Beetroot juice may reduce heart disease risk in menopausal women, say researchers

Women's risk of heart disease increases dramatically after menopause. To improve and support heart and blood vessel health in postmenopausal women, Penn State researchers studied whether beetroot juice could improve the functioning of blood vessels. The results, published today (June 10) in Frontiers in Nutrition, indicated that daily intake of beetroot juice by postmenopausal women could improve the functioning of blood vessels enough to reduce the risk of future heart disease.

Beetroot juice is high in nitrates, which the body converts into nitric oxide. Nitric oxide helps blood vessels expand, making it easier for blood to flow through the circulatory system. According to researchers, nitric oxide's ability to widen blood vessels is especially helpful during periods of limited blood flow and oxygen delivery, such as during a heart attack.

David Proctor, a professor of kinesiology and physiology at Penn State, and Jocelyn Delgado Spicuzza, who received her doctorate in integrative and biomedical physiology from Penn State in May, led an interdisciplinary team of researchers who tested how nitrate-rich beet juice affected blood vessel health in 24 postmenopausal women in their 50s and 60s.

“After menopause, women no longer produce estrogen, which helps maintain nitric oxide in the body,” said Delgado Spicuzza, first author of the study and current SAFE-T Center research project manager. “This decrease in nitric oxide production contributes to the substantial increase in heart disease risk in postmenopausal women. Nitrate-rich foods — especially beets — are being investigated as a natural, non-pharmaceutical way to protect the heart and blood vessels.”

Nitrates are an approved food additive for some animal-based food products, such as processed meats. However, according to Delgado Spicuzza, nitrate food additives and preservatives are strictly regulated due to their potential to cause cancer. In contrast, plants such as beets, spinach and lettuce naturally accumulate nitrates from the soil. These plant-based sources of nitrate have cardiovascular benefits because the human body can convert nitrates from plants into nitric oxide, which it cannot do with nitrates added to meat.

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In this study, participants had their vascular function tested at the Penn State Clinical Research Center and then drank two 2.3-ounce bottles of beet juice as a starting dose, followed by one bottle every morning for a week. All participants drank concentrated beet juice, which contained as much nitrate as three large beets in each serving. A few weeks later, participants drank beet juice without the nitrates removed.

Neither the researchers nor the participants knew which juice was being consumed at the time of the test. One day after their last dose, the participants returned for tests of their vascular function. The researchers compared how well the blood vessels expanded for each woman when they were and were not consuming the nitrate-rich beet juice.

The researchers used an ultrasound sensor to monitor how blood flowed through the brachial artery — which is in the upper arm and supplies blood to the hands — during a stress test in which blood flow to each participant's forearm was restricted for five minutes. When the restriction was removed, the researchers measured how blood flow in the brachial artery changed again.

The results showed that consuming nitrate-rich beetroot juice each day improved blood flow, compared with participants drinking nitrate-free beetroot juice. This level of improved blood vessel functioning – if it can be maintained in the years after menopause – could substantially reduce the risk of heart disease, the researchers said. The long-term health benefits of beetroot juice have not yet been studied, but the long-term benefits of nitrate-rich vegetables have been confirmed, they said.

“Women may need to drink beet juice every day — or even more often — to experience all of the potential cardiovascular benefits,” Proctor said. “Still, this research shows that beet juice may be very useful in protecting the health of blood vessels in middle-aged women during a period of increased risk for heart disease.”

The study included women who were considered early postmenopausal, or one to six years after menopause, and women who were considered early postmenopausal, or six or more years after menopause. The late postmenopausal women experienced similar benefits to the early postmenopausal group.

Delgado Spicuzza said the research team was particularly excited to find that beetroot juice improved the health of blood vessels in women who had gone through menopause several years earlier. Some treatments to protect cardiovascular health in postmenopausal women — such as hormone therapy — are safe only during the first several years after menopause. After that, hormone therapy may increase the risk of cancer and stroke.

“Some physicians are already prescribing beetroot juice to men and women with high blood pressure,” Delgado Spicuzza said. “By providing a safe and effective way to improve blood vessel function, beets may help maintain cardiovascular health in postmenopausal women. When you consider that most women live in the postmenopausal state for at least a third of their lives, you can begin to understand the potential importance of these results.”

Delgado Spicuzza won the Mid-Atlantic American College of Sports Medicine 2023 Doctoral Student Investigator Award for her presentation on this research in the fall of 2023. She said it was heartening to see that this research resonated with other researchers, and especially the women involved in the study, who seemed to embrace the potential of beetroot juice.

“Many participants said they wanted to continue drinking beetroot juice even after the study ended,” he said. “It seems that postmenopausal women have a real desire to improve their cardiovascular health without taking additional medications. In part, I believe beets could be a complementary food to improve blood vessel health in millions of women as they age.”

Reference: Delgado Spicuzza JM, Gosalia J, Zhong L, et al. Seven-day dietary nitrate supplementation significantly improves basal macrovascular function in clinically menopausal women: a randomized, placebo-controlled, double-blind, crossover clinical trial. Front Nut2024;11. doi: 10.3389/fnut.2024.1359671

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