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Zagatto AM, Lopes VHF, Dutra YM, de Poli RAB, Dolan E, Rasica L, Murias JM, de Azevedo PHSM. Sodium bicarbonate induces alkalosis, but improves high-intensity cycling performance only when participants expect a beneficial effect: a placebo and nocebo study. Eur J Appl Physiol 2024; 124:1367-1380. [PMID: 38032386 DOI: 10.1007/s00421-023-05368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
The study aimed to investigate the effects of sodium bicarbonate (NaHCO3) intake with divergent verbal and visual information on constant load cycling time-to-task failure, conducted within the severe intensity domain. Fifteen recreational cyclists participated in a randomized double-blind, crossover study, ingesting NaHCO3 or placebo (i.e., dextrose), but with divergent information about its likely influence (i.e., likely to induce ergogenic, inert, or harmful effects). Performance was evaluated using constant load cycling time to task failure trial at 115% of peak power output estimated during a ramp incremental exercise test. Data on blood lactate, blood acid-base balance, muscle electrical activity (EMG) through electromyography signal, and the twitch interpolation technique to assess neuromuscular indices were collected. Despite reduced peak force in the isometric maximal voluntary contraction and post-effort peripheral fatigue in all conditions (P < 0.001), neither time to task failure, EMG nor, blood acid-base balance differed between conditions (P > 0.05). Evaluation of effect sizes of all conditions suggested that informing participants that the supplement would be likely to have a positive effect (NaHCO3/Ergogenic: 0.46; 0.15-0.74; Dextrose/Ergogenic: 0.45; 0.04-0.88) resulted in improved performance compared to control. Thus, NaHCO3 ingestion consistently induced alkalosis, indicating that the physiological conditions to improve performance were present. Despite this, NaHCO3 ingestion did not influence performance or indicators of neuromuscular fatigue. In contrast, effect size estimates indicate that participants performed better when informed that they were ingesting an ergogenic supplement. These findings suggest that the apparently ergogenic effect of NaHCO3 may be due, at least in part, to a placebo effect.
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Affiliation(s)
- Alessandro Moura Zagatto
- Laboratory of Physiology and Sport Performance (LAFIDE), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Post-Graduate Program in Movement Sciences, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, SP, CEP 17033-360, Brazil.
| | - Vithor Hugo Fialho Lopes
- Laboratory of Physiology and Sport Performance (LAFIDE), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Post-Graduate Program in Movement Sciences, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, SP, CEP 17033-360, Brazil
| | - Yago Medeiros Dutra
- Laboratory of Physiology and Sport Performance (LAFIDE), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Post-Graduate Program in Movement Sciences, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, SP, CEP 17033-360, Brazil
| | - Rodrigo Araujo Bonetti de Poli
- Laboratory of Physiology and Sport Performance (LAFIDE), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Post-Graduate Program in Movement Sciences, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Vargem Limpa, Bauru, SP, CEP 17033-360, Brazil
| | - Eimear Dolan
- Applied Physiology and Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Letizia Rasica
- Faculty of Kinesiology, Human Performance Lab, University of Calgary, Calgary, Canada
| | - Juan M Murias
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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2
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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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3
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de Oliveira LF, Dolan E, Swinton PA, Durkalec-Michalski K, Artioli GG, McNaughton LR, Saunders B. Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis. Sports Med 2022; 52:505-526. [PMID: 34687438 DOI: 10.1007/s40279-021-01575-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
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 [ES0.5 = 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 [ES0.5 = 0.18 (0.13-0.24)] and > 10 min [ES0.5 = 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) [βSmall:Medium = 0.16 (95% CrI 0.02-0.32), βSmall:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [βSC: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.
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Affiliation(s)
- Luana Farias de Oliveira
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Krzysztof Durkalec-Michalski
- Department of Sports Dietetics, Poznań University of Physical Education, Poznań, Poland
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland
| | - Guilherme G Artioli
- Department of Life Sciences, Manchester Metropolitan University, John Dalton Building, Manchester, M1 5GD, UK
| | - Lars R McNaughton
- Sports Nutrition and Performance Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Bryan Saunders
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
- Department of Sports Dietetics, Poznań University of Physical Education, Poznań, Poland.
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
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Areta JL, Elliott-Sale KJ. Nutrition for Female Athletes: what we know, what we don't know, and why. Eur J Sport Sci 2022; 22:669-671. [PMID: 35195492 DOI: 10.1080/17461391.2022.2046176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- José L Areta
- Research Institute for Sport and Exercise Sciences, School of Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Kirsty J Elliott-Sale
- Musculoskeletal Physiology Research Group, Sport Health and Performance Enhancement Research centre, Nottingham Trent University, UK
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5
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Methodology Review: A Protocol to Audit the Representation of Female Athletes in Sports Science and Sports Medicine Research. Int J Sport Nutr Exerc Metab 2022; 32:114-127. [PMID: 35168200 DOI: 10.1123/ijsnem.2021-0257] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/17/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022]
Abstract
Female-specific research on sports science and sports medicine (SSSM) fails to mirror the increase in participation and popularity of women's sport. Females have historically been excluded from SSSM research, particularly because their physiological intricacy necessitates more complex study designs, longer research times, and additional costs. Consequently, most SSSM practices are based on research with men, despite potential problems in translation to females due to sexual dimorphism in biological and phenotypical parameters as well as differences in event characteristics (e.g., race distances/durations). Recognition that erroneous extrapolations may hamper the efforts of females to maximize their athletic potential has created an impetus to acknowledge and readdress the sex disparity in SSSM research. To direct the priorities for future research, it is prudent to first develop a comprehensive understanding of the gaps in current knowledge by systematically "auditing" the literature. By conducting audits of the literature to highlight underdeveloped topics or identify potential problems with the quality of research, this information can then be used to expediently direct new research activities. This paper therefore presents a standardized audit methodology to establish the representation of female athletes in subdisciplines of existing SSSM research, including a template for reporting the results of key metrics. This standardized audit process will enable comparisons over time and between research subdisciplines. This working guide provides an important step toward achieving sex equity across SSSM research, with the eventual goal of providing evidence-based recommendations specific to the female athlete.
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de Sousa MV, Lundsgaard AM, Christensen PM, Christensen L, Randers MB, Mohr M, Nybo L, Kiens B, Fritzen AM. Nutritional optimization for female elite football players-topical review. Scand J Med Sci Sports 2021; 32 Suppl 1:81-104. [PMID: 34865242 DOI: 10.1111/sms.14102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Women's football is an intermittent sport characterized by frequent intense actions throughout the match. The high number of matches with limited recovery time played across a long competitive season underlines the importance of nutritional strategies to meet these large physical demands. In order to maximize sport performance and maintain good health, energy intake must be optimal. However, a considerable proportion of female elite football players does not have sufficient energy intake to match the energy expenditure, resulting in low energy availability that might have detrimental physiologic consequences and impair performance. Carbohydrates appear to be the primary fuel covering the total energy supply during match-play, and female elite football players should aim to consume sufficient carbohydrates to meet the requirements of their training program and to optimize the replenishment of muscle glycogen stores between training bouts and matches. However, several macro- and micronutrients are important for ensuring sufficient energy and nutrients for performance optimization and for overall health status in female elite football players. The inadequacy of macro-and micronutrients in the diet of these athletes may impair performance and training adaptations, and increase the risk of health disorders, compromising the player's professional career. In this topical review, we present knowledge and relevant nutritional recommendations for elite female football players for the benefit of sports nutritionists, dietitians, sports scientists, healthcare specialists, and applied researchers. We focus on dietary intake and cover the most pertinent topics in sports nutrition for the relevant physical demands in female elite football players as follows: energy intake, macronutrient and micronutrient requirements and optimal composition of the everyday diet, nutritional and hydration strategies to optimize performance and recovery, potential ergogenic effects of authorized relevant supplements, and future research considerations.
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Affiliation(s)
- Maysa V de Sousa
- Laboratory of Medical Investigation, LIM-18, Endocrinology Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Anne-Marie Lundsgaard
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Christensen
- Department of Nutrition, Exercise and Sports, Section of Obesity Research, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Morten B Randers
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark.,School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Magni Mohr
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark.,Centre of Health Science, Faculty of Health, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, Section of Integrative Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Bente Kiens
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Andreas M Fritzen
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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7
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Grgic J, Pedisic Z, Saunders B, Artioli GG, Schoenfeld BJ, McKenna MJ, Bishop DJ, Kreider RB, Stout JR, Kalman DS, Arent SM, VanDusseldorp TA, Lopez HL, Ziegenfuss TN, Burke LM, Antonio J, Campbell BI. International Society of Sports Nutrition position stand: sodium bicarbonate and exercise performance. J Int Soc Sports Nutr 2021; 18:61. [PMID: 34503527 PMCID: PMC8427947 DOI: 10.1186/s12970-021-00458-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Jozo Grgic
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Bryan Saunders
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, Sao Paulo, Brazil
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, Sao Paulo, Brazil
| | - Guilherme G Artioli
- Centre for Bioscience, Manchester Metropolitan University, Manchester, M1 5GD, UK
| | | | - Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - David J Bishop
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Richard B Kreider
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Jeffrey R Stout
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, USA
| | - Douglas S Kalman
- Nutrion Department, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, 33314, USA
- Scientific Affairs. Nutrasource, Guelph, ON, Canada
| | - Shawn M Arent
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Trisha A VanDusseldorp
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, USA
| | - Hector L Lopez
- The Center for Applied Health Sciences, Stow, OH, USA
- Supplement Safety Solutions, Bedford, MA, 01730, USA
| | | | - Louise M Burke
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Jose Antonio
- Exercise and Sport Science, Nova Southeastern University, Davie, FL, 33314, USA
| | - Bill I Campbell
- Performance & Physique Enhancement Laboratory, University of South Florida, Tampa, FL, 33612, USA
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