The blood acid base and gastrointestinal response to three different forms of sodium citrate encapsulation

Enterically coated (ENT) or delayed-release (DEL) capsules may lessen gastrointestinal symptoms (GIS) following acute sodium citrate (SC) ingestion, although the effects on blood acid-base balance are undetermined. Fourteen active males ingested 0.4 g.kg-1 body mass (BM) SC, within gelatine (GEL), DEL and ENT capsules or 0.07 g.kg-1 BM sodium chloride control (CON). Blood acid-base balance and GIS were measured for 4 h. Ingestion form had no significant effect on total GIS experienced (GEL: 2 ± 7; DEL: 1 ± 8; ENT: 1 ± 4 AU). Most (7/14) participants experienced zero symptoms throughout. Peak GIS typically emerged ≤100 min post-ingestion, with a similar time to reach peak GIS between ingestion form (GEL: 36 ± 70; DEL: 13 ± 28; ENT: 15 ± 33 AU). Blood [HCO3-] was significantly higher with ENT versus GEL (ENT: 29.0 ± 0.8; GEL: 28.5 ± 1.1 mmol.L-1, P = 0.037). Acute ingestion of a reduced SC dose elicited minimal GIS, producing significant changes in blood [HCO3-] from rest, irrespective of ingestion form (GEL: 6.0 ± 0.9; DEL: 5.1 ± 1.0; ENT: 6.2 ± 0.8 mmol.L-1). The necessity of individualized ingestion strategies is also challenged, with sustained increases in blood [HCO3-] of ≥4 mmol.L-1 for up to 153 min highlighted. If commencing exercise at peak alkalosis augments subsequent performance above starting at a standardized time point where HCO3- is still elevated remains unclear.

Acute effects of sodium citrate supplementation on competitive performance and lactate level of elite fitness challenge athletes: A crossover, placebo-controlled, double-blind study

Purpose

The performance of sodium citrate has been investigated in high-intensity exercises, but fewer studies have addressed the role of citrate in weight-bearing exercises.

Methods

Twenty fitness challenge athletes, aged 24-32 years, volunteered to participate in this crossover, placebo-controlled, double-blind study. Initially, ten athletes were given a placebo and asked to complete a fitness challenge (i.e., chin-ups, squat jumps, dips, walking lunges, sit-ups, and burpees-devil press). Another ten athletes were supplemented with sodium citrate 0.5 g/kg body mass supplements 3 h prior to performing the fitness challenges. The same procedures were completed two days later with the supplement and placebo dextrose groups switched in a cross-over design. Athletes and assessors were blinded for the experimental condition (placebo vs. verum). Lactate levels were measured 5 min after exercise. The athletes' performance on each item of the fitness challenge as well as their lactate levels, were compared. Differences between the means of the measured variables were contrasted using a dependent t-test.

Results

Supplementing sodium citrate substantially improved athletes' performance in all six fitness challenge items (p < 0.05, 0.69

Conclusion

Acute sodium citrate supplementation may help fitness challengers postpone muscular fatigue and increase performance, potentially via the prevention of lactate accumulation.

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Key Words

• Anaerobic performance
• Dietary supplement
• Lactatemia
• Sodium citrate

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MESH Headings Collapse

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Affiliation(s)

Magshoud Nabilpour Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
Amira Zouita Higher Institute of Sports Sciences and Physical Education ksar said, University of la Manouba, Research Laboratory (UR23JS01) “Sport Performance, Health & Society”, Tunisia
Jerry Mayhew Department of Health and Exercise Sciences, Kirksville, MO, United States
Gholam Rasul Mohammad Rahimi Department of Sport Sciences, Vahdat Institute of Higher Education, Torbat-e-Jam, Iran
Yaser Alikhajeh Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
Morteza Taheri Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran Department of Cognitive and Behavioral Sciences in Sport, Faculty of Sport Science and Health, University of Tehran, Tehran, Iran
Khadijeh Irandoust Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran Department of Cognitive and Behavioral Sciences in Sport, Faculty of Sport Science and Health, University of Tehran, Tehran, Iran
Leila Youzbashi Department of Sport Science, Faculty of Humanities, University of Zanjan, Zanjan, Iran
Urs Granacher Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, Freiburg, Germany
Hassane Zouhal Movement Sport, Health and Sciences Laboratory (M2S) UFR-STAPS, University of Rennes 2-ENS Cachan, Charles Tillon, France Institut International des Sciences Du Sport (2IS), Irodouer, France

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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.

Use of Buffers in Specific Contexts: Highly Trained Female Athletes, Extreme Environments and Combined Buffering Agents-A Narrative Review

This narrative review evaluated the evidence for buffering agents (sodium bicarbonate, sodium citrate and beta-alanine), with specific consideration of three discrete scenarios: female athletes, extreme environments and combined buffering agents. Studies were screened according to exclusion and inclusion criteria and were analysed on three levels: (1) moderating variables (supplement dose and timing, and exercise test duration and intensity), (2) design factors (e.g., use of crossover or matched group study design, familiarisation trials) and (3) athlete-specific factors (recruitment of highly trained participants, buffering capacity and reported performance improvements). Only 19% of the included studies for the three buffering agents reported a performance benefit, and only 10% recruited highly trained athletes. This low transferability of research findings to athletes' real-world practices may be due to factors including the small number of sodium citrate studies in females (n = 2), no studies controlling for the menstrual cycle (MC) or menstrual status using methods described in recently established frameworks, and the limited number of beta-alanine studies using performance tests replicating real-world performance efforts (n = 3). We recommend further research into buffering agents in highly trained female athletes that control or account for the MC, studies that replicate the demands of athletes' heat and altitude camps, and investigations of highly trained athletes' use of combined buffering agents. In a practical context, we recommend developing evidence-based buffering protocols for individual athletes which feature co-supplementation with other evidence-based products, reduce the likelihood of side-effects, and optimise key moderating factors: supplement dose and timing, and exercise duration and intensity.

The Effects of Amorphous Calcium Carbonate (ACC) Supplementation on Resistance Exercise Performance in Women

The effects of 9 weeks of amorphous calcium carbonate (ACC) supplementation (1000 mg/day) and resistance exercise training (RT) on one repetition maximum (1-RM) values were tested. Thirty-one women (33.1 ± 7.3 y) were randomly assigned into a supplement (ACC, n = 14) or a placebo (PL, n = 17) group. On day 1 and following 9 weeks of intervention, the participants underwent anthropometric measurements and filled out a food frequency questionnaire (FFQ) and sports injuries questionnaires. 1-RM values were measured for the back squat and bench press exercises. All the participants significantly (p = 0.01) improved their mean back squat and bench press 1-RM values (time effect). While no between-group difference was observed in the bench press 1-RM values, the ACC groups' mean post-pre bench press 1-RM differences (Δ1-RM) were significantly higher than in the PL group, expressed in kg (p = 0.049), per body mass (p = 0.042), or per lean body mass (p = 0.035). No significant interaction was observed for time X group effect (p = 0.421). No differences (within- or between-groups) were observed in the anthropometric values or in the questionnaires' results. ACC supplementation revealed an ergogenic effect by augmenting the improvement of maximum amount generated force, which can possibly be attributed to the calcium and/or the carbonate components.

Sport supplements and the athlete's gut: a review

Vigorous or prolonged exercise poses a challenge to gastrointestinal system functioning and is associated with digestive symptoms. This narrative review addresses 1) the potential of dietary supplements to enhance gut function and reduce exercise-associated gastrointestinal symptoms and 2) strategies for reducing gastrointestinal-related side effects resulting from popular sports supplements. Several supplements, including probiotics, glutamine, and bovine colostrum, have been shown to reduce markers of gastrointestinal damage and permeability with exercise. Yet, the clinical ramifications of these findings are uncertain, as improvements in symptoms have not been consistently observed. Among these supplements, probiotics modestly reduced exercise-associated gastrointestinal symptoms in a few studies, suggesting they are the most evidenced-based choice for athletes looking to manage such symptoms through supplementation. Carbohydrate, caffeine, and sodium bicarbonate are evidence-based supplements that can trigger gastrointestinal symptoms. Using glucose-fructose mixtures is beneficial when carbohydrate ingestion is high (>50 g/h) during exercise, and undertaking multiple gut training sessions prior to competition may also be helpful. Approaches for preventing caffeine-induced gastrointestinal disturbances include using low-to-moderate doses (<500 mg) and avoiding/minimizing exacerbating factors (stress, anxiety, other stimulants, fasting). Adverse gastrointestinal effects of sodium bicarbonate can be avoided by using enteric-coated formulations, low doses (0.2 g/kg), or multi-day loading protocols.

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.

Extracellular buffer choice influences acid-base responses and gastrointestinal symptoms

To compare the bicarbonate kinetics and gastrointestinal (GI) symptom responses between an equal dose of sodium bicarbonate and sodium citrate using delayed-release capsules. Thirteen active males (age 20.5 ± 2.1 y, height 1.8 ± 0.1 m and body mass [BM] 76.5 ± 9.6 kg) consumed either 0.3 g^.kg^-1 BM sodium bicarbonate, sodium citrate or a placebo, using a double-blind, randomized crossover design. Blood bicarbonate ion (HCO₃^-) concentration, pH and GI symptoms were measured pre-consumption and every 10 min for 180 min post-consumption. Blood HCO₃^- concentration (P < 0.001) and pH (P = 0.040) were significantly higher in the sodium bicarbonate condition compared with sodium citrate condition up to 3 h post-consumption. Peak blood HCO₃^- concentration was significantly higher with the sodium bicarbonate compared with citrate (P < 0.001). Mean GI symptom scores were lower (P = 0.037) for sodium citrate (1.5 ± 1.8 AU) than bicarbonate (2.6 ± 3.1 AU), with considerable inter-individual variability. No GI symptoms were reported following consumption of the placebo. Both substances increase HCO₃^- values significantly, with sodium bicarbonate causing significantly higher pH and HCO₃^- values than the same dose of sodium citrate, but results in slightly more severe GI symptoms.

Capsule Size Alters the Timing of Metabolic Alkalosis Following Sodium Bicarbonate Supplementation

Introduction: Sodium bicarbonate (NaHCO3) is a well-established nutritional ergogenic aid that is typically ingested as a beverage or consumed in gelatine capsules. While capsules may delay the release of NaHCO3 and reduce gastrointestinal (GI) side effects compared with a beverage, it is currently unclear whether the capsule size may influence acid-base responses and GI symptoms following supplementation. Aim: This study aims to determine the effects of NaHCO3 supplementation, administered in capsules of different sizes, on acid-base responses, GI symptoms, and palatability. Methods: Ten healthy male subjects (mean ± SD: age 20 ± 2 years; height 1.80 ± 0.09 m; weight 78.0 ± 11.9 kg) underwent three testing sessions whereby 0.3 g NaHCO3/kg of body mass was consumed in either small (size 3), medium (size 0), or large (size 000) capsules. Capillary blood samples were procured pre-ingestion and every 10 min post-ingestion for 180 min. Blood samples were analyzed using a radiometer (Radiometer ABL800, Denmark) to determine blood bicarbonate concentration ([HCO 3 - ]) and potential hydrogen (pH). GI symptoms were measured using a questionnaire at the same timepoints, whereas palatability was recorded pre-consumption. Results: Capsule size had a significant effect on lag time (the time [HCO 3 - ] changed, T lag) and the timing of peak blood [HCO 3 - ] (T max). Bicarbonate T lag was significantly higher in the large-sized (28 ± 4 min) compared with the small-sized (13 ± 2 min) capsules (P = 0.009). Similarly, T max was significantly lower in the small capsule (94 ± 24 min) compared with both the medium-sized (141 ± 27 min; P < 0.001) and the large-sized (121 ± 29 min; P < 0.001) capsules. The GI symptom scores were similar for small-sized (3 ± 3 AU), medium-sized (5 ± 3 AU), and large-sized (3 ± 3 AU) capsules, with no significant difference between symptom scores (F = 1.3, P = 0.310). Similarly, capsule size had no effect on palatability (F = 0.8, P = 0.409), with similar scores between different capsule sizes. Conclusion: Small capsule sizes led to quicker T lag and T max of blood [HCO 3 - ] concentration compared to medium and large capsules, suggesting that individuals could supplement NaHCO3 in smaller capsules if they aim to increase extracellular buffering capacity more quickly.

The Impact of Individualizing Sodium Bicarbonate Supplementation Strategies on World-Class Rowing Performance

Contemporary meta-analyses have generally demonstrated a positive effect of sodium bicarbonate (NaHCO₃) supplementation on exercise performance. However, despite these claims, there is limited data on contrasting individualized and standardized timing of NaHCO₃ ingestion prior to exercise to further enhance performance outcomes.

Purpose: To determine whether NaHCO₃ ingestion timing impacts 2,000-m rowing time-trial (TT) performance in elite-level rowers (Senior National team including Olympic/World Championships level) adhering to their own individualized pre-race strategies (e.g. nutrition, warm-up, etc.).

Methods: Twenty three (n = 23) rowers across two research centers (using the exact same methods/protocols) completed three trials: NaHCO₃ loading profile at rest to determine the individual's time-to-peak bicarbonate concentration [HCO3-], followed by two randomized 0.3 g·kgBM⁻¹ NaHCO₃ supplementation experimental trials conducted at different time points [consensus timing (CON): TT performed 60 min post-NaHCO₃ ingestion; and individualized peak (IP): TT performed at the rower's individual peak [HCO3-] determined from the profiling trial post-NaHCO₃ ingestion].

Results: There was a significant mean difference of +2.9 [± 0.4 mmol·L⁻¹HCO3- for IP vs. CON (95% CI 2.0 to 3.8 mmol·L⁻¹); p = 0.02; d = 1.08] at pre warm-up, but not immediately prior to the TT (post warm-up). Performance times were significantly different between IP (367.0 ± 10.5 s) vs. CON (369.0 ± 10.3 s); p = 0.007; d = 0.15).

Conclusions: The present study demonstrated a small but significant performance effect of an individualized NaHCO₃ ingestion strategy. Similarities after warm-up between pre-TT sHCO3- values (CON ~ + 5.5 mmol·L⁻¹; IP ~ + 6 mmol·L⁻¹), however, would suggest this effect was not a result of any meaningful differences in blood alkalinity.

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.

Post-exercise Supplementation of Sodium Bicarbonate Improves Acid Base Balance Recovery and Subsequent High-Intensity Boxing Specific Performance

The aim of this study was to assess the effects of post-exercise sodium bicarbonate (NaHCO₃) ingestion (0.3 g.kg⁻¹ body mass) on the recovery of acid-base balance (pH, HCO3-, and the SID) and subsequent exercise performance in elite boxers. Seven elite male professional boxers performed an initial bout of exhaustive exercise comprising of a boxing specific high-intensity interval running (HIIR) protocol, followed by a high-intensity run to volitional exhaustion (T_LIM1). A 75 min passive recovery then ensued, whereby after 10 min recovery, participants ingested either 0.3 g.kg⁻¹ body mass NaHCO₃, or 0.1 g.kg⁻¹ body mass sodium chloride (PLA). Solutions were taste matched and administered double-blind. Participants then completed a boxing specific punch combination protocol, followed by a second high-intensity run to volitional exhaustion (T_LIM2). Both initial bouts of T_LIM1 were well matched between PLA and NaHCO₃ (ICC; r = 0.94, p = 0.002). The change in performance from T_LIM1 to T_LIM2 was greater following NaHCO₃ compared to PLA (+164 ± 90 vs. +73 ± 78 sec; p = 0.02, CI = 45.1, 428.8, g = 1.0). Following ingestion of NaHCO₃, pH was greater prior to T_LIM2 by 0.11 ± 0.02 units (1.4%) (p < 0.001, CI = 0.09, 0.13, g = 3.4), whilst HCO3- was greater by 8.8 ± 1.5 mmol.l⁻¹ (26.3%) compared to PLA (p < 0.001, CI = 7.3, 10.2, g = 5.1). The current study suggests that these significant increases in acid base balance during post-exercise recovery facilitated the improvement in the subsequent bout of exercise. Future research should continue to explore the role of NaHCO₃ supplementation as a recovery aid in boxing and other combat sports.

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.