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Carr AJ, McKay AKA, Burke LM, Smith ES, Urwin CS, Convit L, Jardine WT, Kelly MK, Saunders B. Use of Buffers in Specific Contexts: Highly Trained Female Athletes, Extreme Environments and Combined Buffering Agents-A Narrative Review. Sports Med 2023; 53:25-48. [PMID: 37878211 PMCID: PMC10721675 DOI: 10.1007/s40279-023-01872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Amelia J Carr
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Ella S Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Charles S Urwin
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Lilia Convit
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - William T Jardine
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Monica K Kelly
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Bryan Saunders
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculdade de Medicina FMUSP, School of Physical Education and Sport, Universidade de São Paulo, University of São Paulo, São Paulo, Brazil
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
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Cunha VCR, Aoki MS, Zourdos MC, Gomes RV, Barbosa WP, Massa M, Moreira A, Capitani CD. Sodium citrate supplementation enhances tennis skill performance: a crossover, placebo-controlled, double blind study. J Int Soc Sports Nutr 2019; 16:32. [PMID: 31370896 PMCID: PMC6676531 DOI: 10.1186/s12970-019-0297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 07/08/2019] [Indexed: 11/25/2022] Open
Abstract
Background The efficacy of sodium citrate supplementation (SC) in exercise performance is unclear. Therefore, the aim of this study was to investigate the effect of SC on skilled tennis performance. Methods Ten Brazilian nationally-ranked young male tennis players (age: 17 ± 1 yrs.; stature: 176.7 ± 5.2 cm; body mass: 68.4 ± 7.9 kg) participated in this crossover, placebo-controlled, double-blind study. Upon arrival, at baseline, in both experimental sessions blood was collected, then subjects ingested either sodium citrate (SC - 0.5 g.kg−1BM in capsules of 500 mg) or a placebo (PLA). Two hours later, pre-match blood was collected then skills tests (skill tennis performance test - STPT, repeated-sprint ability shuttle test - RSA) were performed followed by a 1-h simulated match. Immediately following the match, blood was again collected, and STPT, and RSA were administered. Results All metabolic parameters (i.e. base excess, pH, bicarbonate, and blood lactate) increased (p < 0.001) from baseline to pre-match and post-match in SC condition. Each metabolic parameter was greater (p < 0.001) in SC compared to PLA condition at both pre- and post-match. The SC condition elicited a greater (p < 0.01) shot consistency at post-match in the STPT vs. PLA condition (SC: 58.5 ± 14.8% vs. PLA: 40.4 ± 10.4%). A greater (p < 0.001) amount of games won was observed in the simulated match for SC condition vs. PLA condition (SC: 8.0 ± 1.6 vs. PLA: 6.0 ± 1.7). Additionally, the games won during the simulated match in SC condition was positively correlated with percentage shot consistency (r = 0.67, p < 0.001). Conclusions The current findings suggest that SC supplementation is an effective ergogenic aid to enhance skilled tennis performance.
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Affiliation(s)
- Vivian C R Cunha
- School of Applied Sciences, University of Campinas, Rua Pedro Zaccaria 1300, Limeira, 13484-350, Sao Paulo, Brazil
| | - Marcelo S Aoki
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Michael C Zourdos
- Department of Exercise Science and Health Promotion, Muscle Physiology Laboratory, Florida Atlantic University, Kissimme, Florida, USA
| | - Rodrigo V Gomes
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Wesley P Barbosa
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Massa
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Moreira
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Caroline D Capitani
- School of Applied Sciences, University of Campinas, Rua Pedro Zaccaria 1300, Limeira, 13484-350, Sao Paulo, Brazil.
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Retarding progression of chronic kidney disease: use of modalities that counter acid retention. Curr Opin Nephrol Hypertens 2018; 27:94-101. [PMID: 29140821 DOI: 10.1097/mnh.0000000000000386] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Acid retention because of chronic kidney disease (CKD) increases tissue acidity and accelerates progression of CKD, whereas reduction in acid retention slows progression of CKD. Herein, we describe the mechanisms through which increased tissue acidity worsens CKD, modalities for countering acid retention and their impact on progression of CKD, and current recommendations for therapy. RECENT FINDINGS Studies in animals and humans show that increased tissue acidity raises the renal levels of endothelin, angiotensin II, aldosterone, and ammoniagenesis, thereby worsening renal fibrosis and causing progression of CKD. Measures that counter acid retention, such as providing alkali or modifying the quantity or type of dietary protein, reduce the levels of endothelin, angiotensin II, aldosterone, and ammoniagenesis, slowing progression of CKD. Alkali can be provided as NaHCO3, sodium citrate, or base in fruits and vegetables. A serum [HCO3] of 24-26 mEq/l is targeted, because higher values can be associated with adverse consequences. SUMMARY Insights into the mechanisms through which increased tissue acidity mediates progression of CKD and the beneficial impact of ameliorating positive acid balance underlie our recommendation for modalities that counter acid retention in CKD.
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Lancha Junior AH, Painelli VDS, Saunders B, Artioli GG. Nutritional Strategies to Modulate Intracellular and Extracellular Buffering Capacity During High-Intensity Exercise. Sports Med 2016; 45 Suppl 1:S71-81. [PMID: 26553493 PMCID: PMC4672007 DOI: 10.1007/s40279-015-0397-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intramuscular acidosis is a contributing factor to fatigue during high-intensity exercise. Many nutritional strategies aiming to increase intra- and extracellular buffering capacity have been investigated. Among these, supplementation of beta-alanine (~3–6.4 g/day for 4 weeks or longer), the rate-limiting factor to the intramuscular synthesis of carnosine (i.e. an intracellular buffer), has been shown to result in positive effects on exercise performance in which acidosis is a contributing factor to fatigue. Furthermore, sodium bicarbonate, sodium citrate and sodium/calcium lactate supplementation have been employed in an attempt to increase the extracellular buffering capacity. Although all attempts have increased blood bicarbonate concentrations, evidence indicates that sodium bicarbonate (0.3 g/kg body mass) is the most effective in improving high-intensity exercise performance. The evidence supporting the ergogenic effects of sodium citrate and lactate remain weak. These nutritional strategies are not without side effects, as gastrointestinal distress is often associated with the effective doses of sodium bicarbonate, sodium citrate and calcium lactate. Similarly, paresthesia (i.e. tingling sensation of the skin) is currently the only known side effect associated with beta-alanine supplementation, and it is caused by the acute elevation in plasma beta-alanine concentration after a single dose of beta-alanine. Finally, the co-supplementation of beta-alanine and sodium bicarbonate may result in additive ergogenic gains during high-intensity exercise, although studies are required to investigate this combination in a wide range of sports.
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Affiliation(s)
- Antonio Herbert Lancha Junior
- Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, Av. Mello de Moraes, 65 Butanta, São Paulo, SP, 05508-030, Brazil.
| | - Vitor de Salles Painelli
- Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, Av. Mello de Moraes, 65 Butanta, São Paulo, SP, 05508-030, Brazil
| | - Bryan Saunders
- Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, Av. Mello de Moraes, 65 Butanta, São Paulo, SP, 05508-030, Brazil
| | - Guilherme Giannini Artioli
- Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, Av. Mello de Moraes, 65 Butanta, São Paulo, SP, 05508-030, Brazil
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Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update. Am J Kidney Dis 2015; 67:307-17. [PMID: 26477665 DOI: 10.1053/j.ajkd.2015.08.028] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/01/2015] [Indexed: 01/02/2023]
Abstract
The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to <20 to 25mL/min/1.73 m(2), although it can develop with lesser degrees of decreased kidney function. Non-anion gap acidosis, high-anion gap acidosis, or both can be found at all stages of CKD. The acidosis can be associated with muscle wasting, bone disease, hypoalbuminemia, inflammation, progression of CKD, and increased mortality. Administration of base may decrease muscle wasting, improve bone disease, and slow the progression of CKD. Base is suggested when serum bicarbonate concentration is <22 mEq/L, but the target serum bicarbonate concentration is unclear. Evidence that increments in serum bicarbonate concentration > 24 mEq/L might be associated with worsening of cardiovascular disease adds complexity to treatment decisions. Further study of the mechanisms through which metabolic acidosis contributes to the progression of CKD, as well as the pathways involved in mediating the benefits and complications of base therapy, is warranted.
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Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services, VHAGLA Healthcare System, UCLA Membrane Biology Laboratory, Los Angeles, CA; Division of Nephrology, VHAGLA Healthcare System and David Geffen School of Medicine, Los Angeles, CA.
| | - Nicolaos E Madias
- Department of Medicine, Division of Nephrology, St. Elizabeth's Medical Center, Boston, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA.
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Łoniewski I, Wesson DE. The Authors Reply. Kidney Int 2015; 87:1261. [DOI: 10.1038/ki.2015.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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