Muscle power improves in patients with heart failure when they adopt a diet high in nitrates – found in abundance in beetroot juice – a new study shows.

Researchers from Washington University School of Medicine in St. Louis, MO, publishing in the journal Circulation: Heart Failure, wanted to know if patients with heart failure could get the kind of benefits athletes find in beet juice.

This study builds on the team’s previous work that suggests using dietary nitrates improves muscle performance in the world of elite sport.

Nitrates are the active ingredient in beet juice, as well as spinach and other leafy vegetables, including arugula and celery.

During exercise, these nitrates are converted into nitric oxide, with various beneficial effects on blood pressure and cardiovascular health. The benefits are most commonly found during aerobic exercise – that is, when breathing is increased to bring more oxygen into the body, for example, in walking, cycling or swimming.

The researchers hypothesized that heart failure patients may benefit in similar ways to athletes, since heart failure is the gradual loss of pumping capacity. When the heart is weak, fatigue and shortness of breath follow, making everyday activity difficult.

Would something as simple as a nitrate supplement or drink bring improvements?

“A lot of the activities of daily living are power-based – getting out of a chair, lifting groceries, climbing stairs. And they have a major impact on quality of life,” says senior study author Dr. Linda R. Peterson, associate professor of medicine at the Washington University School of Medicine.

“We want to help make people more powerful because power is such an important predictor of how well people do, whether they have heart failure, cancer or other conditions, ” Dr. Peterson adds.

Patients show a 13% increase in power in muscles
Working with a small study group of only nine patients, the research team gave each of them a beet juice treatment.

Fast facts about heart disease

  • Cardiovascular disease is the leading global cause of death, attributable to 17.3 million deaths per year
  • About 5.7 million people in the US are living with heart failure
  • Heart disease is the leading cause of death in the US, killing over 375,000 people a year.

The patients acted as their own control group; everyone received what appeared to be the same beet juice, the difference being that the nitrate content had been removed from some, making it a placebo beet juice.

Between the trial sessions, there was a 1-2-week break.

Neither those taking part in the trial nor the research team knew the order in which patients received the treatment beet juice and placebo beet juice.

Two hours after drinking the juice, patients who consumed the beet juice containing nitrates showed a 13% increase in power in muscles that extend the knee, with the most benefit when they moved at greatest speed.

The size of the benefit was estimated by the researchers by comparing the improvement in muscle power in an exercise program.

Andrew R. Coggan, PhD, assistant professor of radiology at the Washington University School of Medicine, says:

“I have compared the beet-juice effect to Popeye eating his spinach. The magnitude of this improvement is comparable to that seen in heart failure patients who have done 2-3 months of resistance training.”