What to Combine Beetroot Nitrate With

Beetroot nitrates are rarely taken in isolation: athletes combine them with caffeine, citrulline, creatine, and other supplements. The editorial team examined which combinations have biological logic, what research says about their effectiveness, and which combinations are better not practiced.

Why combine nitrates with other supplements

Beetroot nitrates are on the short list of supplements to which the consensus of the International Olympic Committee (Maughan et al., 2018) grants a sufficient evidence base. Alongside them on this list are caffeine, creatine, beta-alanine, and sodium bicarbonate. So it is quite logical that athletes ask: can these agents be combined, and do their effects add up?

The short answer: combining is usually possible, but you should not expect an automatic 'addition' of effects. Each supplement acts through its own mechanism, and in real conditions the gain from a combination often turns out to be less than the sum of the individual effects. In addition, each new ingredient is an additional risk of gastric discomfort on competition day.

The editorial team examines combinations from three positions. The first - whether they have biological logic, that is, whether they act through different mechanisms. The second - whether there is research on the combination specifically, not just on the individual components. The third - practicality: whether it will be possible to take everything at the right time without stomach problems.

Separately, we will talk about 'anti-combinations' - substances and habits that weaken the action of nitrates or make combining them risky for health.

Nitrates and caffeine

Caffeine is the most popular ergogenic supplement in the world. It acts mainly on the central nervous system, blocking adenosine receptors, reducing the sense of fatigue and effort. Nitrates, on the other hand, work in the periphery - in blood vessels and muscles. Theoretically, such different mechanisms could complement each other.

Studies of the 'nitrates + caffeine' combination have been conducted, but they did not reveal unambiguous synergy: in several works caffeine produced its effect, and adding nitrates did not substantially enhance it. The reviews by Jones et al. (2018) note that the data are so far contradictory, and the combination does no harm but also gives no guaranteed bonus.

In practice, the combination is possible if timed correctly. Nitrates are taken 2-3 hours before the start so that the nitrite peak coincides with the exercise. Caffeine at a dose of about 3-6 mg per kilogram of body weight, according to the IOC consensus, is most often taken about an hour before the start. Lower doses can also be effective and are better tolerated.

It is worth considering that both caffeine and large volumes of juice can irritate the stomach. So the combination must be tested during training rather than for the first time on competition day.

Nitrates, citrulline, and arginine

Citrulline and arginine are substrates for the 'classic' pathway of nitric oxide formation through the NO synthase enzymes. Nitrates, on the other hand, feed the alternative nitrate - nitrite - NO pathway, which is most active in tissues with low oxygen content (Lundberg et al., 2008). On paper this is an ideal pair: two independent sources of one signaling molecule.

In practice, however, there is so far a small number of studies of the combination of citrulline with nitrates, and the results are inconsistent. The evidence base for citrulline itself as an ergogenic supplement is weaker than for nitrates, and arginine reaches the systemic circulation poorly because of active breakdown in the intestine and liver.

So if you want to influence the nitric oxide system, the editorial team advises starting with nitrates in doses confirmed by research. Citrulline can be considered an additional experiment, understanding that there is so far little evidence of its benefit in combination with nitrates.

Many 'NO boosters' contain both citrulline and beetroot, but the nitrate doses in them are often token. Before relying on such a mixture, check exactly how much nitrate you get per serving.

Creatine, beta-alanine, bicarbonate, and carbohydrates

Creatine increases phosphocreatine stores in the muscles and works in short-term explosive efforts and in gaining mass. It is taken daily regardless of training time, so combining it with nitrates creates no timing problems. There is no direct evidence of synergy, but there are no reasons to avoid such a pair either.

Beta-alanine increases carnosine levels in the muscles and helps in exercise lasting about 1-4 minutes. It is also taken daily over weeks. Sodium bicarbonate, by contrast, is taken acutely 1-3 hours before the start, and it often causes stomach problems. Combining bicarbonate with beetroot juice is risky precisely from the standpoint of the stomach, so such a combination should be tried very carefully.

Carbohydrates are the basic fuel for endurance. Beetroot juice itself contains sugars, so it is convenient to combine with a pre-start meal. There is no contradiction between carbohydrate nutrition and nitrates.

What to avoid together with nitrates

The most important 'anti-combination' is antibacterial mouthwashes. Govoni and colleagues (2008) showed that they sharply reduce the formation of nitrite after nitrate intake. Kapil and colleagues (2013) found that regular use of a chlorhexidine mouthwash even raised blood pressure. If you take nitrates, it is better to give up antiseptic mouthwashes during this period.

The second group is medications. PDE-5 inhibitors (sildenafil, tadalafil) and medicinal organic nitrates affect the same nitric oxide system. Combining concentrated nitrates with these drugs, as well as with antihypertensive agents, can excessively lower blood pressure. Such a combination is possible only after consulting a doctor.

• Antiseptic mouthwashes and chewing gums - weaken the effect.
• Blood pressure medications, PDE-5 inhibitors, organic nitrates - only with a doctor's permission.
• Nitrate and nitrite salts - do not use as an 'enhancer'; sodium nitrite has caused fatal poisonings.
• Several new supplements at once on competition day - a high risk of stomach problems.

Interestingly, combining nitrates with vegetables rich in vitamin C and polyphenols is, on the contrary, advisable. These substances, according to reviews, promote the formation of nitric oxide from nitrite and inhibit the formation of nitrosamines (Hord et al., 2009). A salad with leafy greens is an excellent 'partner' for a beetroot shot.

Finally, remember the general rule: the more ingredients in your pre-start protocol, the harder it is to understand what exactly is working and what is interfering.

Editorial conclusions

Beetroot nitrates are well compatible with most evidence-based sports supplements - caffeine, creatine, beta-alanine, carbohydrates. However, there is no convincing evidence of synergy for most combinations, so you should not expect a 'double' effect.

The most important thing is correct timing and avoiding what negates the action of nitrates: antiseptic mouthwashes and ill-considered combinations with drugs that affect blood pressure.

For a deeper understanding of the topic, we recommend our materials 'How to take beetroot nitrate: dosage, timing, duration,' 'Who should not take beetroot nitrate,' and 'The benefits of beetroot nitrates for athletes: the evidence base.'

References

1. Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
2. Jones AM, Thompson C, Wylie LJ, Vanhatalo A. Dietary nitrate and physical performance. Annu Rev Nutr. 2018;38:303–328.
3. Lundberg JO, Weitzberg E, Gladwin MT. The nitrate–nitrite–nitric oxide pathway in physiology and therapeutics. Nat Rev Drug Discov. 2008;7(2):156–167.
4. Govoni M, Jansson EA, Weitzberg E, Lundberg JO. The increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash. Nitric Oxide. 2008;19(4):333–337.
5. Kapil V, Haydar SM, Pearl V, et al. Physiological role for nitrate-reducing oral bacteria in blood pressure control. Free Radic Biol Med. 2013;55:93–100.
6. Hord NG, Tang Y, Bryan NS. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. Am J Clin Nutr. 2009;90(1):1–10.
7. Webb AJ, Patel N, Loukogeorgakis S, et al. Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension. 2008;51(3):784–790.