**7. Conclusions**

Osmolytes, such as betaine, are responsible for decreasing hypertonic stress in mammalian cells, which results in preserved functionality and increased survivability. Betaine has been shown to attenuate many types of cellular stressors (i.e., hyperthermia, hypertonicity, acidity, hyperkalemia, and oxidative stress) that require the aid of molecular chaperones. Betaine can independently reduce measures of oxidative damage, improve enterocyte health, as well as attenuate markers of potential liver damage and inflammatory responses to LPS endotoxemia. Thus, betaine bolsters cells against several key points in the proposed mechanistic pathway of LPS endotoxemia and may prevent heat-related injuries.

Using a wide variety of dosing strategies in animal models, pre-loading betaine in the diet has been shown to reduce core temperature, skin temperature, mortality rate, and oxidative damage. Many elite and recreational athletes exercise for long durations in hot-humid environments and encounter many of the aforementioned stressors (i.e., hyperthermia, hypertonicity, acidity, and oxidative stress). Supplemental pre-loaded betaine may successfully combat these issues, as has been shown in animal models. If true on a systemic level, pre-loading with betaine may improve heat tolerance and provide an athlete who finds that heat stress is a major limiting factor, another avenue of protection in their training and performance. Yet, this remains speculative until data demonstrate such e ffects in humans.
