Beetroot extract, derived from Beta vulgaris, has become a popular dietary supplement due to its high nitrate content, which converts to nitric oxide in the body—potentially supporting cardiovascular function and exercise performance. Whilst generally safe for healthy adults, certain individuals should exercise caution or avoid beetroot extract altogether. People with kidney disease, low blood pressure, a history of kidney stones, or those taking specific medications may experience adverse effects. This article examines who shouldn't take beetroot extract, important drug interactions, and when to seek medical advice before supplementation.

Who Shouldn't Take Beetroot Extract

Beetroot extract, derived from Beta vulgaris, has gained popularity as a dietary supplement due to its high nitrate content, which the body converts to nitric oxide—a compound that may support cardiovascular function and exercise performance. However, whilst beetroot extract is generally considered safe for most healthy adults, certain individuals should exercise caution or avoid it altogether.

People who should use beetroot extract with caution or seek medical advice include:

• Individuals with kidney stones or a history of calcium oxalate stones, as beetroot is high in oxalates, which may contribute to stone formation; these individuals should limit high-oxalate intake and seek personalised advice from a renal dietitian

• Those with low blood pressure (hypotension), since beetroot extract may further reduce blood pressure

• People with kidney disease, particularly those with reduced renal function (stages 3-5 CKD), as they should discuss any supplement with their renal team and check the specific product's potassium content

• Individuals with beetroot allergy, though rare, can experience allergic reactions ranging from mild skin irritation to severe reactions requiring emergency care

• Pregnant and breastfeeding women should avoid beetroot extract unless specifically advised by their GP or midwife, as there is insufficient evidence regarding safety in these populations

Additionally, beetroot extract may cause harmless but alarming beeturia—pink or red discolouration of urine or stools—which can be mistaken for blood. Whilst this is not dangerous, it can cause unnecessary anxiety. If you're unsure whether discolouration is beeturia or blood, seek medical advice.

It is essential to recognise that dietary supplements, including beetroot extract, are regulated as foods in the UK by the Office for Product Safety and Standards (OPSS) and Food Standards Agency (FSA). Unlike medicines, they are not assessed for efficacy by the MHRA. Product quality, nitrate content, and potassium levels can vary significantly between manufacturers. Anyone considering beetroot extract should discuss it with their healthcare provider, particularly if they have underlying health conditions or take regular medications.

Medical Conditions That May Prevent Beetroot Extract Use

Several medical conditions warrant particular caution when considering beetroot extract supplementation. Understanding these contraindications is crucial for patient safety and informed decision-making.

Kidney disease and renal impairment represent significant concerns. Beetroot is naturally high in potassium, and individuals with chronic kidney disease (CKD) often require potassium restriction to prevent hyperkalaemia—a potentially life-threatening elevation of blood potassium levels. The kidneys normally regulate potassium balance, but when renal function is compromised, excess potassium can accumulate, leading to cardiac arrhythmias. Patients with stage 3–5 CKD should discuss any supplement with their renal team and check the specific product's potassium content before use.

Kidney stone disease, particularly calcium oxalate nephrolithiasis, requires careful consideration. Beetroot contains oxalates, which can bind with calcium in the urinary tract to form stones. Individuals with a history of kidney stones should limit high-oxalate foods and supplements and follow NHS kidney stone prevention advice, including maintaining good hydration.

Hypotension (low blood pressure) requires careful consideration. Beetroot extract's nitrate content promotes vasodilation through nitric oxide production, which can lower blood pressure. Whilst this may benefit hypertensive individuals, those with baseline low blood pressure may experience dizziness, fainting, or falls. According to the NHS, symptoms of hypotension include lightheadedness, blurred vision, fatigue, and syncope.

Patients with diabetes should monitor blood glucose levels if taking beetroot extract, though current evidence regarding its effects on glycaemic control is limited and inconclusive.

If you have any of these conditions, consult your healthcare provider before taking beetroot extract to determine if it's appropriate for your individual health circumstances.

Medications That Interact With Beetroot Extract

Beetroot extract can interact with several classes of medications, potentially altering their effectiveness or increasing the risk of adverse effects. These interactions primarily relate to beetroot's nitrate content and its blood pressure-lowering properties.

Antihypertensive medications represent the most clinically significant interaction. Beetroot extract may have an additive effect when combined with blood pressure-lowering drugs, including:

• ACE inhibitors (e.g., ramipril, lisinopril)

• Angiotensin receptor blockers (ARBs) (e.g., losartan, candesartan)

• Beta-blockers (e.g., bisoprolol, atenolol)

• Calcium channel blockers (e.g., amlodipine, diltiazem)

• Diuretics (e.g., bendroflumethiazide, furosemide)

This combination may result in excessive hypotension, causing dizziness, syncope, or falls—particularly concerning in elderly patients. Regular blood pressure monitoring is essential if beetroot extract is used alongside these medications.

Nitrate medications, such as glyceryl trinitrate (GTN) used for angina, may interact with beetroot extract. Both contain nitrates that convert to nitric oxide, potentially causing additive vasodilation and hypotension. If you experience symptoms like severe dizziness or fainting while using both, seek medical advice.

Phosphodiesterase-5 (PDE5) inhibitors, including sildenafil (Viagra), tadalafil, and vardenafil, should be used cautiously with beetroot extract. According to MHRA/EMC product information, PDE5 inhibitors are contraindicated with prescribed nitrate medications. While dietary nitrate supplements like beetroot extract are different from prescribed nitrates, they may still enhance nitric oxide effects and potentially lower blood pressure further. Discuss this combination with your doctor.

Patients taking any regular medications should consult their GP or pharmacist before starting beetroot extract. If you experience any concerning symptoms while taking beetroot extract with your medications, seek medical advice promptly. Report any suspected adverse reactions to the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

When to Seek Medical Advice Before Taking Beetroot Extract

Consulting a healthcare professional before starting beetroot extract is essential in numerous circumstances to ensure safety and appropriateness. Proactive medical advice can prevent adverse effects and identify potential contraindications.

You should seek medical advice before taking beetroot extract if you:

• Have any chronic medical condition, including cardiovascular disease, kidney disease, liver disease, or diabetes

• Take any regular prescription medications, particularly antihypertensives, nitrates, or medications for erectile dysfunction

• Have a history of kidney stones or are at increased risk of nephrolithiasis

• Experience low blood pressure or symptoms such as dizziness or fainting

• Are pregnant, planning pregnancy, or breastfeeding, as safety data in these populations is limited

• Have a known allergy to beetroot or other members of the Amaranthaceae family

• Are scheduled for surgery; inform your surgical and anaesthetic team about all supplements, as they may advise stopping depending on your blood pressure and medications

Additionally, if you are already taking beetroot extract and experience any concerning symptoms, contact your GP promptly or use NHS 111 for urgent but non-emergency advice. Warning signs requiring medical attention include:

• Severe dizziness, fainting, or falls

• Persistent nausea, vomiting, or abdominal pain

• Signs of allergic reaction (rash, itching, swelling, difficulty breathing) – call 999 for severe allergic reactions (anaphylaxis)

• Unusual fatigue or weakness

• Changes in urination patterns or flank pain (potential kidney issues)

• Palpitations or irregular heartbeat

• Severe chest pain or fainting – call 999 immediately

It is important to inform all healthcare professionals—including your GP, pharmacist, and any specialists—about all supplements you take. This information should be included in medication reviews and pre-operative assessments. The NHS advises that supplements should complement, not replace, a balanced diet, and professional guidance ensures they are used safely and appropriately within your individual health context.

Safe Alternatives to Beetroot Extract

For individuals who cannot take beetroot extract due to contraindications or interactions, several evidence-based alternatives may provide similar benefits, depending on the intended health goal.

For cardiovascular health and blood pressure management:

• Dietary modifications remain the cornerstone of cardiovascular health. NICE recommends reducing salt intake, eating more fruits, vegetables, and wholegrains, and considering a Mediterranean-style diet pattern

• Leafy green vegetables such as spinach, rocket, and lettuce provide dietary nitrates similar to beetroot but in smaller, more manageable amounts

• Pomegranate juice has demonstrated modest blood pressure-lowering effects in some studies, though evidence quality varies; be mindful of sugar content

• Hibiscus tea may offer mild antihypertensive benefits, though it should still be used cautiously with blood pressure medications and may interact with certain medications like warfarin

• Oily fish consumption (salmon, mackerel, sardines) twice weekly supports cardiovascular health through omega-3 fatty acids, as recommended by NHS healthy eating guidelines

For exercise performance and endurance:

• Structured exercise programmes provide the most robust evidence for improving fitness and endurance

• Adequate hydration and balanced nutrition form the foundation of athletic performance

• Creatine monohydrate has strong evidence for improving high-intensity exercise performance; however, those with kidney disease should consult their renal team before use

• Caffeine (from coffee or tea) may enhance endurance and reduce perceived exertion, though it may worsen palpitations, anxiety, or blood pressure in some individuals

General lifestyle approaches that support the same health goals as beetroot extract include:

• Regular physical activity (150 minutes of moderate-intensity exercise weekly, as per NHS guidelines)

• Maintaining a healthy body weight

• Limiting alcohol consumption

• Smoking cessation

• Stress management techniques

Before starting any alternative supplement or making significant dietary changes, particularly if you have existing health conditions, consult your GP or a registered dietitian. They can provide personalised recommendations based on your medical history, current medications, and health objectives. Remember that whilst supplements may offer benefits, they cannot substitute for evidence-based medical treatment or a healthy lifestyle.

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