nitric oxide beets

Nitric Oxide: A Key to Peak Athletic Performance


By Dr. Rick Cohen, MD
Creator of PureClean Performance

All athletes want to improve performance, so we optimize our training, get plenty of sleep, and focus on the foods we eat. Even so, there’s an important nutrient many athletes still don’t know enough about: nitrates. More specifically, it’s what your body can do with nitrates that should be of great interest to athletes.

Nitrates and Nitric Oxide

Only a few decades ago, scientists discovered the connection between nitric oxide and blood flow. In the presence of NO, blood vessels relaxed, which improved blood flow and reduced blood pressure. At the time, this led to great insights and developments in the treatment of cardiac patients and people with essential hypertension. As more research emerged, the scientific understanding of NO’s roles throughout the body grew.

Because NO is a gas that diffuses rapidly across cellular membranes, it’s involved in many physiological processes. When released inside the body, this gas quickly and easily penetrates cells, promoting optimal, physiological function.

NO is produced 3 ways in your body:

1. It is secreted by the cells in the inner lining (endothelium) of your blood vessels.
2. It is converted by oral bacteria from your intake of nitrates from the foods you eat.
3. It is created by bacteria on our skin when we are exposed to adequate amounts of sunlight.

NO enhances oxygen delivery and blood flow.

From an athletic perspective, nitric oxide’s primary role is to regulate the delivery of oxygen to muscles, It does this by relaxing and opening blood vessels, subsequently improving blood flow. Better blood flow not only translates into lower blood pressure, but a decreased demand on your heart and skeletal muscles. Better blood flow also supports a muscles’ ability to contract and transport metabolic by-products such as lactic acid. Because NO is responsible for delivering oxygen-rich blood to every cell, tissue, and organ system in the human body, it is now recognized by the scientific, medical, and athletic communities as a key, physiological performance variable.

And NO has even more benefits!

NO acts as powerful antioxidant neutralizing harmful, free radical activity and promoting the formation of glutathione, a critical antioxidant. NO facilitates the transmission of messages between nerve cells, contributing to improved memory and learning capacities, better sleep, and a more positive mood. And NO supports the immune system helping fight off infections.

NO can improve athletic performance

Given that NO contributes directly to blood flow, oxygen delivery, glucose uptake, muscle velocity, power output, and muscle growth; a higher NO level may enhance an athlete’s overall performance and endurance — even among athletes who were already fit and healthy.

In fact, a number of studies have shown boosting nitric oxide can reduce the oxygen cost of exercise and improve the function of energy-producing mitochondria, resulting in a lower perceived effort and easier breathing during exercise, in addition to reduced muscle soreness and faster recovery following hard, physical efforts.

Nitric oxide may even improve adaptation to altitude.

People who live at high altitude produce more NO than people at sea level, and populations that thrive at high altitude, like Tibetans, have been found to have NO levels several times those of sea level populations. If you’re planning a trip to a high-altitude location, then it would be wise to consider upping your nitric oxide level. Hypoxia reduces NO levels initially, and studies show that the consumption of dietary nitrates (for instance, red beets) or NO supplementation can improve the body’s adaptation to altitude by keeping NO levels from declining.

But… NO levels decline with age.  

NO levels can decline for a variety of controllable reasons including a lack of dietary nitrates, excessive physical and mental stress, low stomach acid, imbalanced mouth bacteria, anti-inflammatory medicines and arterial damage. But the one we can’t control, aging, is by fat the greatest threat to your NO level.

By the age of 40, your body will produce half the NO it did at the age of 20! By the time you reach 70, it will be capable of producing only 25% of the nitric oxide it needs! And as your body’s ability to generate NO after exercise is reduced, so does your responsiveness to training. To make matters worse, as NO production declines past the age of 40, the health risks from dysfunctional blood vessels rise significantly.

Determining your NO level

Until very recently, there was no easy way to assess your NO level. Testing required costly blood work or a complicated procedure called Flow Mediated Dilation, which indirectly predicted NO levels by measuring the rate of blood flow in the arm after applied pressure. Fortunately, recent advances in laboratory testing technology make it possible for you to easily and regularly measure your NO levels—anywhere, anytime—using nothing more than a test strip and a drop of saliva.

Even before – or in conjunction with – testing NO levels, you can start by assessing how you feel. Ask yourself the following questions. In my experience, if you answer “yes” to any two or more, your NO level is probably low.

  • Are you over the age of 40?
  • Do you rarely or occasionally eat green vegetables and/or red beets?
  • Do you train at high-levels more than 10 hours a week?
  • Are your hormone levels imbalanced?
  • Do you use anti-inflammatory medications such as Motrin or Celebrex?
  • Do you use antacids or suffer from indigestion?
  • Do you frequently use an antiseptic mouthwash?
  • Do you have gum disease or bad breath?
  • Have you recently taken antibiotics?
  • Do you suffer from any form of bowel distress?
  • Do you have circulation problems, high blood pressure and/or fluid retention issues?
  • Do you suffer from abnormally high CRP, or an autoimmune disease?
  • Have you been diagnosed with asthma or bronchitis?

You don’t need to guess.

Over the past 10 years, I have found that almost everyone over the age of 40 and/or is an endurance athlete has less than optimal levels of NO. But, don’t take my word for it.

While it is always helpful to maintain a subjective awareness of any improvements in the way you feel and perform, salivary test strips provide an objective foundation for determining improvements in your NO level. Despite its deceptive simplicity, a salivary nitric oxide assessment is a powerful tool that will allow you to monitor how your NO level changes with dietary and lifestyle choices, training intensity, stress, and the use of nitrate-based supplements.

By using a nitric oxide assessment strip to periodically check your NO level first thing in the morning and an hour or two after consuming nitrate-rich foods and/or a nitric oxide supplement, you can accurately assess your body’s ability to produce and maintain an optimal amount of NO. In addition, by assessing your NO you can determine just how much and when you should be supporting it for maximum health and performance results.

How can you improve your NO levels?

Now that you know the importance of nitric oxide for health and performance and how to gauge your NO levels, the big question how can you improve your NO levels?

Well, since it’s hard to affect the behavior of bacteria in your mouth, or enhance the creation of NO on your skin from sun exposure, the most effective and proven method of optimizing your NO levels is through the use of dietary nitrates.

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Disclosure: CTS has a partnership with PureClean Performance and CTS Coaches use PureClean Performance products during training and training camps.

About Dr. Cohen

Dr. Rick Cohen has worked as a specialist in nutritional medicine and sports performance for more than two decades, and developed a number of innovative treatment programs that have successfully helped patients enhance their sports performance as well as eliminate a variety of health problems.

He received his undergraduate degree with honors of distinction from Duke University in Durham, North Carolina, and received his medical degree from Hahnemann Medical University in Philadelphia, Pennsylvania. He is a proud member of several professional organizations including the American College for the Advancement of Medicine and the American Academy of Anti-Aging Medicine. Dr. Cohen is the creator of PureClean Performance.


Arnold WP, Mittal CK, Katsuki S, Murad F. Nitric Oxide activates guanylate cyclase and increases guanosine 3’:5’-cyclic monophosphate levels in various tissue preparations. National Academy of Sciences 1977;74:3203-7.

Egashira K, Inou T, Hirooka Y, et al. Effects of age on endothelium-dependent vasodilation of resistance coronary artery by acetylcholine in humans. Circulation 1993;88:77-81.

Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetycholine. Nature 1980;288:373-6.

Gerhard M, Roddy MA, Creager SJ, Creager MA. Aging progressively impairs endothelium-dependent vasodilation in forearm resistance vessels of humans. Hypertension 1996;27:849-53.

Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri  G. Endothelium-derived relaxing factor produced and released from artery and vein is Nitric Oxide. Proc Natl Acad Sci USA 1987;84:9265-9.

Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease. The Framingham study. The American journal of cardiology 1971;27:335-46.

Katsuki S, Arnold W, Mittal C, Murad F. Stimulation of guanylate cyclase by sodium nitroprusside, nitroglycerin and Nitric Oxide in various tissue preparations and comparison to the effects of sodium azide and hydroxylamine. Journal of cyclic nucleotide research 1977;3:23-35.

Lakatta EG, Yin FC. Myocardial aging: functional alterations and related cellular mechanisms. The American journal of physiology 1982;242:H927-41.

Taddei S et al. Vasodilation to Bradykinin Is Mediated by an Ouabain-Sensitive Pathway as a Compensatory Mechanism for Impaired Nitric Oxide Availability in Essential Hypertensive Patients. Circulation Journal 1999; 100:1400-1405.

Taddei S, Virdis A, Ghiadoni L, et al. Age-related reduction of N-O availability and oxidative stress in humans. Hypertension 2001;38:274-9.

Vita JA, Treasure CB, Nabel EG, et al. Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease. Circulation 1990;81:491-7.

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Comments 18

  1. Pingback: Uncovering the Benefits of Nitric Oxide: A Comprehensive Guide - Live Life A Health And News Site.

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  5. Thanks for the info doc! I’m a 35 yo endurance jogger who recently started adding beet root powder to my hydration routine and definitely agree with the information you presented. I’ve been drinking about two servings a day for 6 days, and the ease of effort that I’ve gained is mind boggling. Today was a hill training day, which is a total of 6 miles, and with little thought I ended up tacking on another 4.

    I will be honest and say that there are compounding variables, I’ve changed pre-work out powder and started consuming honey mid run.

    Still, to the individual who feels that NO supplementation during training may be detrimental to race day performance… I say nay. Training the body to perform at a higher level has many factors that can affect the effectiveness of said training. One important factor is the brain. The brain needs to be taught that it is capable of performing at a certain level. This is why many trainers tell people to run down hill, because it can help train the brain to lengthen the stride. This is obviously all conjecture that is loosely based on the biological process of learning, but I posit that increasing ease of effort for performance gains during training would translate to a more reliable performance on race day.

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  7. Pingback: Foods and Lifestyle Behaviors that Increase Nitric Oxide Levels - CTS

  8. I have noticed an improvement while using beetroot juice, however I am concerned about how it affects positive adaptation while training. It seems like using beetroot juice as a doping-type strategy for race day may be more effective than training with it. Wouldn’t the body acclimate to being more efficient, therefore losing that gained positive adaptation?

  9. Another potential way to increase nitric oxide is through nasal breathing which costs nothing. If you want to use beets to increase performance a quart of organic beet juice costs around $6. The obviousness of the sales pitch detracts from whatever scientific evidence there may be for using beets to improve recovery and performance. Not CTS’s finest moment.

    1. Hey Doug:

      Thanks for the comments. Nasal breathing, sunbathing, cold immersion, deep sleep, infrared exposure, Gainswave and a few others do improve NO levels but after working with athletes and monitoring blood pressure, HRV, power and heart rate ratios and even saliva nitrate strips, in working with over one thousand athletes we have found no simpler and reliably effective and economical way to support NO levels resulting improve stamina and endurance in people over 35.

      The article was at its heart educational but also to create interest.
      But please don’t take my word for it.

      Measure your baseline NO levels with Berkeley health NO strips (on Amazon), check your morning blood pressure and perform a baseline physical activity such as a time trial.

      Then consume two UNBEETABREW daily and one BEET’UM with one 45 minutes prior to physical activity.

      Train as normal periodically checking NO levels and HRV if you have a Polar H10 and Elite HRV ap.

      After 15 to 20 days with repeat the physical activity 95% of people who do feel better but see significant gains in performance and metrics. We see power go up 5%, systolic BP go down 10mm HG, HRV improve and NO strips turn pink.

      Absolutely add sun exposure and nasal breathing, but alone that won’t touch the results you will see with the challenge.

      Please feel free to reach out to me at any time with questions.

      Rick Cohen, M.D.

  10. That disclaimer should be at the start, since this is just a long-form advertisement.

    Next week: “This athlete didn’t know why everyone was taking her picture. Watch what happens next!”

    1. Hi Dewey:

      Please read my response to Doug. I promise you that if you perform the challenge as described
      you will see significant improvement.

      I am happy to answer any questions or concerns, I have been working with athletes and NO levels for over 6 years. It is the #1 thing people over 35 should strive to optimize for health and performance.

      Please reach out to me with questions.

      Rick Cohen, M.D.

      1. I’m not saying NO supplements don’t work; I think they do. I’m saying the article is an advertisement for a product and should be clearly marked as such.

  11. I guess I have to be a wise consumer and evaluate this information while factoring in the author’s interest in selling products. I appreciate CTS giving full disclosure, however.

  12. I was eating spinach salad daily in taking a concentrated shot of beet juice prior to hard rides or races and I suffered from a slightly closed vocal cord which restricted my breathing and induced heavy breathing very noticeable didn’t realize that it was contributed by the intake of Beetlejuice and high amount of nitric oxide foods .
    Had my lungs tested twice second time while cycling and doctors found no abnormalities if anything they found it I had a gifted system I read once that beat juice could affect the vocal cord so once I stopped there was a noticeable difference of much less heavy breathing and I’ve stopped taking it since and all is well . heavy breathing only occurred During long climbs and cycle cross mostly due to elevated heart rate it was not detectable at any other heart rate other than highly elevated HR

    1. Hey Gary:

      I have had two other people over the years have issues with beet juice and breathing. In all cases, it was determined to be a histamine allergy issue and not a nitrate issue.

      Greens such as celery and arugula have the higher nitrate levels but are not very bioavailable. Spinach is low down on that list.

      Were you using RedAce beet juice or making beet juice shots at home? Most commercial beets and beet juice powder are only 1% nitrate or 100mg/g. So you would need to consume 16 to 24 ounces to get the needed daily nitrate benefits. You would be spending the day on the toilet if you did.

      Only 2 to 3 brands that were tested at ACSM has nitrates over 2%. PureClean Powder was the highest at 2.5%. While the fermented beet juice powder in UNBEETABREW and BEET’UMS is over 5%.

      While you may not be a person who can tolerate beets, I would suggest that you might do just fine with the concentrated synergistic chocolate BEET’UMS. I would be happy to send you some to try out.

      Rick Cohen, M.D.

  13. An scientific article on performance enhancement whose references are all over 18 years old is suspect. This seems like infomercial-type attempt to sell products.

    1. There have been many recent nitrate studies and performance in the past few years. The most recent one showed performance improvement in highly trained athletes with higher nitrate dosages. But honestly, these are only groups and each of is different. As I wrote in more detail to Doug, the proof is in using products that have the needed nitrate content and then perform an objective trial on yourself measuring pre and post BP, HRV, saliva NO levels and objective performance metrics.

      That is the only way you will know for yourself. It is easy and almost everyone we have worked with has significant benefits.

      Please reach out for more information.

      Rick Cohen, M.D.

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