Lessons from Medical School Regarding Health and Performance Enhancers
04-08-2012 12:28 AM
Lessons from Medical School Regarding Health and Performance Enhancers
I used to post here quite a bit several years ago. It was a great forum, with lots of good guys. I was pretty big into the lifting scene back then.
Today, I've finished about 200 semester units of undergraduate education (BS in Biology, and about 80 additional credits in various crap) and I'm about to go into my 4th year of medical school. So, I'm about 10 years in 0_0 And, my God, do I ever want it to be over. Unfortunately, I've got 1yr of medical school and at least 3 years of residency left. Meh, whatever.
Anyway, for some strange reason, I felt like very briefly sharing my opinion on the safety of performance enhancing drugs with a simple arbitrary example. I'm not here to judge, or to nanny, but simply enlighten those who are more concerned about their overall level of health than they are their physique.
In short, here is what I've learned in a single sentence: Ignorance is bliss, but most of that stuff is, in fact, pretty damn bad for you.
Most people have absolutely no idea about the intricacies of human physiology and the clinical picture that is painted with changes in that physiology. And, understandably, people look for "studies" to prove bad side effects. Unfortunately, in the realm of peer reviewed scientific research there is actually far, far, far, far, far more that we have not produced well-designed studies for than what we have. And, unfortunately, people seem to feel that absence of evidence is evidence of absence. Keep in mind that researchers absolutely run away scared from trials that might potential harm the participants, so many of the questions you have will likely never been answered via clinical trials.
I'll also say this: just because your physician may not be aware that a Creatine supplement might give the false appearance of failing kidneys, or that protein supplements are simply milk products (although most up-and-coming physicians are well aware of this stuff) doesn't mean they can't look at the bigger clinical picture and accurately tell you that you're in trouble.
Just for kicks, I'm going to throw out an example. I don't know what the prevailing wisdom is on the topic these days, but lets talk HGH for a second. When I was on these forums way back when, I remember people touting its safety. I even remember some people stating something to the effect of, "the only proven effect is that exogenous hgh in moderate doses might enlarge your heart a little, and we're not even sure if that's bad." Here is the reality from the perspective of a medical mind:
Lets just pick two of the known side effects and take them to their clinical conclusion (not necessarily to happen in a persons life and complicated by a great many factors, but still a strong and undeniable risk):
1. Insulin resistance
2. Cardiomegaly (enlarge heart)
First, lets talk insulin resistance. In short, this means increased blood glucose levels. Hyperglycemia, as it's called, will inevitably do a few things. Most talked about among those is non-enzymatic glycosylation of tissues; in other words, the glucose in the blood will attach itself to stuff. We see this primarily in your blood vessels. This means that those vessels will harden, lose their compliance, and even lose luminal diameter (reduce flow). Reduced flow and decreased compliance means two significant things for people: 1. tissue ischemia (less nutrients), and 2. increased blood pressure. The tissue ischemia has obvious effects. Its means that important organs, such as the heart, kidneys, and brain will slowly die. It also means that other parts of your body will die. For example, the leading cause of limb amputation in the US is diabetes induced (from insulin resistance and the consequential hyperglycemia). The kidneys and heart are where we see a lot of the clinical manifestations of diabetes. The poor perfusion of tissues leads to tissue death. From this you often get sub-clinical myocardial infarctions (heart attacks), and continuously destroy the kidney (a major detoxifier, fluid and electrolyte balancer, and even endocrine organ that is essential to life). The subclinical myocardial infarctions can lead to decreased cardiac contractility, impaired filling, and ultimately to stuff like congestive heart failure where increased fluid volume that was once a reflexive mechanism to increase cardiac output becomes overwhelmed and the tissue stretches to the point where forward flow to the body is insufficient, and flow out of the right side of your heart becomes backed up, leading to massive swelling of your extremities, and more significantly edema (swelling) of your pulmonary vasculature--effectively drowning yourself in your own fluids. Also note that a stretched hear is likely to have electrical conduction abnormalities, predisposing one to dangerous arrythmias, some of which can cause instant death. This would also be complicated by the fact that you'll be losing important proteins in your urine due to the diabetic nephropathy that has destroyed your kidneys to the point that they no longer filter effectively. Not to mention the acid-base and volume disturbances.
Now, clearly we could write volumes of text on the topic. But, lets move on to point #2: cardiomegaly.
Cardiomegaly IS bad. No if's, and's, or but's. As the ventricular tissue hypertrophies its compliance decreases. So, when the atria pump blood into the ventricles the non-compliant ventricle will cause backward fluid volume overload. Often stretching out the atria. This can cause cardiac dysrythmias, like atrial fibrillation which predisposes people to conditions like stroke and a whole host of other conditions. In addition, the forward cardiac output becomes compromised. This leads to poor perfusion of tissues, including heart tissue. This, will also likely be associated with high blood pressure. The combination of high blood pressure and poor perfusion to tissue such as the kidney is horrific and will compound the acceleration toward kidney failure. To structures like the brain, it will further pre-dispose to hemorrhagic stroke (horrible), dementias, and more. To the heart, it will lead to compromised perfusion, and possible subclinical myocardial infarction. Again, this will transition you out of a hypertrophic cardiomegaly into a dilated cardiomegaly and eventually congestive heart failure.
Not to mention, the overall state of your body will be pro-inflammatory and therefore pro-thrombogenic with both of these conditions, and make it more likely for a full on occlusive myocardial infarction where a large segment of your heart is no longer perfused because a huge, clotted plaque is clogging up the pipes. And, those types of MI's (the kind that people notice they have) are pretty darn dangerous.
I can tell you all of this with certainty based on my clinical and physiologic knowledge, and there is no need to have studies that may or may not exist to prove every little detail.
Blood glucose that's a little too high is a bad thing. Blood pressure that's a little too high is a bad thing. Basically, anything that's not exactly how nature intended it is likely to be a bad thing. Too much oxygen, too much free water, etc.
Now, a person missing limbs, in congestive heart failure, and/or renal failure is frankly miserable. I see it every day, and its a pitiful existence. And, this is really just the start of the "possibilities". Its true that these symptoms are not guaranteed in everyone, and many people will probably live their lives without seeing any of this. But, how much do you want to roll the dice?
So, what do I recommend? Eat well, exercise, and just do it as natural as possible. You can still get big and be strong. But, most importantly, you'll be healthy.
If you insist on running cycles, maybe keep it simple with something like testosterone at a conservative dose and always monitor your blood pressure, liver function, and lipid profile. Keep in mind stuff like, while 139/79 is technically still "pre-hypertension", your body really wants to be closer to 115/70 and that's still significantly above a healthy range, and still likely to contribute to some unfortunate physiologic reactive mechanisms. Pre-hypertension is a stupid label. What matters is action-reaction, and elevated blood pressure usually leads to bad things for most people in the long term. Combine that with an LDL of 170 and HDL of 30, and you're just asking for a heart attack if you keep that up.
I mean, you'll still kill yourself faster abusing tyelenol, ibuprofen, etc. But, that's another discussion. My point is to enlighten those who are legitimately concerned for their health and are considering the use of performance enhancing drugs.
Really, it would take far too much time and energy to make a comprehensive post. But, I just wanted to give you all some food for thought. If big muscles are your priority, so be it. But, if your health takes higher priority than your muscles, please consider what I say and step out of the bliss of ignorance and into the security of reality.
I'll check in every now and then to see if I can answer questions. This was all off of the top of my head, so I hope there weren't any inaccuracies or ridiculous typos
04-09-2012 12:48 PM
04-09-2012 01:09 PM
Originally Posted by freefall365
04-09-2012 10:53 PM
Not in anabolics section?
All that physiology was a nice refresher, but if your schooling has been anything like mine, we haven't been given much knowledge on how much this pathophysiology can be applied to anabolic steroids and peptides. For HGH, it is certainly safe to say that insulin resistance as a side effect is not a good thing. But I think you may be making a jump by assuming that HGH (or other peptide/hormones - EXCEPT glucocorticoids) will lead to the same end of the line Type II diabetes state that we see in the patients during our clerkships. Most people that are messing around with HGH and other hormones are pretty healthy and eat extremely clean. HGH might nudge them in the direction of insulin resistance in the long run, but to compare them to the millions of sad obese americans getting their toes and knees cut off is a stretch that you should back up.
Ventricular hypertrophy resulting from AAS use is real and I would not contest anyone stating it as a risk factor of AAS use (the point for debate, and where the need for evidence comes in, is the DEGREE to which AAS use causes hypertrophy, and furthermore, the SEVERITY of hypertrophy that they cause). However, I still would not put people that got enlarged hearts from AAS in the same boat as people that got enlarged hearts from hypertension (or diabetes, or other cardiovascular conditions). They got there by different means, and the presence of comorbidities is a huge difference between the two groups. Its an otherwise very healthy group (obsessively so in some cases) with a group of people that are often falling apart organ by organ.
I don't mean to come off as a dick, as I am in about the same boat as you +1 year. I am a healthy person who most of the time is surrounded by very unhealthy people. We hear of correlations between non-FDA approved substances and adverse reactions (aka "Side Effects") and we easily think of people with the end of the road condition that we saw at the hospital - and possibly fail to appreciate the completely different road they took to get there. People with morbid obesity of 20 years, both legs cut off, infections, dialysis, etc.., got there from terrible eating and a sedintery lifestyle... Not from taking HGH (i know HGH was just an example, but the point is we know the reason people are getting type II diabetes).
I am not defending the use of anabolic steroids or exogenous hormones. The hypercholesterolemia (from AAS) alone is undeniable and proven throughout this very forum (via users' posted bloodtests). There are also people here with a history of anabolic use that have had heart attacks and subsequent echos revealing cardiac hypertrophy... To what degree can we apply such exampels (anecdotes) to the community at large? Obviously, if you want to be perfectly safe, you will never take any of this stuff, and never jaywalk, or ride planes. But many will still want to know how big the risk is, because it might be worth it to them if its not too bad. This is still a hot topic under debate in and out of the medical community - to make a solid statement in either direction requires a little backing up.
04-13-2012 11:09 AM
Very interesting thread... subbed for more thoughts/info
04-13-2012 03:05 PM
Thank you both! This is the kind of stuff I love reading and think we could use a lot more validated opinions on here
04-13-2012 03:18 PM
I'm in a bit of a different position from you and the OP, as I'm a few months away from completing a PhD in exercise physiology.
Originally Posted by MDiocre
I think you bring up a good point here, and its important to distinguish between pathological and physiological (exercise induced) cardiac hypertrophy.
The case of the latter is associated with athletes, especially endurance athletes where both the size of the chamber and the thickness of the ventricular walls increase in size pretty relative to each other. As the myocardiofiber is stretched, it also adapts by expanding in size via increases in myofibrils in series and parallel, allowing it to respond to and generate the pressure needed to achieve a normal ejection fraction.
In the case of concentric hypertrophy, the myocardiocyte does not adapt, and often undergoes apoptosis and necrosis (death and decay) in both the infarcted and non-infarcted ventricular wall. Instead of an increase in cardiac muscle fibers, wall thickness and size is increased via the disproportionate contribution of cardiac fibroblasts that secrete large quanitities interstitial fibrillar collagen (basically scar tissue). So this fibrosis of the myocardium leads to an increased stiffness, reduced filling, and as previously mentioned, less responsiveness and loss of compliance.
So, before we make the absolute conclusion of saying any sort of LVH is bad, lets consider the source of the stimulus, and the way the heart adapts...as eluded to above.
04-13-2012 03:23 PM
For those of you reading this who need clarification or simplification.
Originally Posted by kwyckemynd00
Take 8oz of water and mix a 1/4 cup of sugar into it. Then, place a natural fiber string into the solution and leave it there for a day or two. Pull the string out, and you will see sugar crystals growing on it. This is what occurs to the tissues of a hyperglycemic subject. The proteins of the blood vessels become glycated (crystalized), and you can imagine how that affects their ability to expand and thus affect the amount of pressure the heart has to pump against. Neurons becomes glycated, thus reducing their ability to transmit signals...especially in the lower body of inactive subjects. This is why diabetics can cut their feet, get infected, and not even realize it. And so on and so forth as succinctly described above.
04-15-2012 09:06 PM
Creatine can cause kidney failure? whaaaaat
Originally Posted by kwyckemynd00
04-15-2012 09:20 PM
Very great discussion, guys. I have always wondered, too, how diabetes and hyperglycemia eventually lead to a state where people have to become amputated. I obviously slept through the sections of cell and molecular bio describing glycation of proteins (I know the mechanisms that perform this, and a little about the effects, but I didn't put 2 and 2 together, but neither did my profs), and it's so hard to find this info online sometimes, so it's great it's all here now. In for more discussion.
04-15-2012 10:25 PM
I have heard that extremely large amounts of creatine is hard on the kidneys, but I believe the OP is referring to a situation where a clinician may misinterpret an elevated creatinine value on a basic metabolic panel blood test as an indication of renal failure.
Originally Posted by ISU152
Plasma creatinine levels are used to evaluate overall kidmey function. Elevated (like significantly over 1.0-1.2) is bad, meaning the kidneys are not performing their job of clearing the bllood of substances like creatinine well. All of this is obviated though if the patient is taking significant amounts of creatine, which easily alters to creatinine, thus raising blood creatinine levels.
04-15-2012 11:04 PM
Originally Posted by MDiocre
Ok ok. Thanks for the info guys!
04-19-2012 12:59 AM
Hey all. Great discussion here, glad to see some folks jumping in with some great info!
I just wanted to make a couple of points quickly since I'm short on time.
1. Insulin resistance: any prolonged hyperglycemic state will put you at increased risk of developing type ii diabetes. Like I said, its rolling the dice. I already mentioned that this likely won't happen to a majority of users. Most people who acquire DM II do so because they have both (a) a genetic predisposition and (b) they make poor dietary and lifestyle choices that accelerate their development of the diabetic state. Other than assumptions based on family history, we really cannot effectively screen for this risk. And, given the prevalence of DM 2 in the population, its fair to assume that any one of us could potentially be genotypically predisposed to acquire DM2. So, putting yourself in a hyperglycemic state over a long period of time, effectively increasing your risk, is something that should be given serious consideration by each and every health-minded person. With that in mind, I was simply begging the question: how worth it is the risk? Obviously, that's an individual decision. Even people who become diabetic and revert out of their diabetic state secondary to ideal lifestyle and diet tend to show evidence of permanent endocrine damage because of their tendency to have DM2 relapse permanently at some later point in time.
2. Cardiac hypertrophy: Any hypertrophy that results in outflow obstruction or decreases compliance is clinically pathologic because both result in decreased cardiac output and thus hypoperfusion of critical tissues. So, I respectfully disagree that (in most cases) its very significant "why" there is hypertrophy, but rather "how much" hypertrophy there is. Now, do you see athletes without congenital abnormalities acquiring pathologic levels of hypertrophy due to their exercise? Probably not. However, what we're talking about here is people with excessive bodymass under the influence of AAS and other hormones which induce and/or exacerbate hypertension.
04-19-2012 01:17 AM
I am in no way going against what you are saying. I feel everyone who takes anything hormonal must know the risks associated with using etc.
Originally Posted by kwyckemynd00
I was just wondering what you thought were ways of combating this? We got the low fat camp on one end, the healthy fats plus low to moderate carbs, the full fat bunch with no carbs, etc. What, in the literature has shown to be the best diet for fighting off (mainly number 1) these type of illnesses?
04-19-2012 02:50 AM
So, the literature has repeatedly shown (to the best of my knowledge -- I haven't been keeping current) that the best way to fight / prevent diabetes is through diet and exercise and maintaining a lean body :-P But, the thing is, you really don't need to fight a condition that doesn't exist.
Originally Posted by mattrag
Assuming you've got normal fasting blood sugars, and your body responds normally to a glycemic challenge, just do your best to keep eating healthy (few red meats, high veggie and fruit volume, whole grains, good fats, etc) and exercise. I'm not a nutritionist and can't really answer the "what's best nutritionally" type of questions with any real authority. But, from my experience, for people who have uncomplicated physiology I believe diet/nutrition can be as simple as I outlined above (briefly).
You can't really take away the risk of doing these things. It's inherent in the mechanism of action of the drugs. Some people have more pronounced responses, and some people are more predisposed to developing complications. That's the roll of the dice. You can minimize other risk factors, however. But, again, that's primarily the diet and exercise stuff.
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