Modern evidence-based supplement for blood pressure and athletic performance, with strong clinical support for cardiovascular benefits via nitrate-to-nitric-oxide conversion. Not a traditional medicinal herb - uses emerged from 21st-century research.
Traditions: Egyptian herbalism
Supportive therapy for liver and fatty liver conditions. This is modern government documentation, not ancient traditional knowledge. Limited historical medicinal use.
Blood pressure reduction, athletic performance, cardiovascular health - all derived from nitrate metabolism research, not traditional knowledge.
Beetroot has strong evidence for blood pressure reduction and athletic performance enhancement. Meta-analyses show consistent systolic BP reduction (3.55-5.31 mmHg) and improved muscular endurance. Unlike most herbs, beetroot's therapeutic uses are entirely modern, derived from research on dietary nitrate conversion to nitric oxide.
11 studies, n=349, systolic BP reduction -5.31 mmHg (95% CI: -7.46 to -3.16), no tolerance development with daily use
22 studies, n=1,248, systolic -3.55 mmHg, diastolic -1.32 mmHg. Polyphenols contribute beyond nitrate alone.
27 studies, healthy males, muscular endurance SMD 0.31 (p<0.01), strength when fatigued SMD 0.64 (p<0.01), no effect at rest
n=14 with hypertension, acute dose: -9.28 mmHg post-exercise, +3.18% flow-mediated dilation (p=0.031)
Most studied preparation. For blood pressure: 70-250 mL daily. For athletic performance: 70-140 mL 2-3 hours before exercise, or daily for ≥3 days. Peak plasma levels at 2 hours.
Dehydrated beetroot. Mix in water or smoothies. Dose by nitrate content, not powder weight - varies by product. Similar bioavailability to juice when dissolved.
12-week safety data in older adults. Ensure standardized for nitrate content. Capsules or tablets available.
Beetroot is a modern, evidence-based supplement - not a traditional herb. Its therapeutic uses emerged entirely from 21st-century research on dietary nitrate metabolism, not from traditional medicine systems.
Strong evidence (multiple meta-analyses):
Moderate evidence:
No evidence:
Critical mechanism: Dietary nitrate (NO3-) → salivary bacteria convert to nitrite (NO2-) → stomach/tissues convert to nitric oxide (NO) → vasodilation, blood pressure reduction, improved oxygen efficiency. This is why antibacterial mouthwash kills the effect - you need oral bacteria for the conversion.
Important nuance: Polyphenols and betalains contribute to blood pressure lowering independent of nitrate. Studies using nitrate-depleted beetroot juice showed weaker but present BP effects [2]. Higher nitrate concentrations paradoxically showed smaller BP reductions in some trials - the whole beet matters, not just nitrate.
Egyptian herbalism (contemporary documentation):
Gap between traditional and modern use: The cardiovascular and athletic performance applications are not traditional - they emerged from research published mostly after 2010 on nitrate metabolism. Beetroot’s primary historical role was as a food vegetable, not a medicinal herb.
Regulatory status:
When a vegetable becomes therapeutic not through traditional wisdom but through modern biochemistry, you’re working with a different kind of knowledge base. The evidence is strong, but it’s recent.
Beetroot juice (most studied, most convenient):
For blood pressure:
For athletic performance:
Beetroot powder:
Standardized extract (capsules/tablets):
For blood pressure (hypertension):
For athletic performance:
For general cardiovascular health:
❌ Antibacterial mouthwash: Kills oral bacteria needed for NO3- → NO2- conversion. Avoid entirely or at least 2-3 hours before/after beetroot intake.
❌ Combining with caffeine (for athletic performance): May undermine ergogenic benefits due to opposing vascular effects [7].
Baseline (1 week before starting):
During trial:
RED FLAGS - Stop and consult provider:
What they report: “Blood pressure dropped from 145/90 to 140/85,” “ran 16% longer before exhaustion,” “recovery faster between sets,” “reddish urine doesn’t bother me.”
What they report: “BP didn’t budge,” “no difference in strength at the gym,” “just made my pee pink.”
Pregnancy/Lactation: Food amounts likely safe. High-dose supplementation (200-800 mg nitrate/day) not studied - insufficient data.
Individual variation: Considerable inter-individual variation in plasma nitrate response observed [6]. Some people convert nitrate to nitrite very efficiently, others don’t. Oral microbiome composition matters.
Beetroot juice tastes… very earthy. Sweet, but with a dirt-like quality. Some people love it, others gag. Fresh beetroot juice is more palatable than concentrated shots. Mixing with citrus (lemon, orange) or ginger helps. Capsules and powders (mixed in smoothies) avoid the taste entirely and work just as well.
The problem: Nitrate content varies wildly based on growing conditions, soil nitrate, fertilization, and processing. You can’t dose accurately without knowing nitrate content.
What to look for:
Avoid:
Brands with good reputation (not exhaustive): Look for beetroot juices or extracts with verified nitrate content - commercial concentrated shots designed for athletes often list nitrate clearly.
This is a modern, evidence-based supplement with strong clinical support for blood pressure reduction (3-5 mmHg) and athletic endurance. Unlike traditional herbs, beetroot’s uses emerged from biochemistry research on nitrate metabolism, not ancestral knowledge.
When it works: Meaningful BP reduction for hypertensives, improved endurance and time to exhaustion for athletes, enhanced vascular function, faster recovery. You may see objective improvements (BP readings, performance metrics) within 2-3 weeks.
When it doesn’t: Normotensive individuals with little room for BP reduction, athletes seeking maximal strength (not endurance), those seeking cognitive benefits (no evidence).
Safety profile: Very safe - no serious adverse events in trials up to 13 weeks. Beeturia (reddish urine/stool) is harmless pigmentation. Monitor BP if on antihypertensive medications.
Start with 70-140 mL juice daily (200-400 mg nitrate), avoid mouthwash, track BP or athletic performance, give it 14+ days for cardiovascular effects or 3+ days for performance effects. This isn’t traditional wisdom - it’s modern biochemistry applied to a very old vegetable.
Duration: Minimum 14 days for blood pressure effects, 3-7 days for athletic performance. Long-term use up to 13 weeks studied with no tolerance.
What to notice:
For blood pressure: 200-400 mg nitrate daily (70-140 mL juice), taken consistently any time of day. Effects build over 2+ weeks. For athletic performance: Acute protocol = 400-800 mg nitrate 2-3 hours pre-exercise. Chronic loading = 400-800 mg daily for ≥3 days before competition. Avoid antibacterial mouthwash - it kills oral bacteria needed to convert nitrate to nitrite. Avoid combining with caffeine for athletic performance (may reduce benefits). Individual variation is high - plasma nitrate response varies significantly between people.
Generally considered: safe
Contraindications:
Pregnancy/Nursing: Food amounts likely safe (normal dietary consumption). High-dose supplementation (200-800 mg nitrate/day) not studied in pregnancy/lactation - insufficient data.
Very safe across all clinical trials - no serious adverse events in studies up to 13 weeks [5,6]. Minor: Beeturia (reddish urine/stool) from betalain pigments - completely benign. Theoretical concern: High nitrate intake may exceed WHO acceptable daily intake (222 mg for 60 kg person), potentially forming carcinogenic N-nitroso compounds (NOCs). However, vegetable-source nitrate contains antioxidants (vitamin C, polyphenols) that inhibit NOC formation - appears minimal risk [6]. Drug interactions: Additive blood pressure lowering with antihypertensive medications (monitor BP, may allow medication reduction under medical supervision) [1,2]. Theoretical additive effect with nitrate medications (nitroglycerin, isosorbide) - consult provider. No tolerance development observed - daily use effective long-term [1]. Compliance in trials >90% over 13 weeks [6].