DOI: 10.

54448/ijn22205
REVIEW ARTICLE

Major clinical findings of β-alanine in sports performance:

a systematic review
Leandro Reis Woitas1*, José Wilson Ribas2
1 WOITAS CLINIC - Health and Longevity, Curitiba, Parana, Brazil.
2 REVIV CLINIC - Advanced Center for Integrative Medicine, Brasilia DF, Brazil.

Corresponding Author: Dr. WOITAS CLINIC - Health and

Longevity, Curitiba, Parana, Brazil.
E-mail: [email protected]
DOI: https://doi.org/10.54448/ijn22205
Received: 02-11-2022; Revised: 04-25-2022; Accepted: 04-26-2022; Published: 05-25-2022; IJN-id: e22205

Abstract findings were informed by the study of highly trained

athletes. Recent progress has been made regarding
Introduction: Dietary supplements offer ergogenic aid
skeletal muscle metabolism and personalized exercise
in an attempt to increase energy, improve recovery and
regimens [1]. In this context, regular physical training
modulate body composition, enabling improved
added to dietary supplements has broad health benefits
performance. Thus, β-alanine is a substrate of carnosine
by acting positively on almost all organ systems of the
and is becoming an ergogenic aid for sports
body [2].
performance. Objective: To carry out a systematic
In this sense, dietary supplements offer ergogenic
review to highlight the main scientific evidence on the
aid in an attempt to increase energy, improve recovery
improvement of sports performance with the use of β-
and modulate body composition, enabling improved
alanine. Methods: The PRISMA Platform rules were
performance [3,4]. Thus, β-alanine (Beta-alanine) (BA)
used. The research was developed using the SCOPUS,
is a non-essential amino acid that can be synthesized in
PUBMED, and SCIENCE DIRECT databases. The quality
the liver and obtained from the diet, particularly from
of the studies was based on the GRADE instrument and
white meat (poultry and fish) and red meat [5].
the risk of bias was analyzed according to the Cochrane
endogenous BA derives from the degradation of the
instrument. Results and Conclusion: Studies have
pyrimidines thymine, cytosine, and uracil and its
shown that β-alanine has an important ergogenic role in
transport to skeletal muscle are dependent on sodium
sports performance. Weeks of beta-alanine
and chloride ions [6,7].
supplementation (4-6g per day) significantly increases
Despite this, the entry of BA into cells can be
muscle carnosine concentrations. The only side effect
affected by compounds of similar structures (glycine,
reported is paresthesia. Beta-alanine attenuates
taurine, gamma-aminobutyric acid) that compete for the
neuromuscular fatigue, particularly in older individuals.
same transporter [6]. It is in the skeletal muscle that
Also, combining beta-alanine with other supplements
BA develops its role as an intermediary for the synthesis
can be advantageous when beta-alanine
of carnosine, which is a dipeptide (histidine and BA)
supplementation is high enough (4-6 g per day) and
responsible for reducing fatigue and buffering the
long enough (minimum 4 weeks).
muscles against acidosis [8-11].
Keywords: Beta-alanine. Athletes. Performance. Furthermore, the muscle carnosine content is also
Carnosine. Antioxidant. influenced by muscle contraction and increases with
muscle tension [12]. Thus, increasing the availability of
Introduction BA through dietary supplementation, combined with
training, can improve the performance of athletes who
Many of the established positive health benefits of
perform high-intensity exercise, through increased
exercise have been documented by historic discoveries
muscle buffering capacity (acidity reduction) [13-16].
in the field of exercise physiology. These investigations
In this regard, the supplementation time between
generally assess performance thresholds or exercise-
studies seems to vary generally between 4 to 10 weeks
induced health benefits [1]. Thus, several important
and the doses are distributed throughout the day,
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making the effect of BA supplementation on exercise still Study Quality and Risk of Bias
controversial [14,17]. The quality of the studies was based on the GRADE
In this scenario, the International Association of instrument [20] and the risk of bias was analyzed
Athletics Federations recognizes the importance of according to the Cochrane instrument [21].
nutritional practices in optimizing an athlete's well-being
and performance. In this regard, periodized guidelines Results and discussion
can be provided for the appropriate type, amount, and
timing of food and fluid intake to promote optimal health A total of 125 articles were found involving the use
and performance in different training and competition of β-alanine to increase the performance of athletes.
settings. Thus, the use of medical supplements to Initially, article duplication was excluded. After this
address nutrient deficiencies or sports foods to help the process, the abstracts were evaluated and a new
athlete achieve nutritional goals is notorious. The most exclusion was performed, removing the articles that did
common examples of supplements are caffeine, not cover the theme of this article. In total, 64 articles
bicarbonate, beta-alanine, nitrate, and creatine. Special were fully evaluated and 31 were included and
considerations are required for travel, challenging evaluated in the present study (Figure 1). After
environments (eg heat and altitude); special populations analyzing the thirty-one (31) articles on the main
(eg women, youth athletes, and masters); and restricted findings of the use of BA, it was found that most of the
dietary choice (eg, vegetarian). Ideally, each athlete articles analyzed presented important scientific quality,
should develop a personalized, periodized, and practical according to the rules of GRADE. The main risks of bias
nutritional plan, in collaboration with their coach and were related to the number of participants in each
accredited sports nutrition experts, to optimize their study, as well as the dosage and duration of BA use.
performance [18].
Therefore, due to the well-defined role of β-alanine Figure 1. Eligibility of studies.
as a substrate for carnosine, and the fact that β-alanine
is becoming an ergogenic aid for sports performance,
Articles on PubMed Other databases
Identification

the present study carried out a systematic review to (n = 120) (n = 5)

highlight the main scientific evidence on the
improvement of sports performance with the use of β-
alanine. • Total = 125
• Findings - removal of duplicates (n = 94)

Methods
Variation

Excluded articles
Study Design Articles analyzed (Does not meet the
(n = 64) objective) (n = 20)
The present study followed the systematic review
model according to the PRISMA Platform (Transparent
reporting of systematic reviews and meta-analysis- Excluded articles
Selected articles
Selection

HTTP: //www.prisma-statement.org/) [19]. (n = 44)

(Bias Risk)
(n = 07)

Data Sources and Research Strategy

Studies included in Excluded articles
The search strategies for this systematic review the qualitative (non-GRADE
were based on the keywords (MeSH Terms): “Beta- analysis (n = 37) adherent) (n = 06)
Included

alanine; β-alanine; L-histidine; athletes; Performance;

Muscle acidosis; carnosine; antioxidant ”. The research
Articles included
was developed using the SCOPUS, PUBMED, and Systematic Review
SCIENCE DIRECT databases, including the National (n = 31)

Institutes of Health RePORTER Grant database and

clinical trial registries. In addition, a combination of the
keywords with the Booleans "OR", AND, and the "NOT" As a corollary of scientific development, the
operator were used to target scientific articles of International Society of Sports Nutrition (ISSN) has
interest. Title and abstracts were examined under all shown that four weeks of beta-alanine supplementation
conditions. (4-6g per day) significantly increases muscle carnosine
concentrations. Also, beta-alanine supplementation
currently appears to be safe in healthy populations at

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recommended doses, however, the only reported side the results indicate that β-alanine supplementation did
effect is paresthesia, but studies indicate that this can not adversely affect [24].
be alleviated using smaller divided doses (1.6 g) or Furthermore, a randomized, double-blind,
using a sustained release formula. In addition, daily placebo-controlled study investigated the influence of β-
supplementation with 4 to 6 g of beta-alanine for at alanine supplementation during a high-intensity interval
least 2 to 4 weeks has been shown to improve exercise training (HIIT) program on repeated sprint (RSA) skill
performance, with more pronounced effects in open- performance. Eighteen men performed an incremental
ended/time trial tasks lasting 1 to 4 minutes. Beta- run-to-exhaustion (IRTE) test at baseline and followed
alanine attenuates neuromuscular fatigue, particularly by a 4-week HIIT (10 × 1 min runs 90% of maximum
in older individuals, and preliminary evidence indicates IRTE speed [1-minute recovery]). Then, participants
that beta-alanine may improve tactical performance. were randomized into two groups and performed a 6-
Also, combining beta-alanine with other supplements week HIIT plus supplementation of 6.4 g/day of β-
can be advantageous when beta-alanine alanine (BA) or dextrose (placebo group). The results
supplementation is high enough (4-6 g per day) and showed that BA supplementation during HIIT increased
long enough (minimum 4 weeks) [22]. muscle carnosine and attenuated neuromuscular
In this setting, an eight-week randomized double- fatigue, which may contribute to an RSA performance
blind crossover study aimed to verify the effect of BA enhancement. Furthermore, the improvement in muscle
intracellular versus extracellular buffering agent carnosine content induced by β-alanine
supplementation (alkaline-ALK agents) combined with supplementation may have contributed to an
the usual treatment of branched-chain amino acids attenuation of central fatigue during repeated sprints
(BCAAs) and creatine malate (CM) under natural [25].
training conditions. Thirty-one elite athletes (11 Also, to sarcopenia, increased systemic carnosine
sprinters and 20 endurance athletes) participated in the levels may result in increased antioxidant,
study. After BA-ALK-BCAA and CM supplementation, the neuroprotective, and pH buffering capabilities. Thus, a
total fat-free mass increased in sprinters. No other study of twelve healthy adults (mean age = 60.5 ± 8.6
differences were found in body composition, respiratory years, weight = 81.5 ± 12.6 kg) was randomized and
parameters, aerobic capacity, blood lactate received 2.4 g/d of β-alanine (BA) or Placebo (PL) for
concentration, and hematological indices after 28 days. As a result, BA supplementation increased
supplementation with BA-ALK-BCAA and TCM/ALK-BA- exercise capacity and eliminated resistance exercise-
BCAA and CM. Maximum post-exercise blood ammonia induced declines in executive function observed after
concentration (NH3) decreased in both groups after recovery. Similar PRE vs POST lactate production
supplementation with BA-ALK-BCAA and CM. In indicates an improvement in the BA's ability to extend
addition, lower concentrations of NH3 were observed in exercise duration [26].
endurance athletes in the post-exercise recovery period.
Furthermore, a systematic review and meta-
Thus, the results of our study indicate that combined
analysis study analyzed the effects of BA
BCAA, CM, and BA supplementation is more effective
supplementation on exercise capacity and performance.
than combined BCAA, CM, and ALK supplementation for
A total of 40 individual studies employing 65 different
an increase in fat-free mass and exercise adaptation,
exercise protocols and totaling 70 exercise measures in
but not for improvement. of aerobic capacity [23].
1461 participants were included in the analyses. Meta-
In this context, despite the widespread use of BA, regression demonstrated that exercise duration
understanding of potential adverse effects is limited. significantly moderated effect sizes. Subgroup analyses
Thus, a systematic study and risk assessment meta- also identified exercise type as a significant moderator
analysis was performed. In total, 101 human and 50 of effect sizes within a 0.5-10 min exercise period, with
animal studies were included. Paresthesia was the only larger effect sizes for exercise capacity versus
side effect reported and had an estimated OR of 8.9 performance. There was no moderating effect on
with supplementation versus placebo. β-alanine training status, intermittent or continuous exercise, or
supplementation in animals caused a small increase in the total amount of BA ingested. Furthermore, co-
circulating alanine aminotransferase concentration, supplementation with sodium bicarbonate resulted in
although the mean data remained within the clinical the largest effect size when compared to placebo [27].
reference ranges. Meta-analysis of human data showed
In addition to these findings, recent evidence
no main effect of β-alanine supplementation on skeletal
suggests that high levels of carnosine can improve
muscle taurine or histidine concentration. Therefore,
cognitive performance and increase stress resilience.

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These benefits are believed to result from carnosine's supplementation, exercise lasting 60-240 s was
potential role as an antioxidant [28]. Also, a review improved in BA compared to placebo, as was exercise
study analyzed the available evidence on lasting longer than 240 s. However, no benefit of BA
supplementation optimization, the link between beta- was observed in exercises lasting <60 s [33].
alanine and exercise performance, and the ergogenic Finally, carnosine plays an important role in
mechanism. The factors that determine the loading exercise performance and skeletal muscle homeostasis.
process, as well as the mechanism of the ergogenic Dietary supplementation with the rate-limiting precursor
effect, are still debated. Based on its biochemical of BA leads to an increase in skeletal muscle carnosine
properties, several functions are attributed to carnosine, content, which further potentiates its effects.
of which the intramuscular pH buffer and the calcium Physiological roles in human skeletal muscle include
regulator are the most cited. In addition, carnosine has acting as an intracellular pH buffer, modulating energy
antiglycation and antioxidant properties, suggesting metabolism, regulating Ca handling and myofilament
that it may have the therapeutic potential [29]. sensitivity, and eliminating reactive species. New
Another review study explored the use of BA evidence shows that carnosine can also act as a
supplementation as an ergogenic aid to improve cytoplasmic Ca-H exchanger and form stable conjugates
performance and fatigue resistance in athletes and non- with exercise-induced reactive aldehydes [34].
athletes. Twenty-three studies were selected. Most of
them included physically active individuals. The mean Conclusion
intervention period was 5.2 ± 1.8 weeks, and the mean
dose of BA was 4.8 ± 1.3 g/day. BA supplementation Studies have shown that β-alanine has an
seems to improve the perception of exertion and the important ergogenic role in sports performance. Weeks
biochemical parameters related to muscle fatigue [30]. of beta-alanine supplementation (4-6g per day)
significantly increases muscle carnosine concentrations.
Besides, one study looked at whether BA
The only side effect reported is paresthesia. Beta-
supplementation could attenuate acidosis and improve
alanine attenuates neuromuscular fatigue, particularly in
judo performance. Twenty-three highly trained judokas
older individuals. Also, combining beta-alanine with
were randomly assigned to receive either BA (6.4 g/day)
other supplements can be advantageous when beta-
or placebo (dextrose, same dosage) for 4 weeks. BA
alanine supplementation is high enough (4-6 g per day)
supplementation improved the number of pitches per
and long enough (minimum 4 weeks).
series and the total number of pitches. Placebo did not
change these variables. Blood pH and HCO3- decreased
after exercise, with no differences between groups. Acknowledgement
However, lactate response to exercise increased in the Not applicable.
BA group compared to placebo [31].
Furthermore, a randomized, placebo-controlled (P)
Funding
Not applicable.
study with thirty-three male soccer players analyzed the
effects of creatine © and creatine plus beta-alanine
(CBA) on strength, power, body composition, and
Ethics approval
endocrine changes during a training program. of 10 Not applicable.
weeks resistance. Changes in lean body mass and body
fat percentage were greater in CBA compared to C or P. Informed consent
Significantly greater strength improvements were Not applicable.
observed in CBA and C compared to P. Therefore, the
results demonstrate the effectiveness of creatine and Data sharing statement
creatine plus beta-alanine in strength performance. No additional data are available.
Furthermore, creatine and beta-alanine
supplementation appear to have the greatest effect on Conflict of interest
lean tissue accumulation and body fat composition The authors declare no conflict of interest.
[32].
Moreover, another meta-analysis study showed Similarity check
that BA improved the outcome of exercise measures to It was applied by Ithenticate@.
a greater extent than placebo. Following the claimed
mechanisms for an ergogenic effect of BA About the license

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