Beetroot
Scientific Name(s): Beta cicla (chard)., Beta maritima, Betavulgaris L. (red beet)
Common Name(s): Beet, Beetroot, Chard, Spinach beet, Sugar beet, Swiss chard
Medically reviewed by Drugs.com. Last updated on Jan 15, 2024.
Clinical Overview
Use
Despite traditional use of beetroot for antitumor, carminative, emmenagogue, and hemostatic properties, clinical trials are lacking to substantiate these claims. Data suggest a role as an antioxidant, as a natural source of nitrates and nitrites, and a potential use in exercise performance or cardiovascular conditions, although evidence is limited. In the food industry, beetroot is used for its color.
Dosing
Limited data are available to support therapeutic dosing.
Contraindications
Although not contraindicated, excessive consumption is not advised in patients with hemochromatosis or Wilson disease because of the potential for iron and copper accumulation.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Red urine and coloration of blood (with no apparent consequence) following beetroot consumption is apparent in a small percentage of the population.
Toxicology
Data are limited.
Scientific Family
- Chenopodiaceae
Botany
B. vulgaris is an herbaceous biennial growing 1 to 2 m in height. It bears heart-shaped leaves measuring up to 40 cm long in cultivated varieties. The 5-petaled flowers are 3 to 5 mm in diameter, green or reddish tinged, and densely arranged along a long inflorescence. A hard cluster of "nutlets" are formed as fruits. The main root of the beetroot plant is swollen and composed of alternating layers of darker and lighter conductive and storage tissues.Chevallier 1996, PLANTS 2008 Synonyms include Beta altissima and Beta brasiliensis.
History
References to beetroot are found in Roman scripts for treating fever and constipation, and for use as an aphrodisiac. Hippocrates is said to have advocated using beet leaves for binding wounds. The plant was used throughout the Middle Ages for a variety of ailments. The term "nature's candy" has been associated with the historical use of sugar from beet in the Napoleonic Wars. Traditional use includes antitumor, carminative, emmenagogue, and hemostatic properties.Chevallier 1996, Fugh-Berman 2004 Beetroot juice is utilized in the food industry as an alternative to synthetic colorants in jams, jellies, and sauces.Lee 2005, Stintzing 2004
Chemistry
The leaves contain varying amounts of calcium, phosphorous, iron, vitamins A and C, niacin, thiamine, and riboflavin.Fugh-Berman 2004 A ribosome-inactivating protein, beetin, has been identified in mature plant leaves.Iglesias 2005 The roots mostly consist of saccharose and the same elements and vitamins found in the leaves, as well as folate, zinc, and magnesium. The color is mainly derived from water-soluble nitrogenous pigments called betalains: betacyanins (red) or betaxanthins (yellow), including betanin, betanidin, betalmic acid, and vulgaxanthin.Blázovics 2007, Frank 2005, Lee 2005, Ninfali 2007 Heat labile phenolic acids and flavonol glycosides have also been described.Lee 2005, Ninfali 2007 Assays of the chemical constituents have been performed by high-performance liquid chromatography and spectrophotometry.Kanner 2001, Pavlov 2005
Uses and Pharmacology
Recent discovery of the nitrate-nitrite-nitric oxide (NO) pathway has led to a better understanding of enterally ingested nitrate from beetroot. After systemic absorption, second-pass metabolism takes place when nitrate is concentrated and secreted from the salivary glands. Nitrate reductases produced by the oral microbiome convert nitrate to nitrite in the mouth, which is then further converted at the tissue level to NO. A process that may be limited or prevented with the routine use of antibacterial mouthwashes.(Files 2020) Other oral hygiene or practices that have also been noted as possibly altering the oral microbiome and affecting nitrate metabolism are teeth brushing with antiseptic toothpaste, chewing gum, consuming sweets, taking stimulants (such as caffeine), or drinking alcohol.(Lopez-Samanes 2020)
Antioxidant
Animal and experimental data
In vitro experiments in human blood and in rats indicate antioxidant activity of the betacyanins, including betanin and betanidin. Decreased sensitivity of low-density lipoproteins to oxidation, and prevention of active oxygen-induced and free radical–mediated oxidation of molecules, has been described.(Kanner 2001, Lee 2005, Pavlov 2005, Sembries 2006, Stintzing 2004) In rats, increases of copper and zinc in the liver protecting against reperfusion injury was suggested to be via superoxide dismutase action.(Váli 2007)
Cancer
Older data include animal experiments in mice, evaluating efficacy against skin and lung cancer, but this line of investigation does not appear to have been pursued outside of epidemiological data and antioxidant activity.(Stintzing 2004)
Cardiovascular
Clinical data
Decreases in systolic (SBP) and diastolic blood pressure (DBP) were recorded for healthy and "clinically healthy" volunteers after consumption of a single dose of beetroot juice with up to a 7.9 mm Hg and 5.7 mm Hg decrease, respectively.(Raubenheimer 2017, Webb 2008) A peak effect was recorded at 3 to 4 hours. Endothelial dysfunction following an acute ischemic insult was prevented and platelet aggregation was attenuated ex vivo. The effects were attributed to nitrates in the beetroot. In healthy men with SBP over 120 mm Hg, a significant drop in SBP (−4.7 mm Hg; P = 0.007) was observed compared to baseline 6 hours after consuming a single dose of 500 g of beetroot juice (72% beetroots, 28% apples; 15 mmol nitrate/L) in a double-blind, randomized, placebo-controlled, crossover intervention trial (n = 30; 15 men, 15 women). Significance was retained after removing outliers with large (at least 20 mm Hg) drops in SBP. No adverse events were reported.(Coles 2012) Single-dose high-dose beetroot juice was also observed to significantly improve hemostasis and vascular inflammation markets in "clinically healthy" aging adults.(Raubenheimer 2017)
Clinical trials among patients with cardiovascular conditions are limited, however a 4-week, double-blind, randomized, placebo-controlled crossover pilot study evaluated the effect of beetroot juice on blood pressure and exercise performance in patients with heart failure and preserved ejection fraction. This common form of heart failure is most prevalent in the elderly, particularly women, which was reflected by the 85% female enrollment (n=20), with an average age of 69 years. All participants had a history of hypertension with 70% NYHA class II and 30% class III. A bottle of beetroot juice containing 0.38 g nitrate (6.1 mmol) and nitrate-depleted beetroot juice as placebo containing 0.0003 g nitrate (4.8 mmol) were given as a single dose and as a daily dose for 1 week, with a 5- to 7-day washout. Compared to placebo, plasma levels of nitrate and nitrite were significantly higher following this low dose of beetroot juice given either as a single dose or daily for 1 week. Significant improvements in submaximal aerobic endurance, however, were observed only following the 1-week daily dosing (24% increase; P=0.02) of beetroot juice compared to placebo with no differences in VO2, heart rate, or any other gas exchange measures between the dosing regimens. Resting SBP, but not DBP, was significantly reduced with both dosing regimens: single dose 127 vs 134 mm Hg, P=0.008; 1-week daily 120 vs 134 mm Hg, P<0.001). Additionally, with 1-week daily dosing, SBP after cycling was significantly decreased (P=0.03). No adverse events were reported with either regimen.(Eggebeen 2016)
In 68 hypertensive patients, half drug-naive and half treated, the ability of dietary nitrate supplementation to provide a sustained reduction in BP was evaluated in both groups of patients. The study design was a double-blind, randomized placebo-controlled trial with 250 mL beetroot juice (approximately 6.4 mmol nitrate/dose) taken once daily for 4 weeks by adult patients with daytime BP more than 130/85 mm Hg. SBP and DBP decreased significantly compared to baseline by all 3 measurements in both subgroups with consumption of beetroot juice but not placebo: clinically-measured BP by 7.7 mm Hg (P < 0.001) and 2.4 mm Hg (P = 0.05), 24-hour ambulatory BP by 7.7 mm Hg (P < 0.001) and 5.2 mm Hg (P < 0.001), and home-measured BP by 8.1 mm Hg (P < 0.001) and 3.8 mm Hg (P < 0.01), respectively. Additionally, dietary nitrate consumption was associated with significant improvements in vascular function (pulse wave velocity, augmentation index, peak flow mediated dilatation) in both subgroups, except that pulse wave velocity was not altered in drug-naive patients.(Kapil 2015) A systematic review and meta-analysis was conducted of double-blind, randomized, placebo-controlled crossover trials (n = 16) investigating the effects of inorganic nitrate or beetroot juice supplements on blood pressure. The trials were conducted between 2006 and 2012 with a range of 7 to 30 participants per study (N = 254), most of whom were young and healthy with only 2 studies enrolling older individuals that included healthy as well as obese type 2 diabetes patients. The daily amount of inorganic or beetroot nitrate per dose ranged from approximately 2.5 to 24 mmol or 5.1 to 45 mmol, respectively, and were given for a duration of 2 hours to 15 days. Systolic BP, but not DBP, was significantly reduced by consumption of inorganic nitrate (−4.2 mm Hg, P < 0.001) and beetroot juice supplementation (−4.5 mm Hg, P < 0.001). A dose-response was observed for the effect of inorganic nitrate; however, neither study duration nor plasma nitrate concentration was related to changes in SBP. Both interventions were well tolerated.(Siervo 2013)
Exercise and physical function
Clinical data
A small randomized, placebo-controlled, double-blind crossover trial (n = 8) assessed the effect of acute as well as short-term beetroot juice supplementation (6.5 mmol nitrate per 70 mL) on exercise performance of elite runners. Overall, performance did not change significantly between beetroot and placebo groups. However, 2 of the 8 runners were noted as potential "responders" because of improved performance in the 1,500 m timed trial after acute (by 5.8 and 5 seconds) and 7-day (by 7 and 0.5 seconds) beetroot juice consumption. Reductions in some VO2 max conditions were also noted. Mean baseline nitrate levels increased significantly after acute supplementation with 220 mL of beetroot juice on day 1 and again on day 7 after short-term supplementation with 140 mL/day (P<0.05). Data on nitrate levels after supplementation with placebo (beetroot juice with depleted nitrates) were not reported.(Boorsma 2014) The lack of an acute effect of beetroot juice (70 mL; 6.4 mmol nitrate) on physical performance in highly competitive tennis players was similarly documented in a small double-blind, randomized, placebo-controlled crossover trial (N=13). In contrast, a significant improvement was observed in high-intensity intermittent running performance in trained soccer players after consuming beetroot juice compared to placebo. In a double-blind, randomized, controlled, crossover design, the athletes consumed 140 mL/day of nitrate-enriched beetroot juice (approximately 800 mg or 12.9 mmol/day of nitrate) or beetroot juice placebo for 6 days with at least an 8-day washout period. Improved performance was noted in 56% of athletes with 31% experiencing worsening performance.(Nyakayiru 2017) Data from another small randomized, placebo-controlled crossover conducted in 10 male recreational athletes suggested that the benefit of beetroot juice consumption on performance may be highest in hypoxic/deoxygenated scenarios versus normo- or hyperoxic ones.(Cocksedge 2020)
A significant improvement in endurance was also seen in an elderly population with heart failure and preserved ejection fraction in a 4-week double-blind, randomized, placebo-controlled crossover pilot study (n=20). Improvement in submaximal aerobic endurance (24% increase, P=0.02) was observed following 1-week daily dosing of 6.1 mmol/day beetroot juice compared to placebo with no differences in VO2, heart rate, or any other gas exchange measures between the dosing regimens.(Eggebeen 2016)
In mechanically ventilated critically ill adults at least 55 years of age recovering from acute lung injury, oral or nasogastric administration of 70 mL beetroot juice (400 mg nitrate) once daily for up to 14 days during hospitalization did not significantly affect physical function or strength. Similarly, no changes were observed in systolic or diastolic blood pressure between groups. Nitrate and nitrite plasma levels increased by an average of 219.2 and 0.144 mcM, respectively, at 2 to 3 hours after beetroot juice consumption. The study was conducted as a double-blind, randomized, controlled trial in 22 patients.(Files 2020)
Dosing
Beetroot juice is often used in trials because greater benefit from plant-based nitrate ingestion has been observed compared to sodium nitrate supplementation.Nyakayiru 2017
Limited data are available to support therapeutic dosing; 500 mL of beetroot juice has been administered as a single dose in healthy volunteers and is estimated to contain approximately 360 mg of betanin.Kanner 2001, Webb 2008 A range of 140 to 250 mL beetroot juice over 7 days to 4 weeks has been used in trials with nitrate dosing that ranged from 5.1 to 45 mmol/day.Nyakayiru 2017, Siervo 2013
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. Beetroot has been used traditionally as an emmenagogue and in the treatment of fibroids, but clinical trial data are lacking. Cattle fed large amounts of sugar beet leaves showed infertility and genital tract abnormalities; mice showed increases in uterine weight. Isoflavones are reported to have been detected in the seeds of certain sugar beet varieties.Fugh-Berman 2004
Interactions
None well documented.
Adverse Reactions
Cross-sensitivity to sticky weed (Parietaria) and beet has been recorded.Váli 2007 Beeturia (red urine after eating beetroot) is found in approximately 15% of the populationStintzing 2004 and coloration of the blood has also been documented (with no apparent consequence).Minciullo 2007
Toxicology
Data are limited. Accumulation of metals (copper, iron, magnesium, manganese, phosphorus, and zinc) in the liver with excess consumption is possible, and was demonstrated in rats. Caution is warranted in patients with hemochromatosis or Wilson disease.Blázovics 2007
Index Terms
- Beta altissima
- Beta brasiliensis
References
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