On Twitter, we recently spotted a thread about the adverse effects of consuming pre-workout supplements and fat burners, especially in the wake of increasing incidences of heart ailments and cardiac arrests. “Guys, please don’t panic over the #heartattack incidents happening pan India. I have spoken to a lot of people and have concluded that please limit alcohol, smoking, junk (food), and try abandoning caffeine. Gymgoers, stop using pre-workouts and fat burners. Take care and have fun! Lose weight,” Nishit Shaw, an entrepreneur and trade analyst, wrote.
Guys please don’t panic over the #heartattack incidents happening pan India. I have spoken to a lot of people and have concluded that plz limit alcohol, smoking, junk and try abandoning caffeine. Gym goers stop using pre-workouts & fat burners. Take care and have fun! Lose weight
— Nishit Shaw (@NishitShawHere) December 4, 2022
He added that while “coffee in India is simple — instant, less caffeine, good to go”, the “problem is energy drinks, pre-workouts etc. It takes a toll”.
But, is there any truth to the claim? We reached out to experts to understand the relationship between pre-workout supplements, energy drinks, and heart health.
Is there a link?
According to Dr Zainaulabedin Hamdulay, cardiothoracic surgeon, Masina Hospital, Mumbai, many patients with no previous medical history are showing up on cardiologists’ doors to seek medical assistance. “They aren’t elderly people who may have obvious risk factors for heart disease, like diabetes or obesity. These are, in fact, physically fit, often young adults, who have been referred to us after experiencing high blood pressure or other heart-related problems with no apparent cause,” he said.
Of these, Dr Hamdulay said, many consume protein shakes, energy bars, or sports drinks — also described as “multi-ingredient dietary formulas” by healthline.com — to boost their workout performances in terms of energy and endurance. Concurring, Anam Golandaz, clinical dietician, Masina Hospital, Mumbai, added that those who “want to achieve their training targets even faster” have turned to a wide range of workout supplements to do the trick. “Such supplements contain a variety of ingredients, including amino acids, B vitamins, caffeine, creatine and artificial sweeteners, each playing a specific role in improving performance,” Golandaz told indianexpress.com.
However, she pointed out caffeine is one of the primary ingredients in most pre-workout supplements “as it increases muscle strength and reduces fatigue during exercise”. “Most pre-workout mixes contain more than 200 milligrams of caffeine, the equivalent of two cups of coffee, to improve energy levels. But these highly-caffeinated drinks can cause nausea, insomnia, and a potentially serious heart condition known as Atrial Fibrillation, which causes irregular heartbeat (arrhythmia),” she added.
Further, “very high levels of caffeine and amino acids can lead to palpitations, diarrhoea, nausea, high blood pressure, joint related issues as well”, pointed out Dr Gowri Kulkarni, head of medical operations, MediBuddy, which, according to a 2014-World Health Organization (WHO) study published in Frontiers in Public Health can cause “cause heart failure, leading to death” in extreme cases.
But it’s not just caffeine. Another popular ingredient in many pre-workout supplements is creatine, which is known to increases lean body mass and strength during exercise. “However, high creatine intake may cause bloating, digestive issues, water retention, and weight gain, which also affect heart health,” stressed Golandaz.
Additionally, the artificial sweeteners or sugar alcohols added to pre-workout supplements to enhance flavour makes it imperative for diabetics to exercise caution. “Due to the nature of supplements, it’s sometimes difficult to know exactly what you’re putting into your body, and very easy to suffer heart-related side effects from them if you’re not careful,” Golandaz warned adding that these effects can vary from person-to-person, making it important to discuss your pre-workout and workout regimen with a healthcare worker beforehand.
Dr Hamdulay further pointed out that pre-workout supplements, like many other dietary supplements, are not strictly regulated by the Food and Drug Administration (FDA). “Such products may produce the desired fitness results in the short term, but can be harmful to one’s overall health,” he said.
Since these formulas are not regulated by the FDA, the manufacturers do not need to follow any federally-approved guidelines on safe dosing or content, said Dr Nitin Kumar Rajput, senior consultant CTVS, Minimal Invasive Cardiac Specialist, Narayana Institute of Cardiac Sciences, Bangalore, emphasising that while improving energy levels, they also increase the risk of high blood pressure, arrhythmias, and potentially a heart attack in patients with severe coronary disease.
Consuming them before exercise “can further compound the risks as cardiovascular demands increase with physical activity”, Dr Rajput said. “For example, some findings suggest that an intake of 200-300 mg of caffeine an hour prior to aerobic exercise decreased endothelial cell function in healthy individuals, as indicated by reductions in myocardial blood flow, which further increase the risks,” he added.
There is more
A new pre-workout trend raising concerns is “dry-scooping,” or consuming heavily caffeinated pre-workout powder in undiluted form to boost its effects. “Caffeine is a vasoconstrictor, which means it constricts blood vessels and reduces blood flow to the muscles. It is also a diuretic, which causes increased urination and dehydration. It can be very dangerous,” Dr Hamdulay pointed out.
Some energy drinks also contain compounds similar to ephedrine, a central nervous system stimulant, which is used to treat breathing problems that is even more powerful than caffeine. This could create an even higher risk of negative cardiac side effects, added Dr Hamdulay added.
What can help?
It is ideal to replace workout supplements with real food, say experts. “Increase the amount of natural protein in your diet. Good dietary protein sources include: chicken, milk and milk products, chickpeas, eggs, fish, lentils, milk, peas, and soybean,” said Golandaz, adding that moderation is the key, and that it is “important to get a wide variety of vegetables, fruits, and other foods to boost your energy naturally and fuel a productive workout”.
Dr Pankaj Ramesh Batra, a cardiologist, agreed and said minerals and vitamins like magnesium, Omega 3 fatty acids, L carnitine, and Coenzyme Q10 are necessary for a healthy heart. He added that high fibre foods, garlic, fish oil, green tea can work as antioxidants. “If a person is taking a good diet, then no additional dose is required,” he said.
They unanimously added that supplements must always be consumed after consulting an expert, and those made from natural ingredients such as green tea and beets, which “are far safer alternatives”, should be opted for. “For those who still want to experiment with pre-workout supplements, it’s important to work up to the full dose, especially if it contains any sort of stimulant,” Dr Rajput noted.
Dr Hamdulay maintained that the type of exercise one does is just as important. Lifting heavy weights without following proper breathing technique can also lead to a spike in blood pressure. This, over time, increases the risk of negative cardiovascular events, he said. “So always consult an expert to avoid any mishaps,” he said.