|
2000:
January
| February
| March
| April
| May
| June
| July
| August
| September
| October
| ... |
|
||
|
February
2000
Diuretics:
In the last ten years in bodybuilding there has been an endless proliferation of articles and newsletters surrounding drug use by athletes. While some articles attempt to give a scientific assessment of various drugs used by athletes, others are a dangerous blend of " how to " advice from unqualified self proclaimed experts and gurus in the industry. Still other articles are nothing more than ridiculous "reefer madness" scare tactic articles about the life threatening dangers and overstated side effects of performance enhancement drugs. While not many in the know people take these types of articles seriously, the guru reports are often read with great enthusiasm and bible-like seriousness by wannabe bodybuilders. While this is usually just a minor irritation for the real intellectuals in our industry, it can become dangerous and disastrous advice when discussing the more potentially life-threatening drugs like diuretics. So while guru or expert advice might often just lead you to a bad contest result, such advice in the area of diuretics use could cost you your life! Blind faith in anyone or any product in our day and age can have disastrous results. I would like to caution all readers that GURU is a four-letter word. Why is it in our industry that these gurus who seemingly know all are always trashing the education of qualified people? There are two ways to be an expert at something. One is through formal education and knowledge and the other is through years of applied experience. Of course the greatest experts of all are those who combine both of these qualifications to something they love. When you are considering advice from your favorite guru you should be able to decide if they are truly experts or are they giving you a dog and pony show with a lot of hocus pocus and what I call voodoo guru approach to success. Look for experts who have university educations and scholarships and are working at what they love. If there are no degrees beside their name, be skeptical. Then look for the level of expertise and experience of this expert. Why is it in bodybuilding we will rely on so-called experts with no academic credentials and their experience level is a magic act. I've read the writings of no fewer than five self proclaimed experts and it amazes me that people would listen too much of anything they have to say. Here are supposed experts who have been active in the industry over ten years and who have admitted to using and abusing most anabolic drugs on the market, yet they are all 160lbs,or under soaking wet! Just because someone has big muscles does not make them an expert either, but when self-proclaimed GURUS have nothing to show for their years of drug use, and they have no formal education to speak of, what kind of expertise could they possibly offer? There are real and true experts out there. Most of them are too busy in their chosen careers to worry about pursuing magazine notoriety, but they are out there. Probably the foremost expert on most things related to our industry is Dr. Mauro DiPasquale. But I seriously doubt he would like the moniker of Guru. This month we were asked to cover the issue of diuretics for interested readers. I think this is a good idea considering the rampant misinformation that exists about various drugs in this industry. Also the way athletes are starting to treat drugs with a carefree and reckless regard to the fact that pharmaceuticals of all kinds affect your body in profound ways, is an attitude that can and has killed many athletes in various sports when it comes to diuretics abuse. And make no mistake, athletes are abusing these drugs regularly out of misinformation and a total neglect to why they are prescribed to begin with. The banning and testing for diuretics at contests is probably a good idea, however without explaining the causative factors involved the abusive bodybuilder mindset will just look to alternatives regardless of how dangerous this may be. Although we've all seen and heard of the diuretics related tragedies and near tragedies in our sport, without educating the athletes and consumers as to what is happening in the body they will continue to play dangerous games with very dangerous drugs. When I hear of athletes using the word stacking in relation to diuretics use I know immediately that they are courting disaster. HEAR THIS: There is never a reason for a bodybuilder to use more than one diuretic for final fine-tuning. The interplay of various types of diuretics in the hands of the uninformed, and even among health care professionals for that matter, is where the most danger lies. And remember we're not talking about cramping here we're talking about the very real possibility of terminating one's life by accident. For you bodybuilders who think you know what you're doing, remember that Momo Benaziza figured he knew what he was doing as well. Diuretics are prescribed for severe edematous conditions. edematous means water swelling or water holding) The more potent diuretics are prescribed for the more immediately serious conditions. Examples include congestive heart failure and renal (kidney) impairment and liver cirrhosis and other type of seriously debilitating conditions. These drugs are prescribed to try to keep fluid balance and hence electrolyte balance in check. That is why in most of these cases patients are already hospitalized and doctors will keep a constant monitoring of electrolytes by blood test during diuretics therapy. If trained individuals need to monitor patients receiving diuretics because of potentially dangerous electrolyte changes what makes bodybuilders think that self-medicating with diuretics is a risk free proposition. Electrolyte balance is maintained in exact and delicate ratios and not knowing potential problems means not knowing how to handle them when they occur. Bodybuilders should always consider that they are taking these drugs for very specific reasons other than why they are prescribed. Bodybuilders before a show are not in an edematous state and should not attempt to medicate themselves as if they are. Bodybuilders have mistakenly begun to think that diuretics use will make up for a lack of commitment to diet during the last several weeks before a show. The truth is if a bodybuilder isn't contest ready at least a week out from his show diuretics use will do nothing and diuretics abuse will make the problem worse. The assumption that an athlete cannot get contest ripped without diuretics is a dangerous fallacy perpetuated by gurus and internalized by athletes who don't know any better. However the most consistently ripped athletes are the ones who never seem to have on or off stage cramping or electrolyte related problems. Laura Binetti, Kim Czvesky, Hamdullah Aykutlu, and Shawn Ray, are just a few names that come to mind of extremely ripped and consistently contest ready bodybuilders who never seem to suffer the slings and arrows of diuretics misfortune because they are contest ready way before the contest and they don't practice last minute foolishness like diuretics abuse and hope for the best. Obvious to the reader by now is that diuretics effect electrolytes in potentially profound ways and the tendency for problems with bodybuilders health and performance lies within the electrolyte situation. The tendency for muscles to cramp is related to serum levels of sodium, calcium, magnesium, potassium, and acidity. The lower all of these variables, especially calcium, the greater is the tendency and severity of cramping and further problems. This condition is known as hypovolimia, meaning low blood volume and low serum electrolytes, which is common among pre-contest bodybuilders considering lowered kcalories can sometimes lower blood pressure as can low sodium and too much water intake. Any one of these situations plus using a diuretic, especially a strong one can lead to hypovolimia. This is just one small example of complications of diuretics therapy of all types when applied without pre-considering the overall physiological state of the body at the time of the decision to use diuretics. Smart athletes taking diuretics, and there aren't many smart ones, supplement their diets with calcium magnesium, and sodium, through a high sodium intake. That's right, high sodium intake, not potassium supplementation. Some of the more serious and life threatening effects of diuretics have to do with potassium. High serum levels of potassium is as life threatening or more life threatening than low levels of potassium; this is known as hyperkalemia or high serum potassium level and can cause instant death. As we will see later if an athlete takes a potassium sparing diuretic, and is supplementing his diet with extra potassium or the old myth of taking Slow-K, which is prescription timed released potassium pharmaceutical, he or she could be programming themselves into an instant death situation. One of the ways Momo probably died was from hyperkalemia, where his heart just beat itself to death. CLASSIFYING
THE DIURETICS POTASSIUM
SPARING DIURETICS The above is merely the sodium related side of the coin when it comes to using the potassium sparing diuretics. In the case of potassium the potential for real problems is much higher and much more severe. With this family of drugs all patients are warned not to use any kind of potassium supplements since hyperkalemia is a very real possibility. Often, for certain individuals even diets high in potassium can result in hyperkalemia, and hyperkalemia by definition is a life-threatening event, where the high potassium levels cause cardiac irregularities, which can be fatal. It is important to note that for those prone to this condition, hyperkalemia can occur even in the absence of potassium supplementation. Therefore bodybuilders trying to follow the traditional but faulty logic of their previous compatriots, who supplement potassium and limit sodium are courting disaster even with what is known as the least dangerous of the diuretics. Individuals who are genetically more prone to this condition and also happen to be bodybuilders could find this out the hard way. Not to mention even if the situation doesn't get dangerous, the previous symptomology would make it hard for an athlete to compete at all least of all enjoy it while they are doing it. The top biochemists in the field that are in the know also think that clenbuterol may have a pronounced effect in this area. It is felt that clenbuterol may cause potassium to exit the cell and this is why many clenbuterol users get intense muscle cramps. More importantly, the potassium that clenbuterol causes to exit the cell will increase the plasma levels of potassium. Combine this with the use of diuretics from this family and the potential for hyperkalemia increases tremendously. This is just another example of the possible conflicts of self-medication when athletes know nothing of drugs metabolic effects and therefore why it may be contra-indicated with other drugs that athletes will use anyway. Sometimes this only means putting up with bothersome side effects, but in this case the result could be a tragedy. The early signs of hyperkalemia include parathesia, intense cramps, palpitations or angina (heart or chest pain) and extreme weakness. Anyone who experiences such effects before a show while using drugs from this family should immediately get to a hospital. However, some of the more benign side effects related to this family of drugs, are completely mis-represented. Although the literature reports that these drugs may cause gynocomastia, this effect is related to duration and dosage. Mostly gyno from this group of drugs is only noticed in the elderly who have very low circulating levels of testosterone, and because of heart or kidney problems they are on high doses of these drugs for very extended periods of time, like months or years. So your guru guides who warn of this effect are not only missing the more serious nature of the issue but they are proving once again that a little knowledge is a dangerous thing. For women who because of bad advice, have taken strong male androgens for a contest, taking drugs from this family after a show under the correct medical and nutritional guidance (see above) may offset the potential for androgenic side effects caused by other androgenic steroids. Hopefully women don't get into this situation at all, but if they do this may be one example where a course of drug therapy may be of use to athletes who have mistakenly or otherwise abused their bodies. Because I've stated this group of diuretics are among the more safe ones, and because they are often prescribed for less serious conditions like menstrual bloating etc. let's review what was actually said above before bodybuilders start thinking how safe and great this family of diuretics must be. First consider that these drugs are prescribed to normal individuals who probably are not eliminating crucial electrolytes like sodium from their diets for extended periods of time. Moreover, the normal populace is less likely to be doing crazy things with their carb intake, and cutting their fluids before undertaking diuretics therapy. These factors of use and misuse are what influences potentially dangerous drugs into becoming dangerous drugs in the hands of the uneducated user. Hopefully enough said here! THIAZIDES Drugs from this family are generally prescribed for edema related to more severe conditions associated with heart failure, cirrhosis, and renal failure. The influence on electrolytes by this group is more profound and invasive than the potassium sparing diuretics. The thiazides increase sodium excretion, chloride excretion, and water excretion, and thus it causes a decrease in the amount of extracellular fluid, which is the goal of using these drugs. However, there is a corresponding reduction in circulatory volume, which can lead to orthostatic hypotension, which we covered above. Again because of the way almost all bodybuilders are treating their bodies before a show because of mis-information and bad advice this situation would be quite common amongst bodybuilders. Moreover, the sodium depletion, which accompanies the use of these drugs, can be of immediate concern for the athletes who are needlessly keeping sodium out of their diets to begin with. (hyponatremia) The consequences of these effects are weakness, fatigability, parathesias, and metabolic alkalosis. Because these drugs also cause potassium excretion the condition of hypokalemia is a very real possibility. This is why some manufacturers decided to add a potassium sparing diuretics component to these compounds. This also may be where athletes mistakenly began to get the idea of potassium supplementing before a show. Remember however that drugs given to normal individuals for entirely different medical concerns than why athletes are using them, often means that applying the same logic to their use by athletes is a faulty proposition. This is one such case. Also the combination of low potassium levels and the great loss of magnesium, and some believe chloride, when using these drugs can lead to intense muscle cramps, and most of the other effects listed above. For some unknown reason these drugs cause a reabsorption of calcium in the distal tubule, which can in rare instances cause hypercalcemia, or too much calcium in the blood. However in general, this effect is one of the things that makes this group slightly less dangerous than the next group of diuretics that we will discuss. In mentioning calcium it should be noted that calcium and magnesium need to be present together to prevent intense muscle cramping in real world situations. This delicate balance between calcium and magnesium is often why hard training athletes find themselves cramping regularly in the offseason in specific muscle groups that have recently undergone intense training sessions. Most often cramping related to this situation seem to come at night. Most hardcore athletes know what I'm talking about here but until now never really knew why it was happening. The physicians desk reference guide recommends that in cases of extreme adverse reactions, sodium replacement therapy is the treatment of choice. Many mis-informed and mis-guided bodybuilders have found themselves in the hospital following a bad diuretics episode. Most are given I.V. fluids to help restore them to normal and almost always these fluids are nothing more than saline solution, or in other words, sodium and chloride intravenous. Funny how these bodybuilders whine about their veins disappearing and feeling flat when using these drugs, yet their vascularity returns almost immediately after receiving sodium by intravenous feeding. Has anyone clicked in yet? Again keep your sodium intake high, all through the year but especially pr-contest and especially if you are going to use diuretics. Not only is this a safer and healthier thing to do, but it is also an advantage cosmetically. (see previous article on sodium by the Venice Beach Group) As we can see the list of potential conflicts grows with the more potent diuretics. The one thing to consider here then, is dose indications. The physicians desk reference is quick to point out that doses above 25-50 mgs. one to two times daily will do little to increase effectiveness but will certainly lead to more pronounced side effects. And this is in relation to these drugs as prescribed for actual medical situations. Bodybuilders who try to convince themselves that a little more may be a little better will usually regret such a decision. Consider that bodybuilders close to a contest are already fairly lean, especially compared to normal individuals. Consider also that these athletes are not suffering from any real world edematous conditions. Combine these points with the way bodybuilders try to use these drugs and it becomes obvious that the potential for danger is real and immediate. Sometimes the danger lies with athletes who manage to escape serious side effects the first time they try these drugs so they see them as harmless. This roll of the dice mentality with such potentially dangerous drugs will usually come back to haunt these athletes at some time in the future. So far we've learned that athletes should be keeping their sodium high and that they should probably be supplementing with a good and strong cal/mag especially before a show. We've also learned about the myth and the dangers of potassium supplementation especially in connection with diuretics use, and hopefully we've learned by now that diuretics use is no game, and that different families of these drugs carry with them their own distinct dangers. A diuretic is not a diuretic. Each kind influences the body in different ways and uninformed athletes who don't understand this will not know what to do should specific and real problems arise. THE LOOP
DIURETICS The diuretics from this family are the most powerful diuretics, and are short acting diuretics. Examples include furosemide, better known as lasix, and its analogs, such as bumetanide and piretanide. Even stronger drugs from this family often used only with racehorses have found their way into the athletes drug arsenal. This of course is a colossal mistake. For all intents and purposes these drugs are similar to the thiazides but are quantitatively greater in effect. Unlike the thiazides however, drugs from this group also cause profound losses of calcium. Being by far the strongest and most potent of the diuretics these drugs are usually prescribed for the most severe conditions of acute heart failure, pulmonary edema, and hypercalcemia of the life threatening nature. The drugs from this family cause massive changes in fluid balance. Severe electrolyte depletion can occur with the loop agents especially with higher doses and a restricted sodium intake. This is obviously a situation which would be common to bodybuilders should they choose to use the loop agents. Earliest warning signs are very intense cramps usually beginning in the legs. Athletes using loop agents and experiencing this effect should consider this a warning sign of imminent danger ahead. Unlike the thiazides, loop agents cause a decrease in serum levels of calcium and magnesium because of an increased excretion of both. These conditions are known as hypocalcemia and hypomagnesemia respectively. Intense cramps caused by this effect are painful warning signs of more extreme trauma ahead. Extremely low levels of calcium in the blood can lead to muscle tetany, where the muscles feel locked in a cramped and contracted position and could even tear away from the bone. So important is calcium in the blood that only 1% of calcium in the body circulates in the blood while the other 99% is stored in the bones etc. in order to control the delicate calcium ratios which must be maintained. Calcium can be considered the patriarch of all the electrolytes and in a hypocalcemic situation a cascade of negative and life threatening events can occur. Because the loop agents cause indiscriminate losses of all the electrolytes every dangerous situation of individual low levels of particular electrolyte imbalance is a possibility. We've already discussed the calcium and magnesium related problem potential but the loop agents also cause losses of potassium and sodium, two situations that are life threatening and have already been discussed elsewhere. Because these agents act so swiftly and powerfully, effecting all electrolytes either directly or indirectly, extreme hypotension often occurs. (low blood volume) When left unchecked this condition can and has caused a reduction of blood volume to the point of circulatory collapse. This is another of the possible ways that Momo Benaziza may have died. In regards to the situation of hypovolimia the physician's desk reference warns that since rigid sodium restriction is conducive to both hyponatremia (too low of serum sodium levels) and hypovolimia (too low of circulating blood volume) strict restriction of sodium intake is not advisable in patients receiving the loop agents. This is yet another scientific explanation to keep a high sodium intake in the diet of a pre-contest athlete. The use of loop agents just makes the situation worse. Often athletes for some unnecessary and foolish reason stack the loop agents with other diuretics. Obviously this only increases the potential for tragic complications. The thinking here is that the athletes would need less of each drug if they combine the two together and hence, they can avoid serious consequences. At best this is just wishful thinking. Remember when discussing the thiazides that very low doses were efficient even for medical reasons. Therefore combining the loop agents with other diuretics in order to not have to use, as much is faulty logic since an athlete should be getting results with small doses anyway. The other reason this is a bad idea is because of the indiscriminate nature of the effect of the loop agents. The loop agents will cause electrolyte depletion both inside and outside the muscle cells. This obviously causes smaller, flat muscles, which will be difficult to respond to peaking strategies like carb, or fat loading since crucial electrolyte balance is compromised, and thus so is normal metabolic processes. Indeed the physicians desk reference warns that if loop agents are combined with other diuretics, other diuretics dosage must be reduced by 50% as soon as loop agents are added in order to prevent an excessive drop in blood pressure. When blood pressure continues to fall total discontinuation of other agents is necessary to prevent serious consequences. And remember this is in medically prescribed situations where there is a severe edematous problem to begin with. The bottom line on the use of loop agents is that they are totally unnecessary for bodybuilders before a contest. At best they will make your body look worse, usually flat and soft because of extreme electrolyte depletion; and the worse case scenario is that this family of drugs could cause serious and immediate life threatening consequences via a number of different causative metabolic pathways. Simply because athletes think the stronger drugs are automatically better does not make it so, and in the case of the loop agents this is a ridiculous notion. CONCLUSION In the area of diuretics, it is obvious by now that these drugs do not fill in gaps. If an athlete is not totally contest ready at least one week prior to the event, diuretics use will be a wasted effort. Athletes who think they are holding ten pounds of water should be able to realistically assess that they are simply still fat, and diuretics in this case is also a losing proposition. Combining diuretics of different types is always an unnecessary act that will not produce better results. This idea of diuretics "stacking" is not scientific and only caters to the abusive and weak mindset of the "juiced produced" bodybuilders. The current trend in bodybuilding of a pharmaceuticals arms race is ridiculous. Athletes who think they need a certain drug simply because they read or heard that the competition maybe using it, need to step back and assess the situation. Drugs do not win contests. If they did then all the drug dealers would be the best bodybuilders and that would be all there is to it. People with the drug mentality need to grow up and take responsibility for their own success or failure. Wannabe's who see success or failure as revolving around the drug issue are totally insulting the success of individuals who have worked hard to achieve their high status in the sport. For real athletes who want to excel and be better than they were the answer lies in real and useful information. We will let science and passion lead the way. We hope you come along for the ride. We hope you enjoyed this educational presentation. NOTE: Copyright 2000 Scott Abel. |
2
|
||
|
|