Is beet juice good for heart health?

It improves markers of artery health in short trials, and nobody has tested whether that prevents heart disease. A 2018 meta-analysis of 23 studies of inorganic nitrate, the compound beetroot is rich in, found artery dilation rose by 0.59%, arterial stiffness measured as pulse wave velocity fell by 0.23 m/s, and platelet aggregation fell by 18.9%. Many of those studies were short, some a single dose, and no randomized trial has counted heart attacks, strokes or deaths.

Established. Nitrate from beetroot improves two artery markers in short trials. A 2021 meta-analysis of 27 beetroot trials found pulse wave velocity fell by 0.27 m/s and flow-mediated dilation rose by 0.62%. Other measured parameters did not change.

Unsettled. Whether better markers turn into fewer heart attacks is unknown. The longest trials we found ran about six months, and none was designed to count heart events.

What the trials found

The effect follows the dose, and shrinks with age

A 2025 dose-response analysis of 75 trials in 1823 people found each extra mmol of nitrate lowered medium-term pulse wave velocity by 0.07 m/s (95% CI 0.03 to 0.11) and raised flow-mediated dilation by 0.30% (95% CI 0.15 to 0.46). How much nitrate a bottle of juice carries varies by brand. An earlier meta-analysis of 12 trials in 246 people found the improvement in artery lining function was larger at higher nitrate doses and smaller in older people and in those with higher BMI or higher systolic pressure. Those interventions lasted from 1.5 hours to 28 days.

The longer trials

In a 6-week trial of 69 adults with untreated high cholesterol, daily nitrate-rich beetroot juice raised flow-mediated dilation by 1.1%, about 24% from baseline, while the group on nitrate-depleted juice fell by 0.3%. Because the placebo was the same juice with the nitrate removed, the effect points to nitrate.

In the 6-month VaSera trial, an echocardiography subsample of 87 people with hypertension and type 2 diabetes or its risk, nitrate-rich juice reduced left ventricular end-diastolic volume by 1.3 tsp (95% CI 0.32 to 2.3; metric: 6.3 mL, 1.6 to 11.1) and end-systolic volume by 0.65 tsp (3.2 mL) against placebo juice. This was a secondary analysis, and what that change means for the heart in practice is unknown. In 20 postmenopausal women, 12 weeks of a nitrate-rich beetroot extract lowered carotid artery stiffness at weeks 4, 8 and 12. Twenty people is a very small trial, and an extract is a different product from juice.

Heart failure: no gain in exercise

Myth. Nitrate does not improve exercise capacity in heart failure with preserved ejection fraction. A 2023 meta-analysis of 8 trials in 335 patients found no benefit. In a 6-week crossover trial of 84 such patients, potassium nitrate left peak oxygen uptake at 10.23 against 10.17 mL/min/kg on placebo (P = .73). These trials used nitrate or nitrite salts rather than beet juice.

The only data on deaths are observational

Observational data from 2229 Australians aged 49 or older linked higher vegetable nitrate intake with lower cardiovascular death. Compared with people eating under 69.5 mg of nitrate a day from vegetables, hazard ratios were 0.53, 0.51 and 0.63 across the three higher quarters of intake. This is an association in people eating vegetables in general, not beet juice. The risk did not keep falling beyond the second quarter, and people who eat more vegetables differ in other ways. The abstract gives no absolute death rates.

Beetroot juice also lowers blood pressure a little in short trials. We cover that question separately, on the beetroot juice and blood pressure review.

Who should be careful

People taking clopidogrel. In a small trial of 20 patients with coronary artery disease, a nitrate supplement reduced platelet aggregation only in the 10 who were taking clopidogrel. That trial used a nitrate supplement rather than juice, and it shows nitrate can add to the effect of an antiplatelet drug.

Infants. The American Academy of Pediatrics reports that nitrate poisoning in infants still occurs from home-prepared vegetable foods. Beet juice is not a food for babies.

Large daily amounts. The European Food Safety Authority set an acceptable daily intake for nitrate of 3.7 mg per kg of body weight a day, and it notes that when all dietary sources are counted the safe level may be exceeded at all ages. It set no separate limit for beet juice. On nitrosamines, the worry behind nitrate in processed meat, a 5-week trial of 231 adults with mild hypertension found 300 mg of nitrate a day from leafy vegetables or a supplement left urinary nitrosamines low and unchanged. That trial did not use beetroot, and urine is only a marker.

We have no card on pregnancy. A trial of beetroot juice safety in pregnancy is registered with its status unknown. Our search for oxalate, kidney stones and red urine produced no card for this page.

Not for everyone. If you take clopidogrel or another antiplatelet drug, a daily nitrate-rich juice is worth mentioning to whoever prescribes it.

What expert bodies say

The European Food Safety Authority puts the acceptable daily intake for nitrate at 3.7 mg per kg of body weight a day, and warns that total intake from all sources may exceed it. The American Academy of Pediatrics treats home-prepared vegetable foods as a source of nitrate poisoning in infants. The EU health claims register has no authorized heart or blood vessel claim for beetroot or for nitrate, and the claims filed for red beet juice were not authorized. We did not find a cardiology society position on beetroot juice in this search.

How we searched

What would change this answer

• A randomized trial that counts heart attacks, strokes or deaths. None exists. The longest trials ran three to six months.
• A long trial of beet juice itself, rather than nitrate salts or extracts, in people at cardiovascular risk.
• Results from the registered trial of beetroot juice safety in pregnancy, which would fill the gap on that group.

For what beet juice contains and how it fits a diet, see the beet juice page.

Sources

1. ev-bjhh-01 · Meta-analysis or systematic review · systematic review and meta-analysis of human experimental trials · n = 23 studies in meta-analysis (34 reviewed)
   Inorganic nitrate intake was found to significantly reduce resting blood pressure (systolic blood pressure: -4.80 mmHg, P < 0.0001; diastolic blood pressure: -1.74 mmHg, P = 0.001), improve endothelial function (flow-mediated dilatation: 0.59%, P < 0.0001), reduce arterial stiffness (pulse wave velocity: -0.23 m/s, P < 0.0001; augmentation index: -2.1%, P = 0.05), and reduce platelet aggregation by 18.9% (P < 0.0001).
   
   Who: human experimental trials of oral inorganic nitrate or nitrite intake
   Effect: FMD +0.59% (P < 0.0001); PWV -0.23 m/s (P < 0.0001); augmentation index -2.1% (P = 0.05); platelet aggregation -18.9% (P < 0.0001); SBP -4.80 mm Hg
   Certainty: Best synthesis across heart markers; trials short, many single-dose; no hard outcomes. Authors call for long-term outcome trials.
   Nutr Rev, 2018 · checked 2026-10-07 · we read the abstract
2. ev-bjhh-02 · Meta-analysis or systematic review · GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials · n = 75 RCTs, 1823 participants
   Moreover, a linear dose-response relationship was indicated between each mmol of NO3 intake and medium-term pulse wave velocity (WMD: -0.07 m/s; 95%CI: -0.11, -0.03), medium-term flow-mediated dilation (WMD: 0.30%; 95%CI: 0.15, 0.46), and medium-term augmentation index (WMD: -0.57%; 95%CI: -0.98, -0.15).
   
   Who: participants in randomized controlled trials of dietary nitrate
   Effect: per mmol nitrate, medium term: PWV -0.07 m/s (95% CI -0.11 to -0.03); FMD +0.30% (95% CI 0.15 to 0.46); augmentation index -0.57% (95% CI -0.98 to -0.15)
   Certainty: Linear dose-response; one 17 fl oz (500 mL) serving of beetroot juice can carry several mmol of nitrate, but content varies by brand.
   Nutr J, 2025 · checked 2026-10-07 · we read the abstract
3. ev-bjhh-03 · Meta-analysis or systematic review · systematic review and meta-regression of randomized controlled trials · n = 27 RCTs in meta-analysis (43 reviewed)
   Beetroot inorganic nitrate supplementation significantly decreased Arterial Stiffness (Pulse Wave Velocity (-0.27 m/s, p = 0.04)) and increased Endothelial function (Flow Mediated Dilation: 0.62%, p = 0.002) but did not change other parameters (p > 0.05).
   
   Who: adults in randomized clinical trials of beetroot inorganic nitrate supplementation
   Effect: PWV -0.27 m/s (p = 0.04); FMD +0.62% (p = 0.002); other parameters unchanged (p > 0.05)
   Certainty: Beetroot-specific; authors ask for higher-quality trials.
   Nitric Oxide, 2021 · checked 2026-10-07 · we read the abstract
4. ev-bjhh-04 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 246
   The effect on EF was significantly associated with the dose of inorganic nitrate (β = 0.04, SE = 0.01, P < 0.001), age (β = -0.01, SE = 0.004, P = 0.02), baseline BMI (β = -0.04, SE = 0.02, P = 0.05) and systolic BP (β = -0.01, SE = 0.005, P = 0.02).
   
   Who: participants in RCTs of inorganic nitrate or beetroot vs placebo, 2008 to 2014
   Effect: vascular function SMD 0.36 (95% CI 0.16 to 0.56); effect rose with nitrate dose and fell with age (beta -0.01), BMI (beta -0.04) and systolic BP (beta -0.01)
   Certainty: Interventions lasted 1.5 hours to 28 days.
   Eur J Nutr, 2016 · checked 2026-10-07 · we read the abstract
5. ev-bjhh-05 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 8 RCTs, 335 patients
   We found no benefit of inorganic nitrate/nitrite on exercise capacity in patients with HFpEF.
   
   Who: patients with heart failure with preserved ejection fraction (HFpEF) in randomized controlled trials
   Effect: peak VO2 MD 0.361 (95% CI -0.17 to 0.89, p = 0.183); exercise time MD 9.74 (95% CI -46.47 to 65.95); lower resting SBP and exercise MAP; no change in cardiac output or heart rate
   Certainty: Includes nitrite and non-beetroot nitrate; PMID outside the local corpus.
   Frontiers in Cardiovascular Medicine, 2023, 10:1054666 (inorganic nitrate/nitrite in HFpEF meta-analysis) · checked 2026-10-07 · we read the abstract
6. ev-bjhh-06 · Randomized controlled trial(s) · multicentre randomized double-blind crossover trial, 6-week periods, KNO3 6 mmol three times daily vs KCl · n = 84
   KNO3 did not improve peak oxygen uptake (KNO3, 10.23 [SD, 0.43] mL/min/kg vs KCl, 10.17 [SD, 0.43] mL/min/kg; P = .73) or total work performed (KNO3, 25.9 [SD, 3.65] kilojoules vs KCl, 23.63 [SD, 3.63] kilojoules; P = .29).
   
   Who: patients with symptomatic (NYHA class II/III) HFpEF, median age 68 years, 69% women
   Effect: peak VO2 10.23 vs 10.17 mL/min/kg (P = .73); total work 25.9 vs 23.63 kJ (P = .29); no change in vasodilatory reserve or quality of life; well tolerated
   Certainty: Nitrate salt, not beetroot juice; same active compound.
   JAMA Cardiol, 2025 · checked 2026-10-07 · we read the abstract
7. ev-bjhh-07 · Randomized controlled trial(s) · randomized double-blind placebo-controlled parallel trial, 6 weeks · n = 69 (primary outcome data for 67)
   Dietary nitrate resulted in an absolute increase in the FMD response of 1.1% (an ∼24% improvement from baseline) with a worsening of 0.3% in the placebo group (P < 0.001).
   
   Who: untreated hypercholesterolemic adults
   Effect: FMD +1.1% absolute (about 24% from baseline) vs -0.3% with nitrate-depleted juice (P < 0.001); platelet-monocyte aggregates -7.6% vs +10.1% (P = 0.004)
   Certainty: Placebo was nitrate-depleted beetroot juice, so the effect is attributed to nitrate.
   Am J Clin Nutr, 2016 · checked 2026-10-07 · we read the abstract
8. ev-bjhh-08 · Randomized controlled trial(s) · double-blind randomized factorial trial, 6 months, beetroot juice up to 11.2 mmol nitrate vs nitrate-depleted juice · n = 87
   Nitrate-containing juice (n = 40) decreased left ventricular (LV) end-diastolic volume {-6.3 [95% confidence interval (CI) -11.1, -1.6] ml} and end-systolic volume [-3.2 (95% CI -5.9, -0.5) ml], and increased end-diastolic mass/volume ratio [+0.04 (95% CI 0.00, 0.07)], relative to placebo juice (n = 47).
   
   Who: patients with hypertension and with or at risk of type 2 diabetes, VaSera trial echocardiography subsample
   Effect: LV end-diastolic volume -1.3 tsp (95% CI -2.3 to -0.32; metric: -6.3 mL, -11.1 to -1.6); end-systolic volume -0.65 tsp (95% CI -1.2 to -0.1; metric: -3.2 mL, -5.9 to -0.5); blood pressure did not differ between juices
   Certainty: Secondary analysis in a subsample; clinical meaning of the volume change unknown.
   Br J Clin Pharmacol, 2019 · checked 2026-10-07 · we read the abstract
9. ev-bjhh-09 · Randomized controlled trial(s) · randomized double-blind placebo-controlled parallel trial, 12 weeks · n = 20
   Compared with ND-BEETx, NR-BEETx supplementation significantly reduced PWVβ, β stiffness, elastic modulus, and AIx at weeks 4, 8, and 12, whereas arterial compliance increased by week 12.
   
   Who: postmenopausal females aged 60-85 years
   Effect: reduced carotid PWV-beta, beta stiffness, elastic modulus and AIx at weeks 4, 8 and 12 vs nitrate-depleted extract (8.8 mmol/day); blood pressure unchanged
   Certainty: Very small trial; extract, not juice.
   Am J Physiol Heart Circ Physiol, 2025 · checked 2026-10-07 · we read the abstract
10. ev-bjhh-10 · Observational data · prospective population-based cohort, 14-year follow-up · n = 2229
    In multivariable-adjusted analysis, participants in quartile 2 [69.5-99.6 mg/day; HR 0.53 (95% CI 0.35, 0.82)], quartile 3 [99.7-137.8 mg/day; HR 0.51 (95% CI 0.32, 0.80)], and quartile 4 [> 137.8 mg/day; HR 0.63 (95% CI 0.41, 0.95)] of vegetable nitrate intake had lower hazards for CVD mortality compared to participants in quartile 1 (< 69.5 mg/day).
    
    Who: men and women aged 49 years or older without diabetes or major CVD at baseline, Blue Mountains Eye Study
    Effect: CVD mortality vs quartile 1 (<69.5 mg/day): Q2 HR 0.53 (0.35 to 0.82); Q3 HR 0.51 (0.32 to 0.80); Q4 HR 0.63 (0.41 to 0.95)
    Certainty: Nitrate from all vegetables, not beet juice; no dose-response beyond quartile 2; confounding by overall vegetable intake possible.
    Eur J Nutr, 2019 · checked 2026-10-07 · we read the abstract
11. ev-bjhh-11 · Randomized controlled trial(s) · randomized double-blind placebo-controlled trial · n = 20
    Following nitrate supplementation, plasma RSNO was elevated (4.7 ± 0.8 vs 0.2 ± 0.5 nM) and thrombin-receptor mediated platelet aggregation was reduced (-19.9 ± 6.0 vs 4.0 ± 6.4 U) only in the clopidogrel group compared with placebo.
    
    Who: coronary artery disease patients with (n = 10) or without (n = 10) clopidogrel therapy
    Effect: thrombin-receptor platelet aggregation -19.9 vs +4.0 U and plasma RSNO 4.7 vs 0.2 nM, clopidogrel group only, vs placebo
    Certainty: Nitrate gel, not juice; shows nitrate can add to antiplatelet drug effects, relevant for people on blood thinners.
    Thromb Haemost, 2018 · checked 2026-10-07 · we read the abstract
12. ev-bjhh-12 · Position of an expert body · agency re-evaluation of food additives (news summary) · n = —
    The current acceptable daily intake (ADI) for nitrates is 3.7 milligrams per kilogram of body weight per day (mg/kg bw/day).
    
    Who: general population, EU
    Effect: ADI nitrate 3.7 mg/kg bw/day
    Certainty: The ADI was set for nitrate as a whole; EFSA notes all dietary sources together may exceed it.
    EFSA, 2017, news: EFSA confirms safe levels for nitrites and nitrates added to food (re-evaluation of E 249-252) · checked 2026-10-07 · we read the section
13. ev-bjhh-13 · Position of an expert body · agency re-evaluation of food additives (news summary) · n = —
    However, if all sources of dietary nitrate are considered (food additive, natural presence in foods and environmental contaminants), the safe level may be exceeded for individuals of all age groups.
    
    Who: general population, EU, all age groups
    Effect: ADI may be exceeded from total dietary nitrate (food additives under 5% of exposure)
    Certainty: Context for concentrated beetroot shots; no specific limit on beet juice.
    EFSA, 2017, news: EFSA confirms safe levels for nitrites and nitrates added to food (re-evaluation of E 249-252) · checked 2026-10-07 · we read the section
14. ev-bjhh-14 · Randomized controlled trial(s) · randomized controlled trial, 3 arms, 5 weeks · n = 231
    Total urinary excretion of N-nitrosamines was low across all groups under basal conditions (<5 μg/24 h) and did not significantly change after the intervention.
    
    Who: participants with mild hypertension in a randomized controlled trial
    Effect: urinary nitrate up about 5- to 6-fold; total urinary N-nitrosamines low (<5 ug/24 h) and unchanged
    Certainty: Leafy greens and potassium nitrate, not beetroot; short; urinary marker only.
    Am J Clin Nutr, 2026 · checked 2026-10-07 · we read the abstract
15. ev-bjhh-15 · Position of an expert body · clinical report · n = —
    However, reports of nitrate poisoning from home-prepared vegetable foods for infants continue to occur.
    
    Who: infants
    Effect: infant methemoglobinemia risk from home-prepared vegetable foods and well water
    Certainty: Beet juice is not a food for infants; adults are not the risk group here.
    Pediatrics, 2005 · checked 2026-10-07 · we read the abstract