Body Dismorphia Part I

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    Body Dismorphia Part I





    So... yeah. My biceps are way smaller on a camera than they are in my head. I guess it's usually the other way around.

    Anyway, couple of quick questions...

    I'm 6'2, 220 lbs, been training for about 3 years now. (Up from about 135 lbs 3 years ago)

    So, considering I was 135, I look great... but leaving that out, I am really not happy with how things are going... I don't have nearly the mass I want, and I have way too much fat. That's the background.

    Now for the questions

    1.) Anybody got a good guesstimate of bodyfat? I'm guessing between 16 and 20%. Last time I got it measured it was around 16 but I think I have put on a few pounds since then.

    2.) Pardon my poor artwork - but to get my body in the shape I've drawn in there, how much fat do I need to lose, and how much mass do I need to add on?

    3.) Can somebody out there please tell me they have these same issues when they look at pics of themselves?

    Looks like I need to do some serious modification of my diet and routine :-/ I guess its good that I have put on 85 pounds in 3 years, but at least 20 of it is in the wrong places, meaning fat. Guess I just got to be patient and keep working at it.

    Any input anybody has will be somewhat appreciated lol... but keep it fairly polite, i have a long memory

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    Yeah, dude, your not alone. Your BF% is just really high. The muscle is there, you just can't see it.
    I went through the same deal. I bulked like crazy and got really strong...and pretty fat, 5' 10" at 209. I was really strong but hated how I looked except for those times when I was in the gym and pumped up and heaving the heavy weights.
    With diet and adding in cardio I dropped down to about 183. Although I'm physically smaller, visually I look BIGGER because now you can see a little muscle seperation, lots of veins and a pretty good v-taper. I'm much happier with how I look now all the time not just when I'm at the gym. Friends and family always are saying how much bigger I got but it's funny cause I actually got smaller.

    Don't anybody make this guy feel bad, it takes balls to post up your pics like this. You might want to post this in the weight loss forum though.
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    Not trying to be an ass, but your BF% is closer to 20 than it is to 16. If I were you I would do a recomp. Lose Fat, but at the same time build muscle. I would think after that you would be in a good range BF%. Prolly around 210lbs. Search around for recomp logs and steal some ideas from people in your situation. Good luck bro.
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    Quote Originally Posted by Aggravated View Post
    Not trying to be an ass, but your BF% is closer to 20 than it is to 16. If I were you I would do a recomp. Lose Fat, but at the same time build muscle. I would think after that you would be in a good range BF%. Prolly around 210lbs. Search around for recomp logs and steal some ideas from people in your situation. Good luck bro.
    Thanks man. You guys gotta understand its a really weird position for me to be in; I had gotten sick a few years ago and I was down to like 135, but probly 3-5% body fat. I could see the separation between my two biceps even. My whole life, I have been underweight by at least 30 or 40 pounds, and I could eat a whole pizza and it wouldn't stick. Now, I'm 29 and it's a bit of a different scenario

    20% sounds like something I can deal with still. I'd like to be 215-225 and about 8% bodyfat.

    I posted in this forum rather than weight loss, because I am contemplating my first cycle. Would it be out of line to do an HGH cycle or a cutting cycle as a first cycle?
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    I don't think a cutter would be out of line. But lose as much as you can naturally by tweaking your diet and work outs first. You could drop 10 pounds of that pretty quick by just tweaking your carb intake.
    Once you plateau there, then try some of the otc stuff, like Leviathan or Lev. R.
    Once you've plateaud with the OTC stuff then consider the "other" things but don't even think about GH at this point.

    Progressively add in regimens and ergogens as you master their application/use and reach the point of diminishing returns, Then move onto the next stage.
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    Quote Originally Posted by azr101 View Post
    I don't think a cutter would be out of line. But lose as much as you can naturally by tweaking your diet and work outs first. You could drop 10 pounds of that pretty quick by just tweaking your carb intake.
    Once you plateau there, then try some of the otc stuff, like Leviathan or Lev. R.
    Once you've plateaud with the OTC stuff then consider the "other" things but don't even think about GH at this point.

    Progressively add in regimens and ergogens as you master their application/use and reach the point of diminishing returns, Then move onto the next stage.
    This is sound advice. You could also do both mine, and azr's suggestions. Recomp, then cut. This way you are more solid/full when you lean out. Up to you though. In any case, you will have to make dramatic changes to your diet in order to achieve your goals. Comfortably I can say that your diet makes up about 85% of your success. Supps are really just icing on the cake.
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    Appreciate all the input guys. I have spent the last two weeks working on my diet trying to get it in line. I read the Abs Diet by the editor of muscle and fitness. Decent book. Not sure if I'll use all the principles in it, but it definitely had a lot of good nutrition information. I think my biggest sins are not enough meals and too large portions.. instead of 5-6 smaller meals its usually 2-3 big ones.

    What precisely is a recomp, is it a cycle, or what? Something tells me when I do a search for recomp I'm going to get 1,024 different results.
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    Quote Originally Posted by PhilABowl View Post
    Appreciate all the input guys. I have spent the last two weeks working on my diet trying to get it in line. I read the Abs Diet by the editor of muscle and fitness. Decent book. Not sure if I'll use all the principles in it, but it definitely had a lot of good nutrition information. I think my biggest sins are not enough meals and too large portions.. instead of 5-6 smaller meals its usually 2-3 big ones.

    What precisely is a recomp, is it a cycle, or what? Something tells me when I do a search for recomp I'm going to get 1,024 different results.
    A recomp is a stage in dieting/supplementation where you basically try to lose fat, but stay at roughly the same weight. Basically, all you want to lower is your bf% significantly, while trying not to lose too much weight.

    Basically a "Recomposition".

    Since your bf is a little higher than some others, then you may stand to lose a larger amount of weight vs. someone that is 13-15% bf.

    Understand?
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    My advice would be get your diet in order and the fat will come off. No excuses. You had to do a lot of work (eating crappy food) to get to 20% bf and you'll have to do a lot of work to undo the damage. Get off your ass and follow a strict diet and training program for 3-4 months. Once your bodyfat is at an acceptable level then you can consider a cycle to gain the mass that you want. And not to be a downer, but it seems that you will need years of training before you will resemble that silly drawing.
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    You may also see a few lb loss if you were to switch your number of daily meals from 3 to 6. It will keep metabolism running fast.
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    Quote Originally Posted by Botch View Post
    My advice would be get your diet in order and the fat will come off. No excuses. You had to do a lot of work (eating crappy food) to get to 20% bf and you'll have to do a lot of work to undo the damage. Get off your ass and follow a strict diet and training program for 3-4 months. Once your bodyfat is at an acceptable level then you can consider a cycle to gain the mass that you want. And not to be a downer, but it seems that you will need years of training before you will resemble that silly drawing.
    All truths. If I gave the impression I thought this would happen overnight, it's a mistake I'm not interested in getting that big next month, just eventually. I know 1 cycle isn't gonna get me there.

    Thanks for the input guys. By those definitions I started a "recomp" about two weeks ago. Unfortunately part of that recomp involved adding squats in my regimen that I don't usually do, and f*cked up my lower back so that put me out of the running this week. Same as poops log, gotta remember to give my body time to catch up

    I have been slacking on working my legs - I am fine with the size and strength of them, as I have done things like martial arts, etc. I have never really had to do much to keep them in shape, but I have been learning how much of a role things like squats and deadlifts play in hormone secretion and increasing your metabolism so I started adding that in. I also have added in cardio several days a week, ranging from brisk walks outside to cardio machine work.
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    Quote Originally Posted by Botch View Post
    My advice would be get your diet in order and the fat will come off. No excuses. You had to do a lot of work (eating crappy food) to get to 20% bf and you'll have to do a lot of work to undo the damage. Get off your ass and follow a strict diet and training program for 3-4 months. Once your bodyfat is at an acceptable level then you can consider a cycle to gain the mass that you want. And not to be a downer, but it seems that you will need years of training before you will resemble that silly drawing.
    What would you consider an acceptable level?
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    Quote Originally Posted by Aggravated View Post
    What would you consider an acceptable level?
    When I can clearly see my liver and kidneys through the skin lol.

    I want to be able to have a nice stomach again. My girl is kind enough to lie and say she doesn't care about abs, but I'm sure if I had them she'd care more
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    Quote Originally Posted by PhilABowl View Post
    All truths. If I gave the impression I thought this would happen overnight, it's a mistake I'm not interested in getting that big next month, just eventually. I know 1 cycle isn't gonna get me there.

    Thanks for the input guys. By those definitions I started a "recomp" about two weeks ago. Unfortunately part of that recomp involved adding squats in my regimen that I don't usually do, and f*cked up my lower back so that put me out of the running this week. Same as poops log, gotta remember to give my body time to catch up

    I have been slacking on working my legs - I am fine with the size and strength of them, as I have done things like martial arts, etc. I have never really had to do much to keep them in shape, but I have been learning how much of a role things like squats and deadlifts play in hormone secretion and increasing your metabolism so I started adding that in. I also have added in cardio several days a week, ranging from brisk walks outside to cardio machine work.
    The studies of hormonal secretion from movements like that is kinda vague. Some believe it, some don't. As for the movement though. Stay light in weight and high in reps. Will serve you some good after all this time. If your back is that sensitive, stay away from the free weights for a while. Also try to avoid some exercises where you are forced to hang over top of the weight (like barbell rows) etc.. To strengthen it up you could do some "Good Mornings" with light-moderate weight.
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    I know for all you "hardcore" guys they are probably considered worthless supplements, but, since I already have them on hand, I was contemplating running DecaVol for 3 weeks followed by Novedex for 3-4 weeks. I like decavol because its a deca precursor and i think it will help build my strength up, and novedex xt, while not a prescription AI, im not on anything "heavy" so I think it will do well enough. Plus, with the amount of fat storage I have, anything that will reduce estrogen can't hurt.

    Any strong opinions one way or another?
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    Quote Originally Posted by Aggravated View Post
    What would you consider an acceptable level?
    Thats up to the person to decide. I wouldn't give you a ballpark % of bf because I don't think the number is all that important. The mirror will tell when you are at an acceptable level.
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    Quote Originally Posted by Botch View Post
    Thats up to the person to decide. I wouldn't give you a ballpark % of bf because I don't think the number is all that important. The mirror will tell when you are at an acceptable level.
    I'm inclined to agree with you. What is a typical day in your diet, as far as content, and more importantly, quantity of portions, if you are willing to share? Your body fat level is "slightly lower" than mine
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    Thumbs up


    Bro, I used to be the same way (well kind of). Four years ago when I got back into bodybuilding I weighed a pathetic 160lbs at around 6ft tall. So naturally I lifted heavy and ate like a bear for the next 3-4 years. Needless to say it worked well, maybe to well. I Bulked up to around 200-205lbs (which still wasn't huge for my frame) but a lot of that was due to my increased bf (around 13%).
    So I changed the way I ate (mainly the amounts) drastically as well as adding in cardio 4 times a week and changed my whole workout routine from a 5-6 day split were I worked each muscle individually, to a 3 a week full body circuit training routine. My body responded almost instantly within the next 3-4 months I got my bf down to 6%. NO SH!T!!!!
    I know you'll hear it all the time but eating 6-8 small, high protein, low carb meals will really turn your body into a fcuking inferno. Also stay away from soda and beer because as we all know that sh!t is pure sugar. If you drink 3-4 12 ounce cans of soda a day that ends up as an extra 600-900 calories from sugar a day that's stored as fat. Over the course of weeks, months, years that gets fcuking ridicules. And that's just eliminating one simple item from your diet. You can reach your goals (and NATURALY) just sit down, do the math come up with a good diet (STICK TO IT) and change up your routine and you'll already be half way there.
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    Certainly. I am on the Anabolic Diet which is a carb cycling diet. Monday-Friday it consists of >30g of carbs per day w/ a macro breakdown of 55-60%fat/40-45%pro/~5%carbs during the week and 25-30%fat/10-20%protein/60%carbs on the weekends. Here is a typical weekday:

    Breakfast: 4 eggs scrambled w/ heavy whipping cream and cheddar cheese placed in a low carb tortilla wrap.

    Pre workout: 1 can tuna w/ mustard and mayo, 2 tbsps. extra virgin olive oil.

    Post workout: 40g whey protein w/ 10 caps fish oil.

    1 hr later: 130g chicken breast, spinach salad w/ ranch dressing, 1-2 tbsps extra virgin olive oil.

    Dinner: 150g ground beef (not the lean kind), 3.5 cups spinach, 5 tbsps. milled flax seed.

    Late night snack: 1 turkey sausage, 2 tbsps. natty PB, 1.5 servings of cottage cheese.

    ~3000 cals. This is a solid weekday for me, but keep in mind what I eat really changes from day to day aside from breakfast which doesn't really change much.
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    I have some fish oil and flax seed oil caps.. my only beef with the fish oil is I belch up fish flavors which makes me nauseous. I have found that if I have them before a meal I'm OK. What about on the weekends, what does it look like?
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    Quote Originally Posted by Schism View Post
    Bro, I used to be the same way (well kind of). Four years ago when I got back into bodybuilding I weighed a pathetic 160lbs at around 6ft tall. So naturally I lifted heavy and ate like a bear for the next 3-4 years. Needless to say it worked well, maybe to well. I Bulked up to around 200-205lbs (which still wasn't huge for my frame) but a lot of that was due to my increased bf (around 13%).
    So I changed the way I ate (mainly the amounts) drastically as well as adding in cardio 4 times a week and changed my whole workout routine from a 5-6 day split were I worked each muscle individually, to a 3 a week full body circuit training routine. My body responded almost instantly within the next 3-4 months I got my bf down to 6%. NO SH!T!!!!
    I know you'll hear it all the time but eating 6-8 small, high protein, low carb meals will really turn your body into a fcuking inferno. Also stay away from soda and beer because as we all know that sh!t is pure sugar. If you drink 3-4 12 ounce cans of soda a day that ends up as an extra 600-900 calories from sugar a day that's stored as fat. Over the course of weeks, months, years that gets fcuking ridicules. And that's just eliminating one simple item from your diet. You can reach your goals (and NATURALY) just sit down, do the math come up with a good diet (STICK TO IT) and change up your routine and you'll already be half way there.

    Yeah, I definitely have to ditch the soda. I generally have 1-2 cans a day, but thats easily 300 calories as you say of emptiness. Honestly lately, i have been trying to stick to juices like OJ to satisfy my sugar urges, but I ran out and started drinking soda lol. Just gonna have to stay stocked with juice and not soda.
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    Quote Originally Posted by PhilABowl View Post
    I have some fish oil and flax seed oil caps.. my only beef with the fish oil is I belch up fish flavors which makes me nauseous. I have found that if I have them before a meal I'm OK. What about on the weekends, what does it look like?
    "Enteric Coated" Fish oil caps will get rid of the taste/belches.
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    Quote Originally Posted by Aggravated View Post
    "Enteric Coated" Fish oil caps will get rid of the taste/belches.
    that's the stuff I have... the only thing that works for me is firing food down on top of it, and thats taking ONE cap, let alone 10
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    Quote Originally Posted by PhilABowl View Post
    that's the stuff I have... the only thing that works for me is firing food down on top of it, and thats taking ONE cap, let alone 10
    Oh wow.What brand do you use?
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    Talking


    Juice is defiantly a better option, but not without flaw. It's (depending on what kind you get) still real high in carbs and sugars. But it seems to be the refined sugars like high fructose corn syrup that really sticks to you so look for additives in your juices.
    I've had good success with adding different juice's into my diet as well as honey because they're high on the glycemic index and are good early in the morning and right after workout's to get that extra spike for insulin levels. Just remember when you eat is just as (or more) important as what you eat. I read a book called nutrient timing and it taught me a lot, so diffinatly search for some literature. And I know cardio sucks @ss (I fcuking hate the sh!t out of it!!) but it's addition IS THE ONLY WAY you'll see the results you want naturally.
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    What do you guys think of an 8 week cycle of Trenbolone Acetate at 50 mg ED coupled with Turinabol at 10-20 mg per day?
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    Quote Originally Posted by Aggravated View Post
    Oh wow.What brand do you use?
    whatever costco has.

    I don't mind doing cardio honestly; i used to take martial arts, so that took care of all my cardio needs. I moved out of that area so I am no longer in an MA program, and thats when the fat started sticking.
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    Quote Originally Posted by PhilABowl View Post
    20% sounds like something I can deal with still. I'd like to be 215-225 and about 8% bodyfat.
    Honestly, your goals are unrealistic at best and quite grandious. Consider that this guy is I believe 6' - 6'1" or so and 200lbs and likely 8% when he began his diet. He is a professional bodybuilder. 2007 OCB Midwest States ~ November 17th

    Maybe you should be realistic with your approach. Consider 200lbs at 12-15%. But first get down to a reasonable BF. You will see that you have a lot less muscle then you think. I say that because someone who is 220lb at 8% BF has 202lbs of LBM.

    Right now you are at least 20% bf. How big are your biceps?

    At 220 and 20% (low estimate) you have likely ~175lbs of LBM at the very best. That means you would have to put on another 27lbs of LBM just to get to 202lbs of LBM.

    Get fit. Get healthy. Get a lifestyle. Time and discipline will be the determining factor.

    No disrespect.
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    B5150's a little blunt, but right none the less. At 200lbs and 13% bf by the time I got down to 6% bf(I'm probably more around 8% now) I only weighed 181-183lbs. So take from that what you will.
    And I defiantly wouldn't worry about cycling anything right know. While your that out of condition steroids will place an even higher amount of stress on your heart, lipid levels etc.
    If I was you I would go on a hardcore cut for the next 4-6 months before considering a cycle. And even then running a drier compound that will help you shed any additional bf you might have left over form the cut. You'd be surprised how much bigger your muscles look when your lean as opposed to being real heavy.
    Also there is no supplement for patience and hard work. So get in the right state of mind before you begin your quest for the body you want and nothing will stop you!!!
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    I agree with B5150, Your body fat is around 22% i would say. So what you need to do is go on a fat blast man. Possibly pick up some Ephedra to speed up the process. Lift hard and heavy to retain the muscle you have and do cardio on a daily basis about 5-6 hours away from lifting. Also, you need to dramaticaly cut your carbs.Stay away from the juice, soda and the junk
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    Quote Originally Posted by B5150 View Post
    Honestly, your goals are unrealistic at best and quite grandious. Consider that this guy is I believe 6' - 6'1" or so and 200lbs and likely 8% when he began his diet. He is a professional bodybuilder. 2007 OCB Midwest States ~ November 17th

    Maybe you should be realistic with your approach. Consider 200lbs at 12-15%. But first get down to a reasonable BF. You will see that you have a lot less muscle then you think. I say that because someone who is 220lb at 8% BF has 202lbs of LBM.

    Right now you are at least 20% bf. How big are your biceps?

    At 220 and 20% (low estimate) you have likely ~175lbs of LBM at the very best. That means you would have to put on another 27lbs of LBM just to get to 202lbs of LBM.

    Get fit. Get healthy. Get a lifestyle. Time and discipline will be the determining factor.

    No disrespect.
    My biceps are 16.5". When I was 135 pounds and told people I wanted to break 200, they told me to be realistic Granted some of that is fat, maybe even 40 pounds+ of it, still, people always told me I didn't have the frame to be anything other than skinny.

    I appreciate your candor and all that good stuff. I have a lifestyle, and would say I'm healthy and fit, but carrying too much fat

    I just think that I can be big and am willing to keep working at it - I'm not new to lifting weights, even though it looks like it from my pics I've come a long weigh since I had gotten sick.

    I appreciate all you guys input, it really helps.
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    Quote Originally Posted by Link24 View Post
    I agree with B5150, Your body fat is around 22% i would say. So what you need to do is go on a fat blast man. Possibly pick up some Ephedra to speed up the process. Lift hard and heavy to retain the muscle you have and do cardio on a daily basis about 5-6 hours away from lifting. Also, you need to dramaticaly cut your carbs.Stay away from the juice, soda and the junk
    Please tell me I can at least drink Coffee still... lol
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    Quote Originally Posted by PhilABowl View Post
    Please tell me I can at least drink Coffee still... lol
    Actually drinking to much coffee (caffeine) has been shown to cause an increase in the release of the stress hormone cortisol. Which you probably already know what that means. But I wouldn't trip on the small sh!t to much. I did actually lean out even more when I stopped drinking my normal 4-5 cups a day though. I still drink it every once in a while maybe once or twice a week I'll have a cup. But for you right now your going to have to pick and chose your battles.
    There's some pretty interesting looking fat burners out right now also. Or maybe go for something a little stronger like clen or albuterol. But I've never personally used these products so I can't help you there. Good luck though with whichever way you go! But none of this sh!t :hot:izza::burg: D@mn that's actually making me hungry. lol
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    So in other news I started my Decavol supplementation yesterday (I refuse to call it a "Cycle").
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    http://www.pubmedcentral.nih.gov/art...medid=17075613

    Clinical features of muscle dysmorphia among males with body dysmorphic disorder
    Courtney G. Pope,a Harrison G. Pope,b William Menard,a Christina Fay,a Roberto Olivardia,b and Katharine A. Phillipsac*
    a Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
    b McLean Hospital, Harvard Medical School, Belmont, MA, USA
    c Brown University, Providence, RI, USA
    * Corresponding author. Tel.: +1 401 455 6490; fax: +1 401 455 6539. E-mail address:Katharine_Phillips@bro wn.edu (K.A. Phillips).

    AbstractMuscle dysmorphia – a pathological preoccupation with muscularity – appears to be a form of body dysmorphic disorder (BDD) with a focus on muscularity. However, little is known about muscle dysmorphia in men with BDD, and no study has compared men with BDD who do and do not report muscle dysmorphia. To explore this issue, we reviewed the histories of 63 men with BDD; we compared those rated as having a history of muscle dysmorphia with those who had BDD but not muscle dysmorphia in several domains. The 14 men with muscle dysmorphia resembled the 49 comparison men in demographic features, BDD severity, delusionality, and number of non-muscle-related body parts of concern. However, those with muscle dysmorphia were more likely to have attempted suicide, had poorer quality of life, and had a higher frequency of any substance use disorder and anabolic steroid abuse. Thus, muscle dysmorphia was associated with greater psychopathology.
    Keywords: Muscle dysmorphia, Body dysmorphic disorder, Body image, Males

    IntroductionMuscle dysmorphia, a preoccupation with the idea that one’s body is insufficiently lean or muscular, appears to be a relatively new form of body image disturbance in men that has received little investigation (Pope, Gruber, Choi, Olivardia, & Phillips, 1997; Pope, Phillips, & Olivardia, 2000). Men with muscle dysmorphia believe that they look “puny,” or “small,” when in reality they look normal or may even be unusually muscular. As a result, they may neglect important social or occupational activities because of shame over their perceived appearance flaws or their need to attend to a meticulous diet and time-consuming workout schedule. Some damage their health by excessively working out (Phillips, O’Sullivan, & Pope, 1997), and others report use of anabolic-androgenic steroids in an attempt to get bigger (Kanayama, Barry, Hudson, & Pope, in press; Pope et al., 2000).

    Men in the bodybuilding world have long recognized this syndrome, and even coined the word “bigorexia” to describe it—recognizing that it is in many ways a “reverse” form of anorexia nervosa (Quinion, 2005). Indeed, the first scientific report of the syndrome, to our knowledge, termed it “reverse anorexia nervosa” (Pope, Katz, & Hudson, 1993). Subsequently, Pope et al. (1997) described additional cases and proposed to rename the syndrome “muscle dysmorphia.” This paper also suggested operational diagnostic criteria for diagnosing the disorder, and hypothesized that muscle dysmorphia was likely a form of body dysmorphic disorder (BDD) in which the focus is on muscularity, as opposed to some other aspect of body appearance, such as hair, skin, or facial features. (In DSM-IV, BDD is defined as a preoccupation with an imagined or slight defect in appearance that causes clinically significant distress or impairment in functioning, and is not better accounted for by another disorder, such as anorexia nervosa.) Since the time of that report, a growing literature of popular (Pope et al., 2000; Smith, 1997) and scientific (Cafri et al., 2005; Chung, 2001; Hitzeroth, Wessels, Zungu-Dirwayi, Oosthuizen, & Stein, 2001; Olivardia, Pope, & Hudson, 2000) publications has examined features of men with muscle dysmorphia.

    However, the relationship of muscle dysmorphia to other forms of BDD remains understudied. One recent study noted that 5 of 15 bodybuilders with muscle dysmorphia also displayed other, more classic BDD symptoms (Hitzeroth et al., 2001). This finding suggested that in some individuals, preoccupation with muscularity may be one of several concurrent body-image preoccupations. Another study (Olivardia et al., 2000) found marked comorbidity of muscle dysmorphia with other psychiatric disorders, but did not ask participants about other BDD symptoms—leaving it unclear whether muscle dysmorphia frequently co-occurs with other forms of BDD. To our knowledge, the only previous report (Pope et al., 1997) that has examined the converse topic – muscle dysmorphia in men with BDD – found that 9.3% of 193 subjects with BDD also had apparent muscle dysmorphia. However, this observation was included in a clinical overview of muscle dysmorphia, and no details about this finding were presented. Of particular relevance to the present report, similarities and differences between men with BDD who did and did not have co-occurring muscle dysmorphia were not examined.

    The aim of the present study was to compare characteristics of men with BDD who also had muscle dysmorphia to those of men with BDD but not muscle dysmorphia. To our knowledge, this topic has not previously been examined. We hypothesized that men who also had muscle dysmorphia would have higher rates of eating disorders and anabolic-androgenic steroid abuse or dependence. Comparisons of demographic characteristics, social and occupational impairment, and measures of psychopathology were made, but differences were not expected.

    Method
    Participants
    Participants were 63 men who constituted all of the male subjects from a sample of 200 individuals, all meeting DSM-IV criteria for lifetime BDD, who were participating in a study of BDD’s course. All data in this report are from this study’s intake interview. Of the 63 men, 52 (82.5%) currently met full DSM-IV criteria for BDD, 10 (15.9%) were currently in partial remission from BDD, and 1 (1.6%) was in full remission. All participants were required to be 12 years or older and available for an in-person interview. The only exclusion criterion was the presence of an organic mental disorder. Participants were recruited from mental health professionals (46%), advertisements (38%), our program website and brochures (10%), subject friends and relatives (3%), and nonpsychiatrist physicians (2%). The study was approved by the hospital Institutional Review Board, and all participants signed statements of informed consent (assent plus parental consent for adolescents).


    Procedures
    Data from the intake interview were reviewed by one of the investigators (CGP), who extracted all information from the interview that might possibly be relevant to the diagnosis of muscle dysmorphia. This information was then presented to HGP, who was blinded to all other information (aside from knowing that all cases had some form of BDD). HGP reviewed all 63 cases and assigned a diagnosis of muscle dysmorphia to those men who appeared to meet proposed diagnostic criteria (Pope et al., 1997) (i.e., the BDD criteria noted above as applied to muscularity preoccupations). In six to eight cases, interview information was insufficiently detailed to allow diagnostic certainty; the rater made a forced-choice decision in these instances. A second independent blinded rater (RO) was then later provided with the same abstracted information on each subject, and assigned diagnoses of muscle dysmorphia by the same criteria described above.


    Measures
    Participants were interviewed with measures previously described in more detail elsewhere (Phillips, Menard, Fay, & Weisberg, 2005). Features of BDD (including body areas of concern, excessive BDD-related behaviors, such as excessive weightlifting [operationalized as more than 1 h a day]), and lifetime functional impairment due to BDD) were obtained from the BDD Form (this unpublished scale is available from the last author upon request). This semi-structured measure has been used in previous BDD studies (e.g., Phillips, McElroy, Keck, Pope, & Hudson, 1993). Severity of lifetime BDD was determined with a question from the BDD Form that assessed the greatest social and academic/occupational/role interference ever experienced due to BDD on a scale ranging from none (score of 0) to extreme/incapacitating (score of 8). The rater-administered Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) assessed current BDD severity; scores range from 0 (none) to 48 (most severe) (Phillips et al., 1997). The Brown Assessment of Beliefs Scale (BABS), a rater-administered measure, assessed the degree to which body-image beliefs were delusional; scores range from 0 to 24, with higher scores reflecting greater delusionality (Eisen et al., 1998).
    Self-ratings of current quality of life were assessed by the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), which assesses satisfaction and functioning in the domains of social, leisure, household, work, emotional well-being, physical, and school. Lower scores indicate poorer quality of life (Endicott, Nee, Harrison, & Blumenthal, 1993). (The Q-LES-Q was added later in the study; thus n = 48.) The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) (Ware, 1993) assessed mental health-related quality of life and mental health status; subscale scores range from 0 to 100, with lower scores reflecting poorer quality of life. The Structured Clinical Interview for DSM-IV—Non-Patient Version (SCID-I/NP) was used to diagnose BDD and other psychiatric disorders (First, Spitzer, Gibbon, & Williams, 2001). Studies indicate that the SCID, BDD-YBOCS, BABS, Q-LES-Q, and SF-36 generate scores with acceptable reliability and validity.



    Statistical analysis
    We compared the men with and without muscle dysmorphia on demographic variables. The groups were very closely matched on these indices, suggesting that multivariate analyses with adjustment for demographic differences were unnecessary. Accordingly, we compared the groups using t-tests for continuous variables and Fisher’s exact test for categorical variables. Alpha was set at p = 0.05, two-tailed. Regarding the power of these comparisons, if one assumes that approximately 25% of the 63 men had muscle dysmorphia (as was found by both raters; see below) then there would be approximately an 80% chance of detecting a difference of 0.8 standard deviations between the two groups on a continuous variable. Because the study was exploratory, we did not adjust the alpha level for multiple comparisons. Therefore some findings, especially those close to p = 0.05, may represent chance associations. Effect size estimates were determined with Cohen’s d, and the phi-coefficient. Our primary analyses are based on diagnoses assigned by HGP; we subsequently repeated the analyses using the diagnoses made by the second independent blinded rater.

    ResultsUsing blinded ratings by the first rater, 14 (22.2%) of the 63 men were rated as having muscle dysmorphia. These men did not significantly differ from the 49 men without muscle dysmorphia on demographic indices (Table 1). BDD severity scores and delusionality (BABS score) also did not differ significantly between the groups.

    Table 1
    Demographic and clinical characteristics of muscle dysmorphic versus non-muscle dysmorphic BDD participants

    Of the 14 men with muscle dysmorphia, 12 (86%) had additional non-muscle-related BDD. Of these 12 men, 9 had current muscle dysmorphia and current non-muscle-related BDD, 2 had past muscle dysmorphia and current non-muscle BDD, and 1 had past muscle dysmorphia and past non-muscle BDD. Men with muscle dysmorphia reported significantly more body areas of concern than comparison men. However, when comparing only non-muscle-related body parts (i.e., excluding concern with the chest, calves, stomach, arms, or any other body part that the subject indicated was “too small” or “not muscular enough”) the two groups were similar (Table 1). Among the men with muscle dysmorphia, the most common area of concern, as expected, was muscularity, followed by hair (n = 9) and skin (n = 8). Hair and skin were the most common concerns for the comparison men. As would be expected, men with muscle dysmorphia were more likely than comparison men to lift weights excessively (10 [71%] versus 6 [12%]; p < 0.001), exercise excessively (9 [64%] versus 5 [10%]; p < 0.001), and diet (10 [71%] versus 13 [27%]; p = 0.009). However, other BDD-related behaviors were similar: comparing, mirror checking, and camouflaging were the most common behaviors in both groups.

    Men with muscle dysmorphia had poorer scores than comparison men on all quality-of-life measures, with two of four measures (the Q-LES-Q and SF-36 Mental Health subscale) reaching statistical significance, with large effect sizes. Men with muscle dysmorphia were also significantly more likely to report a suicide attempt. As hypothesized, men with muscle dysmorphia were significantly more likely to have abused anabolic-androgenic steroids—but unexpectedly, we found that they also exhibited a significantly higher lifetime prevalence of substance use disorders. Also as predicted, a higher proportion of men with muscle dysmorphia had a lifetime eating disorder (small–medium effect size), but the between-group difference was not statistically significant.

    The second, independent blinded rater diagnosed muscle dysmorphia in 18 (28.6%) of the 63 men—representing the same 14 men diagnosed as having muscle dysmorphia by the first rater, plus 4 additional cases. Thus, the raters exhibited 93.6% agreement, with kappa = 0.83. We repeated the comparisons in Table 1 using the second rater’s muscle dysmorphia diagnoses, which produced very similar results (all findings significant at the p < 0.05 level remained significant at this level in the second analysis, and all nonsignificant findings remained nonsignificant).

    DiscussionWe found that males with BDD plus muscle dysmorphia were similar to those with BDD but not muscle dysmorphia on many variables, including BDD severity and delusionality, preoccupation with non-muscle-related body parts, and non-muscle dysmorphia-related BDD behaviors. However, the men with muscle dysmorphia were more likely to engage in several compulsive behaviors, and exhibited significantly greater psychopathology in terms of quality of life, suicide attempts, and prevalence of substance use disorders and anabolic-androgenic steroid use. A remarkably high proportion (50% in our primary analysis using ratings of the first rater) had attempted suicide, and their Q-LES-Q and SF-36 scores were strikingly poorer (1.7–2.6 standard deviation units lower) than general population or community norms (Endicott, personal communication; Ware, 1993).

    It is unclear why men with muscle dysmorphia were more impaired. We would hypothesize that preoccupation with additional body areas, combined with additional time-consuming compulsive behaviors (excessive weightlifting, exercising, and dieting), amplifies the distress and impairment typically experienced by individuals with BDD. In a sense, our findings are consistent with studies of other disorders, which have found that greater axis I comorbidity is associated with poorer functioning (Welkowitz, Struening, Pittman, Guardino, & Welkowitz, 2000) and increased suicide attempts (Lecrubier, 2001). Although muscle dysmorphia is considered a form of BDD, rather than a comorbid disorder, the effect of additional symptoms may be similar.

    Of note, several men with muscle dysmorphia reported anabolic-androgenic steroid use to increase muscle mass. This finding may be an underestimate, given that anabolic-androgenic steroid use is often denied (Pope, Kanayama, Ionescu-Pioggia, & Hudson, 2004). Given the medical and psychiatric risks associated with anabolic-androgenic steroid use (Brower, 2002; Pope et al., 2000), this behavior represents a serious clinical concern. The men with muscle dysmorphia also had a remarkably high rate of substance use disorders more generally—a finding that recalls another recent study showing that anabolic-androgenic steroid users exhibited remarkably high rates of other substance abuse and dependence (Kanayama, Pope, Cohane, & Hudson, 2003).

    One study limitation is the small sample size, which limited statistical power. Also, the sample was one of convenience, and participants may not have been entirely representative of those in the community or the subgroup that consults clinicians. In addition, information in some records was insufficient for raters to diagnose muscle dysmorphia with certainty; however, there was a high rate of agreement between the two independent blinded raters, and two separate analyses, using the diagnoses of the two raters, produced very similar results. Furthermore, we did not compare a group of men with “pure” muscle dysmorphia (i.e., men with muscle dysmorphia but not other forms of BDD) to men with BDD but not muscle dysmorphia. (We found that several participants in our study had “pure” muscle dysmorphia, and this was the case for 10 of 15 participants in the study by Hitzeroth et al. (2001).) Such studies are needed to shed additional light on similarities and differences between muscle dysmorphia and more classic BDD symptoms, including whether muscle dysmorphia may be a more severe variant of BDD.

    These findings have several clinical implications. First, when evaluating men presenting with any type of BDD, clinicians should inquire about muscle dysmorphia, since men with other body-part preoccupations may also have muscle dysmorphia, which appears to be associated with greater psychopathology. Second, if our findings are valid, and muscle dysmorphia not infrequently co-occurs with other manifestations of BDD, then it might be expected to respond to treatment similarly to classic BDD (i.e., serotonin uptake inhibitors [Phillips, 2002] or cognitive-behavioral therapy [Rosen, Reiter, & Orosan, 1995]). However, the treatment of muscle dysmorphia symptoms needs to be studied, as do many other aspects of this recently recognized and understudied condition.
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    So to recap:

    1. Workout hard, low volume and heavy - I love 5x5

    2. Calculate your calories for the weight / LBM you wish to be and eat that. Generally focusing more on, in the least getting good clean protein every meal.

    3. Eat your correct amount of food in multiple meals a day i.e. 6

    4. Stack the deck in your favor by having a shake etc immediately following your workout and flood your muscles with the good stuff.

    5. Rest well. 8-10 hrs night

    6. Cardio - HIIT cardio 3 or more times a week will get you there.

    7. Supplementation - Multi, Whey, Fish oil / flax etc, BCAA's, Anti Estrogen, Test Free'r, Creatine.

    Have fun!
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    I guess I could have just posted this and I second what B5150 said, the reallyo deallyo

    1. Workout hard - There are many different workout regimes, many that work well. Generally: Strength training is in the 6 rep range / Bodybuilding in the 8-10 rep range. - Rep range warmup: 15 ( sets 1 & 2 ) Working: 10, 8, 6 last three sets add drop sets to failure )

    2. Fast Efficient Workouts = 1hr - This is not hard and fast but studies have shown that Cortisol rises after 1hr

    3. Protein shake immediately after workout and then protein meal with carbs etc within 1hr

    4. Creatine - Mono or CEE you decide. Both before and after workout.

    5. Daily meals - 5 - 6 day ( including shakes ) protein = 1g per pound of body weight. Meal 1 ( breakies ) is shake plus oatmeal or whatever else you want ( apple is good fibre / system crap mover ), Meal 6 is post workout shake with creatine etc and then solid food meal. Carbs tapered down from morning to evening and fats tapered up from morning to evening. Protein is a constant.

    6. Sleep 8 - 10 hrs a night ( very imp for all natural BB'ers )

    7. Supps - Do you note the order in which these are and where supps come??? - a) Multivitamin / B complex b) Whey protein c) creatine e) Test boosters / stacks etc

    Most importantly do you see the order of these things?

    Exercises: Compound movements i.e. two arm two leg exercises.

    1. Squats - Biggest muscle and boosts test like crazy, work em hard and see results big time.

    2. Deadlifts / Chins / Bent over Rows / Pulldowns - 1st attempt either an palm up or palm down chin at the beginning of your back workout, if you can do one, try two, if you can do 15, add weight. Most important for back is to make the mind / muscle connection. Concentrate ( start with low weight and excellent form ) on getting a good contraction and not swinging with the weight. Calm controlled up down with good squeeze of lats at bottom of rep. All about the connection / squeeze

    3. Leg press

    4. Flat Bench Dumbell / Barbell - Always swap it up, it takes more muscle etc to do dumbells ( stabilizing muscles etc ) but switch it up - Start with dips to hit lower chest then move to flat bench / incline.

    5. Core work - Abs / lower back - work the weaker harder.

    This should give you a good idea....Best thing for test.....squats ....good form, warm up well, be careful and grow!
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    Funny you mention it I was paying attention to that particular post and trying to follow it
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    Had bodyfat measured today... 21%, so its right between the two estimates
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    Quote Originally Posted by PhilABowl View Post
    So in other news I started my Decavol supplementation yesterday (I refuse to call it a "Cycle").
    17a-Methyl-etioallocholan-2-ene-17b-ol is Phera-Plex:

    Pheraplex:
    Innovator: Designer Supplements
    Nomenclature: 17a-Methyl-etioallocholan-2-ene-17b-ol
    Pill Size: 10mg
    Dosages: 10-40mg
    Side Effects: liver toxicity, bad lipid profile, lower back and calf pumps, some users report aggrevation of gynecomastia with this compound.
    Reputation: Solid product for bulking. Wet gains. It is a sometimes used to jumpstart an injectable cycle. This is the less androgenic isomer in the Ergomax LMG matrix.





    Regardless of whether you want to 'call' it a cycle or not, it is.

    It is not a 'supplement', its a steroid and thinking that will get you into trouble.

    I would cease 'supplementation' immediately and get your diet dialed in. Drop the sodas and juices. Eat 6x/day. Calculate your cals and start a food log on fitday.

    I think once you actually 'see' whats going into your mouth you will get a better handle on your bf%.
  

  
 

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