Can super beets support heart health?

Super Beets for Heart Health

While beetroot products contain dietary nitrate that can modestly improve certain cardiovascular parameters in the short term, they are not a substitute for evidence-based dietary patterns like the DASH or Mediterranean diet, which remain the gold standard for cardiovascular disease prevention and should be your primary recommendation. 1

Evidence-Based Dietary Recommendations Take Priority

The American Heart Association and international guidelines consistently identify the DASH and Mediterranean dietary patterns as the most effective nutritional interventions for cardiovascular health, demonstrating up to 30% reduction in cardiovascular events. 1, 2 These comprehensive dietary patterns include:

• Fruits and vegetables (≥400g/day each) with a linear inverse dose-response relationship with atherosclerotic CVD 2
• Whole grains (2 servings/day) replacing refined starches 2
• Legumes (up to 400g/week) as partial replacement for red meat 2
• Extra-virgin olive oil as the primary fat source 2
• Nuts (30g daily) which decrease atherosclerosis progression 2
• Oily fish (1-2 times/week) providing omega-3 fatty acids 2, 3

What the Evidence Shows About Beetroot Products

Acute cardiovascular effects are modest and short-lived:

• Beetroot juice containing nitrate (6.5-7.3 mmol) lowers aortic systolic blood pressure by approximately 5.2 mmHg at 30 minutes, but effects do not persist over 24 hours 4
• Meta-analysis shows beetroot nitrate supplementation modestly improves endothelial function (Flow Mediated Dilation: 0.62%) and reduces arterial stiffness (Pulse Wave Velocity: -0.27 m/s) 5
• Effects on brachial blood pressure are minimal compared to central aortic pressure 4

Critical product quality concerns:

• There is extreme variability in nitrate content between different beetroot products, with a ~50-fold range between lowest and highest products 6
• Even within the same product, nitrate content varies by 30±26% between different lots 6
• Only 5 out of 24 tested products consistently provided ≥5 mmol of nitrate per serving, which appears to be the minimal effective dose 6

Practical Clinical Approach

For patients asking about "super beets":

1. Acknowledge the limited evidence: Explain that while beetroot nitrate has some short-term cardiovascular effects, these are modest and not sustained 4, 5

2. Redirect to proven dietary patterns: Emphasize that the DASH diet is proven effective for multiple CVD risk factors including blood pressure, lipid profiles, and weight loss 1

3. If patients insist on beetroot supplementation: Warn them about significant product variability and that most commercial products may not contain effective doses 6

4. Emphasize whole food sources: Regular consumption of beets as part of a vegetable-rich diet (≥400g vegetables/day) provides nitrate along with fiber, vitamins, and other beneficial compounds within an evidence-based dietary pattern 1, 2

Important Caveats

Beetroot supplements are not recommended as primary therapy because:

• No evidence demonstrates sustained effects on cardiovascular morbidity or mortality 4, 5
• Product quality and nitrate content are highly unreliable 6
• They do not address the comprehensive dietary modifications needed for cardiovascular health 1
• The American Heart Association does not include beetroot supplementation in its evidence-based dietary guidance for cardiovascular health 1

Special populations where beetroot research exists but evidence remains insufficient:

• Heart failure patients showed improved skeletal muscle contractile function in small studies, but this does not translate to a clinical recommendation for routine use 7
• Postmenopausal women with hypertension are being studied, but results are not yet available 8