{"url":"https://whatshealthyandwhy.com/beets/nitrates-and-performance","path":"/beets/nitrates-and-performance","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/beets/nitrates-and-performance.json","markdown":"https://whatshealthyandwhy.com/beets/nitrates-and-performance.md"},"topic":{"slug":"beets","name":"Beets","url":"https://whatshealthyandwhy.com/beets"},"slug":"nitrates-and-performance","order":1,"title":"Dietary Nitrates, Blood Pressure, and Athletic Performance","question":"Does beetroot juice lower blood pressure and boost exercise performance?","answer":"Beetroot juice does lower blood pressure by a few mmHg and modestly improves exercise endurance.","description":"How beetroot's natural nitrates lower blood pressure, boost endurance, and sharpen cognitive function","confidence":5,"confidenceNote":"Meta-analyses of 16 and 22 RCTs plus a double-blind trial agree on blood pressure; a systematic review finds 1–3% performance gains.","evidenceSummary":{"rctCount":4,"observationalCount":0,"metaAnalysisCount":3,"replicated":true,"newestStudyYear":2024},"category":{"categoryTitle":"What's Good For You","categorySlug":"good-for-you","subcategoryName":"Foods & Drinks","subcategorySlug":"foods","url":"https://whatshealthyandwhy.com/explore/good-for-you/foods"},"actions":["Eat whole beets: roasted, boiled or raw all keep their nitrates (raw most), and the greens are rich in nitrates too.","Try 250 mL of beetroot juice daily; in hypertensive patients it lowered systolic pressure about 7.7 mmHg over four weeks [1].","For exercise, most research used 500 mL of juice or a concentrated shot 2–3 hours before exercise."],"cautions":["Avoid antibacterial mouthwash: it kills the mouth bacteria that convert nitrate to nitrite and blunts the blood pressure benefit.","High in oxalates: people with a history of calcium oxalate kidney stones should moderate beets and stay well hydrated.","Beets will not replace medication in severe hypertension; do not change prescribed treatment without your doctor."],"simpleText":"Beets are one of nature's most concentrated sources of dietary nitrates — compounds that your body converts into nitric oxide, a molecule that relaxes blood vessels and improves blood flow throughout your entire body. Research shows that regularly drinking beetroot juice can meaningfully lower blood pressure [1][2], improve athletic endurance [4], and even sharpen cognitive performance [8]. This is whole-food medicine at its most straightforward: eat more beets, get measurably better circulation.","mediumText":"How Beetroot Nitrates Work\n\nThe key mechanism behind beets' health effects is the nitrate-nitrite-nitric oxide (NO) pathway. Beets are exceptionally rich in inorganic nitrate — a single cup of beetroot juice can contain 300–500 mg. When you consume beetroot, bacteria on your tongue convert nitrate into nitrite, which is then reduced to nitric oxide by tissues throughout the body, especially under low-oxygen conditions like active muscles.\n\nNitric oxide (NO) is a signaling molecule that causes smooth muscle in blood vessel walls to relax, a process called vasodilation. This widens blood vessels, lowers resistance, and reduces blood pressure — all without pharmaceutical intervention. The same mechanism delivers more oxygen to working muscles and organs, including the brain.\n\nBlood Pressure Benefits\n\nA landmark phase-2 randomized controlled trial gave hypertensive patients 250 mL of beetroot juice daily for four weeks and found an average reduction of ~7.7 mmHg systolic and ~2.4 mmHg diastolic blood pressure compared to placebo [1]. A meta-analysis pooling multiple trials confirmed the effect is consistent across healthy adults and those with elevated blood pressure [2], with a more recent meta-analysis of 22 RCTs specifically in hypertensive populations further validating the benefit [3].\n\nTo put the magnitude in context: a 5 mmHg reduction in systolic blood pressure is associated with roughly a 10% reduction in stroke risk at the population level. Beets won't replace medication in severe hypertension, but as a dietary strategy they have genuinely meaningful cardiovascular effects.\n\nAthletic Performance\n\nThe performance benefit of beetroot juice has been studied extensively. Nitric oxide reduces the oxygen cost of exercise — your muscles can do the same amount of work using less oxygen. This improves efficiency at sub-maximal intensities and extends time to exhaustion. Elite and recreational athletes both benefit, though the effect is larger in recreational athletes (who have more room for improvement in exercise economy) [4].\n\nBeetroot juice also benefits high-intensity intermittent exercise — the stop-start effort patterns common in team sports — by helping muscles recover faster between bursts [5]. The recommended protocol in most research is 500 mL of beetroot juice (or a concentrated \"shot\") consumed 2–3 hours before exercise.\n\nEndothelial Function and Heart Health\n\nBeyond blood pressure, beetroot juice improves endothelial function — the ability of blood vessel linings to dilate on demand. Healthy endothelial function is considered a central marker of cardiovascular health, and impaired endothelial function is an early sign of atherosclerosis. Studies measuring flow-mediated dilation (FMD) show acute improvements after beetroot juice consumption [6], suggesting benefits at the cellular level of vascular health.\n\nCognitive and Brain Effects\n\nNitric oxide also plays a role in cerebral blood flow regulation. By increasing NO availability, dietary nitrates from beetroot modestly increase blood flow to brain regions involved in executive function and decision-making [7]. A 2024 double-blind crossover RCT found that a chewable beetroot supplement acutely improved cognitive performance compared to placebo, consistent with the vascular mechanism [8].\n\nHow to Use Beets\n\n- Whole beets: Roasted, boiled, or raw — all retain nitrates. Raw beets provide the most.\n- Beetroot juice: 250–500 mL provides a clinically meaningful dose. Look for cold-pressed, low-sugar varieties.\n- Concentrated shots: 70 mL \"beetroot shots\" (used in most athletic research) are convenient for pre-workout use.\n- Beet greens: Don't discard them — the leaves are also rich in nitrates and other nutrients.\n- Avoid antibacterial mouthwash: It kills the oral bacteria that convert nitrate to nitrite, blunting beets' blood pressure benefit. This is a genuine and often overlooked interaction.\n- Expect \"beeturia\": Red or pink urine after eating beets is harmless and affects roughly 10–14% of people.\n\nPractical Note on Oxalates\n\nBeets are high in oxalates, which can contribute to kidney stones in susceptible individuals. People with a history of calcium oxalate kidney stones should moderate beet consumption and stay well hydrated.","deepText":"Evidence Review\n\nBlood Pressure: From Mechanistic to Clinical Evidence\n\nThe case for beetroot's blood pressure effects is unusually well-built for a food-based intervention. Kapil et al. (2015) conducted the most rigorous clinical trial: a phase-2, double-blind, placebo-controlled RCT with 68 patients with hypertension. Participants consumed 250 mL of nitrate-rich beetroot juice or nitrate-depleted placebo daily for four weeks. Clinic blood pressure fell by 7.7/2.4 mmHg in the beetroot group, home BP by 8.1/3.8 mmHg, and 24-hour ambulatory BP by 7.7/5.2 mmHg. Endothelial function improved and arterial stiffness decreased. The effect was sustained over the four-week period, demonstrating that nitrate tolerance does not develop as it does with pharmaceutical nitrates [1].\n\nSiervo et al. (2013) pooled data from 16 randomized trials in a systematic review and meta-analysis published in The Journal of Nutrition, finding a significant reduction in both systolic blood pressure (−3.55 mmHg, 95% CI: −4.95 to −2.16) and diastolic blood pressure (−1.32 mmHg, 95% CI: −2.14 to −0.50) [2]. The more recent meta-analysis by Benjamim et al. (2022) reviewed 22 RCTs specifically in hypertensive populations and confirmed clinically meaningful reductions, with larger effect sizes in those with higher baseline blood pressure [3].\n\nAthletic Performance: A Well-Replicated Finding\n\nThe performance effects of beetroot juice are among the most replicated findings in sports nutrition. The systematic review by Domínguez et al. (2017), published in Nutrients, analyzed studies across endurance sports and found consistent improvements in VO2 max efficiency, time to exhaustion, and exercise economy. The effect magnitude was typically a 1–3% improvement in performance metrics — meaningful at competitive levels [4].\n\nWylie et al. (2016), from Andrew Jones's lab at the University of Exeter (the leading research group in this field), tested beetroot juice on intermittent exercise protocols using a crossover design. They found improved power output at specific intensities and reduced metabolic cost during the recovery phases between intervals [5]. This study extended the nitrate-performance literature beyond pure endurance events into the kind of mixed-intensity exercise patterns more common in real sport and daily life.\n\nEndothelial Function\n\nSoares et al. (2021) demonstrated that acute beetroot juice supplementation improved flow-mediated dilation (FMD) — the gold-standard clinical measure of endothelial function — in HIV-infected individuals, who typically have chronically impaired endothelial health. The mechanism was confirmed as nitric oxide-mediated via use of a NO synthase inhibitor control condition [6]. While this population has specific characteristics, the study provides strong mechanistic confirmation that the dietary nitrate → NO → vasodilation pathway operates as expected in real human tissue.\n\nCognitive Effects\n\nBond et al. (2013) provided early mechanistic evidence that dietary nitrates modulate cerebrovascular hemodynamics, documenting changes in cerebral blood flow consistent with the cardiovascular vasodilatory mechanism [7]. This laid the groundwork for cognitive outcome studies.\n\nVaccaro et al. (2024), published in the European Journal of Nutrition, conducted a double-blind, randomized, placebo-controlled crossover trial using a chewable beetroot supplement. Participants showed acute improvements in cognitive performance tasks, with the crossover design providing strong internal control for individual differences. This remains one of the most rigorous beetroot-cognition trials to date [8].\n\nStrength of Evidence Assessment\n\nThe blood pressure and athletic performance effects of dietary nitrates from beetroot are supported by multiple high-quality RCTs and meta-analyses — this is among the strongest evidence bases for any whole-food intervention. Effect sizes are modest but clinically meaningful. The cognitive evidence is more preliminary, based on acute effects rather than long-term trials. The mechanistic pathway (nitrate → nitrite → nitric oxide → vasodilation) is well-established biochemistry that provides biological plausibility across all three outcome domains.","deepTruncated":false,"references":[{"id":"1","title":"Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study","authors":"Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A","year":2015,"journal":"Hypertension","pmid":"25421976","url":"https://pubmed.ncbi.nlm.nih.gov/25421976/"},{"id":"2","title":"Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis","authors":"Siervo M, Lara J, Ogbonmwan I, Mathers JC","year":2013,"journal":"The Journal of Nutrition","pmid":"23596162","url":"https://pubmed.ncbi.nlm.nih.gov/23596162/"},{"id":"3","title":"Nitrate Derived From Beetroot Juice Lowers Blood Pressure in Patients With Arterial Hypertension: A Systematic Review and Meta-Analysis","authors":"Benjamim CJR, Porto AA, Valenti VE, et al.","year":2022,"journal":"Frontiers in Nutrition","pmid":"35369064","url":"https://pubmed.ncbi.nlm.nih.gov/35369064/"},{"id":"4","title":"Effects of Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes. A Systematic Review","authors":"Domínguez R, Cuenca E, Maté-Muñoz JL, García-Fernández P, et al.","year":2017,"journal":"Nutrients","pmid":"28067808","url":"https://pubmed.ncbi.nlm.nih.gov/28067808/"},{"id":"5","title":"Influence of beetroot juice supplementation on intermittent exercise performance","authors":"Wylie LJ, Bailey SJ, Kelly J, Blackwell JR, Vanhatalo A, Jones AM","year":2016,"journal":"European Journal of Applied Physiology","pmid":"26614506","url":"https://pubmed.ncbi.nlm.nih.gov/26614506/"},{"id":"6","title":"Acute supplementation with beetroot juice improves endothelial function in HIV-infected individuals","authors":"Soares RN, Machado-Santos AP, Barros-Santos E, De Oliveira GV, Murias JM, Alvares TS","year":2021,"journal":"Applied Physiology, Nutrition, and Metabolism","pmid":"32866396","url":"https://pubmed.ncbi.nlm.nih.gov/32866396/"},{"id":"7","title":"Effects of dietary nitrates on systemic and cerebrovascular hemodynamics","authors":"Bond V Jr, Curry BH, Adams RG, Asadi MS, Millis RM, Haddad GE","year":2013,"journal":"Cardiology Research and Practice","pmid":"24455404","url":"https://pubmed.ncbi.nlm.nih.gov/24455404/"},{"id":"8","title":"Acute effects of a chewable beetroot-based supplement on cognitive performance: a double-blind randomized placebo-controlled crossover clinical trial","authors":"Vaccaro MG, Innocenti B, Cione E, Gallelli L, De Sarro G, Bonilla DA, Cannataro R","year":2024,"journal":"European Journal of Nutrition","pmid":"37875637","url":"https://pubmed.ncbi.nlm.nih.gov/37875637/"}],"wordCount":1264,"source":{"path":"src/content/topics/beets/nitrates-and-performance.md"},"citeAs":"“Does beetroot juice lower blood pressure and boost exercise performance?.” What's Healthy and Why. https://whatshealthyandwhy.com/beets/nitrates-and-performance","notice":"General information backed by peer-reviewed research, not medical advice."}