Beetroot extract has gained attention as a natural supplement for cardiovascular health and exercise performance, but determining whether it's worth taking requires understanding the evidence. Derived from Beta vulgaris, beetroot extract contains dietary nitrates that convert to nitric oxide in the body, promoting blood vessel widening and improved blood flow. Whilst research demonstrates modest blood pressure reductions and potential endurance benefits, effects vary between individuals and should complement rather than replace established medical treatments. This article examines the scientific evidence, safety considerations and practical guidance to help you make an informed decision about beetroot extract supplementation.

What Is Beetroot Extract and How Does It Work?

Beetroot extract is a concentrated supplement derived from Beta vulgaris, the common beetroot vegetable. Available in various forms including capsules, powders and liquid concentrates, beetroot extract contains bioactive compounds including dietary nitrates, betalains (pigmented antioxidants) and polyphenols. The quality and nitrate content can vary substantially between products, with many supplements not being standardised for nitrate content.

The primary mechanism of action centres on nitrate metabolism. When consumed, dietary nitrates from beetroot are converted by oral bacteria into nitrite, which is then further reduced to nitric oxide (NO) in the stomach and tissues. This process can be impaired by antibacterial mouthwashes or recent antibiotic use, which may reduce the effectiveness of beetroot extract. Nitric oxide is a signalling molecule that promotes vasodilation — the widening of blood vessels — thereby improving blood flow and potentially reducing blood pressure. This process is particularly active during periods of low oxygen availability, such as during exercise.

Beyond nitrates, beetroot extract contains betalains (including betacyanins and betaxanthins), which possess antioxidant and anti-inflammatory properties. These compounds may help neutralise free radicals, though their clinical significance in humans requires further research. The polyphenolic content may further contribute to potential health effects.

In the UK, beetroot extract is regulated as a food supplement by the Food Standards Agency, not as a licensed medicine.

Evidence-Based Health Benefits of Beetroot Extract

Cardiovascular health represents the most robust area of evidence for beetroot extract. Multiple systematic reviews and meta-analyses have demonstrated that beetroot supplementation can produce modest reductions in blood pressure, typically in the range of 3–5 mmHg systolic and 2–3 mmHg diastolic. These effects appear most pronounced in individuals with elevated blood pressure rather than those with normal readings. The mechanism relates directly to nitric oxide-mediated vasodilation, and effects are generally observed within 2–3 hours of consumption, lasting up to 24 hours.

In the context of exercise performance, evidence suggests beetroot extract may improve endurance capacity and reduce oxygen consumption during submaximal exercise. Studies have shown improvements in time-to-exhaustion tests and time-trial performance, particularly in recreational athletes. However, benefits appear less consistent in elite athletes, possibly due to already optimised nitric oxide production. The ergogenic effects are hypothesised to result from improved mitochondrial efficiency and enhanced blood flow to working muscles, though the exact mechanisms continue to be investigated.

Cognitive function has emerged as an area of interest, with preliminary research suggesting beetroot extract may improve cerebral blood flow, particularly to frontal lobe regions involved in executive function. However, evidence for meaningful cognitive improvements remains limited and inconsistent, and is not sufficient for clinical recommendations. Similarly, whilst some studies have explored potential benefits in inflammatory conditions and metabolic health, these areas require substantially more research before conclusions can be drawn.

It is important to note that whilst these findings are encouraging, beetroot extract should not be considered a replacement for prescribed medications or established lifestyle interventions. The effects, whilst statistically significant in research settings, are generally modest in magnitude.

Potential Side Effects and Safety Considerations

Beetroot extract is generally well-tolerated, with most adverse effects being mild and transient. The most common side effect is beeturia — pink or red discolouration of urine and occasionally stools — which occurs in a variable percentage of the population. This harmless phenomenon results from the excretion of betalain pigments and does not indicate any underlying health problem. However, it can be mistaken for haematuria (blood in urine). If you are unsure, or if discolouration persists or is accompanied by other symptoms, seek medical advice.

Gastrointestinal symptoms including mild stomach upset, bloating or diarrhoea may occur, particularly when starting supplementation or taking higher doses. These effects are typically dose-dependent and often resolve with continued use or dose reduction. Taking beetroot extract with food may help minimise digestive discomfort.

An important consideration is the high oxalate content in beetroot products. Individuals with a history of calcium oxalate kidney stones should exercise caution, as dietary oxalates can contribute to stone formation in susceptible individuals. If you have kidney disease or recurrent kidney stones, consult your GP before taking beetroot extract.

The nitrate content raises theoretical concerns about methaemoglobinaemia (a condition affecting oxygen transport in blood), though this is exceptionally rare in adults taking standard doses. However, beetroot extract is not recommended for infants under six months, and NHS guidance advises limiting nitrate-rich vegetables for children under one year.

Regarding drug interactions, beetroot extract may enhance the blood pressure-lowering effects of antihypertensive medications, potentially causing excessive hypotension. Specific caution is needed with nitrate medicines (such as glyceryl trinitrate or isosorbide mononitrate). PDE5 inhibitors (used for erectile dysfunction) can also lower blood pressure, so combined use with beetroot extract should be discussed with your healthcare provider. Additionally, concentrated beetroot juices and shots contain sugars; people with diabetes should factor this carbohydrate content into their management plan.

If you experience any suspected adverse reactions, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Who Should Consider Taking Beetroot Extract?

Beetroot extract may be worth considering for several specific groups, though it should complement rather than replace evidence-based medical care. Individuals with mildly elevated blood pressure (stage 1 hypertension, clinic readings ≥140/90 mmHg with ambulatory or home readings ≥135/85 mmHg) may benefit from the modest blood pressure-lowering effects, particularly as part of a broader lifestyle approach including dietary modification, weight management and regular physical activity. However, those with established hypertension requiring medication should not substitute beetroot extract for prescribed treatments without medical supervision.

If you have very high blood pressure (≥180/120 mmHg), especially with symptoms such as severe headache, vision problems or chest pain, seek urgent medical care rather than attempting self-management with supplements.

Recreational athletes and fitness enthusiasts seeking to enhance endurance performance represent another group who may find beetroot extract beneficial. The evidence is most supportive for activities lasting 4–30 minutes, though benefits have been observed in longer endurance events. Individuals should trial beetroot extract during training rather than on competition day to assess personal response and tolerance. Elite athletes should note that evidence for performance benefits is less consistent at higher fitness levels and should consider products with Informed-Sport certification.

Older adults concerned about cardiovascular health and cognitive function may consider beetroot extract as part of a heart-healthy lifestyle, though expectations should be realistic regarding the magnitude of benefits. The improved blood flow may support vascular health, but this should not replace established preventive measures.

Who should avoid or use caution? Individuals with kidney stones or kidney disease, those taking multiple blood pressure medications, pregnant or breastfeeding women (due to limited safety data), and anyone with known allergies to beetroot should avoid supplementation or seek medical advice first. If you experience symptoms such as severe gastrointestinal distress, dizziness, or signs of an allergic reaction (rash, difficulty breathing), discontinue use and contact your GP promptly. Ultimately, beetroot extract is not essential for health, and a balanced diet rich in vegetables provides many similar benefits without supplementation.

Dosage, Forms and How to Take Beetroot Extract

Beetroot extract is available in several forms, each with distinct characteristics. Beetroot juice concentrate and beetroot shots typically provide 70–140 ml servings containing approximately 300–500 mg of dietary nitrate. These liquid forms are rapidly absorbed and often used in research studies. Capsules and tablets offer convenience but may deliver variable amounts of nitrate unless specifically standardised. Powdered beetroot extract can be mixed into water, smoothies or food, with typical serving sizes of 5–10 grams, though nitrate content can vary significantly between products.

For blood pressure management, research suggests approximately 300–500 mg of dietary nitrate daily. When choosing products, look for those that specifically declare their nitrate content rather than just the weight of beetroot extract. For exercise performance, similar doses consumed 2–3 hours before activity coincide with peak nitric oxide production.

Timing considerations are important for optimising benefits. Blood nitrate and nitrite levels peak approximately 2–3 hours after consumption, making this the optimal window for exercise performance benefits. For blood pressure management, consistent daily supplementation appears more important than specific timing. Taking beetroot extract with food may reduce gastrointestinal side effects without significantly impairing absorption.

Avoid using antibacterial mouthwashes for several hours before and after taking beetroot extract, as these can impair the oral bacteria needed to convert nitrate to nitrite, potentially reducing effectiveness. Recent antibiotic use may also temporarily reduce benefits.

The European Food Safety Authority has established an Acceptable Daily Intake (ADI) for nitrate of 3.7 mg per kg of body weight per day. Occasional intakes above this level are not concerning, but long-term high-dose supplementation should be considered in this context.

Quality and standardisation vary considerably between products. Look for supplements that specify nitrate content and are manufactured to Good Manufacturing Practice (GMP) standards. In the UK, products bearing certification from organisations such as Informed-Sport provide additional assurance regarding quality and absence of prohibited substances for athletes.

Start with lower doses to assess tolerance, particularly if you experience digestive sensitivity. Note that concentrated juices and shots contain sugars; people needing to limit carbohydrate intake should factor this into their dietary plan or consider low/zero-sugar options. As with any supplement, if you are taking prescribed medications or have underlying health conditions, consult your GP or a registered dietitian before starting beetroot extract to ensure it is appropriate for your individual circumstances.

Frequently Asked Questions