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. Author manuscript; available in PMC: 2019 Jul 1.
Published in final edited form as: J Cardiol. 2018 Mar 12;72(1):42–49. doi: 10.1016/j.jjcc.2018.02.003

Figure 5. Processing of dietary nitrate through the alternative pathway for generation of NO (nitrate-nitrite-NO pathway).

Figure 5

Dietary nitrate enters the entero-salivary circulation and is exposed to oral anaerobic bacteria which express nitrate reductases that reduce nitrate to nitrite. The salivary nitrite is swallowed into the stomach where some of the nitrite is converted to NO and other NO species by gastric acid while most of the nitrite enters into the lower gastrointestinal tract unchanged and is absorbed into the systemic circulation [84]. In the vasculature, various enzymatic and non-enzymatic processes facilitate reduction of nitrite to NO which promotes decreases in vascular tone. Adapted from Webb et al., with permission [85]. Note that antibiotics or antiseptic mouthwashes and proton pump inhibitors can interfere with the functioning of this alternative pathway by decreasing oral bacteria or decreasing gastric acid secretion [84].