Sudden Death in Bodybuilders and Endurance Athletes

I was in the ICU at Florida Hospital.  My good friend, a super-fit triathlete, almost died from a heart attack.  I was stunned.  “This can’t be!” I thought.  The next day, I scheduled an MRI for my heart.  For three days, I was scared shitless waiting on the results, just knowing I did the same damage to my heart. 

I raced triathlons and trained for twenty years thinking this would ensure I lived past the age of 100!  Instead, I was causing damage to my brain and heart and never had a clue.  When my close friends in the endurance and bodybuilder community died young, I never believed the initial report.  I knew in my gut there was more to it.  After that day in the ICU, my views about exercise and lifespan changed forever. 

The latest research on lifespan will cause a tectonic shift in the bodybuilding and endurance communities.  Witnessing the premature deaths of many amazing athletes is what prompted me to begin researching this phenomenon for 30 years—the stories are a metabolic map for people to think about.  These are my observations.  If they save one person, then mission accomplished.

Why I Began Researching the Health of Bodybuilders and Endurance Athletes

In the 1980s, I was a paramedic and raced triathlons across the US.  My keen interest in performance and heart function led me down the rabbit hole of personalized performance enhancement.

It’s in our DNA to form communities with like-minded people.  You don’t have to be a Ph.D. in psychoneuroimmunology to understand our tribes can have a positive or negative affect on our lifespan, transferring learning to behavior.  

My first tribe was that of police, fire and EMS personnel—not exactly a healthy group of people.  The combination of shift work, interrupted sleep, poor diet and alcohol and drug abuse was a recipe for early death.  None of us who witnessed high-velocity trauma ever thought we would make it to age 40, so “live fast, die young and leave a good-looking corpse” was our credo.

I moved away from the emergency services tribe to what I thought was a healthy group of triathletes.  Years of high heart rate training weakens the cardiovascular system.  This happens from years of racing and training in a nutritionally and hormonally deficient state.  Elevating the stress hormone, cortisol, is the first metabolic domino to fall.

Over time, the long hours of training and racing, high-carbohydrate diet, low hormonal levels and elevated cortisol left me weak, sick, depressed and chronically fatigued.  I had arrhythmias called atrial fibrillation.  This is when the top chambers of the heart beat over 200 times per minute.  Actually, the heart is not really beating, but quivering, so the blood cannot be ejected down to the ventricles.  This static blood can clot and cause a stroke or massive heart attack.

Out of necessity, I had to put on muscle to regain my health and quality of life.  From my bodybuilder tribe, I learned to heal myself and avoid the outliers who were dying from using high-dose anabolic steroids.  Of course, there are extremes in any tribe and I navigated in the middle.

The lab work I needed was not offered in conventional medicine, so I packed my bags and flew to research laboratories for my due diligence.  I will never forget what I learned about how brilliant the human metabolism is—it has served me for a lifetime.

The Truth About the Effects of Bodybuilding and Endurance Sports

Remember the physiques of the bodybuilders of the 1960s?  While well-muscled, most bodybuilders were using testosterone and diet only.  Fast forward to the bodybuilders of the 1990s—insulin, growth hormone and IGF-1 were used to drive more amino acids, fats and carbohydrates into the cells allowing bodybuilders to stack 30, 40, 50 pounds of muscle—and this they considered the epitome of health.  In that tribe, “bigger is better” and millions of followers of popular bodybuilders think the same way. 

The data I gathered on what kills endurance athletes and bodybuilders is similar.  There is a groupthink going on at many levels, i.e., if you can run a marathon (26.2 miles) you’ll never get heart disease, if you have 20+ pounds of excess ripped muscle on your frame, you are extremely healthy.  It’s an illusion; both can kill you fast.  What these athletes don’t understand is they are accelerating the aging process.  That’s right, they are speeding the aging process by downing 5,000 to 6,000 calories a day with three meals and three snacks, elevated blood glucose, elevated insulin and oxidative stress.  

When the mitochondria in our cells convert food into energy, this process creates free radicals. Free radical production is a natural process, but an overabundance causes inflammation and oxidative stress, which damages the body’s tissues and causes a number of diseases over time.  The effects of oxidative stress can be seen when you cut an apple in half and spray one half of the apple with lemon juice; only the untreated side gets brown. 

This example shows the antioxidant protection in lemon juice and illustrates why antioxidants are extremely important to the human metabolism.  This browning (oxidation) is what’s happening to your brain and heart every time your body converts food to energy at the cellular level.  Eating well (lots of veggies) ensures you have enough antioxidants to prevent free radical damage.  You can see how intermittent fasting suppresses free radical production as well.

The metabolisms of bodybuilders and endurance athletes were always in a pro-inflammatory state from high mileage running and biking and taking very little time to recover.  If you don’t rest, your body stays in an inflammatory state. 

Causes of Heart Disease in Bodybuilders and Endurance Athletes

Marathon runners and triathletes died from coronary artery disease as well as soft plaque rupture.  Many I’ve worked with had stents and bypass surgery.  Imagine the walls of your arteries are like the walls of your house.  Improper hormone balance, oxidative stress, low thyroid hormone, and elevated cortisol all create inflammation and make gouges in the endothelial lining of your arteries, which is like the “paint” on your walls.   The blood flying through the aorta to oxygenate the coronary arteries causes something called sheer stress, which can also nick the lining and also cause soft plaque ruptures, meaning a piece of the plaque dislodges and creates a blockage.  This is why your artery walls need to be strong.

One cyclist I know had a heart transplant; it’s mind blowing to think about having another person’s heart beating in your chest.  Some research shows you can pick up personality traits of the heart donor, but that’s a subject for another article!

While working inside an imaging center for a few years, we tested the ejection fraction of a few bodybuilders on anabolic steroids.  The ejection fraction is the measure of the percentage of blood leaving the left ventricle of the heart each time it contracts.  The force of each contraction is equal to lifting 70 pounds off the ground one foot.  The left ventricle is the work horse of the heart.  

The bodybuilders we tested had an extremely low ejection fraction due to dilated cardiomyopathy.  The heart is a muscle and taking large doses of anabolic steroids caused their hearts to become so enlarged, their beating capacity was reduced to that of an eighty-year-old.

Bodybuilders, Testosterone & IGF-1

Some bodybuilders who have imbalances in their testosterone to estrogen ratio use high-dose testosterone while taking a drug that blocks estrogen.  This is extremely dangerous and leads to the death of many bodybuilders.  Why?  Both testosterone and estrogen protect the heart.  The correct balance of these hormones allows the walls of the arteries to release nitric oxide, which keeps the arteries dilated (open). 

Some bodybuilders use human growth hormone to increase their IGF-1 (insulin like growth factor) levels.  The normal male range is usually 100 to 300 on a lab report.  If a bodybuilder had baseline labs with an IGF-1 level of 87, he would start injecting human growth hormone and raise it to between 300 and 500 in order to stack muscle.  That’s where it gets dangerous.  Elevated IGF-1 can cause cell proliferation; where there is new muscle growth, there also a chance of metastatic cancer developing.  But because bodybuilders focus on muscle, they fall into the false belief that they are healthy.

Blocking estrogen, adding excess calories, eating six times a day followed by spikes in blood glucose and insulin and escalating IGF-1—this all can lead not only to heart disease but to cancer as well.  New research also shows that cancer spreads in a high glucose environment.  Google bodybuilders that have died in the last 10 years.  It paints a picture of how dangerous the sport has become.

If bodybuilders understand the multiple metabolic pathways involved in building muscle, they can be much safer and avoid death from using high-dose anabolic steroids.  They can lower the dose or find a safe replacement.  If endurance athletes knew that fast race times do not correlate to an extended lifespan, they would be healthier.  Instead, to this day, both groups cause an extreme amount of free radical damage to their bodies, destroying multiple metabolic pathways.  This can go on for years before a critical heart attack or stroke occurs. 

Extending What I Learned While Working with Bodybuilders and Endurance Athletes

Finding the balance of nutritional and hormonal support that works and is safe can take years of education and discovery.  You can’t just go to a physician for help.  They are not trained in interventional endocrinology.  Nutrition, the microbiome and mitochondrial function are topics of a new world order in medicine. It’s not as if this information has not been available.  In 1996, I traveled to the Great Smokies Diagnostics lab to research stool testing and microbiome health.  I learned volumes of information not considered by most modern medicine practitioners.

Our research translated into insights for everyone’s health, not just that of extreme athletes. 

For example, the intestinal tract is critical for bodybuilders and endurance athletes to maintain muscle mass.  Likewise, people with IBS or Crohn’s disease have low growth hormone and low IGF-1 levels.  If the intestinal tract is out of balance, it’s difficult to pull nutrients from food.  When that happens, the metabolism mines these nutrients from muscle, bone, brain and heart tissue.  You are not what you eat, but what you absorb.  Intravenous nutrients can be used to help many conditions, especially if the intestinal tract is compromised.

On the Russ Scala YouTube channel, we focused a video on the research done by Scott Kelly, the first astronaut to spend a year in the space station.  His book, called Endurance, speaks to the bodily damage and muscle wasting (sarcopenia) he encountered.  Even NASA wasn’t sure how to maintain muscle mass.  I’ve always been interested in developing a program for NASA and Space X for the trip to Mars.  Because muscle is a reservoir of vitamins, minerals and amino acids, it is essential to maintaining a healthy metabolism and immune system.  You must look at advanced metabolic pathways to recover from sarcopenia—or any disease, for that matter.  We’re also using our research for people over 60 who lose muscle daily, because lifespan is tied directly to the amount of muscle mass retained. 

When you have a stent installed or bypass surgery, you’re not in the clear; the arteries can become blocked again, which is called restenosis.  Through my interest in heart health for athletes, I developed a protocol focused on the production of nitric oxide, a gas released from the endothelial lining (artery wall).  Nitric oxide keeps the arteries dilated so more oxygenated red blood cells can get to the organs.  The right balance of omega 3 fatty acids keeps the arteries flexible and antioxidants protect the endothelial lining from inflammation.  Today we’re using this protocol on people with high coronary calcium scores.

As a paramedic, I saved many lives—the hard way—during emergency situations.  Today, I try to prevent life-threatening emergencies by open-sourcing this research on the Russ Scala YouTube channel at no cost. 

Check it out.  Be safe, folks.

Image copyright: https://www.123rf.com/profile_mikedesign