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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

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.

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

Antioxidant

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

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

A randomized, placebo-controlled, double-blind crossover trial (n = 8) assessed the effect of short- as well as long-term beetroot juice supplementation (6.5 mmol nitrate per 70 mL) on exercise performance of elite runners. On day 1, mean baseline nitrate levels increased significantly after supplementation with 220 mL of beetroot juice from 37 mcM to 615 mcM at 90 minutes and 569 mcM at 150 minutes (P < 0.05). Likewise, after daily chronic supplementation with 140 mL for 7 days, supplementation with 220 mL of beetroot juice again significantly increased mean baseline plasma nitrate levels from 220 mcM to 870 and 842 mcM at 90 and 150 minutes, respectively. Data on nitrate levels after supplementation with placebo (beetroot juice with depleted nitrates) were not reported. Although overall performance in the 1,500 m timed trial and VO2 max for the submaximal treadmill run did not change significantly between beetroot and placebo supplementation, 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 chronic (by 7 and 0.5 seconds) beetroot juice consumption as well as reductions in some VO2 max conditions.Boorsma 2014 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% with 31% experiencing worsening performance.Nyakayiru 2017

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)

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

References

Beta vulgaris L. USDA, NRCS. 2008. The PLANTS Database (http://plants.usda.gov, July 2008). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
Blázovics A, Sárdi E, Szentmihályi K, Váli L, Takács-Hájos M, Stefanovits-Bányai E. Extreme consumption of Beta vulgaris var. rubra can cause metal ion accumulation in the liver. Acta Biol Hung. 2007;58(3):281-286.17899785
Boorsma RK, Whitfield J, Spriet LL. Beetroot juice supplementation does not improve performance of elite 1500-m runners. Med Sci Sports Exerc. 2014;46(12):2326-2334.24781895
Chevallier A. The Encyclopedia of Medicinal Plants. Dorling Kindersley: London; 1996.
Coles LT, Clifton PM. Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: a randomized, placebo-controlled trial. Nutr J. 2012;11:106.23231777
Eggebeen J, Kim-Shapiro DB, Haykowsky M, et al. One week of daily dosing with beetroot juice improves submaximal endurance and blood pressure in older patients with heart failure and preserved ejection fraction. JACC Heart Fail. 2016;4(6):428-437.26874390
Frank T, Stintzing FC, Carle R, et al. Urinary pharmacokinetics of betalains following consumption of red beet juice in healthy humans. Pharmacol Res. 2005;52(4):290-297.15964200
Fugh-Berman A, Balick MJ, Kronenberg F, et al. Treatment of fibroids: the use of beets (Beta vulgaris) and molasses (Saccharum officinarum) as an herbal therapy by Dominican healers in New York City. J Ethnopharmacol. 2004;92(2-3):337-339.15138021
Iglesias R, Pérez Y, de Torre C, et al. Molecular characterization and systemic induction of single-chain ribosome-inactivating proteins (RIPs) in sugar beet (Beta vulgaris) leaves. J Exp Bot. 2005;56(416):1675-1684.15863448
Kanner J, Harel S, Granit R. Betalains—a new class of dietary cationized antioxidants. J Agric Food Chem. 2001:49(11):5178-5185.11714300
Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015;65(2):320-327.25421976
Lee CH, Wettasinghe M, Bolling BW, Ji LL, Parkin KL. Betalains, phase II enzyme-inducing components from red beetroot (Beta vulgaris L.) extracts. Nutr Cancer. 2005;53(1):91-103.16351511
Minciullo PL, Mistrello G, Patafi M, Zanoni D, Gangemi S. Cross-reactivity between Parietaria pollen and beet. Allergol Immunopathol (Madr). 2007;35(2):74-75.17428404
Ninfali P, Bacchiocca M, Antonelli A, et al. Characterization and biological activity of the main flavonoids from Swiss Chard (Beta vulgaris subspecies cycla). Phytomedicine. 2007;14(2-3):216-221.16698256
Nyakayiru J, Jonvik KL, Trommelen J, Pinckaers PJ, Senden JM, van Loon LJ, Verdijk LB. Beetroot juice supplementation improves high-intensity intermittent type exercise performance in trained soccer players. Nutrients. 2017;9(3).pii:E314.28327503
Pavlov A, Kovatcheva P, Tuneva D, Ilieva M, Bley T. Radical scavenging activity and stability of betalains from Beta vulgaris hairy root culture in simulated conditions of human gastrointestinal tract. Plant Foods Hum Nutr. 2005;60(2):43-47.16021830
Raubenheimer K, Hickey D, Leveritt M, et al. Acute effects of nitrate-rich beetroot juice on blood pressure, hemostasis and vascular inflammation markers in healthy older adults: a randomized, placebo-controlled crossover study. Nutrients. 2017;9(11):E1270.29165355
Sembries S, Dongowski G, Mehrländer K, Will F, Dietrich H. Physiological effects of extraction juices from apple, grape, and red beet pomaces in rats. J Agric Food Chem. 2006;54(26):10269-10280.17177570
Siervo M, Lara J, Ogbonmwan I, Mathers JC. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr. 2013;143:818-826.23596162
Stintzing FC, Carle R. Functional properties of anthocyanins and betalains in plants, food, and in human nutrition. Trends Food Sci Technol. 2004;15(1):19-38.
Váli L, Stefanovits-Bányai E, Szentmihályi K, et al. Liver-protecting effects of table beet (Beta vulgaris var. rubra) during ischemia-reperfusion. Nutrition. 2007;23(2):172-178.17234508
Webb AJ, Patel N, Loukogeorgakis S, et al. Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension. 2008;51(3):784-790.18250365

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