Buffalo
MuscleChemistry Member
When the champions stand onstage in elite bodybuilding competitions, spectators are granted a rare view of the human anatomy. Not due to the scant coverage offered by Lycra posing trunks, but as one appreciates the unobstructed presentation of musculoskeletal structures. Granted, the muscle groups are hypertrophied and symmetrical in a way that Henry Gray could never have envisioned when he was illustrating his iconic textbook, Gray's Anatomy in 1858.
[The original title was Anatomy: Descriptive and Surgical] However, it is the graphic and overt exposure of the muscle fibers and striations made possible by the near-absolute absence of subcutaneous fat and interstitial water.
Professional bodybuilders are experts at shedding body fat; dietary, training and pharmaceutical methods have been honed over the decades, resulting in skinfolds that measure just a few millimeters (or less) in thickness.Yet, even the most diligent bodybuilder can destroy weeks of sacrifice with the momentary curse of water retention.Those who have attended bodybuilding competitions have no doubt seen men stand during morning pre-judging with vascularity that looks like the Los Angeles road map, only to show up to the evening event looking as smooth and puffy as Violet Beauregarde as she was being rolled to the dejuicing room by Oompa Loompas. Conversely, some competitors walk onstage in the morning, showing little in the way of definition. But as the lights heat up and posing progresses, torrents of sweat cascade, separations deepen and striations appear— resulting in a title-worthy physique. Sadly, it comes too late— as the judges must decide based upon the presentation during mandatories and call-outs.
Depleting every last drop of water that could potentially obscure underlying muscle is one of the most challenging aspects of contest preparation. Bodybuilders also have to be wary of "flattening out" or losing vascularity due to hypovolemia (low blood volume). In fact, few competitors would argue that after years of training, weeks of dieting and hours of posing— eliminating that water is the finishing touch.
Water balance is rapidly managed by numerous and redundant regulatory systems in the body. Water is the single most essential nutrient, necessary to regulate electrolytes, blood pressure, thermoregulation and many other processes. Therefore, one has to time manipulations in water balance precisely. The window for optimum appearance does not last much beyond an hour or two. The reward for achieving the perfect state in bodybuilding is so great for competitors that many are willing to take risks well beyond the extremes of reason.
Tragically, this has contributed to the premature death of several great and aspiring bodybuilders, such as Andreas Munzer and Mohammed "Morro" Benaziza. Paul Dillett suffered an embarrassing and intractable cramping onstage during the 1994 Arnold Classic, resulting in him being carried off-stage frozen in a rear double biceps pose like Han Solo encased in carbonite. It is sad that Dillett trusted another individual, unlicensed and without formal training, to inject him with too potent of a dose of Lasix— one of the most indiscriminate and fast-acting diurectics available.Thankfully, Dillett survived and went on to have a successful career as a professional bodybuilder.[h=2]THE "DRY" LOOK[/h]Before looking at the dehydrating protocols used in physique contests (as well as wrestling, boxing, horse racing jockeys, models, etc.), it is best to see why water retention affects bodybuilders.[SUP]1[/SUP] This will be brief and superficial, but give you an idea of the multitude of issues antagonizing the goal of a "dry" look.
Bodybuilders are dependent upon muscular mass to appear dominant.Three of the hormones commonly used/misused actually promote water retention, forcing competitors to not only address the natural factors involved in water balance, but also the pharmaceutically altered excess resulting in water retention.These hormones are testosterone, growth hormone (GH) and insulin. It would be the rare professional who is not dependent upon these drugs in today's events.
Testosterone and related anabolic-androgenic steroids (AAS) are commonly dosed at multiples of replacement concentration.When any hormone is that far out of balance, adverse side effects occur. Perhaps it is nature's way of killing the host before the affected individual is able to mate and pass on those genes— our DNA does not understand drugs, and it assumes that physiologic alterations are the result of faulty programming in our genes or an adverse environment. There are two well-identified but rarely discussed factors that lead to water retention with androgenexcess: suppressed release of natriuretic peptide (NP) and increased aldosterone activity.
Natriuretic peptide is a group of diuretic hormones released from several different tissue types (e.g., heart, brain) in response to a perceived high blood pressure or excess sodium. In addition to its vasodilatory effects (lowering blood pressure by opening blood vessels), NP causes the kidneys to flush out water and sodium, and stimulates the release of stored fat from fat cells.[SUP]2,3[/SUP] Obviously, suppressing NP would lead to a greater retention of water and sodium, as well as increased blood pressure and possibly net fat storage.
Recent research has shown that increasing concentrations of free testosterone are associated with significantly lower concentrations of NP.[SUP]4[/SUP] NP does increase in association with higher estrogen or sex hormone-binding globulin (SHBG) concentrations, but most bodybuilders actually suppress estrogen via aromatase inhibitors— which results in lower SHBG. SHBG is also associated with insulin sensitivity— the higher the SHBG, generally the more insulin sensitive the individual.[SUP]5[/SUP] Not surprisingly, insulin resistance (the state of impaired insulin sensitivity) is also associated with lower NP, a fact that will resurface in the discussion on growth hormone (GH) and insulin.[SUP]6[/SUP] Thus, elevated androgens, especially nonaromatizing AAS or when used in conjunction with aromatase inhibitors, leads to suppressed NP— resulting in water and sodium retention.
Aldosterone is a steroidal hormone involved with water and sodium balance in the kidneys. Testosterone is also associated with increases in aldosterone; estrogens reduce the renin-angiotensin-aldosterone axis activity, resulting in water loss.[SUP]7[/SUP] When testosterone (or more potently non-aromatizing AAS, or in the presence of aromatase inhibitors) is elevated, there is a greater propensity to increase aldosterone activity in the kidneys, resulting in water and sodium reabsorption. The combined effect of decreased NP and increased aldosterone activity likely accounts for the elevations in blood pressure suffered by many AAS users.[SUP]8[/SUP] Many AAS also impair cortisol metabolism in the kidneys, resulting in sodium retention.[SUP]9[/SUP]
Growth hormone was once used as an anabolic drug, but now is more geared toward lipolytic (fat reducing) and repair/recovery. Early adaptors used excessively high doses of GH, resulting is marked edema (fluid retention, like the puffy pooling around your ankles after a long flight or sitting all day), carpal tunnel syndrome and severe insulin resistance. The contemporary practice is to use more physiologic doses of GH, combined with IGF-1 for the anabolic effect. Nonetheless, elevations of the GH/IGF-1 axis result in edema and insulin resistance, even in the relatively moderate ranges.[SUP]10[/SUP] It is suggested in the literature that receptors in the kidney respond to GH and/or IGF-1 (which can be produced locally), resulting in the reabsorption of sodium and phosphates.[SUP]11,12[/SUP] Recall also, that insulin resistance is associated with lower NP, further increasing water and sodium retention.[SUP]6[/SUP] Briefly, high-dose insulin use results in water retention as wel1.[SUP]13[/SUP] Insulin is a vasodilator, and can produce edema, as well as increased fat storage.[SUP]14,15[/SUP] Sadly, it seems to have become a foundation anabolic drug for many competitors.[h=2]DIURETIC DRUGS[/h]Given the strong signaling associated with these common anabolic drugs, along with the elevated cortisol due to physical and emotional stress, it is no wonder that bodybuilders need to resort to potent diuretics to shed the excess water as part of their contest preparation. Leaving aside the practices of carbohydrate depletion, sodium depletion, water restriction and other techniques, a brief discussion of the diuretic drugs is due. [Note: this does not condone or recommend any of the practices, which can be dangerous or life threatening]
Hardly any bodybuilder uses diuretics aside from the immediate pre-contest period or for photo shoots. Diuretics interfere with training, muscle growth, fat loss and mental focus when abused.[SUP]1[/SUP] This is not to say that many bodybuilders are not on anti-hypertensive drugs, which have a mild diuretic effect (e.g., ACE inhibitors). Generally, bodybuilders may begin using somewhat mild diuretics the week or so preceding an event. This aids in motivation, and skin retraction, as the physique begins to really sharpen.There are diuretics that are orally administered that are considered relatively safe. Dyazide (a combination drug with potassium-wasting and potassium-sparing diuretics) is the classic.[SUP]1[/SUP] Bodybuilders will dose Dyazide above the clinically provided directions, but generally not to a great degree. In conjunction with a short period of carbohydrate depletion, water and sodium restriction, dramatic changes can be noted. Dyazide users can still experience dehydration and serious sodium loss, requiring medical attention.[SUP]16[/SUP]
However, on the day of the show, there is one diuretic so potent that it is the unquestioned king of dehydration furosemide (known by the brand name Lasix). Lasix is the prototypical drug in a class known as loop diuretics.[SUP]1,17[/SUP]Essentially, it turns the kidneys from being an intelligently designed organ interacting with the chemical state of the blood- secreting and reabsorbing electrolytes as needed, to maintain the body in a healthy state- into a spigot flushing all the electrolytes out into the urine. Furosemide needs to be dosed carefully, as wasting too much sodium, potassiumand other electrolytes results in electrochemical malfunctions. Paul Dillett's experience serves as the seminal example of failed electrolyte balance. Proper dosing will not be discussed, to avoid the impression of supporting this practice. It is wise to supplement potassium and magnesium, in addition to having ample water and sodium available to treat cramps, much as occurs on sports fields during games in hot environments. The bodybuilder often has to suffer hours of fatigue while maintaining his physique as best possible for the evening show and overall posedown. It is not uncommon for bodybuilders to combine spironolactone with furosemide in the attempt to reduce potassium loss and prevent adverse heart rhythms.[SUP]18[/SUP]
This brief primer addresses some novel issues that have not been previously addressed regarding the anti-diuretic effect of commonly misused anabolic drugs, and briefly comments on diuretics used to flush out excess water to present the underlying musculature with sharpest detail. It did not describe the various compartments of water in the body (e.g., intracellular, extracellular, intravascular, extravascular, interstitial), all of which need to be considered in balance when forcing a negative water balance with the use of diuretic drugs.
Many people obsessed with weight loss will abuse diuretics regularly, even daily. One professional (WWF) wrestler admitted to me in the 1980s using Cytomel (T3 thyroid medication) and Lasix daily to stay cut. Emergency rooms and urgent care clinics regularly see (mostly female) patients with abnormal heart rhythms caused by electrolyte imbalances due to diuretic abuse.There are other diuretic techniques also used that have not been discussed, though these are not as universal (e.g., hyperosmotic enema, intravenous volume expanders).[SUP]19[/SUP]
Most people think of diuretics as a benign factor in bodybuilding. For competitors, it is known as one of the most vital components of pre-contest preparation, but also as the highest-risk practice. Much like insulin, diuretics can rapidly threaten great harm or death. Unless a knowledgeable physician is present with the proper interventions, tragedy can ensue. Don't let the deaths of past greats go unheeded-- RIP Andreas Munzer and Mohammed Benaziza.
By Daniel Gwartney, M.D.
Professional bodybuilders are experts at shedding body fat; dietary, training and pharmaceutical methods have been honed over the decades, resulting in skinfolds that measure just a few millimeters (or less) in thickness.Yet, even the most diligent bodybuilder can destroy weeks of sacrifice with the momentary curse of water retention.Those who have attended bodybuilding competitions have no doubt seen men stand during morning pre-judging with vascularity that looks like the Los Angeles road map, only to show up to the evening event looking as smooth and puffy as Violet Beauregarde as she was being rolled to the dejuicing room by Oompa Loompas. Conversely, some competitors walk onstage in the morning, showing little in the way of definition. But as the lights heat up and posing progresses, torrents of sweat cascade, separations deepen and striations appear— resulting in a title-worthy physique. Sadly, it comes too late— as the judges must decide based upon the presentation during mandatories and call-outs.
Depleting every last drop of water that could potentially obscure underlying muscle is one of the most challenging aspects of contest preparation. Bodybuilders also have to be wary of "flattening out" or losing vascularity due to hypovolemia (low blood volume). In fact, few competitors would argue that after years of training, weeks of dieting and hours of posing— eliminating that water is the finishing touch.
Water balance is rapidly managed by numerous and redundant regulatory systems in the body. Water is the single most essential nutrient, necessary to regulate electrolytes, blood pressure, thermoregulation and many other processes. Therefore, one has to time manipulations in water balance precisely. The window for optimum appearance does not last much beyond an hour or two. The reward for achieving the perfect state in bodybuilding is so great for competitors that many are willing to take risks well beyond the extremes of reason.
Bodybuilders are dependent upon muscular mass to appear dominant.Three of the hormones commonly used/misused actually promote water retention, forcing competitors to not only address the natural factors involved in water balance, but also the pharmaceutically altered excess resulting in water retention.These hormones are testosterone, growth hormone (GH) and insulin. It would be the rare professional who is not dependent upon these drugs in today's events.
Testosterone and related anabolic-androgenic steroids (AAS) are commonly dosed at multiples of replacement concentration.When any hormone is that far out of balance, adverse side effects occur. Perhaps it is nature's way of killing the host before the affected individual is able to mate and pass on those genes— our DNA does not understand drugs, and it assumes that physiologic alterations are the result of faulty programming in our genes or an adverse environment. There are two well-identified but rarely discussed factors that lead to water retention with androgenexcess: suppressed release of natriuretic peptide (NP) and increased aldosterone activity.
Natriuretic peptide is a group of diuretic hormones released from several different tissue types (e.g., heart, brain) in response to a perceived high blood pressure or excess sodium. In addition to its vasodilatory effects (lowering blood pressure by opening blood vessels), NP causes the kidneys to flush out water and sodium, and stimulates the release of stored fat from fat cells.[SUP]2,3[/SUP] Obviously, suppressing NP would lead to a greater retention of water and sodium, as well as increased blood pressure and possibly net fat storage.
Recent research has shown that increasing concentrations of free testosterone are associated with significantly lower concentrations of NP.[SUP]4[/SUP] NP does increase in association with higher estrogen or sex hormone-binding globulin (SHBG) concentrations, but most bodybuilders actually suppress estrogen via aromatase inhibitors— which results in lower SHBG. SHBG is also associated with insulin sensitivity— the higher the SHBG, generally the more insulin sensitive the individual.[SUP]5[/SUP] Not surprisingly, insulin resistance (the state of impaired insulin sensitivity) is also associated with lower NP, a fact that will resurface in the discussion on growth hormone (GH) and insulin.[SUP]6[/SUP] Thus, elevated androgens, especially nonaromatizing AAS or when used in conjunction with aromatase inhibitors, leads to suppressed NP— resulting in water and sodium retention.
Aldosterone is a steroidal hormone involved with water and sodium balance in the kidneys. Testosterone is also associated with increases in aldosterone; estrogens reduce the renin-angiotensin-aldosterone axis activity, resulting in water loss.[SUP]7[/SUP] When testosterone (or more potently non-aromatizing AAS, or in the presence of aromatase inhibitors) is elevated, there is a greater propensity to increase aldosterone activity in the kidneys, resulting in water and sodium reabsorption. The combined effect of decreased NP and increased aldosterone activity likely accounts for the elevations in blood pressure suffered by many AAS users.[SUP]8[/SUP] Many AAS also impair cortisol metabolism in the kidneys, resulting in sodium retention.[SUP]9[/SUP]
Growth hormone was once used as an anabolic drug, but now is more geared toward lipolytic (fat reducing) and repair/recovery. Early adaptors used excessively high doses of GH, resulting is marked edema (fluid retention, like the puffy pooling around your ankles after a long flight or sitting all day), carpal tunnel syndrome and severe insulin resistance. The contemporary practice is to use more physiologic doses of GH, combined with IGF-1 for the anabolic effect. Nonetheless, elevations of the GH/IGF-1 axis result in edema and insulin resistance, even in the relatively moderate ranges.[SUP]10[/SUP] It is suggested in the literature that receptors in the kidney respond to GH and/or IGF-1 (which can be produced locally), resulting in the reabsorption of sodium and phosphates.[SUP]11,12[/SUP] Recall also, that insulin resistance is associated with lower NP, further increasing water and sodium retention.[SUP]6[/SUP] Briefly, high-dose insulin use results in water retention as wel1.[SUP]13[/SUP] Insulin is a vasodilator, and can produce edema, as well as increased fat storage.[SUP]14,15[/SUP] Sadly, it seems to have become a foundation anabolic drug for many competitors.[h=2]DIURETIC DRUGS[/h]Given the strong signaling associated with these common anabolic drugs, along with the elevated cortisol due to physical and emotional stress, it is no wonder that bodybuilders need to resort to potent diuretics to shed the excess water as part of their contest preparation. Leaving aside the practices of carbohydrate depletion, sodium depletion, water restriction and other techniques, a brief discussion of the diuretic drugs is due. [Note: this does not condone or recommend any of the practices, which can be dangerous or life threatening]
Hardly any bodybuilder uses diuretics aside from the immediate pre-contest period or for photo shoots. Diuretics interfere with training, muscle growth, fat loss and mental focus when abused.[SUP]1[/SUP] This is not to say that many bodybuilders are not on anti-hypertensive drugs, which have a mild diuretic effect (e.g., ACE inhibitors). Generally, bodybuilders may begin using somewhat mild diuretics the week or so preceding an event. This aids in motivation, and skin retraction, as the physique begins to really sharpen.There are diuretics that are orally administered that are considered relatively safe. Dyazide (a combination drug with potassium-wasting and potassium-sparing diuretics) is the classic.[SUP]1[/SUP] Bodybuilders will dose Dyazide above the clinically provided directions, but generally not to a great degree. In conjunction with a short period of carbohydrate depletion, water and sodium restriction, dramatic changes can be noted. Dyazide users can still experience dehydration and serious sodium loss, requiring medical attention.[SUP]16[/SUP]
However, on the day of the show, there is one diuretic so potent that it is the unquestioned king of dehydration furosemide (known by the brand name Lasix). Lasix is the prototypical drug in a class known as loop diuretics.[SUP]1,17[/SUP]Essentially, it turns the kidneys from being an intelligently designed organ interacting with the chemical state of the blood- secreting and reabsorbing electrolytes as needed, to maintain the body in a healthy state- into a spigot flushing all the electrolytes out into the urine. Furosemide needs to be dosed carefully, as wasting too much sodium, potassiumand other electrolytes results in electrochemical malfunctions. Paul Dillett's experience serves as the seminal example of failed electrolyte balance. Proper dosing will not be discussed, to avoid the impression of supporting this practice. It is wise to supplement potassium and magnesium, in addition to having ample water and sodium available to treat cramps, much as occurs on sports fields during games in hot environments. The bodybuilder often has to suffer hours of fatigue while maintaining his physique as best possible for the evening show and overall posedown. It is not uncommon for bodybuilders to combine spironolactone with furosemide in the attempt to reduce potassium loss and prevent adverse heart rhythms.[SUP]18[/SUP]
This brief primer addresses some novel issues that have not been previously addressed regarding the anti-diuretic effect of commonly misused anabolic drugs, and briefly comments on diuretics used to flush out excess water to present the underlying musculature with sharpest detail. It did not describe the various compartments of water in the body (e.g., intracellular, extracellular, intravascular, extravascular, interstitial), all of which need to be considered in balance when forcing a negative water balance with the use of diuretic drugs.
Many people obsessed with weight loss will abuse diuretics regularly, even daily. One professional (WWF) wrestler admitted to me in the 1980s using Cytomel (T3 thyroid medication) and Lasix daily to stay cut. Emergency rooms and urgent care clinics regularly see (mostly female) patients with abnormal heart rhythms caused by electrolyte imbalances due to diuretic abuse.There are other diuretic techniques also used that have not been discussed, though these are not as universal (e.g., hyperosmotic enema, intravenous volume expanders).[SUP]19[/SUP]
Most people think of diuretics as a benign factor in bodybuilding. For competitors, it is known as one of the most vital components of pre-contest preparation, but also as the highest-risk practice. Much like insulin, diuretics can rapidly threaten great harm or death. Unless a knowledgeable physician is present with the proper interventions, tragedy can ensue. Don't let the deaths of past greats go unheeded-- RIP Andreas Munzer and Mohammed Benaziza.
By Daniel Gwartney, M.D.
