Pickled, pureed, or baked and drizzled with olive oil, beets are an amazingly versatile food and a great option for weight-conscious individuals due to their stomach-filling water and fiber content. But the health benefits of beets might not stop there. Scientific research is seeking to connect the dots between beets and improved cardiovascular health. In this article, we’ll explore why beets might indeed be a heart-healthy food choice, and why including them as a regular part of your diet could prove beneficial to your overall health.

Health benefits of beets: the nitrate-nitric oxide connection

When it comes to the cardiovascular health benefits of beets, scientists are highly interested in one particular molecule — nitrate (NO₃; a nitrogen atom combined with three oxygen atoms). It isn’t the nitrate itself that is so interesting to scientists, however; rather, it’s what the nitrate turns into: nitric oxide. Nitric oxide (NO) is a nitrogen atom and an oxygen atom combined, and it has several important roles in maintaining our bodies’ health and normal function:

• Neurotransmission
• NO functions as an on-demand signaling molecule in the nervous system.
• Research also supports a neuromodulatory role for NO.
  
  
• Host defense mechanisms
• NO elicits protective immunity against pathogenic bacteria, protozoa, and viruses.
  
  
• Cardiovascular health
• NO regulates vascular tone and blood pressure.
• NO inhibits oxidative stress, platelet aggregation, and leukocyte adhesion.

Additionally, NO insufficiency is strongly correlated with several cardiovascular risk factors, can cause endothelial dysfunction, and has been reported as a significant predictive factor for future atherosclerotic disease progression and cardiovascular events.

There are two main ways by which our bodies obtain NO: the L-arginine/NO-synthase pathway and the nitrate-nitrite-NO pathway. Let’s break these pathways down:

• L-arginine/NO synthase pathway: Nitric Oxide Synthases (NOS) produce NO by combining the nitrogen atom from the amino acid L-arginine with an oxygen atom from molecular oxygen. NO produced this way can be further metabolized into several additional molecules, including nitrate and nitrite.
  
  
• Nitrate-nitrite-NO pathway: Produces NO from dietary sources of nitrate (such as beets!). Bacterial nitrate reductases produced by the bacteria in our mouths (i.e., the oral microbiome) remove one oxygen from nitrate, producing nitrite (NO₂). Nitrite turns into NO in the body via a number of different mechanisms, including by deoxygenated hemoglobin in our blood.

While most of the NO in our bodies is produced via the L-arginine/NOS pathway, this pathway doesn’t function very well during hypoxia (i.e., low oxygen levels; can be cause by lung diseases, heart problems, and even some medications) or acidosis (i.e., acidic conditions in the blood caused by a loss of sodium bicarbonate, such as can occur during severe diarrhea). NO production via L-arginine also drops as we age. Thus, the nitrate-nitrite-NO pathway has been proposed as an efficient “back up system” for NO production under such conditions.

Is dietary nitrate supplementation beneficial?

It was only a little over a decade ago that the nitrate-nitrite-NO pathway to NO production was recognized, and while it seems like a promising alternative mechanism of NO production, scientists have had to ask the question: does the NO produced from dietary nitrate sources (i.e., nitrate salts or food supplements) even do anything? Research in animal models and in humans suggests that dietary nitrate supplementation does indeed have several benefits, particularly for the cardiovascular system:

• Reduced blood pressure
• Protection against myocardial ischemia-reperfusion damage
• Reversal of vascular dysfunction in the elderly

Dietary nitrate supplementation has even been found to reverse some features of metabolic syndrome and has shown some gastroprotective effects as well.

Can real beets or beet juice reduce blood pressure?

If you want to get nitrate naturally, it is mainly found in green leafy vegetables, turnips and — you guessed it — beets. This bright red root vegetable (it also comes in a golden version, which has milder flavor) is a low-calorie, low-fat, and high-fiber food with a high water content, leaving you feeling fuller after eating them. But, do beets also have the same beneficial effects on the cardiovascular system as dietary nitrate supplementation? The answer appears to be yes, but there are some caveats:

• A randomized controlled trial in men found that beetroot juice, when consumed as part of a normal diet, can lower blood pressure.
  
  
• Similarly, another randomized controlled trial reported significant reductions in blood pressure associated with beetroot juice consumption, but the intervention was short-term and not done on people with high cardiovascular risk.
  
  
• A recent study summarized the blood pressure-lowering capabilities of beets and other high-nitrate foods such as kale, but pointed out that most studies examine only short-term effects, and existing long-term studies show no significant effects of nitrate-rich vegetables on blood pressure.
  
  
• A meta-analysis of several randomized controlled trials found consistent reports of reduced blood pressure associated with beetroot juice.

Despite the inconsistencies in studies specifically focused on beets and blood pressure, numerous studies on the Mediterranean and DASH diets, which are both high in vegetables, show consistent reductions in blood pressure in individuals following those diets compared to those eating a more typical high-fat, low-fiber Western diet. Additionally, authors of a recent meta-analysis suggest that some additional factors could be responsible for the inconsistencies between existing trials:

• Nitrate and other compounds in beetroot juice may have an additive effect.
  
  
• Conversely, some compounds in green leafy vegetables may weaken nitrate's action.

Additionally, the oral microbiome could play a role in these inconsistencies. The first step of the nitrate-nitrite-NO pathway (i.e., the dietary pathway to NO) — the reduction of nitrate to nitrite — can only be performed by bacteria. In fact, several studies have shown that the blood pressure-reducing effects of dietary nitrate supplementation are abolished when study participants use an antiseptic mouthwash. Nevertheless, whether differences in the oral microbiome could impact how well beets or any other food lower blood pressure remains unknown.

It is also important to remember that diet shouldn’t be the only means by which blood pressure and other health parameters are held in check. Moving every day — whether you take a walk around the neighborhood, ride your bike, or even do some gardening — is one of the best ways to improve your cardiovascular health, avoid chronic diseases (such as type 2 diabetes), keep your weight down and support whole-body health. Stress reduction and better sleep hygiene also benefit your blood pressure readings.

But don’t nitrates cause cancer?

Dietary nitrate from vegetables such as beets shouldn’t be confused with the nitrates and nitrites added to some meats (ham, bacon, and other processed meats) to prolong shelf life. Several studies have demonstrated that these added nitrates and nitrites can form nitrosamines in the body once they are consumed. Nitrosamines are compounds that are considered carcinogenic based on hundreds of studies in animal models and some epidemiological studies connecting gastrointestinal (GI) cancers to dietary nitrates and nitrites. However, a direct causal role between nitrosamines (particularly at the levels we are exposed to) and cancers in humans has not been established. 

To be on the safe side, until the science is more established, you should consume a widely varied diet with at least five daily servings of fruits and vegetables and avoid regular consumption of processed meats. The benefits of such a diet go far beyond avoiding cancer.

Key takeaways

So, what are the health benefits of beets? Beets are an all-around healthy food — low calorie, low-fat, and high in fiber — so they are a good item for weight management and metabolic health in general. And, the nitrates they contain might be an added plus, as studies consistently show acute and significant drops in blood pressure associated with dietary nitrates. However, long-term trials remain inconsistent, largely failing to demonstrate long-term blood pressure lowering effects of dietary nitrate. Nevertheless, given the other health benefits of beets and diets rich in vegetables, an overall dietary strategy centered on varied, whole foods is the best way to stay in good health and keep your body — and heart — healthy. And, if you're wondering "do beets make your pee red", the answer is yes — if you consume enough of it. But don't worry, as alarming as it may look, it's nothing for you to worry about.