The nitrate in beetroot and leafy greens is turned by bacteria on the tongue into nitrite and then into nitric oxide, the molecule that relaxes blood vessels. A concentrated dose, usually beetroot juice, lowers blood pressure by a few points and modestly improves endurance by cutting the oxygen cost of exercise. The blood-pressure effect is smaller when juice is only added to an ordinary diet, and the sports benefit fades in elite athletes.
An antibacterial mouthwash removes the tongue bacteria the whole pathway depends on and switches it off. The old fear that tars dietary nitrate with the processed-meat cancer brush does not fit the vegetable source.
Findings & Outcomes
What It Is
The nitrate that matters here is inorganic nitrate, and vegetables are its richest source. Beetroot and the leafy greens carry the most: rocket, spinach, chard, lettuce, celery, and beet greens. Eating them raises the body's supply of nitric oxide, the signaling molecule that widens blood vessels and eases the heart's work, because the body converts vegetable nitrate to nitric oxide through an unusual route that passes through bacteria in the mouth.
Beetroot juice is the form the research used most, because it packs a repeatable dose into one small glass, and a large salad of nitrate-rich leaves reaches the same range. This is a different substance from the nitrite added to cured and processed meats, and the cancer concern attached to that nitrite does not apply to the vegetable source.
What It Does
Dietary nitrate does two separate things, and the evidence behind each is a different quality.
The blood-pressure effect is the better established, and it is largest in the people who have the most to gain. Someone with high blood pressure sees the biggest and most durable drop; someone whose pressure is already normal sees little from adding a single juice to an ordinary diet. Pooled across trials the average systolic fall is about 4 mmHg, small on one reading and meaningful across a population, and it adds to the rest of a blood-pressure-lowering diet. In a large Danish cohort a moderate intake of nitrate-rich vegetables tracked with about 15% lower cardiovascular disease, an association that reflects a whole way of eating and not vegetable nitrate alone.
The exercise effect is smaller and narrower. After a few days of dietary nitrate the same easy-to-moderate effort costs less oxygen, so the body produces energy more efficiently. The clearest gain is endurance capacity, holding a hard effort longer before exhaustion; a timed finish changes less, and the benefit is largest in recreational athletes and often absent in the elite, whose physiology is already efficient. The economy benefit has a ceiling: past about 140 ml of concentrated juice there is little more to gain.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Heart And Vascular
A single glass of beetroot juice dropped blood pressure up to 10.4/8 mmHg within hours
A single large glass of beetroot juice dropped blood pressure by up to about 10/8 mmHg a few hours later in healthy people, and the size of the drop matched how much the blood's nitrite rose.
About three hours after a single 500 mL dose of beetroot juice, blood pressure fell by up to 10.4/8 mm Hg in healthy volunteers, tracking the peak rise in plasma nitrite. The dose also protected the endothelium against an ischemic insult and reduced platelet aggregation. Measured in: Healthy volunteers in a mechanistic crossover study. A single-dose acute study in healthy volunteers with a small sample, measuring peak change rather than a sustained average. Interrupting the mouth's conversion of nitrate to nitrite abolished the effect, confirming the pathway but also showing how easily it is switched off.
The study · 1
Webb et al., acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite · Hypertension 2008;51(3):784-790
Daily beetroot juice held 24-hour blood pressure 7.7/5.2 mmHg lower in hypertension
People with high blood pressure who drank beetroot juice every day for four weeks held their blood pressure several points lower than placebo, and the effect did not fade over the month.
In 68 patients with hypertension, four weeks of daily dietary nitrate (250 mL beetroot juice) versus nitrate-free placeholder juice lowered 24-hour ambulatory blood pressure by 7.7/5.2 mm Hg and clinic pressure by 7.7/2.4 mm Hg, improved endothelial function by about 20%, and reduced arterial stiffness, with no tachyphylaxis and good tolerability. Measured in: 68 adults with hypertension, half drug-naive and half already treated. A single four-week trial of 68 people; durable, but not yet extended to hard outcomes like heart attack or stroke.
The study · 1
Kapil et al., 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
Pooled across 16 trials, nitrate lowered systolic blood pressure about 4.4 mmHg
Across sixteen trials, nitrate and beetroot juice lowered the top blood-pressure number by about 4 mmHg on average, with a smaller change in the bottom number that was not statistically clear.
Pooling 16 randomized crossover trials with 254 participants, inorganic nitrate and beetroot juice supplementation lowered systolic blood pressure by 4.4 mm Hg (95% CI -5.9 to -2.8). Diastolic pressure fell by 1.1 mm Hg, which did not reach significance (95% CI -2.2 to 0.1). Measured in: 254 participants across 16 randomized crossover trials. The included trials were short and used crossover designs, and the effect on diastolic pressure was not statistically significant. The authors called for long-term trials and studies in higher-risk groups.
The study · 1
Siervo et al., inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults, a systematic review and meta-analysis · J Nutr 2013;143(6):818-826
Added to a normal diet, beetroot juice did not lower whole-day blood pressure
When a single beetroot juice was simply added to the normal diet of healthy people, whole-day blood pressure did not fall clearly, with a real drop showing up only in the men and only around six hours after drinking it.
In 30 free-living healthy adults, a single 500 g dose of beetroot and apple juice did not significantly lower 24-hour blood pressure versus placebo (a trend to lower systolic pressure at 6 hours, P = 0.064). A significant reduction of 4 to 5 mm Hg at 6 hours appeared only in the men after adjustment. Measured in: 15 women and 15 men, free-living healthy adults. A single-dose crossover in already-healthy people with normal blood pressure, where less room to fall and a normal background diet both blunt the signal. It argues that the food works best as a daily habit and in people with raised pressure.
The study · 1
Coles et al., effect of beetroot juice on lowering blood pressure in free-living, disease-free adults, a randomized, placebo-controlled trial · Nutr J 2012;11:106
Six weeks of beetroot juice improved artery function about 24%
In people with high cholesterol, six weeks of beetroot juice measurably improved how well their arteries widened, a marker of blood-vessel health, while placebo did not.
In people with high cholesterol, six weeks of once-daily nitrate-rich beetroot juice versus nitrate-depleted placebo raised flow-mediated dilatation by 1.1 percentage points in absolute terms, about a 24% improvement from baseline, while the placebo group worsened slightly. Measured in: 69 people with untreated high cholesterol (67 completed), parallel-group design. A single six-week trial measuring a surrogate marker of vessel function rather than clinical events, in a specific group with high cholesterol.
The study · 1
Velmurugan et al., dietary nitrate improves vascular function in patients with hypercholesterolemia, a randomized, double-blind, placebo-controlled study · Am J Clin Nutr 2016;103(1):25-38
Moderate vegetable-nitrate intake tracked with 15% lower cardiovascular disease
In a large Danish study, people who ate a moderate amount of nitrate-rich vegetables had about 15% lower risk of heart disease than those who ate the least, and slightly lower blood pressure, with no extra gain from eating far more.
Among 53,150 people in the Danish Diet, Cancer, and Health Study, a moderate vegetable nitrate intake (median 59 mg/day) was associated with 15% lower risk of cardiovascular disease versus the lowest intake (HR 0.85, 95% CI 0.82-0.89), with the benefit plateauing near that intake. The highest-intake group had 2.58/1.38 mm Hg lower baseline blood pressure. Measured in: 53,150 Danish adults free of cardiovascular disease at baseline. What could explain it instead: People with higher vegetable nitrate intake tend to eat a healthier overall diet, exercise more, smoke less and be of higher socioeconomic status; residual confounding from the whole dietary and lifestyle pattern cannot be separated from vegetable nitrate itself.. This is an association, not proof of cause. People who eat more vegetables plateauing at a modest intake tend to differ in ways the study cannot fully remove.
The study · 1
Bondonno et al., vegetable nitrate intake, blood pressure and incident cardiovascular disease, Danish Diet, Cancer, and Health Study · Eur J Epidemiol 2021;36(8):813-825
Cardiorespiratory Fitness
Three days of dietary nitrate cut the oxygen cost of submaximal exercise about 5%
After three days of dietary nitrate, well-trained men used measurably less oxygen for the same easy-to-moderate cycling, meaning their bodies produced energy more efficiently.
In a randomized double-blind placebo-controlled crossover, three days of dietary sodium nitrate lowered the oxygen cost of submaximal cycling: mean VO2 fell from 2.98 to 2.82 L/min, about 5%, across the four lowest work rates and gross efficiency rose from 19.7% to 21.1%, with no rise in blood lactate. Measured in: 9 healthy, well-trained young men. A small crossover of nine men using a nitrate salt rather than food, at a single dose; the economy gain is small in absolute terms.
Who this may not transfer to:The study enrolled only men. Whether the oxygen-economy effect is the same size in women has not been tested here, and sex differences in nitric-oxide handling are not fully characterized.
The study · 1
Larsen et al., effects of dietary nitrate on oxygen cost during exercise · Acta Physiol (Oxf) 2007;191(1):59-66
Beetroot juice lowered exercise oxygen cost 19% and extended time to exhaustion to 675 seconds
Six days of beetroot juice let men do moderate exercise on less oxygen and hold a hard effort noticeably longer before exhaustion, while also lowering their blood pressure.
In eight men, six days of beetroot juice (500 mL/day) versus placebo raised plasma nitrite, lowered systolic blood pressure (124 vs 132 mmHg), reduced the oxygen uptake of moderate exercise by about 19%, and extended time to exhaustion during severe exercise from 583 to 675 seconds. Measured in: 8 healthy men aged 19-38, crossover design. A small crossover of eight men; the time-to-exhaustion measure exaggerates real-world performance changes compared with a timed event.
Who this may not transfer to:Eight men only. The economy and tolerance effects have not been measured in women in this study, and endurance-physiology research in this area is heavily male-skewed.
The study · 1
Bailey et al., dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans · J Appl Physiol (1985) 2009;107(4):1144-1155
Across 76 trials, nitrate improved time-to-exhaustion (effect size 0.33) but not timed events
Pooling many trials, dietary nitrate reliably helped people last longer in hold-a-hard-effort tests, but its effect on overall performance and on timed events was small and not statistically clear.
Across 47 studies (76 trials), dietary nitrate had a small-to-moderate significant benefit on time-to-exhaustion tests (effect size 0.33, 95% CI 0.15-0.50) but only a trivial, non-significant effect overall (ES -0.10) and a small non-significant effect on graded exercise tests. The benefit is clearest for endurance capacity rather than timed performance. Measured in: 76 trials in healthy adults. The benefit is specific to time-to-exhaustion protocols, which overstate real-world gains; the overall pooled effect was not significant, and elite athletes tend to respond least.
The study · 1
McMahon et al., the effect of dietary nitrate supplementation on endurance exercise performance in healthy adults, a systematic review and meta-analysis · Sports Med 2017;47(4):735-756
Beetroot juice raised power in 4-km and 16.1-km cycling time trials
A dose of beetroot juice before a cycling time trial let trained male cyclists produce more power and finish faster.
In nine club-level competitive male cyclists, acute beetroot juice versus placebo raised plasma nitrite and increased mean power output during 4-km and 16.1-km cycling time trials, improving performance even though VO2 during the trials did not differ significantly. Measured in: 9 club-level competitive male cyclists. A small single-dose study in nine trained male cyclists; effects on timed performance are smaller and less consistent than effects on time to exhaustion, and often shrink in more elite athletes.
Who this may not transfer to:Only male cyclists were tested. Performance effects in female athletes were not measured here.
The study · 1
Lansley et al., acute dietary nitrate supplementation improves cycling time trial performance · Med Sci Sports Exerc 2011;43(6):1125-1131
The oxygen-cost benefit plateaus around 140 ml of beetroot juice
In a dose test, a small beetroot shot did little, a moderate dose lowered the oxygen cost of exercise, and doubling that dose again added nothing, so more is not better past a point.
In 10 healthy men given 70, 140 or 280 mL of beetroot juice, 140 and 280 mL reduced the steady-state oxygen uptake of moderate exercise but 70 mL did not, and there was no additional benefit from the highest dose over the middle one, indicating a ceiling around 140 mL (about 8 mmol nitrate). Measured in: 10 healthy men, balanced crossover. Ten men in a single crossover; the exact ceiling dose likely varies with body size and training status.
Who this may not transfer to:Ten men only. The dose-response curve has not been mapped in women, who differ in body size and plasma volume.
The study · 1
Wylie et al., beetroot juice and exercise, pharmacodynamic and dose-response relationships · J Appl Physiol (1985) 2013;115(3):325-336
How it works
Antibacterial mouthwash removes most of the blood-nitrite rise after a nitrate load
Rinsing with an antibacterial mouthwash kills the tongue bacteria that turn nitrate into nitrite, so the usual rise in the blood's nitrite after eating nitrate largely disappears.
The rise in plasma nitrite that normally follows a dietary nitrate load was markedly attenuated by an antibacterial mouthwash, which removes the commensal tongue bacteria that reduce nitrate to nitrite, interrupting the first step of the pathway. Measured in: Healthy volunteers in a mechanistic study. A small mechanistic study measuring the nitrite step rather than a health outcome; it establishes the mechanism that the blood-pressure studies then confirmed downstream.
The study · 1
Govoni et al., the increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash · Nitric Oxide 2008;19(4):333-337
Three days of antibacterial mouthwash raised systolic blood pressure 2.3 mmHg
In people already treated for high blood pressure, just three days of antibacterial mouthwash nudged their systolic blood pressure up by about 2 mmHg, showing how much the body relies on the mouth's nitrate-handling bacteria.
In 15 treated hypertensive men and women (mean age 65), three days of antibacterial mouthwash use raised systolic blood pressure by 2.3 mm Hg (95% CI 0.5 to 4.0, P = 0.01) versus control, with no significant change in diastolic pressure, by interrupting the oral nitrate-nitrite-nitric oxide pathway. Measured in: 15 treated hypertensive men and women, mean age 65. A small crossover of 15 people over three days; the effect is small, but it points the same direction as the mechanistic work and is a practical reason to keep antibacterial mouthwash away from a nitrate habit.
The study · 1
Bondonno et al., antibacterial mouthwash blunts oral nitrate reduction and increases blood pressure in treated hypertensive men and women · Am J Hypertens 2015;28(5):572-575
How It Works
Swallowed nitrate takes an unusual path. About a quarter of it is drawn back up into the saliva, where bacteria on the back of the tongue reduce it to nitrite. That nitrite is swallowed again, and in the stomach and the blood it converts onward to nitric oxide, most of all where tissue is low on oxygen and widening a vessel helps most. This is the nitrate to nitrite to nitric oxide pathway, and it runs alongside the body's other route to nitric oxide, the one built from the amino acid arginine. The oral microbiome page follows the route in full; the tongue bacteria control the whole effect.
Because the first step depends on living bacteria in the mouth, anything that removes them removes the effect. An antibacterial mouthwash kills those tongue bacteria, the usual rise in the blood's nitrite after a nitrate load largely disappears, and in treated people with high blood pressure three days of it raised systolic pressure by about 2 mmHg.
Anyone eating nitrate-rich food for its cardiovascular effect works against it by rinsing with an antibacterial mouthwash; skip the antiseptic rinse, or keep it well away from the hours around a dose.
Nitric oxide also lowers the energy a muscle uses to contract. This comes from more efficient mitochondria and a lower energy cost of contraction, not from greater blood flow alone, which is why the same food that lowers blood pressure also lets someone hold a pace on less oxygen.
Ways to Do It
This is a food first. The free version is a plate of nitrate-rich vegetables, and the paid version is a measured, repeatable dose in a small volume. A useful active dose is about 5 to 8 mmol of nitrate, the amount in a 70 ml to 140 ml concentrated beetroot shot, 250 to 500 ml of beetroot juice, 300 to 500 g of beetroot, or a large serving of rocket or spinach. Blood pressure begins to fall within two to three hours of a dose and builds over days of daily intake, and for exercise the usual timing is a dose two to three hours before.
Build meals around the leafy greens and beetroot: a large rocket or spinach salad, chard, beet greens, cooked or grated beetroot. A generous daily serving reaches the range the trials used, and it brings the fiber, potassium, and polyphenols of the whole vegetable.
A glass of beetroot juice, plain or blended with apple to soften the earthiness, delivers a known amount in one small volume. This is the form most of the blood pressure trials used, at around 250 to 500 ml a day.
A 70 ml to 140 ml shot standardized to about 5 to 8 mmol of nitrate is the most repeatable dose and the one the exercise studies leaned on, taken two to three hours before an event. Consistent and convenient, and the most expensive way to get the nitrate a salad has for free.
The tongue bacteria that start the pathway are killed by antibacterial mouthwash, which cancels most of the blood pressure effect. If you are eating nitrate for your heart, skip the antiseptic rinse or keep it well away from the hours around a dose. One harmless effect to expect: beetroot can turn urine and stool pink or red, called beeturia, which is the pigment passing through and not blood.
Go Deeper
- The oral microbiome: the tongue bacteria that turn this nitrate into a blood-pressure signal, and why antiseptic mouthwash blunts it.
- High blood pressure: where a few millimeters from food sits among the levers that lower it.
- VO2 max training: the endurance training dietary nitrate makes slightly easier to sustain, and does not replace.
- Sodium reduction and the DASH pattern: the dietary changes that lower blood pressure alongside nitrate-rich vegetables.
- Whole foods: the eating pattern that already carries a daily load of nitrate-rich leaves.
The Chinese Medicine View
Beetroot is not a classical Chinese herb, so the tradition meets it through Chinese dietary therapy, which sorts every food by flavor, by warming or cooling temperature, and by the organ networks it supports. Beetroot is read as sweet and broadly neutral to cooling, and its deep red color places it, in the folk logic of dietary therapy, among the foods thought to nourish and move the Blood and to support the Liver, which stores Blood. The leafy greens that carry the most nitrate are read as cooling and moving, foods that clear heat and support the smooth movement the Liver governs. This is the tradition's own description of the body, a different language from nitric oxide and vascular tone, and the two describe the same plate of food without translating into each other.
As guidance, dietary therapy distinguishes who eats these foods and how. Cooling, moving foods eaten raw and in quantity are traditionally thought to burden a weak digestion, so someone with Spleen Yang deficiency, who runs cold, tires easily, and has loose stools, is pointed toward cooked beetroot and cooked greens over large raw salads, and toward warming companions like ginger. Someone with signs of heat, a red face, thirst, constipation, is the better fit for the cooling raw version. If you work with a practitioner, your constitution and current state are a good thing to ask about, because the tradition's answer is not the same for everyone.
Cautions For This Practice
Everything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
The vegetable nitrate pathway does not carry the processed-meat cancer risk
Inorganic nitrate and nitrite, long regarded as inert end-products or as undesirable, are now understood as a physiological reservoir the body reduces to nitric oxide, with emerging therapeutic interest in myocardial infarction and stroke. This reframes vegetable nitrate as a source of a signaling molecule rather than a contaminant. This is a review setting out the pathway and its promise, not a trial of safety endpoints; the historical infant methemoglobinemia concern and the separate question of nitrite in processed meats sit outside the vegetable-nitrate picture it describes.Lundberg et al., the nitrate-nitrite-nitric oxide pathway in physiology and therapeutics
Red urine or stool from beetroot is harmless
Beetroot pigment can tint urine and stool pink or red for a day. It is called beeturia and it is the color passing through, not bleeding. It is common and it clears on its own, so it does not need attention unless it persists. Blood in urine or stool from another cause is a separate matter and should be checked, not put down to beetroot.
If you take blood-pressure medication, keep an eye on your numbers
Dietary nitrate lowers blood pressure, and added to medication that does the same it can lower it further, occasionally enough to cause light-headedness on standing. This is easy to manage: track your own blood pressure with a home monitor, which you can buy without a prescription, and if you see it running low or feel dizzy, raise it with your prescriber before stopping anything on your own.
A history of calcium-oxalate kidney stones is a reason to go easy
Beetroot, spinach and chard are high in oxalate, and a large daily habit, especially from concentrated shots, adds a meaningful oxalate load. If you have formed calcium-oxalate stones, favor the lower-oxalate nitrate sources such as rocket, lettuce and celery, keep fluids up, and moderate the beetroot and spinach.
Vegetable nitrate is not the processed-meat nitrite risk
The old worry that dietary nitrate causes cancer grew from nitrite added to cured and processed meats, where it can combine with the fats and proteins of the meat during cooking and storage to form nitrosamines. Vegetable nitrate arrives with vitamin C and polyphenols that shift the chemistry the other way, and large vegetable-nitrate intakes track with lower cardiovascular risk. The vegetable source is a different case from the processed-meat one.
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
Common Questions
Does beetroot juice lower blood pressure?
Yes, by a few points, and most in the people who need it. A single large glass lowers blood pressure within about three hours, and in people with high blood pressure a daily glass held it several points lower for a month without fading. Pooled across sixteen trials the average systolic drop is about 4 mmHg. The effect is smaller when a juice is simply added to an already-normal diet, so it works best as a daily habit and against a raised starting point.
Will it help my exercise?
It gives a small, useful edge to endurance, largest if you are not already highly trained. After a few days of dietary nitrate the same effort costs less oxygen, and you can hold a hard pace longer before exhaustion. The gain shows up more as endurance capacity than as a faster finishing time, and it shrinks or disappears in elite athletes whose bodies are already efficient. It does not replace training.
How much beetroot juice should I drink, and when?
A useful daily dose is about 5 to 8 mmol of nitrate, roughly one 70 ml to 140 ml concentrated shot or 250 to 500 ml of beetroot juice. For blood pressure, a daily habit matters more than timing, and the effect builds over days. For a workout or event, take it two to three hours beforehand, when the blood's nitrite peaks. Past about 140 ml of concentrate there is little more to gain.
Why does beetroot turn my urine red?
That is beeturia, and it is harmless. Beetroot pigment can tint urine and stool pink or red for a day, and it is the color passing through, not blood. It is common and it fades on its own. Blood in urine or stool from another cause is a separate matter and should be checked, not put down to beetroot.
Is dietary nitrate the same cancer risk as processed meat?
No. The cancer worry grew from nitrite added to cured and processed meats, where it can combine with the fats and proteins of the meat during cooking and storage to form nitrosamines. Vegetable nitrate arrives with vitamin C and polyphenols that shift the chemistry the other way, and large vegetable-nitrate intakes track with lower cardiovascular risk. The vegetable source is a different case from the processed-meat one.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 14 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.