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Table of Contents
Machine generated contents note: Introduction 1
1 The History of Nitrates in Medicine 3
2 Nitrate, the Nitrogen Cycle and the Fertility of Nature 9
21. The Nitrogen Cycle 10
22. The Increasing Fertility of Nature 12
3 The Metabolism of Nitrate 16
31. The Basic Features 16
32. The Two Sources of Nitrate: Dietary Intake and Endogenous
Synthesis 17
33. The Metabolic Conversions of Nitrate in the Body and its
Fate 21
34. Nitrate Secretion with Saliva and its Transformation to
Nitrite in the Mouth 23
35. Nitrate and Nitrite in the Stomach 26
36. Nitrate Metabolism: a Summary 27
4 Nitrate in Body Fluids 29
41. Healthy Humans 30
42. Pathological Conditions 32
43. Conclusions 34
5 The Case Against Nitrate: a Critical Examination 35
51. The Risk of Methaemoglobinaemia in Infants 35
511. Methaemoglobinaemia: definition 36
512. Infant methaemoglobinaemia: causes and issues 37
513. Methaemoglobinaemia induced by carrot soup 38
514. Spinach-induced methaemoglobinaemia 41
515. Methaemoglobinaemia caused by enteritis 41
516. Methaemoglobinaemia associated with the use of
well water 44
517. Conclusion 52
52. The Risk of Cancer 54
521. Background 54
522. The formation of N-nitroso compounds (NOCs) 55
523. Evidence from animal experiments and
epidemiological studies 58
524. Comments and conclusions 60
53. Other Grievances 63
531. Increased health risk for mother, fetus and child
from nitrate 63
532. Risk of genotoxicity 64
533. Increased risk for congenital malformation 65
534. Tendency towards increased size of the thyroid
gland 65
535. Early onset of hypertension 66
536. Enhanced incidence of childhood diabetes 66
537. Other claims 67
54. Conclusions 68
6 Nitrate Regulations: Presentation and Discussion 69
61. Maximum Nitrate Levels in Drinking Water 69
611. History of regulations 70
612. A look at the early epidemiology as a basis for
present regulations 74
62. Maximum Nitrate Levels in Food 77
63. The Acceptable Daily Intake and the Reference Dose for
Nitrate in Man 79
64. Concluding Comments 82
7 The Beneficial Effects of Nitrate 84
71. The Anti-infective Effects of Nitrate 84
711. The effects in the mouth and gastrointestinal tract 84
712. Anti-infective effects in other organs 87
72. Nitrate, Blood Pressure and Cardiovascular Diseases 88
73. Dietary Nitrate and Gastric Cancer 90
74. Other Beneficial Effects 92
75. Conclusion 92
8 Summary and Conclusions 93
Appendices
Appendix 1 Conversion Factors and Tables 95
Conversion Factors for Nitrate Expressed in Various Units 95
Appendix 2 Sources of Nitrate in Human Food 99
Appendix 3 Nitrate Kinetics in Healthy Adults after Oral Doses of
Nitrate 103
Appendix 4 High Plasma Nitrate Levels in Various Diseases and
Therapies 107
Appendix 5 Human Epidemiological Studies Performed to Evaluate
the Effects of Nitrate Exposure on Cancer Incidence
and Mortality 111
Appendix 6 Massive Intakes of Nitrite and Nitrate: Short-Term
Effects on Health 119
Large Intakes of Nitrite (NO2-) 119
Massive Intakes of Nitrate (NO3-) 121.
1 The History of Nitrates in Medicine 3
2 Nitrate, the Nitrogen Cycle and the Fertility of Nature 9
21. The Nitrogen Cycle 10
22. The Increasing Fertility of Nature 12
3 The Metabolism of Nitrate 16
31. The Basic Features 16
32. The Two Sources of Nitrate: Dietary Intake and Endogenous
Synthesis 17
33. The Metabolic Conversions of Nitrate in the Body and its
Fate 21
34. Nitrate Secretion with Saliva and its Transformation to
Nitrite in the Mouth 23
35. Nitrate and Nitrite in the Stomach 26
36. Nitrate Metabolism: a Summary 27
4 Nitrate in Body Fluids 29
41. Healthy Humans 30
42. Pathological Conditions 32
43. Conclusions 34
5 The Case Against Nitrate: a Critical Examination 35
51. The Risk of Methaemoglobinaemia in Infants 35
511. Methaemoglobinaemia: definition 36
512. Infant methaemoglobinaemia: causes and issues 37
513. Methaemoglobinaemia induced by carrot soup 38
514. Spinach-induced methaemoglobinaemia 41
515. Methaemoglobinaemia caused by enteritis 41
516. Methaemoglobinaemia associated with the use of
well water 44
517. Conclusion 52
52. The Risk of Cancer 54
521. Background 54
522. The formation of N-nitroso compounds (NOCs) 55
523. Evidence from animal experiments and
epidemiological studies 58
524. Comments and conclusions 60
53. Other Grievances 63
531. Increased health risk for mother, fetus and child
from nitrate 63
532. Risk of genotoxicity 64
533. Increased risk for congenital malformation 65
534. Tendency towards increased size of the thyroid
gland 65
535. Early onset of hypertension 66
536. Enhanced incidence of childhood diabetes 66
537. Other claims 67
54. Conclusions 68
6 Nitrate Regulations: Presentation and Discussion 69
61. Maximum Nitrate Levels in Drinking Water 69
611. History of regulations 70
612. A look at the early epidemiology as a basis for
present regulations 74
62. Maximum Nitrate Levels in Food 77
63. The Acceptable Daily Intake and the Reference Dose for
Nitrate in Man 79
64. Concluding Comments 82
7 The Beneficial Effects of Nitrate 84
71. The Anti-infective Effects of Nitrate 84
711. The effects in the mouth and gastrointestinal tract 84
712. Anti-infective effects in other organs 87
72. Nitrate, Blood Pressure and Cardiovascular Diseases 88
73. Dietary Nitrate and Gastric Cancer 90
74. Other Beneficial Effects 92
75. Conclusion 92
8 Summary and Conclusions 93
Appendices
Appendix 1 Conversion Factors and Tables 95
Conversion Factors for Nitrate Expressed in Various Units 95
Appendix 2 Sources of Nitrate in Human Food 99
Appendix 3 Nitrate Kinetics in Healthy Adults after Oral Doses of
Nitrate 103
Appendix 4 High Plasma Nitrate Levels in Various Diseases and
Therapies 107
Appendix 5 Human Epidemiological Studies Performed to Evaluate
the Effects of Nitrate Exposure on Cancer Incidence
and Mortality 111
Appendix 6 Massive Intakes of Nitrite and Nitrate: Short-Term
Effects on Health 119
Large Intakes of Nitrite (NO2-) 119
Massive Intakes of Nitrate (NO3-) 121.