Beetroot pills can lower blood pressure, but the effect depends heavily on the product and dose. Clinical trials using beetroot-derived nitrate show an average systolic blood pressure reduction of about 5 mmHg, with some studies measuring drops as large as 7 to 8 mmHg. That’s a meaningful change, roughly comparable to what some first-line blood pressure medications achieve in mild hypertension. The catch is that not all beetroot supplements deliver enough of the active compound to produce this result.
How Beetroot Lowers Blood Pressure
Beetroot is one of the richest dietary sources of inorganic nitrate. When you eat or swallow it, the nitrate doesn’t do much on its own. The real action starts when bacteria on the back of your tongue convert nitrate into a related compound called nitrite. This happens through what’s known as the enterosalivary circulation: your salivary glands concentrate the nitrate and secrete it back into your mouth, where those bacteria go to work over the next few hours.
Once nitrite reaches your stomach, the acidic environment converts some of it into nitric oxide, a gas that relaxes and widens blood vessels. Additional conversion happens throughout your body, especially in areas where oxygen levels are low, like small blood vessels and working muscles. The widening of blood vessels reduces the resistance your heart has to pump against, which lowers blood pressure. This entire pathway, from nitrate to nitrite to nitric oxide, is the mechanism behind beetroot’s cardiovascular effects.
What the Evidence Actually Shows
A systematic review and meta-analysis of trials in people with high blood pressure found that beetroot-derived nitrate reduced systolic blood pressure (the top number) by an average of about 5 mmHg. When only clinic-measured readings were included, the reduction was closer to 7.7 mmHg. Diastolic blood pressure (the bottom number) showed smaller, less consistent drops of around 1 to 1.4 mmHg that didn’t always reach statistical significance.
To put that in perspective, a 5 mmHg drop in systolic pressure is associated with a meaningful reduction in cardiovascular risk at the population level. In one study of overweight older adults, three weeks of daily beetroot juice containing 350 mg of nitrate produced a 7 mmHg systolic reduction. Blood pressure changes can appear within a couple of hours of a single dose, coinciding with rising nitrite levels in the blood, though sustained daily use over weeks produces the most consistent results.
The Problem With Many Beetroot Pills
Here’s where the distinction between beetroot juice and beetroot pills matters. Not all supplements are created equal, and nitrate content varies wildly across products. Laboratory testing of beetroot products marketed to consumers found that powders had significantly higher nitrate concentrations than liquid forms, averaging 174 micromoles per gram compared to 70 micromoles per milliliter in concentrates. But concentration alone doesn’t tell the full story.
One popular beetroot powder (Superbeets) raised blood nitrite levels within 30 minutes of ingestion, faster than standard beetroot juice, which peaks at 2 to 3 hours. Despite this rapid spike, the product failed to produce a significant reduction in systolic or mean arterial blood pressure. The likely reason: it delivered only about 1 mmol of nitrate per serving, compared to roughly 6 mmol in the effective beetroot juice doses used in clinical trials. The initial nitrite spike couldn’t be sustained long enough to have a lasting vascular effect.
This means that when choosing a beetroot supplement, the total nitrate dose per serving is what matters most. Many capsules and powders simply don’t contain enough. Products that list their nitrate content (often in milligrams or millimoles) give you a way to compare, but many labels are vague or don’t disclose nitrate levels at all.
Dose That Works
The effective range in clinical trials generally falls around 300 to 500 mg of dietary nitrate per day, roughly equivalent to 5 to 8 mmol. Most positive studies used concentrated beetroot juice standardized to deliver about 6 mmol of nitrate. One trial using 420 mg of nitrate daily for one week in people already taking blood pressure medication found no additional benefit, suggesting that higher doses or longer durations may be needed in treated hypertension, or that there may be a ceiling effect when medications are already in play.
If a beetroot pill or powder doesn’t specify its nitrate content, there’s no reliable way to know whether you’re getting an effective dose. Some products contain beetroot extract that has been processed in ways that reduce or eliminate the nitrate, leaving you with a capsule of red pigment and fiber but little of the active compound.
One Thing That Can Block the Effect
Because the conversion of nitrate to nitrite depends on specific bacteria living on your tongue, anything that disrupts those bacteria can short-circuit the entire process. Antibacterial mouthwash is the most common culprit. Studies have shown that using antiseptic mouthwash can significantly blunt the blood pressure lowering effect of dietary nitrate by killing the very bacteria responsible for the first conversion step. If you’re taking beetroot supplements for blood pressure, this is worth keeping in mind.
Side Effects and Safety Concerns
Beetroot supplements are generally well tolerated, but they come with a few quirks. The most noticeable is beeturia, a harmless reddish or pink discoloration of urine that occurs in 10% to 14% of the general population after consuming enough beetroot. The rate jumps to about 45% in people with pernicious anemia. It can be alarming if you’re not expecting it, and it occasionally triggers unnecessary medical testing when clinicians mistake the discoloration for blood in the urine.
A small number of people have true allergic reactions to beetroot, including histamine-related symptoms. Beeturia in these cases is a secondary finding alongside the allergic response, not the cause of it.
A more significant concern involves oxalates. Beetroot juice contains 60 to 70 mg of oxalate per 100 ml, far higher than nearly all other fruit and vegetable juices (most fall below 10 mg per 100 ml). Oxalate binds to calcium in the body and can contribute to kidney stone formation. About 75% of all urinary stones are primarily calcium oxalate. If you have a history of kidney stones or have been told you’re at risk, regular use of concentrated beetroot supplements could increase your oxalate load enough to matter. High dietary oxalate can raise urinary oxalate excretion even in healthy people without any metabolic issues, so this isn’t a concern limited to stone formers.
Beetroot Pills vs. Juice
Most of the strong clinical evidence comes from studies using concentrated beetroot juice with a known, standardized nitrate content. Far fewer trials have used capsules or powders, and the results are more inconsistent. That doesn’t mean pills can’t work. It means the juice formulations have been better studied and more reliably dosed.
If you prefer the convenience of a capsule or powder, look for products that disclose their nitrate content per serving and aim for at least 300 mg of nitrate daily. Products that contain only “beetroot extract” or “beetroot powder” without specifying nitrate levels may deliver very little of the active compound. The color of the product tells you almost nothing about its nitrate content, since the red pigments (betalains) are separate from the nitrates responsible for blood pressure effects.