CME INDIA Presentation by Dr. Akash Kumar Singh, Internist and Diabetologist, Spandan Multi-Specialty Hospital, Vadodara.

Most-fit-of-the-lot may mean trouble.

When terrible premature deaths in young celebrities shook the world

  • The recent months have been terrible with sudden and premature deaths in several known young celebrities who were into extreme forms of bodybuilding. The surprising deaths which occurred were in the so-called “most fit of the lot,” the bodybuilders with pounds of muscle in their bodies.
  • What is well known in medical science is that muscles are healthy, muscles are proteins and this might be the reason for everyone to believe that all the famous musclemen are healthy and going to make it till 100 years of age at least. However, this seems to be otherwise based on the incidents that happened in the recent week where at least 2 prominent personalities with good muscle built and young age on their side suddenly died leaving no clue as to what has happened. Their death was blamed on illnesses currently prevailing in the locality such as dengue, chikungunya etc., but based on the nature of these common and short illnesses, it is highly unlikely that these illnesses may have been the sole cause of sudden death in these individuals.

Do these muscles really prolong life?

  • Further, as a healthcare practitioner who has treated 4-5 reputed bodybuilders and have been very attentive to every detail of theirs, all that I have understood was that there is a very keen competition at the top and certain expectations when you desire to annex the title. Therefore, when we take a closer look at the life of these individuals, it is not so surprising to know that they often have no holds barred approach to get into shape and to wrest titles as Mr. City, Mr. State or so, and they pack the best of muscle and the six-pack abs that can get any normal person into an inferiority complex. But the real questions to ponder are – “Are these muscles really good?” and “Do they prolong life?” These are the questions that need an answer.

In search of an answer

  • One of the most important criteria that is required to build these muscles is the intake of fat percentage, which should be considerably less than even the normal body composition levels. Now the most pertinent question is how does a bodybuilder get that much muscle and reduce the fat to such bare low levels?
  • Organizations such as the World Health Organization (WHO) and other healthcare agencies advise a balanced diet and largely agree that out of recommended total daily calorie intake, carbohydrates should constitute around 40-60% and fat should constitute around 20-30% and protein 15-20% of total daily calorie intake.
  • (See Table 1 for recommendations on % of total daily calorie intake from well-known organizations).

Table 1: Recommendations on % of total daily calorie intake from well-known organizations.

OrganizationCarbohydrate (% of total daily calorie intake)Fiber (% of total daily calorie intake)Protein (% of total daily calorie intake)Fat (% of total daily calorie intake)
ADA 202050-60%Not specified10-15%30-35%
British Diabetes Association 201945-60%<30g/day30-35%<35%
EASD 201945-60%Increased fiber with low GI food10-20%35%
RSSDI-ESI India 202050-60%25-40g/day15%<30%
ADA: American Diabetes Association; EASD:  European Association for the Study of Diabetes.

Using various food supplements

  • These bodybuilders are often advised to take only 5-10 % of fat intake and increase the daily intake of proteins even above the recommended levels, to increase the muscle built which often leads to undesired consequences in most of them. These musclemen often consider using various food supplements which are rich in protein such as whey protein, eggs, creatine, non-vegetarian foods etc and render a promise to increase the muscle mass to make them the cynosure of eyes for the onlookers. However, these food supplements when taken in excess amounts for prolonged duration can cause severe health safety concerns as it is a well-known fact that a high protein diet is one of the causes of deterioration in kidney function, therefore, one can easily imagine the consequences of such types of extreme dietary changes.
  • Another resource that is considered by these bodybuilders is the use of medications to build muscles and burn the fat such as anabolic steroids, Growth factors, ACTH injections, IGF-1, Testosterone etc., which are mainly used to drive more amino acids, fats, and carbohydrates into the cells allowing the body to stack 30, 40, 50 pounds of muscle. There may be many more of such hormones and chemicals being used by these body builders under the methods being used by them to aid in burning body fat and amassing muscle. The main reasons for the bodybuilders to choose these medications or high protein diets, are lack of awareness and being desperate to achieve the winning goal. The most famous perception prevailing in this tribe is “the bigger the better” and millions of followers of popular bodybuilders think the same way.

The Truth About Immortals

Anabolic Steroids

  • What are anabolic steroids? Anabolic steroids are class C manufactured drugs that mimic the effects of the male hormone testosterone and can only be sold by pharmacists under a prescription from a registered medical practitioner. They have limited medical uses and aren’t to be confused with corticosteroids, a different type of steroid drug that’s commonly prescribed for a variety of conditions. However, anabolic steroids are sometimes taken without medical advice to increase muscle mass and improve athletic performance. If used in this way, they can cause serious side effects and addiction. In professional sport, most organisations have banned anabolic steroid use and test competitors for banned steroids.
  • Regular intake of anabolic steroids can lead to physical and psychological changes in both men and women, as well as potentially dangerous medical conditions. Some of the adverse effects of excess use of anabolic steroids in men include reduced sperm count, infertility, shrunken testicles, erectile dysfunction, baldness, breast development, increased risk of prostate cancer severe acne, stomach pain etc. In women, anabolic steroids can cause facial hair growth and unwanted body hair, loss of breasts, swelling of the clitoris, deepened voice, an increased sex drive, problems with menstrual cycle, hair loss and severe acne etc. In addition, both men and women who take anabolic steroids can develop any of the following medical conditions:
    • heart attack or stroke,
    • liver or kidney problems or failure,
    • high blood pressure (hypertension),
    • blood clots,
    • fluid retention and,
    • high cholesterol. 
    • psychological effects like aggressive behavior, mood swings etc.
  • As anabolic steroids are often injected, there are risks associated with sharing needles as well. These are the same risks associated with recreational drug use, and include: damage to veins, leading to ulcers or gangrene, hepatitis B and C and HIV transmission etc. Like many other substances, anabolic steroids are addictive which means the person can crave for the drug- require more to get the same effect, and have withdrawal symptoms when the person suddenly stops taking them. A person who is addicted to anabolic steroids will want to keep using them despite experiencing unpleasant physical, health and/or psychological side effects. When doctors prescribe steroid medication for various other approved medical treatments, they always advise using them under complete medical supervision and coming off the medication slowly by gradually reducing the dose to avoid withdrawal symptoms. However, this kind of medical supervision often lacks among the bodybuilders who use these medications as off-label use for building muscles.

Bodybuilders who go for extreme bodies may often not be as fit as it appears to be

  • These bodybuilders would walk with the confidence of the fittest, confidence showing both in their behavior and their body language making the people around them think they are the healthiest. However, the fact is that these bodybuilders who go for extreme bodies may often not be as fit as it appears to be.
  • They may have multiple risk factors (cardiac and non-cardiac) which include the following:

Premature coronary artery disease and coronary calcification secondary to hormonal treatment, excess of calories, and higher amount of dense calorie intake.
Soft plaques getting into the arteries causing a rupture of the plaque with sudden occlusion of the blood vessel with resultant sudden myocardial infarction.
Kidney damage is secondary to supplements like creatinine which builds muscles to extreme levels but with the toxic effects on the kidneys increasing the chances of kidney failure.
Switching over to lactate metabolism with more generation of ketones, free radicals during these endurance exercises leading to subendothelial damage which often leads to premature aging and premature atherosclerosis and premature MI, arrhythmias, and death.
The majority of these bodybuilders who are into partying have further health issues due to the binge of alcoholism, and calorie-rich foods which they think they can digest easily owing to the heavy workout they perform on daily basis.
Taking large doses of anabolic steroids cause heart to become enlarged reducing its efficiency and gradual cardiac damage culminating in an extremely low ejection fraction  (systolic dysfunction) due to dilated cardiomyopathy in many of these bodybuilders.
By the time the bodybuilders cross into the 4th decade of life, many of them may develop hypertension and diabetes due to use of unreasonable amounts of steroids, hormonal treatments, unbalanced diet, excess dietary supplements, excess alcohol intake etc.
Medical fitness test to rule out pre-existing illnesses (cardiac or non-cardiac) in these individuals pursuing the profession of bodybuilding is not done. This leads to some individuals at risk coming into this field further increasing their health risks.
Periodic (or yearly medical check-up) in these individuals with extreme endurance sport is also not done and many bodybuilders end up developing cardiac abnormalities that are not picked up within time which further adds to the enhanced health risk in these individuals.

Knowing the limit is the key

  • It is now well known that endurance exercise only up to a certain limit is known to benefit and impart long life, and that too only if supplemented by healthy and mindful eating. A very heavy, prolonged (endurance) exercise may cause more harm than good. It is also necessary to be beware of the dubious or unregistered doctors, dieticians, educators, products and medications etc. which seem to cause physical benefits but are responsible for an array of internal damage which can endanger both internal organs and life too.

Final Points

  • Overall, the best of muscles are always not the healthiest ones or are not going to make you live longer than the common population.
  • In many instances, these bodybuilders with their dubious means of increasing muscle mass, may be more diseased internally than we think and these muscles and the inappropriate means they use to develop them can spell doom for them.

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The Truth About Immortals

The Truth About Immortals

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