Is a beets supplement safe and effective for a generally healthy adult or older adult with potential cardiovascular health benefits or enhanced physical performance?

Beet Supplements for Cardiovascular Health and Physical Performance

Beet supplements containing 8.3-16.4 mmol nitrate (515-1017 mg) taken either acutely (2-3 hours before exercise) or chronically (≥3 days) are safe and can modestly improve physical performance in healthy adults, with population-specific benefits: enhanced muscular strength in trained athletes and improved aerobic endurance in non-athletes. 1

Evidence for Physical Performance Benefits

Performance Improvements

• Aerobic endurance: Beetroot juice significantly improves VO2max in healthy adults, though the effect size is small (SMD = 0.16) 1
• Lactate tolerance: Time-to-exhaustion (TTE) and YO-YO intermittent recovery test performance improve with small effect sizes (SMD = 0.25-0.27) in healthy adults 1
• Running performance: Whole beetroot consumption (200g with ≥500 mg nitrate) improved running velocity by 5% during the final 1.8 km of a 5-km time trial, with lower perceived exertion 2
• Muscle strength: Professional athletes show significant muscular strength benefits (SMD = 0.27), while the overall effect across all populations is negligible 1

Mechanism of Action

• Beetroot juice increases plasma nitrite concentrations in a dose-dependent manner, with peak changes occurring 2-3 hours post-ingestion 3
• The nitrate-to-nitrite-to-nitric oxide pathway promotes vasodilation and improved blood flow, potentially enhancing muscle contraction efficiency 4
• Faster phosphocreatine resynthesis may delay its depletion during repetitive high-intensity efforts 4

Evidence for Cardiovascular Benefits

Blood Pressure Effects

• In men consuming beetroot juice as part of a normal diet, systolic blood pressure decreased by 4-5 mmHg at 6 hours post-consumption 5
• The overall trend toward lower systolic blood pressure (P=0.064) suggests modest cardiovascular benefits in free-living adults 5

Important caveat: While the American Heart Association emphasizes the Mediterranean diet (rich in fruits, vegetables, whole grains, fish, and nuts) for cardiovascular health in older adults 6, beetroot specifically is not mentioned in major cardiovascular guidelines. The evidence for beet supplements comes primarily from exercise physiology research rather than cardiovascular outcome trials.

Optimal Supplementation Strategy

Dosing Recommendations

• Effective dose: 8.3-16.4 mmol nitrate (515-1017 mg) daily 1
• Timing options:
  • Acute: 2-3 hours before exercise (small effect size, SMD = 0.20) 1
  • Chronic: ≥3 days of supplementation (negligible effect size, SMD = 0.13) 1
• Practical application: 140-280 ml concentrated beetroot juice or 200g whole baked beetroot 2, 3

Form Considerations

• Whole beetroot is preferable to isolated nitrate supplements, as whole vegetables provide health benefits while nitrates from other sources may have detrimental effects 2
• Beetroot juice on a low-nitrate background diet may be necessary to demonstrate blood pressure effects 5

Population-Specific Considerations

For Older Adults

While the research evidence focuses on younger healthy adults and athletes, older adults should prioritize:

• Optimal nutrition with adequate protein intake (≥0.8 g/kg body weight) combined with exercise programs including aerobic, weight-bearing, and resistance training 6
• Mediterranean diet patterns with large proportions of fruits and vegetables, which have consistently demonstrated favorable cardiovascular effects 6
• Flavonoids from fruits and vegetables (which beetroot contains) are associated with lower cardiovascular mortality risk 6

For Athletes vs. Non-Athletes

• Professional athletes: Focus on muscular strength benefits 1
• Healthy non-athletes: Expect more pronounced aerobic endurance improvements 1
• Recreationally fit individuals: May experience improved running performance and reduced perceived exertion 2

Safety Profile

• No significant adverse effects reported in the included studies 1, 2, 3, 5
• Critical distinction: Nitrates from whole vegetables like beetroot are safe, whereas nitrates from processed sources have been linked to adverse health effects 2
• Exercise heart rate remains unchanged, suggesting cardiovascular safety during physical activity 2

Clinical Pitfalls to Avoid

• Don't expect dramatic effects: Effect sizes are small to negligible across most performance metrics 1
• Don't use as monotherapy: Beet supplements should complement, not replace, evidence-based lifestyle interventions including structured exercise programs and Mediterranean diet patterns 6, 7
• Don't ignore individual variation: The 140 ml dose reduced oxygen cost of exercise by 1.7% while 280 ml reduced it by 3.0%, but exercise tolerance improvements were similar (12-14%) 3
• Avoid isolated nitrate supplements: Obtain nitrates from whole vegetables to maximize health benefits and minimize potential risks 2

Integration with Evidence-Based Exercise

For optimal cardiovascular health and physical performance, beet supplementation should be combined with:

• 150-300 minutes per week of moderate-intensity aerobic activity or 75-150 minutes of vigorous-intensity activity 7
• Progressive resistance training to maintain muscle mass, strength, and balance 7
• Combination training (aerobic plus resistance) for enhanced metabolic benefits 7