Dead Bodybuilders with Dr. Howard Elkin: Rational Wellness Podcast 234

Dr. Howard Elkin and Dr. Ben Weitz discuss Why Bodybuilders Are Dying Young but How Weight Training Promotes Health.

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Podcast Highlights

0:27  Quite a number of professional bodybuilders have been dying recently at young ages due to anabolic steroid use/abuse, including the death of the 2018 Mr. Olympia Shawn Rhoden, who died of a massive heart attack at age 46 several weeks ago.

7:48  The goals of this podcast are 1. to describe the health risks of anabolic steroids for those bodybuilders who are taking them and who are not aware of the risks, and 2. to explain why weightlifting promotes health, so those who hear about bodybuilders dying are not discouraged from weight lifting.

9:20  Weightlifting promotes longevity by allowing you to gain muscle and strength.  Muscles support and stabilize your joints including your spine.  Maintaining muscle strength allows you to maintain your mobility as you get older.  Loss of muscle is called sarcopenia and this can lead to loss of mobility as you age.  Seniors with sarcopenia are more likely to fall and break a hip, which can be catastrophic.  You are much more likely to die in the next few years after breaking a hip.  If seniors end up on the ground, they often cannot get up without help due to them being too weak. In fact, being able to get up from the ground without help has been shown to be a predictor of longevity. (De Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology. 2014;21(7):892-898. doi:10.1177/2047487312471759) On average, after the age of 30, we lose about 1/2 lb of muscle per year unless you do weight training and this loss of muscle accelerates after age 50.

12:38  Weightlifting promotes bone strength.  As we age, the loss of bone, osteopenia or osteoporosis, can lead to fracture, sometimes catastrophic.  Weight training can not only strengthen your muscles, but your bones as well by placing controlled amounts of stress on your bones. Weight training not only loads the bones but also as the muscles contract, they pull on the bones, leading to both better bone density and bone strength.

15:47 The cardiovascular benefits of weight training. Weight training improves your cholesterol and lipids. It increases blood flow, dilates your blood vessels and helps keep the arterial walls compliant and reduces their stiffness. Most studies show that weight training lowers your levels of LDL (“bad” cholesterol) and cholesterol and raises your HDL (“good” cholesterol). (Sheikholeslami Vatani D, Ahmadi S, Ahmadi Dehrashid K, Gharibi F. Changes in cardiovascular risk factors and inflammatory markers of young, healthy, men after six weeks of moderate or high intensity resistance training. J Sports Med Phys Fitness. 2011 Dec;51(4):695-700.)

18:09  Weight training also helps with weight loss, since it raises your metabolic rate, which is the rate at which your burning calories all day long even when you are not exercising.  The more muscle you have, the higher your metabolic rate.  And obesity certainly increases your risk of heart disease.

19:39  While both cardiovascular and weight training reduce epicardial fat, only weight training reduces pericardial fat. (Christensen RH, Wedell-Neergaard A, Lehrskov LL, et al. Effect of Aerobic and Resistance Exercise on Cardiac Adipose TissuesSecondary Analyses From a Randomized Clinical TrialJAMA Cardiol. 2019;4(8):778–787.)  

21:02  Weight training will lower blood pressure. While your blood pressure may rise temporarily during weight training, such as while doing a leg press, performed consistently it will lower blood pressure.(de Sousa EC, et al. Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis. Hypertens Res. 2017 Nov;40(11):927-931.)

22:22  Weight training can also help to reduce the risk of diabetes.  Weight training reduces blood glucose levels and has been shown to reduce hemoglobin A1C, which represents a three month average of blood sugar.  As you use the muscles around the body, they use their glycogen up and then glucose will be pulled from the bloodstream into these muscles, thus lowering blood glucose. And having more muscle gives you more storage for glucose.

25:58  Professional bodybuilders are dying at a young age due to anabolic steroids and other drug use.  What are anabolic steroids?  All our hormones are steroids due to their molecular structure and this includes estrogen, progesterone, and testosterone. But only testosterone is considered to be “anabolic” or growth promoting.  Therefore, anabolic steroids refers to both testosterone and various synthetic derivatives of testosterone that have been designed by chemists to have the muscle growth promoting properties of testosterone without some of the negative effects of taking high levels of testosterone. These drugs have names like Dianabol, Primobolan, and Deca-durabolin.

33:12  Liver damage from taking anabolic steroids.  We may see elevations of liver function on lab testing, esp. AST, ALT, and GGTP levels.  Various things can cause liver function tests to elevate, including drinking alcohol and taking Tylenol and other medications.  Patients who consume a lot of processed carbohydrates and other junk food and who drink soda and eat a lot of sugar can get Nonalcoholic Fatty Liver Disease.  The oral anabolic steroids are the ones that are more likely to damage the liver.  Anabolic steroids can cause a condition called Peliosis hepatitis, which are blood-filled cysts in the liver.  There are also reports of bodybuilders who develop various forms of liver cancer.

36:28  Cardiovascular damage from anabolic steroids.  A lot of these bodybuilders that we have been reading about dying young have been dying from heart attacks and blood clots and heart failures.  They usually have an unhealthy lipid profile. One of the most characteristic features is that they tend to have an extremely levels of HDL, which is the good cholesterol. And it can be extremely low, such as under 10, when it is supposed to be over 50.  And their LDL (bad cholesterol) tends to be mildly elevated.  Having an unfavorable lipid profile means that they’re more likely to develop atherosclerosis which is the buildup of cholesterol plaques in their arteries which can block the flow of blood to their heart. So, it’s increasing the risk of both heart attack and a stroke.

38:46  Bodybuilders tend to develop an increase in their hematocrit levels because they are producing so many red blood cells. Their blood gets thicker, which increases the risk for clotting. This must be treated by getting a therapeutic phlebotomy.  In addition, anabolic steroids tend to promote platelet aggregation, which also leads to the risk of more blood clotting. And platelets play a significant role in heart attacks. We used to think that what happened with a heart attack was that you get a plaque that gets bigger and bigger and occludes the artery and causes a heart attack. But what we know now is that the plaque, which may only occlude the artery by 50%, becomes unstable and ruptures and then platelets come to the area and form a platelet plug, which stops the blood flow to the heart, causing the heart attack.

42:03  Kidney damage from anabolic steroids.  Anabolic steroid users tend to develop high blood pressure, which means the heart is stressed and has to work harder to pump blood around the body, causing the heart to hypertrophy (become enlarged). This also puts stress on the kidneys and causes kidney damage, and kidney damage leads to more high blood pressure.  There are quite a number of professional bodybuilders who have had kidney failure and have ended up on dialysis and had kidney transplants.  The kidney stress is made worse by the common usage among many bodybuilders of nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen.  And this thickening of the heart’s walls leads to difficulty with the ability of the heart to relax during diastole and this leads to congestive heart failure at an early age.



Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California. He has been in practice since 1986. While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for exercise, diet, and lifestyle changes to improve their condition. He also utilizes non-invasive procedures like External Enhanced Counter Pulsation (EECP) as an alternative to angioplasty and by-pass surgery for the treatment of heart disease.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

Why are there so many dead bodybuilders today? I recently read about the death of the 2018 Mr. Olympia Shawn Rhoden at age 46 dying of a massive heart attack and I was saddened. And then I thought I need to call my friend Dr. Howard Elkin, integrative cardiologist, because I think it’s important for some health care professionals to speak up about why so many professional bodybuilders are dying.  And I think that both myself and Dr. Howard Elkins are uniquely qualified to talk about this particular topic. And that’s because we’re both health professionals. Both of us have treated quite a number of professional bodybuilders in the past. And both of us have also competed at bodybuilding at a substantial level in the past.  So, let me introduce myself. I’m Dr. Ben Weitz. And I am a sports chiropractor. And I’m also a functional nutritionist. Howard, perhaps you can introduce yourself.

Dr. Elkin:              Thank you. Thank you, Ben. It’s always great to be with you on these podcasts. I’m Dr. Howard Elkin. I’m an integrative cardiologist and also anti-aging medical specialist. So, I’ve been doing cardiology for 35 years and anti-aging medicine for about 21 years. So I’ve done a lot with hormone replacement in general and, of course, dealing with body builders as well. So, I’m glad we’re here together today.

Dr. Weitz:            Yeah. I am, too. Thank you, Howard. So, both of us have been reading about, it seems like a recent run of quite a number of professional bodybuilders, former professional bodybuilders dying at a relatively young age, largely from cardiovascular but also from liver and kidney disease. I mentioned Shawn Rhoden. Several weeks before that, before the Mr. Olympia, George Peterson died.  There’s just been a whole plethora of professional bodybuilders who have been dying in their 30s, 40s, even 50s. And it’s quite upsetting to me that these men and women who look like the pillars of health are dying early.

Dr. Elkin:              Right. I totally agree. And I think 2021 has been a really bad year for competitive bodybuilding on the professional level, and also the high amateur level. I mean, I did a little research on this. And there’s 16 deaths that I have noticed in 2021 alone. Shawn Rhoden, of course, being the most famous because he was Mr. Olympia. In fact, he was the oldest Mr. Olympia to get the crown.  And so, it’s disturbing and what comes to my mind after reading these people are dying in their sleep, okay, people are having strokes, heart attacks, death of amputation of a limb, these are not things that happen to healthy individuals in their 20s, 30s and 40s. You would expect, like Dr. Weitz, just mentioned that these people are like the pillars of health. But inside, things are happening that are anything but.  And you just saw here these deaths in young people that are healthy. And I think this was like the final straw with Shawn Rhoden. It’s like, “Okay, something’s got to stop here,” because this is not looking good, 16 deaths in less than a year. And I think there were three in October or September. So it’s excessive. Deaths among bodybuilders is not unusual. We’ve dealt with this for years but lately, it’s out of control. And I think we need to address the reasons why.

Dr. Weitz:            And I suspect for every professional bodybuilder who makes the news, there’s 20 amateur bodybuilders. And so, one of the reasons why we both felt that it was really important to speak out is as a professional bodybuilder, you may need to do some things that put your health at risk. Unfortunately, today, this sport of professional bodybuilding, the way it is right now, requires the competitors to take performance enhancing drugs, i.e. anabolic steroids and some take a host of other drugs as well.  And these definitely put their health at risk. I’m not sure everybody’s aware of that. But if you choose to do that as a professional bodybuilder with money and fame on the line, you may decide to make that calculation. But as somebody working out in a gym who just wants to get bigger and stronger, maybe hopes of being a professional bodybuilder one day, those are the people we really want to speak to and make sure they understand what are the specific risks to their health, particularly to their cardiovascular system, to their kidneys, to their liver, on top of a bunch of other, unhealthy side effects that may not be life-threatening but are not happy from taking anabolic steroids.

Dr. Elkin:              I just want to interject one thing. You’re absolutely right at all this. I think what bothers me is that we’re dealing with a lot of young people that looked at these big professional bodybuilders as heroes. Even when I went over all their … the scanty information I could find regarding their death was like, “Oh, we honor these people ourselves.” Of course, anytime anyone passes away, it’s a very sad thing.  Sometimes it’s almost like we honor these people, and yet these death I think in my opinion, a lot of them could have been prevented, avoided. But we’re sending a bad message to the youth. You probably heard Richard Piana, he was a big, massive guy, put tons of stuff.

Dr. Weitz:            Yes, I remember seeing him at Gold’s Gym. When he walked in, it was like a cartoon. I didn’t even think he was a real person.

Dr. Elkin:              Between the tattoos and the size. And he knew he was going to die before 50 and he did. He led up to his own self-fulfilling prophecy. He did excessive stuff. He had a huge, here’s my point, huge amount of followers. A lot of young people think, “Oh, wow, this is really cool. I want to get big. I want to get strong. I want to look like this person or that person.”  And so, although I love it bodybuilding, we’ll get into all those good things that we like about it in a minute, it’s just scary to me because the youth of today are seeing this. And they think that it’s an almost aspiration to be like this. And that’s what really frightens me.

Dr. Weitz:            Absolutely. So, really what we hope and expect to be able to accomplish with this podcast video and we’re both going to be writing articles that we’re going to publish very soon on our websites is, A, make sure all these folks who are taking or are considering taking anabolic steroids know what the risks are. And, B, we also don’t want people to hear about these bodybuilders dying and say, “You know what, I don’t think I want to do weightlifting because it’s unhealthy.” They need to understand that lifting weights, resistance training, weight training, however we want to describe it, is one of the most beneficial activities you can possibly perform to promote your health.

Dr. Elkin:              Absolutely. I’m about to address this whole issue on one of my YouTube blogs coming up about why bodybuilding, that’s the question. And it’s probably the singular best thing we have to fountain of youth if you don’t really have as we age. And I tell everybody regardless of age, we’ll talk about this together, but it’s like muscle is your greatest ally, I don’t care if you’re a woman, a man, what age you are.  I think in your article that I was just recently reading, yeah, studies have shown that people in their 80s and 90s can still gain muscle.

Dr. Weitz:            Absolutely. And muscles are super important, not just for appearance, much more important because they support and stabilize your joints including your spine. Muscles are what allows you to be mobile and active. You need your muscles to fire at an appropriate time to maintain your stability so you can get around.  And one of the things that really jeopardizes our longevity is the loss of muscle. In fact, it’s given a name, sarcopenia. And that’s a health condition. And loss of mobility is a major factor for older people. In fact, there are seniors who cannot get out of bed simply because they lack the strength to do so. And this is really sad. It doesn’t have to happen. There are people whose digestive systems don’t work because they didn’t have enough muscle tone in their abdomen to keep everything in place.  As we get older, if we lose our strength, people fall. They break a hip, just breaking a hip significantly decreases your lifespan. You’re much more likely to die in a few years after breaking a hip.

Dr. Elkin:              End up with a pneumonia. It’s a vicious cycle. When I tell people, “If you don’t have enough strength to open a jar, close a window, shut a garage door, then those are called activities of daily living.” And a lot of the elderly can’t do that because they haven’t prepared for it.

Dr. Weitz:            Absolutely. A lot of seniors, my mom included, if they end up on the ground, on the floor, maybe they bend over to pick something up, they can’t get up. They simply lack the strength. And that’s because on average, after the age of 30, we lose about a half-a-pound of muscle per year unless you do weight training. And this loss of muscle accelerates after age 50.

Dr. Elkin:              I usually call it use it or lose it.

Dr. Weitz:            Exactly. And so, it’s super important for maintaining your muscle that we do some form of resistance training, weight training. And studies show that even men and women who perform regular weight training can gain muscle even in their 70s and 80s.

Dr. Elkin:              Right, absolutely. So, both Dr. Weitz, we promote resistance training, weight training. And in fact, it may be the single most important exercise you do. Cardio is very important but … and also in all fairness, resistance training has not gotten the attention it really deserves. It is now starting to. But for years and years when you read about exercise and the many benefits, they basically talked a lot about cardio, walking, running, jogging, swimming, cycling, etcetera, etcetera, and all of which are good.  But resistance training was relegated to the back bench for some reason. But things are changing. And I think most of us that deal with sports medicine and longevity realize the benefits. We’re trying to really impress that everyone as they age. You’re never too old to work on strength.

Dr. Weitz:            Absolutely. So, we just mentioned the importance of maintaining muscle. But not only does weight training strengthen your muscles, it also strengthens your bones. And as we age, loss of bone, mass quality strength often referred to as osteoporosis is a major factor that affects your ability to get around and your longevity.  So, the way you maintain your bone density is by putting stress on your bones. Your body reacts to controlled amounts of stress by getting stronger. You put controlled amounts of stress on your muscles and you muscles get stronger. You put controlled amounts of stress on your bones and your bones get stronger.

Some people think that you have all the bone density you’re ever going to have when you’re young, but that’s not true. There’s a constant ebb and flow. There are, throughout your life, osteoblastic cells that are building new bone. And you also have osteoclastic cells that are breaking down bone. And why would they be breaking down bone? Because during even normal activities without any weight training, some of the bone gets broken down. And we need to clear out those junky bone cells so we can make way for new healthier cells, just the way you upkeep your house.

Dr. Elkin:              And just one other point, too. It happened to me last week. I had one of my patients who is a master swimmer, I mean, great shape. And so, we did a bone density scan. It was pretty severe osteoporosis. Why? Because swimming which is an excellent, excellent aerobic activity and also for many, many other reasons, also cycling, there’s no real impact.  Listen. So, these people are very … they may be cardiovascular-wise very healthy, but their bones haven’t benefited because there’s no pounding. So that’s why I tell these people, the swimmers and cyclists, you need to implement weight training. Because just doing the aerobic activity that you do alone is not going to make it.

Dr. Weitz:            Absolutely. I am totally on the same page with you. In fact, if I’m talking to a patient and they have an hour to exercise, I’m going to encourage them to do at least 30 or 40 minutes of weight training, and maybe 20 minutes of aerobic or cardiovascular activity because the weight training is so important. And the way that weight training stimulates the bones is that, A, you load the bones. The body feels that stress in the bones and says, “We’ve got to make these bones stronger.”  And also, when you contract the muscles hard, they’re pulling on the bones because muscles are attached through tendons to bones and joints. And they pull. And that pulling stresses the bones, strains the bones, puts torque on the bones, and the body needs to make sure those bones get stronger so they can resist that.

Dr. Elkin:              Absolutely.

Dr. Weitz:            So now, let’s get into the cardiovascular benefits of weight training which I think are generally not that well-known.

Dr. Elkin:              Right. And one of the things you can do which we didn’t know until recent years is that it actually improves your cholesterol, the whole lipid milieu. We thought, “Oh, well, we know that cardio does.” But what is weight training does is it has a beneficial effect. Also, it has a beneficial effect on your circulation in general. When you do load the muscle and the bone, like Dr. Weitz has mentioned, you’re bringing blood to the area. So, an increased blood flow is important.

Dr. Weitz:            You’re dilating those arteries. You’re exercising the arterial walls, keeping them compliant, allowing them to expand and contract.

Dr. Elkin:              Right. Because as we get older, what we see instead is arterial stiffness.

Dr. Weitz:            Yes.

Dr. Elkin:              From the heart going all the way to all your vessels, your big arteries, your small arteries and everything in between. So, weight training has one advantage that we didn’t really appreciate until recently.

Dr. Weitz:            Absolutely. We all know that diet plays a huge role in our cholesterol metabolism, but most people don’t realize. And of course, the studies are mixed, not all the studies are consistent on this. But generally speaking, it appears as though for most of the data that I’ve been looking at that resistance training improves your lipids.  One of the most significant effects is that it raises your levels of HDL which is your healthy cholesterol, your good cholesterol that produces reverse cholesterol transport. And studies also show that it reduces your LDL and total cholesterol.

Dr. Elkin:              Absolutely. And we didn’t really appreciate … I mean, 10 years ago when I was researching exercise, we didn’t really know much about weight training, what did it really do?  But it’s really on par with cardio or aerobic training as far as what it can do for your lipids.  So, it’s really exciting news for me because that’s how we can inculcate the importance of all this to our patients.

Dr. Weitz:            And one factor that affects our overall health, our cardiovascular health in particular, is obesity. And if people want to help fight weight gain, if they want to lose some weight, probably the most beneficial thing you can do is weight training. Now, of course, aerobic training is a great way to burn fat. However, the most significant factor is raising your metabolic rate. That’s the rate at which you’re burning calories all day long even when you’re not exercising.  And in a 24-hour-a-day, even if you’re doing super intense aerobic exercise, the rest of the day, if you don’t have a significant amount of muscle mass, you’re going to have a lower metabolic rate and you’re going to be burning fewer calories at rest.

Dr. Elkin:              I can’t agree with you more. And this comes up all the time especially when I deal with women, “I don’t want to get big, I don’t want to get bulky.” It’s like, “Believe me, it’s not going to happen. You’re not going to look like a bodybuilder unless you do the strange things that bodybuilders do.” A muscle is your greatest ally.  And like Dr. Weitz says, the metabolic rate is so much better. I think we look at a pound of fat versus a pound of muscle. I mean, I think it’s like a difference of … it’s quite a difference. I can’t remember the exact numbers now.

Dr. Weitz:            Yeah. It takes a lot of energy to maintain muscle where essentially fat is relatively inert. Now, one of the interesting things that we learned recently about weight training that’s really unique to it is that while both cardiovascular and weight training reduce epicardial fat, only weight training has been shown to reduce pericardial fat. Perhaps, you can explain what those are.

Dr. Elkin:              Okay. So, if you’re dealing with fat and obesity or visceral fat we call which is a scary kind of fat that as people get older, the middle-aged brother gets bigger and bigger and bigger. We used to think years ago, “Oh, fat is fat.” It’s inert because it has such a poor blood supply. Well, that’s not really true. Fat is really very metabolically active but in a very negative way, because you’ve heard of cytokines, these things that happen during COVID.

And so, there are so many cytokines with the abdominal fat and the visceral fat that actually it promotes inflammation, and it’s not a good thing. So, the same thing happens here in the organ. It’s not just visceral fat. Your liver gets fat. Your pancreas gets fat. And your heart gets fat. So pericardial is the area … peri- means around from the Greek. So, it’s around the heart. And yeah, I’ve seen these hearts at autopsy. They’re not pretty.  They look like a bunch of fat encasing the heart. So, this is new information which is really exciting. I didn’t know that myself until I recently read it.

Dr. Weitz:            And lifting weights reduces blood pressure. Even though while you’re performing a heavy exercise, let’s say you’re doing a set of leg press, for the 30 seconds that you’re doing a leg press, your blood pressure may shoot up. And when done consistently, weight training lowers blood pressure.

Dr. Elkin:              And I’m so glad that resistance training is getting the attention it deserves now because it really was like the back … it’s actually by the back seat for a long, long time. Because everything was based on cardio, cardio, cardio, aerobic training, which still has its role. And I think it’s important, I think you mentioned this, too, Ben that if you take a person that’s the same age as Dr. Weitz and myself, the same size and everything, okay, yeah …

Dr. Weitz:            Two men in their 30s.

Dr. Elkin:              Right. Copy that. Well, if we’re both sitting down watching a football game or something, we’ll lose more fat just sitting there than the other person will.

Dr. Weitz:            Yes.

Dr. Elkin:              Our metabolic rate being higher because of the muscle.

Dr. Weitz:            I have to eat over 3,000 calories a day or I will lose weight. And I’m not trying to lose weight.

Dr. Elkin:              Right, it’s true.

Dr. Weitz:            So, one more thing I wanted to mention is the benefits of weight training for preventing and actually managing diabetes because weight training is actually super beneficial in reducing blood glucose levels, and has been shown to reduce hemoglobin A1c. When your muscles contract, they’re using up the glycogen that’s stored in those muscles. And then that allows the glucose in the bloodstream to go into those muscles.  And because with weight training, you’re not just say using your legs like you might do when you’re running, you’re using your chest muscles, your back muscles, your arm muscles, your leg muscles, your torso muscles. All of those muscles will have need for more glycogen and they’ll pull in glucose. And having more muscle also gives you more storage for glucose to get it out of the bloodstream to reduce inflammation, to reduce it from building up in the liver and the other organs.

Dr. Elkin:              Absolutely. I mean, everything you said is correct. And something I thought but it escaped my memory for a second. But anyway, I’ll tell you about the diabetes thing. One thing I have to say about bodybuilders and I’m not talking about the excessive ones, but bodybuilding in itself and all my patients that are bodybuilders, they’re extremely insulin sensitive which is a great thing, because as we get older, insulin resistance seems to be the, it’s quite known, it seems to be what happens as we get older.  Why? Because we’re less active, we put on fat, muscle does not turn to fat, fat doesn’t turn to muscle. But because we’re inactive and our muscle cells shrink in atrophy, it’s easier to put on weight because we’re not doing anything. But people that work with weights that are bodybuilders and on any level, they tend … and I measure insulin levels in almost all my patients so I see this. They tend to have really low insulin levels and they’re always metabolically healthy.  And only 12% of the adult American population is really metabolically healthy. So, that’s another very good aspect of bodybuilding and resistance training in general.

Dr. Weitz:            Right. And I have quite a number of patients over the years I’ve talked to who don’t like doing weight training. And I just wanted to say one thing about that, is often people who come in my office, they’re very flexible, they can wrap their legs around their head. And when I ask them what kind of exercise they do, “Oh, I do lots of yoga. I don’t like weight training.”  Well, one of the reasons why they like to do yoga is because they’re really good at it. Unfortunately, if you’re really good at it, you probably don’t need it. It’s probably not going to help you as much as doing weight training. And one of the reasons you probably don’t like to do weight training is because you’re not good at it. And this is a case where doing things that you’re not good at are good.

Dr. Elkin:              And I’m sure in your line of work as a chiropractor, you’ve seen a ton of yoga-related injuries.

Dr. Weitz:            Absolutely. People think that stretching is always the way to solve injuries. And the fact is we need a balance of mobility, flexibility and stability. And stability comes from muscle strength.

Dr. Elkin:              Right, absolutely.

Dr. Weitz:            So, let’s talk about why these professional bodybuilders are dying which essentially really has nothing to do with the weight training. It has to do with the drugs that they’re taking.

Dr. Elkin:              Right. So, keep in mind that weight training itself is not going to like tear your aorta or cause a massive heart attack or anything like that. Like I said, we’ve outlined the advantages and why it’s so important. So now, we can focus on what happened to these unfortunates and others. These aren’t the only guys that die. These are the well-known professionals and high-level amateurs.

Dr. Weitz:            Right. Just to give people a little description, I want to mention a story about bodybuilder Andreas Munzer. Yes, I know he died in 1996 but he was a well-known professional bodybuilder. He had extremely low body fat. In the bodybuilding lingo, he was ripped. But he died at age 32. And when he died, he was having internal bleeding and his liver and kidneys failed.  Now, on autopsy, they found within his body 20 different drugs. His liver had a consistency similar to plastic. He had multiple tennis-size tumors in his liver. His kidneys were swelling to immense proportions. And his heart was so enlarged that it was a double the size of a normal heart. And this is basically due to all these drugs that professional bodybuilders take. The most important of which, for what we’re talking about, here are anabolic steroids.  Can you explain what anabolic steroids are, Howard?

Dr. Elkin:              First of all, steroid isn’t some horrible kind of term. I mean, it describes a ring-like structure of hormones. And by the way, besides testosterone being a steroid, estrogen is a steroid, progesterone is a steroid. So, it describes the structure of these hormones. So, we all normally produce testosterone, both men and women, men to a much greater extent. And the same thing with estrogen.  But what happens is that these guys take these performance-enhancing drugs, most notably steroids to get that added edge, to get faster, stronger and whatnot. And it’s when these become excessive that we start seeing these problems.

Dr. Weitz:            So, these guys are taking testosterone which is an anabolic steroid. By the way, that’s one of the differences between testosterone and estrogen is testosterone is anabolic meaning producing-muscle growth. And then they take synthetic derivatives of testosterone. And these are basically designer anabolic steroids. They’ve been around for a long time. The reports show that the Germans first produced Dianabol in World War II to make their soldiers stronger and more aggressive.  And basically, these synthetic testosterone derivatives, these anabolic steroids are designed to enhance the muscle-producing properties of steroids and decrease some of the other properties that are less desirable.

Dr. Elkin:              It’s got to do with the protein synthesis. So the more you can increase protein synthesis within the muscle cell, you’ll have bigger muscle.

Dr. Weitz:            And these drugs, some are taken orally, some probably more often are injected intramuscularly. Howard is an anti-aging doctor and both of us understand and appreciate and support the idea of hormone replacement therapy for men and women, women after menopause, men after andropause who have low levels of hormones, who are taking a physiological dosage to maintain their health and vitality. And we both believe that this can be done in a healthy manner if they were taking the right amount in the right way.  But what these bodybuilders are taking is hundreds of times higher dosages than would be used for hormone replacement.

Dr. Elkin:              Yeah. As opposed to like 100 milligrams of testosterone, they’re talking 1, 2, 3, 4 or five grams a week, I mean, out of sight.

Dr. Weitz:            Right, thousands of milligrams. Yup. And often, they’re taking growth hormone.  Sometimes to facilitate the growth hormone usage, they’re taking insulin. They’re taking diuretics. They’re taking antiestrogen drugs, thyroid stimulants like clenbuterol. So, there’s a whole plethora of drugs. But really, we want to focus on the potential negative effects of anabolic steroids.  And when we look at anabolic steroids, there’s a bunch of side effects that are annoying like acne and water retention, acceleration of male pattern baldness, testicular atrophy, not a great attribute, gynecomastia in males, that’s where the breasts actually … they grow female breasts. Some men have actually been known to squirt out milk, not a pretty sight, sexual dysfunction, voice deepening, clitoral enlargement in women, muscle and tendon tears, violent behavior, etcetera, etcetera.  But what we want to focus on are the negative aspects of anabolic steroids that impact your life which is cardiovascular disease, kidney disease and liver disease.

Dr. Elkin:              Right, those are the three main ones. And one quick segue into oral anabolics. So there’s oral and there’s intramuscular. And actually, oral is much more dangerous because anything oral has to go what we call first pass. So, it goes from the gut to the liver and that’s where the problem is because as they get to the liver, it’s toxic. So the liver has to work very hard to detoxify or make a less toxic substance or metabolite.  And in doing so, the liver takes a brunt. It takes a big brunt. And I can’t tell you how many bodybuilders I’ve seen with liver dysfunction.

Dr. Weitz:            And this is also a reason why women who are taking hormone replacement therapy should not take oral estrogen.

Dr. Elkin:              Right. We don’t use any oral estrogens in dealing with bioidentical hormones with women. So that’s really important, too.

Dr. Weitz:            So, why don’t we start with the liver since you brought that up? And one of the first things we’ll see is liver function tests like AST, ALT. They’ll start to go up.

Dr. Elkin:              Right, exactly. And there’s another one called GGTP which is very specific for the liver.  ALT is specifically for the liver as well.  SGOT could be liver and muscle. But when we start seeing those go up, and now there’s other things that will cause it to go up, drinking alcohol, of course. And a big one that we’re seeing in this day and age, of course, is this entity called nonalcoholic fatty liver disease. That’s a whole different entity.  But steroids themselves and the doses that are being used by these competitors can certainly cause liver injury especially if it’s anything oral. And I can tell you, these guys are taking oral stuff. The women definitely take oral stuff. And the men do, too, to get level because the oral stuff is more of immediate. And along with oral anabolics, you get a lot of water retention. And a lot of water retention, you get a big surge in blood pressure.  And these people go to doctors, most of them don’t. I mean, I get some that do. And the ones that do relatively, I wouldn’t say totally unscathed, but they do okay.

Dr. Weitz:            Yeah. One of the conditions that is seen in anabolic steroid use is a condition called Peliosis hepatitis which are blood-filled cysts in the liver. And this is an extremely unusual condition. And so, this is something that can be directly traced to anabolic steroids.

Dr. Elkin:              Right. And there have been some reports that can you develop liver cancer or what we call … we used to call it hepatoma. Now, we just call it a liver cancer which is not a good cancer to have. I think there have been some reports. I tried to do some research on that. I couldn’t … as a direct quote. I mean, I think any kind of toxic substance like hepatitis C can eventually lead to liver cancer.

Dr. Weitz:            People need to understand when these liver function tests are positive, it often means that there’s damage occurring to the liver. And consider that the liver and the kidneys are your two main organs that are filtering out toxins. And the more you burden those organs, the more you stress them constantly over time, stressing a tissue excessively is something that can lead to cancer.

Now, a lot of the things we’re talking about, unfortunately there are not large randomized clinical trials of double-blind placebo. So, a lot of these are coming from case reports but nobody is going to do a multimillion dollar double-blind placebo-controlled study on anabolic steroids because they’re not used legally in this country. And nobody’s going to pay for that. But there’s certainly plenty of anecdotal reports that both of us have seen about liver damage.  Let’s get into the cardiovascular damage because a lot of these men and women that we’re hearing about are dying of heart attacks and blood clots and heart failures.

Dr. Elkin:              Yeah. So the first thing that comes to my mind always is the lipids, the blood fats. Okay. So, what we characteristically see is really a low … HDL I’ll say is high density, but basically I call it healthy and LDL is lousy just for ease of remembering. But it’s a little more complicated in that. But what we characteristically see in these folks that the LDL tends to be elevated. That’s the bad cholesterol. And HDL tends to be low. And I don’t mean low, I mean real low.  I have seen women competitors that are just doing like the mild steroids but they’re oral, they’re oral. And they have single-digit HDL, it’s like under 10.

Dr. Weitz:            Wow, that’s incredible and interesting. If they weren’t doing weight training, it’s probably even lower.

Dr. Elkin:              Right, exactly.

Dr. Weitz:            And having this unfavorable lipid profile means that they’re more likely to develop atherosclerosis which is the buildup of cholesterol plaques in their arteries which can block the flow of blood to their heart. So, it’s increasing the risk of both heart attack and a stroke.

Dr. Elkin:              For example, I have a 38-year-old bodybuilder. I always like giving stories. Talented guy, he wants to go pro. But he does come to see me. And he’s putting a limit on, “If I don’t do within a year-and-a-half, I’m out.” But okay, in the last year-and-a-half, his blood pressure has gotten super … he’s put on tons of muscle, tons of weight.  So, in the last year-and-a-half, he’s become hypertensive. He’s got sleep apnea. His HDL is in the toilet. He’s now on a statin. The same thing, it’s crazy. So, he was pretty healthy before he was none of these medications. Also, he’s got to get regular phlebotomies because the hematocrit, hemoglobin are too high which we’ll get into.

Dr. Weitz:            Why don’t we talk about that? So, bodybuilders have their blood gets thicker because they’re producing so many red blood cells. So, your blood is made up of this liquid part called plasma. And then there’s also these red blood cells. And there’s a certain percentage of red blood cells you’re supposed to have in a certain liter of blood. And this hematocrit measure is something we measure through blood testing. And when that hematocrit goes up, what that means is you’ve got too many red blood cells which means your blood is thicker.  Now, cyclists who compete in the Tour de France, they encourage this and sometimes do it for a short period of time because it allows them to have more oxygen going to their muscles so they can win the race. But this is very dangerous state to be in.

Dr. Elkin:              Yeah. It’s called doping. And I got to tell you, it’s a major problem. And my folks, a lot of my folks that are on physiological replacement doses, we’re talking low doses like 100 milligrams or less, but some actually still have that tendency to produce too much red blood cells. And now keep in mind, that’s one of the pluses. I mean, we want to have some increased red blood cells because it increases our oxygen-carrying capacity. So you have muscular endurance, improving the muscular endurance.  However, the double-edged sword of that could also … it could be overly done. And even with normal physiologic doses, so I [inaudible 00:40:28] watch all my patients on testosterone and I carefully watch their hematocrits. And if they get too high, we’d have to stop it or they have to do bloodletting. So now, that’s just with regular physiologic replacement doses. Can you imagine these massive doses? And who knows …

Dr. Weitz:            When you say bloodletting, Howard, essentially what you mean is they have to go and donate blood.

Dr. Elkin:             Right, yeah. Either donate blood or you can go to a hospital in your insurance and they’ll … it’s called a therapeutic phlebotomy. You’re actually giving up blood.

Dr. Weitz:            Right. And there’s another factor which is that bodybuilders tend to get increased platelet aggregation. So not only is your blood thicker but it’s more likely to clot because the platelets are the components in the blood that lead to clotting.

Dr. Elkin:             Right. In fact, platelets are usually the final thing that led to this a heart attack. We used to think that with cardiovascular disease, coronary disease that you get a blockage that gets bigger and bigger and bigger in 30 years and eventually just get a heart attack. No, that’s what we thought when I was a fellow many years ago. Now, we know that’s all inflammation. That most of the heart attacks that take place are blockages like probably 50% at most.  But what happens, there’s a rupture. The plaque becomes unstable, it ruptures. And then platelets come to the area and they form what’s called a platelet plug, and then you have no blood flow, and they have a heart attack. So already, just when you have an aggregation … when you have platelet problems and they’re sticking together and coming together, that’s a great that … all you have to have is an unstable plaque and you got a heart attack ready to happen.

Dr. Weitz:            And you mentioned the bodybuilder that you’re seeing who has hypertension, increased blood pressure. And now, that also means that’s putting more stress on the heart because when the heart pumps the blood, if the blood pressure is up, it means that it’s harder for the heart to push the blood around the body. And so, then the heart has to work harder, the heart tends to hypertrophy.  This stresses out the kidneys. You tend to have kidney damage from this. People with kidney problems, that tends to lead to more hypertension. And you have this vicious cycle.

Dr. Elkin:              Yeah. This yin and yang thing because the kidneys respond to the heart, the heart responds to the kidneys. And it’s a big deal. As you know, there are several pro-level bodybuilders that have ended up on dialysis in the past. Even a couple of renal kidney transplants.

Dr. Weitz:            Many, many, many kidney transplants.

Dr. Elkin:              Also, in all fairness, they also take a lot of NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen and Aleve. And they’re taking big doses. And they’re taking it every day which is very renal damaging. But like Dr. Weitz has said, it’s that the hypertrophy of the heart, the heart has to work harder, the kidneys sense that. It is a vicious cycle.  And I think also with this hypertrophy thing, I’ll take it one more stage. So, with years and years of hypertrophy, the heart’s getting thicker and thicker and thicker, because the heart’s a muscle. So you’re stimulating your skeletal muscles and also your heart muscle because the heart is a muscle. But when it gets so thick, then it has a difficulty relaxing.

And there’s these two phases of the cardiac cycle. One is we call it systole which the heart contracts. And then we have one called diastole in which the heart relaxes. And actually, the energy needed to relax the heart is actually more than it is to contract, probably because it’s longer. It’s almost twice as long. So that’s what’s impaired. So the relaxation phase, the diastole, is impaired because the heart is so thick, how can it relax?  And by the way, this can lead … as we see now with older people especially in women, diastolic heart failure is seen in more than 50% of cases that hits the hospital with congestive heart failure. Now, we’re seeing it in bodybuilders which we should not be seeing it at such a young age.

Dr. Weitz:            And this could also be partially related to massive dosages of growth hormone that many of the guys take at the same time with anabolic steroids which can lead to growth of the internal organs, correct?

Dr. Elkin:              I don’t know if you … I’m sure you’ve noticed and we all have noticed. I mean, I don’t go to bodybuilding shows anymore. Why? Because I don’t like the looks. I mean, these big bellies. I mean, you see these big bellies, yet they are ripped because they’ve used so much growth hormone and insulin together that the kidneys get bigger, the intestines get bigger, all the internal organs get bigger, the heart gets bigger. This is like not a good thing.  And guess what. This will never go away. Once you’ve enlarged your organs, that’s how it’s going to be.

Dr. Weitz:            The only thing that doesn’t get bigger is the brain.

Dr. Elkin:              Right, unfortunately.

Dr. Weitz:            Yeah. So, let’s just touch on one more topic which we’ve already talked about which is how anabolic steroids negatively affect the kidneys.

Dr. Elkin:              Okay. Well, I think we’ve mentioned one, the interplay between the heart.

Dr. Weitz:            Well, we could start with the fact that the oral steroids go through the liver, but the injectable steroids make their way into the kidneys.

Dr. Elkin:              Right. And I think it’s a dose-related thing. I’ve never seen a problem with many people on physiologic replacement doses, never. I’ve never seen a kidney problem ever or liver problem because we’re using injectables and we’re using low doses. But well, it could be … some of these are more kidney toxic and others. There’s one called trenbolone. I don’t even know … it’s a synthetic form of testosterone. I don’t really know much about it.  But I can tell you that if you take that for more than six or eight weeks, you are definitely putting your kidneys at risk. It’s directly kidney toxic. And I think probably could be with any of these antibiotics that are overdone. There’s a direct toxic effect on the kidney. And here’s you got to remember, the liver has some ability to regenerate which is … unless you …

Dr. Weitz:            A remarkable ability to regenerate, yeah.

Dr. Elkin:              Kidneys do not regenerate. Once your kidneys damaged, it staged. It does not get better.

Dr. Weitz:            And there’s a particular condition that’s been related directly to anabolic steroids. There’s a condition called focal segmental glomerulosclerosis which is a development of scar tissue in the filtering structures of the kidneys. And I’m not saying that anabolic steroids are the only thing that causes, but it’s been directly linked with the use of anabolic steroids.

Dr. Elkin:              Yeah. I didn’t know that until I read it from you. So, the glomerulus is the part of the kidney … well, there’s millions and millions, but that’s where it all begins. So, that’s where the blood has to filter through this big cap. I call it the big cap of capillaries in order to enter the kidney itself, the nephron to go through the filtering process.  So, if you have less and less glomeruli because of this necrosis we’re just talking about or sclerosis is that then you already having diminished renal function. So yeah, that’s a new one. I mean, I didn’t hear there’s direct effect but the kidneys, yeah. And then if you add the drugs that they use to help with all their pain, like I said, all these nonsteroidal anti-inflammatories, it’s adding insult to injury.  And I mean, some of these bodybuilders I’ve heard, the doses are … it [inaudible 00:48:06] you if you know how much they were taking. And then you add diuretics which dehydrates them which makes the kidneys even worse.

Dr. Weitz:            And then guys, getting ready for shows not only do diuretics, they don’t drink water for sometimes days on end. And that’s stressing your kidneys out, too.

Dr. Elkin:              I have to give you a funny story. Well, it wasn’t funny. But my first matches.

Dr. Weitz:            Bodybuilding contests.

Dr. Elkin:              Matches which is in 2001. And so, I’m on stage. And this guy just passes out. Now, there’s like six of us. I don’t know how many were. So of course, I’m the only doctor so I have to do something. So I had to maintain my form as I went down there. And back then, they didn’t have paramedics there. We called for them and then they came and then looked at the EKG, it was normal. It was dehydration and he uses like because I see this, he uses diuretics.  The same thing happened at my last show which I think was 2012 or ’13. And guy passed out. I said, “What is this? So I had to break … this time, we had paramedics but still they knew … they’re like, “Can you read his EKG?” He was okay.

Dr. Weitz:            That’s great.

Dr. Elkin:              My firsthand bodybuilders collapsing. Thank God it was … didn’t have a heart attack but they could have.

Dr. Weitz:            Yeah. I wonder if there’s more use of diuretics now because when I competed, it was back in the ’80s, in 1985. I won the Mr. LA. I won the Hawaii-Western Open. And I eventually won the Natural Mr. International. But I don’t remember a lot of guys collapsing, but maybe they weren’t using as many drugs or some of the drugs that they’re using now.

Dr. Elkin:              It’s the combination of so many different substances. It’s just excessive.

Dr. Weitz:            Okay. Howard, I think we’ve done a great job with this topic. I think we’ve given people a lot of really useful information. Perhaps, you can tell our listeners and viewers how they can get ahold of you and also let them know about your YouTube Live.

Dr. Elkin:              Okay. So, my website is heartwise.com H-E-A-R-T-W-I-S-E dot com. And then I’m on Instagram under dochelkin, D-O-C-H-E-L-K-I-N. And then on Facebook, it’s Heart Wise Fitness and Longevity Center. I do a YouTube every two weeks. And my next one will be next week. And we’re going to be probably talking about bodybuilding.

Dr. Weitz:            And what time and date is it and how they can get to your YouTube page?

Dr. Elkin:              Okay. So basically, it’s The Medical Advocate Howard Elkin MD, The Medical Advocate, Howard Elkin MD. Well, just have that at the search button. If you subscribe which I suggest that you do, you’ll be getting an alert so you’ll know exactly when I’m going to do it. It’s generally every two weeks. It would have been this week but it’s Thanksgiving. So we’re making it next week. But generally it’s every two weeks, 7:00 p.m, Pacific Standard Time.  And it’s fun. I pick a topic. I talk about 12 minutes and the rest is chat time. So people can ask questions in the chat box. It’s a lot of fun.

Dr. Weitz:            And I’m Dr. Ben Weitz. You can get ahold of me at my chiropractic office in Santa Monica by calling 310-395-3111. And we can see you for chiropractic. We can see you for functional nutrition consultations. If you go to my website www.drweitz.com, you can find links to my podcast and blog posts and more information about my practice.  This is part of my Rational Wellness Podcast which is available on Apple podcasts, Spotify, also my YouTube page Weitz Chiro. And if you enjoy this podcast, please go to Apple podcasts and give me a five-star ratings and review. And look forward to seeing everybody next week.

Dr. Elkin:              You’re a very prolific guy.

Dr. Weitz:            Thank you, Howard.

Dr. Elkin:              All right guys, thank you so much, Ben. We’ll see you soon. Take care.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple podcast and give us a five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts.  And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So, if you’re interested, please call my office 310-395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.


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