Methods: Twenty seven healthy volunteers (21 male) underwent a series of exercise tests at sea level (SL, London, 75 m) and again after 5-8 days at high altitude (HA, Capanna Regina Margherita or ‘Margherita Hut’, 4559 m). Using a double-blind protocol, participants were randomised to consume a beetroot/fruit juice beverage (3 doses per day) with high levels of nitrate (~0.18 mmol/kg/day) or a nitrate-depleted placebo (~11.5 μmoles/kg/day) control drink, from 3 days prior to the exercise trials until completion. Submaximal constant work rate cycle tests were performed to determine exercise efficiency and a maximal incremental ramp exercise test was undertaken to measure aerobic capacity, using breath-by-breath pulmonary gas exchange measurements throughout. Concentrations of nitrate, nitrite and nitrosation products were quantified in plasma samples collected at 5 timepoints during the constant work rate tests. Linear mixed modelling was used to analyse data.
Results: At both SL & HA, plasma nitrate concentrations were elevated in the nitrate supplementation group compared to placebo (P<0.001) but did not change throughout increasing exercise work rate. Delta exercise efficiency was not altered by altitude exposure (P=0.072) or nitrate supplementation (P=0.836). V̇O2peak decreased by 24% at high altitude (P<0.001) and was lower in the nitrate-supplemented group at both sea level and high altitude compared to placebo (P=0.041). Dietary nitrate supplementation did not alter other peak exercise variables or oxygen consumption at anaerobic threshold. Circulating nitrite and S-nitrosothiol levels unexpectedly rose in a few individuals right after cessation of exercise at high altitude.
Conclusion: Whilst regularly consumed during an 8 day expedition to terrestrial high altitude, nitrate supplementation did not alter exercise efficiency and other exercise physiological variables, except decreasing V̇O2peak. These results and those of others question the practical utility of BRJ consumption during prolonged altitude exposure.