Sodium Nitrite and Sodium Nitrate: Processed Meat Preservatives Linked to Cancer

Table of Contents

1. Overview
2. Key Harms at a Glance
3. How They Work
4. Nitrosamine Formation
5. Cancer Risk (Health Effects)
6. Other Health Effects
7. Sources of Exposure (Exposure Routes)
8. The “Uncured” Labeling Question
9. Regulatory Status (Safety)
10. What Research Reports About Lowering Exposure
11. Key Research Papers
12. Connections
13. Featured Videos

Key Harms at a Glance

• Processed meat: Group 1 human carcinogen — IARC 2015, based on sufficient evidence for colorectal cancer. IARC places it in the same evidence category as tobacco smoking and asbestos, and states that this does not mean they are equally dangerous. IARC based it on epidemiological evidence; it named N-nitroso compounds among the chemicals formed during processing and stated that whether and how much they contribute to the risk is unknown.
• Colorectal cancer — IARC’s experts concluded that each 50 g portion of processed meat eaten daily increases colorectal cancer risk by 18%.
• Nitrite with endogenous nitrosation: Group 2A — IARC 2010 classified ingested nitrate or nitrite under conditions that result in endogenous nitrosation as probably carcinogenic to humans.
• Stomach and oesophageal cancer — A 2006 systematic review found case-control evidence supporting an association of nitrite and nitrosamine intake with stomach cancer, and of processed meat with stomach and oesophageal cancer, but judged the evidence not conclusive; cohort evidence was insufficient or inconsistent.
• Methemoglobinemia — Nitrite oxidizes hemoglobin to methemoglobin, which cannot carry oxygen. Infant cases have followed formula made with nitrate-contaminated well water, and medical examiners in Ontario and New York report rising numbers of deaths from intentional sodium nitrite ingestion.
• Coronary heart disease (observational) — A 2010 meta-analysis associated each 50 g/day of processed meat with a 42% higher risk of coronary heart disease; processed meat was not associated with stroke, which only 3 studies had examined.
• Headache — A 1972 report described “hot-dog” headache as an individual susceptibility to nitrite.
• Children — EFSA (2017) found nitrite exposure from food additive use within its ADI for the general population, except for a slight exceedance in children at the highest percentile. US rules prohibit nitrite in baby, junior and toddler foods.

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Overview

Sodium nitrite (chemical formula NaNO₂) is an inorganic salt that appears as a white to slightly yellow crystalline powder highly soluble in water. In food regulation it carries the European Union additive code E250. Its close chemical relative, sodium nitrate (NaNO₃, E251), is less reactive; bacteria gradually reduce it to nitrite, both in meat during long cures and in the human mouth and gut. Most commercially cured products use sodium nitrite directly; nitrate is used as a source of nitrite in cured meat products other than bacon, which is how US rules list it.

A 2012 review traces the practice to nitrate impurities in the salt used to dry meat in ancient times, which improved protection from spoilage and evolved into the deliberate modern use of curing ingredients. The same review notes that the potential for nitrosamine formation in food was discovered in the 1950s and 1960s, which started a debate about the safety of ingested nitrite that came to focus on cured meats. Limits have since changed in some places: the European Union lowered its maximum added nitrite levels for meat products in 2023, applying from October 2025, while the core US limits for cured meat and bacon remain those set out in 9 CFR 424.21 and 424.22.

How They Work

Nitrite has several functions in cured meat. A 2012 review lists them as fixing the characteristic cured colour, creating a distinct flavour, controlling the oxidation of lipids and acting as an antimicrobial:

• Color fixation — Nitrite reacts with myoglobin to form nitrosylmyoglobin, which gives cured meats their pink or red color; without it, cured meats turn grey-brown.
• Antimicrobial action — Nitrite inhibits Clostridium botulinum, which produces botulinum toxin. US rules allow reduced nitrite in bacon only when combined with other measures shown to prevent botulinum toxin production. Regulators and the meat industry argue that removing nitrite could raise botulism risk, and this is the main reason given for its continued use.
• Flavor development — Nitrite contributes to the distinctive cured flavor of bacon, ham and other processed meats. Products made without nitrite generally differ in shelf life, appearance and taste.

Sodium nitrate acts as a slow-release source: bacteria in the meat gradually convert nitrate to nitrite over the long curing periods used for some dry-cured products.

Nitrosamine Formation

The central toxicological concern with sodium nitrite is its ability to react with amines and amides — nitrogen-containing compounds abundant in protein-rich foods — to form N-nitroso compounds, including nitrosamines. This happens in two main settings: during high-temperature cooking and inside the body.

The Chemistry

In acidic conditions nitrite forms nitrous acid (HNO₂) and related nitrosating agents, which react with the nitrogen atom of a secondary amine (R₂NH) to produce an N-nitrosamine (R₂N–N=O). EFSA’s 2023 risk assessment covered the 10 carcinogenic nitrosamines that occur in food, among them:

• N-nitrosodimethylamine (NDMA) — one of the nitrosamines EFSA assessed in food. NDMA also drew regulatory attention in 2018, when it was detected in the blood pressure drug valsartan; reviews were later extended to other sartans and to ranitidine.
• N-nitrosodiethylamine (NDEA) — EFSA based its reference point for all 10 nitrosamines on rat liver tumours induced by NDEA.
• N-nitrosopyrrolidine (NPYR) — the main volatile nitrosamine reported in fried bacon.

EFSA describes these nitrosamines as genotoxic and as inducing liver tumours in rodents. Nitrosamines are alkylating agents: after metabolic activation by cytochrome P450 enzymes they form DNA alkylation adducts, which can cause mutations if not repaired. N-nitroso compounds have induced tumours in 39 animal species, according to a 1981 review.

High-Heat Cooking

Volatile nitrosamines form when nitrite-cured meats are fried or otherwise cooked at high temperatures. A US survey of retail bacon published in 1986 found N-nitrosopyrrolidine in fried bacon at 1 to 65 parts per billion (µg/kg), average 21, and total volatile nitrosamines up to 110 parts per billion. A 1989 comparison found about 11 ng/g of total nitrosamines in skillet-fried bacon and none detectable in bacon microwaved for 45 seconds per slice, although longer microwaving produced some N-nitrosopyrrolidine.

Gastric Formation

IARC’s 2010 evaluation describes an active nitrogen cycle in humans in which nitrate and nitrite are interconverted, and states that nitrosating agents arising from nitrite under acidic gastric conditions react readily with amines and amides to generate N-nitroso compounds, some of which are known carcinogens. A 1997 review estimated that 45–75% of total human exposure to N-nitroso compounds results from formation inside the body, and that diet supplies 72% of exogenous nitrosamine exposure. In a controlled feeding study of 21 men, a high red meat diet and a heme iron supplement both raised fecal N-nitroso compounds, while inorganic iron did not.

Ascorbic Acid as an Inhibitor

Ascorbate blocked the formation of N-nitroso compounds in laboratory experiments reported in 1972. US rules now require 550 ppm of sodium ascorbate or sodium erythorbate in pumped bacon, alongside 120 ppm ingoing sodium nitrite. Nitrosamines were still measured in fried retail bacon in the 1986 survey described above.

Cancer Risk

In October 2015 IARC — the cancer agency of the World Health Organization — classified the consumption of processed meat as carcinogenic to humans (Group 1), based on sufficient evidence in humans that it causes colorectal cancer; red meat was classified as probably carcinogenic (Group 2A). The Working Group of 22 experts from 10 countries, whose summary was published in The Lancet Oncology (Bouvard et al., 2015), considered more than 800 studies; the most influential evidence came from large prospective cohort studies. IARC emphasized that the classification describes the strength of the evidence, not the size of the risk. Its Q&A cites Global Burden of Disease estimates of about 34,000 cancer deaths per year worldwide attributable to diets high in processed meat, against about 1 million per year from tobacco smoking.

Colorectal Cancer

IARC’s experts concluded that each 50 g portion of processed meat eaten daily increases the risk of colorectal cancer by 18%. A 2006 meta-analysis of 14 prospective studies reported a relative risk of 1.20 for the highest versus lowest processed meat intake, and a 2008 review put the excess risk in the highest category of processed meat eaters at between 20% and 50% compared with non-eaters. Colorectal cancer was the third most commonly diagnosed cancer worldwide in 2022 and the second leading cause of cancer death (GLOBOCAN 2022).

Stomach Cancer

A 2006 meta-analysis reported a relative risk of stomach cancer of 1.15 per 30 g/day of processed meat in cohort studies and 1.38 in case-control studies, and 1.37 for highest versus lowest bacon intake; the authors noted that confounding by other factors could not be ruled out. IARC judged the processed-meat evidence for stomach cancer not conclusive, and its 2010 nitrite evaluation linked nitrite in food with increased stomach cancer on limited evidence.

Esophageal Cancer

In a 2006 systematic review of 61 studies, 8 of 9 case-control studies found a positive association between processed meat intake and oesophageal cancer, while evidence on nitrite and nitrosamine intake and oesophageal cancer was insufficient and cohort evidence was insufficient or inconsistent. In the NIH-AARP cohort of about 500,000 people, oesophageal cancer was associated with red meat intake; processed meat was associated with colorectal and lung cancer.

Pancreatic Cancer

A 2012 meta-analysis of 11 prospective studies in the British Journal of Cancer found a relative risk of pancreatic cancer of 1.19 for each 50 g/day increase in processed meat consumption. IARC reported an association with pancreatic cancer for red meat, not for processed meat.

Other Health Effects

Methemoglobinemia

Nitrite oxidizes the ferrous iron (Fe²⁺) in hemoglobin to ferric iron (Fe³⁺), creating methemoglobin — a form of hemoglobin unable to carry oxygen. The use of nitrate-contaminated well water to prepare infant formula is a well-known risk factor for infant methemoglobinemia (“blue baby syndrome”), which can progress rapidly to coma and death if not recognized and treated. US rules prohibit nitrite and nitrate in baby, junior and toddler foods.

Intentional ingestion of concentrated sodium nitrite has become a reported method of suicide. An Ontario case series of 28 deaths with methemoglobinemia or toxic-salt ingestion (1980 to 2020) found 25 with evidence of intentional sodium nitrite or nitrate ingestion, most in the final two years; it notes the first reported case in the literature was in New Zealand in 2010. In two New York medical examiner jurisdictions, 36 sodium nitrite deaths were confirmed, with none found from 2000 to 2018 and yearly increases from 2019 to 2022, largely missed by poison center surveillance.

Cardiovascular Effects

Dietary nitrate and nitrite can be converted in the body to nitric oxide (NO), which dilates blood vessels; a 2013 meta-analysis of 16 short crossover trials found that inorganic nitrate and beetroot juice lowered systolic blood pressure by 4.4 mm Hg. Processed meat shows a different pattern in observational studies. A 2010 meta-analysis of 20 studies associated each 50 g/day of processed meat with a 42% higher risk of coronary heart disease (relative risk 1.42) and a 19% higher risk of diabetes; red and processed meat were not associated with stroke, but only 3 studies had examined it. In the EPIC cohort of 448,568 adults, processed meat was associated with higher all-cause mortality (hazard ratio 1.18 per 50 g/day after correction for measurement error), particularly from cardiovascular disease. These studies measure processed meat, not nitrite alone.

Migraine Triggering

A 1972 report in The Lancet described “hot-dog” headache as an individual susceptibility to nitrite. A 2016 study of the American Gut Project cohort found higher levels of nitrate-, nitrite- and nitric oxide-reducing bacteria in the mouths of people with migraine than in those without; its authors list nitrates in cardiac drugs and food additives as common headache triggers. Neither study measured how often cured meat triggers migraine.

Potential Link to Neurodegeneration

Researchers led by Suzanne de la Monte at Brown University have proposed that nitrosamines contribute to insulin-resistance diseases, including Alzheimer’s-type neurodegeneration, which the group has described as a form of diabetes of the brain. In a 2009 rat study, pups injected with N-nitrosodiethylamine and then fed high-fat (60%) chow for 6 weeks developed type 2 diabetes, fatty liver disease (NASH), spatial learning deficits and neurodegeneration with liver and brain insulin and/or IGF resistance; the combination was worse than either exposure alone. In a 2009 review the same group argued that rising mortality from diabetes, Alzheimer’s and Parkinson’s disease parallels increasing human exposure to nitrates, nitrites and nitrosamines through processed foods. These are animal experiments and population trend comparisons; they do not establish that dietary nitrosamines cause Alzheimer’s disease in people.

Sources of Exposure

• Bacon — Nitrite in bacon reacts with amines at frying temperatures to form volatile nitrosamines, chiefly N-nitrosopyrrolidine; fried bacon is among the processed meat products with the highest reported volatile nitrosamine levels.
• Hot dogs and frankfurters — Conventional hot dogs are typically cured with sodium nitrite.
• Ham and deli meats — Ham, cured turkey, salami, bologna and other cured sliced meats sold at deli counters or pre-packaged commonly contain sodium nitrite.
• Sausages — Cured and smoked sausages such as kielbasa, pepperoni and salami are cured with nitrite and/or nitrate; fresh (uncured) sausages generally are not.
• Beef jerky and meat snacks — Many commercial jerky products use sodium nitrite for preservation and color.
• Smoked fish — US FDA rules (21 CFR 172.175) permit sodium nitrite in smoked, cured sablefish, salmon and shad (up to 200 ppm in the finished product) and in smoked, cured tunafish (up to 10 ppm); 21 CFR 172.170 permits sodium nitrate in the same smoked, cured sablefish, salmon and shad up to 500 ppm.
• Canned meats — Products such as canned ham, corned beef and Vienna sausages are typically cured with nitrite.
• Vegetables — A 2009 review estimates that about 80% of dietary nitrate comes from vegetables (especially leafy greens, beets and celery), while sources of nitrite include vegetables, fruit and processed meats. Vegetables also supply vitamin C and polyphenols, and ascorbate blocks nitrosation reactions in laboratory experiments. In the French NutriNet-Santé cohort, nitrite and nitrate from food additives were associated with some cancers while those from natural sources were not.

The “Uncured” Labeling Question

Products labeled “uncured,” “no nitrites added” or “no nitrates added” are widely sold. Most use celery powder, celery juice or another vegetable ingredient high in nitrate, together with a nitrate-reducing starter culture that converts the nitrate to nitrite during processing — producing typical cured-meat properties.

• Residual nitrite is present — A 2007 analysis of retail uncured, no-nitrate/nitrite-added hams, bacons and frankfurters found residual nitrate and nitrite in all of them except two bacons (under 1 ppm nitrite), and most had cured color, aroma and flavor similar to the nitrite-added control.
• Amounts are hard to control — A 2007 review states that the amount of nitrite produced by this process cannot be measured analytically, and that labeling, standardized manufacturing and microbiological safety are open issues.
• Same chemistry — Nitrite from a vegetable source is the same nitrite ion as synthetic sodium nitrite and can take part in the same nitrosation reactions.
• Consumer perception — A 2019 review describes consumers rejecting conventional curing agents while accepting natural forms of the same constituents.

US labeling rules (9 CFR 317.17, last amended in 1979) allow a product made without added nitrate or nitrite to use its usual name preceded by “Uncured,” and require the statement “No Nitrate or Nitrite Added” and, unless otherwise preserved, “Not Preserved—Keep Refrigerated.” USDA’s Fall 2021 regulatory agenda listed a planned rule on “Changing the Labeling Requirements for Processed Products That Contain Nitrate or Nitrite.” A search of the Federal Register in October 2026 found no proposed or final rule published under that title, and the current eCFR text of 9 CFR 317.17 is unchanged.

Regulatory Status

United States

• Cured meat and poultry (USDA) – 9 CFR 424.21 limits nitrite in cured meat and poultry to no more than 200 ppm in the finished product (calculated as sodium nitrite) and prohibits nitrite in baby, junior and toddler foods. For bacon, 9 CFR 424.22 sets sodium nitrite at 120 ppm ingoing for pumped and immersion-cured bacon, with 550 ppm sodium ascorbate or erythorbate required in pumped bacon, and up to 200 ppm ingoing for dry-cured bacon.
• Smoked fish (FDA) – 21 CFR 172.175 permits sodium nitrite up to 200 ppm in smoked, cured sablefish, salmon and shad and up to 10 ppm in smoked, cured tunafish; 21 CFR 172.170 permits sodium nitrate up to 500 ppm in smoked, cured sablefish, salmon and shad.
• Prior sanction – Sodium and potassium nitrite used in curing red meat and poultry are covered by prior sanctions issued by USDA (21 CFR 181.34), a status that predates the modern food-additive approval process.
• Nitrosamine testing of bacon – In 2025 FSIS removed the regulations providing for its sampling and testing of pumped bacon for nitrosamines, noting that it stopped that sampling in 1998.

European Union

• Reduced limits – Regulation (EU) 2023/2108 lowered the maximum amount of nitrites (E 249–250) that may be added to most meat products from 150 to 80 mg/kg (55 mg/kg for sterilised meat products, previously 100), applying from 9 October 2025, and added maximum residual levels from all sources.
• Denmark – The European Commission (Decision (EU) 2021/741) approved for a limited period Denmark’s request to keep more stringent national provisions with lower maximum nitrite levels for certain meat products.
• Intake limits – JECFA (2002) set an ADI for nitrite of 0–0.07 mg/kg body weight/day; EFSA’s 2017 re-evaluation derived an ADI of 0.07 mg nitrite ion/kg body weight/day, based on increased methemoglobin levels in humans and animals.
• Nitrosamines – EFSA’s 2023 assessment of carcinogenic nitrosamines in food concluded that the margin of exposure at high (95th percentile) exposure is highly likely to be below 10,000 for all age groups, which raises a health concern, and identified meat and meat products as the main contributing food category.

What Research Reports About Lowering Exposure

• Amount eaten — IARC states that colorectal cancer risk increases with the amount of processed meat consumed; for an individual the risk remains small.
• Cooking method — In the 1989 bacon study, microwaving for 45 seconds per slice produced no detectable nitrosamines, while skillet frying did.
• Vitamin C — Ascorbate blocked the formation of N-nitroso compounds in laboratory experiments (1972); US rules require 550 ppm sodium ascorbate or erythorbate in pumped bacon.
• “Uncured” products — Products labeled “uncured” or “no nitrites added” typically contain nitrite formed from vegetable nitrate, as described above.
• Products without nitrite or nitrate — Meat products made with no nitrite or nitrate source exist; they lack the cured color and, unless otherwise preserved, US labels must state “Not Preserved—Keep Refrigerated.”
• Fresh meat and other proteins — Fresh-cooked meats, fresh (uncured) sausages, eggs and legumes contain no added nitrite.
• Children — EFSA’s 2017 opinion found a slight exceedance of the nitrite ADI from food additives in children at the highest percentile of exposure.

Decisions about diet and health belong with a clinician.

Key Research Papers

The following research papers and authoritative sources underpin the claims on this page. Links resolve to DOI, PubMed records or the agency document.

1. Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncology. 2015;16(16):1599-1600. — doi:10.1016/S1470-2045(15)00444-1 · PubMed PMID: 26514947
2. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 114: Red Meat and Processed Meat. Lyon: IARC; 2018. IARC Monographs Vol. 114
3. Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283. — doi:10.1161/CIRCULATIONAHA.109.924977 · PubMed PMID: 20479151
4. Cross AJ, Leitzmann MF, Gail MH, et al. A prospective study of red and processed meat intake in relation to cancer risk. PLoS Medicine. 2007;4(12):e325. — doi:10.1371/journal.pmed.0040325 · PubMed PMID: 18076279
5. Larsson SC, Wolk A. Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. International Journal of Cancer. 2006;119(11):2657-2664. — doi:10.1002/ijc.22170 · PubMed PMID: 16991129
6. Jakszyn P, Gonzalez CA. Nitrosamine and related food intake and gastric and oesophageal cancer risk: a systematic review of the epidemiological evidence. World Journal of Gastroenterology. 2006;12(27):4296-4303. — doi:10.3748/wjg.v12.i27.4296 · PubMed PMID: 16865769
7. Larsson SC, Wolk A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies. British Journal of Cancer. 2012;106(3):603-607. — PubMed PMID: 22240790
8. de la Monte SM, Tong M, Lawton M, Longato L. Nitrosamine exposure exacerbates high fat diet-mediated type 2 diabetes mellitus, non-alcoholic steatohepatitis, and neurodegeneration with cognitive impairment. Molecular Neurodegeneration. 2009;4:54. — doi:10.1186/1750-1326-4-54 · PubMed PMID: 20034403
9. Hord NG, Tang Y, Bryan NS. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. American Journal of Clinical Nutrition. 2009;90(1):1-10. — doi:10.3945/ajcn.2008.27131 · PubMed PMID: 19439460
10. Sebranek JG, Bacus JN. Cured meat products without direct addition of nitrate or nitrite: what are the issues? Meat Science. 2007;77(1):136-147. — doi:10.1016/j.meatsci.2007.03.025 · PubMed PMID: 22061404
11. Sindelar JJ, Milkowski AL. Human safety controversies surrounding nitrate and nitrite in the diet. Nitric Oxide. 2012;26(4):259-266. — doi:10.1016/j.niox.2012.03.011 · PubMed PMID: 22487433
12. Tricker AR. N-nitroso compounds and man: sources of exposure, endogenous formation and occurrence in body fluids. European Journal of Cancer Prevention. 1997;6(3):226-268. — doi:10.1097/00008469-199706000-00003 · PubMed PMID: 9306073
13. Milkowski A, Garg HK, Coughlin JR, Bryan NS. Nutritional epidemiology in the context of nitric oxide biology: a risk-benefit evaluation for dietary nitrite and nitrate. Nitric Oxide. 2010;22(2):110-119. — doi:10.1016/j.niox.2009.08.004 · PubMed PMID: 19748594
14. Rohrmann S, Overvad K, Bueno-de-Mesquita HB, et al. Meat consumption and mortality — results from the European Prospective Investigation into Cancer and Nutrition. BMC Medicine. 2013;11:63. — doi:10.1186/1741-7015-11-63 · PubMed PMID: 23497300
15. Santarelli RL, Pierre F, Corpet DE. Processed meat and colorectal cancer: a review of epidemiologic and experimental evidence. Nutrition and Cancer. 2008;60(2):131-144. — doi:10.1080/01635580701684872 · PubMed PMID: 18444144
16. Gilchrist M, Shore AC, Benjamin N. Inorganic nitrate and nitrite and control of blood pressure. Cardiovascular Research. 2011;89(3):492-498. — doi:10.1093/cvr/cvq309 · PubMed PMID: 20884639
17. IARC Monographs Q&A on the carcinogenicity of the consumption of red meat and processed meat (Volume 114).
18. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Ingested Nitrate and Nitrite, and Cyanobacterial Peptide Toxins. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 94. Lyon: IARC; 2010. Chapter 6, Evaluation and Rationale. — NCBI Bookshelf NBK326535
19. Larsson SC, Orsini N, Wolk A. Processed meat consumption and stomach cancer risk: a meta-analysis. Journal of the National Cancer Institute. 2006;98(15):1078-1087. — PubMed PMID: 16882945
20. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024;74(3):229-263. — PubMed PMID: 38572751
21. Chazelas E, Pierre F, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaesse C, et al. Nitrites and nitrates from food additives and natural sources and cancer risk: results from the NutriNet-Santé cohort. International Journal of Epidemiology. 2022;51(4):1106-1119. — PubMed PMID: 35303088
22. EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). Re-evaluation of potassium nitrite (E 249) and sodium nitrite (E 250) as food additives. EFSA Journal. 2017;15(6):e04786. — PubMed PMID: 32625504
23. EFSA Panel on Contaminants in the Food Chain (CONTAM). Risk assessment of N-nitrosamines in food. EFSA Journal. 2023;21(3):e07884. — PubMed PMID: 36999063
24. Fahrer J, Christmann M. DNA alkylation damage by nitrosamines and relevant DNA repair pathways. International Journal of Molecular Sciences. 2023;24(5):4684. — PubMed PMID: 36902118
25. Bogovski P, Bogovski S. Animal species in which N-nitroso compounds induce cancer. International Journal of Cancer. 1981;27(4):471-474. — PubMed PMID: 7275353
26. Ruepp R, Frötschl R, Bream R, Filancia M, Girard T, Spinei A, Weise M, Whomsley R. The EU response to the presence of nitrosamine impurities in medicines. Frontiers in Medicine. 2021;8:782536. — PubMed PMID: 34869504
27. Canas BJ, Havery DC, Joe FL Jr, Fazio T. Current trends in levels of volatile N-nitrosamines in fried bacon and fried-out bacon fat. Journal of the Association of Official Analytical Chemists. 1986;69(6):1020-1021. — PubMed PMID: 3804941
28. Miller BJ, Billedeau SM, Miller DW. Formation of N-nitrosamines in microwaved versus skillet-fried bacon containing nitrite. Food and Chemical Toxicology. 1989;27(5):295-299. — PubMed PMID: 2744660
29. Cross AJ, Pollock JR, Bingham SA. Haem, not protein or inorganic iron, is responsible for endogenous intestinal N-nitrosation arising from red meat. Cancer Research. 2003;63(10):2358-2360. — PubMed PMID: 12750250
30. Mirvish SS, Wallcave L, Eagen M, Shubik P. Ascorbate-nitrite reaction: possible means of blocking the formation of carcinogenic N-nitroso compounds. Science. 1972;177(4043):65-68. — PubMed PMID: 5041776
31. Knobeloch L, Salna B, Hogan A, Postle J, Anderson H. Blue babies and nitrate-contaminated well water. Environmental Health Perspectives. 2000;108(7):675-678. — PubMed PMID: 10903623
32. Hickey TBM, MacNeil JA, Hansmeyer C, Pickup MJ. Fatal methemoglobinemia: a case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide. Forensic Science International. 2021;326:110907. — PubMed PMID: 34298207
33. Bloom J, Sharpe A, Nulman S, Monday K, Marraffa JM, Stayton C, et al. Comparing confirmed sodium nitrite suicide deaths with poison center surveillance estimates. JAMA Network Open. 2024;7(9):e2434192. — PubMed PMID: 39312240
34. Siervo M, Lara J, Ogbonmwan I, Mathers JC. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. Journal of Nutrition. 2013;143(6):818-826. — PubMed PMID: 23596162
35. Henderson WR, Raskin NH. “Hot-dog” headache: individual susceptibility to nitrite. Lancet. 1972;2(7788):1162-1163. — PubMed PMID: 4117590
36. Gonzalez A, Hyde E, Sangwan N, Gilbert JA, Viirre E, Knight R. Migraines are correlated with higher levels of nitrate-, nitrite-, and nitric oxide-reducing oral microbes in the American Gut Project cohort. mSystems. 2016;1(5):e00105-16. — PubMed PMID: 27822557
37. de la Monte SM, Neusner A, Chu J, Lawton M. Epidemilogical trends strongly suggest exposures as etiologic agents in the pathogenesis of sporadic Alzheimer’s disease, diabetes mellitus, and non-alcoholic steatohepatitis. Journal of Alzheimer’s Disease. 2009;17(3):519-529. — PubMed PMID: 19363256
38. Sindelar JJ, Cordray JC, Olson DG, Sebranek JG, Love JA. Investigating quality attributes and consumer acceptance of uncured, no-nitrate/nitrite-added commercial hams, bacons, and frankfurters. Journal of Food Science. 2007;72(8):S551-S559. — PubMed PMID: 17995620
39. Rivera N, Bunning M, Martin J. Uncured-labeled meat products produced using plant-derived nitrates and nitrites: chemistry, safety, and regulatory considerations. Journal of Agricultural and Food Chemistry. 2019;67(29):8074-8084. — PubMed PMID: 31299152
40. US Code of Federal Regulations. 9 CFR 424.21 (use of food ingredients and sources of radiation) and 9 CFR 424.22 (certain other permitted uses, including nitrite in bacon). — eCFR 9 CFR 424.21 · eCFR 9 CFR 424.22
41. US Code of Federal Regulations. 9 CFR 317.17 (labeling of cured products; “Uncured” and “No Nitrate or Nitrite Added”). — eCFR 9 CFR 317.17
42. US Code of Federal Regulations. 21 CFR 172.175 (sodium nitrite in smoked, cured fish), 21 CFR 172.170 (sodium nitrate) and 21 CFR 181.34 (prior sanctions for nitrite in meat curing). — eCFR 21 CFR 172.175 · eCFR 21 CFR 172.170 · eCFR 21 CFR 181.34
43. US Department of Agriculture. Semiannual Regulatory Agenda, Fall 2021 (entry: Changing the Labeling Requirements for Processed Products That Contain Nitrate or Nitrite). Federal Register document 2021-27969. — Federal Register 2021-27969
44. Food Safety and Inspection Service. Removal of Pumped Bacon Sampling Regulations. Final rule. Federal Register 2025;90:27973 (document 2025-12212). — Federal Register 2025-12212
45. European Commission. Commission Regulation (EU) 2023/2108 of 6 October 2023 amending Annex II to Regulation (EC) No 1333/2008 and the Annex to Regulation (EU) No 231/2012 as regards food additives nitrites (E 249–250) and nitrates (E 251–252). — EUR-Lex: Regulation (EU) 2023/2108

PubMed Topic Searches

1. PubMed: Sodium nitrite processed meat carcinogenicity search

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