Bodybuilding is often considered a sport that promotes health promotion through a rigorous diet, reduced body fat, and increased lean muscle. In 2021 several bodybuilding deaths made the headlines labeling bodybuilding a dangerous sport. Most articles would mention that the death was directly related to high doses of anabolic steroids as the contributing cause of death.
PREMATURE DEATH BY STEROIDS SUMMARY
- The authors of the study suggest that in addition to anabolic steroids, other contributing factors, such as extreme exercise, high protein intake, sports supplements, weight cycling, growth hormone, diuretics, recreational drugs, and other performance-enhancing drugs may be a contributing factor to premature deaths in bodybuilding.
Bodybuilding is often considered a sport that promotes health promotion through a rigorous diet, reduced body fat, and increased lean muscle. In 2021 several bodybuilding deaths made the headlines labeling bodybuilding a dangerous sport. Most articles would mention that the death was directly related to high doses of anabolic steroids as the contributing cause of death.
Despite bodybuilding being considered a sport for improving health, many weight lifters typically don’t have the life-extension benefits of aerobic exercise. (Kettunen et al., 2015; Kujala et al., 2001)
Intense resistance exercise can cause changes in the heart muscle to accommodate the large increases in blood pressure during resistance exercise. One study found that peak blood pressure reached 320/250 during heavy leg presses! (MacDougall et al., 1985) However, long-term resistance exercise is generally associated with lower systolic blood pressure. (Igarashi, 2023) Thus, resistance exercise does not cause impaired cardiovascular function, but other lifestyle factors may contribute to early death.
DO STEROIDS CAUSE HEART ATTACKS?
The positive effects of steroids include increases in protein synthesis, reduced body fat percentage, increased muscle gains and strength.
The textbook side effects of steroid use include erectile dysfunction, bad cholesterol, liver damage, hair loss, and increased risk of heart disease (i.e., heart attack, blocked coronary arteries, etc.).
The Washington Post recently did an article on the extreme bodybuilding risks many competitive bodybuilders use. Even though 21 bodybuilders passed away in 2021, several bodybuilders have gone on to live long, healthy lives well in their 70s, such as Arnold Schwarzenegger, Lou Ferrigno, and Frank Zane, all of whom have admitted steroid use. If anabolic steroids are the direct cause of death, there should be other sports that use anabolic steroids that have a high death rate.
The sport that involves the greatest number of disqualifications for steroid use is cycling in the Olympics, followed by weightlifting, boxing, triathlon, and baseball. Cyclists from the Tour De France in the early 70s were known to use performance-enhancing drugs combined with anabolic steroids, but their death rate is lower than the general population.(Marijon et al., 2013)
An excellent review article that’s free for public use was published in Sports Medicine titled “Premature Death in Bodybuilders: What Do We Know?” (Smoliga et al., 2023) This article will give you a synopsis of the article and its review of the literature on steroid use and early death in bodybuilders. The author reviews the current evidence on whether anabolic steroids are directly attributable to early deaths.
The author reviews the existing literature and makes compelling evidence that most of the scientific literature on bodybuilder-related side effects is primarily based on case studies and small cohort studies, but there is little direct epidemiologic evidence that bodybuilders are at increased risk of adverse clinical outcomes.
CONFLICTING RESEARCH STUDIES ON LONG-TERM ANABOLIC STEROID USE
The research of side effects related to anabolic steroids has been well documented, such as reduced HDL, increased LDL, higher cholesterol, and homocysteine levels which are all associated with increased risk of cardiovascular disease.
One study suggested that anabolic steroid-using bodybuilders had many structural similarities to patients with hypertrophic cardiomyopathy (i.e., enlarged heart), with a decreased work efficiency of the heart. However, there were key regional differences in the heart that differentiated an anabolic steroid user’s heart from a disease like hypertrophic cardiomyopathy.(Grandperrin et al., 2022)
Other studies reported increased left ventricular mass and wall thickness in bodybuilders using anabolic steroids compared to non-using bodybuilders. (Dickerman et al., 1997; Smit et al., 2021)
It must be noted that not all studies have found that anabolic steroids cause cardiac abnormalities. For example, a study of bodybuilders using anabolic steroids compared to those not using anabolic steroids found that both bodybuilders had increased heart size compared to the control group.
Still, the heart parameters were the same between steroid and non-steroid users. However, anabolic steroid users had higher systolic and diastolic blood pressure levels. Non-users had lower blood pressure responses during exercise. (D’Andrea et al., 2007)
Most of the literature points to reversible side effects of higher-dose anabolic steroids. Most studies show cardiac abnormalities can return to baseline after several months of discontinuation. (De Piccoli et al., 1991)
WHY DO STEROIDS CAUSE HEART ATTACKS? ARE OTHER FACTORS RELATED TO BODYBUILDING-RELATED DEATHS?
The review states that many studies do not consider the extreme lifestyle factors that also occur with competitive bodybuilding. In a study of over 100 men using anabolic steroids, >20% were using other drugs that may also impair cardiac function, such as GH, thyroid, clenbuterol, and other stimulants. (Smit et al., 2021)
POTENTIAL FACTORS CONTRIBUTING TO CARDIAC-RELATED DEATHS
The review article lists several other factors that must be considered that can contribute to cardiac abnormalities and related deaths in bodybuilding.
- Extreme Strength Training-the practice of extreme strength training changes in the heart is not just a common occurrence in bodybuilders, but competitive weightlifters, powerlifters, strongmen, and football players. (Silva et al., 2018; Weiner et al., 2013)
- High Protein Intake– the review mentions that although studies have shown that high protein intake does not impair kidney function, excessive intakes may adversely affect outcomes. The study mentions a case study in which an amateur bodybuilder suffered a heart attack using anabolic steroids; shockingly, he consumed 750 grams of protein per day (i.e., 500 grams of whey protein per day). (Jain & Goel, 2020)
- Weight Cutting and Weight Cycling– the use of diuretics is a common occurrence with bodybuilders that can lead to dehydration and electrolyte imbalance.
- Excessive use of bodybuilding supplements such as stimulants and pre-workout can also result in many cardiac abnormalities.
- Injection Infections, hepatitis, and other factors.
The review does a great job of making the point that there are many contributing factors, such as a genetic predisposition to heart disease, the combination of other drugs (i.e., GH, diuretics, stimulants), and other lifestyle factors that are being taken by bodybuilders that are often not considered.
The review concluded, “Reports of premature deaths in the mainstream media, combined with case reports in the medical literature, suggest that bodybuilding seems to be associated with an increased mortality rate, and this is mostly attributed to AAS use. However, there is currently insufficient high-quality scientific evidence to support a causal link for either claim, especially given numerous plausible confounders.”
The paper’s authors made it clear that they are not advocating steroid use and are not saying that anabolic steroids are not without side effects or that the common deaths in bodybuilding are worsened by steroids. Rather, the article aims to improve the realm of research to understand the health risks of bodybuilding.
The negative side effects are real and should not be dismissed. Increasing testosterone levels thru the use of anabolic steroids should only be done under the guidance of medical supervision.
REFERENCES
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De Piccoli, B., Giada, F., Benettin, A., Sartori, F., & Piccolo, E. (1991). Anabolic steroid use in bodybuilders: an echocardiographic study of left ventricle morphology and function. Int J Sports Med, 12(4), 408-412. https://doi.org/10.1055/s-2007-1024703
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