06/21/2025
A patient asked me this week if BEETROOT JUICE can help her breathe or exercise better? YES! Read on...
I wrote two versions of the answer: One for non-medical people (first) and the secondy for medical people (see lower half):
NON-MEDICAL PEOPLE
Answer: Yes, it might. Beetroot, especially in the form of beetroot juice, has been studied for its possible health benefits, especially in people with lung conditions like COPD (chronic obstructive pulmonary disease) and PAH (pulmonary arterial hypertension).
Beetroot is rich in dietary nitrate, which the body turns into nitric oxide. This helps blood vessels relax, lowers blood pressure, and helps your muscles use oxygen more efficiently. While it doesn’t directly improve pulmonary function tests (PFTs), it may help some people feel and perform better during physical activity.
What the Research Shows:
• In COPD patients:
Several studies have shown that beetroot juice can help people walk farther and feel less tired during exercise. This is likely because of better oxygen delivery and muscle performance—not because it opens the airways or changes spirometry results.
For example, one study found that drinking beetroot juice helped COPD patients walk longer during a walking test. Blood pressure also improved. However, lung function numbers (like FEV1) did not change.
• In PAH patients:
Some early research shows that beetroot juice might help people with PAH breathe more efficiently during exercise. It may reduce how fast they breathe, but it’s still unclear whether it improves how far or how long they can exercise. More research is needed.
• In healthy people:
Beetroot juice can increase nitric oxide levels, but there’s no proof it improves breathing or lung function in people without lung disease.
Bottom Line:
Beetroot juice might help people with COPD or possibly PAH improve their exercise tolerance and breathing efficiency, but it does not improve actual lung function (like FEV1 or FVC). It’s not a cure or replacement for regular treatment, but it may be a helpful addition for some patients.
My usual disclaimer: As always, talk to YOUR doctor before starting any supplement, especially if you have other health conditions or take medications.
Your friendly neighborhood phlegm slinger,
Dr. Pamer
MEDICAL VERSION FOR COLLEAGUES:
Beetroot (typically as beetroot juice) can improve exercise capacity and certain aspects of breathing in specific populations, particularly patients with chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH), but it does not directly improve lung function parameters such as FEV1 or FVC. The mechanism is primarily through dietary nitrate, which is converted to nitric oxide, leading to improved vascular function, reduced blood pressure, and enhanced skeletal muscle oxygen utilization.
In patients with COPD, randomized controlled trials have shown that beetroot juice supplementation increases exercise endurance and walking distance, likely by improving oxygen delivery and muscle efficiency, rather than by bronchodilation or direct improvement in spirometry values.[1-4]
For example, supplementation with nitrate-rich beetroot juice (12.9 mmol nitrate) acutely increased endurance shuttle walk test time and improved endothelial function in hypoxic COPD patients.[1] Similar findings were observed in longer-term studies, with improved 6-minute walk distance and blood pressure reduction.[3] However, pulmonary function tests (e.g., FEV1) were not significantly changed.[2]
In PAH, short-term supplementation increased exhaled nitric oxide and was associated with a reduction in breathing frequency during exercise, suggesting a potential benefit in ventilatory efficiency, though effects on exercise capacity were variable and require further study.[5]
In healthy individuals, beetroot juice acutely increases exhaled nitric oxide, but there is no evidence it improves baseline breathing or lung function in the absence of underlying disease.[6]
In summary, beetroot can improve exercise tolerance and some aspects of breathing efficiency in patients with COPD and possibly PAH, but it does not directly improve lung function in healthy individuals.[7]
References:
1. Pavitt MJ, Lewis A, Buttery SC, et al. Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over study. Thorax. 2022;77(10):968-975. doi:10.1136/thoraxjnl-2021-217147.
2. Kerley CP, James PE, McGowan A, Faul J, Cormican L. Dietary nitrate improved exercise capacity in COPD but not blood pressure or pulmonary function: a 2 week, double-blind randomised, placebo-controlled crossover trial. Int J Food Sci Nutr. 2019;70(2):222-231. doi:10.1080/09637486.2018.1492521.
3. Alasmari AM, Alsulayyim AS, Alghamdi SM, et al. Oral nitrate supplementation improves cardiovascular risk markers in COPD: ON-BC, a randomised controlled trial. Eur Respir J. 2024;63(2):2202353. doi:10.1183/13993003.02353-2022.
4. Pavitt MJ, Tanner RJ, Lewis A, et al. Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC, a multicentre, double-blind, placebo-controlled, randomised parallel group study. Thorax. 2020;75(7):547-555. doi:10.1136/thoraxjnl-2019-214278.
5. Henrohn D, Björkstrand K, Lundberg JO, et al. Effects of oral supplementation with nitrate-rich beetroot juice in patients with pulmonary arterial hypertension: results from BEET-PAH, an exploratory randomized, double-blind, placebo-controlled, crossover study. J Card Fail. 2018;24(10):640-653. doi:10.1016/j.cardfail.2018.09.010.
6. Kroll JL, Werchan CA, Rosenfield D, Ritz T. Acute ingestion of beetroot juice increases exhaled nitric oxide in healthy individuals. PLoS One. 2018;13(1):e0191030. doi:10.1371/journal.pone.0191030.
7. Chen M, Chang S, Xu Y, Guo H, Liu J. Dietary beetroot juice: effects in patients with COPD—a review. Int J Chron Obstruct Pulmon Dis. 2024;19:1755-1765. doi:10.2147/COPD.S473397.
