Can consuming fermented red beets increase nitric oxide levels and improve cardiovascular health?

Fermented Red Beets, Nitric Oxide, and Cardiovascular Health

Consuming beetroot products, including fermented red beets, can increase nitric oxide levels and improve cardiovascular health, particularly by reducing blood pressure in hypertensive individuals by approximately 5 mmHg systolic. 1, 2, 3

Mechanism of Action

Beetroot products work through the nitrate-nitrite-nitric oxide (NO₃⁻/NO₂⁻/NO) pathway to increase endogenous nitric oxide production. 1, 4

• Dietary nitrate from beets is converted to nitrite and subsequently to nitric oxide in vivo, bypassing the traditional enzymatic nitric oxide synthase (NOS) pathway 4
• Nitric oxide functions as a critical vasodilator and signaling molecule that regulates cardiovascular function 5, 4
• Aldosterone blockers and other cardiovascular medications work partly by increasing nitric oxide bioactivity, demonstrating the importance of this pathway 5

Cardiovascular Benefits: Blood Pressure Reduction

The most robust evidence supports blood pressure reduction as the primary cardiovascular benefit of beetroot consumption. 1, 2, 3

In Hypertensive Patients:

• A meta-analysis of randomized controlled trials in hypertensive patients (218 participants) demonstrated a significant reduction in systolic blood pressure of -4.95 mmHg (95% CI: -8.88 to -1.01, p<0.001) with GRADE evidence rated as moderate 3
• Diastolic blood pressure showed a non-significant trend toward reduction of -0.90 mmHg (95% CI: -3.16 to 1.36, p=0.06) 3
• Intervention periods ranged from 3 to 60 days with daily dosages of 70-250 mL of beetroot juice 3

In Free-Living Adults:

• In healthy men, beetroot juice consumption reduced systolic blood pressure by 4-5 mmHg at 6 hours post-consumption when consumed as part of a normal diet 6
• The effect was most pronounced in male participants 6

Additional Cardiovascular Benefits Beyond Blood Pressure

Raw beetroot juice provides broader cardiovascular benefits including improved endothelial function and reduced systemic inflammation. 2

• Flow-mediated dilation (FMD), a marker of endothelial function, significantly improved with raw beetroot juice compared to cooked beet 2
• Inflammatory markers including high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) were significantly reduced 2
• Adhesion molecules (ICAM-1, VCAM-1) and other inflammatory markers (IL-6, E-selectin) decreased significantly 2
• Total antioxidant capacity increased, and atherogenic lipids (non-HDL, LDL, total cholesterol) decreased with raw beetroot juice 2

Raw vs. Fermented/Cooked Preparations

Raw beetroot juice demonstrates superior cardiovascular effects compared to cooked preparations, though both forms provide benefits. 2

• Raw beetroot juice had greater antihypertensive effects than cooked beet (250g daily) 2
• More improvement in endothelial function and systemic inflammation occurred with raw juice versus cooked preparations 2
• Both forms effectively improved blood pressure, but raw preparations preserved more bioactive compounds 2

Important caveat: While the question specifically asks about fermented red beets, the strongest evidence exists for raw beetroot juice and cooked beets. The fermentation process may alter nitrate content and bioavailability, though fermented foods generally provide probiotic benefits 5. The cardiovascular benefits of specifically fermented beetroot products require further study.

Practical Recommendations

For cardiovascular benefit, consume 250 mL of beetroot juice daily or 250g of beetroot daily as part of a diet rich in vegetables. 2, 6

• This aligns with general guideline recommendations for 2-3 servings (≥200g per serving) of vegetables daily 5
• Beetroot products should be incorporated into a broader dietary pattern emphasizing vegetables, fruits, whole grains, and legumes 5
• The nitrate-rich vegetable approach represents a cost-effective, evidence-based nutritional strategy for blood pressure control 1

Clinical Context and Populations

Beetroot supplementation is appropriate for healthy individuals, pre-hypertensive populations, and diagnosed hypertensive patients as an adjunct to standard therapy. 1

• The intervention is safe and well-tolerated across diverse populations 1, 3
• Benefits occur when consumed as part of normal daily activities and diet 6
• This dietary approach can complement, but not replace, standard antihypertensive medications in diagnosed hypertensive patients 1

Factors Requiring Further Study

Several factors related to beetroot intake need deeper investigation, including gender differences (effects appear stronger in men), optimal dosing strategies, and the specific effects of fermentation on nitrate bioavailability and secondary metabolite content 1, 6.