The Great Debate Around Dietary Nitrate

Ancient Chinese Medicine

《腐行诀脏腐用药法要》之"救猝死中毒开突方五首"

着舌以通心氣.
Putting under the tongue to cause heart qi to flow freely.
治中惡急, 心痛, 手足逆冷者, 頃刻可殺人.
For treating symptoms such as struck by evil, acute heart pains and cold in the hands and feet which can kill a patient in an instant.
看其人指, 爪青者是.
Look at the patient’s fingers and those with greenish black nails are such cases.
硝石五錢匕 雄黃一錢匕.
Saltpetre (5 spoonfuls) and realgar (1 spoonful).
右二味, 共為極細末, 啟病者舌, 着散一匕於舌下, 若有涎出令, 病者隨涎咽下.
Combine these two into a fine powder. Lift the patient’s tongue and sprinkle 1 spoonful under the tongue. If saliva is produced have the patient swallow it.
必愈
This is a certain cure.

Source: Butler AR, Moffett J. In: Lo EY, Cullen C, eds. Medieval Chinese Medicine: The Dunhuang Medical Manuscripts. London, UK: Routledge; 2004.
Butler, Anthony, and John Moffett. "Saltpetre in early and medieval Chinese medicine." Asian Medicine 5.1 (2009): 173-185.

Nobel Prize Recognition

The Nobel Prize in Physiology or Medicine 1998 recognized the discovery of nitric oxide as a signaling molecule in the cardiovascular system, revolutionizing our understanding of vascular biology.

In atherosclerosis, plaques reduce blood flow in the arteries. This decreases oxygen supply to the heart muscle causing chest pain (angina pectoris) and sometimes even myocardial infarction. Treatment with nitroglycerine provides NO, dilates the vessels, and increases blood flow. Nitroglycerine, an important heart medicine, acts as a NO donor, causes dilation of the blood vessels, increases oxygen supply and protects the heart from damage and cell death.

Source: The Nobel Prize in Physiology or Medicine 1998. NobelPrize.org. Nobel Prize Outreach AB 2024. www.nobelprize.org/prizes/medicine/1998/summary/ .
Nitroglycerine, a 100 year old explosive and heart medicine. NobelPrize.org. Nobel Prize Outreach 2025. Sun. 21 Sep 2025. Nitroglycerine, a 100 year old explosive and heart medicine .

Nitrate and the Fertilizer Revolution and Challenge

The widespread adoption of nitrogen fertilizers since the mid-20th century has transformed global agriculture, enabling unprecedented food production to support growing populations. However, this agricultural revolution has come with significant environmental costs that directly relate to nitrate concerns in food and water systems.

Research shows that globally farmers apply around 115 million tonnes of nitrogen to crops every year, with only around 35% utilized by plants, meaning 75 million tonnes of nitrogen runs off into rivers, lakes and natural environments. This excess nitrogen represents a massive environmental challenge, as it creates ecological imbalances in ecosystems and water bodies.

The connection between agricultural nitrogen use and dietary nitrate exposure is complex: while fertilizer runoff contaminates water supplies, it also increases nitrate concentrations in drinking water and vegetables grown in nitrogen-rich soils. Understanding this agricultural-environmental-dietary nexus is crucial for developing sustainable approaches to both food security and public health.

Source: Our World in Data. Share of global excess nitrogen from croplands. ourworldindata.org/grapher/share-global-excess-nitrogen .
Picetti, R., Deeney, M., Pastorino, S., Miller, M. R., Shah, A., Leon, D. A., Dangour, A. D., & Green, R. (2022). Nitrate and nitrite contamination in drinking water and cancer risk: A systematic review with meta-analysis. Environmental research, 210, 112988. https://doi.org/10.1016/j.envres.2022.112988 .