British Journal of Nutrition (2022), 128, 1130–1136 doi:10.1017/S0007114522002434 © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
A compound that is increased in healthy dietary patterns, as it is closely associated with fruit and vegetable intake, is dietary nitrate(27). It is estimated at the population level, in Western countries, that dietary nitrate intake is approximately 110 mg/d(28)
A previous review(27) estimated that the nitrate content of healthy dietary patterns, such as the MedDiet or DASH diet, could be 10-fold higher (approximately 1000–1200 mg/d) than the estimated average nitrate intake of Western populations (approximately 110 mg/d)(28) and considerably higher than the level of nitrate intake currently recommended by the WHO (3·7 mg/kg of body weight (corresponding to approximately 280 mg/d for a person with a body weight of 70 kg))(29)
The protective effects of dietary nitrate on cardiometabolic and neurocognitive health have been consistently reported in randomised trials(19,30). The protective effects of higher levels of nitrate intake (approximately 400–800 mg/d) on cardiometabolic and neurocognitive health have been consistently reported in randomised trials(19,30).
Some studies have also suggested an interaction with ageing such that older individuals may need higher nitrate doses to elicit similar effects on vascular outcomes to those observed in younger groups(31,32).
Mario Siervo1*, Abrar Babateen2,3, Mushari Alharbi1,4, Blossom Stephan5 and Oliver Shannon2 1 School of Life Sciences, The University of Nottingham, Medical School, Nottingham, UK Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK 3 Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah, Saudi Arabia 4 Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia 5 Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK 2 (Submitted 19 July 2022 – Final revision received 21 July 2022 – Accepted 22 July 2022)
Abstract
Dementia is a significant public health priority with approximately 55 million cases worldwide, and this number is predicted to quadruple by
2050. Adherence to a healthy diet and achieving optimal nutritional status are vital strategies to improve brain health. The importance of this area
of research has been consolidated into the new term ‘nutritional psychiatry’. Dietary nitrate, closely associated with the intake of fruits and
vegetables, is a compound that is increased in dietary patterns such as the Mediterranean and MIND diets and has protective effects on cognition
and brain health. Nitrate is characterised by a complex metabolism and is the precursor of the nitrate–nitrite–nitric oxide (NO) pathway con-
tributing to systemic NO generation. A higher intake of dietary nitrate has been linked to protective effects on vascular outcomes including blood
pressure and endothelial function. However, the current evidence supporting the protective effects of dietary nitrate on brain health is less
convincing. This article aims to provide a critical appraisal of the current evidence for dietary nitrate supplementation for improving brain health
and provide suggestions for future research. Dietary nitrate and brain health
The pre-clinical and clinical data herein summarised suggest that diets rich in nitrate may prevent, reverse or mitigate the physiological decay observed during healthy ageing or age-associated disorders. Cardiovascular dysfunction, neurological deficits and metabolic impairment are the major causes of morbidity and mortality among older adults but nitrate supplementation is now emerging as a nutritional approach to enhance cognitive and functional abilities in the elderly. However, some questions remain to be answered. For instance, given that nitrate improves muscle mitochondrial function and oxygen consumption in young volunteers, how would it impact in •muscle mitochondria in older adults? Would changes in NO bioavailability in old subjects interfere with the mitochondrial effects of nitrate observed in young populations? May mitochondrial function and intracellular calcium handling concur to improve muscle contractile function in old subjects? Finally, given the prevalence of metabolic disorders in the elderly, it is mandatory to translate the antidiabetic and antilipemic effects of nitrate observed either in rodents or young volunteers to old populations. Thus, the impact of nitrate in the healthy life expectancy should now be studied in large multicentre trials to ascertain if nitrate-rich diets or supplements could be used in the more generalised context of gerontology.
🔎 Detailed Recent Studies (2021–2025):
Kim, D.J.K., et al. (2024).
Effects of short-term dietary nitrate supplementation on exercise and coronary blood flow responses in patients with peripheral artery disease.
Findings: Short-term inorganic nitrate supplementation improved coronary blood flow and exercise tolerance in patients with peripheral artery disease (PAD).
Note: Benefits extended beyond peripheral circulation to coronary perfusion.
📄 Read Full Study (Frontiers in Nutrition)
📄 PDF Version
Ferdina, A.R., & Setiawan, M.I. (2024).
Role of Dietary Nitrate for Human Health: A Narrative Review.
Findings: Emphasizes that nitrate from natural sources (like beetroot juice) is safer. Discusses that inorganic nitrate elevates NO bioavailability and lowers blood pressure but warns of over-supplementation risks.
📄 Read Full Study (Iraqi Journal of Pharmaceutical Sciences)
📄 PDF Version
Benjamim, C.J.R., & da Silva Gonçalves, L. (2025).
Restoring nitric oxide production using dietary inorganic nitrate: recent advances on cardiovascular and physical performance in middle-aged and older adults.
Findings: Inorganic nitrate supplementation led to improved vascular health, reduced arterial stiffness, and enhanced physical performance in older adults.
Caution: Long-term safety remains unverified for high or continuous dosing.
📄 Read Full Study (Medical Gas Research)
📄 PDF Version
📚 Summary Table:
Study Population Outcome Notes
Kim et al. (2024) PAD patients Improved coronary blood flow and exercise capacity Short-term benefit
Ferdina & Setiawan (2024) General population Boosted NO levels, lowered BP Prefer dietary sources
Benjamim & Gonçalves (2025) Middle-aged and older adults Reduced arterial stiffness, better performance Need more long-term studies
🧠 Key Points to Remember:
Short-term nitrate supplementation is beneficial in improving vascular and exercise outcomes.
Long-term safety is still uncertain.
Vegetable-based nitrate is safer than isolated chemical forms.
Clinical use is not yet fully mainstream without medical supervision.
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You said:
Is there research data addressing the inorganic nitrite and nitrate supplementation and the prevention or reversal of dementia.
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Here’s what the latest research says about inorganic nitrate/nitrite supplementation and dementia prevention or reversal:
🧠 Collective Insight (Overview):
Recent studies suggest that inorganic nitrate and nitrite supplementation could improve cerebral blood flow, enhance cognitive performance, and potentially slow cognitive decline associated with aging. However, while small short-term trials show positive trends, no large clinical trial has yet conclusively proven that these supplements can prevent or reverse dementia.
Cognitive benefits seem largely vascular-mediated — improving blood supply to the brain — rather than directly reversing neurodegeneration. Dietary sources (vegetables) are preferred over synthetic supplements.
🔍 Selected Key Studies (2021–2025):
Rocha, B.S. (2021).
The nitrate-nitrite-NO pathway on healthy ageing.
Finding: Acute nitrate supplementation boosts plasma nitrite and enhances brain perfusion in older adults.
Potential for dementia? Promising, but reversal of dementia not yet demonstrated.
📖 Full article
📄 PDF
Shannon, O.M., et al. (2022).
Dietary nitrate, aging, and brain health: the latest evidence.
Finding: Dietary nitrate improved cerebral blood flow and executive function in small studies.
Caution: Most studies were short and lacked dementia-specific endpoints.
📖 Full article
Clifford, T., et al. (2019).
Effects of inorganic nitrate and nitrite on cognitive function and cerebral blood flow: A systematic review and meta-analysis.
Finding: Positive effects on cerebral blood flow but only modest or no improvements in memory and executive function.
📖 Full paper
📄 PDF
Siervo, M., et al. (2022).
Dietary nitrate and brain health: Too much ado about nothing or a solution for dementia prevention?
Finding: Higher dietary nitrate intake correlates with better cognitive function in cross-sectional studies, but no RCT confirms dementia prevention.
📖 Full article
📄 PDF
Justice, J.N., et al. (2015).
Sodium nitrite supplementation improves motor and cognitive function in middle-aged adults.
Finding: Sodium nitrite improved motor skills and cognitive function biomarkers in healthy older adults.
Scope: Not focused directly on dementia patients.
📖 Full article
📄 PDF
Kelly, J., et al. (2013).
Short-term dietary nitrate supplementation on cognitive function.
Finding: Nitrate supplementation increased frontal cortex blood flow, but did not significantly enhance cognitive performance.
📖 Full article
📄 PDF
Wang, Y., et al. (2022).
Nitrate metabolism and ischemic cerebrovascular disease.
Finding: Suggests nitrate therapy may benefit vascular dementia by enhancing cerebral perfusion.
📖 Full article
📄 PDF
Carballo-Casla, A., et al. (2023).
Could dietary nitrate affect dementia development?
Finding: Theoretical models suggest benefit, but clinical evidence is insufficient to recommend nitrate supplementation to prevent dementia today.
📖 Full article