Going gaga over beetroot

            Beetroot (Beta vulgaris L. ssp. vulgaris) is an interesting and high-nutrient vegetable grown for salads, juice, and natural pigments. The presence of betalains in the cell vacuoles gives beet its deep dark red colour.¹

Beetroot is known to have potent antioxidant activity and contain health-promoting compounds such as magnesium, folic acid, niacin, biotin, vitamin B6, iron, zinc, calcium, phosphorus, sodium, potassium and soluble fibre.²

Beetroot provides dietary nitrate, an important source of nitric oxide, via the nitrate-nitrite-NO pathway. Dietary nitrate is an important component of 'healthy diets', such as the DASH diet to lower blood pressure and the Mediterranean diet to lower cardiovascular and cancer risk.³ Dietary supplementation of nitrate with beetroot juice or other medicinal botanical derivatives (e.g., visnagin and Danshen), provides both antihypertensive properties and mitigates anthracycline-induced cardiotoxicity.⁴ Doxorubicin and epirubicin are anthracyclines and are usually part of breast cancer treatment protocol.

Beetroot contains 2 groups of betalain pigments: red-violet betacyanins and yellow betaxanthins. The betacyanins are mainly betanin (betanidin 5-O-β-glucoside) and isobetanin, which is the predominant isomer.⁵ Betanin is known for its nontoxic properties.

Apparently, beetroot is highly popular and widely used among cancer patients in German as well as Trinidad.^6,7 In Malaysia, there is yet a study to gauge the popularity of this awesome vegetable. However, based on words of mouth information, some cancer patients do routinely consume this vegetable as a drink, especially during chemotherapy, to boost energy and improve the blood counts.

Personally I think beetroot juice has helped me cope with the stress during the chemotherapy months. I enjoy both freshly made as well as the fermented juice (Biota Breuss Organic Beetroot Juice).  Interestingly, a study has indicated that the anticancer activity is stronger in the organic beetroot fermented juices as compared with the conventional ones.⁸ I guess it doesn’t really matter as long as we hope to harness the goodness of this superfood!  

Most studies on beetroot and cancer were carried out in vitro and in animal studies. No clinical trials were reported though.

Studies on beetroot’s nitrogenous compounds:

• Betacyanins have antioxidant and radical scavenging activities.^9,10
• Oral administration of betanin inhibited DMBA initiated and UV-B promoted skin tumorigenesis.¹¹
• Betanin has antiproliferative effects on human chronic myeloid leukemia cell line-K562.¹²
• Betanin significantly decreased tumor multiplicity and tumor load in two mouse lung tumor models.¹³
• Betanin and betaine extracted from beetroots have some antiproliferative effects against hepatocellular cells.¹⁴
• Betanin has anti-inflammatory and cancer prevention properties.¹⁵

Studies on beetroot juice or extracts:

• Beetroot extract prevents lung and skin cancer in mice.¹⁶
• Beetroot extract induces NOQ1 in the murine hepatoma cells, both in vitro and in vivo. NQO1 is a key enzyme responsible for detoxification of DMBA.¹⁷
• Oral consumption of red beetroot food color inhibits tumors in rat esophagus.¹⁸
• In vivo studies confirmed anticarcinogenic activity of beetroot in mouse lung, skin and liver carcinogenesis models.¹⁹
• Beetroot juice is protective against against N-nitrosodiethylamine (NDEA)-induced oxidative stress and liver injury in male rats.^20,21
• Beetroot juice protects female rat against DMBA-induced liver damage and reduces the markers of hepatic damage elevation as a result of DMBA treatment.²²
• Beetroot extracts and doxorubicin provide synergic cytotoxicity against human pancreatic, breast and prostate cancer cell lines. ²³
• Betanin-enriched beetroot extract induces apoptosis and autophagic cell death in breast cancer cells.²⁴

Unfortunately, only an isolated case report on beetroot and cancer that was published:

• 15 days of administration of beetroot-carrot juice therapy in a patient with chronic lymphocytic leukemia resulted in improved appetite, a sense of general well-being and increased vigor. Substantial reduction in leukocytes and lymphocytes count in peripheral blood and improvement in the relevant biochemical parameters were noted.²⁵

References

1.      Jackman RL, Smith JI. 1996. Natural food colourants. In: Hendry GAF, Houghton JD, editors. Anthocyanin and betalanins. 2nd ed. London, UK: Chapman & Hall.

2.     Wootton-Beard PC, Ryan L. 2011. A beetroot juice shot is a significant and convenient source of bioaccessible antioxidants. J Funkt Foods 3: 329–334.

3.     Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science why dietary nitrate is hard to 'beet'! Part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol 2017 Jan;83(1):140-151.

4.     Kuriakose RK, Kukreja RC, Xi L. Potential Therapeutic Strategies for Hypertension-Exacerbated Cardiotoxicity of Anticancer Drugs. Oxid Med Cell Longev. 2016 .

5.     Nemzer B, Pietrzkowski Z, Sporna A, Stalica P, Thresher W, Michalowski T, Wybraniec S. 2011. Betalainic and nutritional profiles of pigment-enriched red beet root (Beta vulgaris L.) dried extracts. Food Chem 127(1):42–53.

6.     Obrist R, von Meiss M, Obrecht JP. [The use of paramedical treatment methods by cancer patients. A inquiry on 101 ambulatory patients]. Dtsch Med Wochenschr. 1986 Feb 21;111(8):283-7. German.

7.     Clement YN, Mahase V, Jagroop A, Kissoon K, Maharaj A, Mathura P, Quan CM, Ramadhin D, Mohammed C. Herbal remedies and functional foods used by cancer patients attending specialty oncology clinics in Trinidad. BMC Complement Altern Med. 2016 Oct 21;16(1):399.

8.     Kazimierczak R, Hallmann E, Lipowski J, Drela N, Kowalik A, Püssa T, Matt D, Luik A, Gozdowski D, Rembiałkowska E. Beetroot (Beta vulgaris L.) and naturally fermented beetroot juices from organic and conventional production: metabolomics, antioxidant levels and anticancer activity. J Sci Food Agric. 2014 Oct;94(13):2618-29.

9.     Pedreno MA, Escribano J. 2000. Studying the oxidation and the antiradical activity of betalain from beetroot. J Biol Educ 35(1):49–51.

10.   Kanner J, Harel S, Granit R. 2001. Betalains—a new class of dietary cationized antioxidants. J Agric Food Chem 49(11):5178–85.

11.    Kapadia GJ, Tokuda H, Konoshima T, Nishino H. 1996. Chemoprevention of lung and skin cancer by Beta vulgaris (beet) root extract. Cancer Lett 100: 211–214.

12.   Sreekanth D, Arunasree MK, Roy KR, Reddy C, Reddy GV, Reddanna P. 2007. Betanin a betacyanin pigment purified from fruits of Opunita ficus-indica induces apoptosis in human chronic myeloid leukemia cell line K562. Phytomedicine 14: 739–746.

13.   Zhang Q, Pan J, Wang Y, Lubet R, You M. Beetroot red (betanin) inhibits vinyl carbamate- and benzo(a)pyrene-induced lung tumorigenesis through apoptosis. Mol Carcinog. 2013 Sep;52(9):686-91.

14.   Lee EJ, An D, Nguyen CT, Patil BS, Kim J, Yoo KS. Betalain and betaine composition of greenhouse- or field-produced beetroot ( Beta vulgaris L.) and inhibition of HepG2 cell proliferation. J Agric Food Chem. 2014 Feb 12;62(6):1324-31.

15.   Zielińska-Przyjemska M, Olejnik A, Dobrowolska-Zachwieja A, Łuczak M, Baer-Dubowska W. DNA damage and apoptosis in blood neutrophils of inflammatory bowel disease patients and in Caco-2 cells in vitro exposed to betanin. Postepy Hig Med Dosw (Online). 2016 Apr 6;70:265-71.

16.   Kapadia GJ, Tokuda H, Konoshima T, Nishino H. Chemoprevention of lung and skin cancer by Beta vulgaris (beet) root extract. Cancer Lett. 1996 Feb 27;100(1-2):211-4.

17.   Lee CH-H, Wettasinghe M, Bolling B, Ji L-L, Parkin K. 2005.Betalains, phase II enzyme-inducing components from redbeetroot (Beta vulgaris L .) extracts. Nutr Cancer 53:91–103.

18.   Lechner JF, Wang LS, Rocha CM, Larue B, Henry C, McIntyre CM, Riedl KM, Schwartz SJ, Stoner GD. Drinking water with red beetroot food color antagonizes esophageal carcinogenesis in N-nitrosomethylbenzylamine-treated rats. J Med Food. 2010 Jun;13(3):733-9.

19.   Kapadia GJ, Rao GS. 2012. Anticancer effects of red beet pigments. In Red Beet Biotechnology. Food and Pharmaceutical Application, Bhagyalakshmi, Neelwarne, (ed.) Springer Sciences and Business Media: New York; 125–154.

20.   Kujawska M, Ignatowicz E, Murias M, Ewertowska M, Mikołaj czyk K,Jodynis-Liebert J. 2009. Protective effect of red beetroot againstcarbon tetrachloride- and N-nitrosodiethylamine-induced oxida-tive stress in rats. J Agric Food Chem 57:2570–2575.

21.   Krajka-Kuźniak V, Szaefer H, Ignatowicz E, Adamska T, Baer-Dubowska W. 2012. Beetroot juice protects againstN-nitrosodiethylamine-induced liver injury in rats. Food ChemToxicol 50: 2027–2033.

22.   Szaefer H, Krajka-Kuźniak V, Ignatowicz E, Adamska T, Baer-Dubowska W.2014. Evaluation of the effect of beetroot juice on DMBA-induced damage in liver and mammary gland of female Sprague-Dawley rats. Phytother Res Jan;28(1):55-61

23.   Kapadia GJ, Rao GS, Ramachandran C, Iida A, Suzuki N, Tokuda H. Synergistic cytotoxicity of red beetroot (Beta vulgaris L.) extract with doxorubicin in human pancreatic, breast and prostate cancer cell lines. J Complement Integr Med. 2013 Jun 26;10.

24.   Nowacki L, Vigneron P, Rotellini L, Cazzola H, Merlier F, Prost E, Ralanairina R, Gadonna JP, Rossi C, Vayssade M. Betanin-enriched red beetroot (Beta vulgaris L.) extract induces apoptosis and autophagic cell death in MCF-7 Cells. Phytother Res 2015 Dec;29(12):1964-73.

25.   Shakib MC, Gabrial SG, Gabrial GN. Beetroot-carrot juice intake either alone or in combination with antileukemic drug 'chlorambucil' as a potential treatment for chronic lymphocytic leukemia. Open Access Maced J Med Sci. 2015 Jun 15;3(2):331-6.