health benefits of beetroot juice

What is beetroot

The beetroot is the taproot portion of the beet plant 1) usually known in North America as the beet, also table beet, garden beet, red beet, or golden beet. It is one of several of the cultivated varieties of Beta vulgaris grown for their edible taproots and their leaves (called beet greens). These varieties have been classified as B. vulgaris subsp. vulgaris Conditiva Group 2).

Other than as a food, the juice of the beetroot, has potential antioxidant and blood pressure lowering effect 3). Beetroot contains nitrate, which while in your body changes to a chemical called nitrite and then to nitric oxide in the blood. Nitric oxide is a gas that opens up blood vessels and aids blood flow. In a preliminary study, people with high blood pressure who drank a cup of beetroot juice each day had a 10 mm Hg decrease in blood pressure over the following 24 hours 4).

Beetroots have also been used as a food coloring and as a medicinal plant. Many beet products are made from other Beta vulgaris varieties, particularly sugar beet.

Usually the deep purple roots of beetroot are eaten boiled, roasted or raw, and either alone or combined with any salad vegetable. A large proportion of the commercial production is processed into boiled and sterilized beets or into pickles. In Eastern Europe, beet soup, such as borscht, is a popular dish. In Indian cuisine, chopped, cooked, spiced beet is a common side dish. Yellow-coloured beetroots are grown on a very small scale for home consumption.

The green, leafy portion of the beet is also edible. The wild beet, the ancestor of today’s known beetroot vegetable, was initially grown for the beet greens which to this day tastes delicious, chopped, steamed and drizzled with olive oil and lemon juice. The young leaves can be added raw to salads, whilst the adult leaves are most commonly served boiled or steamed, in which case they have a taste and texture similar to spinach.

Beetroot nutrition facts

Raw beetroot is 88% water, 10% carbohydrates, 2% protein, and less than 1% fat (table 1). In a 100 gram amount providing 43 calories, raw beetroot is a rich source (27% of the Daily Value, DV) of folate and a moderate source (16% DV) of manganese, with other nutrients having insignificant content.

Table 1. Beetroot (raw) nutrition facts

[Source: United States Department of Agriculture Agricultural Research Service 5)]
health benefits of beetroot juice

Benefits of beetroot juice

In the last 20 years or so there has been renewed interest in the potential of inorganic nitrate (NO3-) to control blood pressure in humans 6). Dietary inorganic nitrate is absorbed rapidly and completely in the proximal small intestine with 100% bioavailability 7). Approximately 25% of the nitrate circulating in the plasma is then concentrated in the salivary glands and secreted into the mouth where around 20% (or ≈ 5 – 8% of intake) is converted to nitrite (NO2-) by commensal bacteria on the tongue and subsequently swallowed 8). Upon reaching the stomach the NO2- is either absorbed directly or reduced to nitric oxide (NO) as a result of the acidic environment of the stomach 9), 10). Endogenously produced NO and NO2- are vasoprotective agents with the ability to increase vasodilation, decrease blood pressure (BP) and improve cardiovascular function 11). Reduced endogenous NO production is associated with hypertension 12) and there is evidence to support the hypothesis that the NO and NO2- produced as a result of dietary NO3- could induce health benefits 13).

In addition, a potent signaling molecule that affects cell function in many body tissues, NO is endogenously produced by synthesizing nitric oxide from l-arginine oxidation. The molecule has important hemodynamic and metabolic functions 14), 15), being a major vasodilator that can increase blood flow to muscles 16) and promote oxygen transfer in the muscle. Additional physiological benefits of NO include improved mitochondrial efficiency and glucose uptake in muscle 17) and enhanced muscle contraction and relaxation processes 18). Other researchers have reported that NO can act as an immunomodulator 19) and stimulates gene expression and mitochondrial biogenesis 20). Given the positive effects of beetroot juice, which are induced by means of NO, this supplement has been proposed as part of the therapeutic approach in people with chronic obstructive pulmonary disease 21), hypertension 22), heart failure 23) and insulin resistance 24).

Figure 1. Exogenous (dietary inorganic nitrate [NO3] in certain vegetables and fruit & nitrite [NO2]) and endogenous nitric oxide production

nitrate and nitric oxide productions

Note: A schematic diagram of the physiologic disposition of nitrate, nitrite, and nitric oxide from exogenous (dietary) and endogenous sources. The action of bacterial nitrate reductases on the tongue and mammalian enzymes that have nitrate reductase activity in tissues are noted by the number 1. Bacterial nitrate reductases are noted by the number 2. Mammalian enzymes with nitrite reductase activity are noted by the number 3. The generation of up to ≈70% of systemic nitric oxide is accomplished by endothelial nitric oxide synthase (eNOS), one of 3 members of the NOS family of enzymes, in the vascular endothelium 25). These enzymes synthesize nitric oxide from the amino acid l-arginine and molecular oxygen to accomplish vasodilation, blood pressure regulation, inhibition of endothelial inflammatory cell recruitment, and platelet aggregation 26). As a result, the normal production of nitric oxide and nitrite and the ability of the endothelium to respond to these species may prevent various types of cardiovascular disease, including hypertension, atherosclerosis, and stroke 27).

[Source 28)]

The individual daily intake of dietary nitrate has been estimated to be ≈81–106 mg/d (not including loses from washing, peeling and cooking) in the typical Western diet, with vegetables contributing approximately 80% of this value 29), 30). The vegetables with the highest nitrate contents (>250 mg/ 100 g fresh weight) are celery, cress, chervil, lettuce, red beetroot, spinach and rocket (see Table 3 below) 31). Green leafy vegetables have recently been shown to be among the foods most beneficial in the prevention of coronary heart disease and ischemic stroke 32), 33). This effect has been postulated to be due to the high inorganic NO3- content of these vegetables 34), 35), 36).

Other food sources nitrates and nitrites

Table 2. Nitrate and nitrite contents of edible components of vegetables

Vegetable types and varietiesNitriteNitrate
mg/100 g fresh weightmg/100 g fresh weight
Root vegetables
 Carrot0.002–0.02392–195
 Mustard leaf0.012–0.06470–95
Green vegetables
 Lettuce0.008–0.21512.3–267.8
 Spinach0–0.07323.9–387.2
Cabbage
 Chinese cabbage0–0.06542.9–161.0
 Bok choy0.009–0.242102.3–309.8
 Cabbage0–0.04125.9–125.0
 Cole0.364–0.53576.6–136.5
Melon
 Wax gourd0.001–0.00635.8–68.0
 Cucumber0–0.0111.2–14.3
Nightshade
 Eggplant0.007–0.04925.0–42.4
[Source 37)]

Table 3. Classification of vegetables according to nitrate content

Nitrate content (mg/100 g fresh weight)Vegetable varieties
Very low, <20Artichoke, asparagus, broad bean, eggplant, garlic, onion, green bean, mushroom, pea, pepper, potato, summer squash, sweet potato, tomato, watermelon
Low, 20 to <50Broccoli, carrot, cauliflower, cucumber, pumpkin, chicory
Middle, 50 to <100Cabbage, dill, turnip, savoy cabbage
High, 100 to <250Celeriac, Chinese cabbage, endive, fennel, kohlrabi, leek, parsley
Very high, >250Celery, cress, chervil, lettuce, red beetroot, spinach, rocket (rucola)
[Source 38)]

In addition to the provision of nitrate and nitrite by diet or via the oxidation of nitric oxide to nitrite, vascular and gastrointestinal nitric oxide production can be enhanced through various means based on lifestyle and food choices. Physical activity, commensal bacteria, and dietary factors can influence nitric oxide production. Exercise enhances nitric oxide production in vascular endothelium 39) and post-exercise plasma nitrite concentrations have been proposed as an index of exercise capacity 40). In fact, aging is associated with an impaired capacity of the vasculature to increase plasma nitrite during exercise 41). Strikingly, it has been found that dietary nitrate supplementation, at concentrations achievable by vegetable consumption, results in more efficient energy production without increasing lactate concentrations during submaximal exercise 42).

Beetroot is a rich source of dietary NO3- 43) and a number of studies have investigated its potential for reducing blood pressure in humans 44), 45), 46), which appears to be more potent in men.

In addition, beetroot juice contains antioxidants, including betacyanin, which scavenge free radicals and beetroot contains high levels folic acid. Beetroot is particularly rich in inorganic nitrate content (typically ranging from 110 to 3670 mg nitrate/kg) 47) and it has therefore been utilized in several studies as a nutritional strategy to test the effects of inorganic nitrate intake on blood pressure. For example, Webb et al. 48) showed in healthy participants that 24 hour after a single dose of 500 mL beetroot juice, systolic and diastolic blood pressure were reduced by 10.4 and 8.0 mm Hg, respectively.

The BP-lowering effects of inorganic nitrate may derive from increased generation of nitric oxide (NO) 49), 50), a molecule involved in the vasodilation of large arteries and resistance vessels 51), 52). Reduced nitric oxide (NO) bioavailability has been associated with impairment of endothelial function and increased risk of hypertension and cardiovascular diseases 53), 54).

Beetroot juice and nitrate salt (sodium nitrate/potassium nitrate) supplementation was tested in 17 studies 55). The daily amount of nitrate in the beetroot juice consumed varied between 321–2790 mg. The volume of the beetroot juice drinks ranged from 140 to 500 mL/d and the beetroot juice was given as a concentrated solution in 2 studies 56), 57). The most common side effect reported in the beetroot juice trials was beeturia (red urine) and red stools 58), 59). Beetroot juice supplementation were associated with a significant decrease in blood pressure, which may potentially have important implications for the primary and secondary prevention of cardiovascular diseases. A systolic BP reduction of at least 5 mm Hg (as observed here) could decrease the risk of mortality due to stroke by 14% and mortality from cardiovascular diseases by 9% 60).

In another systematic review and meta-analysis meta-analysis on the medium-term effects of dietary nitrate supplementation on systolic and diastolic blood pressure in adults involving 13 trials 61). The duration of each intervention ranged from 1 to 6 weeks. Ten trials assessed BP in resting clinic conditions, whereas 24 hour ambulatory and daily home monitorings were used in six and three trials, respectively. Overall, dietary nitrate was associated with a significant decline in systolic BP (-4.1 mmHg) and diastolic BP (-2.0 mmHg). However, the effect was only significant when measured in resting clinical settings as no significant changes in BP were observed using 24-h ambulatory and daily home BP monitorings.

A double-blind, randomized, placebo-controlled, crossover study involving fifteen women and fifteen men 62) were randomized to receive 500 g of beetroot and apple juice (72% beetroots and 28% apples) or a placebo juice (apple juice concentrate). Subjects ranged in age from 23 – 68 years. Subjects were generally healthy with none of the male subjects and approximately half of the female subjects not medicated. Individual BP changes from baseline after each treatment showed a drop of 4.6 mmHg with 500 g of beetroot (72% beetroots and 28% apples juice) and 3.4 mmHg with placebo apple juice concentrate at 3-h, 6.2 mmHg and 2.2 mmHg respectively at 6-h and 4.5 mmHg and 2.3 mmHg respectively, at 24 hour. Statistically the 6-h difference was a trend overall, with men showing a difference of −4.7 mmHg, and women a difference of −2.5 mmHg. In conclusion, it was demonstrated here that in free-living people consuming an unrestricted diet and a single dose of 500 g of beetroot and apple juice, a trend to lower blood pressure by 4–5 mmHg at 6-h was observed 63).

Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes

Cardiorespiratory endurance is defined as a health-related component of physical fitness that relates to the ability of the circulatory and respiratory systems to supply fuel during sustained physical activity and to eliminate fatigue products after supplying fuel 64). Cardiorespiratory endurance is a performance factor in all sports in which adenosine triphosphate (ATP) is resynthesized, mainly by aerobic metabolism or oxidative processes that produce energy. In these sports, the expended effort typically lasts longer than five minutes, primarily depending on the metabolic level of the oxidative processes involved 65). Factors that limit performance in this type of endurance patterns include maximum oxygen uptake (VO2max), ventilatory thresholds (first and second ventilatory threshold) and energy efficiency or economy 66), 67), 68), 69).

According to the American College of Sports Medicine 70), adequate selection of nutrients and supplements, adjusting intake according to the exercise performed, is necessary for optimal performance in athletes. However, not all supplements have been shown to produce a positive effect on performance. The Australian Institute of Sport 71), classified supplements to which athletes have access, with the goal of categorizing nutritional supplements based on the level of evidence for impact on an athlete’s performance (Table 4). However, the effectiveness of supplements also depends on dosage and type of effort, because the potential ergogenic effect may differ by the specific type of sport 72).

Table 4. Classification of nutritional supplements, based on performance effect. Adapted from Australian Institute of Sport 73) and Burke 74)

CategorySub-CategoriesSupplements
High level of evidenceWill improve athletic performance with adequate dosing and specific types of effortβ-alanine
Sodium bicarbonate
Caffeine
Creatinine
Beetroot juice
Moderate level of evidenceMay improve performance, under specific dosing and effort conditions, although additional research is neededFish oils
Carnitine
Curcumin
Glucosamine
Glutamine
HMB
Quercetin
Vitamins C and E
Tart cherry juice
Low level of evidenceNo demonstrated beneficial effectsSupplements not found in other categories
Prohibited supplementsMay result in positive doping tests and therefore are prohibitedSubstances on the list published annually by the World Anti-Doping Agency (WADA)
[Source 75)]

Beetroot juice is used as a supplement because of its high inorganic nitrate (NO3−) content, a compound found naturally in vegetables. Athletes use nutritional supplementation to enhance the effects of training and achieve improvements in their athletic performance. Beetroot juice increases levels of nitric oxide (NO), which serves multiple functions related to increased blood flow, gas exchange, mitochondrial biogenesis and efficiency, and strengthening of muscle contraction. These biomarker improvements indicate that supplementation with beetroot juice could have ergogenic (performance enhancing) effects on cardiorespiratory endurance that would benefit athletic performance.

Nitric oxide (NO) induces several physiological mechanisms that influences O2 utilization during contraction skeletal muscle (Domínguez R, Cuenca E, Maté-Muñoz JL, et al. Effects of Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes. A Systematic Review. Nutrients. 2017;9(1):43. doi:10.3390/nu9010043. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295087/)). Physiological mechanisms for NO2− reduction are facilitated by hypoxic conditions, therefore, nitric oxide (NO) (vasodilator) is produced in those parts of muscle that are consuming or in need of more O2. This mechanism would allow local blood flow to adapt to O2 requirement providing within skeletal muscle an adequate homogeneous distribution. This physiological response could be positive in terms of muscle function, although it would not explain a reduced O2 cost during exercise 76). Another probable mechanism is related to nitrite (NO2−) and nitric oxide (NO) as regulators of cellular O2 utilization 77).

Peak NO2− concentration in blood is obtained within 2–3 h of NO3− supplementation 78) and the ergogenic effects of supplementation with beetroot juice can be observed at 150 min after ingestion 79). Oral antiseptic rinses should not be taken with beetroot juice supplementation, as these can prevent the desired increase in NO2− levels after NO3− ingestion 80). Although the majority of studies show ergogenic effects of beetroot juice at a supplementation dose of 6–8 mmol NO3−, it is possible that high performance athletes might require a slightly higher dose. For example, in high performance kayakers, the ergogenic effect of supplementation with beetroot juice was 1.7% in a 500-m test after ingestion of 9.6 mmol of NO3− but a 4.8 mmol dose did not significantly improve results in a 1000-m test 81).

Acute supplementation with beetroot juice may have an ergogenic effect on reducing VO2 at less than or equal to VO2max intensity, while improving the relationship between watts required and VO2 level, mechanisms that make it possible to enable increase time-to-exhaustion at less than or equal to VO2max intensity. In addition to improving efficiency and performance in various time trials or increasing time-to-exhaustion at submaximal intensities, chronic supplementation with beetroot juice may improve cardiorespiratory performance at the anaerobic threshold and VO2max intensities.

However, not all studies show a positive effect to acute beetroot supplementation indicating that the efficacy of acute nitrate supplementation will be attributed to several factors such as the age, diet, physiological and training status, and other parameters as the intensity, duration, endurance modality and environment conditions 82). Although most of the studies determine a supplementation dose of 6–8 mmol NO3−, it is unclear that this supplementation dose can be effective to improve cardiorespiratory performance in sports modalities such as kayaking or rowing. The dose should possibly be increased in sports modalities where muscular groups of upper limbs are implicated. Endurance athletes should take the dose of NO3−, approximately 90 min before the competition without oral antiseptic. Acute supplementation with beetroot juice is not sufficient to induce mitochondrial biogenesis, suggesting that mitochondrial adaptations could only occur after longer supplementation protocols. In chronic supplementations with beetroot juice, it appears that the benefits in cardiorespiratory performance might be produced in longer intake protocols of about six days 83), 84). Time-to-exhaustion at several intensities (between 70% and 100% VO2max, VT1) and the load at anaerobic threshold could be enhanced while aerobic energy expenditure could be diminished. Longer-term beetroot supplementation (15 or more days) could be effective, although it would be necessary other studies analyzing the mitochondrial biogenesis to corroborate whether mitochondrial adaptations depend on endurance training and/or beetroot supplementation. To date, this assumption is unknown.

The scientific literature shows discrepancies regarding the improvement of the cardiorespiratory performance induced by the supplementation of beetroot juice under hypoxic conditions. NO3− could mitigate the ergolytic effects of hypoxia on cardiorespiratory in endurance athletes 85).

Apparently, the effects of supplementation with beetroot juice might not have a positive interaction with caffeine supplementation, mitigating the effects of beetroot juice intake on cardiorespiratory performance, however, more work is needed to confirm the results of these investigations because the number of studies analyzing the effects of the combination of beetroot juice with other supplements, such as caffeine, is limited 86).

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