It's really weird, but I haven't had all that much experience with death in my personal life. Sure, my parents died after relatively long lives, one close friend died of cancer, and two acquaintances committed suicide, but beyond that, I really haven't had to contend with it all that much... yet.
However, when it comes to my professional life, it's an altogether different matter. I know dozens of bodybuilders and assorted fitness people who've died early deaths from heart attacks. These are people I'd worked with, interviewed, or at least had conversations with.
There are so many of them that death could use them to put together a pretty formidable football team, complete with separate 11-man squads for offense and defense, along with a solid bench of second-stringers.
Sorry if that came off as flippant; I only wanted to convey that a disproportionate number of bodybuilders have died in the last 30 years, at least disproportionate to almost any equal, similarly-aged, random sampling of non-lifters in that same time period.
Their deaths are always unsettling to me, to say the least, but what's almost as unsettling is that more often than not, I looked at them at some time in the past and gotten a sense that they weren't long for this earth.
Maybe it was the ruddiness of their skin, their labored breathing, or the look that they were just going to pop – the victims of excess size, excess eating, excess drugs, excess everything – that made me sense that their hold on life was tenuous.
Why, if I could see it, couldn't they? Or their friends or families?
I'll leave those questions, along with any remembrances and tributes, to some other writer. Instead, what I want to discuss, what I want to analyze, is why most of them died so young. Was it, as most are quick to offer, steroids, or was it something else?
I have a theory. In fact, I have a couple of them. For starters, I suspect we can't blame their premature deaths entirely on the actual steroids. Rather, it was largely the result of their stupendous body mass that was largely facilitated through the use of these drugs.
That may not sound like much of a distinction, but let me explain.
A House Too Big
Let me draw an analogy. Let's say you live in a 1,500 square foot, one-story house with a furnace that kicks out about 50,000 BTUs – plenty to heat the place, even during the coldest nights. But then you start building onto the house, adding a family room one year and maybe a nursery the next.
You've still got the same furnace, though, only it has to force heat through a lot more cubic feet and through a lot more ducts that are perhaps too narrow for the new size of the house. Suddenly, it's not as efficient as it once was. Then you get the wild idea to add on a rental apartment, still using the same furnace.
After a while, your nice, cozy 1,500 square foot house is now closer to 4,000 square feet with skinny ductwork. It's not only inefficient, but it puts a constant strain on the furnace. Then one day, Rufus, your tenant, cranks the heat up to 90 degrees and the furnace finally blows, its capacities overextended.
I'm sure you can see what I'm getting at. I once read that it takes 10 times as many blood vessels to vascularize a pound of muscle as a pound of fat. If that's true, then an obese truck driver with a body fat percentage around 35% probably has a better chance of living a long life than a bodybuilder who's gradually added on around three to five times the muscle mass of an ordinary human.
Even if that number 10 regarding vascularization isn't entirely accurate, the basic fact is true – muscle has a lot more capillaries in it than an equivalent amount of fat, and someone who's carrying around 100 pounds more muscle mass than he did before he started lifting is putting a tremendous amount of strain on his heart.
Having the heart work that hard to oxygenate the body is, if you'll tolerate another analogy, like a single horse pulling an 8-horse carriage.
Yes, having that much mass is a problem in itself, but we can't deny that steroids themselves, in the ridiculous amounts used by most competitive bodybuilders, can also directly hurt the cardiovascular system in a number of other, insidious ways.
Generally speaking, exercise causes blood vessels to release nitric oxide (NO), and that's a good thing. NO is a chemical that relaxes arteries, and it plays a crucial role in regulating blood pressure and overall circulation.
However, when something interferes with the production of NO, a cascade of bad things start to happen. The blood vessels lose their elasticity and end up being physiologically close to a cheap garden hose that's been left out in the sun too long. This increases the resistance against which the ticker struggles to pump blood.
All this resistance causes the walls of the heart to start to thicken, leaving insufficient space inside the chambers of the heart to handle the blood. It all adds up to decreased efficiency, and without intervention, it can lead to heart failure.
(As if all this wasn't enough, this high blood pressure can also thicken and narrow the blood vessels that serve the kidneys, which causes waste to build up in the blood, along with the possibility of eventual kidney failure.)
So yeah, you guessed it. Anabolic steroids interfere with the production of NO, thereby increasing the chances of premature hardening of the arteries and all its implications. The drugs also accelerate the accumulation of arterial plaque.
And then there's the way anabolic steroids increase circulating sympathetic amine levels, which further constrict the blood vessels. Oh, and there's also the anabolic-steroid activated increase in mineralcorticoid levels, which causes fluid retention. That means blood pressure can increase even further.
I left out one thing, though, and it's the basis of my second theory on the premature deaths of steroid-abusing bodybuilders.
Can An Enlarged Prostate Kill You?
Many people, men and women alike, have heart attacks in the night or early morning, and this is certainly true of many steroid-using bodybuilders, too.
Cardiologists have long noted that humans are more susceptible to heart attacks just before waking up in the morning. It makes perfect sense. Cortisol levels are highest in the morning, and cortisol boosts blood pressure (along with blood sugar). Catecholamine levels also rise in the AM, leading to an increase in oxygen consumption while contributing to further constriction of blood vessels.
Add to that that platelets are particularly "sticky" in the morning, meaning they're more apt to stick to the sides of blood vessels where they might cause a red blood cell traffic jam, resulting in a stroke or heart attack.
And this is all stuff that occurs in healthy people. Imagine how close you might be to falling off the mortal coil if you add in risk factors like stupendous body mass, already-compromised blood vessels, hypertension, and a heart with enlarged chambers.
This all ties into my second theory. All steroid users know that the drugs increase the production of red blood cells, which can further increase the chances of red blood cells getting into one of those life-threatening "traffic jams" in the blood vessels.
This is why keeping hematocrit (the measure of red blood cells in the blood) levels below a certain threshold is imperative (less than 50%). It also makes proper hydration crucial. Without enough water, the blood is even thicker, harder to pump (regardless of the aforementioned anabolic steroid-activated increase in fluid retention from elevated mineralcorticoid levels).
Here's where we have to take into consideration a seemingly unrelated side effect of steroids – they increase the size of the prostate (BPH).
In the case of competitive bodybuilders, it's probably a safe assumption that their prostates are as formidable as their muscle mass. In practical terms, it means they have to pee more. This might not be too much of a problem, except at night. Having to get up to urinate several times a night is not conducive to a good night's sleep.
The natural response is to refrain from drinking water before they go to bed so they have a fighting chance of getting a good night's sleep. That's perfectly understandable, but as mentioned, dehydration, even minor dehydration, makes the blood thicker. Dehydration also negatively affects endothelial function. In fact, the authors of a 2016 study compared the effects of mild dehydration on endothelial function to that of smoking a cigarette.
And the level of dehydration required to do that is minor, less than 2%. To give you a frame of reference, 2% is around the threshold when people start feeling thirsty.
Add those last few facts together – the avoidance of fluids before and during the night so your sleep isn't interrupted by the need to pee, along with the endothelial dysfunction and blood thickening caused by mild dehydration – and the words, "If I die before I wake, I pray the Lord my soul to take," take on more significance than they might otherwise.
But You Just Said...
Here's where I do a slight turnabout. Additional muscle mass is, in general, a healthful thing, as of course is resistance training in general. Weight training increases the production of NO, which leads to healthier blood vessels. In fact, research shows that there's a negative relationship between muscle mass and cardiovascular disease – the more muscle you have, the less your chances are of developing heart diseases.
Furthermore, additional mass can help you weather a devastating disease. Consider the case of EAS founder and my old boss, Bill Phillips. He contracted COVID, was hospitalized, and spent a couple of months hooked up to a ventilator in an ICU, much of it in an induced coma, and he lost 70 pounds of body weight.
Had he not had that extra muscle mass, he would surely have died, because once you lose enough mass (it varies slightly from individual to individual), your body shuts down and dies, regardless of what else is going on.
All that being said, I'm talking about sane amounts of muscle mass and not the wretched excesses you see in most competitive bodybuilders. Granted, the early death of many of these steroid-abusing bodybuilders isn't a certainty. Most probably won't die in their fifties, forties, or even thirties. Heck, as dangerous as cigarette smoking is, only about 1 out of 5 of them will develop lung cancer.
Some steroid-using bodybuilders will monitor their hematocrit. Some will build up their respiratory systems along with their musculature. Some will drink plenty of fluids. And hopefully, some will know when enough is enough when it comes to adding size.
I'm not against the use of anabolic steroids. In fact, I think the use of modest amounts is either relatively harmless or, in some cases, can even improve health. I'm only against the bat-shit crazy doses used by so many competitive bodybuilders to achieve the body mass of a rhino, especially when they die as a result of those bat-shit crazy doses.
- Giannis Arnaoutis, et al. "The effect of hypohydration on endothelial function in young healthy adults," European Journal of Nutrition, 2017, 56, 1211-1217.
- Aaron L. Baggish, et al. "Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use," Circulation, 2017, May 23;135(21):1991-2002.
- S A Wemyss-Holden, "Steroid abuse in athletes; prostatic enlargement and bladder outflow obstruction – is there a relationship?" Br J Urol. 1994 Octt;74(4):476-8.
- Walter Krause Neto, et al. "Testosterone is key to increase the Muscle Capillary Density of Old and Trained Rats," J Morphol Sci 2019;36:182-189.
- Preethi Srikanthan, et al. "Relation of Muscle Mass and Fat Mass to Cardiovascular Disease," The American Journal of Cardiology, 2016;117 (8): 1355.