Beetroot vs. Fermented Beets for Nitric Oxide Production
Standard beetroot (fresh juice or supplements) is the evidence-based choice for increasing nitric oxide production, as there is no clinical research supporting fermented beets for this purpose. 1
Evidence for Standard Beetroot
The available guideline and research evidence exclusively supports non-fermented beetroot products for nitric oxide enhancement:
Mechanism and Efficacy
Beetroot works through dietary nitrate conversion: The high nitrate content (NO3-) in beetroot is reduced to nitrite and subsequently to nitric oxide through both nitric oxide synthase (NOS)-dependent and -independent pathways 2
Plasma nitrite levels increase significantly: Studies demonstrate beetroot juice increases plasma nitrite (a marker of NO) threefold within 60 minutes of consumption, with corresponding decreases in systolic blood pressure (-6.2 mmHg) and diastolic blood pressure (-5.2 mmHg) 3
Vascular benefits are well-documented: Beetroot juice supplementation augments NOS-independent vasodilation and reduces mean arterial pressure in healthy humans 4
Recommended Dosing Protocol
The UEFA Expert Group provides specific guidance for nitrate supplementation 1:
- Acute dosing: 5-9 mmol of nitrate (310-560 mg) consumed 2-3 hours before activity for immediate performance benefits
- Chronic dosing: Prolonged intake over >3 days may provide sustained benefits
- Food-first approach: High nitrate-containing foods include leafy greens, rocket salad, celery, and beetroot
Performance and Clinical Applications
Exercise performance: Beetroot juice improves intermittent high-intensity exercise efforts through faster phosphocreatine resynthesis and improved muscle power output 5
Cardiovascular effects: Nitrate-rich beetroot (0.9 mmol/L) prevents pulmonary hypertension development in animal models through nitrate-dependent mechanisms 6
Dose-response relationship: Low-dose beetroot juice (nitrate: 1.3 mmol/L) was more effective than high-dose (4.3 mmol/L) in preventing pulmonary hypertension, suggesting optimal dosing is critical 6
The Fermented Beets Problem
No clinical evidence exists for fermented beets: The medical literature contains zero studies examining fermented beetroot products for nitric oxide production or any related cardiovascular or performance outcomes.
Critical Considerations
Fermentation may reduce nitrate content: The fermentation process could potentially alter or reduce the bioavailable nitrate that is essential for NO production, though this has not been studied
Individual response varies: The UEFA guidelines note individual response to nitrate supplementation varies, with possible minor gastrointestinal upset 1
Quality assurance matters: Third-party testing programs (Informed Sport, Kölner Liste) should be used when selecting supplements to minimize contamination risk 1
Clinical Bottom Line
Choose standard beetroot juice or beetroot supplements with verified nitrate content rather than fermented products. The optimal approach is consuming 310-560 mg of nitrate 2-3 hours before desired effects, or using chronic supplementation (>3 days) for sustained benefits 1. Alternatively, incorporate high-nitrate whole foods like fresh beetroot, spinach, and rocket salad as a food-first strategy 1.