Does beet concentrate improve vasodilation?

Beet Concentrate and Vasodilation

Yes, beet concentrate improves vasodilation through its high dietary nitrate content, which converts to nitrite and subsequently to nitric oxide—a potent vasodilator that relaxes vascular smooth muscle in veins, arteries, and arterioles. 1

Mechanism of Vasodilation

The vasodilatory effects of beetroot concentrate operate through a well-established nitrate-nitrite-nitric oxide pathway:

• Dietary nitrate from beetroot is converted to nitrite via bacterial reduction on the tongue surface, then further reduced to nitric oxide (NO) in the circulation and tissues 2
• Nitric oxide acts as an endothelium-derived relaxing factor (EDRF), directly relaxing vascular smooth muscle cells in both large epicardial arteries and smaller resistance vessels 1
• This mechanism is endothelium-independent, meaning it works even when endothelial function is impaired—a common feature in cardiovascular disease 3, 4

The ACC/AHA guidelines confirm that nitric oxide is "an important endogenous modulator of vascular tone" and that nitrate administration provides "an exogenous source of nitric oxide" to restore impaired vascular function 1

Evidence for Vasodilation Effects

Microvascular Vasodilation

• Beetroot juice (70 mL containing 0.45 g nitrate for 3 days) significantly augmented cutaneous vasodilation during local heating (91% vs. 79% maximal vascular conductance, P<0.05) 3
• This effect was primarily through NOS-independent pathways, demonstrating that beetroot provides vasodilation beyond normal endothelial function 3

Compensatory Vasodilation Under Stress

• Beetroot juice supplementation (70 mL, 0.4 g nitrate for 5 days) restored compensatory vasodilation in individuals who normally lack this response during compromised perfusion (568 vs. 714 mL·min⁻¹·100 mmHg⁻¹, P=0.005) 5
• This translated to preserved exercise capacity when perfusion pressure was reduced, with plasma nitrite levels increasing from 39 to 245 nmol/L (P<0.001) 5

Endothelial Protection

• Acute beetroot ingestion (500 mL beetroot juice) prevented endothelial dysfunction induced by ischemic injury in the human forearm 2
• Beetroot bread containing 100 g beetroot (1.1 mmol nitrate) increased endothelium-independent vasodilation measured by laser Doppler iontophoresis over 6 hours (P=0.017) 4

Blood Pressure Reduction

The vasodilatory effects translate to clinically meaningful blood pressure reductions:

• Acute ingestion of 500 mL beetroot juice reduced blood pressure by 10.4/8 mmHg approximately 3 hours post-ingestion, correlating with peak plasma nitrite concentrations 2
• Three days of beetroot juice (70 mL daily) reduced mean arterial pressure from 90 to 83 mmHg and diastolic pressure from 74 to 62 mmHg (P<0.05) 3
• Three weeks of beetroot juice concentrate reduced daily systolic blood pressure by 7.3 mmHg (P=0.02) in overweight older adults 6
• Beetroot bread acutely lowered diastolic blood pressure over 6 hours (P=0.032) 4

Optimal Dosing Protocol

Based on the highest quality evidence:

• Acute effects: 500 mL beetroot juice (approximately 5-9 mmol or 310-560 mg nitrate) produces vasodilation within 2-3 hours 1, 2
• Short-term supplementation: 70 mL beetroot juice concentrate (0.4-0.45 g nitrate) daily for 3-5 days produces sustained effects 3, 5
• Chronic supplementation: Continued daily intake maintains benefits, but effects diminish within 1 week of discontinuation 6

The UEFA expert group confirms that "acute performance benefits are most likely seen within 2-3 hours following a nitrate bolus of 5-9 mmol (310-560 mg)" and that "prolonged periods of nitrate intake (>3 days) may also be beneficial" 1

Critical Caveats and Contraindications

When to Avoid Nitrate Supplementation

• Hypotension (systolic BP <90 mmHg): Nitrates cause venodilation and further preload reduction, potentially causing cardiovascular decompensation 1, 7
• Right ventricular infarction: These patients depend on adequate preload to maintain cardiac output and can experience profound hypotension 1, 7
• Recent phosphodiesterase inhibitor use: Contraindicated within 24 hours of sildenafil/vardenafil or 48 hours of tadalafil due to risk of severe hypotension 1, 7

Potential Adverse Effects

• Gastrointestinal upset: One study found that nitrate supplementation (800 mg) increased intestinal epithelial injury by 50% compared to water during moderate exercise 1
• Headaches: Common side effect of nitrate-induced vasodilation 1
• Urine discoloration: Beetroot juice may discolor urine (benign effect) 1

Important Mechanistic Consideration

The enterosalivary conversion pathway is essential: When oral bacteria on the tongue surface are disrupted (e.g., by antibacterial mouthwash), the conversion of nitrate to nitrite is blocked, completely abolishing the vasodilatory and blood pressure-lowering effects 2

Clinical Bottom Line

Beetroot concentrate reliably produces vasodilation through nitric oxide-mediated mechanisms, with effects evident within 2-3 hours and sustained with daily supplementation. The evidence demonstrates both microvascular and macrovascular vasodilation, with clinically significant blood pressure reductions of 7-10 mmHg systolic and 3-8 mmHg diastolic. However, avoid use in hypotensive patients, those with right ventricular infarction, or recent phosphodiesterase inhibitor users. 3, 2, 5