Workout Supplements

A popular category of dietary supplements

are workout supplements, which are
typically taken before (‘pre-workout’) or
after exercising (‘post-workout’), and are
sold in a variety of forms from pills to
powders and ready-to-drink shakes. The
global pre-workout supplement market size
alone was estimated to reach $13.98 billion
in 2020 and almost double in size to $23.77
billion by 2027.

Fitness gurus and blogs touting these products as crucial for peak
performance, fat loss, and explosive muscle growth in combination with
complicated scientific-sounding names and labels might have you
believing you can’t effectively exercise without them. But do these
supplements live up to the hype, and are they even necessary—or in some
cases, safe? Like other dietary supplements in the U.S., the Food and Drug
Administration (FDA) does not review workout supplements for safety or
effectiveness before they are sold to consumers. It’s a good idea to
research their effects and ingredients and consult with your physician
before adding them to your fitness routine.

Pre-Workout Supplements
Pre-workout supplements are designed to provide energy and aid
endurance throughout a workout. They are typically taken 15-30 minutes
before a workout, but can also be consumed during exercise. Below are
common ingredients found in pre-workout supplements that the Academy
of Nutrition and Dietetics, Dietitians of Canada, and the American College
of Sports Medicine have highlighted as having evidence-based uses in
sports nutrition. These supplements have also been categorized as
apparently safe and having strong evidence to support efficacy by the
International Society of Sports Nutrition. However, it is important to
consult a physician or dietitian before using these supplements, as they
are not reviewed by the FDA for safety or effectiveness.
Beta-Alanine
Beta-alanine is an amino acid that is produced in the liver and also found
in fish, poultry, and meat. When dosed at 4–6g/day for 2–4 weeks, this
supplement has been shown to improve exercise performance,
particularly for high-intensity exercise lasting 1–4 minutes, such as high-
intensity interval training (HIIT) or short sprints. It has also been shown to
reduce neuromuscular fatigue, particularly in older adults. How does it
work? During exercise the body breaks down glucose into lactic acid,
which is then converted into lactate. This produces hydrogen ions, which
lower muscle pH levels. This acidity reduces muscles’ ability to contract,
causing fatigue. Beta-alanine increases muscle concentrations of
carnosine, which is a proton buffer that reduces muscle acidity during
high-intensity exercise, which in turn reduces overall fatigue. This
supplement is often combined with sodium bicarbonate, or baking soda,
which also reduces muscle acidity. A common side effect of beta-alanine
supplementation is paresthesia, or a skin tingling sensation, but this effect
can be attenuated by taking lower doses (1.6g) or using a sustained-
release instead of a rapid-release formula. In short, this supplement can
help you exercise at high-intensity for a longer period of time, which could
potentially lead to increased muscle mass. The International Society of
Sports Nutrition has asserted that “beta-alanine supplementation
currently appears to be safe in healthy populations at recommended
doses,” but it is important to consult with your doctor before beginning
supplementation.

Caffeine
Caffeine is a stimulant that is often included in pre-workout supplements,
as it has been shown to benefit athletic performance for short-term high
intensity exercise and endurance-based activities. It is important to
understand that these studies have been conducted with Olympic and
competition athletes, and thus the average individual who exercises
recreationally should consult with a doctor before using caffeine as a
supplement. For high performance athletes, the International Olympic
Committee recommends 3–6mg caffeine/kg of body weight consumed an
hour before exercise. Evidence also suggests that lower caffeine doses (up
to 3mg/kg body weight, ~200 mg) taken before and during prolonged
exercise can increase athletic performance. Mechanistically, caffeine
increases endorphin release, improves neuromuscular function, vigilance,
and alertness, and reduces perception of exertion during exercise. Despite
some benefits from smaller doses, larger doses of caffeine (>=9mg/kg of
body weight) have not been shown to increase performance, and may
induce nausea, anxiety, and insomnia. The U.S. Food and Drug
Administration (FDA) considers 400 milligrams of caffeine to be a safe
amount for daily consumption, but some pre-workout supplements may
exceed this amount in a single serving or fail to disclose the amount of
caffeine they contain, so it is important to always review the label of any
supplement before consumption. Caffeine powder is also marketed as a
stand-alone pre-workout supplement, but the FDA has advised against
using this product, as even very small amounts may cause accidental
overdose. Powdered caffeine has been linked to numerous deaths—a
single tablespoon (10 grams) is a lethal dose for an adult, but the product
is often sold in 100-gram packages.

Creatine
Creatine is a naturally occurring compound found in skeletal muscle that is
synthesized in the body from amino acids and can be obtained from red
meat and seafood. In the body, it helps produce adenosine triphosphate
(ATP), which provides energy for muscles. Creatine is a popular workout
supplement marketed to increase athletic performance, especially for
weight training. Research suggests that creatine supplementation
increases muscle availability of creatine, which in turn can enhance
exercise capacity and training adaptations in adolescents, younger adults,
and older adults. Specifically, these adaptations allow for individuals to
increase training volume (e.g., the ability to perform more repetitions with
the same weight), which in turn can lead to greater increases in lean mass
and muscular strength and power. Although the exact mechanisms
through which creatine improves performance have not been identified
with certainty, various theories have been investigated, including the
potential for creatine to stimulate muscle glycogen levels. Creatine
supplementation is primarily recommended for athletes who engage in
power/strength exercises (e.g., weight lifting), or for athletes who engage
in sports involving intermittent sprints and other brief repeated high-
intensity exercises (e.g., soccer, basketball). The International Society of
Sports Nutrition recommends an initial dosage of 5g of creatine
monohydrate (~0.3g/kg body weight) four times daily for 5–7 days to
increase muscle creatine stores; once muscle creatine stores are fully
saturated, stores can be maintained by ingesting 3–5 g/day. [13] Many
powdered creatine supplements recommend this regimen in the
directions on their packages. The Society also notes that an alternative
supplementation protocol is to ingest 3g/day of creatine monohydrate for
28 days. [13] While the scientific literature has generally found
supplementation to be safe at these levels, [18] creatine may not be
appropriate for people with kidney disease or those with bipolar disorder.
It is important to consult a doctor before taking this supplement. Of note,
creatine supplementation has been shown to increase total body water,
which causes weight gain that could be detrimental to performance in
which body mass is a factor, such as running. [14] The International
Society of Sports Nutrition, the American Dietetic Association, and the
American College of Sports Medicine have all published statements
supporting creatine supplementation as an effective way of increasing
high-intensity exercise capacity and lean body mass during training for
high-performance athletes.

Post-Workout Supplements
A variety of post-workout supplements are marketed to consumers to
increase muscle mass through enhanced muscle repair, recovery, and
growth. Below is a review of some of the most common ingredients in
post-workout supplements.

Carbohydrates
Replenishing glycogen stores after a workout with
sufficient carbohydrate intake is important for muscle recovery, and
beginning the next workout with sufficient muscle glycogen stores has
been shown to improve exercise performance. [22-24] However, normal
dietary intake is typically sufficient to restore muscle glycogen stores after
low-intensity exercises, such as walking, yoga, or tai chi (3–5 g
carbohydrate/kg body weight per day), and even for moderate-intensity
exercise, such as one hour or more of walking, jogging, swimming, or
bicycling at modest effort (5–7 g carbohydrate/kg body weight per day).
[24] Post-workout supplementation with carbohydrates and protein
within 24–36 hours is only recommended following strenuous physical
activity, which includes one hour or more of vigorous exercise such as
interval training, running, swimming, bicycling, soccer, or basketball at a
moderate to intense effort (where one can only carry on brief
conversations or cannot speak); in this case, 6–12 g carbohydrates/kg
body weight per day is recommended to be consumed after exercise to
fully restore muscle glycogen stores. [24]
Protein
Recommended levels of daily protein intake for the general population
(0.8 grams of protein for every kilogram of body weight, or about 7 grams
of protein every day for every 20 pounds of body weight) are estimated to
be sufficient to meet the needs of nearly all healthy adults.
Recommendations for protein supplementation during exercise vary
based on the type of exercise being conducted: endurance training (e.g.,
long-distance bicycling) or resistance training (e.g., weight lifting). Very
few studies have investigated the effects of prolonged protein
supplementation on endurance exercise performance. A review
conducted by the International Society of Sports Nutrition found that
protein supplementation in the presence of adequate carbohydrate intake
does not appear to improve endurance performance, but may reduce
markers of muscle damage and feelings of soreness. On the other hand,
individuals who engage in high-intensity resistance training may benefit
from increased protein consumption to optimize muscle protein synthesis
required for muscle recovery and growth, but research is inconclusive,
with the majority of studies investigating the effects of protein
supplementation on maximal strength enhancement finding no benefit.
The extent to which protein supplementation may aid resistance athletes
is highly contingent on a variety of factors, including intensity and
duration of training, individual age, dietary energy intake, and quality of
protein intake. For individuals engaging in strenuous exercise to build and
maintain muscle mass, the International Society of Sports Nutrition
recommends an overall daily protein intake of 1.4–2.0 g/kg of body
weight/day. This can be ingested in the form of protein foods or protein
powder.

Branched-Chain Amino Acids (BCAAs)

Three out of the nine essential amino acids have a chemical structure
involving a side-chain with a “branch”, or a central carbon atom bound to
three or more carbon atoms. These three amino acids, leucine, isoleucine,
and valine, are called branched-chain amino acids (BCAAs). They can be
obtained from protein-rich foods such as chicken, red meat, fish, and eggs,
and are also sold as dietary supplements in powdered form. BCAAs are key
components of muscle protein synthesis, and research has shown that
leucine in particular drives protein synthesis and suppresses protein
breakdown. Although short-term mechanistic data suggests that leucine
plays an important role in muscle protein synthesis, longer-term trials do
not support BCAAs as useful workout supplements. For example, a trial of
leucine supplementation during an 8-week resistance training program did
not result in increased muscle mass or strength among participants.
Studies have generally failed to find performance-enhancing effects of
BCAAs such as accelerated repair of muscle damage after exercise.
Another reason to be cautious of a high intake of BCAAs is its potentially
negative effect on glucose metabolism and diabetes. BCAAs, particularly
leucine, can disrupt the normal action of insulin, a hormone that regulates
blood glucose. In an epidemiological study composed of three large
cohorts of men and women followed for up to 32 years, a higher intake of
BCAAs (obtained mainly from meats) was associated with a higher risk of
developing type 2 diabetes.

Chocolate Milk
Although you may not think of it as a “supplement,” a number of pro
athletes have begun to promote chocolate milk as an ideal post-workout
beverage due to its combination of protein, carbohydrates, water, and
electrolytes (in the form of sodium and calcium). A review of the effects of
chocolate milk on post-exercise recovery found that chocolate milk
provided similar or superior results compared to water or other sports
drinks, while another review found that low-fat chocolate milk was an
effective supplement to spur protein synthesis and glycogen regeneration.
However, the authors noted that evidence is limited and high-quality
clinical trials with larger sample sizes are warranted. Of note, many studies
of chocolate milk as a post-workout supplement are sponsored by the
dairy industry, which may introduce bias. Chocolate milk generally
contains high amounts of added sugars and saturated fat, and is likely
most useful for athletes conducting high-intensity exercise for multiple
hours a day, such as professional swimmers competing in the Olympics.
However, for most individuals conducting moderate-intensity physical
activity, such as an hour of jogging or bicycling, water is a healthier
alternative as a post-workout beverage.

Electrolytes
Many supplements include electrolytes, which are chemicals that conduct
electricity when mixed with water, and include sodium, potassium, and
calcium. Electrolytes are important for hydration and the regulation of
nerve and muscle function; for example, calcium, sodium, and potassium
all work together to help muscles contract properly. The body loses
electrolytes through sweating, so sports drinks (which typically contain
carbohydrates/sugar and electrolytes) and other electrolyte supplements
are often marketed as being necessary after a workout. However, the
American College of Sports Medicine has asserted that there is little
evidence of any difference in performance between those who drink
beverages containing carbohydrates and electrolytes compared to those
who drink plain water after exercising for less than one hour. Sports drinks
and other electrolyte supplements are generally only appropriate for
people exercising vigorously for more than an hour, especially if causes
them to sweat heavily. Learn more about sports drinks here.

Bottom Line
Workout supplements such as caffeine and creatine may be used to
enhance exercise performance for high-intensity, strenuous physical
activity, such as training to run a marathon or power lifting. However,
a healthy diet with adequate amounts of healthy carbohydrates, protein,
and water is sufficient to fuel the body for moderate amounts of physical
activity, such as an hour of jogging or bicycling. As workout supplements
are not reviewed by the FDA for safety or effectiveness, you should
consult with a doctor before incorporating them into your exercise routine
and discuss if there are any potential contraindications if you have existing
medical conditions.