Beetroot extract, derived from *Beta vulgaris*, has gained attention for its potential health benefits in men, particularly regarding cardiovascular function and exercise performance. Rich in dietary nitrates and antioxidant betalains, this concentrated supplement works primarily by increasing nitric oxide production, which promotes blood vessel dilation and improved blood flow. Whilst beetroot extract is widely available as a food supplement in the UK, it is not regulated as a medicine by the MHRA and has not been evaluated for treating specific medical conditions. This article examines the evidence for beetroot extract's effects on men's health, including cardiovascular support, exercise performance, and metabolic function, alongside important safety considerations.

What Is Beetroot Extract and How Does It Work?

Beetroot extract is a concentrated supplement derived from the root vegetable Beta vulgaris, commonly known as beetroot. The extract is typically available in powder, capsule, or liquid form and contains high levels of naturally occurring nitrates, betalains (pigmented antioxidants), and other bioactive compounds. Beetroot has been consumed as a food for centuries, but its concentrated extract form has gained attention in recent years for potential health applications, particularly in cardiovascular and exercise physiology.

The primary mechanism of action centres on dietary nitrate metabolism. When consumed, the nitrates (NO₃⁻) in beetroot extract are converted by oral bacteria into nitrite (NO₂⁻), which is 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, reduce blood pressure, and enhance oxygen delivery to tissues. This process is particularly relevant during physical activity when muscles require increased oxygen supply.

Beyond nitrates, beetroot extract contains betalains (such as betanin and vulgaxanthin), which possess antioxidant and anti-inflammatory properties. These compounds may help reduce oxidative stress and support cellular health. The combination of nitrate-mediated vascular effects and antioxidant activity forms the basis for beetroot extract's proposed benefits in men's health, particularly regarding cardiovascular function, exercise performance, and metabolic health. It is important to note that beetroot extract is regulated as a food supplement in the UK (under Food Standards Agency oversight), not as a medicine, and therefore has not been evaluated by the MHRA for treatment of any medical condition. The nitrate content can vary significantly between products, so those with declared or verified nitrate levels may offer more consistent effects.

Potential Benefits of Beetroot Extract for Men's Health

Beetroot extract has been investigated for several health outcomes that may be particularly relevant to men. One area of interest is erectile function, given that nitric oxide plays a central role in penile vasodilation and blood flow. Some proponents suggest that beetroot extract's ability to increase nitric oxide bioavailability could theoretically support erectile function, though there is no official link established through robust clinical trials specifically examining beetroot extract for erectile dysfunction. There is no NICE or NHS recommendation for beetroot extract in erectile dysfunction management, and it should not be used as a treatment for this condition. Men experiencing persistent erectile difficulties should consult their GP, as this may indicate underlying cardiovascular disease or other health conditions requiring medical assessment.

Prostate health is another area where beetroot's antioxidant content has generated interest. Betalains and other phytochemicals may help reduce oxidative stress and inflammation, processes implicated in benign prostatic hyperplasia (BPH) and prostate cancer development. However, current evidence is largely preclinical, and there are no NICE-endorsed recommendations for beetroot extract in prostate disease management. Men with lower urinary tract symptoms should seek appropriate medical evaluation rather than relying on supplements alone, particularly if experiencing red flag symptoms such as visible blood in urine, inability to urinate, recurrent urinary tract infections, unexplained weight loss, or bone pain.

Beetroot extract may also support metabolic health. Some preliminary research suggests that dietary nitrates might influence insulin sensitivity and glucose metabolism, which could be beneficial for men at risk of type 2 diabetes or metabolic syndrome. However, these findings are inconsistent and of low certainty. The anti-inflammatory properties of betalains may contribute to overall metabolic function, but this should not be a reason to alter established diabetes therapy. These potential benefits should be viewed as complementary to, rather than replacements for, established lifestyle interventions such as regular physical activity, healthy diet, and weight management. Men with existing metabolic conditions should discuss supplement use with their healthcare provider to ensure it aligns with their overall treatment plan.

Evidence for Beetroot Extract in Exercise and Performance

The most robust evidence for beetroot extract relates to exercise performance and endurance. Multiple systematic reviews and meta-analyses have examined the effects of beetroot juice and extract supplementation on athletic performance, with generally positive findings. The proposed mechanism involves improved oxygen efficiency: by increasing nitric oxide availability, beetroot extract may reduce the oxygen cost of exercise, allowing muscles to work more efficiently during both aerobic and anaerobic activities.

Studies have demonstrated that beetroot supplementation (typically providing 300–600 mg of nitrate, equivalent to approximately 5–9 mmol) consumed 2–3 hours before exercise can improve time-to-exhaustion in endurance activities such as running and cycling. The effect appears most pronounced in moderate-intensity exercise lasting 4–30 minutes. For example, research has shown improvements of 1–3% in time-trial performance, which, whilst modest, can be meaningful in competitive settings. The benefits may be less apparent in elite athletes who already have highly efficient cardiovascular systems, compared to recreational exercisers or those with lower baseline fitness levels.

Resistance training and high-intensity exercise have also been investigated, though results are more variable. Some studies suggest beetroot extract may reduce muscle fatigue and enhance recovery between sets, potentially through improved blood flow and reduced oxidative stress. However, the evidence is less consistent than for endurance performance. It is worth noting that individual responses to beetroot supplementation vary considerably, with some people classified as "responders" who experience clear benefits, and others as "non-responders" who show minimal change. Factors such as baseline fitness, oral microbiome composition (which affects nitrate conversion), and habitual dietary nitrate intake may influence individual responses. Men interested in using beetroot extract for performance should consider a trial period to assess personal response, ideally under guidance from a sports nutritionist or exercise physiologist. Competitive athletes should choose products with Informed-Sport certification to reduce the risk of contamination with prohibited substances.

Cardiovascular and Blood Pressure Effects in Men

Beetroot extract's cardiovascular effects have been extensively studied, with particular focus on blood pressure reduction. Meta-analyses of randomised controlled trials indicate that beetroot juice and extract supplementation can produce modest but clinically relevant reductions in blood pressure. The typical effect is in the range of 3–5 mmHg for systolic pressure, with benefits appearing within 2–3 hours of consumption and lasting up to 6 hours after a single dose. Regular consumption appears necessary to maintain these effects. This blood pressure-lowering effect is attributed to increased nitric oxide production and subsequent vasodilation.

For men with high-normal blood pressure or mild hypertension, beetroot extract may offer a complementary approach alongside lifestyle modifications. However, it is crucial to emphasise that beetroot extract is not a substitute for prescribed antihypertensive medications. NICE guidelines for hypertension management (NG136) prioritise lifestyle interventions (including dietary changes, physical activity, weight management, and reduced salt intake) and, where indicated, pharmacological treatment with drugs such as ACE inhibitors, calcium channel blockers, or thiazide-like diuretics. Men with diagnosed hypertension should not discontinue or alter prescribed medications without consulting their GP or specialist.

Endothelial function—the health of blood vessel linings—is another cardiovascular parameter that may benefit from beetroot extract. Improved nitric oxide bioavailability can enhance endothelium-dependent vasodilation, a marker of vascular health and a predictor of cardiovascular risk. Some research suggests that regular beetroot supplementation may improve flow-mediated dilation (FMD), a non-invasive measure of endothelial function. This could be particularly relevant for men with cardiovascular risk factors such as obesity, diabetes, or smoking history. Men with advanced chronic kidney disease or those on potassium-restricted diets should exercise caution with beetroot juice products, which can contain significant amounts of potassium. Men with established cardiovascular disease, including coronary artery disease, heart failure, or previous myocardial infarction, should discuss supplement use with their cardiologist, as interactions with medications (particularly nitrates used for angina) could occur.

How to Use Beetroot Extract Safely and Effectively

Beetroot extract is available in several formulations, including concentrated beetroot juice shots, powders, and capsules. The effective dose varies depending on the product's nitrate content, but most studies have used doses providing approximately 300–600 mg of dietary nitrate (roughly equivalent to 5–9 mmol, or 500 ml of beetroot juice or 70 ml of concentrated beetroot shot). When selecting a product, men should look for those with declared nitrate content, though it's worth noting that many supplements do not list this information. Products with verified nitrate levels may offer more consistent effects.

Timing of consumption can influence effectiveness. For exercise performance benefits, beetroot extract is typically consumed 2–3 hours before activity, which corresponds to the peak in plasma nitrite levels. For blood pressure management, regular daily consumption appears more beneficial than sporadic use, with effects accumulating over days to weeks. Some products recommend taking beetroot extract with food to minimise gastrointestinal discomfort, though this may slightly delay nitrate absorption.

Men should be aware that antibacterial mouthwash can significantly reduce the effectiveness of beetroot extract. The conversion of nitrate to nitrite depends on oral bacteria, so using antiseptic mouthwash several hours before or after taking beetroot extract can disrupt this process and diminish the supplement's benefits. Similarly, proton pump inhibitors (PPIs) used for acid reflux may theoretically affect nitrite-to-nitric oxide conversion in the stomach, though clinical significance remains unclear.

Quality and safety considerations are important when choosing beetroot supplements. As food supplements are not subject to the same regulatory oversight as medicines, quality can vary between manufacturers. Men should look for products from reputable companies that provide third-party testing certificates. Competitive athletes should choose Informed-Sport certified products to minimise the risk of contamination with prohibited substances. Organic certification may reduce exposure to pesticide residues. It is advisable to start with a lower dose to assess tolerance before increasing to the recommended amount, and to maintain adequate hydration when exercising.

Side Effects and Precautions for Men Taking Beetroot Extract

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—which occurs in approximately 10–14% of people and is harmless. This phenomenon results from the excretion of betalain pigments and does not indicate any medical problem, though it can be alarming if unexpected. Similarly, beetroot consumption may cause red or pink discolouration of stools, which should not be confused with gastrointestinal bleeding.

Gastrointestinal symptoms are occasionally reported, including mild stomach upset, bloating, or diarrhoea, particularly with higher doses or concentrated formulations. These effects are usually dose-dependent and can often be minimised by taking beetroot extract with food or reducing the dose. Men with irritable bowel syndrome (IBS) or other functional gastrointestinal disorders may be more susceptible to these effects and should introduce beetroot extract gradually.

Important contraindications and precautions include:

• Kidney stones: Beetroot is high in oxalates, which can contribute to calcium oxalate kidney stone formation. Men with a history of kidney stones should exercise caution and may need to avoid beetroot extract or consume it only under medical supervision.

• Chronic kidney disease: Men with advanced kidney disease or those on potassium-restricted diets should be cautious with beetroot juice products, which can contain significant amounts of potassium.

• Hypotension: Given beetroot extract's blood pressure-lowering effects, men with already low blood pressure should use caution, as further reductions could cause dizziness, fatigue, or fainting.

• Medication interactions: Beetroot extract may interact with nitrate medications (such as glyceryl trinitrate for angina), potentially causing excessive blood pressure drops. Men taking antihypertensive medications should consult their GP before starting beetroot supplementation, as dose adjustments may be necessary.

• Diabetes management: Whilst beetroot extract may influence glucose metabolism, men taking diabetes medications should monitor blood glucose levels and discuss any supplement use with their healthcare provider.

Men should seek immediate medical attention for black tarry stools, bright red rectal bleeding not attributable to beetroot, severe dizziness or fainting, chest pain, or signs of severe allergic reaction. For other concerns, contact NHS 111 or your GP. Suspected side effects can be reported via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

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