What are nitrates used for?

Marine toxicity
Nitrates are medicines that are used to prevent and relieve chest pain
In freshwater or estuarine systems close to land, nitrate can reach (angina) due to coronary artery disease. They belong to a class of
high levels that can potentially cause the death of fish. While nitrate medications called vasodilators that cause blood vessels to widen.
is much less toxic than ammonia or nitrite,[9] levels over 30 ppm of The most common types of nitrates are nitroglycerin (glyceryl
nitrate can inhibit growth, impair the immune system and cause stress trinitrate or GTN), isosorbide dinitrate, and isosorbide mononitrate.
in some aquatic species.[10] However, in light of inherent problems Nitrates can be used to treat angina in three ways:
with past protocols on acute nitrate toxicity experiments, the extent of
• Short-term nitrates are taken to relieve angina on an as-
nitrate toxicity has been the subject of recent debate.[11]
needed basis
In most cases of excess nitrate concentrations in aquatic systems, the
• Short-term nitrates are also taken right before activities
primary source is surface runoff from agricultural or landscaped areas
known to cause an attack to prevent angina
which have received excess nitrate fertilizer. These levels of nitrate
can also lead to algae blooms, and when nutrients become limiting • Long-term nitrates are taken daily to decrease the number
(such as potassium, phosphate or nitrate) then eutrophication can of angina attacks
occur. As well as leading to water anoxia and dead zones, these
How do nitrates work?
blooms may cause other changes to ecosystem function, favouring
Heart-related chest pain occurs when the heart muscle doesn’t get as
some groups of organisms over others. Consequently, as nitrates form
much oxygen as it needs. This is usually due to narrowing of the
a component of total dissolved solids, they are widely used as an
arteries that supply blood to the heart, which is caused by
indicator of water quality.
atherosclerosis – the buildup of fatty plaque on the lining of the
Nitrates are also a by-product of septic systems. Specifically, they are arteries. Nitrates work by relaxing and widening the blood vessels in
a naturally occurring chemical that is left after the break down or the body, allowing more blood and oxygen to flow to the heart.
decomposition of animal or human waste. Water quality may also be Since the arteries are wider, it is easier for the heart to pump blood,
affected through ground water resources that have a high number of so it does not require as much blood and oxygen.
septic systems in a watershed. Septics leach down into ground water
What is nitrate tolerance?
resources or aquifers and supply near by bodies of water. Lakes that
If you have nitrate in your bloodstream all the time, your body grows
rely on ground water are often affected by nitrification through this
accustomed to it and the medicine will lose its ability to dilate your
process.
blood vessels and therefore its ability to prevent or relieve angina.
Human toxicity This loss of effectiveness is called nitrate tolerance. Nitrate tolerance
is not a problem for patients taking short-acting nitrates, which are
Nitrate toxicosis in humans occurs through enterohepatic metabolism
only in your bloodstream for a short time. However, patients taking
of nitrates to ammonia, with nitrite being an intermediate[3]. Nitrites
long-acting nitrates need to have periods during each day where there
oxidize the iron atoms in hemoglobin from ferrous iron (2+) to ferric
are no nitrates in the body, and this is why your medicine may be
iron (3+), rendering it unable to carry oxygen[4]. This process can lead
prescribed to be taken at irregular intervals throughout the day.
to generalized lack of oxygen in organ tissue and a dangerous
condition called methemoglobinemia. Methemoglobinemia can be How are nitrates taken?
treated with methylene blue, which reduces ferric iron (3+) in Nitrate medications come in many forms. Short-term nitrates that are
affected blood cells back to ferrous iron (2+). used on an as-needed basis for chest pain mainly come in sublingual
(under the tongue) tablets, chewable tablets, and sprays. Long-term
Infants in particular are especially vulnerable to methemoglobinemia
nitrates that are taken every day to prevent chest pain come as a pill,
due to nitrate metabolizing triglycerides present at higher
skin patch, or ointment. Different kinds may be combined to give you
concentrations than at other stages of development.
the best possible relief. If you are hospitalized for chest pain or a
Methemoglobinemia in infants is colloquially know as "blue baby
heart procedure, you may also receive liquid nitrates through an IV.
syndrome". Initial exposure is most often caused by high levels of
Nitroglycerin tablets, a form of short-term nitrates, are absorbed
nitrates in drinking water. However nitrate exposure may also occur
quickly into the bloodstream when they dissolve under the tongue,
if eating for instance vegetables containing high levels of nitrate.
and should ease chest pain within 1 to 5 minutes. If you are taking
Lettuce may contain elevated nitrates under growth conditions such
short-term nitrates to prevent an anticipated attack, placing a tablet
as reduced sunlight, undersupply of the essential micronutrients
under the tongue 10 minutes before the activity will prevent angina
molybdenum (Mo) and iron (Fe), or high concentrations of nitrate
for about an hour. If you are taking long-term nitrates, you may need
due to reduced assimilation of nitrate in the plant. High levels of
to take them at uneven intervals throughout the day to prevent nitrate
nitrate fertilization also contribute to elevated levels of nitrate in the
tolerance.
harvested plant .[5]
How should I store my nitrate medication?
Some adults can be more susceptible to the effects of nitrates than
Nitrates, particularly sublingual nitroglycerin tablets, may not work
others. The methemoglobin reductase enzyme may be under-
as well as they should if they are exposed to heat, moisture, or air for
produced or absent in certain people who have an inherited
long periods of time. You can’t tell if a tablet is working based on a
mutation[6]. Such individuals cannot break down methemoglobin as
tingling or burning sensation under your tongue or flushing or
rapidly as those who do have the enzyme, leading to increased
warmth in your face and neck — not everyone feels these effects and
circulating levels of methemoglobin (the implication being that their
some newer types of tablets don’t cause them at all. The only way to
blood is not as oxygen-rich). Those with insufficient stomach acid[7]
be sure your pills are working is to keep them dry in a closed bottle
(including some vegetarians and vegans) may also be at risk.
and be sure to throw out medication that has expired.
Ironically, the increased consumption of green, leafy vegetables that
Nitroglycerin tablets are the least stable form of nitrates and typically
typically accompanies these types of diets may lead to increased
need to be replaced every 3 to 6 months. Other types of nitrates such
nitrate intake. A wide variety of medical conditions, including food
as spray nitroglycerin are not as easily ruined and can last longer. Be
allergies, asthma[8], hepatitis, and gallstones may be linked with low
sure to check the expiration date on the bottle and refill your
stomach acid; these individuals may also be highly sensitive to the
prescription before the medication expires.
effects of nitrates.
What are the possible side effects of nitrates?
The most common side effects of nitrates are a
throbbing headache (in about 50% of people),
warmness and flushing of the skin, and dizziness or
Nitrates lightheadedness. These side effects are not serious
and usually become less severe with continued use of
the medication. If the headache persists, ask your
doctor if you can take aspirin, acetaminophen
(Tylenol), or ibuprofen (Advil, Motrin). Other possible
non-serious side effects include a fast pulse,
restlessness, and nausea or vomiting. Nitrate skin
patches may cause skin irritation, which can be
avoided by putting the patch in a different place each
time
Nitrate and Man
Toxic, Harmless or Beneficial?
J.L. Hatfield, Laboratory Director
National Soil Tilth Laboratory 2150 Pammel Drive Ames, Iowa
50011
(hatfield@nstl.gov)
human body and the results from all of the different studies, and is a
resource that is valuable and educational in itself.
The current debate on nitrate levels in drinking water in the United
States and throughout the world is causing a lot of potential energy to
be expended on reducing nitrate levels to less than 10 mg L–1. I don't
believe we should take these conclusions from the book to cease our
efforts to reduce nitrate leaching and the potential improvement on
water quality but to place our efforts to focus on helping agriculture
use nitrogen more efficiently. I recommend this book as a reading
material for all researchers involved in studying nitrate and nitrite
levels not because of the introduction into the medical debate but the
approach these authors have taken to survey and evaluate the current
literature to arrive at conclusions that raise questions. This book helps
place the information into a context about nitrate levels in our water
and food and the meaning of these concentrations on our health. This
book would be a good resource for environmental science classes to
create another source of information on water quality. This book is a
must-read for all environmental scientists to create an inquisitiveness
about the sources and interpretation of the data being used to create
policy.

J. L'hirondel and J.-L. L'hirondel, CAB International, Wallingford,

Oxfordshire, OX10 8DE, UK. Translated from the French version
Les nitrates et l'homme: Le mythe de leur toxicité (Editions de
I'Institut de l'Environnement, 1996). 2001. 168 p. $65.00 hardcover.
ISBN 0851995667.

The concluding paragraph of the book notes that "The history of

nitrate is that of a world-scale scientific error that has lasted for more
than 50 years. The time has now come to rectify this regrettable and
costly misunderstanding." The senior author of this book was a
pediatrician who devoted a portion of his life to the study of
methaemoglobinaemia in infants and the relationship to nitrate
concentrations in water supplies. This book is not a biased casual
overview of the nitrate problems and the levels in drinking water but
an extremely thorough and thought-provoking analysis of our current
understanding of the role of nitrate and nitrite in our drinking water
and diet. There are more than 620 references cited in this book from
all of the studies conducted around the world on nitrates and human
health. The authors are to be commended for their thoroughness in
this analysis. The contents of this book are divided into eight
chapters: "The History of Nitrates in Medicine," "Nitrate, the
Nitrogen Cycle and the Fertility of Nature," "The Metabolism of
Nitrate," "Nitrate in Body Fluids," "The Case Against Nitrate: A
Critical Examination," "Nitrate Regulations: Presentation and
Discussion," "The Beneficial Effects of Nitrate," and "Summary and
Conclusions."
Nitrates and their role in human health have been the subject of study
since the 12th century and various forms of nitrate have been
considered important for our well-being. We tend to look at nitrate
and nitrite as negatives in terms of our well-being. The current
concern about nitrate and methaemoglobinaemia can be traced to an
article written in 1945 by Comly (J. Am. Med. Assoc. 129:112–116)
and the carcinogenic effects from nitrosamines to an article in 1956
by Magee and Barnes (Br. J. Cancer 10:114–122). However, how
many of us have taken the time to evaluate critically the original
paper that is used to provide the supporting evidence for policy that is
being used to drive a lot of the current research on nitrogen
management? The authors have conducted an analysis of the evidence
for the 10 mg L–1 on methaemoglobinaemia and conclude that there is
confounding data on the nitrate levels because many of the studies
that show a health effect of high nitrate levels may have been more
related to bacterial contamination that created the biological reaction.
There has also been a lack of methaemoglobinaemia cases in the past
50 years caused more by the increase in water quality due to reduced
biological contamination rather than a reduction in nitrate levels. The
authors do not have any stake in the nitrate debate and offer the
evidence as a pursuit of a more complete understanding of the
confusion over nitrate levels and their effect on the human body. The
appendix in this book contains a summary of the role of nitrate in the