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Beet Juice – Is it worth it?

Over the past few years, there has been a surge of interest in beet juice and its effects on improving athletic performance.  Prior to discussing beet juice, we need to have a lesson on physiology, more specifically, the cardiovascular system. 


The Cardiovascular System

The Cardiovascular System is composed of a pump and the tubing which transports oxygen from the outside to the tissues and carbon dioxide from the tissues to the outside.  The heart pumps the blood through the systems.  The pulmonary system allows for the gas exchange.  The systemic system delivers the blood and oxygen to the organs to meet the metabolic demand. 


The goal of the Cardiovascular system is to match the oxygen supply to the tissue metabolic demand.  This is measured with Cardiac Output. 

Cardiac Output = Heart Rate X Stroke Volume

The Heart Rate is the number of times the heart beats per minute.

The Stroke Volume is the volume of blood ejected per beat.

The Cardiac Output changes depending on the changes of the metabolic demands of the body.  By looking at the diagram above, there are many things which may influence the rate in which oxygen is brought to the tissues.

-increase the oxygen perfusion in the lungs (either increase the volume in the lungs, or increase rate of inflation)

-increase pump strength (make the muscle stronger to push more volume per beat, beat more frequently)

-Increase the tubing size (increase the volume of fluid to be pumped throughout body)

-Increase oxygen carrying capacity (increase amount of hemoglobin via red blood cells in the blood)

-increase the perfusion to the tissues (increase the volume to the tissues via number of capillaries, increase the efficiency of oxygen processing by the mitochondria)

All of the above increase the rate of transport of oxygen from the air to the tissues.

How does Beet Juice help to improve athletic performance?

In a nutshell, consumption of beet juice helps to temporarily vasodilate (expand) the blood vessels, increasing blood flow and therefore increase the transportation of oxygen to the tissues. 

Like lettuce, spinach, and fennel, beets have a very large concentration of nitrates.  By ingesting beet juice, one is also ingesting a concentrated bolus of nitrates.  Nitrates stimulate the blood vessels to dilate or widen, increasing the flow of blood to the tissues.  More oxygen is available to the tissues during exercise, increasing efficiency and exercise tolerance. A few studies out of England in the last few years have supported this theory, specifically with cycling (time trials).  In these studies, the cyclists tested after drinking beet juice at certain intervals prior to exercise were able to ride longer in duration and faster over set intervals.

There have been a few recent studies suggesting that nitrates also stimulate the mitochondria in the tissues to process oxygen more efficiently.  However, there has yet to be any conclusive evidence to support this theory.

I have found one article in Outside magazine (June, 2012) quoting Allen Lim, sports physiologist, regarding the dosing of beet juice. In this article, the dosage is eight ounces (two juiced beets) three times a week.

Potential dangers of Beet Juice:

Like all dietary supplements, consuming beet juice is not without risk.  Those dangers include: Temporary paralysis of vocal cords, Liver toxicity, Kidney toxicity (from crystal build-up due to by products from beet ingestion), Diarrhea, Vomiting, Red stool and urine, Low blood pressure, Fainting.

Although beet juice has been supported as an adjuvant to training and fitness in athletes, it is to be used with caution in those who are just starting an exercise program.  Large amounts of beet and or nitrate consumption may be detrimental to people who have other medical conditions, such as kidney or liver disease.  As always, one should always consult with their primary care physician prior to starting a new exercise program or diet to assure safety.


Personal notes (not completely supported by science, just my medical opinion)

First concept: Thinking about the concept of beet juice makes me wonder about hypertensive medications.  Nitrates (eg, nitroglycerin) are used for emergent heart conditions.  Nitrates open up (dilate) the arteries to the heart, increasing blood flow, lowering blood pressure and relieving chest pain (angina), and reducing the heart's workload.   So I asked myself a question.  If nitrates open vessels that efficiently, why not use nitrates to manage blood pressure?  Upon my research, I have found the following.  Nitrates were previously used to manage hypertension.  However, over time the nitrates were found to be ineffective at lower doses, and subsequently higher doses were needed to manage patients.  In short, the body develops a tolerance to the medication. 

Point:  one may consider drinking beet juice for athletic performance to increase oxygen delivery to the tissues.  But, due to previous medical research on the use of nitrates and managing blood pressure, one may consider taking “beet juice vacations”, ie, drinking it prior to competition, but taking a holiday during training.

Second concept:  Ingesting nitrates dilates the blood vessels and allows for faster transmission of red blood cells and therefore oxygen throughout the body.  By dilating the blood vessels, the volume of fluid in those vessels must also expand or increase.  Drinking fluids and hydrating will maintain that fluid level.  However, as one increases the volume, it inherently decreases the concentration (or dilutes) of red blood cells in that fluid.  A low concentration of hemoglobin will stimulate the body to form red blood cells.   It takes approximately four days to form red blood cells in the body to “catch-up”. 

Point: One may consider drinking beet juice at least one week prior, if not two, to competition to allow the body to catch-up on the production of red blood cells due to the initial dilution from the volume expansion.


and Chondroitin
does it help with osteoarthritis pain?


What is osteoarthritis?

Osteoarthritis is the most common cause of arthritis.  It is often called the wear and tear arthritis as it is a condition in which the lining of the joint slowly wears away over time, much like the treads on a tire.

Every joint is made up of two or more bones connected together by multiple ligaments and a dense layer of tissue called the joint capsule.  This joint capsule is lined on the inside by a tissue called synovium.  The synovium produces a thick viscous fluid which lubricates the joint.  The consistency is similar to motor oil.  The ends of the bones are covered with a thick layer of cartilage.  This cartilage is called articular cartilage.  It is very smooth and allows the bones to glide smoothly when in motion.  Arthritis, by definition, is a loss of that cartilage.  With time, the cartilage in the joints becomes worn and exposes the bone underneath, such that the bones no longer glide easily.  It is irregular and grinds as the bones move.  This causes the body to react by becoming inflamed and painful.  A secondary effect of the disease is a thinning of the synovial fluid.  The water content increases and therefore loses the ability to cushion the bones as they move, making the grind that much more severe.  To date, many efforts have been made to restore the synovial fluid and the articular cartilage.  Early progress has been made to regrow cartilage in large joints, such as the knee, however it is available for use in only a small portion of the population. 

Examples of Osteoarthritis:  

These are intra-operative specimens of a radial head (from the elbow).  In the first figure, there are areas pointed by the blue arrows of a white smooth surface.  This surface is articular cartilage and lines every joint.  In most cases it is smooth all the way across the bone.  In this example, there are a couple of "wear" spots of early arthritis, marked with the red arrows.

In this image, the radial head is almost completely worn of its articular cartilage.  Note there are very few areas of white left in the surface of the bone.  As the arthritis progresses, it may even expose the bone underneath, which has a yellow, sand-paper appearance.

What are Glucosamine and Chondroitin?

Glucosamine and Chondroitin are naturally occurring complex molecules in the body.  Both molecules are considered building blocks for maintaining the thickness of the cartilage as well as maintaining the viscosity of the synovial fluid.

There are many forms of Glucosamine available (Glucosamine Sulfate, Glucosamine Hydrochloride, N-acetyl-glucosamine).  Glucosamine Sulfate has been most widely researched and shown the most consistent results.

One intention of taking Glucosamine is to potentially restore the viscosity of the synovial fluid.  A second use of Glucosamine is to provide the building blocks to restore the cartilage in the joints will theoretically reduce the pain caused by arthritis.

The research done on Chondroitin to date has not shown any effectiveness in diminishing the pain caused by arthritis.  This research has been done by using Chondroitin by itself and in combination with Glucosamine.  As the research as not shown any positive effects with the use of Chondroitin, the remaining portion of this blog will focus on Glucosamine.

Why and how is Glucosamine used?

Unfortunately, there have been many conflicting studies as to the effectiveness of the use of Glucosamine and its contribution to pain relief caused by arthritis.  Most studies assessing the benefits of taking Glucosamine have been small with inconsistent results.  A large clinical trial, the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT/2006) showed limited pain relief in patients with arthritis of the knee, except for a small subset of patients with moderate to severe arthritis, in which it showed mild pain relief.  There has not been any data to support its contribution to slowing the progression of the disease or restoring the cartilage itself.

The recommended dose of Glucosamine for arthritis is 1500mg once a day, or 500mg by mouth three times a day.

Taking Glucosamine on a daily basis may diminish the pain caused by arthritis in about 4 to 8 weeks.

What are the safety concerns with the use of Glucosamine?

-To date, there are no significant FDA controls on the labeling and distribution of Glucosamine.  Research has shown a varying percentage of Glucosamine in pills, regardless of what was noted on the label.  Therefore one must be very careful when taking Glucosamine.  Consider a reputable manufacturer and confirm with your pharmacist prior to taking the medication.

-Side effects to taking Glucosamine include:  nausea, heartburn, diarrhea, constipation, headaches and skin reaction.

-Glucosamine is often produced from shellfish shells.  As a result, those with a shellfish or iodine allergy should be very cautious if considering taking Glucosamine as it may cause a dangerous, potentially life-threatening reaction.

-The effects of Glucosamine are unknown if taken during pregnancy or if taken by children, and therefore it is not recommended.

-Some reports show potential negative effect in those patients with diabetes and asthma, potentially increasing blood sugars or contributing to allergy attacks, respectively.

-Glucosamine is known to interfere with the action of Warfarin (Coumadin) and some chemotherapeutic medication.  As a result, if you are on one of these medications, it is strongly recommended to avoid taking Glucosamine as it may cause very dangerous effects on the body.

ALWAYS check with your doctor and your pharmacist prior to starting any new medication.  Be sure to let them know all the medications you are currently taking, including vitamins and herbal supplements.  That way they can give you proper advice as to whether the new medication is safe for you to take.


My Personal Notes:

  1. Always try the standards first – diet, weight control and exercise.  Keeping healthy, maintaining a healthy weight and exercising routinely, help to diminish the burden on the joints as well as keep them lubricated to slow the progression of the arthritis.
  2. ALWAYS check with your doctor and your pharmacist prior to starting any new medication.  Be sure to let them know all the medications you are currently taking, including vitamins and herbal supplements.  That way they can give you proper advice as to whether the new medication is safe for you to take.
  3. After doing much research, I am unclear that the body is able to absorb Glucosamine and Chondroitin effectively.  There have been some studies that Glucosamine  is absorbed through the gastrointestinal tract and distributed throughout the body.   However, it has yet to be confirmed that the molecules are taken up and transported specifically into the joints.  So, you made be taking the medication by mouth, but it may not be actually getting to the joints as expected.
  4. Anecdotally, I have seen many people give glucosamine and chondroitin to their aging pets, many of which do move better after given the medication.  Can I correlate that to what I see in people, unfortunately no.  But, it would be nice.


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