Beetroot: Benefits, Forms, Dosing, and Side Effects

Beetroot supplements and juice are rich sources of dietary nitrate, which the body converts to the vasodilator nitric oxide. This mechanism has driven interest in beetroot for lowering blood pressure, improving exercise performance, and supporting cardiovascular health. Clinical trials have used doses providing approximately 300-600 mg of nitrate daily, though results have been mixed — particularly in people already taking blood pressure medication and in well-trained athletes.

Table of Contents

• Overview
• Forms and Bioavailability
• Evidence for Benefits
• Recommended Dosing
• Safety and Side Effects
• Drug Interactions
• Dietary Sources
• References

Overview

Beetroot supplements and juice are rich sources of dietary nitrate, which the body converts to nitric oxide — a vasodilator that relaxes blood vessels. This mechanism has driven interest in beetroot for lowering blood pressure, improving exercise performance, and supporting cardiovascular health.

The amount of nitrate in beetroot products varies enormously. An analysis of 24 products found nitrate ranging from 12-69 mg per fluid ounce in juices, 60-244 mg in concentrates, and 6-16 mg per gram of powder [1]. Even fresh beetroot varies from 11-152 mg per 100 grams [2]. This variability makes product selection and dose consistency a significant challenge.

Forms and Bioavailability

Beetroot is available in several forms:

• Beetroot juice: Fresh or bottled. Must be refrigerated — unrefrigerated juice loses all nitrate within 7 days. Adding lemon juice or vitamin C preserves nitrate [3].
• Beetroot concentrate: Higher nitrate per volume (60-244 mg/fl oz). Products like Beet It Sport are commonly used in research.
• Beetroot powder: Economical but nitrate varies widely (6-16 mg/g). Some add synthetic nitrate (betaine nitrate/NO3-T).
• Beetroot extract: Standardized products with known nitrate percentages.
• Chews: Tend to contain the least nitrate relative to cost and calories.

Bacteria in the mouth convert dietary nitrate to nitrite, which is then either absorbed or converted to nitric oxide in the stomach. Using antibacterial mouthwash may reduce this conversion and negate benefits. Beetroot should be taken with meals or as directed by the specific product.

Evidence for Benefits

Blood Pressure Reduction

In adults without hypertension: A pooled analysis of 16 small RCTs (245 participants) found beetroot reduced systolic blood pressure by a modest 4 mmHg with no significant diastolic effect. The benefit was mainly at night and tended to be smaller in older individuals [4]. Several individual studies, including a 12-week trial with 544 mg nitrate/day in healthy older adults, found no blood pressure reduction [5][6].

In people with hypertension: Mixed results. One 60-day study in untreated hypertensive adults found 400 mg nitrate/day reduced systolic BP by 10 mmHg and diastolic by 5.4 mmHg [7]. A 4-week study in medicated patients found 7.7-8.1 mmHg systolic reduction [8]. However, other studies in treated hypertension found no benefit [9], and one study found dietary sodium reduction more effective than beetroot supplementation [10].

Exercise Performance

In younger adults: A review of 17 trials found 300-600 mg nitrate (taken 1-3 hours pre-exercise) moderately improved endurance [12]. A later review concluded over 527 mg nitrate may be needed to improve performance [13]. However, one study found benefits only in men — women showed no ergogenic effect despite greater blood nitrite increases [14].

In older adults with cardiovascular disease: In 20 adults with heart failure, 380 mg nitrate/day for one week improved aerobic endurance by 24% [15]. In peripheral artery disease, 262 mg nitrate before exercise sessions allowed walking 2 minutes longer and 32 yards farther without pain [16].

In trained athletes: Benefits are less clear, likely because elite athletes have already optimized oxygen utilization [18][19]. Products with very low nitrate content (~15 mg) show no benefit [20].

Recommended Dosing

Based on clinical trials:

• Blood pressure: 300-600 mg of nitrate daily, typically as concentrated beetroot juice
• Exercise performance: 300-600 mg nitrate, consumed 1-3 hours before exercise. Daily supplementation for 3-7 days may be more effective than a single dose
• Duration: Studies have used daily supplementation up to 12 weeks

Look for products listing nitrate content on the label. Nitrate content varies widely between products, making unlabeled products unreliable.

Safety and Side Effects

Common and generally harmless effects:

• Red urine and stools (beeturia)
• Gastrointestinal discomfort and headaches

More significant concerns:

• Oxalate content: Beets contain ~440 mg total oxalate per half cup [21]. May increase kidney stone risk in susceptible individuals.
• Methemoglobinemia: Rare but potentially fatal condition from excessive nitrate. The EFSA acceptable daily intake is 3.7 mg/kg/day (~300 mg for a 175-lb adult); some products exceed this per serving.
• Blood sugar: One study found nitrate modestly decreased insulin levels [5]. People with diabetes should consult their doctor.
• Thyroid: Nitrate can inhibit iodide uptake, though short-term studies found no significant effect on thyroid hormones [25].
• Migraine: High-nitrate foods may trigger migraines in susceptible individuals.

Drug Interactions

• Antihypertensive medications: May have additive blood pressure-lowering effects. Not a substitute for prescribed medication.
• Medications increasing methemoglobinemia risk: Dapsone, topical benzocaine, and others. Avoid high-nitrate beetroot products.
• Blood sugar medications: Potential to affect insulin levels; monitor accordingly.

Dietary Sources

Natural dietary sources of nitrate include:

• Canned beetroot: 241 mg nitrate per half cup
• Cooked spinach: 247 mg per half cup
• Raw celery: 98 mg per stalk
• Fennel: 61 mg per cup
• Lettuce: 41 mg per cup

People following a Mediterranean diet may consume up to 400 mg of nitrate daily from food alone. Other nitrate-rich vegetables include watercress, arugula, chervil, and cabbage.

References

1. Gallardo EJ et al. Nitrate concentration in beetroot products. Int J Sport Nutr Exerc Metab. 2019.

2. Brzezinska-Rojek J et al. Nitrate variation in fresh beetroot. Foods. 2023.

3. Bescos R et al. Nitrate stability in beetroot juice. Food Sci Nutr. 2023.

4. Siervo M et al. Inorganic nitrate and beetroot juice supplementation reduces blood pressure. J Nutr. 2013.

5. Pinheiro LC et al. Beetroot extract in healthy older adults. Nutrients. 2024.

6. Vanhatalo A et al. Beetroot concentrate and vascular function. Free Radic Biol Med. 2025.

7. Siervo M et al. Beetroot juice and blood pressure in Tanzanian adults. J Nutrition. 2020.

8. Kapil V et al. Dietary nitrate provides sustained blood pressure lowering. Hypertension. 2015.

9. Bondonno CP et al. Beetroot juice in treated hypertension. AJCN. 2015.

10. Duus CK et al. Beetroot versus sodium reduction in hypertension. J Hum Hypertens. 2025.

11. Kelly J et al. Nitrate-rich beetroot juice and blood pressure during exercise. Am J Physiol Regul Integr Comp Physiol. 2013.

12. Hoon MW et al. Nitrate supplementation and exercise endurance. Int J Sport Nutr Exerc Metab. 2013.

13. Jones AM et al. Dietary nitrate and physical performance. Annu Rev Nutr. 2018.

14. Ortiz de Zevallos J et al. Sex differences in beetroot juice response. J Appl Physiol. 2023.

15. Eggebeen J et al. Beetroot juice in heart failure. JACC Heart Fail. 2016.

16. Woessner M et al. Beetroot juice in peripheral artery disease. Circ Res. 2018.

17. Ramos GO et al. Beetroot extract and muscle strength in postmenopausal women. Free Radic Biol Med. 2025.

18. Christensen PM et al. Nitrate supplementation in elite athletes. Scand J Med Sci Sports. 2013.

19. Porcelli S et al. Aerobic fitness and nitrate supplementation. Med Sci Sports Exerc. 2015.

20. Benjamim CJR et al. Low-nitrate beetroot extract and exercise recovery. Int J Environ Res Public Health. 2023.

21. Han H et al. Oxalate content of foods. Clin Nutr Res. 2015.

22. Sierer JM et al. Oxalate in beetroot juice. J Food Compost Anal. 2016.

23. McKnight GM et al. Dietary nitrate in man: friend or foe? Br J Nutr. 1999.

24. Bondonno CP et al. Dietary nitrate and urinary N-nitrosamines. Am J Clin Nutr. 2026.

25. Pinheiro LC et al. Beetroot juice and thyroid hormones. Food Biosci. 2021.

26. Artene SA et al. Beetroot consumption and thyroid function. Practica Medicala. 2016.

27. Lorei ML et al. Beetroot supplementation and diving hypoxia. J Sci Med Sport. 2024.