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Pre-Workout Supplements – What Are The Side Effects?

Medically reviewed by Susan Kerrigan, MD and Marianne Madsen on February 5, 2023

Arnold Schwarzenegger had a simple pre-workout energizer: He sipped a cup of coffee. In the early 1980s, the seven-time Mr. Olympia winner believed it reduced fatigue during intense lifting sessions. Sergio Olivia one-upped the Austrian Oak. The only person to defeat Schwarzenegger at bodybuilding’s top competition, Olivia consumed a whole thermos of coffee during workouts. Besides energy, he believed coffee helped him sweat.


The 1980s is infamous for energizers. Unfortunately, many were unsafe and even illegal.


Dangerous MIPS


Ultimate Orange arrived on the scene in 1982. Crafted in the bodybuilding mecca of Venice, California, it became a workout staple for nearly 20 years. It was great at energizing athletes. It also had an unfortunate side effect: it occasionally triggered heart attacks. The rush athletes got from taking Ultimate Orange came from its main ingredient: ephedra. Found in the Chinese herb ma huang, in high doses it constricts blood vessels and raises blood pressure. Before the U.S. Food and Drug Administration banned the sale of products containing ephedra in 2003, it was linked to 155 deaths including the death that year of 23-year-old Baltimore Orioles pitcher Steve Bechler. 


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Ultimate Orange was the first multi-ingredient pre-workout supplement or MIPS. Since then, there have been many others. MIPS are a blend of ingredients like caffeine, branched-chain amino acids, or creatine. Labeled as a “proprietary blend,” MIPS rarely list the percentage of active ingredients or their quantity. The FDA only requires that dietary ingredients be listed in descending order by weight. This can make it hard to determine whether or not the active ingredient is included in sufficient amounts. Still, there’s some evidence that the best of the lot work as advertised. A review of studies about MIPS found that their pre-exercise consumption had a positive effect on the mood of users and their muscular endurance. Using them regularly along with resistance training like lifting weights also improves fat-to-muscle ratios for MIPS consumers versus non-MIPS consumers. 


Today’s supplements are safer than ever but they are not risk free. Online claims that they are able to treat, cure, or prevent a disease are illegal–the FDA only permits this for drugs. Otherwise, the rules for manufacturing and distributing dietary supplements are less strict than those for prescription or over-the-counter drugs. As the U.S. Department of Health and Human Services explains:


“Companies only have to submit safety data about any new ingredient not sold in the United States in a dietary supplement before 1994. In all other cases, the FDA is not authorized to review dietary supplements for safety and effectiveness before they are marketed.”


Despite the plethora of safe and effective MIPS, if you are new to pre-workout supplements you should focus on those with a single active ingredient from a respected manufacturer. Anyone trying a new supplement should consult their doctor–especially if they are taking prescription medication. Even benign substances can interact negatively with other drugs. One 2015 study suggested that in the U.S. some 23,000 emergency department visits every year were related to dietary supplements.


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Caffeine and Sleep

Caffeine and Sleep



The simplest supplement isn’t confined to coffee, tea or soda pop. Popular with long-haul truckers and bodybuilders for decades, caffeine pills will increase your energy. Recent studies suggest they can improve performance in both anaerobic exercises like weightlifting and aerobic ones like cycling.  


Coffee and tea have numerous health benefits. Taken as a supplement, caffeine can bring as many risks as rewards. In this case, it’s all about the delivery system. Some supplements are equal to five cups of coffee. It’s way easier to swallow a pill than drink that much java before exercising. The high dose increases your risk for a bad case of the jitters or even worse. Caffeine can increase your blood pressure and elevate your heart rate. If you are prone to anxiety, overdoing the caffeine can escalate it. Even if you’ve never had a panic attack, too much caffeine can trigger one.


The scariest part about caffeine supplements is how easy it is to overdose. Viewed as benign when it’s in a latte or mocha, caffeine remains a potentially dangerous drug. It’s pretty tough to get a lethal dose when it means drinking 100 cups of coffee. Mindlessly swallowing a supplement makes it much, much easier. So the best advice is the same you’d give to an exercise newbie: take it slow. Listen to your body. Caffeine can boost performance but if you want it in pill form, start with a dose equal to a cup of coffee. That’s around 95 milligrams of caffeine.




When creatine monohydrate first gained popularity among athletes in the 1990s, numerous myths about their side effects arose. This was partly because creatine aids in muscle growth. Some linked it to far more dangerous muscle-building substances like anabolic steroids. Instead, side effects like liver or kidney damage have been disproven. A naturally occurring substance, creatine is a non-protein nitrogen––a compound which contains nitrogen but is not a protein. Synthesized in the pancreas and the liver, it is mainly stored in skeletal muscle.


One reason creatine works so well as a supplement is because while the average person stores 120 grams, they have the capacity to store 160. Although it is present in meat and fish, you would have to eat enormous quantities to reach those maximum levels. Instead, creatine powders are usually stirred into high-sugar fruit juice (which aids in delivery). Most athletes go through a loading phase of 0.3 grams per kilogram of weight for five to seven days (usually around five grams taken four times per day), followed by around three grams a day thereafter.


Does it work? One review of numerous studies concluded that it is the most effective nutritional supplement available that is intended to enhance physical performance, stamina, or recovery. It documented athletes who used creatine to increase their high-intensity exercise capacity. They also improved their lean body mass. Vegetarians and vegans have the most to gain from the supplement, although others can benefit as well. Side effects are minimal. They include bloating and upset stomachs during the loading phase. If these become intolerable, reduce the amount or skip a day. Those with hyperglycemia may want to mix the powder in water or other low-sugar alternatives.

Amino Acids and Vitamins 


There are a number of common amino acids and vitamins that have found their way into pre-workout regimens. The amino acid beta alanine can help reduce that painful burn in your muscles during exercise. Studies suggest it reduces fatigue and improves performance. Its main side effect is a tingling sensation in your hands and feet. Niacin, also known as Vitamin B3, is popular for its metabolizing effects. Since most people get enough through their diet, it’s generally unnecessary. Once a popular pre-workout supplement, branched-chain amino acids are fairly safe but damaging to your wallet––there’s little evidence they work. On the other hand, the amino acid taurine improves metabolism.


Some athletes enjoy a protein-laden, pre-workout smoothie. While most nutritionists insist that even the physically fit get enough protein in their diet, fitness fanatics insist on that protein shake. The truth is, too much of just about anything can have negative consequences. The best way to know what you are putting into your body is to read the labels. If you are uncertain, don’t buy it. 


A final caveat. Online retailers are a convenient source for supplements but be cautious about third-party sellers. Many are based in China. Sellers there have an outsized reputation for selling counterfeit, dangerous, or illegal supplements. While not every distant seller is sketchy, you are better off purchasing products from your own region. They are generally better regulated. Besides, if your neighborhood gym or health food store has what you need, you will be helping your community. That’s a great pre-workout exercise.


Written by John Bankston

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