Beetroot Juice and Postmenopausal Heart Oxygen Balance After Hard Exercise: A Small Trial

The evidence is a randomised, double-blind, placebo-controlled trial in 24 postmenopausal women. The paper describes it as a sub-analysis of a larger trial. The women averaged 60 years old and were about 10 years past menopause. Twelve drank beetroot juice and twelve drank a look-alike placebo with the nitrate removed.

The measure at the centre of the study is the Buckberg ratio. It is a non-invasive estimate of how well the heart's oxygen supply keeps up with its demand. It comes from the pressure wave in the large artery leaving the heart. The software compares pressure during the heart's resting phase, when the heart muscle is fed, with pressure during the pumping phase, when it works hardest. Higher values mean more favourable blood flow to the heart muscle. Lower values have been linked to reduced coronary perfusion and to heart problems.

The authors give the background. Heart disease risk rises after menopause. Falling oestrogen lowers nitric oxide, a molecule that helps blood vessels relax and widen. Postmenopausal women also tend to have a lower Buckberg ratio than men of the same age. Dietary nitrate, found in beetroot, is turned by the body into nitric oxide through a route that does not rely on the vessel lining's own production.

Each woman did three testing visits in random order, at least 48 hours apart. One was a rest-only control. One was moderate-intensity exercise. One was high-intensity exercise. The two exercise sessions were matched for calories burned. The Buckberg ratio was measured at rest and then every 30 minutes for three hours afterwards.

The juice group took about 13 mmol of nitrate a day, in two 70 mL bottles, for roughly two days. They took a final dose two hours before testing. Blood tests showed the supplement raised the body's nitrate levels as intended. Plasma nitrate rose from about 65 to about 1,114 μM. Plasma nitrite rose from about 118 to about 357 nM.

The authors had predicted that the ratio would fall after exercise, more so after hard exercise, and that beetroot juice would soften the fall. Their conclusion is that nitrate supplementation might help preserve coronary perfusion during higherintensity exercise stress. That wording is cautious, and it fits the study's size and design.

There are clear limits. Twelve women per group is small. The women were healthy, were not on hormone therapy, and were sedentary or only recreationally active. The Buckberg ratio is an estimate, not a direct measure of blood flow in the heart's arteries, and clinical events such as heart attacks were not an outcome of the study. Supplementation lasted about two days and effects were tracked for three hours. The trial tested one product, beetroot juice. It did not test leafy greens or other nitraterich foods. Participants were told to avoid high-nitrate foods during the study, so the paper offers no direct evidence on them.

The study does not show that beetroot juice protects the heart in daily life or lowers the risk of heart disease. The weakest point of this account is that the Buckberg results themselves are not in the text we could check, so the central claim rests on the authors' stated conclusion that nitrate might help preserve coronary perfusion.

What to watch next

Larger trials, longer supplementation, and studies that include women with existing heart or vascular conditions.

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