placebo. Theauthors suggest that itrte levels may have continued 10 rise during the 5 km run, resulting in the late race benefits Therefore, it appears thatthe ingestion of whole-foodscon- taining inorganie NO, (such as betroot or BRI) inreases plasma nitrite and ultimately NO levels, which favorably ect the cellular and vascular pathways, which ikely result in the observed improvements in athletic performance For a summary, see Table | 2 ‘Nowion and Dietary Supplements 20135Beetroot and performance uns 45 240 Buinp sey ss hideaway = ‘Anoop Zuuuns w wwouDrosdan weBUBsuDN, « modi in es Kanooa4 5g a4 uoRanp s+ uorpue> >poui or soueifo 8% pours oaeond 10 (Con rou 8 fy pavenuasuo> jou oF aon 20 FON Bu gns= Yat 10011909 8 ooe poe 40 (SON foun €4) RIOT SLO de > te Aang pans arnopeeopuey 6 aewommewen consond 10 (FON wows re) NEIOTS0 — panMo poeRTopURY 8 armartiny eel CON aMz9) NBTSO —_-SosFOM pamopiny ‘ esol 0 CON 9 Appou 79) 810180 prRROPPenOPHEY 6 get fouey onpond 10 ‘ON AprouN 7S) NBTSO ——_sosson poumeg 8 arm ojemen onsond 19 FON Apnos13)FYBTSO._ parg-stqop paZOpUTY 6a dong sans hyn By pony x posenu pe ued mos expo o CON Apyout $9) 48010 8a fone ‘ouedpnaed poodas syuawiesouduy souewuoyiog sop tua asap hors ee ‘Sueung u safueyp ssueuuoqied 10; son! yoo.naq Bush yaieaso1 jo GENS | IGE, ‘Noviion and Dietary Siploments 20135Ormsbee et 21unp ‘4 simsfprais psoaps1 aye ys JO 1 O82 PUE TW OL + umuoyd ponds uo 9p 04 pomoup oom paseduo> aspioxo anes Apes Sup ‘On amo} # pam « soumusoyad 1 uo} 191 pono Anu ame ji0m 9 jurmeugns © Buunp “Op pasoMmo yg jo 0p ofus « ‘pmoadsas Bufo sawed yeod gg put wo "09 21 421 ue 91 4 Aa URI BSDIOKD pana fyB «| 09 0 spueuuoyod 10 S020 {OA V0 SDAHPON + ‘pauls fag ate eid a paren we SQ 5 doo using as U3 30 yo Ned Spud 1 Bump nso fy 0ye souBey Kaueys 210m Suonero209 aM EUs pouodss susworosdusy ouewoyog (1.0011 e pre suds roe pu0935-01 ny 39 Yo rupee 09 1 ppd ergrgnop paxHopuey ung sjnop pszopuey rqajnop pezxopuey yo qu 0g 10 (FON Tous) fue 0m OZ sep 21-4 1} 092204130 [4a J0-150 png 285 pozauopuey sep 910) ogped 2 fuB 10150 sep 920) ‘oqpn 10 Aepnisiom Apog yo yqOU L0}0 ep fas.10150 ep 9305 ‘ON seofousy BH 9A 200ns8g Ns NORMAREY ou Ag 01 ate 24kN yeh yeu pouren g spk oannatics g sojeuoanse ‘Ayeuone2.201 6 unset paviduc> 8) se 9 pany fA are 8 wD 1829 WORDEN, 89 puog pouen ojeu oz ett 0 4205 ‘suedpaed Joaquin ‘@onuve>) ‘Nowion and Dietary Supplements 20135Dover Beetroot and performance Power output and performance Given the impact of BRI on aerobic performance, it ‘would seem likely that BRJ would also favorably impact other markers of athletic performance. The effects of BRI Ingestion on power output, oxygen consumption (VO, and eycling time trial (TT) performance was examined by Lansley etal” using nine competitive male cyclists who con- sumed ether 0.5 L BRI (6.2 mmol of NO, )or placebo con- taining NO,-depleted BRI (0.0047 mmol of NO,”) before each TT of 4 km or 16 km. BRI consumption inereased plasma nitrite by 138% and resulted insignificantly reduced time to completion and increased power output during both the 4 km (2.8% and 5%, respectively; P=0.05) and 16 km TTs (2.7% and 6% ly; P=<0.05) compared to the placebo treatment.” Similarly, in a crossover study, Bailey et al!" supple mented eight healthy, recreationally active men with 0.5 L of BRJ (5.5 mmoliday of NO) or a low-calorie blackeur- rant juice cordial (negligible NO, content) for 6 days, and they performed moderate (80% gas exchange threshold) and intense cycling (70% of the differ Power output at the gas exchange threshold and VO, peak) protocols during the last 3 days. BRJ ingestion inereased the average plasma nitrite by 96% and reduced muscle deoxy- hemoglobin amplitude by 13%, suggesting that fractional O, extraction was reduced. In addition, BRJ consumption reduced the amplitude of the VO, slow component (defined asadelayed onset of VO, consumption during high intensity exercise Similarto the previous data reported these authors ‘concluded that increased dietary inorganic NO,- consump- tion from BRI has the potential to improve high-intensity exercise tolerance." While it appears that BRJ does improve exercise performance, the minimal time needed to use BRI for a performance benefit remains tobe elucidated, One attempt to answer these questions was reported by Vanhatalo et l.? These authors examined the effects of acute (1 and 5 days) and chronic (15 days) BRJ consumption on a moderate- intensity exercise bout (90% gas exchange threshold) and an ineremental eyele ergometer ramp test (inereasing work rate by 1 W every 2 seconds [30 W/minute) to exhaustion, Eight healthy subjects (five males, three females) con- sumed either 0.5 L BRJ (5.2 mmolday NO,”) or a placebo (blackcurrant juice cordial with negligible NO, content) for 15 days and were exercise tested on days 1, 5, and 15, Plasma nitrite was significantly inereased on all test days following BRJ compared to placebo. The O, cost of rmoderate-intensity exerese (inerease in VO, relative to the between the increase in external work rate) was lower during BRI inges- tion and was maintained throughout the 1S days (P00 effect size, 0.51), Maximal O, consumption (VO,max), peak power output, and the work rate associated with the anaerobic threshold were all higher following 15 days of BRI consumption compared to placebo and baseline con- ditions, In addition, systolic and diastolic blood pressures were reduced by 4 mmHg (~ ‘Compared with placebo, systolic blood pressure was significantly lower at 2.5 hours as well as at 2, 12, and 15 days post-ingestion of BRI (95% confidence interval =12.4 101.1; P<0.05) The mean diastolic blood pressure as significantly different between groups (P=0,003) and ‘decreased with BRJ compared to placebo (95% confidence imerval 4.3 to-1.3; P<0,01). The authors concluded that acute (1-$ days) dietary NO, supplementation significantly decreased blood pressure and the O, cost of submaximal ‘exercise and increased VO, max and peak power output, and these outcomes were maintained for atleast 15 days with continued BRJ supplementation."® While more studi agree with these findings. not all agree. Interestingly, Christensen et al* recently noted that in highly trained cyclists with an average VO, max of 72 + 4 mL/kg/min, consuming 0.5 L of BRJ had no effect on performance. ‘This suggests that the impact of BRJ may be influenced by the training status of the individual consuming this product (see Table 1). In nonathletie populations, the impact of BRI may also have a positive influence. In fact, Kenjale et a” studied patients with peripheral arterial disease to test whether BRJ would increase plasma nitrite and exercise tolerance and decrease muscle fractional O, extraction, Eight partici pants consumed either 0.5 L of BRI (18.1 mmol/L NO,-) ‘or an isocalorie placebo on two separate occasions, while performing an incremental, graded treadmill running tes. The increased plasma nitrite following BRJ consumption ‘was associated with increased exercise tolerance (walked 18% longer before claudication pain onset and experienced 217% longer peak walking time) and decreased fractional (0, extraction. Thus, these findings support dietary NO,- ingestion, inthe form of BRJ, increases nitrite-related NO signaling, resulting in enhanced peripheral tissue oxygen- ation in hypoxic areas and increased exercise tolerance in individuals with peripheral arterial disease.” While it appears that BRJ supplementation may be useful for both athletes and nonathletes alike in order to improve aerobic ‘exercise performance, the impact of BRJ on resistance exercise performance is not as clear. % and ~5%, respectively) ‘Noviion and Dietary Siploments 20135 3IOrmsbee et Dove BR) and resistance exercise Extremely limited research has been conducted on the eects ‘of BRJ and resistance exercise In ation. only three stud- ies to date have been published that investigate the use of betaine (a major BRI constituent) on resistance exercise performance" The findings from these betaine studies ‘re equivocal, with the overarching theme being @ modest improvement in resistance exercise performance. With specific regard to BRI on resistance exercise petforman tionally active males (age 28 +7 years) to consume either 0.5 Liday of BRI (5.1 mmol/day NO,") or a placebo (blackcurrant juice cordial with negligible NO, content) for 6 days During the last 3 days of supplementation, participants completed low and high (15% and 30! tary isometric contractions, respectively) intensity “step” knee extension tests, Results indicated that BRJ more than doubled plasma nitrite concentrations and resulted in @ 25% reduction in pulmonary VO, from rst 10 low-intensity ‘exercise! In adltion, BRI consumption resulted ina 36% reduction inthe amount of phosphocreatine (PCr) degraded uring low-intensity exetesecknee extensions) anda 39% reduction during high-intensity exercise compared to pla- cebo." These reductions in PCr usage were accompanied by a reduction in the total ATP utilization during both high and low-density exercise. However, the authors speculate thatthe reduced O, cost may be due roan improved cou pling between ATP hydrolysis and skeletal masce force production rather than an increased mitochondrial phos- phate/O, ratio (P/O ratio), which is the number of inorganic phosphate (Pi) molecules used for ATP synthesis for every O, consumed."' Another intriguing finding of this study svas «25% increased time to task failure (knee extension ‘exercise in all seven participants that consumed BRI. This, may be a result of sparing PCr stores and reducing the O, Bailey et al! enlisted seven re maximal volun- BRJ and hypoxic conditions Compelling research is highlighting the effectiveness of performing exercise under moderate hypoxi conditions to improve performance." To determine whether the dietary NO,” in BRJ would improve metabolism and oxidative function in musle during hypoxic conditions, Vanhatalo ‘et al” performed a double-blind crossover study with nine healt pancpants, moderately trained in recreational spor. The participants consumed ether 0.75 L of BRS (93 mmol NO, JoraNO, deplete pacebo (0.006 mmol NO, before performing low (28 + 2 W) and high intensity 48 + 4 W) knee extension exercises to exhaustion. These exercises were performed under normoxic (control) and hypoxic (14.45% + 0.05% 0.) conditions, witete the percentage of (0, was controlled by a filtration system. BRI reduced hypoxic muscle metabolic " indicated by PCr degra- dation and Pi accumulation) during high-intensity exercise and returned exercise tolerance to normoxic conditions, In addition, BRJ eliminated the reduction in the PCr recovery rate with hypoxia." These findings suggest BRJ consumed under hypoxic conditions provides an additional perfor- mance stimulus to working muscle and allows participants to function as if in a normoxic environment, Practically, this research implicates that athletes may benefit from BRI consumption when working at very high-intensities and/or at altitude by enhancing O, utilization. Overall, the majority of the published rescarch indicates a benefit for athletes from BRJ supplementation. Dosing of BR) and dietary NO, Its important to note thatthe acute dose of NO used in research tues ranges from 5.1 mmol (0.32 g)to 18.1 mmol (1.12 g) which is four to 12 times greater than the typical daily dictary NO intake in the United States.” Mechanisms of action for BRJ Several mechanisms have been postulated for the various exercise improvement effects of BRI. A reduction in PCr degradation and the reduetion of build-up of adenosine diphosphate (ADP) and Pi at the same relative exereise inten- sity following BRI consumption” ar likely mechanisms responsible forthe decrease in O, cost (oxidative phospho- rylation) of exercise and increased time to exercise failure (reduced muscle fatigue). Indeed NO may Tessen fatigue at the same exercise intensity dt to a slowing of eross-bridge cycling kinetics by reducing calcium (Ca) sensitivity by decreasing the numberof eross bridges in the force gen- crating state or by inhibiting the mechanical properties ann! adenosine triphosphatase activity of myofibi.” NO also modulates ryanodine receptor (Ca relense channels) aetivty by S-nitrosyltion or oxidation of several classes of eysteine residues associated with the protein, thereby affecting Ca® release” and inhibiting Ca°-adenosine triphosphatase activity.” Consequently, these data suggest that BRJ may have a regulatory influence on the ATP cost of force production." Larsen el! reportd that muscle mitochondria extracted ater NO, supplementation indicated an improvement in oxi- dative phosphorylation efficiency (P/O ratio anda decrease 2 ‘Nowion and Dietary Supplements 20135Dover Beetroot and performance in state 4 respiration (basal respiration associated with maintenance costs). The improved mitochondrial P/O ratio cor related witha reduction in O, cos at rest and during exercise. Those authors" and others" indicate that NO,” reduces the expression of ATP/ADP translocase, an enzyme involved in proton conductance." ATP/ADP translocase is a transporter provein tha filtates the mobilization of ATP and ADP into and out ofthe inner mitochondrial membrane for ATP use." Several proposed mechanisms for BRJ to enhance PCr! musele recovery duting hypoxia, such as that experienced during high-intensity exercise scenarios, include increased efficiency of mitochondria and increased delivery and per- fusion of O, to working muscles.” Whether overall eelular metabolism is enhanced is yet to be determined. It is possible that gene expression regulation, mitochondrial biogenesis, immunomodulation, and cell eycle/apoptosis control also account for the ergogenic effects of BRL"! Antioxidant benefits While improvements in performance of both aerobic and anaerobic exercise are reported via numerous proposed mechanisms, the impact of BRJ serving as a potent dietary antioxidant must be explored. As such, the antioxidant capa- bilities of BRI and its constituents could further enhance the ability to sustain exercise, oF possibly, aid in recovery from exercise. Intense exercise, especially to exhaustion, has been shown, to inerease free radical concentrations in the muscles and liver by two to three times. Interestingly, several recent investigations have examined the potential antradical prop- erties of certain constituents of BRJ, namely betacyanins and betaxanthins, the main pigments of red beetroots In audition, Kanner et al reported that linoleate peroxidation by cytochrome ¢ was inhibited by betanin from red beets It was suggested that regular beetroot consumption may provide protection against certain oxidative stress-related disorders in humans, and therefore may serve as useful strategy to enhance recovery from exercise and subsequent exercise performance. Conclusion Research examining the efficacy of BRJ as an exercise enhancer appears to support its use. Most studies have shown BRJ or its constituents to increase number of repetitions, power, and time to fatigue.” "*"* However, while at least ‘one of these performanee improvements is typical, they are not all observed in each of these studies. NO, from BRI, ‘working alone or synergistically with other components of BRJ, has demonstrated a reduced O, cost of exerci ‘The primary mechanism of action for the efficacy of BRI to improve performance appears to be related to muscle bioenergetics, specifically attenuating the decline in PCr concentrations, coupled with enhanced efficiency of oxida- tive phosphorylation. However, more research is required to fully elucidate all of the potential mechanisms. Of note for consumers, the effective dose yielding performance ‘nd health benefits in scientific research studies of dietary NO} is approximately 1,500 mg/L."2" Nevertheless, BRI appears to improve performance without any side effects, although more standardized research methods may be needed to clarify the above findings as well as potential contraindications of BRI for endurance athletes (ie, pote tial hypotension eoncems from over consumption of NO,” Interestingly, other constituents of BRU, such as betalain, betaine, betanin, betacyanin, and betaxanthin, may offer additional performance and antioxidant health! benefits, albeit via alternate mechanisms Acknowledgments ‘Theauthors would ike to thank Amber Kinsey and Ann Frost for technical assistance in preparing tis review article Disclosure ‘The authors report no conflicts of interest in this work, References 1. Nutrition business jourma’s supplement business report. Nutrition Busines Journal, 2010232956 2, Bene {webpage onthe tet] Baltimore, MD: Universit of Maryland “Medicl Center 21 updsted May 7, 2013). Available fro: parm, ‘sheathed aimed ppiement etsne. Aesesed ane 2013 3. Eseribao J Podeebo MA, Gaes-Carmona F MuiozR.Charsetrzation ofthe antracalaetvity of tains from beta vulgaris L. rots Photochem Anal 1998393) 124-127 4, Kanner , Harel S, Grant R Betltins anew clas of itary catoniaed ttinidants Agric Fd Chem, 20014 1)S17S-SI8S. 5, Deopoulou Paogiotaos DB AnionapouluS Piss, StetanadisC Dietary choline and fst intakes in relation to concentrations of| inlamamatey’ markers in belly adults: the ATFICA study. Ame Clo Nur. 2008;872)424 430, “Trepanowsk JE, Famey TM, McCarthy CG, Schilling BK, Cnig SA Bloomer Rl. The eet of chronic besine suplemenation on 8 ‘ise performance, skeletal muscle oxygen satration and nssocited bochenical parameters ia esisance ned men.J Sength Cond Res 2011 28(1243461-3471 7. Lansley KE, Winyard PG, Bailey St a. Acie dietary nitrate upple- mentation improves ying time til perfomance Med Se Sports Exar 2011:436)1125-1131 8, Murphy M, Eliot K, Heuer RM, Weis E. Whole esto consumption scat improves runing performanse. J Acad Net Dit, 20121128) Sie 59, 98, Latsley KE, Winya PG, Flor tal. Detay nite spplementation recs tho 02 cos of walking and runing: placabo-coaoled sud App Pio. 201131 10(3)891-600. 6 ‘Noviion and Dietary Siploments 20135 3Ormsbee et Dovepress 10, Bailey Sh, Winyand Vantaa A ta Distr irate supplementation reduces the 02 cost of low-intensity exercise and enhanees tolerance to hihsintensity exercise in uma. Appl Po. 2008; 1070: Mae I13s, 11, Bailey’ 8, Pfr, Vantaa ta: istry nitrate supplementation enances muscle contact efficiency dving newextensor exercise in mane ppt Pho. 201010941 138-148, 12, Vanhatlo A Batley S, Blackwell JR, etal. Acuteand chronic efetsof tary irate supplementation on blvd pressure andthe py solic responsestomoderatitensity and incremental excise. 4avJ Pisol Regal Iter Comp Physiol. 201029918) RUDI-RISL 1B, Hord NG, Tang ¥, Bryan NS. Food sources of nitrates and nities: the pysilogi etext fo potential health beets. dn J Cla Nut 2009:90(h- 1-10. 14, Larsen FI, Scifer TA, Boriguel S, eal Dietary inorganic irate improves mitochondaefcency in humans Cell Meta. 20115182): 149-159, 15, Webb AJ, Patel N, Loukogeowabis, et a, Acute blood pressure Fowering, vasopotcetve and antilateet properties of dctary nite a bioconversion to nitrite, Hypertension. 208:81(: 784790 16, Maines A, O'Driscoll G, Taylor R, Green D. Exersie andthe nitric oxide vasodilator syst. Sports Me. 2003:33(14)-1013-1035, 17, Hiokner RC, Fisher JS, Fant AA, Kabet WM. Role of nite oxide in skeletal muscle blood flow a estan! ding dynamic exesise in humans. A.J Physiol 197-273(1 Pes H405- HAO. 18. Gilligan DM, Panza JA, Kilsyne CM, Waclaviwe MA, Casino PR, (Quyyumi AA. Contribution of eadothlium-deived nivie oxide to sxeciae induced vacation, Cinulation 194 96)2885-2858 19, Bradley SJ, Kingwell BA, McConell GK, Nitric oxide synthase inhibition reduces eg glucose uptake bt et blood No: during yale rcse in mans, Dates, 199:48(9; 115-1NZL, 20, Balon TW, Nadler JL Evidence that nivie oxide increases plocose transport in skeletal muscle. J App! Pho 19973821 389-363, 21. Bloomer RJ, Nivie axide supplements for spr. Siren Cond J 2010:32:14-20. 2, Kelly J, Vantaa A, Wikeron DP, Wyle LI, Joes AM, Effects of nitrate onthe power-dration elanship for severe intensity exercise Md Sei Spots Ever, 2013:38(9):1798-1806, 23, Jones AM, Vanhatalo A, Bailey SJ Influence of ditary aitate ‘unplementton on exercise tolerance and performance, Neste Nar Inst Workshop Ser. 2013:7827-40 24, Muggerige DJ, Howe CC, SpeniffO, Pella C, James PE, Eason C The effects of a single dose of concentrated beetroot jules on performance i tesined Batwater kayakers. In J Sport Nutr Exere Metab. Epub Apel 9, 2013, 25, Wylie LI, Kelly J, Bailey Si, etal Beetoot juice and exercise: Pharmacodynamic and dose-response relationships. J Appl Plast Do13.115(3)325-336 26, Christensen PM, Nyberg M, Bangsbo J. Influence of nitrate supplementtion on VO. kinetic andendurance oft eycliss Scond | Med Sei Sports 201324 1)e21-e 27, Keajale AA, Ham KL, Stabe, tal. Dietary nits supplementation enlances exercise performance in poigheal atrial disease J Appt Physiol 201151106 1582-1591 28, Hottian JR, Ratamess NA, Kang J, Gonzalez AM, Beller NA, Craig SA. Eifect of 15 days of betaine ingestion concealed escent free outputs during isokinetic exes. J Sonath Cond Res 2011,25(8,2235-2241 28, Lee BC, Maresh CM, Kraemer WI, eta. Ergogenc effects of betaine supplementation on suenth and power performance. JI Soe Sports Nut. 2010572, 20, Masschelein E, Van Thienen R, Wang X, Von Schepae! A, Thoms M, Hespel PDistary nitrate improves musele bu not cerebral oxs3en- ation satus during exereise in hypoxi. J App! Psiol, 20121188) T6-T, #4. %6. ” 8 x. 4 2. 4. 45 ao. ”. 50. Wang J8, Wu MH, Mao TY, Fu TC, Hsu CC. Eifets of nommoxic and hyposieexereise regimens on calc, muscular and erebral hemodynamics suppessdby severe hypoxia ia humans. pp Pnsiol 2010;105(1; 219-22 ‘antl, Fulfo ,Baiey SI Blackwell, Wind PG, anes AM. Dietary nitrate reduces muscle metabolic perturbation and improves exercise tolerance in hypoxia. J Physiol. 2011558 2: 817-5528 “Mensinga TT Speiiers Gi, Mevlenbelt J. Health implications of| ‘exposure fo environmental mitogenous compounds. Taco! Rev. 2003221.41-31 Hanks LM, Cody MU. Giger PC, Dethuizen PN, Sick GC. Nitric ‘ide irpsirs Ca2+ activation and kos eratbridge cylin Kinetics in skeletal muscle. J App Psi. 200191(3}:2288-2239 Galler 8, Hilber K, Gabesberger A. Effects of nitric oxide on foce- generating ptsine of skeletal muscle, Pagers drei: 19743403 22 2s, Hart 1D, Dlluaty AF. Nit ovide ctivates inhibits skeletal sce ryanodine eeptrs depending on is concentration, membrane penta an ligand binding. J Membr Biol. 2000:1733)227 236 Viner RI, Williams TD, Schéncich C. Nitric oxide-dependent modification of th sarcoplasmic raiulum Ca-ATPase: localization ‘of eytene target sites. Fee Radic Bal Med 200026) 489 196, Berg IM, Iymoczko IL, Stet L. Biochemistry the San Francisco, (CA: WH Freeman: 2007 ‘Thomas DD, Lis X, Kanto SP Lancster IR The bile iene ‘fue oxide: implications forthe pesasula dynamics of NO and (02. Pr Nat Acad Se US 4. 2001981 1)385-360. Hagen T Taylor CT, Lam & Moncada S. Redistribution of inaelular jxygen in hypoxia by nitric oxide effect on HIFIalpha. Science 2003:302(5682 1978-1978, Viet VM, Nuiez C,D'Océa P Taylor T, Fsplugues JV, Moncada S. Regulation of oxygen distribution in tssos by endothelial nit oxide. Cire Res 2009104 10 1178-1183, Davies Ki, Quintana AT, Brooks GA, Packer L. Free radials nd tissue damage produced by exercise. Biohem Biophys Res Commun 19821074 1198-1205, Hoon MW, Johnson NA, Chapman PG, Burke LB. The effet of tate supplementation on exercise performance in healthy individuals ‘systematic review and meta-analysis JJ Sport Nur Exe Metab Epub april, 2013, Pryor I, Craig SA, Swensen Elect of betaine supplementation on eyeing seit performance J la Soe Sports Nu 2012112 Vashatalo A, Fulford) DiMlenn HJoaes AM. lnuence of hyperoxia ‘on muscle metabolic responses ad the power dirtionreatonship ‘during severe-inteasity exereise in humans: 2 31P magnetic rsoaance Spectroscopy study Exp Physiol. 2010:988):528- S40 Cermak NM, Gibala MI, van Loon LI. Nate supplementation improvement of Ik ie-trilprformancein rained cyci Int] ‘Sport Nur Bxore Metab. 2012221164 Cermak NM, Res P, Sinkens R, Lundberg 10, Gibala MI, van [Loon LIC. No improvement in endurance performance after single ose of beewoot juice. fat J Sport Nutr Exere Metab. 2012226) 400-418 Bond H, Morton L, Braakhuis AJ. Distary nitrate supplementation improves owing performance in welltsinel ower. ft J Spt Nir Bxere Mewb. 2012:224)281-256 Wilkerson DP Haynard GM, Baily Sl, Vanhatlo A, Blakwell JR, Jones AM. Infsene of acidity nist plementation on 0 mie time tral performance in welltsined cyclist, Eur J Apo! Phys 2012;112(12)4127-4134, Mugucrdge DI, Howe CC, SpenifO, PedlarC, James PE, Easton C A single dose of beetroot juice enkances cycling performance in simulated alte. Me Se Sports Ener Epa July 10,2013, M ‘Noertion and Distary Supplements 20135Dovepress Beetroot and performance Nutrition and Dietary Supplements Publish your work in this journal ution and Dictary Suplements is an intmational,peerzeviewed, fpen accessjoumal fos on research nt tional requirements Iheath and dlsease impact on metabolism and the Wenication ad ‘pial se of dietry atateges and supplements necessary for nor tal growth and development. The jour weleomes papers coven Dovepress ‘tiginal research, basic science; clinical & epidemiological studies, ‘eviews and evaluations, guidelines expet opinion and commentary, ase reprtsand extended reports The manuscript manggcrent system {ecompletely online and includes «very guick and far peersevew ‘system: which sal cay tous ‘Novton and Dietary Supplements 201355 35