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β-alanine is a popular supplement among athletes with 61% of competitive team sport players recently surveyed reporting β-alanine use.1 Despite its popularity, there is limited evidence on the most effective supplementation strategy and the systematic review and meta-analysis published by Sauders B et al2 has shed some light on this issue. Athletes' understanding of β-alanine potential benefits and appropriate daily dose and duration of consumption is low,1 potentially compromising the impact of β-alanine supplementation in a real world setting. This editorial aims to highlight issues regarding the efficacy of β-alanine supplementation and suggest possible approaches to improve its effectiveness in the field.
What we know
The mechanism of ergogenic effect of β-alanine as the precursor to carnosine synthesis is associated with an expansion of its key physiological role as a proton buffer with potential for antioxidant, glycation and calcium regulation influence.3 Increases in carnosine muscle levels depend on the β-alanine load provided.4 β-alanine supplementation of 4–6 g/day for at least 2–4 weeks has been shown to improve performance in exercise lasting 1–4 min.2
A ceiling on the supplement dosage amount stems from reported paraesthesia experienced in some individuals although slow release formulations are available that appear to alleviate this effect. Doses of 4–6 g/day, spread evenly over doses of 800 mg, for 4 weeks have elevated muscle carnosine levels by 64%5 and extending the supplementation to 10 weeks has been shown to increase muscle carnosine by 80%.6 The meta-analysis reported a smaller effect on trained than non-trained individuals; however, the reason for this difference is not clear.2 Combining β-alanine with sodium bicarbonate has also been shown to further improve performance compared with β-alanine alone.2 ,3
Why β-alanine may not work in all situations?
Disparity of reported β-alanine ergogenic effect could be due to its biological effect and the adaptive response of the individual. With regards to the first point, carnosine contribution to the muscle buffering capacity might be as low as 7%. As far as the individual variations are concerned, it has been shown that 5–6 weeks of β-alanine supplementation might result in muscle carnosine content increases of 15–55%.7 Variations in the extent of loading between individuals may be due to preingestion initial carnosine levels, muscle fibre type composition and training status. In particular, muscle carnosine seems to be higher in those consuming carnosine-containing foods (ie, beef, pork, fish, etc) and in fast-twitch compared with slow-twitch muscle fibres3 as well as trained individuals.
Understanding supplement misconceptions
The efficacy of β-alanine on athletic performance is compromised by incomplete knowledge, habits and preconceived ideas on supplements. A recent study investigated the behaviour and the level of knowledge regarding β-alanine use among professional rugby union, rugby league and Australian Rules football players.1 Their findings showed that only 15% of all participants consumed β-alanine with the recommended dosage (4–6 g/day) and 50% consumed half the recommended daily dose. Only 35% of this survey's participants were able to identify correctly the benefits of β-alanine supplementation on performance.1
Have we missed something? Tips to improve the impact of science in the field
Information dissemination from the meta-analysis2 and proper communication with athletes and coaches is fundamental in building an effective nutritional supplementation strategy. Athletes and coaches views and preferences should be considered with concurrent education on evidence-based supplement choices and strategies. A survey of coaches indicated their preferred knowledge acquisition is informal learning (ie, peer discussion and social media)8 and should be taken into account when providing recommendations in the sporting community. This highlights the value of developing meaningful relationships with coaches and athletes to be a trusted advisor. Furthermore, it is recommended that the decision to supplement β-alanine for individual athletes in team sport environments is done on a case by case basis. Common practice in these environments is to provide a blanket supplementation recommendation for all athletes without attention for individual needs or appropriateness.
The meta-analysis of Sauders et al2 shed some light into the efficacy of β-alanine. At the same time, their findings show the gaps in the literature. Some applied questions that require further investigation are:
What is the effect of β-alanine on repeated sprint and team sports performance?
Does supplementation affect strength outcomes?
What is the impact of multi-ingredient supplementation on muscle carnosine levels and β-alanine supplementation?
Is there any concern regarding its long-term ingestion (beyond 8 weeks)?
Is continuous sustained supplementation with β-alanine most effective for team sport athletes or should a periodised approach be used?
Is a split dose maintenance protocol (1 g 2–3 times per day) better than a single dose (2–3 g/day) in the maintenance phase to help keep carnosine levels up?
Is there an effective alternative β-alanine supplementation in trained individuals?
Can responders and non-responders of β-alanine be identified?
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Contributors GPN drafted the manuscript. BS and CGS reviewed the manuscript and approved it.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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