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Sodium Bicarbonate—A Potent Ergogenic Aid?

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Abstract

This report aims to look at the role of Sodium bicarbonate as a potent Ergogenic aid and its role in improving the per-formance of athletes. It includes the mechanism of action of sodium bicarbonate during high-intensity exercise. The report also shows the various types of athletes who can be benefited from sodium bicarbonate loading, evidences for improvement in performance, conflicting evidences, recommended dosages and side-effects for bicarbonate loading.
Food and Nutrition Sciences, 2010, 1, 1-4
doi:10.4236/fns.2010.11001 Published Online July 2010 (http://www.SciRP.org/journal/fns)
Copyright © 2010 SciRes. FNS
1
Sodium Bicarbonate—A Potent Ergogenic Aid?
Jose Shelton1, Gideon V. Praveen Kumar²
1Victoria University, Melbourne, Australia; 2School of Biosciences and Technology, VIT University, Vellore, India.
Email: {josenoel2008, gideonpraveenkumar}@gmail.com
Received May 30th, 2010; revised July 4th, 2010; accepted July 7th, 2010.
ABSTRACT
This report aims to look at the role of Sodium bicarbonate as a potent Ergogenic aid and its role in improving the per-
formance of athletes. It includes the mechanism of action of sodium bicarbonate during high-intensity exercise. The
report also shows the various types of athletes who can be benefited from sodium bicarbonate loading, evidences for
improvement in performance, conflicting evidences, recommended dosages and side-effects for bicarbonate loading.
Keywords: Sodium Bicarbonate, Ergogenic Aid, High-Intensity Exercise, Anaerobic Glycolytic System
1. Introduction
An ergogenic aid is defined as any substance, food,
chemical, or training method that helps the body work
harder and perform better. Ergogenic aids are any
external influences that can positively affect physical or
mental performance [1]. These include mechanical aids,
pharmacological aids, physiological aids, nutritional aids,
and psychological aids. Athletes at all levels of competi-
tions are constantly striving for a means to obtain a lead-
ing edge over their opponents and many of them use er-
gogenic aids to improve their energy and performance [2].
Ergogenic aids may directly influence the physiological
capacity of a particular body system thereby improving
performance, remove psychological constraints which
impact performance, and increase the speed of recovery
from training and competition [3].
The term Ergogenic means “to produce work”. Nutri-
tional ergogenic aids are dietary manipulations that can
increase physical power or energy production, enhance
mental strength, or provide a mechanical edge and there-
by improve sport performance [4]. Dietary manipulations
encompass 3 major efforts: alteration of food choices,
addition of macronutrients for specific uses in sports and
exercise, addition of micronutrients for specific uses in
sports and exercise [3].
2. Energy System for High-Intensity
Exercise
Of the 3 primary energy pathways, the anaerobic glyco-
lytic system provides fuel sources, primarily carbohy-
drates, for high-intensity exercises (exercises lasting be-
tween 20 seconds up to about 90 seconds). Anaerobic
glycolysis provides the primary fuel source for exercise
of near-maximal intensity lasting longer than about 30
seconds. High-intensity exercises (anaerobic work) in-
volve the breakdown of carbohydrates (muscle glycogen).
As the glycogen stores are rapidly depleted, there is a
resulting increase in hydrogen ion (H+) concentrations
and lactic acid in both the muscle and blood. It is this
increase in H+ concentration (drop in pH) that causes a
progressive increase in the acidity of the muscle cells
(intracellular environment). The increase in H+ produces,
among other reactions, an inhibition of calcium release
from the sarcoplasmic reticulum and an inhibition of the
interaction between actin and myosin [5]. The drop in pH
as a result of lactic acid accumulation is thought to in-
hibit the resynthesis of adenosine triphosphate (ATP) as
well as inhibit muscle contraction. This in turn results in
muscular fatigue defined as a decrease in force produc-
tion in the presence of increased perception of effort and
an inability to maintain high exercise intensities [6,7].
3. Sodium Bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the
chemical compound with the formula NaHCO3. Sodium
bicarbonate is a white solid that is crystalline but often
appears as a fine powder. It has a slight alkaline taste
resembling that of washing soda (sodium carbonate). It is
a component of the mineral natron and is found dissolved
in many mineral springs. The natural mineral form is
known as nahcolite. It is also produced artificially. Since
it has long been known and is widely used, the salt has
many related names such as baking soda, bread soda,
cooking soda, bicarbonate of soda. Colloquially, its name
is shortened to sodium bicarb.
Sodium Bicarbonate – A Potential Ergonomic Aid?
Copyright © 2010 SciRes. FNS
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4. Role of Sodium Bicarbonate during
High-Intensity Exercise
During high-intensity exercise, muscles keep up with the
demand for energy by converting some carbohydrate to
lactic acid. A build-up of acid inside the muscle cells is
one of the factors responsible for fatigue. This system’s
total capacity is limited by the progressive increase in
acidity within the muscles caused by the accumulation of
lactate and H+ ions. Increased acidity ultimately inhibits
energy transfer and the ability of the muscles to contract,
leading to a decrease in exercise performance. Reducing
the build-up of acid should reduce fatigue and allow the
athlete to go faster or further. The body’s defences against
an increase in acidity are the bicarbonate “buffers”,
which help to neutralize the acid produced by intense
exercise. The natural bicarbonate supply, part of the
body’s buffering system, provides a rapid first line of
defence against this increased acidity.
5. Acting Mechanism
Sodium bicarbonate is an alkalising agent and therefore
reduces the acidity of the blood (known as a buffering
action). By buffering acidity in the blood, bicarbonate
may be able to draw more of the acid produced within
the muscle cells out into the blood and thus reduce the
level of acidity within the muscle cells themselves. This
in turn could delay the onset of fatigue [8]. Studies [9,10]
have confirmed that increased extracellular pH and
higher bicarbonate raise the H+ and lactic acid efflux
from active muscles. This is due to an increase in the
activity of the Lactic acid/H+ co-transporter, which be-
comes more active as the intracellular/extracellular H+
gradient increases, during contraction as well as during
recovery. It has been suggested that this mechanism
causes a decrease in muscular fatigue, delaying the de-
crease in pH level and leading to a greater contractile
capacity of the muscular tissue involved by means of
enhanced muscle glycolytic ATP production. It has been
proven that all of these metabolic perturbations imply a
shift in muscle metabolism toward anaerobic energy
production, which is especially advantageous during
high-intensity exercise [5].
Taking a sufficient quantity of sodium bicarbonate
(baking soda) before high-intensity event makes the
muscles and blood less acidic during the event and can
enhance physical performance [11].
6. Athletes Benefiting from Sodium
Bicarbonate Loading
Athletes have been practising “soda loading” or “bicar-
bonate loading” for over 70 years in an attempt to delay
the onset of muscular fatigue during prolonged anaerobic
exercise. The specific athletes who might stand to benefit
from bicarb supplementation are those who typically
compete in events that last between 1 and 7 minutes, i.e.
400 m - 1500 m running, 100 m - 400 m swimming,
sprint cycling, kayaking, rowing and canoeing events at
intensities that fall between 80 and 125% of peak maxi-
mal oxygen uptake, and many team sports with their re-
peated nature of high intensity exercise. All these events
stress the anaerobic glycolysis system significantly and
produce a lot of acidity. Sports that are dependent on
repeated anaerobic bursts may also benefit from bicar-
bonate loading [6,8].
7. Evidences for Improvement in
Performance
A study done by McNaughton et al. [9], among moder-
ately trained female athletes, showed significant im-
provement in both work and power output, during high
intensity exercise of 60 second duration. The ingestion of
sodium bicarbonate in the experimental trial had the de-
sired effect of raising blood bicarbonate levels by 60%
above the resting bicarbonate value.
According to Stellingwerff [12], a meta-analysis of 29
studies on the performance effects of sodium bicarbonate,
featuring predominately untrained individuals, found that
bicarbonate supplementation resulted in a performance
effect that was 0.44 standard deviations better than in the
control trial. An improvement of 0.44 of the standard
deviation would bring the 2006 average men’s 800m
Golden League time of 1:46.36 down to 1:45.52, which
is a worthwhile improvement. In summary, most data
suggest that the ingestion of 0.3 g/kg body weight of so-
dium bicarbonate administered in solution approximately
1-2 hours before exercise offers a small, but significant,
effect on middle-distance race performance.
In one study [7] designed to simulate athletic competi-
tion, trained non-elite middle-distance runners performed
a simulated 800 m race. In the alkalotic condition, they
ran almost 3 s faster than in the placebo or control trials.
Another report by Maughn et al. [13] indicated similar
improvements (3-4 s) over a distance of 1500 m in run-
ners who completed simulated races in about 4 min 15s.
Although these effects on performance might appear
small, they are of considerable significance to the athlete,
for whom an improvement of even a fraction of a second
in these events is considered to be a major achievement.
In a study by VanMontfoort et al. [10], ingestion of so-
dium bicarbonate was found to increase the sprint per-
formance in elite male athletes compared to citrate, lac-
tate and chloride ingestion.
Studies by McNaughton et al. [14] have also found
that sodium bicarbonate can be used as an ergogenic aid
to offset the fatigue process in high-intensity, competi-
tive cycle ergometry of 1 hour duration.
Sodium Bicarbonate – A Potential Ergonomic Aid?
Copyright © 2010 SciRes. FNS
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8. Conflicting Evidence
However, even though many of the studies have shown
that sodium bicarbonate administration modifies the
blood acid-base balance, its effects on performance are
not always positive [5]. For instance, no improvements
have been registered following 90 seconds of maximal
cycle exercise by untrained men [15].
No differences were found between the experimental
or placebo trials in female cyclists pedalling at 95% VO2
max [9]. This suggested that bicarbonate buffering does
not improve performance in female athletes during re-
peated bouts of high intensity exercise.
The reasons for the conflicting effects are not alto-
gether clear, but are at least in part due to variations in
the intensity and duration of the exercise tests used, the
nature of the exercise task, the dosage of bicarbonate
administered and the time delay between bicarbonate
administration and the beginning of the exercise test (i.e.
the amount of metabolic alkalosis induced). Performance
has been monitored over exercise durations ranging from
a few seconds to more than 1 hour, and during continu-
ous, incremental and intermittent dynamic exercise as
well as during sustained isometric contractions [13].
There is no clear pattern of exercise duration between
those studies where a positive effect was observed and
those where no effect was seen. In most studies, a dose of
0.3 g of sodium bicarbonate/kg of body weight has been
used to induce alkalosis, and this has usually been ad-
ministered orally in solution or in capsule form. Such a
dose has usually resulted in an increase of 4-5 mmol.L-1
in the plasma buffer base 2-3 hours after administration,
although the time-course of changes in acid-base status
was not carefully followed in most of these studies [16].
Those studies in which high-intensity and short-term
exercises (less than 2 minutes) were used, and in which
the doses of sodium bicarbonate given were lower than
0.3 g/kg body weight, did not generally produce an en-
hancement of performance, which might be due to the use
of an insufficient dose or due to the short duration of the
effort [5]. Therefore, it has been suggested that exercises
lasting less than 1 minute may not be of sufficient duration
for the glycolytic metabolism to activate completely, in
that the capacity of the intracellular buffer is exceeded and
a positive gradient between the intracellular and extracel-
lular medium is established. The main reason for the lack
in performance improvement may consequently be due
more to the exercise duration than to the doses used.
9. Recommended Dosage
Many studies indicate an effective dose of 300mg of
sodium bicarbonate per kg body weight taken 1-2 hours
prior to short-term maximal, high intensity performance
lasting 60 sec shows 30% improvement in performance
[6,11]. Sodium bicarbonate appears to be safe when
taken in the recommended dose of 140mg/pound of body
weight. For a 150 pound athlete this translates to a dose
of 5 teaspoons of baking soda that provides 21,000mg or
21g of bicarbonate. Safety should not be confused with
side effects. Baking soda should be consumed with
plenty of water, (eg. a litre or more), when taken 1 or 2
hours prior to exercise [4].
10. Side Effects
There are of course potential problems of severe alkalo-
sis associated with the use of increased doses of bicarbo-
nate. Additionally side effects like vomiting, gastrointes-
tinal discomfort, bloating, and diarrhea may occur parti-
cularly if sufficient water is not taken with sodium
bicarbonate. Vomiting and diarrhea are frequently report-
ed as a result of ingestion of even relatively small doses
of bicarbonate, and this may limit any attempt to improve
athletic performance by this method, certainly among
those individuals susceptible to gastrointestinal problems.
There have been reports of athletes using this interven-
tion, which is not prohibited by the rules of the sport,
being unable to compete because of the severity of these
symptoms. Although unpleasant and to some extent
debilitating, these effects are not serious and there are no
long term adverse consequences [17].
11. Acute vs Chronic Loading
Given that some individuals exhibit urgent gastrointesti-
nal distress with bicarbonate, such as vomiting and diar-
rhoea, it is important for athletes to experiment with bi-
carbonate in training that features daily consecutive races,
since much of the gastrointestinal distress seems to occur
after a race (semi-finals), which could limit performance
in any subsequent race (finals) [12].
Studies [18,19] have shown more favourable gastroin-
testinal tolerance effects after chronic multiday bicar-
bonate supplementation as compared to acute pre-exer-
cise single-dose administration. Performance in high-
intensity exercise may be enhanced for a full 2 days after
cessation of chronic bicarbonate supplementation which
might alleviate many of the severe gastrointestinal side-
effects found with acute bicarbonate loading.
Not withstanding these results, more research is need-
ed to show performance efficacy for chronic bicarbonate
ingestion protocols in elite athletes, and to better eluci-
date the dosing and time-course effects between the ces-
sation of dosing and exercise performance testing.
12. Conclusions
In conclusion, there are sufficient data to suggest that
sodium bicarbonate can be used as a nutritional ergogenic
aid or dietary supplement for improving performance in
short term, high intensity exercise, provided it is taken in
the recommended dosage of 300 mg (0.3g)/kilogram
Sodium Bicarbonate – A Potential Ergonomic Aid?
Copyright © 2010 SciRes. FNS
4
body weight. Continued use of bicarbonate may help
athletes become less susceptible to the side effects and
may give even larger improvements in performance.
13. Further Research
Since the time elapsed from the ingestion of bicarbonate
to the beginning of exercise (time of absorption) varies
considerably, until further research can clarify the time
course and cessation of dosing that that can lead to per-
formance enhancement, the individual athlete is advised
to experiment in training to judge their own case. The
athlete needs to discover not only the potential for per-
formance improvement, but also the likelihood of un-
wanted side-effects. Further research is also needed to
find out the longest duration of endurance exercise that
benefits from the use of sodium bicarbonate.
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... Sodium bicarbonate is the chemical compound with the formula NaHCO 3 . By buffering acidity in the blood, bicarbonate may be able to draw more of the acid produced within the muscle cells out into the blood and thus reduce the level of acidity within the muscle cells themselves [2]. NaHCO 3 may affect muscle physiology and motor pathways associated with early rate of force development and/or the metabolic properties associated with contractile shortening velocity, and this effect appears more pronounced in fast-twitch fibres [3]. ...
... Additionally side effects like vomiting, gastrointestinal discomfort, bloating, and diarrhea may occur particularly if sufficient water is not taken with sodium bicarbonate. Currently, there are no data regarding the long term adverse consequences of NaHCO 3 [2]. ...
... Anecdotal information from swimmers shows that some swimmers utilise passive recovery, other swimmers utilise active recovery through low-intensity swimming, and other swimmers utilise active recovery through the ingestion of sodium hydrogen carbonate (NaHCO 3 ). There is a long tradition of research on the potential effects of NaHCO 3 ingestion on sport performance (McNaughton et al. 2008;Carr et al. 2011;Shelton and Kumar 2010) and specifically on swimming performance; however, the results are equivocal. Some studies support the idea that NaHCO 3 ingestion affects swimming performance during the front-crawl stroke (Lindh et al. 2007;Mero et al. 2013), while others do not (Joyce et al. 2012). ...
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Purpose The aim of this study was to determine how sodium hydrogen carbonate (NaHCO3) ingestion during a 1-h recovery period after a 200-m front-crawl swim affects blood–gas levels, acid–base balance, and performance during a successive trial. Methods Fourteen national-level male swimmers (age: 21 ± 3 years, body mass (BM):77 ± 10 kg, stature: 181 ± 7 cm) performed four maximal 200-m front-crawl tests. On one of the two days, the swimmers swam two 200-m tests with a 1-h recovery break, during which they drank water (WATER); on the other day, they performed the same protocol but consumed 0.3 g min⁻¹ NaHCO3 solution during the recovery break (NaHCO3). Results The ingestion of NaHCO3 before the second test had no effect on swim time despite a greater [HCO3-HCO3{HCO}_{3}^{-}] (19.2 ± 2.3 mmol L⁻¹) than that measured during the first test (NaHCO3) (14.5 ± 1.1 mmol L⁻¹) and the other two tests (WATER) (12.7 ± 2.4 and 14.8 ± 1.5 mmol L⁻¹; F = 18.554; p = 0.000) and a higher blood pH (7.46 ± 0.03) than that measured during the first test (NaHCO3) (7.39 ± 0.02) and the other two tests (WATER) (7.16 ± 0.04 and 7.20 ± 0.05); (F = 5.255; p = 0.004). An increase in blood pCO2 (0.2 ± 0.3 kPa) between both tests (NaHCO3) compared to unchanged pCO2 values (− 0.1 ± 0.3 kPa) between the other two tests (WATER) (t = − 2.984; p = 0.011; power = 0.741) was confirmed. Conclusions NaHCO3 ingestion during the recovery period between two 200-m front-crawl time trials had a strong buffering effect that did not positively affect performance. An increase in pCO2 may have counterbalanced this impact.
... É um constituinte normal do organismo, sendo responsável pelo equilíbrio ácido-base. Apresenta-se como um sólido cristalino, na forma de pó branco, inodoro, com sabor ligeiramente salgado e alcalino, podendo ser produzido sinteticamente [6,9,10,11]. Pode também ser obtido através do processo de Solvay. ...
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Introducción: El uso de ayudas ergogénicas resulta el último recurso legal dentro del deporte organizado. Además representa una opción ética para auxiliar a personas no deportistas con interés en realizar actividad física regular, cuidando su equilibrio orgánico. Objetivo: analizar la respuesta renal en sujetos sedentarios ante la ingesta del agua bicarbonatada, previo a la ejecución de actividad aeróbica. Materiales y métodos: Se evaluaron a cinco (5) sujetos del sexo masculino con edades promedio de 31 años para el grupo control y 29,3 años para el experimental, el cual ingirió una disolución al 5% de Bicarbonato de Sodio (NaHCO3), La muestras de pH y volumen urinario fueron tomadas antes de la prueba y luego de finalizada la misma, con un intervalo de 15 minutos para la recolección post-test. Resultados: Se pudo evidenciar un tendencia a la alcalinidad del pH urinario en el grupo experimental siendo su valor en pre-test 6,58 y post-test en la última recolección de 7,21; mientras el grupo control mantuvo la acidez desde su valor pre-test en 6,47 manteniéndose ácido hasta 6,35. El volumen urinario mantuvo una tendencia a la reducción durante la recuperación del ejercicio en ambos grupos. Conclusiones: Al monitorear la respuesta renal, se evidencia que el efecto tampón del bicarbonato se manifiesta de manera eficiente, y se considera eficaz para el grupo en estudio la tolerancia orgánica de la estrategia de elaborar disolución al 5% de concentración de NaHCO3.
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Performance in different athletic activities has continued to improve over time, with some athletes from diverse parts of the world registering new world records from time to time. With stiff competition from athletes from different parts of the world, constant upgrading of sports science based approaches to training and competition are employed to achieve more success. However, some approaches used to improve sports performance may pose ethical concerns and may challenge sports as a concept of celebrating natural human abilities. This book chapter interrogates the factors associated with efforts towards improvement of performance in endurance sports events, with a specific focus on marathon races, and the future implications for training, competition, and the nature of sports. While the interplay between nature and nurture determines the unique psychophysiological responses to training and competition, technological exploits leading to advanced sports products coupled with favourable natural and/or manipulated internal (body) and external environmental conditions will ensure continued improvement in performance. However, there is a need to censor commercial interest as well as safeguard safety and the nature of sports as a medium to celebrate natural human abilities.
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Bicarbonate has long been touted as a putative ergogenic aid that improves exercise performance and blood buffering capacity during strenuous exercise. However, the underlying mechanisms of action of bicarbonate intake on skeletal muscle metabolism have yet to be fully elucidated. Herein, we apply two orthogonal analytical platforms for nontargeted profiling of metabolites and targeted analysis of electrolytes from mass-limited muscle tissue biopsies (≈ 2 mg dried mass) when using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS) and CE with indirect UV detection, respectively. Seven untrained men performed a standardized bout of high intensity interval exercise trial following either bicarbonate (0.40 g/kg) or placebo ingestion in a double-blinded, placebo-controlled, cross-over study design, where paired skeletal muscle tissue and plasma specimens were collected at three time intervals at rest, post-exercise and recovery. Optimization of a quantitative microextraction procedure was first developed for lyophilized tissue prior to characterization of the human muscle metabolome, which resulted in the identification and quantification of more than 80 polar/ionic metabolites reliably (CV < 30%) detected in a majority (> 75%) of samples with quality control. Complementary univariate and multivariate statistical methods were used to identify biomarkers associated with strenuous exercise and/or bicarbonate treatment responses, whereas structural elucidation of biologically significant intramuscular metabolites was performed using high resolution MS/MS. Importantly, bicarbonate ingestion prior to strenuous interval exercise was found to elicit a modest treatment effect (p < 0.05) as compared to placebo on metabolic pathways associated with ionic homeostasis (potassium), purine degradation (uric acid), and oxidative stress as regulated by glutathione metabolism (oxidized mixed glutathione disulfide) and histidine-containing dipeptides (anserine) within muscle tissue that was distinctive from dynamic metabolic changes measured in circulation. This work provides deeper biochemical insights into the impact of acute alkalosis in preserving contracting muscle function during high-intensity exercise, which is also applicable to the study of muscle-related pathologies relevant to human health and ageing.
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Introducción: El uso de ayudas ergogénicas resulta el último recurso legal dentro del deporte organizado. Además representa una opción ética para auxiliar a personas no deportistas con interés en realizar actividad física regular, cuidando su equilibrio orgánico. Objetivo: analizar la respuesta renal en sujetos sedentarios ante la ingesta del agua bicarbonatada, previo a la ejecución de actividad aeróbica. Materiales y métodos: Se evaluaron a cinco (5) sujetos del sexo masculino con edades promedio de 31 años para el grupo control y 29,3 años para el experimental, el cual ingirió una disolución al 5% de Bicarbonato de Sodio (NaHCO3), La muestras de pH y volumen urinario fueron tomadas antes de la prueba y luego de finalizada la misma, con un intervalo de 15 minutos para la recolección post-test. Resultados: Se pudo evidenciar un tendencia a la alcalinidad del pH urinario en el grupo experimental siendo su valor en pre-test 6,58 y post-test en la última recolección de 7,21; mientras el grupo control mantuvo la acidez desde su valor pre-test en 6,47 manteniéndose ácido hasta 6,35. El volumen urinario mantuvo una tendencia a la reducción durante la recuperación del ejercicio en ambos grupos. Conclusiones: Al monitorear la respuesta renal, se evidencia que el efecto tampón del bicarbonato se manifiesta de manera eficiente, y se considera eficaz para el grupo en estudio la tolerancia orgánica de la estrategia de elaborar disolución al 5% de concentración de NaHCO3.
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The use of nutritional supplements in sport is widespread and few serious athletes do not, at some stage in their career, succumb to the temptation to experiment with one or more nutritional supplements. Nutritional ergogenic aids are aimed primarily at enhancing performance (either by affecting energy metabolism or by an effect on the central nervous system), at increasing lean body mass or muscle mass by stimulation of protein synthesis and at reducing body fat content. Although not strictly ergogenic (i.e. capable of enhancing work performance), supplements aimed at increasing resistance to infection and improving general health are seen by athletes as important in reducing the interruptions to training that minor illness and infection can cause. Creatine is perhaps the most widely used supplement in sport at the moment. Supplementation can increase muscle creatine phosphate levels and, although not all published studies show positive results, there is much evidence that performance of short-term high-intensity exercise can be improved by supplementation. Ingestion of large doses of bicarbonate can enhance performance of exercise where metabolic acidosis may be a limiting factor, but there is a significant risk of adverse gastrointestinal side effects. Caffeine can also improve performance, in part by a stimulation of fatty acid mobilization and sparing of the body's limited carbohydrate stores, but also via direct effects on muscle and possibly by central nervous system effects on the perception of effort and fatigue. Carnitine plays an essential role in fatty acid oxidation in muscle but, although supplements are used by athletes, there is no good evidence of a beneficial effect of supplementation. None of these products contravenes the International Olympic Committee regulations on doping in sports, although caffeine is not permitted above a urine concentration of 12 mg/l. Supplementation is particularly prevalent among strength and power athletes, where an increase in muscle mass can benefit performance. Protein supplements have not been shown to be effective except in those rare cases where the dietary protein intake is otherwise inadequate. Individual amino acids, especially ornithine, arginine and glutamine, are also commonly used, but their benefit is not supported by documented evidence. Cr and hydroxymethylbutyrate are also used by strength athletes, but again there are no well-controlled studies to provide evidence of a beneficial effect. Athletes use a wide variety of supplements aimed at improving or maintaining general health and vitamin and mineral supplementation is widespread. There is a theoretical basis, and limited evidence, to support the use of antioxidant vitamins and glutamine during periods of intensive training, but further evidence is required before the use of these supplements can be recommended.
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Athletes use a variety of nutritional ergogenic aids to enhance performance. Most nutritional aids can be categorized as a potential energy source, an anabolic enhancer, a cellular component, or a recovery aid. Studies have consistently shown that carbohydrates consumed immediately before or after exercise enhance performance by increasing glycogen stores and delaying fatigue. Protein and amino acid supplementation may serve an anabolic role by optimizing body composition crucial in strength-related sports. Dietary antioxidants, such as vitamins C and E and carotenes, may prevent oxidative stress that occurs with intense exercise. Performance during high-intensity exercise, such as sprinting, may be improved with short-term creatine loading, and high effort exercise lasting 1-7 min may be improved through bicarbonate loading immediately prior to activity. Caffeine dosing before exercise delays fatigue and may enhance performance of high-intensity exercise.
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Numerous ergogenic aids that claim to enhance sports performance are used by amateur and professional athletes. Approximately 50 percent of the general population have reported taking some form of dietary supplements, while 76 to 100 percent of athletes in some sports are reported to use them. Physicians can evaluate these products by examining four factors (method of action, available research, adverse effects, legality) that will help them counsel patients. Common ergogenic aids include anabolic steroids, which increase muscle mass. These illegal supplements are associated with a number of serious adverse effects, some irreversible. Creatine modestly improves athletic performance and appears to be relatively safe. Dehydroepiandrosterone and androstenedione do not improve athletic performance but apparently have similar adverse effects as testosterone and are also banned by some sports organizations. Caffeine has mild benefits and side effects and is banned above certain levels. Products that combine caffeine with other stimulants (e.g., ephedrine) have been linked to fatal events. Protein and carbohydrate supplementation provides modest benefits with no major adverse effects.