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Beetroot (dietary nitrate) and endurance performance: grade B

Moderate evidence. Direction: Benefit.

B ModerateShort-term only

Educational guidance, not medical advice

Why this grade

Rubric condition met: Meta-analyses of placebo-controlled trials in healthy adults show a consistent small benefit for time to exhaustion; A is blocked by the rubric because a pooled healthy-adult meta-analysis and a 2026 athlete meta-analysis were null

An NIH-funded meta-analysis of 80 placebo-controlled crossover studies found a small benefit (d = 0.174), not seen in well-trained endurance athletes or in women-only studies. A meta-analysis of 73 studies (no funding) and a 2025 umbrella review found longer time to exhaustion, but no clear change in time-trial performance. A 2026 meta-analysis of 45 trials in athletes found no significant pooled effect. Trials were short.

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)2015202020252030Umbrella reviewMeta-analysisPoon 2025, 2025: umbrella review, n = 2,672, result not recordedGao 2021, 2021: meta-analysis, n = 1,061, result not recordedXie 2026, 2026: meta-analysis, n = 659, result not recordedMcMahon 2017, 2017: meta-analysis, n not recorded, result not recordedSenefeld 2020, 2020: meta-analysis, n not recorded, result not recorded
each study this grade rests on, by publication year and design. Solid: effect versus the comparator; half-filled: mixed; hollow: no effect; dashed: result not recorded yet. Larger marks had more participants.
Show the numbers
StudyYearDesignParticipantsResult
McMahon 20172017meta-analysisnot recordedresult not recorded
Senefeld 20202020meta-analysisnot recordedresult not recorded
Gao 20212021meta-analysis1061result not recorded
Poon 20252025umbrella review2672result not recorded
Xie 20262026meta-analysis659result not recorded

The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis.

McMahon NF, Leveritt MD, Pavey TG. The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis Sports Med, 2017. PMID 27600147

Result not recorded
Design
Systematic review and meta-analysis of 47 studies (76 trials)
Population
Healthy adults
Funding
not stated in the PubMed or Crossref record; full text not read

Dietary Nitrate Supplementation and Exercise Performance in Athletes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Xie Y, Han Y, Du Q. Dietary Nitrate Supplementation and Exercise Performance in Athletes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials Sports (Basel), 2026. PMID 42931603

Result not recorded
Design
Systematic review and meta-analysis of 45 randomized, placebo-controlled trials
Sample
n = 659
Population
Healthy athletes (Tier 2 or higher)
Funding
not stated in the PubMed or Crossref record; full text not read

Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses.

Poon ET, Iu JC, Sum WM. Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses Sports Med, 2025. PMID 40085422

Result not recorded
Design
Umbrella review with meta-analysis of 20 systematic reviews (180 primary studies)
Sample
n = 2,672
Population
Participants in placebo-controlled exercise trials
Funding
No specific grant (stated in the paper)

The effects of dietary nitrate supplementation on endurance exercise performance and cardiorespiratory measures in healthy adults: a systematic review and meta-analysis.

Gao C, Gupta S, Adli T. The effects of dietary nitrate supplementation on endurance exercise performance and cardiorespiratory measures in healthy adults: a systematic review and meta-analysis J Int Soc Sports Nutr, 2021. PMID 34243756

Result not recorded
Design
Systematic review and meta-analysis of 73 placebo-controlled studies (GRADE-assessed)
Sample
n = 1,061
Population
Adults taking part in endurance-based activity
Funding
No funding (paper states no funding was required)

Ergogenic Effect of Nitrate Supplementation: A Systematic Review and Meta-analysis.

Senefeld JW, Wiggins CC, Regimbal RJ. Ergogenic Effect of Nitrate Supplementation: A Systematic Review and Meta-analysis Med Sci Sports Exerc, 2020. PMID 32936597

Result not recorded
Design
Systematic review and meta-analysis of 80 randomized, crossover, placebo-controlled studies
Population
Young, healthy adults (mostly recreationally active men)
Funding
US National Institutes of Health (NHLBI F32 HL131151, R35 HL139854; NIDDK T32 DK007352)

Search and history

Search (): (nitrate[ti] OR beetroot[ti] OR beet[ti]) AND (endurance[tiab] OR performance[tiab] OR "time trial"[tiab] OR exhaustion[tiab]) AND (meta-analysis[pt] OR systematic review[pt])

  • Graded B (proposed): Proposed in the monograph draft
  • B to B (approved): Editor sign-off November 13, 2026: grade matches the editor-approved final page