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We often see patients who aren’t the type of people you’d expect to see in a cardiologist’s office. They’re not older folks with obvious risk factors for heart disease, such as obesity or diabetes. These are young, physically fit adults—often young men—who have been referred to us after having high blood pressure or other heart-related trouble with no apparent reason for their symptoms.
Along with the usual tests, we’ve gotten into the habit of asking these patients if they’re currently taking any workout or pre-workout supplements, as patients often don’t think to note these items on their lists of current medications. Many times, they tell me they are taking one or more of these supplements.
It’s important to note that not all supplements are bad; in fact, some can provide a powerful edge in workout routines. But 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.
Caffeine’s Effects on the Heart
Almost invariably, if one of my patients is taking a pre-workout supplement, its ingredients will include caffeine or some other stimulant. Caffeine is included in many supplements taken before exercise because it makes you feel good, gives a slight sense of euphoria, and gives you a burst of energy during your workout.
In moderation, caffeine is safe for your heart. Studies have found that it’s safe for adults to consume about 400 milligrams of caffeine per day. That’s the equivalent of the amount of caffeine in just over four 8-ounce cups of coffee, according to the U.S. Department of Agriculture (USDA).
The problem with supplements, energy drinks, and other workout-related products, however, is that they often contain huge amounts of caffeine—far more than the USDA’s recommended daily limit in one concentrated serving. Some popular pre-workout supplements contain more than the USDA’s maximum dose of caffeine in just one serving.
Consuming high doses of caffeine from pre-workout supplements, on top of your normal daily intake of caffeine in coffee, soda, or other sources, can lead to a number of heart-related side effects, including increased blood pressure (hypertension), which can raise your risk of a heart attack. It can also lead to palpitations and other heart rhythm problems. These effects can vary from person to person, which is why it’s important to discuss your pre-workout and workout regimen on an individual basis with your primary care doctor or a cardiologist.
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Related Reading: How much caffeine is safe for you and your child
What Else Is in Your Supplement?
Unfortunately, supplements aren’t controlled or regulated by the Food and Drug Administration (FDA) as strictly as medications are, so we often don’t know exactly what they contain. This often makes it easier for supplements to cause harmful side effects that are challenging to track down due to hard-to-identify ingredients.
When patients who are taking workout supplements come see me, I do a search of pharmacology references and medical literature to look for side effects other people may have experienced as a result of that specific supplement. For example, I had one patient who was experiencing vasospasms, a sudden contraction of the blood vessels that can reduce blood flow. As we talked about what medications and supplements the patient was taking, to our surprise we found that the patient was taking a number of supplements that are marketed as being heart healthy, but can also cause vasospasms. By eliminating the supplements that could lead to vasospasm, we were able to improve the patient’s symptoms.
I’ve seen patients who have noticed many symptoms, whether heart-related or affecting other areas of the body, that ended up being related to their intake of workout supplements, such as:
- High blood pressure
- Heart palpitations or tachycardia
- Liver toxicity
- Rhabdomyolysis, a breakdown of muscle fibers and tissue
- Spontaneous coronary artery dissection (SCAD), a tear in the wall of an artery
Replace Workout Supplements with Real Food
I wish I could say there was a “magic bullet” out there—a single supplement you could take or one thing you could do to protect yourself from heart-related supplement side effects. But it takes patience and discipline to live a healthy lifestyle that complements your fitness routine.
I believe that a natural approach is best, but I'm talking about real, wholesome foods, not supplements that often are ground up; concentrated; and sold to you in pill, powder, or drink form. If you can look at something on the shelf at your grocery store and know it’s a tomato, a carrot, or some other fruit or vegetable, that’s a natural product. If it’s hard to identify what ingredients originally went into the product because it’s in a pill bottle, I would treat that as a potentially powerful medicine, and check with your doctor before taking it.
Another thing I tell patients is that moderation is key. Too much of any one thing is dangerous. It’s important to get a wide variety of vegetables, fruits, and other foods to boost your energy naturally and fuel a productive workout. When I was growing up, our parents and teachers used to tell us to “eat the rainbow.” That refers to having a plate that’s full of many colors of fruits and veggies, which means you’re getting a good balance of nutrients.
If you find yourself craving a snack or wanting a little extra energy for your workout, reach for some nuts, especially almonds. Healthy, low-sodium nuts can boost your energy levels while cutting your cholesterol and lowering your blood pressure, and they’re pretty light on calories.
Some of my patients take protein supplements for weightlifting because they want to build muscle. However, my advice is to put away the protein shake and increase the amount of natural protein in your diet. Good dietary protein sources include:
Of course, many people take their supplements because they feel good from the energy boost they get to power through their workouts. However, if you’re doing a high-intensity, calorie-burning workout, carbohydrates are an excellent source of long-lasting energy. I know many fitness enthusiasts avoid carbs at all costs, but consider incorporating some healthy sources of unprocessed carbohydrates, such as:
- Starchy vegetables, such as potatoes, carrots, and squash
- Whole-wheat bread
Keep Yourself and Your Heart Safe While You Exercise
As our country faces an ongoing obesity epidemic, which affects nearly 40 percent of the U.S. population, exercising and living a healthy, active lifestyle is essential. Just recognize that, when you incorporate supplements into your fitness routine, you are taking medications that have side effects. And because supplements aren’t as well-regulated as pharmaceutical drugs are, we often can’t say for sure what effects those supplements are having on your heart.
Whenever possible, stick to natural foods as part of your overall wellness regimen, and ask your primary care doctor or cardiologist if you have concerns about how your workout routine might be affecting your heart.