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Bodybuilding’s Mounting Death Toll – Part 2

by Mike Arnold

In Part 1 we discussed the growing trend of steroid abuse and its consequences. In Part 2, we will begin learning how to protect ourselves from these side effects…Steroids, Cardiovascular Health, and Reversing the Trend.

Responsibility to the Responsible

As undesirable as these side effects may be, your decision to implement corrective/preventative action will have a significant impact on the degree to which these side effects manifest themselves, if at all. While some individuals have equated steroid use to Russian Roulette (thereby removing personal responsibility), history has shown that those individuals who ignore their cardiovascular health are at the greatest risk of developing one or more of these problems. Fortunately, the majority of these side effects, particularly those with a strong causative link to cardiovascular disease, are easily detectable and largely preventable.

For those who wish to adopt a pro-active stance towards this aspect of their health, the 1st step is a comprehensive assessment of the internal landscape via physician monitored bloodwork.

This initial evaluation allows us to diagnose any issues which may be present, thereby assisting us in putting together a treatment plan ideally suited to our needs. In addition to the cardiovascular system, bloodwork is also necessary for evaluating our renal (kidney), hepatic (liver), hormonal, and reproductive function. While whole-body health maintenance is always recommended, the end-point of cardiovascular disease, as well as the frequency with which it tends to occur in steroid users, should make its prevention a priority.

The best place to begin is by assessing the 3 primary cardiovascular health markers, which includes blood pressure, lipids, and hematocrit. While high blood pressure can be self-diagnosed with a simple at home blood pressure device (many pharmacies also offer free blood pressure readings), hematocrit and lipids problems cannot. A simple trip to your family doctor, followed by a visit to the lab, will provide you with the answers you seek (Note: As a general rule, I recommend that steroid users get bloodwork no less than once every 6 months, while heavier users may want to increase their frequency to once every 3-4 months).

By pin-pointing the problem we are no longer forced to rely on guesswork and can more accuaretly formulate a plan of attack. In most cases, changes in supplementation, drugs, and/or lifestyle are all it takes to bring these health markers back into range.

Enacting Change

The supplement market is filled with OTC products claiming to deliver various cardioprotective effects, but when deciding which to include in your program, how do you know which to choose? Above all, the product(s) you select should be clinically proven to deliver beneficial effects. Otherwise, how will you really know if the product does what it claims to do? Having met this prerequisite, you should prioritize your selection(s) according to your needs. All of the products listed below have been subjected to rigorous clinical testing with positive outcomes. Let’s begin with blood pressure products.

One of the most common is Hawthorne extract; a medicinal herb which has been used to treat various medical conditions since the 1st century AD. Today, it is a concentrated preparation containing 3 groups of active compounds (proanthocyanidins, flavonoids, and catechins), which are responsible for a number of beneficial effects, such as a reduction in liver fats, increased antioxidant activity, and reduced anxiety, but the most promising are its cardioprotective effects.

Some tend to view Hawthorne solely as a blood pressure supplement, but its cardioprotective effects are much more comprehensive and tailor-made for any steroid user. Hawthorne significantly increases blood flow to the heart muscle itself, thereby lowering the risk of heart attack (which is a direct result is poor heart muscle oxygenation). Hawthorne accomplishes this through multiple mechanisms, which include improved nerve signal transmission (improved heart contractility), a reduction in peripheral vascular resistance (lowered blood pressure), an improved lipid profile (better cholesterol values), and by providing an antiarrhythmic effect (restores a regular heartbeat). It may also increase the heart’s tolerance to oxygen deficiency.

Hawthorne is regularly used by the U.S. medical community to treat congestive heart failure, most frequently in conjunction with other therapies. In countries such as Brazil, France, Germany, and Russia, Hawthorne is categorized as an official drug. With an abundance of clinical evidence demonstrating Hawthorne’s ability to improve cardiovascular function, its inclusion in the programs of steroid users is a no-brainer. See below for one of many clinical trials available on this compound:

Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension.

Hugh Sinclair Unit of Human Nutrition, School of Food Biosciences, The University of Reading, Whiteknights, PO Box 226, Reading RG6 6AP, UK. A.F.Walker@afnovell.reading.ac.uk


This pilot study was aimed at investigating the hypotensive potential of hawthorn extract and magnesium dietary supplements individually and in combination, compared with a placebo. Thirty-six mildly hypertensive subjects completed the study. At baseline, anthropometric and dietary assessment, as well as blood pressure measurements were taken at rest, after exercise and after a computer ‘stress’ test. Volunteers were then randomly assigned to a daily supplement for 10 weeks of either: (a) 600 mg Mg, (b) 500 mg hawthorn extract, (c) a combination of (a) and (b), (d) placebo. Measurements were repeated at 5 and 10 weeks of intervention. There was a decline in both systolic and diastolic blood pressure in all treatment groups, including placebo, but ANOVA provided no evidence of difference between treatments. However, factorial contrast analysis in ANOVA showed a promising reduction (p = 0.081) in the resting diastolic blood pressure at week 10 in the 19 subjects who were assigned to the hawthorn extract, compared with the other groups. Furthermore, a trend towards a reduction in anxiety (p = 0.094) was also observed in those taking hawthorn compared with the other groups. These findings warrant further study, particularly in view of the low dose of hawthorn extract used.

The second compound on our list is Coenzyme Q10. A staple in many BB’ing products, some of you will already be acquainted with this endogenously produced, vitamin-like substance. CoQ10 is necessary for basic cell functioning and provides potent antioxidant effects, particularly in the heart, in which it is found in higher quantities. Levels of this essential co-enzyme gradually decrease as we age, leading to speculation that replacement therapy may reduce the incidence of age-related cardiovascular damage. In addition, studies have shown that those suffering from cardiovascular conditions often have below average levels of this essential co-enzyme relative to their age group, which has caused many in the medical community to recommend CoQ10 as a preventative therapy.

Successful clinical trials evaluating the effects of CoQ10 in the treatment of congestive heart failure and elevated blood pressure have led to its extensive use in the U.S., Japan, Europe, and Russia for the treatment of these conditions. Its antioxidant activity may also help protect the heart from potentially heart damaging medications, stress, and sickness. Although technically an OTC product, CoQ10 is treated more like a drug than a supplement in many parts of the world and with good reason.

Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials.

Cardiac Surgical Research Unit, Alfred Hospital, Melbourne, Australia. f.rosenfeldt@alfred.org.au


Our objective was to review all published trials of coenzyme Q10 for hypertension, assess overall efficacy and consistency of therapeutic action and side effect incidence. Meta-analysis was performed in 12 clinical trials (362 patients) comprising three randomized controlled trials, one crossover study and eight open label studies. In the randomized controlled trials (n=120), systolic blood pressure in the treatment group was 167.7 (95% confidence interval, CI: 163.7-171.1) mm Hg before, and 151.1 (147.1-155.1) mm Hg after treatment, a decrease of 16.6 (12.6-20.6, P<0.001) mm Hg, with no significant change in the placebo group. Diastolic blood pressure in the treatment group was 103 (101-105) mm Hg before, and 94.8 (92.8-96.8) mm Hg after treatment, a decrease of 8.2 (6.2-10.2, P<0.001) mm Hg, with no significant change in the placebo group. In the crossover study (n=18), systolic blood pressure decreased by 11 mm Hg and diastolic blood pressure by 8 mm Hg (P<0.001) with no significant change with placebo. In the open label studies (n=214), mean systolic blood pressure was 162 (158.4-165.7) mm Hg before, and 148.6 (145-152.2) mm Hg after treatment, a decrease of 13.5 (9.8-17.1, P<0.001) mm Hg. Mean diastolic blood pressure was 97.1 (95.2-99.1) mm Hg before, and 86.8 (84.9-88.8) mm Hg after treatment, a decrease of 10.3 (8.4-12.3, P<0.001) mm Hg. We conclude that coenzyme Q10 has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side effects.

While there is no doubt that supplementation is a useful tool in the management of high blood pressure, a comprehensive approach is likely to yield superior results. This often requires going right to the source of the problem, which in many cases, originates with the individual’s PED program.

One of the primary causes of high blood pressure in steroid using BB’rs is water retention. This can be caused by either the steroid itself, or an increase in estrogen levels as a result of aromatization. While there is little we can do to reverse direct, steroid-induced water retention outside of discontinuation, estrogen induced water retention is another story.
While science has confirmed the role of estrogen in muscle growth, do not be fooled into thinking that excessive levels of estrogen will further expedite the muscle building process, as science has failed to establish any link between above normal levels of estrogen and muscle growth in males. On the other hand, water retention has the potential to dramatically elevate blood pressure, particularly in the more extreme cases.

There are no proven benefits associated with elevated estrogen levels, but we don’t need to look far in order to see the multiple, undesirable side effects associated with estrogen excess. Needless to say, as it stands right now, the evidence is heavily in favor of managing estrogen levels, which is most effectively done via an aromatase inhibitor. For this reason aromatase inhibiting drugs should be considered a basic ancillary item in any cycle which contains aromatizing AAS. In many instances this is all it takes to alleviate high blood pressure and bring one’s reading into a more acceptable range.

This section wouldn’t be complete without at least touching on cardiovascular exercise. It is no secret that most bodybuilders hate doing “cardio”. In the opinions of many, this heart healthy exercise is both boring and time consuming. So, if you needed another reason to start including it in your training program, perhaps the following will suffice. Just a short 20 minute session, when done at a sufficient intensity, has been shown to measurably reduce blood pressure shortly after completion. When 3-4 sessions are performed per week, long-lasting changes are noted, so long as its remains a part of one’s program.

Part 3 coming soon…

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