With the media attention that comes with bodybuilding, when a bodybuilder dies early it’s usually bigger news than it might have been. But there certainly have been a lot of bodybuilders who have died in the last few years. Often from heart problems. Is this coincidence? Or can bodybuilding kill you?
Bodybuilding has been shown to increase the risk of heart complications in later life. But this is mostly down to anabolic steroid use. Bodybuilding also involves many risky practices such as the use of diuretics before a competition, the use of insulin, and extreme calorie restrictions. Natural bodybuilding performed properly could reduce your chances of dying early.
In this article, I will take a look at the main causes of death among bodybuilders who die early. I will also look at what makes bodybuilding so dangerous to some people, and talk about ways to avoid the increased risk of dying early.
The death of Rich Piana shook the bodybuilding world to its core, but should it have? Piana hadn’t looked very healthy for about a decade, was clearly using anabolic steroids, and also appeared to be a recreational drug user. I don’t write this as a criticism of his lifestyle, just as a fact.
This was a man who pushed his body to its limits. He pushed himself in positive ways (exercise) and in negative ways (drug use). He was repentant about his anabolic steroid use in later years, and had this warning for younger bodybuilders:
“If you have the choice to do steroids or stay natural, stay natural. There’s no reason to do steroids. You’re only hurting your body and hurting yourself.”
The stats are there for all to see, and I’ve talked about it before, anabolic steroids are linked to an increased incidence of heart complications that lead to dying early. A 2020 study by Perry et al found that:
“there was evidence that suggests an association with CVD, primarily myocardial infarction, fatal arrhythmias, and cardiomyopathy in AS users.”
Perry et al (2020)
But anabolic steroids are not the only cause of early deaths in bodybuilders. Insulin use is incredibly dangerous for non-diabetics but is rife within bodybuilding. It has led to several deaths. Human Growth Hormone (HGH) is another common bodybuilding drug that has led to several deaths.
You also have the risks that accompany using diuretics before a competition, which has led to many bodybuilders and fitness models becoming unwell or even dying. There is also the mental health side of things.
This article will take a look at each of these issues in turn, before focusing on ways to avoid these risks.
It’s difficult to explain just how endemic anabolic steroid use is within bodybuilding. Not just bodybuilding either, but amateur sport in general. A 2018 study found that 43.6% of amateur athletes admitted to having used anabolic steroids in the past.
The difference between bodybuilding and athletics though is the amount of anabolic steroids used, not just how prevalent it is. Steroid use for performance can be quite minimal, whereas the amount of anabolic steroids required for the huge physiques in bodybuilding is much higher, requiring prolonged usage over decades.
This is why there is a greater correlation between steroid use in bodybuilding and early deaths. The biggest issue with anabolic steroids is the effect that they have on your heart. As cardiosmart.org put it:
“Steroid users had significantly more plaque build-up in their arteries than non-users. The longer men reported taking steroids, the worse their arteries were. Plaque build-up is a sign of heart disease, which is the No. 1 killer of men and women in the United States.”
But it isn’t just the arteries that are affected, studies have shown that anabolic steroid use can reduce the amount of oxygenated blood that the heart pumps with each contraction.
“This study provides strong evidence that anabolic steroids pose serious and sometimes even fatal dangers to the muscle and the blood vessels of the heart. Given that some 3 million Americans have tried these drugs, this represents a significant public health problem”
What’s interesting to note (and tragic) is that even bodybuilders who live longer lives tend to die due to heart complications. Bodybuilding legend Franco Columbu died of a heart attack while swimming at the age of 78.
Honestly, I could go on and on, but I think I’ve proved my point. Check out this article from Fitness Volt for a complete list of all of the bodybuilders who died between 2017 and 2020. Remember, these are just the famous ones.
While the heart complications caused by steroids are the most common, there are many ways in which anabolic steroids use can kill you. Here are some other issues:
As you can probably guess, some of these causes of death are unlikely to affect most people. It should be easy to avoid HIV or hepatitis for example. I will talk about the mental health issues surrounding bodybuilding separately. Not because anabolic steroids aren’t a likely cause of depression (they are) but because there are so many other factors that can lead to depression in bodybuilding.
The use of insulin in bodybuilding has absolutely skyrocketed over the last 30 years. It is the main reason behind the much more muscular looking Mr Olympia competitors and is used by most Pro bodybuilders (if not all).
Insulin use leaves no trace, so it is impossible to test for. Meaning that its use in regular sports could be much higher than assumed, and thanks to its incredible ability to increase glycogen and build muscle it is unlikely to be going anywhere.
The problem is that insulin use can be incredibly dangerous. Insulin lowers your blood sugar, if your blood sugar becomes too low then it can lead to hypoglycaemia, which can result in death. Diabetics are okay to take insulin because their body is not producing enough insulin already. But bodybuilders who take insulin without having diabetes may already have low blood sugar. Hence the risk.
You can read a harrowing report of a 31-year-old bodybuilder who was found unconscious in his house after taking insulin. Luckily, doctors were able to identify the problem and save his life, but they won’t always be so lucky.
“However, this potentially lethal drug has serious consequences should things go wrong, particularly as it is usually used in secret without even the knowledge of loved ones. This puts the user at risk of developing hypoglycaemia for prolonged periods away from possible medical assistance potentially resulting in coma and death”
Evans & Lynch 2003
Unlike anabolic steroids, there aren’t really long-term issues with taking insulin. The risk is much more immediate. Taking just one shot of insulin could kill you. This is what most likely killed bodybuilder and aspiring WWE wrestler Ghent Wakefield in December 2016.
This excellent YouTube video by Generation Iron Fitness sums up the issues surrounding insulin use very well.
I’m not going to lie and pretend that Human Growth Hormone (HGH) is as dangerous as anabolic steroids, but there is a reason why it is illegal to use without a prescription. You get all the usual risks associated with taking drugs via injection, and there appears to be some risk of developing certain cancers or developing diabetes (not in itself fatal, but certainly not healthy). The Guardian wrote an article about it in 2010.
“Inexperienced syringe users can slash an artery and bleed to death, create blood clots, or hit a nerve and risk permanent paralysis. Long-term use can, according to Graham, lead to carpal tunnel syndrome (the compression of nerves in the wrists, which causes incessant tingling), raised blood sugar levels (which can trigger Type 2 diabetes), heart failure and – in excessive doses – gigantism, the disproportionate growth of body parts.”
The risks of accidentally slashing your wrists and bleeding to death are ridiculously low, but even so, not something that you really should be risking at all! All in all, if you are going to die from bodybuilding, HGH is unlikely to be the cause. But it is possible.
Diuretics have two uses, they can be used to remove all body water (making you appear leaner) and they can mask the use of other drugs. This is why they are banned by every major sporting organisation.
It’s not just the drugs themselves, the whole process of water manipulation can be dangerous. Many bodybuilders will eat high-sodium foods the night before and avoid water during the competition.
I remember going to see a work colleague compete for an amateur bodybuilding comp, and witnessing him drinking massive bottles of water post-show, followed by several electrolyte drinks. All because he had dehydrated himself to an extreme level. He did win though!
As you can imagine, this extreme practice has led to tragedy on a number of occasions. Most of these deaths actually occurred on stage! Check out this article to learn more about it.
Of course, there will be many people who dismiss the risks. Pointing out that if you know what you are doing the risks are minimal. The counter-argument would be that several Pro bodybuilders have died from it. All of whom would have claimed to know what they were doing beforehand.
There are several reasons why bodybuilders may be at a higher risk of depression and/or suicide than other demographics. Though obviously, this will differ from person to person. As I mentioned earlier, there is certainly a connection between anabolic steroid withdrawal and depression. But there are also issues surrounding the culture of bodybuilding that rarely get talked about. Here are some potential causes of mental health issues:
In this section, I will take a look at each of these four mental health issues and how they may affect bodybuilders.
Steroids work by mimicking the effects of testosterone and similar sex hormones in the body. They do this so well that your body soon stops producing its own testosterone. This can be a problem, but bodybuilders have numerous ways to deal with it. However, you can’t do this forever. There is going to be a point where you stop taking steroids and want to get your natural testosterone levels back.
During this time, your body will go through a period of having very low testosterone levels. Because you aren’t producing any, and you aren’t getting any from steroids. Low testosterone is correlated with depression, and the risk of suicide will of course be higher. Many bodybuilders and pro wrestlers have died through suicide with steroid withdrawal being a suspected cause.
When people talk about body image and low self-confidence, it is usually in reference to young women, particularly women in the fashion or beauty industries. But poor body image (body dysmorphia) is not something that affects just women. Men can also suffer from it.
Bodybuilders are perhaps most likely to have issues around body image. Think about it, your actual job is to make yourself look “perfect” and then to get up on stage and be judged for that look. Many men who get into bodybuilding often talk about having a bad self-image or low self-esteem before they got into it.
Think about how many bodybuilders referenced that famous Charles Atlas comic strip as a motivator to get into shape. You know the one, where a really skinny guy gets sand kicked in his face by a big strong man, but is too puny to do anything. He then becomes a bodybuilder and punches the man in the face.
Who is that advert aimed at? Young men who feel bad about their bodies. The advert is from the 50s, so it is aimed at skinny guys. If the advert was made today it would probably be aimed at overweight men.
“Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.”
Picture a man with an absolutely incredible physique, who is fighting back tears because he feels like his delts are too small. Does that not sound exactly like body dysmorphic disorder? As you can imagine, extreme body dysmorphia is linked with depression, anxiety, and suicidal tendencies. It is estimated that as many as 54% of men who exercise may suffer from body dysmorphia.
Technically, body dysmorphia and disordered eating could easily have been grouped together. But I want to keep them separate. Because I believe that there are men who don’t have body dysmorphia but who do suffer from disordered eating.
What is disordered eating?
“Eating disorders are a group of related conditions including anorexia, bulimia and binge eating. Symptoms of an eating disorder include worrying about your weight, eating too little or making yourself sick after eating.”
Again, there is this perception that only young women can get an eating disorder. But this simply is not true. Let’s take a look at each of the three common forms of disordered eating. Anorexia nervosa, bulimia, and binge eating, and I’ll show you how they can tie into bodybuilding.
If you have the time, check out my article on overtraining in bodybuilding. Thanks to large amounts of anabolic steroids and assorted other drugs, bodybuilders often train twice per day for six or seven days per week. This will absolutely lead to overtraining eventually.
The side effects of overtraining? Low testosterone (though if they are taking steroids this won’t be noticeable), bad sleep, injury, pain, stiffness, stress, anxiety, mood swings, and depression. Is training-induced depression likely? It’s hard to say, there are so many other factors that can cause depression in bodybuilders (see above), that pinning a bodybuilder’s depression down to just overtraining is unlikely.
But yes, it is certainly possible, and it could end up with suicide if that bodybuilder doesn’t get the help they need.
I think that the biggest thing that most men can do to reduce their risk of death would be to avoid anabolic steroids, insulin, HGH, and all other forms of doping. I also think that bodybuilders should probably get a therapist if they are feeling low, or overly stressed about their appearance.
But realistically, I know that this is unlikely to happen. Men are much less likely than women to ask for help when they need it. Bodybuilding, which is still a very macho community, perhaps suffers more because of that.
Suicide is the number one cause of death for men aged 20-49 in the UK.
I worry about this when it comes to bodybuilding, because of the increased likelihood of body dysmorphia, eating disorders, stress, anxiety, low testosterone, bad sleep, and mood swings. Steroids may make a lot of this worse, but even natural bodybuilders can be susceptible to mental health problems.
It’s frustrating, because done right, bodybuilding can be incredibly good for your health, both physical and mental.
Natural bodybuilding focuses on regular exercise, eating healthily, rest and recovery, and getting enough sleep. Every aspect of natural bodybuilding should help to improve your health and fitness, which can add decades to your life.
Bodybuilding itself is not harmful to your health. The problems I mentioned above, are down to the culture that surrounds it. You don’t need to take diuretics, you don’t need to inject yourself with anabolic steroids or HGH. You certainly don’t need insulin injections.
Yes, bodybuilding can kill you. But so can many things when followed incorrectly. This site is called Beer n Biceps, if I drank 20 cans of lager each night I could die of liver failure within a decade. But I drink sensibly and therefore should be fine.
It is possible to gamble once a week for 50 years and never become addicted. Or you could go to Vegas for the first time and gamble your house away within a couple of hours. Different people respond to things in different ways.
Bodybuilding is extreme. For good or bad, it will attract extreme personalities. This has caused a lot of good, but it has also led to a lot more danger over the years. You could follow a natural bodybuilding routine, exercise regularly, eat right, and live to 110 years old.
You could even do a couple of steroid cycles sensibly, and you would probably still be absolutely fine.
But take steroids for 20 years, inject insulin before workouts, use diuretics before shows, and deal with the massive mood swings that all of this can cause, and you may be putting your life at risk. I’m not here to tell people how to bodybuild, I’m just sharing some facts.
Matt Smith is the owner of Beer N Biceps. He has a degree in Sports Science, 10 years of experience working in the fitness industry, and has written for hundreds of fitness websites. He is a lover of good quality beer and believes that drinking in moderation can form part of a healthy lifestyle.