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

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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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Authors and Affiliations

  1. Applied Physiology & Nutrition Research Group, Rheumatology Division, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil

    Luana Farias de Oliveira, Eimear Dolan & Bryan Saunders

  2. School of Health Sciences, Robert Gordon University, Aberdeen, UK

    Paul A. Swinton

  3. Department of Sports Dietetics, Poznań University of Physical Education, Poznań, Poland

    Krzysztof Durkalec-Michalski & Bryan Saunders

  4. Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland

    Krzysztof Durkalec-Michalski

  5. Department of Life Sciences, Manchester Metropolitan University, John Dalton Building, Manchester, M1 5GD, UK

    Guilherme G. Artioli

  6. Sports Nutrition and Performance Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK

    Lars R. McNaughton

  7. Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil

    Bryan Saunders

Authors
  1. Luana Farias de Oliveira
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  2. Eimear Dolan
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  4. Krzysztof Durkalec-Michalski
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  5. Guilherme G. Artioli
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  6. Lars R. McNaughton
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Corresponding author

Correspondence to Bryan Saunders.

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Funding

No specific funding was received for this review. Bryan Saunders (2016/50438-0), Eimear Dolan (2019/05616 and 2019/26899-6) and Guilherme Artioli (2019/25032-9) have been financially supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001. Bryan Saunders has received a grant from Faculdade de Medicina da Universidade de São Paulo (2020.1.362.5.2). Krzysztof Durkalec-Michalski has received a grant from the Polish National Science Centre (Grant number 2018/02/X/NZ7/03217).

Competing Interests

Several of the authors (LFO, GGA, BS) have previously received sodium bicarbonate, sodium citrate and calcium lactate supplements at no cost from a national supplement company (Farmácia Analítica, Rio de Janeiro, Brazil) for work unrelated to the current article. Farmácia Analítica have not had any input (financial, intellectual or otherwise) into this review. The remaining authors report no conflicts of interest.

Ethics Approval, Consent to Participate and Consent for Publication

Not applicable.

Data Availability Statements

Extracted data and analysis codes are available upon reasonable request.

Authors Contributions

LFO, ED and BS are responsible for the conception of the work. LFO and ED performed the literature search, article selection and data extraction. PS performed all data analysis. LFO and BS drafted the first version of the manuscript, ED, KD-M, GGA and LRM critically revised the work and content. All authors read and approved the final version.

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de Oliveira, L.F., Dolan, E., Swinton, P.A. et al. Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis. Sports Med 52, 505–526 (2022). https://doi.org/10.1007/s40279-021-01575-x

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