REVIEW Open Access
International society of sports nutrition
position stand: Beta-Alanine
Eric T. Trexler1†
, Abbie E. Smith-Ryan1*†
, Jeffrey R. Stout2
, Jay R. Hoffman2
, Colin D. Wilborn3
, Craig Sale4
,
Richard B. Kreider5
, Ralf Jäger6
, Conrad P. Earnest5,7
, Laurent Bannock8
, Bill Campbell9
, Douglas Kalman10
,
Tim N. Ziegenfuss11
and Jose Antonio12
Abstract
Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of
the mechanisms and use of beta-alanine supplementation. Based on the current available literature, the conclusions of
the ISSN are as follows: 1) Four weeks of beta-alanine supplementation (4–6 g daily) significantly augments
muscle carnosine concentrations, thereby acting as an intracellular pH buffer; 2) Beta-alanine supplementation
currently appears to be safe in healthy populations at recommended doses; 3) The only reported side effect is
paraesthesia (tingling), but studies indicate this can be attenuated by using divided lower doses (1.6 g) or using a
sustained-release formula; 4) Daily supplementation with 4 to 6 g of beta-alanine for at least 2 to 4 weeks has
been shown to improve exercise performance, with more pronounced effects in open end-point tasks/time trials
lasting 1 to 4 min in duration; 5) Beta-alanine attenuates neuromuscular fatigue, particularly in older subjects, and
preliminary evidence indicates that beta-alanine may improve tactical performance; 6) Combining beta-alanine
with other single or multi-ingredient supplements may be advantageous when supplementation of beta-alanine
is high enough (4–6 g daily) and long enough (minimum 4 weeks); 7) More research is needed to determine the
effects of beta-alanine on strength, endurance performance beyond 25 min in duration, and other health-related
benefits associated with carnosine.
Introduction
Beta-alanine is a non-proteogenic amino acid that is
produced endogenously in the liver. In addition, humans
acquire beta-alanine through the consumption of foods
such as poultry and meat. By itself, the ergogenic properties
of beta-alanine are limited; however, beta-alanine
has been identified as the rate-limiting precursor to carnosine
synthesis [1, 2], and has been consistently shown
to increase levels of carnosine in human skeletal muscle.
Doses of 4 to 6 g/day of beta-alanine have been shown
to increase muscle carnosine concentrations by up to
64 % after 4 weeks [1], and up to 80 % after 10 weeks
[3]. Baguet et al. [4] demonstrated that individuals vary
in the magnitude of response to 5 to 6 weeks of betaalanine
supplementation (4.8 g/day), with high responders
increasing muscle carnosine concentrations by
an average of 55 %, and low responders increasing by an
average of only 15 %. The difference between high and
low responders seems, at least in part, to be related to
baseline muscle carnosine content and muscle fiber
composition [5].
While evidence suggests that athletes engaged in resistance
training and high-intensity exercise have higher
concentrations of muscle carnosine [6, 7], longitudinal
training studies have demonstrated equivocal changes
in intramuscular carnosine [8–11]. The variability of
increases in carnosine appears to be reflective of baseline
levels, with vegetarians having greater increases in
carnosine concentrations compared to carnivores. In
humans, muscle carnosine contents generally range
from 10 – 40 mmol/kg dry weight [5, 6, 12] with
average values around 20–30 mmol/kg dry weight
[5, 13–15], although these contents can be influenced
by a number of factors. Carnosine concentrations
tend to be higher in males compared to females [15],
and in fast-twitch compared to slow-twitch muscle
* Correspondence: abbiesmith@unc.edu
†
Equal contributors
1
Applied Physiology Laboratory, Department of Exercise and Sport Science,
University of North Carolina, Chapel Hill, NC, USA
Full list of author information is available at the end of the article
© 2015 Trexler et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30
DOI 10.1186/s12970-015-0090-y
fibers [16–18]. Carnosine concentrations may also decline
with age and is most likely influenced by habitual
dietary intake of carnosine-containing foods (e.g. beef,
pork, poultry, fish, etc.) [5, 14].
Despite this, beta-alanine supplementation will still
increase carnosine concentrations, regardless of low or
high baseline levels [19, 20], with no upper limit for
muscle carnosine concentrations having yet been identified.
While cross-sectional studies have shown higher
baseline carnosine contents in the gastrocnemius
muscle of sprinters [7] and resistance-trained athletes
[6] versus their untrained counterparts, beta-alanine
supplementation has also been shown to increase
muscle carnosine in both trained [20] and untrained
[1] populations. A recent study by Bex et al. [21] suggests
that increases in whole muscle carnosine concentrations
may be slightly higher in trained athletes
compared to non-athletes supplementing with betaalanine,
but more research is needed to replicate this
finding and account for potential differences in single
muscle fiber concentrations. Much of the research
evaluating increases in muscle carnosine has been performed
in young males, but evidence also suggests that
beta-alanine supplementation is effective in females
[22, 23] and the elderly [24].
Over the past ten years, beta-alanine has grown to become
one of the most popular sports nutrition ingredients.
Although relatively new, with the first human study
published in 2006, beta-alanine use and formulation has
expanded into nearly every pre-workout formula on the
market, and a number of daily and recovery formulas. In
summary, the purpose of the International Society of
Sports Nutrition Position Stand is to provide a critical
review on the effects of beta-alanine and thus provide
reasonable guidelines for its use as an ergogenic aid.
This Position Stand is presented as a general review of
literature, including a relative effects analysis to evaluate
performance effects.
Mechanism of action
Carnosine (β-Alanyl-L-histidine) is a naturally occurring
dipeptide with numerous potential physiological functions
and is formed by combining its constituent amino
acids, L-histidine and beta-alanine, with the assistance of
the enzyme carnosine synthetase. Carnosine is predominantly
stored within skeletal muscle, and can vary
widely between species [16]. Carnosinase, the enzyme
that catalyzes the breakdown of carnosine, is present in
serum and various tissues in humans, but is absent in
skeletal muscle [25] and many animals. It is important
to note that carnosinase is not present in most nonprimate
mammals [26], which must be considered
when evaluating carnosine supplementation and data
obtained from animal models. Therefore, oral carnosine
supplementation is an inefficient method of augmenting
muscle carnosine levels in humans, as ingested
carnosine is ultimately metabolized before reaching
skeletal muscle [27].
Carnosine’s role as an intracellular proton buffer was
first identified by Severin et al. in 1953 [28], who demonstrated
that the absence of carnosine resulted in
more rapid fatigue and acidosis. By virtue of a pKa of
6.83 and high concentrations in muscle [29], carnosine
has been shown to be more effective at sequestering
protons than either bicarbonate (pKa 6.3) or inorganic
phosphate (pKa 7.2), the other two major physiochemical
buffers, over the physiological pH range. With
respect to carnosine’s structure, nitrogen atoms on the
imidazole ring can readily accept a proton at physiological
pH, and therefore it has been suggested that carnosine
buffering precedes involvement of the bicarbonate buffering
system during exercise [30]. Preliminary estimates of
what contribution carnosine may play in buffering suggested
as much as 40 % of the buffering capacity of muscle
[31] when evaluated in animals; more recent research in
humans has indicated the contribution may be as low as
7 % [15]. More evidence documenting the contribution of
carnosine in muscle buffering is needed to further identify
its role in exercise performance. Nonetheless, beta-alanine
supplementation has been shown to increase muscle
carnosine concentrations [1, 3] and attenuate exerciseinduced
reductions in pH [32], supporting the concept
that carnosine plays a significant role in buffering
exercise-induced acidosis.
The potential physiological roles of carnosine extend
beyond its function as a proton buffer. Previous research
has suggested that reactive oxygen species (ROS), which
are produced at an elevated rate during exercise [33],
may contribute to muscle fatigue and exercise-induced
muscle damage under certain circumstances [34, 35].
Carnosine has been shown to act as an antioxidant by
scavenging free radicals and singlet oxygen [36, 37],
thereby reducing oxidative stress. Carnosine can further
reduce oxidative stress by chelating transition metals,
such as copper and iron [37]. In doing so, these transition
metals are prevented from reacting with peroxides
in the Fenton reaction, which results in the production
of free radicals. Carnosine is abundant in human skeletal
muscle, and may influence these contributors to fatigue
and oxidative stress by buffering excess protons [28],
scavenging free radicals [36, 37], and chelating transition
metals [37]. As the rate-limiting precursor to carnosine
synthesis, beta-alanine supplementation has been shown
to consistently elevate carnosine in a variety of populations,
and may therefore improve performance during
high-intensity exercise and/or enhance the quality of
training in athletes participating in strength and power
sports [38].
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 2 of 14
 Beta-alanine works by enhancing muscle carnosine
concentrations.
Supplementation strategies
The supplementation strategy for beta-alanine is important
to maximize its effects. To date, research suggests that
beta-alanine requires a chronic loading dose of 4 to 6 g
daily in divided doses of 2 g or less, for a minimum of two
weeks (which results in a 20-30 % increase in muscle carnosine
concentrations) [4], with greater benefits seen after
4 weeks (40-60 % increase) [19, 39]. To increase muscle
carnosine, a larger dose of 6 g, divided into 4 equal doses
would be more advantageous. Additionally, if supplementing
with a non-time release version, consuming a total
daily dose of 6 g would be important for augmenting
muscle carnosine [40]. Single large boluses of beta-alanine
have been shown to induce paraesthesia (i.e. tingling), and
have not been effective for performance outcomes likely
due to strong paraesthesia, rapid changes in pH, higher
excretion rates, and inability to effectively load the muscle
contents. Combining beta-alanine consumption with a
meal during beta-alanine loading has also been shown to
be effective for further augmenting muscle carnosine
levels [41]. In addition, a recent meta-analysis [42] suggested
that supplementation with a total ingestion of
179 g of beta-alanine (the average dose across all studies)
resulted in a median performance improvement of 2.85 %
compared with a placebo. Washout time, or time required
for values to return to baseline, may vary between nonresponders
and responders, requiring 6 to 15 weeks to return
to normal [4]. Despite these findings, the maximal
concentration or retention of carnosine in human muscle
is not well known; thus, we cannot yet provide information
on the optimal loading or maintenance doses.
 A loading phase (~4 weeks) of beta-alanine
supplementation is essential for increasing
carnosine levels.
Beta-alanine safety
Paraesthesia (i.e., tingling) is the most widely known side
effect of beta-alanine and is commonly experienced in
individuals consuming more than 800 mg of betaalanine
in a non-sustained release form [1]. It appears
that the symptoms of paraesthesia are substantially reduced
with the use of sustained-release formulations.
In studies using the non-sustained release supplement,
paraesthesia has generally been reported to disappear
within 60 to 90 min following supplementation [40]. It
is hypothesized that beta-alanine activates Mas-related
genes (Mrg) [43], or sensory neuron specific G-protein
coupled receptors. Specifically, MrgD, which is expressed
in the dorsal root ganglion, terminates in the skin [44]. It
is likely that activation of MrgD from beta-alanine results
in paraesthesia on the skin. To date, there is no evidence
to support that this tingling is harmful in any way. The
paraesthesia side effect is typically experienced in the
face, neck, and back of hands. Although not all individuals
will experience paraesthesia, it is typically dosedependent,
with higher doses resulting in greater side
effects. Recent data also suggests that males of Asian
descent may experience a reduced effect, with Asian
females experiencing greater paraesthesia [45]. Moreover,
there is no known mechanism to explain why certain
individuals may be predisposed to experiencing
paraesthesia. Currently, there is no safety data on the
long-term use of beta-alanine (i.e., > 1 year). However,
due to the non-essential nature of this constituent (i.e.,
beta-alanine is produced endogenously), the likelihood
of safety concerns are low.
A secondary effect of beta-alanine supplementation is
a potential decrease in taurine concentrations. Betaalanine
and taurine share the same transporter (Tau-T)
into skeletal muscle, with beta-alanine thereby inhibiting
taurine uptake within the muscle [46]. In animal models,
beta-alanine has been shown to decrease circulating taurine
levels by about 50 % [47]. Interestingly, Harris et al.
[1] reported that 4 weeks of beta-alanine supplementation
(10–40 mg∙kg−1
bw) resulted in an increase in
plasma taurine concentration; however, there was no significant
decrease in muscle taurine content. While taurine
has a number of essential physiological functions, to
date there is no human data to support decreases with
beta-alanine supplementation. Additionally, when extrapolated
to humans, the decrease in taurine would not be of
physiological significance.
 Current, although limited information, suggests
that beta-alanine is safe in healthy individuals at
recommended doses.
Consensus of findings
To gain a better consensus of published findings, this
review includes an analysis of the relative effects (RE)
of literature obtained from PubMed and Google
Scholar databases. The primary search terms included
beta-alanine AND supplementation AND carnosine
AND exercise. The search was limited to articles published
as of March 2015 and written in English. To construct
figures, literature with similar outcome variables was
reviewed to identify studies evaluating the effects of
beta-alanine supplementation for (a) open-ended exercise
tasks, such as time to exhaustion (TTE), (b) fixed
end-point exercise such as time trials, or (c) indices of
neuromuscular fatigue.
To graphically depict the RE of beta-alanine in in
comparison to placebo, RE was calculated using the
following equation [48, 49]:
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 3 of 14
RE ¼
PostBA
PreBA
 
 100
PostPl
PrePl
 
 100
0
@
1
A Â 100
Where PrePLis the pre-test value in the placebo group,
PostPL is the post-test value in the placebo group, PreBA
is the pre-test value in the beta-alanine group, and
PostBA is the post-test value in the beta-alanine group.
For Figures 1 and 3, an RE greater than 100 represents
an increase or improvement in performance versus a
placebo group. In Fig. 2, an RE less than 100 represents an
improvement for fixed end-point tests, such as cycling time
trials, where participants completed their work tasks faster.
 Relative effects were calculated to compare a
number of studies on the same parameter.
 For time to exhaustion and neuromuscular fatigue
(Figs. 1 and 3), a relative effect over 100
demonstrates an ergogenic effect of beta-alanine
compared to placebo.
Fig. 1 The relative effects of beta-alanine supplementation on time to exhaustion (TTE) lasting (A) 0–350 s (0–6 min) and (B) lasting
500–1400 s (8–25 min)
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 4 of 14
 For time trial or fixed end-point data (Fig. 2), a
relative effect of less than 100 demonstrates an
ergogenic effect.
Effects of Beta-alanine on exercise performance
It has been suggested that chronic beta-alanine supplementation
improves high-intensity exercise performance
by increasing muscle carnosine content, thereby enhancing
intracellular proton buffering [50, 51]. Excess protons
are also buffered independently of carnosine by a number
of physicochemical buffering constituents; extracellular bicarbonate
is the most relevant for increasing muscle
buffering capacity [52], thereby acting to maintain intramuscular
pH. As a result of augmented muscle buffering
and mitigating H+
accumulation, beta-alanine has been
suggested to be most beneficial in activities limited by
acidosis, generally ranging from 2 to 4 min [25]. A collective
view of the literature on anaerobic (0–4 min) and aerobic
performance, neuromuscular fatigue, strength, and
tactical challenges has been included.
Anaerobic exercise performance
The primary physiological mechanism associated with
beta-alanine supplementation is most likely related to
80
90
100
110
120
130
140
150
RelativeEffect
Effects of Beta-Alanine Supplementation on Neuromuscular Fatigue
Smith-Ryanetal.,2014
Stoutetal.,2006
McCormacketal.,2013
Smithetal.,2008
Stoutetal.,2007
Stoutetal.,2008
Fig. 3 Relative effects of beta-alanine on neuromuscular fatigue (i.e. threshold/workload that can be sustained without fatigue)
Fig. 2 Relative effects of beta-alanine on time trial/fixed end-point exercise performance
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 5 of 14
enhancing intracellular buffering capacity, consequently
it has been hypothesized that beta-alanine supplementation
would have ergogenic potential for activities that are
primarily reliant on anaerobic metabolism. A metaanalysis
on beta-alanine supplementation [42] indicated
that supplementation improved exercise capacity in
tasks lasting 60 to 240 s, but not in tasks lasting under
60 s in which acidosis is not likely the primary limiting
factor. Additionally, literature evaluating repeated
short-duration sprint tasks do not seem to demonstrate an
effect: Sweeney et al. [53] reported no significant improvements
in power output in repeated five-second bouts, and
Derave et al. [20] did not report significant improvements
in 400 m sprint time in response to beta-alanine supplementation
(average sprint time = 51.3 s).
The effects of beta-alanine supplementation on time to
exhaustion (TTE) are presented in Fig. 1 [3, 22, 54–60],
with effects on fixed end-point exercise, such as races
and time trials, presented in Fig. 2 [20, 61–67]. Similar
to the results of Hobson et al. [42], the most pronounced
effects of beta-alanine supplementation
on TTE are seen in tasks under 270 s. For example,
Hill et al. [3] reported marked improvements in
cycling TTE at 110 % of maximal power output
(average time = 104.1 s), resulting in a relative effect
of 115.2, suggesting an improvement in performance
(Fig. 1). A similar percentage increase (13-14 %) in
cycling TTE for the beta-alanine groups was reported
by Sale et al. [68] and Danaher et al. [69].
In a critical velocity test, Smith-Ryan et al. [56] showed
large improvements in TTE for female participants running
at 90 % and 100 % of the velocity at which VO2max
was achieved (average time = 267.6 and 132.3 s), resulting
in relative effects of 129.3 and 117.0, respectively. It
should be noted that results are not entirely consistent,
as relative effects below 100 are seen for anaerobic exercise
tests between 1 to 4 min, as reported in Fig. 1. According
to data from Jagim et al. [55], beta-alanine
resulted in a relative effect of 95.1 for sprinting at 140 %
of VO2max (Fig. 1). Further, data from Smith-Ryan et al.
[56] indicated relative effects of 81.1 and 87.1 for male
participants running at 100 % and 90 % of the velocity
at which VO2max was achieved, respectively. In all
three instances, relative effect calculations were influenced
by substantial performance improvements in placebo
groups ranging from 8 to 15 %.
In a recent meta-analysis, Hobson et al. [42] concluded
that beta-alanine improved exercise capacity, or open endpoint
tests to volitional exhaustion, to a greater extent than
fixed end-point exercise performance, such as race times
or time trial performance. Relative effects for fixedendpoint
performance are displayed in Fig. 2. In agreement
with Hobson et al. [42], relative effect values near 100 indicate
modest effects of beta-alanine supplementation.
Nonetheless, the three largest relative effects were observed
in exercise bouts lasting 63.2-141.0 s [62, 63]. Taken
together, research currently suggests that beta-alanine has
the greatest potential to improve performance in highintensity
exercise lasting over 60 s, with more pronounced
effects observed in open end-point exercise tasks taken to
volitional exhaustion.
 Beta-alanine generally enhances high intensity
exercise lasting over 60 s, with greater effects on
open end point exercise bouts, such as time to
exhaustion tasks.
Aerobic exercise performance
For exercise bouts lasting greater than four minutes, ATP
demand is increasingly met via aerobic metabolic pathways.
As such, it has been suggested that beta-alanine
is not beneficial for exercise bouts lasting over 4 min.
To the contrary, however, Hobson et al. [42] concluded
that beta-alanine supplementation resulted in improvements
of exercise tests of >4 min duration, when compared
to the effect of a placebo, although the effect size
calculated was smaller in comparison to exercise bouts
lasting 1 to 4 min.
Research has demonstrated a modest benefit of betaalanine
supplementation on TTE in exercise tests over
4 min in duration (Fig. 1). In conjunction with 6 weeks
of interval training, Smith et al. [59] demonstrated larger
improvements in TTE in a graded exercise test with
beta-alanine supplementation compared to placebo. Participants
consuming a placebo improved TTE from
1128.7 s to 1299.6 s, whereas the beta-alanine group improved
from 1168.2 s to 1386.7 s (RE = 103.1; Fig. 1).
Similarly, Stout et al. [22] showed that participants supplementing
with beta-alanine for 28 days improved
TTE in a graded exercise test from 1117.6 s to 1146.7 s,
while no improvement was shown in the placebo group
(RE = 102.6; Fig. 1). In aerobic, open end-point exercise,
beta-alanine appears to result in modest improvements
that, nonetheless, could be meaningful in competitive
athletics, such as running, cycling, etc.
Benefits have also been reported using fixed end-point
exercise bouts lasting over 4 min (Fig. 2). Baguet et al. [61]
showed that participants supplementing with beta-alanine
performed a 2,000-m rowing time trial 4.3 s faster than
the placebo group, despite being 0.3 s slower at baseline.
While such results suggest modest benefits (RE = 98.8;
Fig. 2), changes of this magnitude may be meaningful to
competitive athletes. Similarly, Ducker et al. [64] showed
beta-alanine to improve 2,000-m rowing performance by
2.9 s, resulting in a relative effect of 99.0.
Currently, limited research is available for exercise
over 25 min in duration. In a graded exercise test, Van
Thienen et al. [57] reported that eight weeks of betaTrexler
et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 6 of 14
alanine supplementation (2–4 g∙day−1
) was unable to
improve TTE more than placebo. Although the betaalanine
group did improve TTE from 49.7 to 54.2 min,
slightly larger improvements were observed in the placebo
group (48.4 to 53.5; RE = 99.0), suggesting beta-alanine
had limited effects. Chung et al. [70] investigated the
effects of beta-alanine supplementation on one-hour
time trial performance in trained cyclists. Although
beta-alanine supplementation substantially increased
muscle carnosine concentrations, both the beta-alanine
and placebo groups saw performance decrements following
six weeks of supplementation [70]. Overall, available
research indicates that beta-alanine provides a modest
benefit for exercise lasting up to approximately 25 min
in duration. To date, research beyond this time frame is
limited and does not demonstrate a consistent positive
effect.
 Beta-alanine may improve exercise duration during
tasks requiring a greater contribution from aerobic
energy pathways
Neuromuscular fatigue
The physical working capacity at fatigue threshold
(PWCFT) indicates the highest cycling power output
that results in a non-significant increase in vastus
lateralis muscle activation. This measurement is a validated
and reliable method of determining the power
output at which the onset of neuromuscular fatigue
occurs [71], and has been used to determine the
effects of beta-alanine supplementation on neuromuscular
fatigue.
In 2006, Stout et al. [71] reported a 16.9 % improvement
in PWCFT in men after 28 days of beta-alanine
supplementation (RE = 119.5; Fig. 3). Similar results were
reported in female participants the following year
(14.4 % improvement; RE = 118.2) [22]. During 6 weeks
of high-intensity interval training, Smith et al. [72]
showed a 20.4 % improvement in electromyographic fatigue
threshold (EMGFT) in recreationally active participants
supplementing with beta-alanine combined with
interval training. Despite marked improvements, the
relative effect calculated was below 100, as the group
consuming a placebo improved by 25.5 % with interval
training alone (RE = 95.9; Fig. 3). Using slightly different
methodology to quantify neuromuscular fatigue, SmithRyan
et al. [60] found a modest (5.6 %) improvement of
physical working capacity at heart rate threshold in young
men and women consuming beta-alanine (RE = 111.9).
The effects of beta-alanine on neuromuscular fatigue
appear to be more pronounced in longer studies utilizing
older subjects. In a sample of older subjects (age = 70.7 ±
6.2 years), McCormack et al. [73] showed that fortifying
a nutritional supplement with 1200 mg of beta-alanine
improved PWCFT in comparison to placebo after
12 weeks of supplementation (RE = 123.0). In a similar
sample (age = 72.8 ± 11.1 year), Stout et al. [24] showed
90 days of beta-alanine supplementation resulted in a
37.3 % improvement in PWCFT. Collectively, the evidence
suggests that beta-alanine supplementation attenuates
neuromuscular fatigue, particularly in older subjects.
Improvements in fatigue threshold may be augmented
with concurrent participation in high-intensity interval
training.
 Beta-alanine attenuates neuromuscular fatigue,
particularly in older subjects.
Strength outcomes
Studies investigating the effects of beta-alanine on
strength outcomes have reported mixed findings.
While short-term (30 days) studies by Hoffman et al.
[38, 74] did not show statistically significant improvements
in performance, supplementation was shown to
increase training volume and reduced subjective ratings
of fatigue. In a similar length study (4 weeks),
Derave et al. [20] showed beta-alanine supplementation
increased muscle carnosine content and attenuated
fatigue in five sets of 30 maximal dynamic knee
extensions, while isometric endurance was unaffected.
In contrast, Sale et al. [75] demonstrated a significant
improvement in isometric endurance following 4 weeks
of supplementation.
It has been hypothesized that the documented improvements
in training volume and fatigue may translate to
meaningful changes over prolonged interventions. Despite
improvements from baseline testing, Kern and Robinson
[66] did not show eight weeks of beta-alanine supplementation
to significantly improve flexed arm hang performance
in wrestlers or football players compared to placebo.
In a 10-week intervention, Kendrick et al. [8] showed significant
improvements in isokinetic force production,
whole body strength, arm curl repetitions to fatigue, and
body composition, but with no difference between the
beta-alanine and placebo groups. Finally, Hoffman et al.
[76] investigated the effects of creatine monohydrate, creatine
+ beta-alanine, or placebo in conjunction with ten
weeks of training. Compared to placebo, both creatine and
creatine + beta-alanine significantly improved squat 1RM,
bench press 1RM, and weekly squat intensity. Only creatine
+ beta-alanine improved body composition and weekly
training volume for squat and bench press, but differences
were not significantly greater than creatine alone. Collectively,
the evidence suggests that beta-alanine may improve
indices of training volume and fatigue for resistance exercise,
but more long-term studies are needed to clarify
potential effects on strength and body composition
compared to placebo.
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 7 of 14
 Beta-alanine appears to increase training volume,
however, current research does not indicate an
additive benefit on strength gains during resistance
training.
Tactical athletes
The training and duties of military personnel and other
tactical athletes often consist of prolonged and rigorous
exercise, resulting in reductions in physical and cognitive
performance [77]. Beta-alanine supplementation may be
advantageous in this population, potentially attenuating
fatigue, enhancing neuromuscular performance, and reducing
oxidative stress. In 2014, an expert panel published
a review regarding the use of beta-alanine in
military personnel [78]. The panel concluded that there
was insufficient evidence to recommend the use of betaalanine
by military personnel [78]. More recently, the
use of beta-alanine in tactical personnel was directly investigated
by Hoffman et al. [77]. Soldiers involved in
military training supplemented with either beta-alanine
or placebo for 28 days, with researchers testing a number
of outcomes pertaining to physical and cognitive
performance. While cognitive performance was not affected,
beta-alanine resulted in moderate improvements
in peak power, marksmanship, and target engagement
speed, compared to placebo [77]. A subsequent study by
Hoffman et al. [79] showed beta-alanine to significantly
increase muscle carnosine, cognitive function, and performance
on a test simulating a 50-m casualty carry;
however, beta-alanine did not improve performance in a
2.5 km run, one minute sprint, repeated sprints, or
marksmanship. Recently, it was reported that beta-alanine
had no significant effect on brain carnosine or cognitive
function in non-tactical athletes [80]. While evidence in
this population is scarce, it would appear that beta-alanine
supplementation yields promising results for tasks relevant
to tactical personnel. More research is needed to determine
which tasks are consistently improved with
supplementation.
 Initial results in tactical athletes demonstrate a
positive effect on military-specific tasks.
Beta-alanine combined with other sports supplements
The combined effects of beta-alanine with other ergogenic
aids, such as sodium bicarbonate, creatine, and
multi-ingredient pre-workout formulas, have gained
popularity. Due to the potential positive effects of betaalanine
during high-intensity exercise, it has been hypothesized
that combining it with other ergogenic aids
may further augment performance and proton buffering.
Sodium bicarbonate (SB) supplementation has been
shown to acutely increase bicarbonate levels, blood pH,
and high-intensity exercise performance [81], prompting
interest in combined supplementation with beta-alanine.
Sale et al. [68] first examined the effects of this combination
on exercise performance and showed that betaalanine
supplementation alone improved performance
on a cycling test at 110 % of maximal power output, and
that there was a 70 % probability of an additive effect
of beta-alanine + SB compared to beta-alanine alone.
Tobias et al. [82] investigated the effects of beta-alanine,
SB, or the combination on repeated upper-body Wingate
performance, separated by 3 min of rest. Both betaalanine
and SB improved mean power output, but the
results for the beta-alanine + SB group were superior,
but not significant, compared to either supplement alone.
Despite non-significant differences between groups, authors
of other studies have calculated the probability of an
additive effect with combined beta-alanine and SB supplementation.
In a 2,000-m rowing time trial, Hobson et al.
[65] used magnitude-based inferences to determine that
beta-alanine was very likely to improve time trial performance
(96 % chance of positive effect), SB was likely to improve
performance (87 % chance), and that adding acute
SB supplementation to chronic beta-alanine consumption
had a small, possibly beneficial affect compared to betaalanine
alone (64 % probability). In swimmers, de Salles
Painelli et al. [62] showed a 71.8 % and 78.5 % probability
of an additive effect on 100-m and 200-m sprints, when
adding SB to beta-alanine supplementation. In contrast to
these studies, other findings do not suggest a synergistic
effect between beta-alanine and SB.
In a series of two repeated 100-m sprints in swimmers,
Mero et al. [83] showed that SB supplementation alone
attenuated increases in sprint time for the second sprint,
but neither beta-alanine nor beta-alanine + SB resulted
in significant improvements compared to placebo.
Ducker et al. [84] investigated the efficacy of betaalanine
and SB in the context of a repeated sprint test
consisting of three sets of 6 (18 total), 20-m sprints. Results
demonstrated that SB supplementation improved
performance more than placebo, beta-alanine, or a combination
of beta-alanine and SB. Saunders et al. [85] had
participants complete a repeated sprint protocol (five
bouts of 6-s sprints) before, in the middle, and after a
simulated football game in hypoxic conditions. Results
indicated that neither beta-alanine, SB, nor beta-alanine
plus SB improved performance on the sprint test.
Bellinger et al. [86] showed that SB improved mean
power output on a 4-min cycling test, but beta-alanine
did not. While not statistically significant, subjects consuming
beta-alanine + SB did improve power slightly
more than those consuming SB alone, and 6 of 7 participants
consuming beta-alanine saw an increase in average
power output after additional supplementation with SB.
It is also important to note that the protocols employed
by Ducker et al. [84] and Saunders et al. [85] consisted
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 8 of 14
of very short bouts (<7 s), in which proton buffering
would not be the primary factor limiting performance.
Collectively, the body of literature suggests a modest
additive effect when adding SB to beta-alanine supplementation
in exercise bouts in which metabolic acidosis
may be performance-limiting. While this additive benefit
is not typically revealed with traditional statistical analyses,
studies using magnitude-based inferences have
suggested that a modest additive effect is likely to exist
[62, 65, 68]. The studies reviewed have used supplement
dosages ranging from 4.8-6.8 g/kg/day of beta-alanine
for at least 28 days, and 0.3-0.5 g/kg of SB taken acutely.
However, the only study to indicate a statistically significant
synergistic effect of beta-alanine and SB [82]
employed a unique dosing protocol for SB, providing
daily doses of 0.5 g/kg/day for seven days, whereas other
studies typically provide a dose of 0.3 g/kg acutely in the
hours preceding the exercise bout. Individual responses
to SB supplementation may vary, likely due to side effects
including headache and gastrointestinal discomfort
[68, 85, 87]. In terms of practical application, those wishing
to combine beta-alanine and SB supplementation must
carefully evaluate the dosage and timing with which SB is
consumed and weigh the modest additive benefit against
the risk of potentially ergolytic side effects.
Given the proton-buffering capacity of muscle carnosine
[51], beta-alanine is most commonly purported to improve
performance in exercise of high enough intensity to
induce intramuscular acidosis. Creatine supplementation
has been consistently shown to improve high-intensity
exercise performance, primarily by increasing phosphorylcreatine
and adenosine triphosphate (ATP) availability
[88]. The first study investigating co-ingestion of
these ingredients was reported in a published abstract
by Harris et al. [89], finding that power output in a 4min
cycling test was improved more by creatine + betaalanine
than creatine alone. Similarly, Hoffman et al.
[76] showed greater improvements in lean mass, fat
mass, and strength in creatine + beta-alanine compared
to creatine alone. Notably, these studies did not include
a treatment arm ingesting beta-alanine alone. Zoeller
et al. [58] investigated the effects of beta-alanine and
creatine on performance on a graded, maximal exercise
test on a cycle ergometer. No significant group effects
were shown (creatine, beta-alanine, creatine + beta-alanine,
or PL), but authors noted that the creatine + beta-alanine
did have significant within-group improvements for 5 of
the 8 outcomes measured, compared to only one in the
beta-alanine group and two in the creatine group. Stout
et al. [71] showed that beta-alanine and creatine + beta-alanine
improved PWCFT compared to creatine and PLA.
There was no evidence of a synergistic effect on this outcome,
as CRE + beta-alanine was not significantly different
than beta-alanine alone. Kresta et al. [90] investigated both
aerobic and anaerobic exercise outcomes. The creatine
group trended toward an increase in VO2max, while the
beta-alanine group trended toward an improvement in rate
of fatigue on a series of two Wingate tests. However, no
significant effects on performance were noted for any treatment
arm, and results did not suggest a synergistic effect
between creatine and beta-alanine.
Two studies have shown additive ergogenic effects
when beta-alanine is combined with creatine supplementation
[76, 89], but did not include a treatment
group ingesting beta-alanine only. Other studies including
a beta-alanine treatment arm have not demonstrated
a synergistic effect between beta-alanine and creatine
[71, 90]. Despite promising findings from initial studies
[76, 89], more research is needed to evaluate potential
synergy between creatine and beta-alanine supplementation.
Based on the ergogenic mechanisms of each ingredient,
performance improvements are more likely to
occur in high-intensity bouts of exercise, and studies investigating
exercise bouts over 15 min in duration have
not shown beta-alanine + creatine to be significantly
more effective than placebo [58, 90].
Multi-ingredient pre- and post-workout supplements
have become increasingly popular, with formulations
that include a number of purportedly ergogenic ingredients
including creatine, caffeine, branched-chain amino
acids, whey protein, nitric oxide precursors, and other
isolated amino acids [91–98]. Such supplements are typically
consumed once per day prior to training, with
beta-alanine doses generally ranging from 2 to 4 g single
boluses. When ingested acutely before exercise, previous
studies have shown these multi-ingredient supplements
to improve muscular endurance [92, 98], running time
to exhaustion [91], and power output [98]. Some studies
have documented improvements in subjective feelings of
energy and focus [91, 92], while Gonzalez et al. [98] did
not. When taken chronically for a period of 4 to 8 weeks,
multi-ingredient pre-workout supplements have been
shown to increase measures of strength [93, 94, 97], power
output [96], and lean mass [93–95]. In contrast, Outlaw
et al. [99] found no significant benefit for body
composition, strength, or power output with ingestion
of a multi-ingredient supplement versus placebo.
While the supplement group tended to improve leg
press strength to a greater degree than the placebo
group, this difference was not statistically significant
(p = 0.08). These discrepant findings may be attributed to
the short duration of supplementation (8 days), or the substantial
improvements in lean mass, strength, and peak
power output displayed by the placebo group.
Overall, the body of literature suggests that acute and
chronic ingestion of multi-ingredient pre-workout supplements
can contribute to improvements in performance
and body composition. It is difficult to attribute
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 9 of 14
these ergogenic effects directly to beta-alanine, as
multi-ingredient supplements include a wide range of
ergogenic ingredients that may improve performance
independently (e.g., caffeine, creatine, etc.). It typically
takes a number of weeks (at least 2 weeks) for betaalanine
supplementation to yield meaningful increases in
muscle carnosine content [3, 19]. As such, it is unlikely
that beta-alanine is the primary ingredient improving performance
outcomes in studies utilizing acute, one-time
supplementation. In studies extending over 4 to 8 weeks,
the likelihood of beta-alanine contributing to improvements
in performance and indirect effects on body composition
is greater. While it is difficult to determine the
relative contributions of individual ingredients, research
has demonstrated that multi-ingredient pre-workout
supplements containing 2 to 4 g of beta-alanine are safe
and efficacious when taken acutely, or chronically for
up to 8 weeks.
 Co-ingestion of beta-alanine with sodium bicarbonate
or creatine have modest additive ergogenic benefits;
ingestion of beta-alanine as part of a multi-ingredient
pre-workout product may be effective, if the
supplementation period is sufficient to increase
carnosine levels and the product is taken for at
least 4 weeks.
Health
Decades of literature support a potential for carnosine to
influence some mechanisms related to health including
antioxidant properties, anti-aging, immune enhancing,
and neurotransmitter actions. However, the majority of
these health benefits have been explored in vitro and in
animal models. Carnosine is widely considered an important
anti-glycating agent that serves to prevent reactions
that threaten to impact the structure and function
of proteins in the body. Advanced glycation end products
are associated with the aging process and diabetic
complications, but carnosine is thought to reduce the
formation of these end products [100, 101]. Previous
research has also indicated that carnosine acts as a
“sacrificial peptide,” reacting with carbonyl groups of
aldehydes, ketones, and proteins to prevent damage to
proteins [102, 103].
Carnosine is also known to be an antioxidant that is
capable of preventing the accumulation of oxidized
products derived from lipid components of biological
membranes [104, 105]. The antioxidant mechanism of
carnosine has been postulated to be due to metal chelation
or free radical scavenging [106]. The combination
of histidine-containing compounds, such as carnosine, at
near physiological concentrations, have resulted in synergistic
antioxidant activity [37]. Minimal data in
humans exists regarding the potential antioxidant effect
of increasing muscle carnosine vis-a-vis beta-alanine.
Initial research suggests that beta-alanine may effectively
reduce lipid peroxidation and mitigate accumulation of
free radicals when combined with aerobic exercise in
men and women [107, 108]. Future research evaluating
potential anti-aging effects and the impact of potential
antioxidant properties in humans would be important to
explore, especially due to the positive effects beta-alanine
has shown in older populations [24, 73]
 Beta-alanine may act as an antioxidant.
Remaining questions
It is widely accepted that as a result of increases in
muscle carnosine concentration, the primary mechanism
driving enhanced performance is the improvement in H+
buffering within skeletal muscle. Interestingly, humans
also have carnosine within the brain, eye, and heart tissue
[37, 109]. Therefore some initial data has explored
the neuronal effects of carnosine [80, 110], as well as
potential effects on cardiac tissue and heart rate [60].
Future research exploring the effects of beta-alanine to
induce changes in carnosine concentrations in these
tissues would be beneficial, as well as explorations of
potential physiological effects in humans. An additional
potential function of carnosine has been linked to improvements
in calcium sensitivity in muscle fibers [111, 112].
As a result of improved calcium sensitivity, there may
be a direct impact on muscular performance. This
mechanism has not yet been fully explored in humans.
One recent paper by Hannah et al. [113] suggests that
an improvement in calcium kinetics is not the mechanism
by which beta-alanine influences performance. Future
studies should further explore this mechanism. Lastly,
there is a need for long-term safety data on beta-alanine
supplementation as well as more information on potential
benefits in special populations such as elderly and tactical
athletes.
Summary & recommendations
 Four weeks of beta-alanine supplementation
(4–6 g daily) significantly augments muscle
carnosine concentrations, thereby acting as an
intracellular pH buffer.
 Beta-alanine supplementation currently appears to
be safe in healthy populations at recommended doses.
 The only reported side effect is paraesthesia
(i.e., tingling) but studies indicate this can be
attenuated by using divided lower doses (1.6 g)
or using a sustained-release formula.
 Daily supplementation with 4 to 6 g of beta-alanine
for at least 2 to 4 weeks has been shown to improve
exercise performance, with more pronounced effects
Trexler et al. Journal of the International Society of Sports Nutrition (2015) 12:30 Page 10 of 14
in open end-point tasks/time trials lasting 1 to 4
min in duration.
 Beta-alanine attenuates neuromuscular fatigue,
particularly in older subjects, and preliminary
evidence indicates that beta-alanine may improve
tactical performance.
 Combining beta-alanine with other single or multiingredient
supplements may be advantageous when
the dose of beta-alanine is sufficient (i.e., 4–6 g
daily) and the treatment duration is at least 4 weeks.
 More research is needed to determine the effects of
beta-alanine on strength, endurance performance
beyond 25 min in duration, and other health-related
benefits associated with carnosine.
Competing interests
ETT has no conflicts to disclose. AESR has received grants as Principal
investigator to evaluate the efficacy of dietary supplements. JRS has received
grants to examine the efficacy of BA. JRH has been funded by Natural
Alternatives Inc., in support of research with beta-alanine. CDW has no
conflicts to disclose. CS has no conflicts to disclose. RBK has received grants
as Principal Investigator through institutions with which he has been
affiliated to conduct exercise and nutrition related research, has served as a
legal and scientific consultant, and currently serves as a scientific consultant
for Nutrabolt (Bryan, TX). RJ has no competing interests to disclose. CPE is a
research scientist at Texas A&M University and Director of Research for the
dietary supplement company, Nutrabolt (Bryan, TX). LB has no conflicts to
disclose. BC writes and is compensated for various media outlets on topics
related to sports nutrition and fitness; has received funding for research
related to dietary supplements; serves on an advisory board for a sports
nutrition company and is compensated in product donations. DK has no
conflicts to disclose. DK works for a contract research organization that does
conduct clinical trials for pharmaceutical nutrition industries. TNZ has
received research support from companies to study beta-alanine and has
co-formulated products containing beta-alanine. JA has no conflicts to
declare.
Authors’ contributions
AESR & ETT prepared and complied the draft for review and editing by
coauthors. All other coauthors reviewed, edited, and approved the draft, and
the final manuscript.
Author details
1
Applied Physiology Laboratory, Department of Exercise and Sport Science,
University of North Carolina, Chapel Hill, NC, USA. 2
Department of Sport and
Exercise Science, University of Central Florida, Orlando, FL, USA. 3
Human
Performance Laboratory, Department of Exercise Science, University of Mary
Hardin-Baylor, Belton, TX, USA. 4
Health and Performance Enhancement
Research Centre, Department of Sport Science, Nottingham Trent University,
Nottingham, UK. 5
Exercise & Sport Nutrition Lab, Department of Health &
Kinesiology, Texas A&M University, College Station, TX, USA. 6
Increnovo LLC,
2138 E Lafayette Pl, Milwaukee, WI, USA. 7
Nutrabolt International, Bryan, TX,
USA. 8
Guru Performance LTD, London, UK. 9
Performance & Physique
Enhancement Laboratory, University of South Florida, Tampa, FL, USA.
10
Department of Nutrition & Endocrinology, Miami Research Associates,
QPS-MRA, Miami, FL, USA. 11
The Center for Applied Health Sciences, 4302
Allen Rd, STE 120 Stow, OH, USA. 12
Exercise and Sports Science, Nova
Southeastern University, Davie, FL, USA.
Received: 16 June 2015 Accepted: 17 June 2015
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