… clinical evidence is suggestive that by admixing nitrate from beets may counter the hypertensive effects of table salt. Despite our healthcare provider’s admonishments to reduce sodium in our diets, our craving for salt remains doubly high. Hypertension is the most expensive, reversible disease… maybe there is a partial solution. The Hypertension article by Kurtz’s lab, Small Amounts of Inorganic Nitrate or Beetroot Provide Substantial Protection From Salt-Induced Increases Blood Pressure, raises the possibility that adding a pinch of inorganic nitrate to salty foods may blunt sodium-driven hypertension (1). The authors show that when salt-sensitive rodents were given table salt, sodium chloride, along with a small amount of sodium nitrate or beetroot juice — a rich source of inorganic nitrate, likely in the form of potassium nitrate — the animals were protected against sodium chloride–induced elevation in blood pressure. Most striking was the observation that the addition of inorganic nitrate was >100× more effective than potassium (1). Envision for a moment that the researchers had substituted sodium nitrate with potassium nitrate as proposed in the letter to the editors of AHA Hypertension. If so, the potential benefical response may have been equally effective at a lower concentration with the presumed dual antihypertensive action of both potassium and nitrate; here, potassium flushing sodium out of the body while nitrate being reduced by the microflora to nitric oxide and eliciting a direct vasodilatory response. While Kurtz et al are not necessarily advocating that we spike our salty foods with sodium nitrate, the study does provoke the idea that we might reformulate our cherished table salt by adding a pinch of inorganic nitrate, ideally, derived from leafy green vegetables and beets, to curb the hypertensive effects of sodium chloride. When viewed through a traditional dietary lens, the idea of adding a dash of inorganic nitrate salt, much less saltpeter, seem to border dietary lifestyle malpractice. However, several clinical studies consisting of 100s of participants consuming dietary inorganic nitrate delivered in the form of well-defined, commercially available beet juices consisting of 360 to 400+ mg of nitrate per serving size/day to sodium and potassium nitrate delivered in water or a capsule — ranging from 157 to 1488 mg per serving/day — resulted in blood pressure reduction from 4 to 11 mm Hg with a restoration of endothelial function in hypertensives (3–6). Further, strict adherence to the Dietary Approaches to Stop Hypertension diet is predicted to exceed 1000 mg nitrate/day, and the authors conclude that dietary nitrate should be considered a necessary micronutrient in our daily diet (6). Collectively, a growing body of evidence is suggestive that dietary inorganic nitrate represents a safe and effective intervention to provide a sustained reduction of blood pressure and improvement in vascular health in the population including hypertensive individuals and those at risk of becoming hypertensive (5). The recent study by Kurtz et al reinforces the importance of consuming nitrate-rich vegetables to our salty meals. And, of course, potassium and nitrate are best delivered with the daily consumption of leafy greens and other potassium nitrate–rich vegetables, which are the primary source of inorganic nitrate found in the mediterranean diet, dietary approaches to stop hypertension diet, mediterranean dietary approaches to stop hypertension diet intervention for neurodegenerative delay diet, and the traditional Japanese diet (2,7–10). Sadly, just 1 in 10 Americans meet the minimum recommended 2 to 3 cups of vegetables a day, and on average, we typically eat 1.5 cups per day according to the USDA, which is far short of 4 to 5 cup servings suggested by the dietary approaches to stop hypertension diet to combat elevated blood pressure. And despite our healthcare provider’s admonishments to reduce sodium in our diets, our craving for salt remains high. According to the World Health Organization, we consume nearly twice the recommended level of sodium. To compound the problem, we are also deficient in potassium with low intake and poor dietary compliance of potassium-rich vegetables and fruits. So, we continue to raise our blood pressure with high consumption of sodium-rich foods while simultaneously depriving ourselves of potassium and nitrate-rich vegetables and fruits. Aside from the need to create new models to drive behavioral change and dietary compliance to integrate cardioprotective, plant-based foods rich in potassium and inorganic nitrate into our daily meals, the excessive consumption of sodium is not going away. With that said, a dash of inorganic nitrate added to our salt shakers may be a solution with a measurable impact on salt-induced hypertension. Modified from a Letter to the Editor at AHA’s Hypertension journal regarding an article entitled, Small Amounts of Inorganic Nitrate or Beetroot Provide Substantial Protection From Salt-Induced Increases in Blood Pressure. Monitor and Optimize your your nitric oxide with MyFitStrip, the first saliva nitric oxide test that validates diets rich in prebiotic nitrate and whether your oral+gut microbiome is healthy to convert nitrate-rich diets into nitric oxide. 1. Morris Jr RC, Pravenec M, Šilhavý J, DiCarlo SE, Kurtz, TW. Small amounts of inorganic nitrate or beetroot provide substantial protection from salt-induced increases in blood pressure. Hypertension. 2019;73:1042–1048. doi: 10.1161/HYPERTENSIONAHA.118.12234 2. Kurtz TW, DiCarlo SE, Pravenec M, Morris RC. Functional foods for augmenting nitric oxide activity and reducing the risk for salt-induced hy pertension and cardiovascular disease in Japan. J Cardiol. 2018;72:42–49. doi: 10.1016/j.jjcc.2018.02.003 3. Gee LC, Ahluwalia A. Dietary nitrate lowers blood pressure: epidemiolog ical, pre-clinical experimental and clinical trial evidence. Curr Hypertens Rep. 2016;18:17. doi: 10.1007/s11906–015–0623–4 4. Ashor AW, Shannon OM, Werner AD, Scialo F, Gilliard CN, Cassel KS, Seal CJ, Zheng D, Mathers JC, Siervo M. Effects of inorganic nitrate and vitamin C co-supplementation on blood pressure and vascular function in younger and older healthy adults: a randomised double-blind crossover trial. Clin Nutr. 2019. In press. 5. Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015;65:320–327. doi: 10.1161/HYPERTENSIONAHA.114.04675 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;90:1–10. doi: 10.3945/ajcn.2008.27131 7. Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science why dietary nitrate is hard to ‘beet’! Part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol. 2017;83:140–151. doi: 10.1111/bcp.12918 8. Morris MC, Wang Y, Barnes LL, Bennett DA, Dawson-Hughes B, Booth SL. Nutrients and bioactives in green leafy vegetables and cognitive decline: prospective study. Neurology. 2018;90:e214–e222. doi: 10.1212/WNL.0000000000004815 9. Shannon OM, Stephan BCM, Minihane AM, Mathers JC, Siervo M. Nitric oxide boosting effects of the mediterranean diet: a potential mechanism of action. J Gerontol A Biol Sci Med Sci. 2018;73:902–904. doi:10.1093/gerona/gly087 10. Jackson JK, Patterson AJ, MacDonald-Wicks LK, Bondonno CP, Blekkenhorst LC, Ward NC, Hodgson JM, Byles JE, McEvoy MA. Dietary nitrate and diet quality: an examination of changing dietary intakes within a representative sample of Australian women. Nutrients. 2018;10:E1005