Beetroot juice / dietary nitrate (Beta vulgaris)

Beetroot juice and powder are sold as a «natural way to lower blood pressure». The Siervo 2013 meta-analysis (n = 254, 16 trials) reported a reduction of about 4.4 mmHg systolic and 1.1 mmHg diastolic BP with 300–500 mg/day dietary nitrate. The Bahadoran 2017 update confirmed the modest effect and identified a nitrate-independent component. The effect is not significant in normotensive subjects. ESC/ESH 2024 and SEH-LELHA 2022 do not include beetroot in hypertension treatment algorithms. Substituting ACE inhibitors, ARBs, thiazides or calcium channel blockers with beetroot juice is not justified. If BP remains above 140/90 mmHg, discuss standard pharmacotherapy with a general practitioner or cardiologist.

Beetroot juice is one of the most studied ergogenic supplements in sports science. The Jones 2018 review describes an average 1–3% improvement in time-to-exhaustion in recreational and sub-elite athletes after acute or short-term nitrate loading of 300–600 mg, 2–3 hours before exertion. In elite athletes with high baseline NO bioavailability the effect becomes negligible. Biohacker blogs promote beetroot as a «secret weapon for marathoners», yet the real gain is modest and unstable and is easily wiped out by poor sleep or feeding strategy. AESAN and AEMPS have not registered beetroot juice as an ergogenic aid. Pre-race chlorhexidine mouthwash abolishes the effect because antibacterial mouth care blocks the nitrate-to-nitrite step.

Beetroot juice is sold as a «universal vascular remedy». Cardiovascular outcomes (myocardial infarction, stroke, mortality) are not demonstrated in quality RCTs: short-term gains in NO bioavailability do not translate into fewer cardiovascular events. EFSA 2017 re-evaluated nitrate safety and confirmed an acceptable daily intake of 3.7 mg/kg – a dietary, not therapeutic, threshold. ESC 2021 builds primary prevention on SCORE2, BP, lipid and glucose control and Mediterranean diet; beetroot fits as an ordinary vegetable, not a «drug». Regular dietary beetroot is safe and useful; high-dose nitrate powder supplements are marketing with disproportionately small benefit.