Cited by 21Drug Solubulity and Delivery SystemsRenal function and acid-base balanceGastrointestinal motility and disorders

Enteric-Coated Sodium Bicarbonate Attenuates Gastrointestinal Side-Effects

Open access
Hilton, Nathan Philip, Leach, Nicholas Keith, Craig, Melissa May, Sparks, S. Andy, McNaughton, Lars Robert·2020·International Journal of Sport Nutrition and Exercise Metabolism

Abstract

Enteric-formulated capsules can mitigate gastrointestinal (GI) side effects following sodium bicarbonate (NaHCO 3) ingestion; however, it remains unclear how encapsulation alters postingestion symptoms and acid–base balance. The current study aimed to identify the optimal ingestion form to mitigate GI distress following NaHCO 3 ingestion. Trained males (n = 14) ingested 300 mg/kg body mass of NaHCO 3 in gelatin (GEL), delayed-release (DEL), and enteric-coated (ENT) capsules or a placebo in a randomized cross-over design. Blood bicarbonate anion concentration, potential hydrogen, and GI symptoms were measured pre- and postingestion for 3 hr. Fewer GI symptoms were reported with ENT NaHCO 3 than with GEL (p = .012), but not with DEL (p = .106) in the postingestion phase. Symptom severity decreased with DEL (4.6 ± 2.8 arbitrary units) compared with GEL (7.0 ± 2.6 arbitrary units; p = .001) and was lower with ENT (2.8 ± 1.9 arbitrary units) compared with both GEL (p < .0005) and DEL (p = .044) NaHCO 3. Blood bicarbonate anion concentration increased in all NaHCO 3 conditions compared with the placebo (p < .0005), although this was lower with ENT than with GEL (p = .001) and DEL (p < .0005) NaHCO 3. Changes in blood potential hydrogen were reduced with ENT compared with GEL (p = .047) and DEL (p = .047) NaHCO 3, with no other differences between the conditions. Ingestion of ENT NaHCO 3 attenuates GI disturbances for up to 3 hr postingestion. Therefore, ENT ingestion forms may be favorable for those who report GI disturbances with NaHCO 3 supplementation or for those who have previously been deterred from its use altogether.

AI snapshot

Written from the paper’s full text.

TL;DR

Enteric-coated sodium bicarbonate (NaHCO₃) reduced gastrointestinal symptom severity compared with gelatine and delayed-release capsules in trained males, but it also blunted blood bicarbonate and pH responses. Delayed-release capsules better preserved extracellular buffering, suggesting a trade-off between GI tolerability and bioavailability.

Key findings

  • GI symptom severity was lower with enteric-coated NaHCO₃ (2.8 ± 1.9 AU) than with gelatine (7.0 ± 2.6 AU; P < 0.0005) and delayed-release (4.6 ± 2.8 AU; P = 0.044) capsules.
  • Blood [HCO₃⁻] increased in all NaHCO₃ conditions versus placebo (P < 0.0005), but was lower with enteric-coated than gelatine (P = 0.001) and delayed-release (P < 0.0005) NaHCO₃.
  • Changes in peak blood pH were reduced with enteric-coated (0.06 ± 0.02 AU) compared with gelatine (0.08 ± 0.02 AU; P = 0.047) and delayed-release (0.08 ± 0.02 AU; P = 0.047) NaHCO₃.
  • Delayed-release NaHCO₃ maintained blood [HCO₃⁻] above 5 mmol·L⁻¹ for longer than gelatine capsules, which the authors suggest may provide a greater “ergogenic window.”

Methods

  • Double-blind, placebo-controlled, randomised crossover design with five laboratory visits; 14 trained males (age 23.6 ± 4.9 years, BM 80.9 ± 11.5 kg, maximal oxygen uptake 57.7 ± 5.3 mL·kg⁻¹·min⁻¹) ingested 300 mg·kg⁻¹ BM NaHCO₃ in gelatine, delayed-release, or enteric-coated capsules, or placebo.
  • Blood [HCO₃⁻] and pH were measured pre-ingestion and every 20 min for 180 min post-ingestion, with 10 min sampling from 80 to 140 min; GI symptoms were recorded at the same time points using a 9-item questionnaire on a 10 cm visual analogue scale.
  • Data were analysed with two-way repeated-measures ANOVA, one-way repeated-measures ANOVA, Bonferroni post-hoc comparisons, partial eta squared effect sizes, and Pearson correlations.

Limitations

  • The paper states that future research should determine the effects of enteric-coated NaHCO₃ on exercise performance, and that it is difficult to suggest which GI symptoms may adversely affect performance based on the current data.
  • Evident from the text: the study measured GI symptoms and acid-base responses but not exercise performance, so performance implications remain speculative.
  • Evident from the text: the sample was 14 trained males without GI-related disorders, limiting generalisability to other populations, and assessments were limited to 3 h post-ingestion.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1123/ijsnem.2019-0151

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 7 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingnone given
    § [INSERT FIGURE 3 NEAR HERE] DISCUSSION

    Timing of peak blood bicarbonate concentration varied dramatically (60-180 min) across ingestion forms.

    “Given the dramatic variation in the timing of peak blood [HCO 3 -] (60-180 min) across ingestion forms, it is recommended that athletes continue to adopt an individualised ingestion strategy.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Gastrointestinal symptoms

    Ingestion of 300 mg/kg body mass NaHCO3 in enteric-coated capsules resulted in fewer GI symptoms than gelatine capsules in the post-ingestion phase.

    “The ENT trial also resulted in significantly lower GI symptom scores compared to GEL (4.8 ± 1.4 AU; 95% CI 1.0-8.6AU; P = 0.025) but not DEL (P = 0.211) post-ingestion.”
    Quote in the paperSubstantial claim
  • Findingreasoning
    § [INSERT FIGURE 3 NEAR HERE] DISCUSSION

    Changes in blood bicarbonate concentration were less variable with enteric-coated capsules.

    “Interestingly, changes in blood [HCO 3 -] were less variable with enteric-coated capsules which suggests that much of the variation derives from the degree of neutralisation in the stomach.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § [INSERT FIGURE 3 NEAR HERE] DISCUSSION

    Blood bicarbonate concentration was increased above 5 mmol/L for longer with delayed-release NaHCO3 compared to gelatine capsules.

    “Interestingly, blood [HCO 3 -] was increased above 5 mmol•L -1 for longer with delayed-release NaHCO 3 compared to the gelatine capsules (Figure 2), which may provide a greater 'ergogenic window' following supplementation (Carr et al., 2011b), although this has yet to be confirmed.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § [INSERT FIGURE 2 NEAR HERE]

    Changes in peak blood pH were reduced with enteric-coated NaHCO3 compared with gelatine and delayed-release NaHCO3.

    “Changes in peak blood pH were similar in the GEL (0.08 ± 0.02 AU) and DEL (0.08 ± 0.02 AU) trials, whereas changes with ENT (0.06 ± 0.02) were significantly lower than with GEL (P = 0.047) and DEL (P = 0.047) NaHCO 3 .”
    Quote in the paperSubstantial claim
  • May combine two claims. 8
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 8
  • May combine two claims.

    Premisecitation
    § [INSERT FIGURE 3 NEAR HERE] DISCUSSION

    Bicarbonate anions are actively transported across the intestinal mucosa rather than passively and become saturated.

    “Bicarbonate anions are actively transported across the intestinal mucosa rather than passively and become saturated (Turnberg, 1970), which could explain why blood concentrations are reduced with enteric-coated NaHCO 3 .”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Turnberg, 1970 source

      The Discussion says bicarbonate absorption is at least partially saturable at high luminal concentrations and can occur against steep electrochemical gradients. But the Introduction and Abstract attribute that absorption to active hydrogen-ion secretion, rather than direct transport of bicarbonate anions. Page numbers are not provided in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • May combine two claims.

    Findingreasoning
    § [INSERT FIGURE 3 NEAR HERE] DISCUSSION

    Enteric-coated NaHCO3 reduced the bioavailability of bicarbonate, with changes of approximately 4 mmol/L post-ingestion.

    “Indeed, enteric-coated capsules reduced the bioavailability of bicarbonate with changes of ~ 4 mmol•L -1 post-ingestion, which may hinder the effect on exercise performance.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim.

    Findingown data
    § Acid-base responses

    Blood bicarbonate concentration increased in all NaHCO3 conditions compared to placebo.

    “No changes in blood [HCO 3 -] or pH were observed for PLA throughout the post-ingestion phase (P > 0.05).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Statistical analysis

    Data were assessed for normality using standard graphical methods prior to analyses.

    “Data were assessed for normality using standard graphical methods prior to analyses (Grafen & Hails, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grafen & Hails, 2002
  • May combine two claims.

    Premisecitation
    § INTRODUCTION

    Enteric-coated capsules resist disintegration in the stomach and release compounds in the small intestine, decreasing overall GI transit time.

    “Through encapsulation in a polymer barrier, which is less soluble at high acidity (Mazarati et al., 2016), capsules resist disintegration in the stomach and compounds are released in the small intestine, therefore preventing GI disturbances.”
    • Also stated in: § [INSERT FIGURE 3 NEAR HERE] DISCUSSION · hedged
      “Furthermore, as enteric-coated capsules do not disintegrate until reaching the small intestine, overall GI transit time is decreased which may have contributed to reduced blood concentrations.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mazarati et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Assessment of acid-base balance

    Blood samples were analysed immediately for blood bicarbonate concentration and pH.

    “Samples were collected in heparincoated glass capillary tubes (Radiometer Medical Ltd, Denmark) using an aseptic technique and were analysed immediately (Radiometer ABL800 BASIC, Denmark) for blood [HCO 3 -] and pH.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given
    § 517

    Experimental trials were counterbalanced in order of administration and conducted at least 48 h apart to allow blood bicarbonate to return to normal.

    “Experimental trials were counterbalanced (balanced Latin-square) in the order of administration and conducted at least 48 h apart to allow for blood bicarbonate concentration ([HCO 3 -]) to return to 'normal' values.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § Experimental overview

    The study used a double-blind, placebo-controlled, randomised crossover design.

    “In a double-blind, placebo-controlled, randomised crossover design, participants attended the laboratory on five separate occasions.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Experimental overview

    Capsules were manually filled by the same individual and doses were tested for accuracy.

    “Capsules were manually filled by the same individual using a capsule filling device (Capsule Connection LLC, USA) and doses were tested for accuracy (Fisher, OHAUS™).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Experimental overview

    Participants abstained from alcohol or caffeine for 12 h and strenuous exercise for 24 h before each laboratory visit.

    “Participants were required to abstain from alcohol or caffeinecontaining beverages for 12 h, and strenuous exercise 24 h before each laboratory visit.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation
    § Experimental overview

    Experimental trials took place under standardised laboratory conditions and commenced at the same time of day to account for circadian rhythms.

    “Experimental trials took place under standardised laboratory conditions (temperature 20-22 °C, humidity 50 ± 5 %) and commenced at the same time of day to account for circadian rhythms (Reilly et al., 1990).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Reilly et al., 1990

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Experimental overview

    Participants arrived after an overnight fast of approximately 12 h, which was verbally confirmed upon arrival.

    “Participants arrived at the laboratory after an overnight fast (~ 12 h) which was verbally confirmed upon arrival.”
    Quote in the paperNot a substantial claim
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract and results give different ENT-versus-GEL symptom P values

    Major

    Both passages describe post-ingestion GI symptoms for ENT compared with GEL, but the abstract reports P = 0.012 and the results report P = 0.025.

  • Severity at peak alkalosis conflicts between results and discussion

    Major

    The results say symptoms reported at T max were rated less than 3/10, while the discussion says participants with symptoms at peak alkalosis all had diarrhoea rated 10.0 AU.

  • ENT symptom count disagrees with Table 1

    Minor

    The results say twelve of fourteen participants experienced symptoms in the ENT trial, whereas Table 1 reports 92.9%, or thirteen of fourteen, for ENT under "Any."

  • Table 3 labels a time-to-peak variable with concentration units

    Minor

    Table 3 gives T max units of mmol•L -1, although the methods define it as a time and the results report T max in minutes.

  • Peak bicarbonate increases are assigned to opposite capsule types

    Minor

    The results assign 6.5 mmol•L -1 to GEL and 6.0 mmol•L -1 to DEL, but Table 3 assigns 6.0 to GEL and 6.5 to DEL.

  • Abstract and results give different ENT-versus-DEL symptom P values

    Minor

    For post-ingestion GI symptoms comparing ENT with DEL, the abstract reports P = 0.106, while the results report P = 0.211.

6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

Cited by

Sorted by citations

Authors
Hilton, N. P., Leach, N. K., Craig, M. M., Sparks, S. A., & McNaughton, L. R.
Affiliations
  • Edge Hill University (GB)
  • Liverpool Heart and Chest Hospital NHS Trust (GB)
Venue
International Journal of Sport Nutrition and Exercise Metabolism
Published
2020-01-01
Volume
30
Issue
1
Pages
62-68
ISSN
  • 1526-484X (ISSN-L)
  • 1543-2742
OpenAlex
W2991001708
Cited by
20
References
33
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 6 · 2020: 3
FWCI
1.13
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Edge Hill University Research Information Repository (Edge Hill University) (acceptedVersion, cc-by-nc-nd)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Drug Solubulity and Delivery Systems
  • Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
sodium bicarbonate, enteric-coated capsules, delayed-release capsules, gelatin capsules, gastrointestinal adverse effects, acid-base balance, blood bicarbonate, potential hydrogen, sodium bicarbonate supplementation
MeSH terms
Acid-Base Equilibrium, Adult, Biological Availability, Double-Blind Method, Gastrointestinal Diseases, Humans, Hydrogen-Ion Concentration, Male, Tablets, Enteric-Coated, Sodium Bicarbonate, Cross-Over Studies, Young Adult

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