Infographics

Br J Sports Med: first published as 10.1136/bjsports-2019-101129 on 2 August 2019. Downloaded from http://bjsm.bmj.com/ on 5 August 2019 at Boston University Medical Library Serials
Infographic. A systematic review and meta-analysis of the
effect of β-alanine supplementation on exercise capacity
and performance
Bryan Saunders,‍ ‍ 1,2 Adam Virgile,3 Kirsty Jayne Elliott-Sale,4 Guilherme Giannini Artioli,1 Paul A Swinton,5
Eimear Dolan,1 Hamilton Roschel,1 Craig Sale,4 Bruno Gualano1

Dept L-12. Protected by copyright.

Carnosine (β-alanyl-L-histidine) is an
abundant compound in skeletal muscle,
suggesting it plays an important role
during exercise, with a key physiological
role considered to be intracellular pH
regulation.1 Chronic β-alanine supple-
mentation can increase muscle carnosine
content when taken for several weeks,2
and studies have shown that supple-
mentation between 4 and 24 weeks can
improve high-intensity exercise capacity,
with the gains in exercise associated
with the increase in muscle carnosine
content.3 4 Although several studies have
demonstrated the efficacy of β-alanine
supplementation as an ergogenic aid, there
are a number of confounding factors that
may modify its effect, including exercise
type, duration and mode, training status
and cosupplementation, which may influ-
ence the effects of β-alanine supplementa-
tion. The aim of our systematic review and
meta-analysis was to determine the effects
of β-alanine supplementation accounting
for these potential modifying factors.5
There was a significant overall ergo-
genic effect of β-alanine supplementation
on exercise measures. Exercise dura-
tion was the greatest factor influencing
the effect size of β-alanine; exercise
0.5–10.0 min in duration results in the
greatest effect, while very short dura-
tion exercise (<0.5 min) clearly resulted
in no benefits. Longer duration exercise
(>10 min) was not significantly improved
with β-alanine, although there was still a
moderate-sized effect. Exercise capacity
and performance protocols were both
improved by supplementation, although
effect sizes were larger for capacity tests,
particularly during exercise lasting from
0.5 to 10.0 min in duration. The effect of
β-alanine on trained individuals showed
smaller effect sizes than that on non-trained
individuals, although these gains may
translate into worthwhile improvements
in applied settings (ie, competition).
Isolated limb and whole-body exercise
benefitted equally from β-alanine supple-
mentation, whereas cosupplementation
of β-alanine with sodium bicarbonate,
thereby increasing both intracellular
and extracellular buffering capacity, was
shown to result in greater improvements
above β-alanine alone.
These meta-analytical data allow
coaches and athletes to make informed
decisions as to the likelihood of an ergo-
genic effect with β-alanine supplemen-
tation based on their specific exercise
demands, with those performing high-in-
tensity tasks between 30 s and 10 min
most likely to benefit. Individuals can
safely supplement daily with β-alanine for
up to 24 weeks at a dose of 3.2–6.4 g/day
ingested at several time points throughout
the day (0.8–1.6 g every 3–4 hours) to
avoid acute side effects (ie, paraesthesia).
­
1
Applied Physiology and Nutrition Research Group,
School of Physical Education and Sport; Rheumatology
Division; Faculdade de Medicina FMUSP, Universidade
de Sao Paulo, Sao Paulo, Brazil
2
Institute of Orthopaedics and Traumatology, Faculty of
Medicine FMUSP, University of São Paulo, São Paulo,
Brazil

Saunders B, et al. Br J Sports Med Month 2019 Vol 0 No 0    1

 Infographics
3
Independent Researcher, New York City, New York,
USA
4
Musculoskeletal Physiology Research Group, Sport,
Health and Performance Enhancement Research Centre,
Nottingham Trent University, Nottingham, UK
5 regulation of skeletal muscle. Comp Biochem Physiol A
School of Health Sciences, Robert Gordon University,
Aberdeen, UK
Correspondence to Dr Bryan Saunders,
Rheumatology Division, University of São Paulo, São
Paulo - SP 05508-030, Brazil;
​drbryansaunders@​outlook.​com
Contributors BS was the principal writer of the
article, while all authors contributed to drafting
the article and revising it critically. AV designed the
infographic. All authors approved the final version to
be submitted.
Funding BS (2016/50438-0 and 2017/04973-4),
GGA (2014/11948-8) and ED (2015/11328-2) were
financially supported by Fundação de Amparo à
Pesquisa do Estado de São Paulo.
Competing interests BS has previously received
financial support from Natural Alternatives International
2 Saunders B, et al. Br J Sports Med Month 2019 Vol 0 No 0
(NAI), a company that produces β-alanine, to undertake
a study unrelated to this review. NAI have also provided
β-alanine supplements free of charge for further
experimental investigations and supported open access
page charges for several of the author’s manuscripts.
NAI have not had any input (financial, intellectual or
otherwise) into this review.
Patient consent for publication Not required.
Provenance and peer review Not commissioned;
externally peer reviewed.
© Author(s) (or their employer(s)) 2019. No commercial
re-use. See rights and permissions. Published by BMJ.
To cite Saunders B, Virgile A, Elliott-Sale KJ, et al.
Br J Sports Med Epub ahead of print: [please include
Day Month Year]. doi:10.1136/bjsports-2019-101129
Accepted 18 July 2019
Br J Sports Med 2019;0:1–2.
doi:10.1136/bjsports-2019-101129
Br J Sports Med: first published as 10.1136/bjsports-2019-101129 on 2 August 2019. Downloaded from http://bjsm.bmj.com/ on 5 August 2019 at Boston University Medical Library Serials
References
1 Dolan E, Saunders B, Harris RC, et al. Comparative
physiology investigations support a role for histidine-
containing dipeptides in intracellular acid-base
Mol Integr Physiol 2019;234:77–86.
2 Harris RC, Tallon MJ, Dunnett M, et al. The absorption
of orally supplied beta-alanine and its effect on muscle
carnosine synthesis in human vastus lateralis. Amino
Acids 2006;30:279–89.
3 Hill CA, Harris RC, Kim HJ, et al. Influence of beta-
alanine supplementation on skeletal muscle carnosine
concentrations and high intensity cycling capacity.
Amino Acids 2007;32:225–33.
4 Saunders B, DE Salles Painelli V, DE Oliveira LF, et al.
Twenty-Four weeks of β-alanine supplementation on
carnosine content, related genes, and exercise. Med Sci
Sports Exerc 2017;49:896–906.
5 Saunders B, Elliott-Sale K, Artioli GG, et al. β-alanine
supplementation to improve exercise capacity and
performance: a systematic review and meta-analysis. Br
J Sports Med 2017;51:658–69.
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