Beetroot extract is a concentrated dietary supplement derived from Beta vulgaris, the common beetroot, and has gained considerable attention for its potential cardiovascular and performance-enhancing properties. Rich in dietary nitrates, betalains, and antioxidants, beetroot extract is primarily used to support blood pressure management and athletic performance. Whilst evidence suggests modest benefits in certain contexts, it remains a complementary approach rather than a replacement for evidence-based treatments. This article examines what beetroot extract is used for, the scientific evidence supporting its applications, and important safety considerations for those considering supplementation.

What Is Beetroot Extract?

Beetroot extract is a concentrated preparation derived from the root vegetable Beta vulgaris, commonly known as beetroot or red beet. The extract is typically produced through processes such as juicing, drying, and powdering, or through more sophisticated extraction methods that concentrate specific bioactive compounds. The resulting product contains higher levels of key constituents than fresh beetroot.

The primary active components in beetroot extract include dietary nitrates (predominantly in the form of nitrate ions), betalains (pigmented antioxidants responsible for the characteristic deep red colour), polyphenols, flavonoids, and various vitamins and minerals including folate, manganese, and potassium. Nitrate content can vary considerably depending on growing conditions, cultivar, and processing methods, typically ranging from 250–500 mg per 100 g of fresh beetroot, with concentrated extracts potentially providing substantially higher amounts per serving.

Beetroot extract is available in multiple formulations including capsules, tablets, powders, and liquid concentrates. The standardisation of these products varies considerably between manufacturers, with some products standardised to nitrate content whilst others focus on betalain concentration. When choosing products, it's advisable to select those that clearly disclose nitrate or betalain content per serving.

In the UK, beetroot extract is usually sold as a food supplement and regulated under food safety legislation by the Food Standards Agency (FSA). However, the Medicines and Healthcare products Regulatory Agency (MHRA) may classify products as medicines if medicinal claims are made about them. The European Food Safety Authority (EFSA) has established an Acceptable Daily Intake (ADI) for nitrate of 3.7 mg per kg of body weight per day, which some concentrated beetroot products may approach or exceed when used at recommended doses.

Common Uses of Beetroot Extract

Beetroot extract is primarily used as a dietary supplement for several purported health applications, though the strength of evidence varies considerably across these uses. The most common reason individuals take beetroot extract is to support cardiovascular health, particularly in relation to blood pressure management. Many users incorporate beetroot extract into their daily routine as a complementary approach alongside conventional lifestyle modifications such as dietary changes and increased physical activity.

Athletic performance enhancement represents another major use of beetroot extract, particularly among recreational and competitive athletes. The supplement is consumed with the aim of improving exercise capacity, endurance, and recovery. Timing of consumption varies, with some individuals taking beetroot extract 2–3 hours before exercise to maximise potential nitrate availability, whilst others use it as part of a regular supplementation regimen. This practice has gained considerable popularity in endurance sports including cycling, running, and rowing. It's worth noting that using strong antibacterial mouthwash around the time of beetroot extract consumption may reduce its effectiveness by inhibiting the oral bacteria needed to convert nitrate to nitrite, so it may be advisable to avoid mouthwash for a few hours before and after taking the supplement.

Some individuals use beetroot extract for its antioxidant properties, seeking to reduce oxidative stress and support general wellbeing. The betalain pigments in beetroot possess antioxidant and anti-inflammatory properties in laboratory studies, which has led to interest in their potential protective effects. Additionally, beetroot extract is occasionally used by those seeking to support cognitive function and digestive health, though evidence for these applications remains very limited and preliminary.

In clinical practice, it is important to note that whilst beetroot extract is widely available and used, it should not replace prescribed medications or evidence-based treatments. Patients considering beetroot extract should discuss this with their GP or pharmacist, particularly if they have existing medical conditions or take regular medications. Concentrated beetroot supplements are generally not recommended for children, and pregnant or breastfeeding women should seek medical advice before use.

Potential Health Benefits and Evidence

The evidence base for beetroot extract centres primarily on its nitrate content and cardiovascular effects. When consumed, dietary nitrates undergo conversion to nitrite by oral bacteria, and subsequently to nitric oxide (NO) in various tissues. Nitric oxide is a crucial signalling molecule that promotes vasodilation (widening of blood vessels), thereby potentially reducing blood pressure. Several systematic reviews and meta-analyses have examined this effect, with moderate-quality evidence suggesting that beetroot juice and extract may produce small but statistically significant reductions in blood pressure, typically in the range of 3–5 mmHg systolic pressure. However, the clinical significance of these reductions remains debated, and individual responses vary considerably.

A 2013 meta-analysis published in the British Journal of Clinical Pharmacology found that inorganic nitrate and beetroot juice supplementation was associated with significant reductions in blood pressure. Subsequent research has generally supported these findings, though effect sizes tend to be modest. NICE guidance on hypertension (NG136) does not currently recommend beetroot extract as a treatment option, emphasising instead evidence-based approaches including lifestyle modification, dietary changes (particularly reduced salt intake, increased fruit and vegetable consumption, and following the NHS Eatwell Guide), and antihypertensive medications where indicated. Patients with hypertension should not rely on beetroot extract as a sole intervention.

Regarding exercise performance, research suggests that nitrate supplementation may improve exercise efficiency and time to exhaustion in some contexts, particularly during submaximal exercise. The proposed mechanism involves enhanced mitochondrial efficiency and improved blood flow to working muscles. However, effects appear most pronounced in recreational athletes and less trained individuals, with elite athletes often showing minimal or no benefit. A 2017 systematic review in the Journal of the International Society of Sports Nutrition concluded that beetroot supplementation may offer small performance benefits in specific circumstances, but results are inconsistent.

Antioxidant and anti-inflammatory effects have been demonstrated in laboratory and animal studies, primarily attributed to betalains. However, human clinical evidence remains limited and preliminary. Some small studies suggest potential benefits for markers of inflammation and oxidative stress, but larger, well-designed trials are needed. There is currently insufficient evidence to recommend beetroot extract specifically for cognitive function, though the nitrate-nitric oxide pathway theoretically could influence cerebral blood flow. Overall, whilst beetroot extract shows promise in certain areas, particularly blood pressure modulation, patients should maintain realistic expectations and prioritise evidence-based treatments.

Safety Considerations and Side Effects

Beetroot extract is generally considered safe for most individuals when consumed in typical supplemental doses, though several important safety considerations warrant attention. The most common and benign side effect is beeturia—the excretion of red or pink urine following beetroot consumption. This harmless phenomenon is relatively common and results from the excretion of betalain pigments. Whilst alarming to some patients, beeturia requires no treatment and resolves once beetroot consumption ceases. However, individuals experiencing red urine should ensure this is indeed beeturia rather than haematuria (blood in urine), particularly if they have not consumed beetroot products. Similarly, beetroot can cause red or pink discolouration of stools, which is also harmless.

Gastrointestinal effects represent another common concern, with some users reporting mild stomach upset, bloating, or diarrhoea, particularly when initiating supplementation or consuming higher doses. These effects are typically transient and can often be minimised by starting with lower doses and gradually increasing intake. The high fibre content in some beetroot extract preparations may contribute to these symptoms.

More significant safety considerations include potential effects on blood pressure. Whilst the hypotensive effect may be beneficial for some individuals, those already taking antihypertensive medications should exercise caution, as additive effects could theoretically lead to excessive blood pressure reduction. Patients should consult their GP before combining beetroot extract with blood pressure medications, and blood pressure should be monitored if supplementation is initiated. Similarly, individuals with hypotension (low blood pressure) should avoid beetroot extract or use it only under medical supervision.

Beetroot extract is high in oxalates, which may be problematic for individuals with a history of kidney stones, particularly calcium oxalate stones. High oxalate intake can increase urinary oxalate excretion and potentially contribute to stone formation in susceptible individuals. Patients with kidney disease should also consult their healthcare provider before using beetroot extract, as the potassium content may be relevant in those with impaired renal function.

Drug interactions are relatively uncommon but possible. The nitrate content may theoretically interact with medications for erectile dysfunction (phosphodiesterase-5 inhibitors) or organic nitrates used for angina, though this interaction is primarily documented with pharmaceutical nitrates rather than dietary sources. Nevertheless, caution is advised.

Pregnancy and breastfeeding: There is insufficient evidence regarding the safety of concentrated beetroot extract during pregnancy and lactation. Whilst dietary beetroot consumption is generally considered safe, concentrated supplements have not been adequately studied in these populations. Pregnant and breastfeeding women should consult their healthcare provider before using beetroot extract supplements.

Children: Concentrated beetroot supplements are generally not recommended for children. Additionally, parents should be aware that the NHS advises against giving large amounts of nitrate-rich vegetables to young infants.

Patients should not exceed the recommended doses on product labels, particularly given the EFSA's established Acceptable Daily Intake for nitrate. If experiencing persistent gastrointestinal symptoms, dizziness, or symptoms of low blood pressure (lightheadedness, fainting) after taking beetroot extract, medical advice should be sought. Suspected adverse reactions can be reported via the MHRA Yellow Card scheme (www.mhra.gov.uk/yellowcard). As with all supplements, quality varies between manufacturers, and consumers should choose products from reputable sources that provide clear information about nitrate or betalain content.

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