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Beetroot Juice: Sip it or Skip it?

Written by Dr. Ruscio on January 10, 2024

Written by Dr. Ruscio on January 10, 2024 — Reviewed by Aimee Gallo

Using the Humble Beet to Maximize Your Wellness Goals

• What Are the Benefits of Beetroot Juice?|
• Beetroot Juice: How It Works|
• Beetroot Juice and Cardiovascular Health|
• Beetroot Juice and Performance Enhancement|
• Beetroot Juice and Fatigue|
• Beets, Juice, or Supplements?|
• Is Beetroot Juice Safe?|
• Add Beetroot Juice to a Healthy Foundation|

At some point along the line, you’ve probably been told to “eat your beets.” While they may not have known the specifics, your caregivers wanted you to reap the benefits of this earthy root vegetable. And it turns out, they were right—quite a bit of research has confirmed that beets provide a myriad of health advantages.

Beetroot juice, the juice from raw beets, has become popular among fitness enthusiasts and folks with high blood pressure alike, for its exercise and heart-health benefits. Some of these positive effects can be attributed to the high nitrate content of beetroot juice. In your body, nitrates get converted into nitric oxide, which relaxes your blood vessels and improves blood flow. 

However, the process of converting nitrates into nitric oxide requires a healthy digestive tract, so if you have poor gut health, you’ll likely not reap the maximum benefits of beetroot juice. This is one of the reasons I recommend first laying the foundation with a whole-food, anti-inflammatory diet, and then peppering in specific foods or beverages, like beetroot juice, to enhance your results.

In this article, I’ll share the science-backed benefits of beetroot juice, the best ways to incorporate it into your routine, and a delicious blueberry beetroot smoothie recipe. Let me first share a brief overview of how beetroot juice impacts your health.

What are the Benefits of Beetroot Juice?

Before I get into the specifics of how beetroot juice can improve your health, let me share a brief overview of its science-backed benefits. Beetroot juice is probably best known for its ability to lower blood pressure and enhance exercise performance, but it may also improve [1, 2]:

• Dental health and the balance of bacteria in your mouth
• Blood flow, which helps warm up your fingers after being in the cold
• Asthma symptoms
• Cognition

So, what is it about beetroot juice that makes it so special? While beets themselves are full of nutrients, many health benefits of beetroot juice may be related to its high nitrate content [1]. 

Beetroot Juice: How It Works

Beets are a type of root vegetable that many consider a superfood because they contain a variety of nutrients like fiber, potassium, vitamin C, beta-carotene, folate, zinc, and vitamin A [3]. Outside of these vitamins and minerals, beets (and beetroot juice) also contain nitrates (not the potentially cancerous ones found in processed meats). 

The good kind of dietary nitrates are naturally occurring compounds in foods (like beets, spinach, lettuce, celery, and radishes) that your body can recycle into nitric oxide [1]. After you consume beetroot juice or other foods containing nitrate, most of the nitrate is absorbed into the bloodstream via the stomach and small intestine [4]. About three-quarters of the absorbed nitrate is then excreted in urine, while the kidneys, gallbladder, and salivary glands reabsorb the rest [4]. In the mouth, oral bacteria convert much of the nitrate you eat, plus reabsorbed nitrate from the salivary glands, into nitrite [4]. The nitrite then goes into the stomach, where it’s converted to nitric oxide [4]. Early evidence suggests that even gut bacteria can convert some nitrate to nitrite and then to nitric oxide [5]. You can see from this why a healthy gut is important for extracting nitrates from food and converting them to nitric oxide.

Once it’s in your bloodstream, nitric oxide relaxes your blood vessels (in a process called vasodilation) to improve your blood flow, lower your blood pressure, and increase the amount of oxygen and nutrients that get delivered to your body [1]. 

You’re probably starting to see that beetroot juice can benefit your heart health, so let’s look at the research to understand how.

Beetroot Juice and Cardiovascular Health

Keeping your blood pressure in check is one of the most important strategies for maintaining great heart health as you age. While it’s vital to create a healthy foundation with an anti-inflammatory diet, exercise, restful sleep, and minimal stress, adding beetroot juice may be a simple option for even better blood pressure control. 

To be clinically relevant and reduce heart disease risk, any blood pressure-lowering intervention should reduce:

• Systolic blood pressure (the top number, indicating blood pressure when your heart contracts) by 5–12 mm Hg, and 
• Diastolic blood pressure (the bottom number, showing blood pressure when your heart relaxes between beats) by 5–6 mm Hg [6].  

A 2018 systematic review found that six hours after consuming beetroot juice, men had an average reduction in systolic blood pressure of 4–5 mm Hg, and women’s dropped by 2–3 mm Hg. Overweight participants had an average drop in systolic pressure of 11 mm Hg, and people with high blood pressure (hypertension) had blood pressure reductions comparable to the effects of blood pressure medication [6]. 

Considering these reductions, you may be wondering if it’s safe to drink beetroot juice if you’re on prescription blood pressure-lowering medication. Research suggests that beets don’t seem to increase the risk of low blood pressure readings (hypotension) for people on blood pressure meds, but it’s always best to check with your healthcare professional first [6].

The blood pressure benefits of beetroot juice are often attributed to its nitrate content. But a 2017 meta-analysis of 22 clinical trials found that beetroot juice reduced blood pressure, even when the nitrates were removed. This tells us that other, non-nitrate factors may be responsible for the mighty beet’s blood pressure effects [7]. 

Nevertheless, as we age, our nitric oxide levels tend to be lower, which may contribute to higher blood pressure, and beetroot juice may combat some of that age-related nitric oxide decline [7]. Indeed, a 2021 review found a large body of research confirming the blood pressure benefits of beetroot juice in older adults [1]. 

Since beetroot juice has a positive impact on your blood vessels and cardiovascular health, you can probably guess that it may boost your athletic performance as well.  

Beetroot Juice and Performance Enhancement

Beetroot juice, and other high nitrate foods, may give some people an exercise edge by boosting muscular oxygen uptake and promoting [1]:

• More strength and power
• Less muscle fatigue
• Better exercise performance
• Faster exercise recovery
• Better muscle efficiency

For example, a 2021 meta-analysis of 6 studies with healthy, physically active people found that beetroot juice improved strength recovery, jump performance, and pain after exercise. That’s impressive, considering it had no effect on exercise-related oxidative stress (disturbed balance between free radicals and antioxidants) or muscle damage [8]. Similarly, a 2017 systematic review of 23 studies showed that trained athletes taking beetroot juice had better physical performance, cardiorespiratory endurance, and muscle function during exercise [9]. 

What might explain these results? It could be that when physically active people drink beetroot juice before exercise, it reduces the amount of energy and oxygen their muscles need, so they don’t have to work as hard to achieve more [9].

However, a 2022 meta-analysis looking at various supplements on exercise performance in female athletes found the evidence for beetroot juice supplementation to be inconclusive [10]. Additional meta-analyses have shown that beetroot juice doesn’t seem to improve performance during specific activities, like high-intensity interval training or sprint interval training [11], and the jury is still out on its benefits for combat sports [12]. 

So, it looks like beetroot juice can help healthy, well-trained people perform better at certain activities. But what about people with compromised health? Though we need more data to be sure across health conditions, a meta-analysis of 8 clinical trials found that beetroot juice had no benefits for blood pressure, heart rate, exercise performance, or exercise capacity in people with chronic obstructive pulmonary disease (COPD) [13].

Overall, beetroot juice seems to improve cardiovascular health and exercise performance in healthy, well-trained people. The next logical question is, can beetroot juice give you a little lift when it comes to your energy level or fatigue?

Beetroot Juice and Fatigue

Some people swear by the energy-boosting benefits of beetroot juice, but the research doesn’t seem to bear this out yet. The majority of beetroot juice studies are focused on cardiovascular health and exercise performance, so it’s difficult to draw conclusions about its usefulness as an everyday option for fatigue. That said, high-quality evidence suggests that beetroot juice improves exercise tolerance, or the amount of exercise you can do before feeling breathless and tired from overexertion [1, 9]. 

So, for people who don’t tolerate the side effects of caffeine, which is often used to boost exercise performance and tolerance, beetroot juice may be a great pre-workout beverage. And there’s no harm in trying beetroot juice, so it’s worth a shot to see how you respond. 

This is a great place for me to point out that if you’re struggling with chronic fatigue and brain fog, then you may want to consider interventions like diet, probiotics, stress management, and exercise to address the root causes of your symptoms. Along those same lines, the process of creating nitric oxide from nitrates in foods like beetroot juice partially depends on the bacteria in your mouth, as well as your stomach acid levels [1]. So, if you have poor gut health, which often underlies chronic fatigue, you’re probably not going to reap the optimal benefits of beetroot juice. 

If you’re struggling with the symptoms of an unhealthy gut, I’ve laid out an easy-to-follow, step-by-step gut-healing protocol in my book Healthy Gut, Healthy You. 

Now, let’s shift gears and parse out whether it’s best to eat beets, drink beetroot juice, or opt for beetroot powder.

Beets, Juice, or Supplements?

I’m a fan of consuming foods in their most natural state because processing a food into a juice or a pill generally removes a lot of nutrients, especially fiber. If you have a healthy gut, fibrous foods feed your gut bacteria to positively influence the health of your gut microbiome [7, 14]. And, to bring this full circle to beetroot juice, preliminary research suggests that a healthy gut microbiome could play an important role in converting dietary nitrate to nitric oxide [5]. 

But if you don’t handle the fiber well or care for the earthy taste of beets, there are plenty of ways to tame the flavor and make it easier to incorporate them into your diet. Remember that delicious blueberry beetroot smoothie I mentioned before? Here’s its simple recipe:

Ingredients:

• 10 ounces coconut milk (unsweetened)
• ½ cup frozen blueberries
• ½ cup frozen pineapple
• 1 small cooked beet, peeled and diced
• 1 scoop Evolution Meal Replacement Shake
• 1 tsp honey

Directions:

1. Place all ingredients into a high-powered blender.
2. Blend until smooth

Serves: 1

Beets offer a wide range of nutrients, so if you tolerate them, they’re great to add to your meal plan. If you experience digestive symptoms when you eat beets, it could be their FODMAP content. FODMAPs are fermentable carbohydrates that can feed “bad bugs” in your gut. For some people, this can cause uncomfortable symptoms like gas and bloating. 

Does this mean you need to strictly avoid beets? Not at all—you have some options. Raw beetroot is high in FODMAPs, but both canned and pickled beetroot are low in FODMAPs. You may want to try the canned or pickled options, or simply limit the amount of raw beets you eat to 2 thin slices at a meal. 

If you’re using beets for their exercise or cardiovascular benefits, you may want to opt for the ease of beetroot juice or a freeze-dried powder, which have a higher concentration and standardized dose of nitrates.

Both beetroot juice and beetroot powder tend to have similar nitrate content, so their benefits are likely equivalent when it comes to heart health and exercise performance [15]. That said, beetroot powder (without added sugar) is lower in sugar content, so it may prevent the blood sugar swings that can come along with fruit and vegetable juices. 

However, if you take beetroot powder in a capsule, you may miss out on the oral health benefits of beetroot juice. For example, when you eat beets, drink beetroot juice, or add loose powder to a beverage, the bacteria in your mouth break down some of the nitrates, which may contribute to a better oral microbiome profile and a lower risk of dental cavities [15]. 

When it comes to questions about dosage, here’s a table that shows how much beetroot juice or beetroot powder to take for enhancing exercise and heart health [6, 7]

Getting precise with your dosing of beetroot juice or beetroot powder will probably be difficult: Research shows significant variability in the nitrate content between products and batches [16]. Not only that, but one review discovered that only five products out of 24 met the minimum nitrate dose required to improve exercise performance [16]. 

Instead of trying to micromanage your dose of beetroot juice or beetroot powder, try picking one product that is GMP certified, free of major allergens, and third-party validated for potency, and see if you benefit from the lower ends of the above dose ranges. If you don’t notice improvements, consider increasing your dose. 

And again, if you’re using beetroot juice or powder to address fatigue, it’s probably best to explore and address the underlying causes, such as imbalanced gut health, first. While drinking beetroot juice and taking beetroot powder are likely harmless for most people, there are a few safety considerations.

Is Beetroot Juice Safe?

Beetroot juice, taken short or long term, is considered to be very safe and generally well tolerated [15]. 

It’s worth noting that the betalain pigment that gives red beets their color can turn your urine red. This side effect is completely harmless but can be alarming if you’re not expecting it [15]. The color can also appear in your poop [17] and complicate visual diagnostics of urine or stool tests. Next time you have a urine or stool test, you’ll know why the instructions may specifically say not to eat beets for a period before your test.

Outside of discolored urine and poop, beetroot juice is high in sugar (6 grams per half-liter [500 mL], the upper end of the dose range above) and lacks the fiber to slow down your sugar absorption [15]. Depending on how much you drink and whether you drink it alone or with other foods, you may experience blood sugar spikes and crashes. 

If you’re already dealing with dysregulated blood sugar, you probably want to steer clear of concentrated beetroot juice. Instead, you could try the powder form, which should have much less sugar (2 grams in one tablespoon, which is more than 8 times the higher end of the dose range above) [18]. You could also make your own beetroot juice recipe at home—this allows you to retain some of the fiber in the beets for your gut microbiome and reduce your chance of having blood sugar spikes. 

Additionally, I’ll remind you that if you have digestive symptoms when you eat beets, drink beetroot juice, or take a powder supplement, it could be the FODMAP content. This is where you may want to experiment with lower FODMAP versions of beets while you’re working on improving your gut health.

And finally, if you have kidney disease and you’re overdoing it with beets or beetroot juice, you may have a higher potential of developing oxalate crystals in your kidneys (kidney stones) [19]. Your kidneys remove oxalates from your body, and beets and beetroot juice are high in oxalates. Therefore, if your kidneys aren’t functioning well or you’re consuming more oxalates than they can handle, the oxalates from beets can start to build up and develop into crystals that essentially plug up your kidneys. 

Now that we’ve discussed the pros and cons of beetroot, here’s a detailed table for how to incorporate it into your routine based on your specific health goals or conditions:

I’ll reiterate that beets and beetroot juice are generally very safe [15]. However, if you have a history of kidney stones or other kidney-related issues, you should err on the side of caution: Discuss beets and beetroot supplements with your doctor, or just avoid concentrated beetroot juice altogether. Instead, you may be able to incorporate a moderate amount of whole beets as part of your nutritious, whole-foods diet.

Add Beetroot Juice to a Healthy Foundation

Beetroot, whether in juice or powder form, has made a name for itself in the wellness space as an attractive option for enhancing fitness and lowering blood pressure. Research has confirmed that beetroot juice can indeed improve exercise performance and recovery, and it can benefit your blood pressure. Beetroot supplements may also have other benefits related to oral health and asthma. 

In general, you’ll get more beetroot bang for your buck when you first lay a healthy foundation with a whole-foods diet (which can include beets), healthy exercise, restful sleep, and stress management techniques before adding in beetroot supplements. But if you’re already healthy and you’d like to experiment with beetroot juice, give it a shot. Pick a high-quality product, either juice or powder, add it to your routine, and take note of any improvements. 

One caveat: if you have kidney disease or a history of kidney stones, check with your doctor. You may want to avoid concentrated beetroot juice or powder and opt instead for adding moderate amounts of whole beets to your meal plan to avoid any issues with oxalates.

Another caveat is that, if any part of your digestive tract isn’t working well, you may not reap the maximum benefits of beetroot juice. You need a healthy mouth, stomach, and intestines to absorb nitrates into the bloodstream and convert some of them to nitric oxide. If you’ve got digestive problems, it’s probably best to forgo the beetroot juice or powder supplements and instead target the root cause(s) of your symptoms. Once you’ve restored robust gut health, then it makes sense to layer in beetroot juice or powder. 

For guidance on how to improve your gut health, check out my Great-in-Eight Action Plan for gut healing in Healthy Gut, Healthy You. For more personalized guidance, contact us for an appointment at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.