The Death Study

The Vital Whole Human
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How Bodybuilders Die
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by Chris Shugart

This new study of over 20,000 competitive bodybuilders is eye-opening. Check it out.

Don't be fat, lift weights. Follow that simple advice and live a healthier, happier, better-looking life. But things get weird when competition is involved. Building muscle and being lean is healthy. Building as much muscle as possible and getting as shredded as possible, by any means necessary, sometimes leads to an untimely death.

We've all noticed this trend, and so has Dr. Marco Vecchiato. He decided to get to the bottom of it, and he published his findings in the European Heart Journal. Let's break it down.

The Study

Dr. Vecchiato's study investigated mortality risks among 20,286 male bodybuilders who competed in IFBB events between 2005 and 2020. He cataloged 121 deaths, with most occurring around age 45.

  • Causes of Death: Sudden cardiac death (SCD) accounted for 38% of deaths, with pro bodybuilders showing a risk over five times higher than amateurs. Other causes included kidney-related issues, multi-organ failure, and non-traumatic sudden death.
  • Cardiac Issues: Autopsies, available for 10% of cases, revealed severe left ventricular hypertrophy, cardiomegaly, myocardial fibrosis, and necrosis. Coronary artery disease was also prevalent.
  • Risk Factors: The study highlights practices like rapid weight loss, severe dietary restrictions, dehydration, and (of course) performance-enhancing substance use as contributors to cardiovascular strain, irregular heart rhythms, and structural heart changes.

Dr. Vecchiato called for "...a different cultural approach that firmly rejects the use of performance-enhancing substances" and "stronger anti-doping measures" in competitions. (Good luck with that!)

He also addressed the number of sudden traumatic deaths (15%), which includes car crashes, suicides, murders, and overdoses. He said, "These findings underline the need to address the psychological impact of bodybuilding culture. These mental health challenges sometimes worsen with substance abuse and can elevate the risk of impulsive or self-destructive behaviors."

Heart
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The Heart of the Matter

Heart disease – including coronary artery disease, heart failure, and sudden cardiac death – is the number one killer in America, whether you're a drug-using competitive bodybuilder or not. Besides the obvious stuff (don't be fat and exercise), here are a few things we can do to avoid becoming a statistic:

  1. Take Fish Oil – Heart disease is a disease of inflammation, and omega-3s tamp that down. Fish oil also fights against left ventricular remodeling, thins the blood to a healthy level, reduces triglycerides, helps prevent arrhythmias, slows plaque buildup, and lowers blood pressure. Take it daily using a high-dose, self-emulsifying formula. That's 3 softgels of Flameout DHA-Rich Fish Oil (Buy at Amazon).

Biotest Flameout

  1. Get Your Magnesium Levels Up – Higher magnesium levels result in improved glucose and insulin metabolism, which leads to reduced glycation levels, a process affecting the pliability of blood vessels, crucial to cardiovascular health. Magnesium also improves lipid profiles and acts as an antihypertensive and anti-inflammatory agent. Take 400 mg nightly using a chelated formula for guaranteed absorption. Elitepro Mineral Support (Buy at Amazon) contains this amount.

ElitePro Minerals

  1. Consider Using Nattokinase – Atherosclerosis is the primary cause of heart disease and stroke. The blood vessels clog up with organic and inorganic deposits. Nattokinase acts as a clot preventor and dissolver. Take 200 mg or 4000 FU daily. This is a good one (Buy at Amazon).
  2. Take Niacin – Niacin (vitamin B3) increases the production of nitric oxide synthase, which relaxes blood vessels and causes them to dilate, allowing increased blood flow. It also appears to be one of the few things that can combat lipoprotein(a), a lipoprotein that seems to triple the risks of having a heart attack. As extra insurance for your heart, take an immediate or extended-release form of niacin daily, about 1000 mg in divided doses. Here are two good ones:
  3. Consider K2 and CoQ10 – Calcium can accumulate on the insides of the arteries and around heart valves. Vitamin K2 helps prevent that. Take 600 mcg daily. This is a good brand (Buy at Amazon). CoQ10 regulates NO production, basically "blowing open" blood vessels, enabling more oxygen-rich blood to flow. It fortifies cardiac muscle cells and reduces inflammation and oxidative stress in the cardiovascular system. CoQ10 is fat-soluble, so take 100 mg with the fattiest meal of the day for maximum absorption. This is a good one (Buy at Amazon).

Reference

  1. Marco Vecchiato, et al. Mortality in male bodybuilding athletes. European Heart Journal, 2025; DOI: 10.1093/eurheartj/ehaf285

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The heart disease can be an interesting “chicken and egg” sorta thing (which, hey, along with that, chicken tends to be a source of Omega 6s, which are inflammatory and bodybuilders eat SO much of that stuff, whereas whole eggs are rich in Vitamin K2, but bodybuilders tend to just eat the whites…but I digress), in that, often, it’s kidney disease that results in the high blood pressure, which causes a negative feedback loop resulting in the ventricular hypertrophy as the heart gets BIGGER from having to work HARDER to pump blood.

We saw a rash of this happening in the strongman community. Guys were junking up their kidneys abusing Motrin and the like to reduce inflammation from training (Nick Best recently had a kidney removed due to years of excessive Motrin use), causing blood pressure to rise, and then the rising blood pressure was putting extra pressure on the glomeruli in the kidney, creating that negative feedback loop, and when you’re 400lbs your heart is already working pretty damn hard.

I have to wonder if abuse of diuretic is a big culprit here, as the rate of bodybuilders dropping dead seemed to increase upon the introduction of this and insulin. We didn’t see this trend from dudes in the 60s and 70s.

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IMO, the trend strongly suggests diuretics is a major contributor to the higher death rate. I believe a good starting point is testing everyone who places in a IFBB show for diuretics. They could start with a high threshold to test positive. That is to say, a little diuretics is allowed, but keeping them at a safer level.

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The study did mentioned “…aesthetically motivated weight loss and dehydration, frequently via diuretic drug intake…” and cited some studies on diuretic abuse, but the author didn’t spend much time on it. Definitely a factor.

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I know this isn’t the ideal thread to ask this, but I would like to get a little more into the weeds about vitamin K2.

Vitamin K2 can be divided into MK-4 (Menaquinone-4) to MK-13 (Menaquinone-13) depending on the length of the isoprenoid (side chain). Vitamin K2 that exists in the body and has a commercialized structure containing MK4 and MK7. MK4 is contained in butter and cheese, whereas Vitamin K2 MK7 can be found in foods fermented with soybeans, such as natto and cheonggukjang.

Vitamin K2 can be purchased in either MK4 or MK7 form, or both of them, or who knows what forms as they are not noted on the bottle.

What is the optimal amount of each if we want to take K2 as a daily supplement?

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I trust Life Extension to be on top of it, so I use the one recommended in the article. It’s a big dose though, so I take it every other day. Here’s the label:

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MK4 has a very short half-life.

MK7 has a half-life of about 3 days, so its bioavailability is much higher than MK4.

Life Extension’s version has only 100mcg of MK7, which is fairly typical with other brands.

I don’t know if taking MK4 is of much benefit, though it is a larger dose.

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What about powerlifters???

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We don’t see the same death rate. But there also isn’t a professional powerlifting organization like there is with bodybuilding, so its a bit harder to stratify. The barrier to entry is so much lower for powerlifting, with much larger numbers and more varied demographics of competitors.

But they also use fewer drugs.

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I’ll vouch for the fact that they can definitely get you into very dangerous territory. Even when taking them as prescribed.