210 Participants Needed

Beetroot Juice for Peripheral Arterial Disease

(BEET PAD Trial)

Recruiting at 3 trial locations
KD
Mary McGrae McDermott, MD ...
Overseen ByMary McDermott, MD

Trial Summary

What is the purpose of this trial?

The BEET PAD Trial is a multi-centered double-blind randomized clinical trial designed to determine whether beetroot juice, compared to placebo, improves six-minute walk distance at four month follow-up in people with lower extremity peripheral artery disease (PAD). Investigators hypothesize that by simultaneously increasing lower extremity perfusion, gastrocnemius muscle mitochondrial activity, and myofiber health and regeneration, beetroot juice will significantly improve walking performance in people with PAD. The primary aim is to determine whether beetroot juice significantly improves six-minute walk distance at 4-month follow-up in people with PAD, compared to placebo. Preliminary evidence suggests that beetroot juice has both acute and chronic effects on walking performance in PAD. The primary outcome will measure the combined acute and chronic effect of beetroot juice (i.e. the maximal effect) on change in 6-minute walk at 4-month follow-up. In secondary aims, investigators will distinguish between acute and chronic effects of beetroot juice on six-minute walk and delineate biologic pathways by which beetroot juice improves walking performance in PAD, by measuring change in gastrocnemius muscle perfusion (MRI arterial spin labeling) and gastrocnemius muscle health. The trial will assess the durability of beetroot juice effects on six-minute walk. Nitrate in beetroot juice is metabolized to nitrite and subsequently to NO, attaining peak nitrite levels 2.5 hours after ingestion. The trial will determine whether a higher peak or a greater increase in plasma nitrite at 2.5 hours after beetroot juice consumption at baseline has a greater effect on six-minute walk at 4-month follow-up, compared to a lower peak or a smaller increase, respectively.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you must stop consuming beetroot juice, oral nitrate or nitrite, and beetroot supplements for 30 days before the trial and throughout its duration.

What data supports the effectiveness of the treatment Beetroot Juice for Peripheral Arterial Disease?

Research shows that beetroot juice, which is high in dietary nitrate, can improve blood flow and exercise performance in patients with peripheral arterial disease. It helps increase walking distance and improve muscle function, making it easier for patients to walk longer without pain.12345

Is beetroot juice safe for human consumption?

Research shows that beetroot juice, which is high in dietary nitrate, is generally safe for human consumption. It has been used in studies to lower blood pressure and improve cardiovascular function without significant adverse effects.12567

How is beetroot juice treatment different from other treatments for peripheral arterial disease?

Beetroot juice is unique because it is rich in dietary nitrate, which the body converts to nitric oxide, a molecule that helps improve blood flow and oxygen delivery to muscles. This can enhance exercise tolerance and walking distance in patients with peripheral arterial disease, offering a natural alternative to traditional medications.12468

Eligibility Criteria

This trial is for people over 50 with peripheral artery disease (PAD), which means they have poor blood flow in their legs. They must have specific test results showing PAD and be able to walk a certain distance. People can't join if they've had major leg amputations, severe limb issues, need walkers or wheelchairs, have other conditions limiting walking, recent surgeries or heart events, mental impairment scores below a threshold, allergies to beetroot juice, don't speak English, are in another study recently or consume lots of beets.

Inclusion Criteria

I am 50 years old or older.
I have been diagnosed with PAD based on vascular tests or angiography.
My ABI is between 0.90 and 1.00, and it drops by 20% or more after a physical test.
See 2 more

Exclusion Criteria

I have severe leg pain at rest due to poor blood flow.
I have a current foot ulcer on the bottom of my foot.
I haven't been in a clinical trial for at least 3 months, or 6 months if it was for stem cell/gene therapy.
See 18 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive beetroot juice or placebo twice daily to assess its effects on six-minute walk distance and other health metrics

16 weeks
Regular visits for monitoring and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of walking performance and muscle health

4 weeks
2 visits (in-person)

Treatment Details

Interventions

  • Beetroot juice
  • Placebo
Trial OverviewThe BEET PAD Trial is testing whether drinking beetroot juice improves walking ability after four months compared to a placebo drink. The idea is that the natural compounds in beetroot juice might help increase blood flow and muscle health in the legs of those with PAD.
Participant Groups
2Treatment groups
Active Control
Placebo Group
Group I: Beetroot juiceActive Control1 Intervention
The beetroot juice intervention comes in a single 70 ml drink and is manufactured by James White Drinks. Each drink contains beetroot juice and 2% lemon juice, made from concentrates. Each serving of 70 mL of beetroot juice contains 400 mgs (6.45 millimoles) of nitrate and will be taken twice daily for a total daily dose of 800 mgs (12.90 millimoles) of nitrate.
Group II: PlaceboPlacebo Group1 Intervention
The placebo comes in a single 70 ml drink and is manufactured by James White Drinks. The placebo contains beetroot juice and 2% lemon juice, made from concentrates, and is filtered to remove nitrate.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials
1,674
Recruited
989,000+

University of Virginia

Collaborator

Trials
802
Recruited
1,342,000+

University of Chicago

Collaborator

Trials
1,086
Recruited
844,000+

National Institute on Aging (NIA)

Collaborator

Trials
1,841
Recruited
28,150,000+

Findings from Research

Acute dietary nitrate supplementation from beetroot juice significantly increased plasma nitrate and nitrite levels and reduced resting arterial pulse wave velocity, indicating a biological effect on vascular function.
However, despite these systemic changes, the supplementation did not enhance blood flow or brachial artery dilation during graded handgrip exercise in healthy young men, suggesting that its benefits may not extend to improving exercise-induced blood flow.
Acute dietary nitrate supplementation does not augment submaximal forearm exercise hyperemia in healthy young men.Kim, JK., Moore, DJ., Maurer, DG., et al.[2018]
In a study involving 18 patients with peripheral arterial disease, both nitrate-rich vegetables and beetroot juice significantly increased plasma nitrate and nitrite levels, with beetroot juice showing the highest increase.
Despite the increase in plasma nitrate and nitrite, there were no improvements in exercise tolerance, muscle oxygenation, or cardiovascular function, indicating that higher nitrate levels do not necessarily enhance physical performance in these patients.
Acute Effects of Dietary Nitrate on Exercise Tolerance, Muscle Oxygenation, and Cardiovascular Function in Patients With Peripheral Arterial Disease.van der Avoort, CMT., van Loon, LJC., Verdijk, LB., et al.[2022]
In a study involving 15 COPD patients, acute ingestion of beetroot juice significantly improved exercise capacity, allowing patients to exercise longer at a submaximal workload compared to a placebo.
Beetroot juice also led to notable reductions in both resting and exercise-induced blood pressure, indicating potential cardiovascular benefits alongside improved exercise performance.
Dietary nitrate supplementation improves exercise performance and decreases blood pressure in COPD patients.Berry, MJ., Justus, NW., Hauser, JI., et al.[2018]

References

Acute dietary nitrate supplementation does not augment submaximal forearm exercise hyperemia in healthy young men. [2018]
Acute Effects of Dietary Nitrate on Exercise Tolerance, Muscle Oxygenation, and Cardiovascular Function in Patients With Peripheral Arterial Disease. [2022]
Dietary nitrate supplementation improves exercise performance and decreases blood pressure in COPD patients. [2018]
Moderate dose of dietary nitrate improves skeletal muscle microvascular function in patients with peripheral artery disease. [2023]
Dietary nitrate load lowers blood pressure and renal resistive index in patients with chronic kidney disease: A pilot study. [2018]
Pharmacokinetics of Nitrate and Nitrite Following Beetroot Juice Drink Consumption. [2021]
Nitrate-rich beet juice intake on cardiovascular performance in response to exercise in postmenopausal women with arterial hypertension: study protocol for a randomized controlled trial. [2023]
Dietary nitrate supplementation enhances exercise performance in peripheral arterial disease. [2021]