Acute sodium bicarbonate loading has negligible effects on resting and exercise blood pressure but causes gastrointestinal distress

The effect of sodium bicarbonate mini-tablets ingested in a carbohydrate hydrogel system on 40 km cycling time trial performance and metabolism in trained male cyclists

INTRODUCTION

Sodium bicarbonate (NaHCO3) ingestion has been found to be ergogenic in high-intensity exercise that ranges from 1 to 10 min; however, limited studies have investigated high-intensity exercise beyond this duration.

PURPOSE

The present study aimed to determine the effect of NaHCO3 ingested using a carbohydrate hydrogel delivery system on 40 km time trial (TT) performance in trained male cyclists.

METHODS

Fourteen trained male cyclists ingested 0.3 g kg-1 BM NaHCO3 (Maurten AB, Sweden) to determine individualised peak alkalosis, which established time of ingestion prior to exercise. Participants completed a 40 km familiarisation TT, and two 40 km experimental TTs after ingestion of either NaHCO3 or placebo in a randomised, double-blind, crossover design.

RESULTS

NaHCO3 supplementation improved performance (mean improvement = 54.14 s ± 18.16 s; p = 0.002, g = 0.22) and increased blood buffering capacity prior to (HCO3- mean increase = 5.6 ± 0.2 mmol L-1, p < 0.001) and throughout exercise (f = 84.82, p < 0.001, pη2 = 0.87) compared to placebo. There were no differences in total gastrointestinal symptoms (GIS) between conditions either pre- (NaHCO3, 22 AU; Placebo, 44 AU; p = 0.088, r = 0.46) or post-exercise (NaHCO3, 76 AU; Placebo, 63 AU; p = 0.606, r = 0.14).

CONCLUSION

The present study suggests that ingesting NaHCO3 mini-tablets in a carbohydrate hydrogel can enhance 40 km TT performance in trained male cyclists, with minimal GIS. This ingestion strategy could therefore be considered by cyclists looking for a performance enhancing ergogenic aid.

Management of chronic kidney disease: The current novel and forgotten therapies

Chronic kidney disease (CKD) is a progressive and incurable condition that imposes a significant burden on an aging society. Although the exact prevalence of this disease is unknown, it is estimated to affect at least 800 million people worldwide. Patients with diabetes or hypertension are at a higher risk of developing chronic kidney damage. As the kidneys play a crucial role in vital physiological processes, damage to these organs can disrupt the balance of water and electrolytes, regulation of blood pressure, elimination of toxins, and metabolism of vitamin D. Early diagnosis is paramount to prevent potential complications. Treatment options such as dietary modifications and medications can help slow disease progression. In our narrative review, we have summarized the available therapeutic options to slow the progression of chronic kidney disease. Many new drug treatments have recently become available, offering a beacon of hope and optimism in CKD management. Nonetheless, disease prevention remains the most critical step in disease management. Given the significant impact of CKD on public health, there is a pressing need for further research. With the development of new technologies and advancements in medical knowledge, we hope to find more effective diagnostic tools and treatments for CKD patients.

Oral regimen for high dose methotrexate urine alkalinization: a systematic review and meta-analysis

OBJECTIVE

Urine alkalinization prevents nephrotoxicity in patients receiving high-dose methotrexate (HDMTX). While the standard approach involves IV sodium bicarbonate, alternative oral bicarbonate regimens are crucial in drug shortages and outpatient settings. This study aims to review the efficacy and safety of such regimens.

METHODS

PubMed, WOS, and Scopus were systematically searched using the PRISMA protocol for relevant studies involving human subjects, including randomized clinical trials, retrospective, prospective, cohort, case reports, and case series studies. There were no restrictions on language, time, or age group. Qualified and eligible papers were used to extract data on efficacy and safety indicators, and the final relevant records were assessed for quality using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) assessment tool.

RESULTS

12 studies with 1212 participants were included in the systematic review, with pooled data from 8 studies used for meta-analysis. No significant differences in mean differences (MDs) or odds ratio (OR) were found after the oral bicarbonate regimen, except for when urine pH fell to < 7 (MD: 0.91, 95% CI: 0.32, 1.5, P < 0.05) and the incidence of diarrhea (OR: 2.92, 95% CI: 1.69, 5.05, P < 0.05).

CONCLUSION

An oral bicarbonate regimen is a safe and effective way to alkalize HDMTX urine, providing a viable and cost-effective alternative to IV protocols. Further prospective multicenter studies are necessary. Systematic review registration identifier: CRD42023379666.

Sodium Bicarbonate Decreases Alcohol Consumption in Mice

We previously reported that mice with low neuronal pH drink more alcohol, demonstrating the importance of pH for alcohol reward and motivation. In this study, we tested whether systemic pH affects alcohol consumption and if so, whether it occurs by changing the alcohol reward. C57BL/6J mice were given NaHCO3 to raise their blood pH, and the animals' alcohol consumption was measured in the drinking-in-the-dark and two-bottle free choice paradigms. Alcohol consumption was also assessed after suppressing the bitterness of NaHCO3 with sucrose. Alcohol reward was evaluated using a conditioned place preference. In addition, taste sensitivity was assessed by determining quinine and sucrose preference. The results revealed that a pH increase by NaHCO3 caused mice to decrease their alcohol consumption. The decrease in high alcohol contents (20%) was significant and observed at different ages, as well as in both males and females. Alcohol consumption was also decreased after suppressing NaHCO3 bitterness. Oral gavage of NaHCO3 did not alter quinine and sucrose preference. In the conditioned place preference, NaHCO3-treated mice spent less time in the alcohol-injected chamber. Conclusively, the results show that raising systemic pH with NaHCO3 decreases alcohol consumption, as it decreases the alcohol reward value.

Effects of Enteric-Coated Formulation of Sodium Bicarbonate on Bicarbonate Absorption and Gastrointestinal Discomfort

Sodium bicarbonate is used as an ergogenic supplement to enhance people's performances in various exercises. This study aimed to evaluate the effects of intestinal delivery of sodium bicarbonate on bicarbonate absorption and associated side effects in an experimental human trial. After preparing and assessing enteric-coated and uncoated sodium bicarbonate tablet formulations, pharmacokinetic analysis and gastrointestinal symptom tests were performed after oral administration in the human body. The dose required to increase blood bicarbonate concentration over 5 mmol∙L-1 for the purpose of improving performance during high-intensity exercise was also determined. Enteric-coated tablet formulation protects sodium bicarbonate under acidic conditions and releases bicarbonate in the intestine. Enteric-coated tablet formulation also reduced the oral dose required to achieve a blood bicarbonate concentration over 5 mmol∙L-1 from 300 mg∙kg-1 of uncoated tablet formulation to 225 mg∙kg-1. Gastrointestinal discomfort was significantly decreased for the group given 225 mg∙kg-1 enteric-coated tablets compared to that given 300 mg∙kg-1 uncoated tablets. These results suggest that enteric-coated tablet formulation could reduce the oral dose required in order to achieve a blood bicarbonate concentration over 5 mmol∙L-1 by 25%, from 300 mg∙kg-1 to 225 mg∙kg-1, along with its ability to reduce gastrointestinal discomfort associated with the dosage.

Effect of Pre-exercise Sodium Citrate Ingestion on Repeated Sprint Performance in Soccer Players

ABSTRACT

Kuru, D, Aktitiz, S, Atakan, MM, Köse, MG, Turnagöl, HH, and Koşar, ŞN. Effect of pre-exercise sodium citrate ingestion on repeated sprint performance in soccer players. J Strength Cond Res 38(3): 556-562, 2024-This study aimed to test the hypothesis that sodium citrate (CIT) administered 180 minutes before exercise improves repeated sprint performance in athletes within a field-based setting. Twenty male soccer players (mean ± SD : age = 20.9 ± 2.3 years; body mass [BM] = 73.8 ± 5.9 kg) performed a running-based anaerobic sprint test (RAST) with 0.5 g·kg -1 BM of CIT or with placebo (PLC; NaCl) ingestion 180 minutes before exercise in a randomized, crossover, and double-blind design, with at least 6 days between the trials. Blood samples were collected before exercise and at first, third, fifth, and seventh minutes after exercise to analyze blood pH, bicarbonate, and lactate levels. Gastrointestinal symptoms were also monitored at 30-minute intervals for 180 minutes after CIT and PLC ingestion. Pre-exercise blood pH (CIT = 7.49 ± 0.03 vs. PLC = 7.41 ± 0.02) and bicarbonate (CIT = 30.57 ± 1.33 vs. PLC = 25.25 ± 1.52) increased with CIT compared with PLC ( p < 0.001). Blood pH, bicarbonate, and lactate at the first, third, fifth, and seventh minutes after RAST with CIT were higher than PLC ( p < 0.05), except for lactate at first minute ( p > 0.05). Compared with PLC, CIT ingestion significantly improved minimum power output ( p = 0.024) and percentage decrement score ( p = 0.023). Gastrointestinal symptoms were significantly higher after CIT ingestion vs. PLC at 30th ( p = 0.003) and 60th minutes ( p = 0.010). However, there were no significant differences at 90th, 120th, 150th, or 180th minutes ( p > 0.05). The ingestion of 0.5 g·kg -1 BM of CIT 180 minutes before exercise is an effective ergogenic aid for improving repeated sprint ability as evidenced by improvements in minimum power output and percentage decrement score.

The Effects of a Carbohydrate Hydrogel System for the Delivery of Bicarbonate Mini-Tablets on Acid-Base Buffering and Gastrointestinal Symptoms in Resting Well-trained Male Cyclists

BACKGROUND

A new commercially available sodium bicarbonate (SB) supplement claims to limit gastrointestinal (GI) discomfort and increase extracellular buffering capacity. To date, no available data exists to substantiate such claims. Therefore, the aim of this study was to measure blood acid-base balance and GI discomfort responses following the ingestion of SB using the novel "Bicarb System" (M-SB). Twelve well-trained male cyclists completed this randomised crossover designed study. Maximal oxygen consumption was determined in visit one, whilst during visits two and three participants ingested 0.3 g∙kg-1 BM SB using M-SB (Maurten, Sweden) or vegetarian capsules (C-SB) in a randomised order. Finger prick capillary blood samples were measured every 30 min for pH, bicarbonate (HCO3-), and electrolytes (potassium, chloride, calcium, and sodium), for 300 min. Visual analogue scales (VAS) were used to assess GI symptoms using the same time intervals.

RESULTS

Peak HCO3- was 0.95 mmol∙L-1 greater following M-SB (p = 0.023, g = 0.61), with time to peak HCO3- achieved 38.2 min earlier (117 ± 37 vs. 156 ± 36 min; p = 0.026, r = 0.67) and remained elevated for longer (p = 0.043, g = 0.51). No differences were observed for any electrolytes between the conditions. Aggregated GI discomfort was reduced by 79 AU following M-SB (p < 0.001, g = 1.11), with M-SB reducing stomach cramps, bowel urgency, diarrhoea, belching, and stomach-ache compared to C-SB.

CONCLUSIONS

This is the first study to report that M-SB can increase buffering capacity and reduce GI discomfort. This presents a major potential benefit for athletes considering SB as an ergogenic supplement as GI discomfort is almost eliminated. Future research should determine if M-SB is performance enhancing.

The effects of sodium bicarbonate ingestion on swimming interval performance in trained competitive swimmers

The use of sodium bicarbonate (NaHCO3) supplementation to improve repeated high-intensity performance is recommended; however, most swimming performance studies examine time trial efforts rather than repeated swims with interspersed recovery that are more indicative of training sessions. The aim of this study, therefore, was to investigate the effects of 0.3 g.kg-1 BM NaHCO3 supplementation on sprint interval swimming (8 × 50 m) in regionally trained swimmers. Fourteen regionally competitive male swimmers (body mass (BM): 73 ± 8 kg) volunteered for this double-blind, randomised, crossover designed study. Each participant was asked to swim 8 × 50 m (front crawl) at a maximum intensity from a diving block, interspersed with 50 m active recovery swimming. After one familiarisation trial, this was repeated on two separate occasions whereby participants ingested either 0.3 g.kg-1 BM NaHCO3 or 0.05 g.kg-1 BM sodium chloride (placebo) in solution 60 min prior to exercise. Whilst there were no differences in time to complete between sprints 1-4 (p > 0.05), improvements were observed in sprint 5 (p = 0.011; ES = 0.26), 6 (p = 0.014; ES = 0.39), 7 (p = 0.005; ES = 0.60), and 8 (p = 0.004; ES = 0.79). Following NaHCO3 supplementation, pH was greater at 60 min (p < 0.001; ES = 3.09), whilst HCO3- was greater at 60 min (p < 0.001; ES = 3.23) and post-exercise (p = 0.016; ES = 0.53) compared to placebo. These findings suggest NaHCO3 supplementation can improve the latter stages of sprint interval swimming performance, which is likely due to the augmentation of pH and HCO3- prior to exercise and the subsequent increase in buffering capacity during exercise.

Transcutaneous delivery of sodium bicarbonate increases intramuscular pH

Introduction: Oral bicarbonate loading improves the buffering of metabolic acidosis and may improve exercise performance but can also result in gastric distress. Momentous' PR Lotion contains a novel composition intended to provide a transdermal delivery vehicle for sodium bicarbonate which could allow the same ergogenic effect without the gastric distress. The present study explored the effect of transdermal delivery of sodium bicarbonate in a resting condition. Methods: We measured the pH from intramuscular dialysate, via microdialysis, of the vastus lateralis during a 2 h application of PR Lotion (40 g of lotion per leg) in 9 subjects (3 women, 6 men). Venous blood samples were obtained for serum pH before and after application. A placebo time control was also performed in 4 subjects (2 women, 2 men). We hypothesized that PR Lotion application would increase pH of intramuscular dialysate. Results: PR Lotion resulted in a rise in pH of 0.13 ± 0.04 units (p < 0.05), which translates to a 28% reduction in [H⁺]. Increases in serum pH were smaller (∼9%) yet consistent (p < 0.05). In contrast, placebo time control pH tended to decrease (p = 0.08). The effect of PR Lotion on pH tended to correlate with the dose per kg body weight of each individual (r = 0.70, p = 0.08). Conclusion: These observations support the idea of transdermal bicarbonate delivery impacting pH buffering both systemically and intramuscularly. Further work investigating these potential benefits in an exercising model would be critical to establishing PR Lotion's utility as an ergogenic aid.

Acute enteric-coated sodium bicarbonate has negligible effect on anaerobic performance but affects metabolomics and attenuates the gastrointestinal response

Sodium bicarbonate ingestion before exercise has a performance-enhancing effect on high-intensity exercise. However, gastrointestinal symptoms can be a problematic side-effect. Enteric-coated sodium bicarbonate can attenuate gastrointestinal symptoms following acute bicarbonate loading. In addition, the subsequent effects on exercise performance and metabolomics have not been investigated. The purpose of this study was to investigate the acute effect of enteric-coated sodium bicarbonate supplementation on the anaerobic performance, physiological profile, and symptoms of gastrointestinal discomfort after severe-intensity intermittent exercise. At the same time, targeted metabolomics was used to study the changes in urine metabolism after ingestion of enteric-coated sodium bicarbonate and to explore the characteristics of biological metabolism. In a randomized crossover design, twelve male college students completed four Wingate anaerobic 30-s cycling tests (WACT) after consuming a placebo (PL) and two experimental conditions: 0.2 g/kg body mass in enteric-coated sodium bicarbonate pills (ES) or general sodium bicarbonate pills (GS). Blood lactate (BLA), heart rate (HR), ratings of perceived exertion (RPE), and gastrointestinal–symptoms assessment questionnaire (GSAQ) were measured pre-exercise and post-exercise. In contrast, mean power (MP) and peak power (PP) were recorded immediately post-exercise. Urine samples were collected before formal tests and 50 min after the third WACT. Our findings indicate the following: 1) mean power and peak power showed no significant difference among conditions (MP: F_{2.0, 33} = 0.541, p = 0.587, η² = 0.032; PP: F_{2.0, 33} = 0.526, p = 0.596, η² = 0.031). The PP decline of the ES and GS after the third WACT was lower than that of the PL; 2) There were no significant differences in physiological responses, such as BLA (F_{2.0, 33.0}= 0.191, p = 0.827, η² = 0.011) and heart rate (F_{2, 33} = 0.418, p = 0.662, η² = 0.025), between the three conditions. Although blood lactate concentration after 10 min of the third WACT was lower with ES and GS than with placebo; 3) Fewer participants experienced gastrointestinal symptoms with enteric-coated than with general sodium bicarbonate; 4) The metabolites with differences among the three conditions 50 min after exercise were 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, cis-aconitate, oxaloacetate, and citrate. ES had higher levels of 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, and cis-aconitate than GS. The 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, and cis-aconitate levels in GS were significantly lower than in PL. In contrast, the citrate level in GS was significantly higher than that in other experimental conditions. Compared to PL, the level of oxaloacetate was higher after exercise in ES. This data suggests that supplementation of enteric-coated and general sodium bicarbonate before exercise can alter energy metabolism following anaerobic exercise, involving the metabolism of 3-phospho-d-glycerate, D-Glucose 6-phosphate, pyruvate, cis-aconitate, oxaloacetate, citrate, and lactate. However, they do not affect anaerobic performance and blood lactate. The supplementation of acute enteric-coated sodium bicarbonate and general sodium bicarbonate can enhance some of the weak effects of blood lactate clearance during anaerobic exercise, which may be beneficial for glycolytic energy supply. In addition, enteric-coated sodium bicarbonate intake mitigates gastrointestinal symptoms compared to general sodium bicarbonate.

Effects of serial and acute enteric-coated sodium bicarbonate supplementation on anaerobic performance, physiological profile, and metabolomics in healthy young men

Background

Previous studies have reported that sodium bicarbonate ingestion may enhance high-intensity exercise performance and cause severe gastrointestinal distress. However, enteric-coated sodium bicarbonate may reduce gastrointestinal symptoms of sodium bicarbonate after oral administration. This remains to be confirmed. This study aimed to verify the effects of serial and acute enteric-coated sodium bicarbonate supplementation on anaerobic performance, physiological profile, and metabolomics in healthy young men.

Methods

Healthy young males (n = 12) ingested 0.2 g/kg body mass of enteric-coated sodium bicarbonate (ES) in serial enteric-coated sodium bicarbonate (SES, continuous ES supplementation for 5 days) and acute enteric-coated sodium bicarbonate (AES, acute ES supplementation before exercise) or a placebo (PL) in a randomized crossover design. After each supplement protocol, the participants completed four Wingate anaerobic tests (WAT). The first three Wingate tests (testing anaerobic capacity) were performed with a 5-min passive recovery between each. After the third Wingate test, participants were required to complete a 50-min recovery followed by a fourth WAT test (testing the recovery of anaerobic capacity after 50-min intervals). Blood lactate (BLA), heart rate (HR), and ratings of perceived exertion (RPE) were measured in all conditions during the test, as was the subjective gastrointestinal–symptoms assessment questionnaire (GSAQ). Mean power (MP) and peak power (PP) were recorded after four WATs. Urine samples were collected before the test and 50 min after the 3rd WAT.

Results

Serial enteric-coated sodium bicarbonate supplementation improved anaerobic capacity in the third bout of WATs, as observed based on an increase in mean power (SES vs. PL (613 ± 57 vs. 542 ± 64 W), P = 0.024) and peak power (SES vs. PL (1,071 ± 149 vs. 905 ± 150 W), P = 0.016). Acute ES supplementation did not affect anaerobic capacity. The occurrence of gastrointestinal symptoms after enteric-coated sodium bicarbonate supplementation was minimal and no difference compared to placebo in the current study. In particular, serial enteric-coated sodium bicarbonate supplementation had no gastrointestinal side effects before the test. The AES and SES groups had a trivial effect on blood lactate compared to the PLA group. There was no significant difference in HR and RPE among the three groups. Based on targeted metabolomics analysis, the 50 min after the third WAT, the levels of lactate (P &lt; 0.001), L-Malic acid (P &lt; 0.05), and oxaloacetate (P &lt; 0.05) were significantly higher in the SES group than in the PL group. Compared with the AES group, the levels of lactate and fumarate in the SES group were significantly increased (P &lt; 0.05).

Conclusions

Our study indicates that serial enteric-coated sodium bicarbonate supplementation positively improves anaerobic performance among healthy young men. However, acute ingestion of enteric-coated sodium bicarbonate did not improve anaerobic exercise performance. Either with serial or acute supplementation doses, enteric-coated sodium bicarbonate produced fewer gastrointestinal symptoms and no difference compared to placebo, especially with no gastrointestinal side effects after serial supplementation. Serial and acute supplementation of enteric-coated sodium bicarbonate might tend to promote lactate clearance. Furthermore, serial enteric-coated sodium bicarbonate ingestion may cause changes in the metabolism of lactate, L-Malic acid, oxaloacetate, and fumarate 50 min after exercise, which presumably may promote the tricarboxylic acid cycle and lactate clearance.

Effect of functional excipients on the dissolution and membrane permeation of furosemide formulated into multiple-unit pellet system (MUPS) tablets

The effect of functional excipients (i.e. chitosan, sodium lauryl sulphate, NaHCO₃, and CaCO₃) formulated in multiple-unit pellet system (MUPS) tablets has been investigated on the dissolution and permeability of furosemide, a BCS class IV compound. Spherical beads were produced and compressed into MUPS tablets. MUPS tablet formulations were evaluated for hardness, disintegration, mass variation, friability, and dissolution (pH 1.2, pH 4.6, and pH 7.4). Ex vivo permeability studies were conducted across excised pig tissues (pyloric antrum and duodenal region) on selected experimental MUPS tablet formulations. Histological analysis was conducted on the tissues after exposure to selected experimental MUPS tablet formulations. Dissolution results in the 0.1 M HCl (pH 1.2) showed the highest effect of the excipients on furosemide release. Dissolution parameters showed increased dissolution of furosemide for the MUPS tablet formulations containing functional excipients: a 4.5-10-fold increase in the AUC values, the %_max showed a 60-70% increase and up to a 19-fold increase in DRi was seen. Permeability results revealed a 2.5-fold higher cumulative percentage transport for selected formulations. The results proved that functional excipients incorporated into beads, compressed into MUPS tablet formulations increased furosemide release as well as permeation across excised intestinal tissues.

Effect of β-alanine and sodium bicarbonate co-supplementation on the body's buffering capacity and sports performance: A systematic review

Muscle acidification is one of the main factors causing fatigue during exercise, thus compromising performance. The sport supplements beta alanine (β-A) and sodium bicarbonate (SB) are thought to enhance the effects of the body's buffer systems by reducing H⁺ concentrations. The aim of this systematic review was to analyze the effects of β-A and SB co-supplementation on the organism's buffering capacity and sport performance. The databases PubMed, Web of Science, Medline, CINAHL and SPORTDiscus were searched until November 2021 following PRISMA guidelines. Randomized controlled trials, at least single-blind, performed in athletes of any age were considered. Nine studies including a total of 221 athletes were identified for review. Athletes were supplemented with β-A and SB while they performed exercise tests to assess physical performance and buffer capacity. Five of the nine studies indicated there was some additional improvement in buffering capacity and performance with co-supplementation, while one study concluded that the effect was comparable to the added effects of the individual supplements. According to the results of the studies reviewed, we would recommend β-A and SB co-supplementation during high intensity exercises lasting between 30 s and 10 min.

International Society of Sports Nutrition position stand: sodium bicarbonate and exercise performance

Based on a comprehensive review and critical analysis of the literature regarding the effects of sodium bicarbonate supplementation on exercise performance, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Supplementation with sodium bicarbonate (doses from 0.2 to 0.5 g/kg) improves performance in muscular endurance activities, various combat sports, including boxing, judo, karate, taekwondo, and wrestling, and in high-intensity cycling, running, swimming, and rowing. The ergogenic effects of sodium bicarbonate are mostly established for exercise tasks of high-intensity that last between 30 s and 12 min. 2. Sodium bicarbonate improves performance in single- and multiple-bout exercise. 3. Sodium bicarbonate improves exercise performance in both men and women. 4. For single-dose supplementation protocols, 0.2 g/kg of sodium bicarbonate seems to be the minimum dose required to experience improvements in exercise performance. The optimal dose of sodium bicarbonate dose for ergogenic effects seems to be 0.3 g/kg. Higher doses (e.g., 0.4 or 0.5 g/kg) may not be required in single-dose supplementation protocols, because they do not provide additional benefits (compared with 0.3 g/kg) and are associated with a higher incidence and severity of adverse side-effects. 5. For single-dose supplementation protocols, the recommended timing of sodium bicarbonate ingestion is between 60 and 180 min before exercise or competition. 6. Multiple-day protocols of sodium bicarbonate supplementation can be effective in improving exercise performance. The duration of these protocols is generally between 3 and 7 days before the exercise test, and a total sodium bicarbonate dose of 0.4 or 0.5 g/kg per day produces ergogenic effects. The total daily dose is commonly divided into smaller doses, ingested at multiple points throughout the day (e.g., 0.1 to 0.2 g/kg of sodium bicarbonate consumed at breakfast, lunch, and dinner). The benefit of multiple-day protocols is that they could help reduce the risk of sodium bicarbonate-induced side-effects on the day of competition. 7. Long-term use of sodium bicarbonate (e.g., before every exercise training session) may enhance training adaptations, such as increased time to fatigue and power output. 8. The most common side-effects of sodium bicarbonate supplementation are bloating, nausea, vomiting, and abdominal pain. The incidence and severity of side-effects vary between and within individuals, but it is generally low. Nonetheless, these side-effects following sodium bicarbonate supplementation may negatively impact exercise performance. Ingesting sodium bicarbonate (i) in smaller doses (e.g., 0.2 g/kg or 0.3 g/kg), (ii) around 180 min before exercise or adjusting the timing according to individual responses to side-effects, (iii) alongside a high-carbohydrate meal, and (iv) in enteric-coated capsules are possible strategies to minimize the likelihood and severity of these side-effects. 9. Combining sodium bicarbonate with creatine or beta-alanine may produce additive effects on exercise performance. It is unclear whether combining sodium bicarbonate with caffeine or nitrates produces additive benefits. 10. Sodium bicarbonate improves exercise performance primarily due to a range of its physiological effects. Still, a portion of the ergogenic effect of sodium bicarbonate seems to be placebo-driven.

Increased Performance in Elite Runners Following Individualized Timing of Sodium Bicarbonate Supplementation

The present study investigated individualized sodium bicarbonate (NaHCO3-) supplementation in elite orienteers and its effects on alkalosis and performance in a simulated sprint orienteering competition. Twenty-one Danish male and female elite orienteers (age = 25.2 ± 3.6 years, height = 176.4 ± 10.9 cm, body mass = 66.6 ± 7.9 kg) were tested twice in order to identify individual time to peak blood bicarbonate (HCO3- peak) following supplementation of 0.3 g/kg body mass NaHCO3 with and without warm-up. The athletes also performed two 3.5 km time-trial runs (TT-runs) following individualized timing of NaHCO3 supplementation (SBS) or placebo (PLA) on separate days in a randomized, double-blind, cross-over design. The occurrence of individual peak HCO3- and pH ranged from 60 to 180 min. Mean HCO3- and pH in SBS were significantly higher compared with PLA 10 min before and following the TT-run (p < .01). SBS improved overall performance in the 3.5 km TT-run by 6 s compared with PLA (775.5 ± 16.2 s vs. 781.4 ± 16.1 s, respectively; p < .05). SBS improved performance in the last half of the TT-run compared with PLA (p < .01). In conclusion, supplementation with NaHCO3 followed by warm-up resulted in individualized alkalosis peaks ranging from 60 to 180 min. Individualized timing of SBS in elite orienteers induced significant alkalosis before and after a 3.5 km TT and improved overall performance time by 6 s, which occurred in the last half of the time trial. The present data show that the anaerobic buffer system is important for performance in these types of endurance events lasting 12-15 min.

Nausea after Repeated Sprints: Is Lactic Acidosis Really the Culprit?

INTRODUCTION

Nausea caused by exhaustive sprinting is associated with high lactate ([La-]) and hydrogen ion concentrations ([H+]) and fall in blood pCO2, thus raising the issue of whether there is a causal link between nausea and these variables. For this reason, this study aimed to determine whether interspersing repeated sprints (RS) with periods of active, compared with passive, recovery results in lower levels of both nausea and changes in [La-], [H+], and pCO2.

METHODS

Twelve male participants completed two separate sessions comprising four 30-s sprints separated by 20 min of either active (AR; cycling at 40% V˙O2peak) or passive recovery (PR). At 6 and 18 min of each recovery period, nausea was assessed via a visual analog scale (VAS), and blood samples were collected to measure [La-], [H+], and pCO2.

RESULTS

RS significantly increased VAS score in both AR (P < 0.001) and PR (P < 0.01). After the first sprint, VAS was higher than preexercise in only AR (P < 0.01). AR was associated with lower VAS, [La-], [H+], and higher pCO2 (all P = 0.001) compared with PR after sprints 2-4. Linear mixed modeling indicated that each of the variables significantly predicts VAS scores (P < 0.0001). Repeated-measures correlation (rrm2) indicated that [La-] had the closest association with VAS (rrm2 = 0.22, P < 0.0001).

CONCLUSION

The lower levels of both nausea and changes in [La-], [H+], and pCO2 in response to AR suggest that nausea associated with RS may be causally related with these variables. However, the absence of a close relationship between these variables after the first sprint and the findings that [La-], [H+], and pCO2 only account for 13%-22% of the variation in VAS indicate that other mechanisms may also mediate nausea.

Effect of Huperzine A on Cognitive Function and Perception of Effort during Exercise: A Randomized Double-Blind Crossover Trial

Huperzine A has shown the ability to acutely improve cognitive function in certain populations, and therefore is commonly added to pre-workout supplements. However, its effects have not been studied in exercise-trained individuals.

OBJECTIVE

We hypothesized that acute consumption of huperzine A would improve cognitive function during exercise, which may be beneficial for exercise performance.

METHODS

From January to April, 2018, 15 exercise-trained individuals (11 women [height 166 ± 2 cm, weight 60.5 ± 3.0 kg] and 4 men [height 173 ± 4 cm, weight 82.0 ± 11.0 kg], BMI 23.5 ± 1.4 kg/m2, age 30.4 ± 3.6 years) were studied in a double blind randomized-sequence cross-over study, in which they underwent tests for cognitive function (digit span, verbal/word fluency, and Stroop), neuromuscular performance (sharpened Romberg and dart throwing), and exercise performance (estimated aerobic capacity, hand-grip strength, vertical jump, and push-up) after acute ingestion of huperzine A (200 mcg) or placebo. One week separated the two trials.

RESULTS

No measures of cognitive function differed between placebo and huperzine A trials (all p ≥ 0.296). Heart rates (157 ± 4 vs. 158 ± 4 bpm; p = 0.518) and ratings of perceived exertion (13.7 ± 0.56 vs. 13.9 ± 0.61; p = 0.582) did not differ between placebo and huperzine A trials, respectively. Ratings of subjective difficulty post-exercise (0-10 scale) were significantly higher (5.7 ± 0.38 vs. 6.8 ± 0.38; p = 0.002) in the huperzine A trial than the placebo trial. No differences were observed for neuromuscular or exercise performance measures between groups (all p ≥ 0.497).

CONCLUSIONS

Huperzine A does not enhance cognitive function during exercise despite it being marketed as a cognitive enhancer. Because of its inability to enhance cognitive function, its inclusion in pre-workout supplements warrants reconsideration. Other more practical and effective strategies should be considered.

Enteric-Coated Sodium Bicarbonate Attenuates Gastrointestinal Side-Effects

Enteric-formulated capsules can mitigate gastrointestinal (GI) side effects following sodium bicarbonate (NaHCO3) ingestion; however, it remains unclear how encapsulation alters postingestion symptoms and acid-base balance. The current study aimed to identify the optimal ingestion form to mitigate GI distress following NaHCO3 ingestion. Trained males (n = 14) ingested 300 mg/kg body mass of NaHCO3 in gelatin (GEL), delayed-release (DEL), and enteric-coated (ENT) capsules or a placebo in a randomized cross-over design. Blood bicarbonate anion concentration, potential hydrogen, and GI symptoms were measured pre- and postingestion for 3 hr. Fewer GI symptoms were reported with ENT NaHCO3 than with GEL (p = .012), but not with DEL (p = .106) in the postingestion phase. Symptom severity decreased with DEL (4.6 ± 2.8 arbitrary units) compared with GEL (7.0 ± 2.6 arbitrary units; p = .001) and was lower with ENT (2.8 ± 1.9 arbitrary units) compared with both GEL (p < .0005) and DEL (p = .044) NaHCO3. Blood bicarbonate anion concentration increased in all NaHCO3 conditions compared with the placebo (p < .0005), although this was lower with ENT than with GEL (p = .001) and DEL (p < .0005) NaHCO3. Changes in blood potential hydrogen were reduced with ENT compared with GEL (p = .047) and DEL (p = .047) NaHCO3, with no other differences between the conditions. Ingestion of ENT NaHCO3 attenuates GI disturbances for up to 3 hr postingestion. Therefore, ENT ingestion forms may be favorable for those who report GI disturbances with NaHCO3 supplementation or for those who have previously been deterred from its use altogether.

The time to peak blood bicarbonate (HCO3-), pH, and the strong ion difference (SID) following sodium bicarbonate (NaHCO3) ingestion in highly trained adolescent swimmers

The timing of sodium bicarbonate (NaHCO₃) supplementation has been suggested to be most optimal when coincided with a personal time that bicarbonate (HCO₃^–) or pH peaks in the blood following ingestion. However, the ergogenic mechanisms supporting this ingestion strategy are strongly contested. It is therefore plausible that NaHCO₃ may be ergogenic by causing beneficial shifts in the strong ion difference (SID), though the time course of this blood acid base balance variable is yet to be investigated. Twelve highly trained, adolescent swimmers (age: 15.9 ± 1.0 years, body mass: 65.3 ± 9.6 kg) consumed their typical pre-competition nutrition 1–3 hours before ingesting 0.3 g∙kg BM^-1 NaHCO₃ in gelatine capsules. Capillary blood samples were then taken during seated rest on nine occasions (0, 60, 75, 90, 105, 120, 135, 150, 165 min post-ingestion) to identify the time course changes in HCO₃^–, pH, and the SID. No significant differences were found in the time to peak of each blood measure (HCO₃^–: 130 ± 35 min, pH: 120 ± 38 min, SID: 98 ± 37 min; p = 0.08); however, a large effect size was calculated between time to peak HCO₃^– and the SID (g = 0.88). Considering that a difference between time to peak blood HCO₃^– and the SID was identified in adolescents, future research should compare the ergogenic effects of these two individualized NaHCO₃ ingestion strategies compared to a traditional, standardized approach.

Dietary and Ergogenic Supplementation to Improve Elite Soccer Players' Performance

BACKGROUND

Soccer is an extremely competitive sport, where the most match important moments can be defined in detail. Use of ergogenic supplements can be crucial to improve the performance of a high-performance athlete. Therefore, knowing which ergogenic supplements are important for soccer players can be an interesting strategy to maintain high level in this sport until final and decisive moments of the match. In addition, other supplements, such as dietary supplements, have been studied and increasingly referenced in the scientific literature. But, what if ergogenic supplements were combined with dietary supplements? This review brings some recommendations to improve performance of soccer athletes on the field through dietary and/or ergogenic supplements that can be used simultaneously.

SUMMARY

Soccer is a competitive sport, where the match important moments can be defined in detail. Thus, use of ergogenic supplements covered in this review can improve performance of elite soccer players maintaining high level in the match until final moments, such as creatine 3-5 g day-1, caffeine 3-6 mg kg-1 BW around 60 min before the match, sodium bicarbonate 0.1-0.4 g kg-1 BW starting from 30 to 180 min before the match, β-alanine 3.2 and 6.4 g day-1 provided in the sustained-release tablets divided into 4 times a day, and nitrate-rich beetroot juice 60 g in 200 mL of water (6 mmol of NO3- L) around 120 min before match or training, including a combination possible with taurine 50 mg kg-1 BW day-1, citrulline 1.2-3.4 g day-1, and arginine 1.2-6 g day-1. Key Messages: Soccer athletes can combine ergogenic and dietary supplements to improve their performance on the field. The ergogenic and dietary supplements used in a scientifically recommended dose did not demonstrate relevant side effects. The use of various evidence-based supplements can add up to further improvement in the performance of the elite soccer players.

The Effects of High Mineral Alkaline Water Consumed Over Three Consecutive Days on Reaction Time Following Anaerobic Exercise - A Randomized Placebo-Controlled Crossover Pilot Study

Drinking alkaline water after intense anaerobic exercise may enhance both cognitive and physical performance. This study aimed to investigate the effect of high mineral alkaline water consumed over three consecutive days on reaction time after anaerobic exercise in twelve healthy young males (aged 21.1 ± 1.3 years) with a valid sports medical examination. Participants were excluded when they took any medications or performance-enhancing supplements for the period of at least four weeks before the study commenced. Participants were randomly divided into two groups in this double-blind, placebo-controlled crossover pilot study. They ingested either alkaline water (AW) or regular table water ( RTW) for three consecutive days before anaerobic exercise. The anaerobic exercise consisted of two 2-min high-intensity step-tests with a passive rest interval of 3 minutes between the two bouts of exercise. Performance in the step-test (W), reaction time for visual and auditory signals, the rate of perceived exertion (RPE), urine specific gravity, and lactate concentration were analysed. No effect of AW was found on reaction time and the other variables except anaerobic performance. An-aerobic performance was significantly higher after ingestion of AW in both step-tests (p < 0.05). The ingestion of AW for three consecutive days before anaerobic exercise seems to positively affect anaerobic performance.

Effect of sodium bicarbonate contribution on energy metabolism during exercise: a systematic review and meta-analysis

Background

The effects of sodium bicarbonate (NaHCO₃) on anaerobic and aerobic capacity are commonly acknowledged as unclear due to the contrasting evidence thus, the present study analyzes the contribution of NaHCO₃ to energy metabolism during exercise.

Methods

Following a search through five databases, 17 studies were found to meet the inclusion criteria. Meta-analyses of standardized mean differences (SMDs) were performed using a random-effects model to determine the effects of NaHCO₃ supplementation on energy metabolism. Subgroup meta-analyses were conducted for the anaerobic-based exercise (assessed by changes in pH, bicarbonate ion [HCO₃⁻], base excess [BE] and blood lactate [BLa]) vs. aerobic-based exercise (assessed by changes in oxygen uptake [VO₂], carbon dioxide production [VCO₂], partial pressure of oxygen [PO₂] and partial pressure of carbon dioxide [PCO₂]).

Results

The meta-analysis indicated that NaHCO₃ ingestion improves pH (SMD = 1.38, 95% CI: 0.97 to 1.79, P < 0.001; I² = 69%), HCO₃⁻ (SMD = 1.63, 95% CI: 1.10 to 2.17, P < 0.001; I² = 80%), BE (SMD = 1.67, 95% CI: 1.16 to 2.19, P < 0.001, I² = 77%), BLa (SMD = 0.72, 95% CI: 0.34 to 1.11, P < 0.001, I² = 68%) and PCO₂ (SMD = 0.51, 95% CI: 0.13 to 0.90, P = 0.009, I² = 0%) but there were no differences between VO₂, VCO₂ and PO₂ compared with the placebo condition.

Conclusions

This meta-analysis has found that the anaerobic metabolism system (AnMS), especially the glycolytic but not the oxidative system during exercise is affected by ingestion of NaHCO₃. The ideal way is to ingest it is in a gelatin capsule in the acute mode and to use a dose of 0.3 g•kg^− 1 body mass of NaHCO₃ 90 min before the exercise in which energy is supplied by the glycolytic system.

Sodium Bicarbonate Ingestion Improves Time-to-Exhaustion Cycling Performance and Alters Estimated Energy System Contribution: A Dose-Response Investigation

This study investigated the effects of two sodium bicarbonate (NaHCO₃) doses on estimated energy system contribution and performance during an intermittent high-intensity cycling test (HICT), and time-to-exhaustion (TTE) exercise. Twelve healthy males (stature: 1.75 ± 0.08 m; body mass: 67.5 ± 6.3 kg; age: 21.0 ± 1.4 years; maximal oxygen consumption: 45.1 ± 7.0 ml.kg.min⁻¹) attended four separate laboratory visits. Maximal aerobic power (MAP) was identified from an incremental exercise test. During the three experimental visits, participants ingested either 0.2 g.kg⁻¹ BM NaHCO₃ (SBC2), 0.3 g.kg⁻¹ BM NaHCO₃ (SBC3), or 0.07 g.kg⁻¹ BM sodium chloride (placebo; PLA) at 60 min pre-exercise. The HICT involved 3 × 60 s cycling bouts (90, 95, 100% MAP) interspersed with 90 s recovery, followed by TTE cycling at 105% MAP. Blood lactate was measured after each cycling bout to calculate estimates for glycolytic contribution to exercise. Gastrointestinal (GI) upset was quantified at baseline, 30 and 60 min post-ingestion, and 5 min post-exercise. Cycling TTE increased for SBC2 (+20.2 s; p = 0.045) and SBC3 (+31.9 s; p = 0.004) compared to PLA. Glycolytic contribution increased, albeit non-significantly, during the TTE protocol for SBC2 (+7.77 kJ; p = 0.10) and SBC3 (+7.95 kJ; p = 0.07) compared to PLA. GI upset was exacerbated post-exercise after SBC3 for nausea compared to SBC2 and PLA (p < 0.05), whilst SBC2 was not significantly different to PLA for any symptom (p > 0.05). Both NaHCO₃ doses enhanced cycling performance and glycolytic contribution, however, higher doses may maximize ergogenic benefits.

Sodium bicarbonate improves sprint performance in endurance cycling

OBJECTIVES

Oral sodium bicarbonate intake (NaHCO₃) may improve performance in short maximal exercise by inducing metabolic alkalosis. However, it remains unknown whether NaHCO₃ also enhances all-out performance at the end of an endurance competition. Therefore, the present study investigated the effect of stacked NaHCO₃ loading on sprint performance following a 3-h simulated cycling race.

DESIGN

Double-blind randomized placebo-controlled cross-over study.

METHODS

Eleven trained male cyclists (22.3 (18.3-25.3) year; 73.0 (61.5-88) kg; VO₂max: 63.7 (57-72) mlkg^-1min^-1) ingested either 300mgkg^-1 body weight NaHCO₃ (BIC) or NaCl (PL). NaHCO₃ or NaCl was supplemented prior to (150mgkg^-1) and during (150mgkg^-1) a 3-h simulated cycling race with a 90-s all-out sprint (90S) at the end. Capillary blood samples were collected for determination of blood pH, lactate and HCO₃^- concentrations. Analysis of variance (lactate, pH, HCO₃^-) and paired t-test (power) were applied to compare variables across condition (and time).

RESULTS

NaHCO₃ intake improved mean power during 90S by ∼3% (541±59W vs. 524±57W in PL, p=0.047, Cohen's D=0.28, medium). Peak blood lactate concentration and heart rate at the end of 90S were higher (p<0.05) in BIC (16.2±4.1mmoll¹, 184±7bpm) than in PL (12.4±4.2mmoll^-1, 181±5bpm). NaHCO₃ ingestion increased blood [HCO₃^-] (31.5±1.3 vs. 24.4±1.5mmoll^-1 in PL, p<0.001) and blood pH (7.50±0.01 vs. 7.41±0.03 in PL, p<0.05) prior to 90S.

CONCLUSIONS

NaHCO₃ supplementation prior and during endurance exercise improves short all-out exercise performance at the end of the event. Therefore, sodium bicarbonate intake can be applied as a strategy to increase success rate in endurance competitions.

Topical Sodium Bicarbonate: No Improvement in Blood Buffering Capacity or Exercise Performance

PURPOSE

To assess the efficacy of a topical sodium bicarbonate (0.3 g/kg body weight NaHCO3) application (PR lotion; Amp Human) on blood buffering capacity and performance in recreationally active participants (study A) and moderately trained athletes (study B).

METHODS

In Study A, 10 participants completed 2 experimental trials: oral NaHCO3 (0.3 g/kg body weight + placebo lotion) or PR lotion (0.9036 g/kg body weight + oral placebo) applied 90 minutes prior to a cycling task to exhaustion (30-s sprints at 120% peak power output with 30-s rest). Capillary blood was collected and analyzed for pH, bicarbonate, and lactate every 10 minutes throughout the 90-minute loading period and postexercise at 5, 10, and 15 minutes. In Study B, 10 cyclists/triathletes completed 2 experimental trials, applying either PR or placebo lotion 30 minutes prior to a cycling performance task (3 × 30-s maximal sprints with 90-s recovery). Capillary blood samples were collected at baseline, preexercise, and postexercise and analyzed as per study A.

RESULTS

In Study A, pH and bicarbonate were significantly elevated from baseline after 10 minutes in the oral NaHCO3 condition and throughout recovery compared with no elevation in the PR lotion condition (P < .001). No differences in cycling time occurred between PR lotion (349 [119] s) and oral NaHCO3 (363 [80] s; P = .697). In Study B, no differences in blood parameters, mean power (P = .108), or peak power (P = .448) were observed between conditions.

CONCLUSIONS

PR lotion was ineffective in altering blood buffering capacity or enhancing performance in either trained or untrained individuals.

The influence of progressive-chronic and acute sodium bicarbonate supplementation on anaerobic power and specific performance in team sports: a randomized, double-blind, placebo-controlled crossover study

Background

The aims of this study were to verify the effect of progressive-chronic and acute sodium bicarbonate (SB) supplementation on the anaerobic capacity, blood acid-base balance, and discipline-specific performance in team sports disciplines.

Methods

Twenty-four trained male field hockey players completed a randomized, placebo-controlled, crossover trial of either progressive-chronic (increments from 0.05 up to 0.2 g/kg) or an acute one-off dose (0.2 g/kg) supplementation protocol. Before and after treatments, athletes completed an exercise protocol that comprised of a discipline-specific field performance test conducted between two separate Wingate anaerobic tests (WAnTs).

Results

Progressive-chronic SB supplementation improved anaerobic capacity in the first bout of WAnTs, as observed based on an increase in mean power (MP: 575 ± 71 vs. 602 ± 67 W, p = 0.005, ~ + 4.7%), peak power (PP: 749 ± 94 vs. 777 ± 96 W, p = 0.002, ~ + 3.7%), power carry threshold (P_CT) at 97%_PP (727 ± 91 vs. 753 ± 93 W, p = 0.002, ~ + 3.6%) and average power over P_CT (739 ± 94 vs. 765 ± 95 W, p = 0.001, ~ + 3.5%). Acute SB supplementation had no effect on anaerobic capacity. However, an improvement in time during discipline-specific field performance test was observed after progressive-chronic (919 ± 42 vs. 912 ± 27 s, p = 0.05; ~ - 0.8%) and acute (939 ± 26 vs. 914 ± 22 s, p = 0.006, ~ 2.7%) SB supplementation. Acute SB supplementation also improved post-exercise parameters of acid-base balance (based on blood pH, bicarbonate concentration and base excess) compared to no supplementation or placebo.

Conclusions

Our study indicates that both chronic and acute SB supplementation positively supports discipline-specific performance among field hockey athletes. Moreover, the chronic protocol supported anaerobic power indices before the inset of exercise-induced fatigue but had no significant impact afterwards. However, only the acute protocol significantly affected the buffering capacity, which can be used to determine athlete's performance during high-intensity sporting events. This study design therefore highlighted that future studies focusing on sodium bicarbonate supplementation in team sports should concentrate on the efficiency of chronic and acute supplementation in varying time frames.

Enteric-coated sodium bicarbonate supplementation improves high-intensity cycling performance in trained cyclists

Purpose

Enteric-coated sodium bicarbonate (NaHCO₃) can attenuate gastrointestinal (GI) symptoms following acute bicarbonate loading, although the subsequent effects on exercise performance have not been investigated. The purpose of this study was to examine the effects of enteric-coated NaHCO₃ supplementation on high-intensity exercise performance and GI symptoms.

Methods

Eleven trained male cyclists completed three 4 km time trials after consuming; a placebo or 0.3 g∙kg^–1 body mass NaHCO₃ in enteric-coated or gelatin capsules. Exercise trials were timed with individual peak blood bicarbonate ion concentration ([HCO₃^–]). Blood acid–base balance was measured pre-ingestion, pre-exercise, and post-exercise, whereas GI symptoms were recorded pre-ingestion and immediately pre-exercise.

Results

Pre-exercise blood [HCO3⁻] and potential hydrogen (pH) were greater for both NaHCO₃ conditions (P < 0.0005) when compared to placebo. Performance time was faster with enteric-coated (− 8.5 ± 9.6 s, P = 0.044) and gelatin (− 9.6 ± 7.2 s, P = 0.004) NaHCO₃ compared to placebo, with no significant difference between conditions (mean difference = 1.1 ± 5.3 s, P = 1.000). Physiological responses were similar between conditions, although blood lactate ion concentration was higher with gelatin NaHCO₃ (2.4 ± 1.7 mmol∙L^–1, P = 0.003) compared with placebo. Furthermore, fewer participants experienced GI symptoms with enteric-coated (n = 3) compared to gelatin (n = 7) NaHCO₃.

Discussion

Acute enteric-coated NaHCO₃ consumption mitigates GI symptoms at the onset of exercise and improves subsequent 4 km cycling TT performance. Athletes who experience GI side-effects after acute bicarbonate loading may, therefore, benefit from enteric-coated NaHCO₃ supplementation prior to exercise performance.

Effects of daily ingestion of sodium bicarbonate on acid-base status and anaerobic performance during an altitude sojourn at high altitude: a randomized controlled trial

Background

The present study investigated the effects of chronic sodium bicarbonate (NaHCO₃) ingestion on a single bout of high-intensity exercise and on acid-base balance during 7-day high-altitude exposure.

Methods

Ten recreationally active subjects participated in a pre-test at sea level and a 7-day hiking tour in the Swiss Alps up to 4554 m above sea level. Subjects received either a daily dose of 0.3 g/kg NaHCO₃ solution (n = 5) or water as a placebo (n = 5) for 7 days. Anaerobic high-intensity exercise performance was assessed using the portable tethered sprint running (PTSR) test under normoxic and hypoxic conditions (3585 m). PTSR tests assessed overall peak force, mean force, and fatigue index. Blood lactate levels and blood gas parameters were assessed pre- and post-PTSR. Urinary pH and blood gas parameters were further analyzed daily at rest in early morning samples under normoxic and hypoxic conditions.

Results

There were no significant differences between the bicarbonate and control group in any of the PTSR-related parameters. However, urinary pH (p = 0.003, ηp² = 0.458), early morning blood bicarbonate concentration (p < 0.001, ηp² = 0.457) and base excess (p = 0.002, ηp² = 0.436) were significantly higher in the bicarbonate group compared with the control group under hypoxic conditions.

Conclusions

These results indicate that oral NaHCO₃ ingestion does not ameliorate the hypoxia-induced impairment in anaerobic, high-intensity exercise performance, represented by PTSR-related test parameters, under hypobaric, hypoxic conditions, but the maximal performance measurements may have been negatively affected by other factors, such as poor implementation of PTSR test instructions, pre-acclimatization, the time course of hypoxia-induced renal [HCO₃⁻] compensation, changes in the concentrations of intra- and extracellular ions others than [H⁺] and [HCO₃⁻], or gastrointestinal disturbances caused by NaHCO₃ ingestion. However, chronic NaHCO₃ ingestion improves blood bicarbonate concentration and base excess at altitude, which partially represent the blood buffering capacity.

Greater lactate accumulation following an acute bout of high-intensity exercise in males suppresses acylated ghrelin and appetite postexercise

High-intensity exercise inhibits appetite, in part, via alterations in the peripheral concentrations of the appetite-regulating hormones acylated ghrelin, active glucagon-like peptide-1 (GLP-1), and active peptide tyrosine-tyrosine (PYY). Given lactate may mediate these effects, we used sodium bicarbonate (NaHCO₃) supplementation in a double-blind, placebo-controlled, crossover design to investigate lactate's purported role in exercise-induced appetite suppression. Eleven males completed two identical high-intensity interval training sessions (10 × 1 min cycling bouts at ~90% heart rate maximum interspersed with 1-min recovery), where they ingested either NaHCO₃ (BICARB) or sodium chloride (NaCl) as a placebo (PLACEBO) preexercise. Blood lactate, acylated ghrelin, GLP-1, and PYY concentrations, as well as overall appetite were assessed preexercise and 0, 30, 60, and 90 min postexercise. Blood lactate was greater immediately (P < 0.001) and 30 min postexercise (P = 0.049) in the BICARB session with an increased (P = 0.009) area under the curve (AUC). The BICARB session had lower acylated ghrelin at 60 (P = 0.014) and 90 min postexercise (P = 0.016), with a decreased AUC (P = 0.039). The BICARB session had increased PYY (P = 0.034) with an increased AUC (P = 0.031). The BICARB session also tended (P = 0.060) to have increased GLP-1 at 30 (P = 0.003) and 60 min postexercise (P < 0.001), with an increased AUC (P = 0.030). The BICARB session tended (P = 0.059) to reduce overall appetite, although there was no difference in AUC (P = 0.149). These findings support a potential role for lactate in the high-intensity exercise-induced appetite-suppression.NEW & NOTEWORTHY We used sodium bicarbonate to increase lactate accumulation or sodium chloride as a placebo. Our findings further implicate lactate as a mediator of exercise-induced appetite suppression, given exercise-induced increases in lactate during the sodium bicarbonate session altered peripheral concentrations of appetite-regulating hormones, culminating in a reduction of appetite. This supports a lactate-dependent mechanism of appetite suppression following high-intensity exercise and highlights the potential of using lactate as a means of inducing a caloric deficit.

Gastrointestinal Effects of Exogenous Ketone Drinks are Infrequent, Mild, and Vary According to Ketone Compound and Dose

Exogenous ketone drinks may improve athletic performance and recovery, but information on their gastrointestinal tolerability is limited. Studies to date have used a simplistic reporting methodology that inadequately represents symptom type, frequency, and severity. Herein, gastrointestinal symptoms were recorded during three studies of exogenous ketone monoester (KME) and salt (KS) drinks. Study 1 compared low- and high-dose KME and KS drinks consumed at rest. Study 2 compared KME with isocaloric carbohydrate (CHO) consumed at rest either when fasted or after a standard meal. Study 3 compared KME+CHO with isocaloric CHO consumed before and during 3.25 hr of bicycle exercise. Participants reported symptom type and rated severity between 0 and 8 using a Likert scale at regular intervals. The number of visits with no symptoms reported after ketone drinks was n = 32/60 in Study 1, n = 9/32 in Study 2, and n = 20/42 in Study 3. Following KME and KS drinks, symptoms were acute but mild and were fully resolved by the end of the study. High-dose KS drinks caused greater total-visit symptom load than low-dose KS drinks (13.8 ± 4.3 vs. 2.0 ± 1.0; p < .05) and significantly greater time-point symptom load than KME drinks 1–2 hr postdrink. At rest, KME drinks caused greater total-visit symptom load than CHO drinks (5.0 ± 1.6 vs. 0.6 ± 0.4; p < .05). However, during exercise, there was no significant difference in total-visit symptom load between KME+CHO (4.2 ± 1.0) and CHO (7.2 ± 1.9) drinks. In summary, exogenous ketone drinks cause mild gastrointestinal symptoms that depend on time, the type and amount of compound consumed, and exercise.

Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial

INTRODUCTION

Bloating is one of the most common gastrointestinal complaints. Evidence has linked fiber and sodium to bloating; however, randomized trials examining these diet components are lacking. Here, we used a randomized trial to examine the effects of the high-fiber DASH diet and dietary sodium intake on abdominal bloating. We hypothesized that both the high-fiber DASH diet and higher sodium intake would increase bloating.

METHODS

The DASH-Sodium trial (1998-1999) randomized healthy adults to a high-fiber (32 g/d) DASH or low-fiber (11 g/d) Western diet (control). On their assigned diet, participants ate 3 sodium levels (50, 100, and 150 mmol/d at 2100 kcal) in 30-day periods in random order, with 5-day breaks between each period. The participants reported the presence of bloating at baseline and after each feeding period. Statistical analyses included log-binomial models to evaluate the risk of bloating.

RESULTS

Of 412 participants (mean age 48 years; 57% women; 57% black), 36.7% reported bloating at baseline. Regardless of the diet, high sodium intake increased the risk of bloating (risk ratio = 1.27; 95% confidence interval: 1.06-1.52; P = 0.01). The high-fiber DASH diet also increased the risk of bloating over all sodium levels (risk ratio = 1.41; 95% confidence interval: 1.22-1.64; P < 0.001). The effect of high-fiber DASH on bloating was greater in men than in women (P for interaction = 0.001).

DISCUSSION

Higher dietary sodium increased bloating, as did the high-fiber DASH diet. Although healthful high-fiber diets may increase bloating, these effects may be partially mitigated by decreasing dietary sodium intake. Future research is needed to explore mechanisms by which sodium intake and diet can influence bloating.

A Novel Ingestion Strategy for Sodium Bicarbonate Supplementation in a Delayed-Release Form: a Randomised Crossover Study in Trained Males

Background

Sodium bicarbonate (NaHCO₃) is a well-established nutritional ergogenic aid, though gastrointestinal (GI) distress is a common side-effect. Delayed-release NaHCO₃ may alleviate GI symptoms and enhance bicarbonate bioavailability following oral ingestion, although this has yet to be confirmed.

Methods

In a randomised crossover design, pharmacokinetic responses and acid-base status were compared following two forms of NaHCO₃, as were GI symptoms. Twelve trained healthy males (mean ± SD age 25.8 ± 4.5 years, maximal oxygen uptake (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$\end{document}V˙O2max) 58.9 ± 10.9 mL kg min⁻¹, height 1.8 ± 0.1 m, body mass 82.3 ± 11.1 kg, fat-free mass 72.3 ± 10.0 kg) underwent a control (CON) condition and two experimental conditions: 300 mg kg⁻¹ body mass NaHCO₃ ingested as an aqueous solution (SOL) and encased in delayed-release capsules (CAP). Blood bicarbonate concentration, pH and base excess (BE) were measured in all conditions over 180 min, as were subjective GI symptom scores.

Results

Incidences of GI symptoms and overall severity were significantly lower (mean difference = 45.1%, P < 0.0005 and 47.5%, P < 0.0005 for incidences and severity, respectively) with the CAP than with the SOL. Symptoms displayed increases at 40 to 80 min post-ingestion with the SOL that were negated with CAP (P < 0.05). Time to reach peak bicarbonate concentration, pH and BE were significantly longer with CAP than with the SOL.

Conclusions

In summary, CAP can mitigate GI symptoms induced with SOL and should be ingested earlier to induce similar acid-base changes. Furthermore, CAP may be more ergogenic in those who experience severe GI distress with SOL, although this warrants further investigation.

Does Sodium Citrate Cause the Same Ergogenic Effect As Sodium Bicarbonate on Swimming Performance?

The aim of this study was to investigate the effect of ingesting sodium bicarbonate (SB) and sodium citrate (SC) on 400 m high-intensity swimming performance and blood responses. Six nationally ranked male swimmers (20.7 ± 2.1 yrs; 184 ± 6 cm; 79.9 ± 3.9 kg; 10.6 ± 1% body fat) participated in a double blinded, placebo controlled crossover trial. Ninety minutes after consuming SB (0.3 g·kg^-1), SC (0.3 g·kg^-1) or a placebo (PL) participants completed a single 400-m freestyle maximal test on three consecutive days. The order of the supplementation was randomized. Capillary blood samples were collected on 4 occasions: at rest (baseline), 60 min post-ingestion, immediately post-trial and 15 min post-trial. Blood pH, HCO_3- concentration and base excess (BE) were determined. Blood pH, HCO_3-, BE were significantly elevated from before loading to the pre-test (60 min post-ingestion) (p < 0.05) after SB ingestion, but not after SC ingestion (p > 0.05). Performance times were improved by 0.6% (p > 0.05) after supplementation of SB over PL in 5 out of 6 participants (responders). In contrast, ingestion of SC decreased performance by 0.2% (p > 0.05). No side effects were observed in either trial. Delayed blood response was observed after SC ingestion compared to SB and this provided no or modest ergogenic effect, respectively, for single bout high-intensity swimming exercise. Monitoring the magnitude of the time-to-peak level rise in alkalosis may be recommended in order to individualize the loading time accordingly before commencement of exercise.

The Effect of a New Sodium Bicarbonate Loading Regimen on Anaerobic Capacity and Wrestling Performance

Gastrointestinal side effects are the main problem with sodium bicarbonate (SB) use in sports. Therefore, our study assessed the effect of a new SB loading regimen on anaerobic capacity and wrestling performance. Fifty-eight wrestlers were randomized to either a progressive-dose regimen of up to 100 mg∙kg⁻¹ of SB or a placebo for 10 days. Before and after treatment, athletes completed an exercise protocol that comprised, in sequence, the first Wingate, dummy throw, and second Wingate tests. Blood samples were taken pre- and post-exercise. No gastrointestinal side effects were reported during the study. After SB treatment, there were no significant improvements in the outcomes of the Wingate and dummy throw tests. The only index that significantly improved with SB, compared to the placebo (p = 0.0142), was the time-to-peak power in the second Wingate test, which decreased from 3.44 ± 1.98 to 2.35 ± 1.17 s. There were also no differences in blood lactate or glucose concentrations. In conclusion, although the new loading regimen eliminated gastrointestinal symptoms, the doses could have been too small to elicit additional improvements in anaerobic power and wrestling performance. However, shortening the time-to-peak power during fatigue may be particularly valuable and is one of the variables contributing to the final success of a combat sports athlete.

The effect of chronic progressive-dose sodium bicarbonate ingestion on CrossFit-like performance: A double-blind, randomized cross-over trial

Background

Sodium bicarbonate (SB) has been proposed as an ergogenic aid, as it improves high-intensity and resistance exercise performance. However, no studies have yet investigated SB application in CrossFit. This study examined the effects of chronic, progressive-dose SB ingestion on CrossFit-like performance and aerobic capacity.

Methods

In a randomized, double-blind, cross-over trial, 21 CrossFit-trained participants were randomly allocated to 2 groups and underwent 2 trials separated by a 14-day washout period. Participants ingested either up to 150 mg∙kg^-1 of SB in a progressive-dose regimen or placebo for 10 days. Before and after each trial, Fight Gone Bad (FGB) and incremental cycling (ICT) tests were performed. In order to examine biochemical responses, blood samples were obtained prior to and 3 min after completing each exercise test.

Results

No gastrointestinal (GI) side effects were reported during the entire protocol. The overall FGB performance improved under SB by ~6.1% (p<0.001) and it was ~3.1% higher compared to post placebo (PLA_post) (p = 0.040). The number of repetitions completed in each round also improved under SB (mean from baseline: +5.8% to +6.4%). Moreover, in ICT, the time to ventilatory threshold (VT) (~8:25 min SB_post vs. ~8:00 min PLA_post, p = 0.020), workload at VT (~218 W SB_post vs. ~208 W PLA_post, p = 0.037) and heart rate at VT (~165 bpm SB_post vs. ~161 bpm PLA_post, p = 0.030) showed higher SB_post than PLA_post. Furthermore, the maximum carbon dioxide production increased under SB by ~4.8% (from ~3604 mL∙min^-1 to ~3776 mL∙min^-1, p = 0.049). Pyruvate concentration and creatine kinase activity before ICT showed higher SB_post than PLA_post (~0.32 mmol∙L^-1 vs. ~0.26 mmol∙L^-1, p = 0.001; ~275 U∙L^-1 vs. ~250 U∙L^-1, p = 0.010, respectively). However, the small sample size limits the wide-application of our results.

Conclusions

Progressive-dose SB ingestion regimen eliminated GI side effects and improved CrossFit-like performance, as well as delayed ventilatory threshold occurrence.

Effect of acute ingestion of β-hydroxybutyrate salts on the response to graded exercise in trained cyclists

Acute ingestion of ketone salts induces nutritional ketosis by elevating β-hydroxybutyrate (βHB), but few studies have examined the metabolic effects of ingestion prior to exercise. Nineteen trained cyclists (12 male, 7 female) undertook graded exercise (8 min each at ∼30%, 40%, 50%, 60%, 70%, and 80% VO_2peak) on a cycle ergometer on two occasions separated by either 7 or 14 days. Trials included ingestion of boluses of either (i) plain water (3.8 mL kg body mass^-1) (CON) or (ii) βHB salts (0.38 g kg body mass^-1) in plain water (3.8 mL kg body mass^-1) (KET), at both 60 min and 15 min prior to exercise. During KET, plasma [βHB] increased to 0.33 ± 0.16 mM prior to exercise and 0.44 ± 0.15 mM at the end of exercise (both p < .05). Plasma glucose was 0.44 ± 0.27 mM lower (p < .01) 30 min after ingestion of KET and remained ∼0.2 mM lower throughout exercise compared to CON (p < .001). Respiratory exchange ratio (RER) was higher during KET compared to CON (p < .001) and 0.03-0.04 higher from 30%VO_2peak to 60%VO_2peak (all p < .05). No differences in plasma lactate, rate of perceived exertion, or gross or delta efficiency were observed between trials. Gastrointestinal symptoms were reported in 13 out of 19 participants during KET. Acute ingestion of βHB salts induces nutritional ketosis and alters the metabolic response to exercise in trained cyclists. Elevated RER during KET may be indicative of increased ketone body oxidation during exercise, but at the plasma βHB concentrations achieved, ingestion of βHB salts does not affect lactate appearance, perceived exertion, or muscular efficiency.

Cholinergic anti-inflammatory pathway and gastrointestinal diseases

Upon stimulation, vagus nerves release acetylcholine in local tissues, which can regulate immunecell function and inflammatory responses, operationally through alpha 7 nicotinic acetylcholine receptor. This process is termed cholinergic anti-inflammatory pathway (CAP). It has been shown that CAP exhibits physical functions, and also contributes to the progression of a variety of gastrointestinal diseases, such as inflammatory bowel disease, esophagitis, allergic intestine inflammation, peptic ulcer, colitis, and hepatitis. This review discusses the physical function of CAP, as well as its pivotal role in the development of gastrointestinal diseases.

Effects of dietary Acid load on exercise metabolism and anaerobic exercise performance

Dietary acid load, quantified as the potential renal acid load (PRAL) of the diet, affects systemic pH and acid-base regulation. In a previous cross-sectional study, we reported that a low dietary PRAL (i.e. alkaline promoting diet) is associated with higher respiratory exchange ratio (RER) values during maximal exercise. The purpose of the present study was to confirm the previous findings with a short-term dietary intervention study. Additionally, we sought to determine if changes in PRAL affects submaximal exercise RER (as a reflection of substrate utilization) and anaerobic exercise performance. Subjects underwent a graded treadmill exercise test (GXT) to exhaustion and an anaerobic exercise performance test on two occasions, once after following a low-PRAL diet and on a separate occasion, after a high-PRAL diet. The diets were continued as long as needed to achieve an alkaline or acid fasted morning urine pH, respectively, with all being 4-9 days in duration. RER was measured during the GXT with indirect calorimetry. The anaerobic performance test was a running time-to-exhaustion test lasting 1-4 min. Maximal exercise RER was lower in the low-PRAL trial compared to the high-PRAL trial (1.10 ± 0.02 vs. 1.20 ± 0.05, p = 0.037). The low-PRAL diet also resulted in a 21% greater time to exhaustion during anaerobic exercise (2.56 ± 0.36 vs. 2.11 ± 0.31 sec, p = 0.044) and a strong tendency for lower RER values during submaximal exercise at 70% VO2max (0.88 ± 0.02 vs. 0.96 ± 0.04, p = 0.060). Contrary to our expectations, a short-term low-PRAL (alkaline promoting) diet resulted in lower RER values during maximal-intensity exercise. However, the low-PRAL diet also increased anaerobic exercise time to exhaustion and appears to have shifted submaximal exercise substrate utilization to favor lipid oxidation and spare carbohydrate, both of which would be considered favorable effects in the context of exercise performance. Key pointsShort-term (4-9 days) changes in the acid or alkaline promoting qualities of the diet, quantified as potential renal acid load (PRAL), alter systemic pH, as evidenced in the present study by changes in fasted morning urine pH. Low-PRAL (alkaline promoting) diets are characterized by high intakes of vegetables and fruits with limited consumption of meats, cheeses, and grains while high-PRAL diets are characterized by the opposite dietary pattern.An alkaline promoting (low-PRAL) diet increases anaerobic exercise performance, as evidenced by greater time-to-exhaustion during high-intensity treadmill running.Preliminary evidence suggests that an alkaline promoting (low-PRAL) diet increases lipid oxidation and may have a carbohydrate-sparing effect during submaximal endurance exercise, although further studies are needed.In contrast to what has been observed in response to habitual/long-term dietary patterns, a short-term low-PRAL diet does not increase maximal exercise respiratory exchange ratio and even appears to lower it. This suggests that short-term and long-term alterations in PRAL have different physiologic effects on this parameter.