Impact of sodium citrate ingestion during recovery after dehydrating exercise on rehydration and subsequent 40-km cycling time-trial performance in the heat

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.

Impact of sodium citrate ingestion during recovery after strenuous exercise in the heat on heart rate variability: A randomized, crossover study

Changes in hydration status influence plasma volume (PV) which is associated with post-exercise parasympathetic reactivation. The present study hypothesized that, after dehydrating cycling exercise in the heat (DE), stimulation of PV expansion with sodium citrate (CIT) supplementation would promote heart rate variability (HRV) recovery in endurance-trained men. Twelve participants lost 4% of body mass during DE. During subsequent 16-h recovery, participants consumed water ad libitum (CIT =5.5-L, PLC =5.1-L) and ate prescribed food supplemented with CIT or placebo in a randomized, double-blind, crossover manner. Relative changes in PV were assessed across DE and 16-h recovery. HRV was analyzed before and 16 h after DE in three conditions for altogether four 5-min periods: supine in a thermoneutral environment, supine in the heat (32°C, 46% relative humidity; 2 periods), and standing in the heat. A larger expansion of PV across 16-h recovery occurred in CIT compared to placebo trial (p < 0.0001). However, no between-trial differences appeared in HRV parameters (lnRMSSD, lnSDNN, lnLF/HF) in any 5-min period analyzed before or 16 h after DE (in all cases p > 0.05). Increases in HR (p < 0.001) and lnLF/HF (p = 0.005) and decreases in lnRMSSD (p < 0.001) and lnSDNN (p < 0.001) occurred following DE in both trials. Larger PV expansion induced by CIT supplementation after DE does not improve recovery of HRV at rest and has no influence on HRV responsiveness in endurance-trained men.

Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis

BACKGROUND

Extracellular buffering supplements [sodium bicarbonate (SB), sodium citrate (SC), sodium/calcium lactate (SL/CL)] are ergogenic supplements, although questions remain about factors which may modify their effect.

OBJECTIVE

To quantify the main effect of extracellular buffering agents on exercise outcomes, and to investigate the influence of potential moderators on this effect using a systematic review and meta-analytic approach.

METHODS

This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for articles that were screened according to inclusion/exclusion criteria. Bayesian hierarchical meta-analysis and meta-regression models were used to investigate pooled effects of supplementation and moderating effects of a range of factors on exercise and biomarker responses.

RESULTS

189 articles with 2019 participants were included, 158 involving SB supplementation, 30 with SC, and seven with CL/SL; four studies provided a combination of buffering supplements together. Supplementation led to a mean estimated increase in blood bicarbonate of + 5.2 mmol L^-1 (95% credible interval (CrI) 4.7-5.7). The meta-analysis models identified a positive overall effect of supplementation on exercise capacity and performance compared to placebo [ES_0.5 = 0.17 (95% CrI 0.12-0.21)] with potential moderating effects of exercise type and duration, training status and when the exercise test was performed following prior exercise. The greatest ergogenic effects were shown for exercise durations of 0.5-10 min [ES_0.5 = 0.18 (0.13-0.24)] and > 10 min [ES_0.5 = 0.22 (0.10-0.33)]. Evidence of greater effects on exercise were obtained when blood bicarbonate increases were medium (4-6 mmol L^-1) and large (> 6 mmol L^-1) compared with small (≤ 4 mmol L^-1) [β_Small:Medium = 0.16 (95% CrI 0.02-0.32), β_Small:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [β_SC:SB = 0.10 (95% CrI - 0.02 to 0.22)].

CONCLUSIONS

Extracellular buffering supplements generate large increases in blood bicarbonate concentration leading to positive overall effects on exercise, with sodium bicarbonate being most effective. Evidence for several group-level moderating factors were identified. These data can guide an athlete's decision as to whether supplementation with buffering agents might be beneficial for their specific aims.

The Hyperhydration Potential of Sodium Bicarbonate and Sodium Citrate

Buffering agents have not been comprehensively profiled in terms of their capacity to influence water retention prior to exercise. The purpose of this investigation was to profile the fluid retention characteristics of sodium bicarbonate (BIC) and sodium citrate (CIT) to determine the efficacy of these buffering mediums as hyperhydrating agents. Nineteen volunteers (13 males and six females; age = 28.3 ± 4.9 years) completed three trials (randomized and cross-over design). For each trial, a baseline measurement of body mass, capillary blood, and urine was collected prior to ingestion of their respective condition (control condition [CON] = 25 ml/kg artificially sweetened water; BIC condition = CON + 7.5 g/L of sodium in the form of BIC; CIT condition = CON + 7.5 g/L of sodium in the form of CIT). The fluid loads were consumed in four equal aliquots (0, 20, 40 and 60 min; fluid intake was 1.972 ± 361 ml [CON]; 1.977 ± 360 ml [BIC]; 1.953 ± 352 ml [CIT]). Samples were recorded at 20 (body mass and urine) and 60 min (blood) intervals for 180 min. Blood buffering capacity (HCO3-) was elevated (p < .001) in both BIC (32.1 ± 2.2 mmol/L) and CIT (28.9 ± 3.8 mmol/L) at 180 min compared with CON (25.1 ± 1.8 mmol/L). Plasma volume expansion was greater (p < .001) in both BIC (8.1 ± 1.3%) and CIT (5.9 ± 1.8%) compared with CON (-1.1 ± 1.4%); whereas, total urine production was lower in BIC and CIT at 180 min (BIC vs. CON, mean difference of 370 ± 85 ml; p < .001; CIT vs. CON, mean difference of 239 ± 102 ml; p = .05). There were no increases observed in body mass (p = .9). Under resting conditions, these data suggest BIC and CIT induce a greater plasma hypervolemic response as compared with water alone.

Influence of Sodium Citrate Supplementation after Dehydrating Exercise on Responses of Stress Hormones to Subsequent Endurance Cycling Time-Trial in the Heat

Background and objectives: In temperate environments, acute orally induced metabolic alkalosis alleviates exercise stress, as reflected in attenuated stress hormone responses to relatively short-duration exercise bouts. However, it is unknown whether the same phenomenon occurs during prolonged exercise in the heat. This study was undertaken with aim to test the hypothesis that ingestion of an alkalizing substance (sodium citrate; CIT) after dehydrating exercise would decrease blood levels of stress hormones during subsequent 40 km cycling time-trial (TT) in the heat. Materials and Methods: Male non-heat-acclimated athletes (n = 20) lost 4% of body mass by exercising in the heat. Then, during a 16 h recovery period prior to TT in a warm environment (32 °C), participants ate the prescribed food and ingested CIT (600 mg·kg-1) or placebo (PLC) in a double-blind, randomized, crossover manner with 7 days between the two trials. Blood aldosterone, cortisol, prolactin and growth hormone concentrations were measured before and after TT. Results: Total work performed during TT was similar in the two trials (p = 0.716). In CIT compared to PLC trial, lower levels of aldosterone occurred before (72%) and after (39%) TT (p ˂ 0.001), and acute response of aldosterone to TT was blunted (29%, p ˂ 0.001). Lower cortisol levels in CIT than in PLC trial occurred before (13%, p = 0.039) and after TT (14%, p = 0.001), but there were no between-trial differences in the acute responses of cortisol, prolactin or growth hormone to TT, or in concentrations of prolactin and growth hormone before or after TT (in all cases p > 0.05). Conclusions: Reduced aldosterone and cortisol levels after TT and blunted acute response of aldosterone to TT indicate that CIT ingestion during recovery after dehydrating exercise may alleviate stress during the next hard endurance cycling bout in the heat.