A Nitrate-Rich Beetroot Supplement Lowers Blood Pressure Like a Drug and Improves Artery (Endothelial) Function in Pre-Hypertensive Subjects

Kirk's overview video of Dr. Budoff interview (4:00 min)
Kirk’s audio interview (podcast) with Dr. Matthew Budoff (12:12 min)
Why Study a Nitrate Rich Beetroot Product?
Dr. Budoff is interested in studying nutraceutical products claiming they can increase nitric oxide to validate their efficacy and understand how they work. Nitric oxide is a potent vasodilator and protects the endothelial cells against atherosclerosis. Nitric oxide is a cardioprotective substance, but in the past it was difficult to measure nitric oxide limiting research on it.

Study Intention
This study evaluated pre-hypertensives in the 130-140 range systolically (with new guidelines defined as stage 1 hypertension). If these patients drop their blood pressure 6-10 points, they might be able to avoid prescription medication.

Nutraceuticals vs. Drugs
The difference between treating with a drug and a nutraceutical is potency and proof of outcome. In the pharmaceutical the active ingredient is highly purified. The example would be comparing red yeast rice and lovastatin. They are both lovastatin but there are more milligrams of lovastatin, and more consistent amounts of lovastatin in the pharmaceutical lovastatin than in red yeast rice. The same named nutraceutical may vary from product to product in potency and content of active ingredients. There is more consistency and more proven outcomes with pharmaceuticals.

Treating Hypertension with A Nutraceutical
A nutraceutical, such as a nitrate rich beetroot product (Berkeley Life Nitric Oxide Support), will almost always have a better side effect profile, be safer and have better acceptance by patients than a pharmaceutical. So, there is a big advantage to treating patients with a natural product. But you wouldn’t want to treat someone with really high blood pressure, for example at 180 mm systolically with this beetroot product alone if you only going to get a 10 point drop in blood pressure. The patient would still be at risk for stroke and other cardiovascular complications.

Testing for Nitric Oxide
The saliva was tested for nitric oxide from a test strip and nitric oxide was also tested in the blood (test strip made and supplied by Berkeley Life Professional). Nitrate (NO3) in the beetroot converts to nitrite (NO2) in the saliva and then to nitric oxide (NO) in the mouth and stomach.

Endothelial Function Testing
An indirect test for NO in the endothelium is testing brachial flow mediated dilation. This is the oldest test and gold standard for testing endothelial function. It puts a cuff over the arm and restricts blood flow for a certain period of time then releases the cuff and measures the speed and the extent to which the blood vessel dilates after being constricted. A robust response is a big dilation of the artery suggesting a healthy artery (endothelium) and increased nitric oxide, while a blunted response (a small or no increase in the artery diameter) is a more dysfunctional endothelium or one that is given the placebo.

The Study and Results (See ACC Study Poster Presentation)
In this study a significant improvement was seen in those taking the beetroot extract by increased flow mediated dilation, but there was not a significant change in those that received the placebo. This 12-week study was long enough to assess endothelial function, blood pressure and parameters like cholesterol levels. They enrolled 67 people so they would have at least 30 subjects in each arm of the study (active ingredient – beetroot product (30) and placebo (32)) and tested them at baseline, two hours after their first dose (acute effect) and again at the end of the study. The beetroot product was 1 pill containing 314 mg of NO3 (nitrate) from the beetroot extract along with thiamine, potassium and vitamin C (Berkeley Life Nitric Oxide Support, www.berkeleylifeprofessional.com). The product was very well tolerated with no side effects, but long-term studies would have to be done to confirm absolute safety.

“Dramatic” Blood Pressure Results
There was a dramatic response with a blood pressure drop of 12.5 millimeters in systolic blood pressure over 12 weeks which would be very comparable to prescription therapy. The net reduction was a 6 millimeter drop in blood pressure because the placebo group dropped 6 millimeters which is commonly seen in the placebo group when evaluating anti-hypertensive medications. This placebo group effect could be from patients being more compliant and reducing their salt intake. There was also a significant drop in the diastolic blood pressure.

How to Use This Beetroot Extract
This product could be used alone in pre-hypertensive subjects or in combination with an anti-hypersensitive medication safely. Dr. Budoff’s main concern is people with high systolic blood pressure (ex.170 mm systolically) using the beetroot extract only and this won’t be adequate to bring their blood pressure down enough, and they will be at risk for complications from the hypertension.  He doubts any significant interactions with other pharmaceuticals, possibly a compounding effect with vasodilators such as nitrates (i.e. nitroglycerin, nitrites, etc.) or PDE inhibitors such as Cialis or Viagra.

Long-Term Anti-Hypertensive and Artery Protective Effects
Dr. Budoff believes these 12-week benefits in blood pressure reduction and improved endothelial function would be sustained as long as one is taking the supplement because the blood pressure lowering effect was sustained over the 12-week period, but a longer trial is needed. Also, it is reasonable to assume, though this would have to be proven over a year-long trial, that the improvement in endothelial function and reduction in blood pressure might lead to slowing of coronary calcification and possibly the reversal of soft plaque. Lowering of blood pressure, plaque regression and slowing of coronary calcification (atherosclerosis) has been shown with aged garlic extract in over five studies with the early studies showing similar reductions of blood pressure and improvement in endothelial function as this study. But at least a year-long study with this beetroot supplement is needed to confirm this assumption.  

Future Research
Dr. Budoff was very favorably impressed and actually surprised to see such a significant blood pressure lowering effect of this beetroot extract product. The Berkeley Life Nitric Oxide Support product also had a nice improvement in the brachial blood flow indicating improved endothelial function. He would like to do a year-long trial with this product and evaluate these same parameters along with assessing coronary calcification and plaque growth or regression

Matthew J. Budoff, MD, Prof Medicine, UCLA, Director, Cardiac CT & Fellowship Program, Division of Cardiology, Harbor-UCLA Med Cent 1124 West Carson Street, RB-2 Torrance, CA 90502  Lundquist Institute (formerly LABiomed)  Budoff@ucla.edu  (310) 222-4104/ (310)787-0448 (FAX)

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