|Title||Nitrite and Nitrate in Human Health and DiseaseRegulation of Dietary Nitrate and Nitrite: Balancing Essential Physiological Roles with Potential Health Risks|
|Year of Publication||2011|
|Series Editor||Bryan, NS, Loscalzo, J|
|Number of Pages||155 - 166|
US and European Union regulatory limits on nitrates in drinking water are necessary to limit environmental pollution known as eutrophication. Health concerns of excessive nitrate and nitrite consumption have driven regulatory actions due to perceived risk of methemoglobinemia in infants and gastrointestinal cancer risk in adults. The World Health Organization’s Acceptable Daily Intake recommendations for nitrate can be exceeded by normal daily intakes of single foods and recommended dietary patterns, such as the DASH diet. Inconsistent positions on the health risks and benefits of foods containing nitrates and nitrites by the International Agency for Research on Cancer (IARC) and the European Food Safety Authority (EFSA) may contribute to confusion for consumers; regulators must take the opportunity to clarify and expand upon these positions in order to provide coherent dietary guidance. The established vasoprotective, blood pressure lowering, and antiplatelet aggregation properties of nitrite alone, or of nitrite originating from dietary nitrate, requires a new regulatory paradigm that incorporates the concepts of physiological deficiency, sufficiency and excess. There is a need to engage an independent panel of experts from academia, industry, and governmental and non-governmental sectors to undertake the first comprehensive, systematic review of the potential health risks and benefits of food sources of nitrates and nitrites. U.S. Institute of Medicine’s Dietary Reference Intake paradigm may be a useful guide to the development of coherent dietary nitrate and nitrite intake recommendations.