Who Should Avoid Beetroot? 8 People Who Should Be Cautious

The Quick Answer: Who Should Avoid Beetroot?

Beetroot is one of the most studied functional foods of the last two decades. For most people, it’s genuinely safe, and the benefits around blood pressure, exercise performance, and nitric oxide production are real. But “most people” isn’t everyone.

Here are the 8 groups who should be cautious or avoid beetroot entirely: people with already-low blood pressure, people taking blood pressure medications, those with a history of kidney stones (particularly calcium oxalate stones), people on PDE-5 inhibitors like Viagra or Cialis, people taking nitrate heart medications like nitroglycerin, those with iron overload conditions like hemochromatosis, people with G6PD deficiency, and anyone scheduled for surgery within the next two weeks.

None of these are obscure edge cases. I see several of them regularly. The beetroot side effects and drug interactions listed above range from mildly inconvenient to genuinely dangerous, depending on the person. Read the full breakdown before starting any daily beet protocol.

1. People with Already-Low Blood Pressure

Here’s the thing: beetroot’s headline benefit is also its biggest risk for the wrong person.

The nitrates in beetroot convert to nitric oxide in the body, which relaxes blood vessel walls and lowers blood pressure. Webb and colleagues (2008), publishing in Hypertension, showed systolic blood pressure drops of 5 to 10 mmHg after a single dose of beetroot juice in healthy adults. That’s a meaningful reduction.

For someone already running at 95/60, that same reduction can mean dizziness, lightheadedness, or fainting, especially when standing up quickly (orthostatic hypotension). I tell patients with chronically low blood pressure to skip the daily beet shot entirely, not because the research is weak, but because the mechanism works too well. If you’re already symptomatic from low blood pressure, adding a potent vasodilator to your morning routine isn’t clever.

2. People on Blood Pressure Medications

The concern here isn’t beetroot alone. It’s the additive effect.

ACE inhibitors, ARBs, calcium channel blockers, diuretics: all of these lower blood pressure through various pathways. Beetroot pushes in the same direction via nitric oxide. Stack them together without adjustment, and you can over-correct into symptomatic hypotension territory. That means fatigue, brain fog, falls in elderly patients, and in serious cases, cardiac events.

I’ve seen patients whose lisinopril dose needed reviewing after they started daily beetroot juice, not because they did anything wrong, but because nobody told them about the interaction. This is one of those beetroot warnings that gets glossed over in wellness content. Don’t gloss over it. If you’re on antihypertensives and want to add regular beetroot, talk to your prescribing doctor first. The solution might be timing your beet intake away from your medication dose, or a modest medication review, but that decision shouldn’t be made unilaterally.

3. People with a History of Kidney Stones

This one gets me more questions than almost any other beetroot warning, and for good reason.

Raw beetroot contains roughly 600 to 700 mg of oxalates per 100 grams. That’s high. Calcium oxalate stones account for approximately 80% of all kidney stone cases, and dietary oxalate is a direct contributor to stone formation in susceptible individuals. Beetroot powder concentrates this further since you’re working with a dehydrated, condensed product.

Occasional cooked beets as a side dish? Probably fine for most stone formers, since cooking reduces oxalate content somewhat and the total dose stays manageable. Daily beet powder supplementation? That’s where I’d pump the brakes hard if someone has had a calcium oxalate stone. The hydration counter-strategy (drinking more water to dilute urinary oxalate) can help, but it doesn’t eliminate the risk. If your urologist has already told you to watch oxalates, beetroot powder belongs on your avoid list.

4. People Taking Erectile Dysfunction Medications (PDE-5 Inhibitors)

So what exactly happens when you combine beetroot with sildenafil (Viagra), tadalafil (Cialis), or vardenafil?

Both work through overlapping nitric oxide pathways. PDE-5 inhibitors block the enzyme that breaks down cGMP, a signaling molecule activated by nitric oxide. Beetroot floods the system with more nitric oxide to begin with. The result can be a dramatic, rapid drop in blood pressure that goes well beyond what either compound does alone.

This interaction is serious enough that the same contraindication exists for nitrate heart medications combined with PDE-5 inhibitors, a combination that’s actually contraindicated in cardiology guidelines. The beetroot version isn’t quite as acute, but the principle holds. If you’re taking any ED medication regularly, I’d avoid daily high-dose beetroot supplementation, full stop.

5. People Taking Nitrate Heart Medications

Nitroglycerin, isosorbide mononitrate, isosorbide dinitrate: these are prescribed for angina and other cardiac conditions precisely because they cause vasodilation via nitric oxide. They’re powerful. Adding the nitrate load from regular beetroot juice or powder on top of these medications creates potential for dramatic hypotension, severe headache, and fainting.

I would never recommend a daily beet shot to a cardiac patient on nitrate therapy without explicit guidance from their cardiologist. The beetroot blood pressure effect isn’t a cute wellness perk in this context. It’s a pharmacological interaction with real consequences. This is one of the clearest cases where “natural” does not mean “safe to combine with everything.”

6. People with Iron Overload (Hemochromatosis)

✓Positive Finding

Beetroot itself has modest iron content, roughly 0.8 mg per 100 grams. That’s not alarming on its own.

The more relevant issue is that dietary nitrates and vitamin C (both present in beetroot) can enhance non-heme iron absorption from co-consumed foods. For the average person, this is a non-issue or even beneficial. For someone with hereditary hemochromatosis or other iron overload conditions who is actively trying to limit iron accumulation, enhancing iron absorption from every meal is the opposite of what they need.

That said, the occasional serving of roasted beets with dinner is probably fine even for hemochromatosis patients. It’s the daily supplementation regimen, paired with iron-rich meals, where the concern becomes practical.

7. People with G6PD Deficiency

This one is less talked about, but I always ask about it before recommending high-pigment supplements.

G6PD (glucose-6-phosphate dehydrogenase) deficiency is a genetic condition that affects red blood cell stability under oxidative stress. It’s more common than most people realize, particularly in Mediterranean, Middle Eastern, African, and Southeast Asian populations. The betanin pigments in beetroot, combined with the overall oxidative load of concentrated beet products, have been flagged as potential triggers for hemolytic reactions in G6PD-deficient individuals.

The evidence here is less definitive than the blood pressure and oxalate data. That said, the mechanism is plausible, the population at risk is identifiable, and the downside of caution is low. If you have G6PD deficiency, flag it before starting any beet-based supplement.

8. People About to Have Surgery

Beetroot has mild anti-platelet activity, meaning it can reduce the blood’s tendency to clot. The magnitude of this effect is smaller than, say, aspirin or ginkgo biloba, but it’s still clinically relevant in a surgical context.

The general recommendation I follow: stop beetroot supplements 1 to 2 weeks before any planned procedure. This is the same window applied to garlic supplements, fish oil at high doses, and ginkgo. Surgeons aren’t typically alarmed by a patient who ate beets last week, but daily high-dose beetroot powder is a different exposure level. Tell your surgical team what you’re taking. All of it.

What About Pregnancy and Breastfeeding?

Normal food amounts of beetroot during pregnancy are generally considered safe, and there’s actually a good argument for including it. Beetroot contains natural folate, which is exactly what’s needed in early pregnancy for neural tube development.

The concern shifts when you move to high-dose concentrated beet powder. There simply isn’t enough safety data on supplemental doses during pregnancy to make a confident recommendation either way. My position: whole beets and moderate beet juice are reasonable during pregnancy; aggressive daily beet powder supplementation should be discussed with your OB before starting. This isn’t excessive caution. It’s an honest acknowledgment that the research hasn’t caught up yet.

The Honest Bottom Line

For most healthy adults, beetroot is well tolerated. The “beeturia” phenomenon (pink or red urine and stools after eating beets) alarms people constantly, but it’s completely harmless, just a pigment effect. The studied range for therapeutic beetroot dosing is roughly one 250 ml glass of beet juice or 5 to 7 grams of beetroot powder daily. That’s where the blood pressure and exercise performance data is strongest.

The 8 groups covered above need to think carefully before jumping on the beet bandwagon. Some need to avoid it entirely (nitrate heart medications, PDE-5 inhibitors, active kidney stone formers). Others just need a conversation with their doctor first (blood pressure medications, upcoming surgery, hemochromatosis). The distinction matters.

Beetroot is not risky for most people. But “not risky for most people” still leaves a meaningful number of individuals for whom caution is the smarter move.

Frequently Asked Questions

Who should not drink beetroot juice? People with low blood pressure, those on blood pressure medications or nitrate heart drugs, anyone on PDE-5 inhibitors like Viagra or Cialis, people with a history of calcium oxalate kidney stones, and those with G6PD deficiency or hemochromatosis should avoid beetroot juice or use it only under medical supervision.

Can beetroot lower blood pressure too much? Yes. Beetroot’s nitrates can reduce systolic blood pressure by 5 to 10 mmHg. For people already at low readings, or those on antihypertensive medications, this additive effect can cause dizziness, fainting, or symptomatic hypotension.

Does beetroot cause kidney stones? Beetroot is high in oxalates (approximately 600 to 700 mg per 100 g raw), and calcium oxalate kidney stones are the most common type. People with a history of oxalate stones should limit or avoid beetroot, particularly in concentrated powder form.

Is beetroot safe with blood pressure medication? Not always. Beetroot has additive blood pressure-lowering effects when combined with ACE inhibitors, ARBs, calcium channel blockers, or diuretics. The combination can drop blood pressure too low. Talk to your doctor before combining them.

Can beetroot interact with Viagra? Yes. Both beetroot and PDE-5 inhibitors like sildenafil (Viagra) act through nitric oxide pathways. Combining them can cause a severe drop in blood pressure. This is a real pharmacological interaction, not a theoretical one.

How long before surgery should I stop beetroot? Stop beetroot supplements 1 to 2 weeks before any planned surgical procedure. Beetroot has mild anti-platelet activity that can affect bleeding. Always tell your surgical team about all supplements you’re taking.

Frequently Asked Questions

MD, PhD

Dr. Dimitar Marinov

Medical Reviewer - Chief Assistant Professor, Medical University of Varna

Dr. Marinov is a licensed physician and scientist specializing in nutrition and dietetics with years of experience in clinical and preventive medicine. His research focuses on nutrition and physical activity as preventive measures to improve human health. He is passionate about creating evidence-based content and takes great care in referencing every statement with high-quality research.

LinkedIn Instagram Google Scholar ResearchGate Website