Pre-workout supplements are consumed with the intention of increasing the availability of energy substrates, reducing fatigue and creating conditions favouring physical performance, endurance, strength and gain in muscle mass. These supplements often contain a combination of ingredients including caffeine, creatine and arginine, besides others.

The majority of pre-workout mixes contain over 200 mg of caffeine, equivalent to two cups of coffee. While it no doubt can boost energy levels, it can also elevate the risk of high blood pressure, arrhythmias and even a heart attack in patients with severe coronary disease. Since caffeine is a vasoconstrictor, it narrows blood vessels and reduces flow to the muscles. It is a diuretic as well, causing frequent urination, often leading to dehydration.

A new menace is “dry-scooping”, which is consuming heavily caffeinated pre-workout powder in undiluted form, and can magnify its effects, sometimes with dangerous consequences.

What do pre-workout supplements do?

# Amino acids: In general, amino acids help grow and repair muscles, lessen muscle soreness and aid in energy production.

# Beta-alanine: This specific amino acid helps in the production of carnosine, which improves muscular endurance.

# Caffeine: It helps increase endurance for high-intensity workouts and can improve focus and reaction time.

# Creatine: Another popular ingredient, creatine provides fuel to your muscles, increases power and improves performance.

# Glucose: Glucose or sugar, included in pre-workout supplements, can increase energy levels.

# Nitric oxide: Comprising oxygen and nitrogen, nitric oxide increases blood flow, improving intense bursts of exercise, like sprints or weightlifting.

# B vitamins: These critical vitamins help converting food to energy and transport nutrients through your body.

Side-effects of over-caffeination

A racing heartbeat.
Gastrointestinal issues, like diarrhoea.
High blood pressure.
Tingling feeling in your limbs.
Nausea.

Stick to a healthy diet, ditch supplements

The best way to get energy for your workouts is to eat healthy food rich in vitamins and nutrients. Before going to the gym, instead of supplements, try:

Coffee.
Whole-grain sandwich with lean protein.
Turkey.
Yogurt.
Cheese.
Eggs.
Celery, beets or leafy greens.

Pre-workout supplements and heart attack

If not used as directed, these supplements carry risks, specifically due to stimulants like caffeine and synephrine.

Stimulant effects: High doses of stimulants can temporarily increase heart rate and BP by triggering the release of adrenaline.
Risk factors: These changes can cause problems for individuals with pre-existing heart conditions (like hypertension, arrhythmias, coronary artery disease) or a sensitivity to caffeine, sometimes causing palpitations, chest pain, or in rare cases, even a heart attack.
Unregulated sector: Since the supplements industry is largely unregulated, doses and ingredients can vary and certain unlisted or potentially harmful substances can elevate the risk.
Individual reaction: While common ingredients like creatine and nitric oxide boosters are generally considered safe, the overall formulation can trigger varied individual reaction.

Anabolic steroids and heart attack risk

Anabolic-androgenic steroids (AAS), synthetic derivatives of testosterone, carry a much higher and well-documented risk of heart attack, due to direct and lasting damage to the cardiovascular system.

Structural damage: Misuse can lead to pathological changes like left ventricular hypertrophy (enlargement and thickening of the heart's main pumping chamber), which impairs its function and can lead to heart failure.
Atherosclerosis: Steroids change lipid metabolism by raising levels of LDL or bad cholesterol and decreasing HDL or good cholesterol, causing plaque buildup inside arteries.
Blood clotting: These steroids elevate the risk of blood clots forming in blood vessels, which can block blood flow to the heart or brain, causing a heart attack or stroke.
Hypertension: Use of steroids is linked to high blood pressure, putting extra pressure on the heart and blood vessels.