A few months ago, I answered my phone and heard, “Russ, this is Dorian Yates, not sure if you know who I am.”

Yes, six-time Mr. Olympia Dorian Yates.  

“Hello, Dorian, yes, I know who you are.  How’s it going?”

“I just saw your video on what’s killing bodybuilders on YouTube.  I also saw your video on endothelial dysfunction.  I’ve had two DVTs—seems my physicians can’t figure out how this happened.”

Deep vein thrombosis (DVT) is when a clot forms in the lower leg, then breaks free and travels to the heart or lungs—a life-threatening condition.  I’ve seen hundreds of men and women with DVT, but recently I started getting calls from athletes like Dorian.  DVT is common in people over 50.  The risk factors are obesity, sitting for long periods of time, injury or surgery, smoking, cancer, IBS and using birth control pills.

“Yes,” I replied.  “I’ve researched the outliers—endurance athletes and bodybuilders that have had deep vein thrombosis.  My first case was in 1999.  A Boston Marathon participant was flying back to Orlando when it happened.  I’ve investigated quite of few of these situations.”

“This has come out if the blue and I’m really concerned.”

“Not many cardiologists know this, and the bodybuilding community will go crazy when they hear it, but estrogen blockers—which they all take—damage the endothelial lining.  It’s critical for these athletes to protect themselves and understand that the estrogen/testosterone ratio, when out if balance, may lead to DVT.”

For years, research has told us the gas nitric oxide releases from the endothelial lining to keep the arteries dilated.  Nitric oxide is extremely important.  The estrogen/testosterone ratio determines the amount of nitric oxide.  Too much or too little can lead to problems.  The test for asymmetric dimethylarginine indicates your nitric oxide levels and risk of cardiovascular disease (CVD).

A Champion’s Dilemma with DVT

As Dorian proceeded with his story, my thoughts would take different turns.  He was worried that he would go to bed, throw a blood clot in his sleep and die.  I understood his concern and reassured him that while on blood thinners, he was stable.

My brain in flow is like a slide projector, flashing and dropping screens.  Soon my brain went from a slow slide presentation, one picture at a time, to a full movie clip of rapid-fire questions.  What’s his hemoglobin and hematocrit?  Is his ferritin elevated?  What’s causing the platelets to clot in the lower leg?  Was it recent trauma or dehydration?  What’s his diet—the carb, fat and protein ratio?  How many hours does he work out a day past anabolism (muscle building)?  

I rubbed my forehead, thinking about clots in athletes, overtraining, elevating cortisol, slow recovery, increased platelet count, clotting factor kicked into overdrive, laying down clots in the lower legs… What else?  What are we missing? 

All those years of bodybuilding, six-time champion, the best in the world.  Why didn’t Dorian have blood clots when using anabolics and training like a god?  I asked Dorian if he was tested for the genetic mutation called Factor V Leiden which caused blood clots; he said he was, and it was negative.  Dorian was well-versed in the science, but his physicians in the UK and Spain were a little lost; all his lab tests were normal. 

Elite Athletes Are Complex Cases

Racing as a triathlete in the early 80s I would see all kinds of heart problems that baffled the best cardiologists—why?  No cardiologist was trained to care for these super endurance athletes; it was that simple.  Athletes had to ask for their own blood work to prove there were problems.  Cardiologists saw twenty-five people a day but none of those people were athletes and the sport of triathlon racing was only a few years old.  Conventional medicine was just not ready for these ultra-fit outliers.

My focus in the 90s changed from endurance athletes to bodybuilders because I wanted to prevent sarcopenia in the elderly.  Sarcopenia is muscle wasting.  The more muscle you have, the longer you live and the better your immune surveillance works, but too much muscle accelerates the aging process and damages multiple metabolic systems from the brain to the gut. 

There were not many studies at the time for bodybuilders.  I studied the number of anabolics they used, what cycles worked best and how many had strokes or heart attacks.  It’s a mindbender when you realize that endurance athletes and bodybuilders are actually unhealthy.  Trust me, I was one of these people; the harder and faster I pushed my body, the fitter I thought I was.  That kind of thinking is just dangerous; I had a heart arrhythmia called atrial fib on and off for two years.

With my background as a long-distance endurance athlete for 20 years, I’ve consulted on hundreds of DVTs.  The major cause is running a marathon (26.2 miles) then flying home the next day.  The combination of lower leg trauma, 30,000 feet of elevation, dehydration and then sitting for long periods of time causes the blood to pool in the lower legs.  Venous return is slowed way down and a clot forms.  Therefore, I tell all the athletes to hydrate till your urine is clear, get your electrolytes and wear compression socks up to your knees.  When flying, get up from sitting and walk to the jet’s bathroom every twenty minutes of flight time.  The same happens to scuba divers as well, but Dorian was not a runner or scuba diver so down the rabbit hole I went.

Metabolic Detectives for DVT

Many times, I’m dropped into the second act of a three-act play.  I needed to understand what Dorian was doing six months up to the formation of the DVT.  Our conversations were intense and mind expanding.  Dorian is well-versed in the human metabolism—much more than any physician.  Dorian and I kept our conversations short, but we were always thinking, researching and brainstorming.  I told him I didn’t have all the answers, but we could drill down together.  I also asked Dorian to share this research with his physicians to get them on the same page.

Together, we kept building our knowledge as well as areas to test and consider.  This is the reason I’m so into education.  Once people understand the basics of their metabolism, they can build on the knowledge every year and soon not a physician on the planet will argue with them.  The new citizen science movement is here to stay.

I advised Dorian we need to look at two other areas: polycythemia and erythrocytosis; both these conditions can cause clots by increasing red blood cells.  Physical, mental and emotional stress can also increase red blood cells and thicken the blood; this is normal.  There’s a natural human evolutionary adaptation to the fight or flight response, which will elevate the red blood cells and thicken the blood if we suffer an injury or laceration.  This prevents us from bleeding to death. 

Endurance athletes train at high altitudes to increase red blood cells.  More red blood cells mean more oxygen to the muscles and less lactic acid, which yields a better performance.  This is a beneficial form of erythrocytosis.  This also happens with testosterone replacement.  One of the beneficial effects of testosterone—forget muscle and libido—is more oxygenation of multiple organs, which improves function, and arterial protection.

The one area that bubbled to the surface during our research was how antidepressants cause the blood to thicken.  Antidepressant use is associated with an increased risk of venous thromboembolism (VTE), a life-threatening condition in which blood clots form in the veins of the legs or the lungs.  We have 28,000 psychiatrists in the US writing prescriptions to 47 million people.  The military thinks antidepressants are the best tools to treat vets.  Because I’ve also worked with alcohol and opiate addicts, I can tell you it’s much harder to ween patients from antidepressants and it can take 12 to 24 months.  Dr. Peter Breggin wrote many best sellers on the topic of antidepressant withdrawal.  All this must be investigated—another rabbit hole.

On the Path to More Answers

During one of our conversations, Dorian said he was in lockdown for a few months and did no exercise.  He just took it easy.  Then, on the day the lockdown was over, he went on a 20-mile easy bike ride and had blood clots the next day.  Could this have been ground zero?  We know Covid-19 can thicken the blood because it increases pro-inflammatory cytokines; maybe this is what happened.  Or another simple explanation—as we age past 50, our blood thickens.

Dorian was in lockdown, not as mobile as he should, sitting and standing for long periods of time.  This can cause clotting and DVT.  Dorian stayed on his testosterone which naturally elevated red blood cells. The 20-mile bike ride may have caused just enough lower leg trauma to start the clotting cascade.  Add to that a little dehydration and BANG! a clot forms.  Dorian thought that made sense.

In about a month of going back and forth, reviewing medications and blood tests (and adding tests his physician didn’t consider), Dorian and I compiled a wealth of research for his condition and unique biochemistry, which he sent to his doctors.  They adjusted his medications to mimic his natural metabolism more closely.  Dorian also asked to get off certain medications, which could contribute to blood clots.  Like trying to find a serial killer, this process is slow and takes time.

I am very proud of our work.  Now Dorian is sharing my videos and his podcast with all his followers so we can save a few more lives together.