The desire to attain an ideal physique and well-defined muscles is so powerful that they place faith in gym trainers and rarely consult medical experts for guidance. As a result, doctors have a list of vast case studies dealing with side effects of the overuse or misuse of gym supplements.
Sample this: Abhishek Singhal, now a dentist with a private practice, started at a local gym during his college days (a first-year undergraduate student of dental surgery).
It was all going well, and he would do 60 minutes of intense sessions with his trainer – the results were visible.
“But I got a bit too impatient and started expecting more. So, like everyone at my gym, I asked my trainer for supplements in hopes that it will speed up the results,” he told me. “My friends from Delhi were taking supplements and so was everyone in my circle. What could go wrong?”
But turns out, a lot.
“I started on whey protein and pre-workout shakes. In the first few weeks, I was on a roll. I could exercise longer and had fewer injuries and less fatigue. I could push myself somewhat more,” Singhal said. “But after the initial thrill, at my medical college, when we were being taught how to take blood pressure, mine was also taken.”
His blood pressure came out to be considerably higher (160/100) and he couldn’t piece together why. “I was exercising, eating healthy and even taking appropriate supplements. I didn’t take any chances and rushed back to Delhi to consult a cardiologist. He ordered some tests and through them found out even uric acid was high. He helped me pinpoint the exact cause – gym supplements,” he said.
Pre-workout contains caffeine in high purity, which raises alertness and metabolic rate, and raises blood pressure as well.
“One month of caffeine was the culprit,” Singhal said. “Protein breaks down into amino acids upon digestion, which are further excreted out of the body as nitrogenous compounds – urea and uric acid.”
Uric acid is responsible for a number of ailments, including gout, painful joints and even eye disorders. These usually arise in the event of kidney disease. “In my case, I was lucky, it was only due to overconsumption of protein – the supplemental whey protein I was using. With time, the results came back to normal,” he said.
While Singhal was lucky, this is not the case for everyone.
Dr Mayank Madan, director (minimal access and bariatric surgery) at CK Birla Hospital in Gurugram, shared another experience. He said he has come across a couple of patients who have been prescribed “indiscriminate supplements”.
“One case that I can immediately recall is of a patient who came with a history of repeated anabolic steroid injections,” Dr Madan said.
Vijay (name changed) would get those injections often, maybe every month or so in his buttocks area; and he had presented to Dr Madan with a peculiar condition, under which the fat distribution in the buttocks area was erratic.
“There was so much lumpiness,” Vijay’s doctor said, adding, “we technically or medically call it lipodystrophy or lipoatrophy also, in which due to repeated injections in a particular area, fat cell distribution becomes abnormal.”
Sometimes, there is loss of fat from certain areas so there is an abnormal appearance of the underlying muscles and the vessels. “This patient came to me and it was grossly abnormal,” Dr Madan said.
He did an MRI scan and other imaging to ascertain the cause, but on repeated questioning, he found out that Vijay was receiving steroid injections.
Dr Madan has seen other patients who come to him with altered bowel habits. “Sometimes they get chronic constipation because of these protein supplements as these supplements are devoid of fibre. So these patients tend to get constipated and then they can come with anus-related problems like haemorrhoids, bleeding or fissures,” he said.
Some months ago, after actor Siddhaanth Surryavanshi died during a routine workout, medical experts highlighted that cardiac deaths could also be caused due to “hyper-gymming” and excessive use of gym supplements.
The big business of gym supplements
The market for these supplements is huge. According to a report by research consultancy IMARC Group, the Indian dietary supplements market size reached Rs 43,600 crore in 2022. They expect the market to reach Rs 95,800 crore by 2028, exhibiting a growth rate (CAGR) of 13.5 percent during 2023-2028.
A random search at a popular online platform threw more than 6,900 products under the “health and nutrition” category, specifically for men. The segments are divided into whey protein, BCAA (branched-chain amino acids), mass gainers, multivitamins, weight management among others.
These products – for pre and post-workout – are offered in a number of flavours including chocolate, kesar, mango, hazelnut and vanilla, and prices vary from Rs 500 to Rs 12,000 for different sizes and brands. These supplements fall under the category of nutraceuticals and are licensed by the food regulator of India, Food Safety and Standards Authority of India (FSSAI).
The consumption of gym supplements is also unregulated and does not require any prescription for sale. These powders, pills or shakes can be consumed by anyone irrespective of their health history, family’s medical history, current health status, allergies, or existing medications.
Experts advise buying with caution
Dr Rajeev Jayadevan, a senior consultant gastroenterologist and a former president of the Indian Medical Association, told me that gym supplements are “prescribed” or “recommended” by people who work at the gymnasium and almost invariably have no formal healthcare training or credentials in nutrition.
“Attending a few classes on nutrition does not count,” he said in a sarcastic tone.
Gym supplements, according to Dr Cyriac Abby Philips, a specialist in hepatology and liver transplant medicine in Kerala, are now a major cause for liver injury, liver failure, death or increasing liver transplantation in the Western countries. “A commonly used supplement is Ashwagandha.”
A multicenter study — the largest series on Ashwagandha-related liver injury, from India, by The Liver Research Club India which is currently accepted for publication in the official journal of the American Association of Study of Liver Disease — demonstrated that Ashwagandha-hepatitis can lead to progressive liver failure and death in those with pre-existing liver disease.
Philips said that multi herbal gym supplements containing green tea extracts, turmeric and garcinia cambogia (or malabar tamarind) are also known to cause severe liver injury, liver failure and death.
“Gym supplement products containing synthetic ageline (which naturally occurs in Bael fruit) was responsible for liver failure and death among many consumers which made the US FDA ban the product from further sales.”
One of the biggest issues with such supplements, Philips believe, is that they interact with other essential medications or supplements and either reduce the effectiveness of important medications or increase the toxicity of medications.
Dr Sakshi Manchanda, a consultant at the internal medicine team at Medanta in Lucknow, has also been seeing some cases of gym supplement abuse. She said it’s “concerning to hear that gym supplements are being prescribed randomly and without proper guidance”.
Globally, the majority of regulators – almost everyone – do not approve dietary supplements for safety and effectiveness or their labelling before they are sold. The rules are lax across the globe.
In November 2022, the US Food and Drug Administration, one of the strictest health regulation bodies, said it has received hundreds of adverse event reports, including those showing evidence of serious liver injury. It found some bodybuilding products may illegally contain steroids or steroid-like substances associated with potentially serious health risks, including liver injury that can be life-threatening.
Similarly, an investigation by UK health agency MHRA found 84 illegal products, such as energy and muscle-gain products, being sold containing dangerous ingredients such as steroids, stimulants and hormones.
In short…
Before adding supplements to your long-term routine, it’s essential to consult with a certified nutritionist or a physician if you have an existing health condition. Additionally, ensure the safety of the supplement’s components by confirming the ingredient profile. Refrain from consuming any product lacking clearly indicated ingredients and trust only reputed brands.
Supplements are sometimes known to contain heavy metals, pesticides, plant products like ephedra, caffeine and steroids. Hence, keep your health parameters under check by undergoing full-body health check-ups until on supplements.
Make a rule: before adding anything new to your diet (including gym supplements), talk to medical practitioners, understand the ingredients, stick to the advised dosage and listen to your body.
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