Beetroot extract, derived from Beta vulgaris, has gained popularity as a food supplement due to its high dietary nitrate content and bioactive compounds. These nitrates convert to nitric oxide in the body, promoting vasodilation and improved blood flow. Whilst research suggests potential benefits for cardiovascular health and exercise performance, it's important to understand that beetroot extract is a food supplement, not a medicine, and should not replace prescribed treatments. This article examines the evidence-based benefits, safe usage, and important safety considerations for beetroot extract in the UK context.

What Is Beetroot Extract and How Does It Work?

Beetroot extract is a concentrated food supplement derived from Beta vulgaris, the common beetroot vegetable. Available in various forms including capsules, powders, and liquid concentrates, beetroot extract has gained attention due to its bioactive compounds. The nitrate content in commercial beetroot products can vary significantly, with many UK supplements not stating standardised levels of active compounds.

The primary mechanism of action centres on dietary nitrates (NO₃⁻), which are abundant in beetroot. Once ingested, nitrates undergo a two-step reduction process: first converted to nitrite (NO₂⁻) by oral bacteria, then further reduced to nitric oxide (NO) in the stomach and tissues. Nitric oxide is a crucial signalling molecule that promotes vasodilation — the widening of blood vessels — which can improve blood flow and reduce blood pressure. This process is particularly active in areas of low oxygen tension, making it potentially beneficial during physical exercise.

Beetroot extract also contains betalains, which are nitrogen-containing pigments with antioxidant and anti-inflammatory properties in laboratory studies, though their clinical significance in humans remains under investigation. Additionally, the extract may provide folate, potassium, and other micronutrients, though amounts vary considerably depending on the extraction method and concentration, and are generally not a reason to choose extracts over whole foods.

The bioavailability of nitrates from beetroot extract is generally high, with peak plasma nitrite levels typically occurring 2–3 hours after consumption. This relatively rapid absorption makes beetroot extract popular among athletes and individuals seeking cardiovascular support, though it's important to note that these are food supplements, not MHRA-licensed medicines.

Evidence-Based Health Benefits of Beetroot Extract

Research into beetroot extract has identified several potential health benefits, though the strength of evidence varies across different applications. The most robust evidence relates to cardiovascular health, particularly blood pressure management. Systematic reviews and meta-analyses have demonstrated that beetroot juice and extract can produce modest reductions in blood pressure in adults. Typical reductions range from 3–5 mmHg systolic pressure in most studies, with effects generally more pronounced in individuals with elevated baseline blood pressure. These effects are attributed to the nitrate-to-nitric-oxide pathway, which promotes arterial relaxation and improved endothelial function.

Exercise performance represents another area of considerable research interest. Studies suggest that beetroot extract may enhance exercise capacity and reduce oxygen consumption during physical activity, particularly during submaximal exercise. The proposed mechanism involves improved mitochondrial efficiency and enhanced blood flow to working muscles. However, benefits appear most consistent in recreational athletes and less trained individuals, with elite athletes showing more variable responses. The effect size is generally modest, with improvements in time-to-exhaustion typically ranging from 1–3% in controlled studies.

Emerging evidence suggests potential benefits for cognitive function, particularly in older adults. The increased cerebral blood flow resulting from nitric oxide production may support brain health, though large-scale clinical trials are needed to confirm these preliminary findings. Some research has explored beetroot extract's role in inflammation and oxidative stress, with betalains showing promise in laboratory studies, though human clinical data remain limited.

It is important to note that whilst these benefits are supported by research, beetroot extract should not replace prescribed medications or established treatments. NICE guidelines (NG136) do not recommend beetroot products for hypertension management. The evidence base, whilst growing, does not yet support beetroot extract as a standalone therapeutic intervention for any specific medical condition. Individuals considering beetroot extract for health purposes should discuss this with their GP, particularly if they have existing cardiovascular conditions or are taking medications.

How to Take Beetroot Extract Safely

Beetroot extract is available in several formulations, each with different dosing considerations. Concentrated beetroot juice shots typically contain 70–140 ml per serving and provide approximately 300–400 mg of nitrates per 70 ml shot. Capsules and tablets usually contain 500–1000 mg of beetroot extract powder per dose, though nitrate content varies significantly between products. Powdered extracts can be mixed with water or smoothies, with typical serving sizes of 5–10 grams.

For cardiovascular support, research studies have commonly used doses providing 300–500 mg of dietary nitrates daily, equivalent to approximately 500 ml of beetroot juice or one concentrated shot (70 ml). When using supplements, it is essential to check the product label for actual nitrate content, as total beetroot extract weight does not directly indicate nitrate levels. Effects on blood pressure typically become apparent within 2–4 weeks of regular consumption, though acute effects on blood flow may occur within hours.

The European Food Safety Authority (EFSA) has established an Acceptable Daily Intake (ADI) for nitrate of 3.7 mg/kg body weight per day. Long-term high-dose use beyond typical dietary intakes should be discussed with a healthcare professional.

For exercise performance, many athletes consume beetroot extract 2–3 hours before activity to coincide with peak plasma nitrite levels. Athletes should consider products certified by Informed-Sport to minimise contamination risk, and review UK Anti-Doping (UKAD) guidance on supplement use.

Practical considerations include:

• Timing: Take with or without food, though some evidence suggests absorption may be enhanced on an empty stomach

• Consistency: Regular daily intake appears more beneficial than sporadic use for cardiovascular effects

• Oral hygiene: Avoid using antibacterial mouthwash for approximately 2 hours before or after consumption, as oral bacteria are essential for nitrate conversion

• Storage: Follow manufacturer guidelines; liquid extracts typically require refrigeration after opening

• Diabetes: Beetroot juice contains natural sugars; people with diabetes should factor this into their carbohydrate management

Patients should consult their GP before starting beetroot extract if they have kidney disease, are taking blood pressure medications, nitrate medications (such as glyceryl trinitrate or isosorbide mononitrate), PDE5 inhibitors (e.g., sildenafil), or have any chronic health conditions. It is not a substitute for prescribed antihypertensive medications, and blood pressure should continue to be monitored as directed by healthcare professionals. Beetroot extract is not generally recommended for children, especially infants, due to nitrate concerns and lack of safety data.

Potential Side Effects and Who Should Avoid Beetroot Extract

Beetroot extract is generally well tolerated, but several side effects and contraindications warrant consideration. The most common and benign effect is beeturia — pink or red discolouration of urine and occasionally stools. This occurs in approximately 10–14% of the population and results from betalain pigments passing through the digestive system. Whilst alarming in appearance, beeturia is harmless and typically resolves within 24–48 hours of discontinuing the supplement. It may be more noticeable in individuals with iron deficiency or low stomach acid.

Gastrointestinal symptoms including bloating, flatulence, and diarrhoea can occur, particularly with higher doses or concentrated formulations. These effects are generally mild and may diminish with continued use as the digestive system adapts. Starting with lower doses and gradually increasing can help minimise discomfort.

A significant concern involves individuals with impaired kidney function. The kidneys play a crucial role in nitrate excretion, and reduced renal function may lead to elevated nitrate levels. Additionally, beetroot juice contains potassium which could increase the risk of hyperkalaemia in those with chronic kidney disease or taking potassium-sparing medications. Patients with kidney disease should avoid beetroot extract unless specifically advised otherwise by their nephrologist. Similarly, individuals with kidney stones (particularly calcium oxalate stones) should exercise caution, as beetroot contains oxalates which may contribute to stone formation in susceptible individuals.

Contraindications and cautions include:

• Hypotension: Those with already low blood pressure should avoid beetroot extract, as further reductions could cause dizziness, fainting, or falls

• Medications: Concurrent use with nitrate-based medications (glyceryl trinitrate, isosorbide mononitrate/dinitrate), antihypertensives, or PDE5 inhibitors may cause excessive blood pressure lowering

• Pregnancy and breastfeeding: Whilst dietary beetroot is safe, concentrated extracts have not been adequately studied in these populations

• Scheduled surgery: Inform your surgical team about supplement use; they may advise stopping before the procedure based on individual risk

• Children: Not recommended for children, especially infants, who are more sensitive to nitrates

When to seek medical advice: Contact your GP if you experience persistent gastrointestinal symptoms, dizziness, unusual fatigue, or if you notice blood in urine (which may be difficult to distinguish from beeturia). Individuals taking warfarin or other anticoagulants should maintain a consistent diet and inform their anticoagulation clinic of any significant dietary changes, though beetroot root is relatively low in vitamin K. Seek urgent medical attention for syncope, chest pain, or suspected true haematuria.

Report suspected side effects from supplements or medicines via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

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