Bodybuilding’s Mounting Death Toll – Part 3

Bodybuilding’s Mounting Death Toll: Part #3

by Mike Arnold

Having concluded our discussion on blood pressure in Part 2, we will be moving onto the topic of using supplementation to maintain normal cholesterol values and concluding with a similar chapter on hematocrit…

In addition to blood pressure management, maintaining a balanced lipid profile, which is comprised of LDL cholesterol, HDL cholesterol, and triglycerides, should be at the top of your list. While total cholesterol levels are often used as a measure of lipid health, the ratio of LDL to HDL cholesterol is actually a more accurate indicator of cardiovascular risk, as HDL (the “good” cholesterol) helps to off-set the negative effects of LDL cholesterol on arterial health. Therefore, by simply increasing HDL levels in the blood, we can minimize (and potentially eliminate) the harmful effects of LDL on cardiovascular health.

Of all the different supplements on the market purported to improve one’s cholesterol profile, the majority are either ineffective or provide only marginal benefit. However, the same can’t be said of niacin (vitamin B3), which has held up under clinical scrutiny in dozens of studies. Being a plain old vitamin, you might be tempted to think of niacin as only moderately effective, yet research shows that niacin is capable of increasing HDL levels by a full 35%. Combined with its low cost, it is a must have supplement for any BB’r dealing with cholesterol issues.

Niacin and cholesterol: role in cardiovascular disease (review).

Atherosclerosis Research Center, Department of Veterans Affairs Healthcare System, Long Beach, California, USA.


Niacin has been widely used as a pharmacologic agent to regulate abnormalities in plasma lipid and lipoprotein metabolism and in the treatment of atherosclerotic cardiovascular disease. Although the use of niacin in the treatment of dyslipidemia has been reported as early as 1955, only recent studies have yielded an understanding about the cellular and molecular mechanism of action of niacin on lipid and lipoprotein metabolism. In brief, the beneficial effect of niacin to reduce triglycerides and apolipoprotein-B containing lipoproteins (e.g., VLDL and LDL) are mainly through: a) decreasing fatty acid mobilization from adipose tissue triglyceride stores, and b) inhibiting hepatocyte diacylglycerol acyltransferase and triglyceride synthesis leading to increased intracellular apo B degradation and subsequent decreased secretion of VLDL and LDL particles. The mechanism of action of niacin to raise HDL is by decreasing the fractional catabolic rate of HDL-apo AI without affecting the synthetic rates. Additionally, niacin selectively increases the plasma levels of Lp-AI (HDL subfraction without apo AII), a cardioprotective subfraction of HDL in patients with low HDL. Using human hepatocytes (Hep G2 cells) as an in vitro model system, recent studies indicate that niacin selectively inhibits the uptake/removal of HDL-apo AI (but not HDL-cholesterol ester) by hepatocytes, thereby increasing the capacity of retained HDL-apo AI to augment cholesterol efflux through reverse cholesterol transport pathway. The studies discussed in this review provide evidence to extend the role of niacin as a lipid-lowering drug beyond its role as a vitamin.

The next compound on the list will be immediately recognizable to most PED users as an anti-gynecomastia agent, although a much smaller percentage of BB’rs are aware of its effect on cholesterol levels. In case you haven’t guessed, I am referring to the selective estrogen receptor modulator (S.E.R.M) known as Tamoxifen; also known as Nolvadex. Although Tamoxifen cannot claim OTC status, its regular inclusion in the programs of BB’rs, as well as its significant positive impact on cholesterol levels, is enough to warrant a place on this list of OTC cholesterol supplements.

Tamoxifen works by down-regulating cholesterol synthesis via inhibition of delta 8-cholestenol to lathosterol, ultimately reducing both LDL and total cholesterol. Interestingly, Toremifene, another S.E.R.M, works through the same mechanisms as Tamoxifen to improve the cholesterol profile. Clinical studies demonstrate nearly identical results between these two S.E.R.Ms, making either one equally suitable for cholesterol management.

While aromatase inhibitors have the upper-hand in terms of estrogen management, BB’rs afflicted with impaired cholesterol values might want to consider using Tamoxifen/Toremifene instead of an AI when trying to prevent of estrogenic induced side effects, as the benefits associated with improved cholesterol values may outweigh the benefits associated with systematic estrogen reduction in these individuals. Further strengthening this recommendation are clinical trials which show AI’s to be injurious to cholesterol values.

Tamoxifen and toremifene lower serum cholesterol by inhibition of delta 8-cholesterol conversion to lathosterol in women with breast cancer.

Department of Medicine, University of Helsinki, Finland.


PURPOSE Long-term effects of tamoxifen and toremifene, a new antiestrogen that closely resembles tamoxifen, were investigated on serum lipids and cholesterol metabolism.
PATIENTS AND METHODS The study group consisted of 24 postmenopausal Finnish women with advanced breast cancer from an international multicenter study of 415 patients. Cholesterol metabolism was evaluated by measuring the cholesterol precursor (delta 8-cholestenol, desmosterol, and lathosterol, reflecting cholesterol synthesis) and plant sterol (markers of cholesterol absorption) and cholestanol levels by gas-liquid chromatography.

RESULTS Tamoxifen and toremifene lowered significantly serum low-density lipoprotein (LDL) cholesterol levels after 12 months of treatment by 16% and 15%, with no change in high-density lipoprotein (HDL) cholesterol or serum triglyceride levels. Serum delta 8-cholestenol was increased 40- and 55-fold during toremifene and tamoxifen treatment, respectively, while the increase of desmosterol less than doubled and was lacking for lathosterol by toremifene. Plant sterols and cholestanol were only inconsistently increased in serum.

CONCLUSION Tamoxifen and toremifene inhibit the conversion of delta 8-cholestenol to lathosterol so that serum total and LDL cholesterol levels are lowered by downregulation of cholesterol synthesis. Thus, inhibition of the delta 8-isomerase may be the major hypolipidemic effect of these agents. Reduced risk of coronary artery disease will probably occur also during long-term toremifene treatment, because the drug reduces cholesterol and its synthesis, similarly to tamoxifen.

Over the last 15 years, the general public’s awareness of the importance of omega 3 fatty acids has gradually increased, resulting in a sharp rise in fish oil sales across the country. With such a wide range of beneficial effects and a general deficiency of omega 3’s in the typical American diet, it is easy to see how this supplement got so popular, but it is the cardiovascular benefits which are of particular interest to steroid users.

The active ingredients in fish oil are the omega 3 fatty acids EPA & DHA, which have been clinically proven to reduce the risk of coronary heart disease, lower blood pressure, and alleviate hyperlipidemia (elevated triglycerides). Anecdotal evidence appears to confirm this position, as populations which consume a diet high in fatty fish have lower rates of heart disease. The “Eskimo Study” offers us further insight into this subject. Zeina Makhoul, a postdoctoral researcher in the Cancer Prevention Program of the Public Health Sciences Division at the Hutchinson Center, agrees. She says “Because Yup’ik Eskimos have a traditional diet that includes large amounts of fatty fish and have a prevalence of obesity that is similar to that of the general U.S. population, this offered a unique opportunity to study whether omega-3 fats change the association between obesity and chronic disease risk”.

After evaluating triglyceride and C-reactive protein (a marker of inflammation) levels of 330 people living in the Yukon Kuskokwim Delta region of southwest Alaska, in which 70% of the population was obese, the researchers came to a surprising conclusion. Those individuals with blood levels of DHA & EPA similar to those living in the lower 48 states had elevated levels of triglycerides and C-reactive protein, while those with high blood levels of DHA & EPA had triglyceride and C-reactive protein levels comparable to non-obese people.

The same phenomenon was observed in the Asian countries of Japan and China before the dietary habits of Americans’ pervaded their culture. The link between inflammation and heart disease (as well as other metabolic conditions) has been clearly established and with fatty fish being proven to significantly reduce whole-body inflammation, as well as reduce triglycerides by up to 40%, it would be foolish for any steroid user to forgo this inexpensive and readily available supplement.

Omega-3 fatty acids in inflammation and autoimmune diseases.

The Center for Genetics, Nutrition and Health, Washington, DC 20009, USA.


Among the fatty acids, it is the omega-3 polyunsaturated fatty acids (PUFA) which possess the most potent immunomodulatory activities, and among the omega-3 PUFA, those from fish oil-eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)–are more biologically potent than alpha-linolenic acid (ALA). Some of the effects of omega-3 PUFA are brought about by modulation of the amount and types of eicosanoids made, and other effects are elicited by eicosanoid-independent mechanisms, including actions upon intracellular signaling pathways, transcription factor activity and gene expression. Animal experiments and clinical intervention studies indicate that omega-3 fatty acids have anti-inflammatory properties and, therefore, might be useful in the management of inflammatory and autoimmune diseases. Coronary heart disease, major depression, aging and cancer are characterized by an increased level of interleukin 1 (IL-1), a proinflammatory cytokine. Similarly, arthritis, Crohn’s disease, ulcerative colitis and lupus erythematosis are autoimmune diseases characterized by a high level of IL-1 and the proinflammatory leukotriene LTB(4) produced by omega-6 fatty acids. There have been a number of clinical trials assessing the benefits of dietary supplementation with fish oils in several inflammatory and autoimmune diseases in humans, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches. Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs.

Red wine/red wine extract’s distinct and potent cardiovascular-protective effects have earned it a place on my “top supps” list for those BB’rs attempting to mitigate the damaging effects of steroids on the cardiovascular system. Red wine possesses antithrombic (protects against blood clots), antioxidant (protects against free-radicals), anti-ischemic (protects against atherosclerosis), vasorelaxant (widens blood vessels), and anti-hypertensive properties (reduces blood pressure), effectively protecting against arterial damage and reducing the risk of heart disease and heart attack.

Red wine’s cardioprotective effects are thought to be generated, at least in part, by a particular flavonoid called trans-resveratrol, which belongs to a group of compounds called polyphenols. While trans-resveratrol can be purchased by itself in supplement form, many believe that red wine’s full effects can only be procured by either drinking red wine or consuming red wine extract, as they contain the full complement of flavonoids found in red wine, which are thought to work synergistically to promote cardiovascular health.

As with fish oil, anecdotal evidence also supports the use of red wine/red win extract in the treatment and prevention of cardiovascular health problems. In similar fashion to the Eskimo study, populations which consume a large amount of red wine have been found to exhibit a lower rate of heart disease & heart attack. A perfect example of this is what is known as the “French Paradox”. Although the French consume a large amount of saturated fat, the incidence of coronary heart disease is significantly lower than other populations which consume a similar or even lower amount of saturated fat. The traditionally heavy red wine consumption of the French is believed to account for the decreased morbidity and mortality due to coronary artery disease.

Protective effects of red wine polyphenolic compounds on the cardiovascular system


Phenolic phytochemicals are widely distributed in the plant kingdom. In terms of protective effects on organisms, the group of polyphenols is the most important. In various experiments, it has been shown that selected polyphenols, mainly flavonoids, confer protective effects on the cardiovascular system and have anti-cancer, antiviral and antiallergic properties. In coronary artery disease, the protective effects are due mainly to antithrombic, antioxidant, anti-ischemic and vasorelaxant properties of flavonoids. Flavonoids are low molecular weight compounds composed of a three-ring structure with various substitutions, which appear to be responsible for the antioxidant and antiproliferative properties. It has been hypothesized that the low incidence of coronary artery disease in the French population may be partially related to the pharmacological properties of polyphenolic compounds present in red wine. Many epidemiological studies have shown that regular flavonoid intake is associated with reduced risk of cardiovascular diseases.

Keywords: Anti-ischemic effect, Antioxidant activity, Antithrombic effect, Flavonoids, Polyphenols, Vasorelaxant properties
Consumption of diets high in saturated fat and cholesterol is usually associated with increased risk of cardiovascular disease. However, epidemiological evidence has shown that cardiovascular disease is less prevalent in the French population than expected in light of their saturated fat intake and serum cholesterol concentrations. This paradoxical finding has been attributed to regular consumption of fresh vegetables, fruit and red wine (1,2).

Law and Wald (3), however, predicted that it would be only a matter of time before the ‘French paradox’ resolved itself as the only recently comparable pattern of risk factors (animal fat consumption, serum cholesterol concentrations and blood pressure) between France and Britain would be translated into similar death rates from coronary disease. Although red wine consumption remains higher in France than in Britain, the authors rejected this as a possible explanation because they consider that wine intake greater than one unit a day confers no greater benefit (3). The protective effect of moderate consumption (two to three units) of red wine on the risk of cardiovascular disease morbidity and mortality, however, has been consistently shown in many epidemiological studies (reviewed in 2). Phenolic compounds and especially a group of flavonoids seem to be responsible for the majority of protective effects of red wine. A major activity of plant polyphenols is their antioxidant properties, which may explain many of their beneficial effects on cardiovascular function (4–6). Polyphenols also act on other targets involved in the metabolism of mammalian cells, including nitric oxide (NO), which regulates hemostasis (6,7), thrombus development (8) and vascular tone (9,10). The beneficial properties of NO may therefore explain in part the anti-ischemic activities of plant polyphenols.

This mini-review describes the protective effects of red wine polyphenolic compounds on cardiovascular disease, particularly their antithrombic, antioxidant, anti-ischemic, vasorelaxant and antihypertensive properties.

Moving on from cholesterol-lipids, we are going to conclude by addressing the final cardiovascular health marker; hematocrit. While several of the above compounds have been proven to reduce the incidence of blood clots (thereby reducing the level of danger associated with elevated hematocrit), we should still place ample emphasis on the management of this important health marker, as AAS use increases the risk of experiencing serious elevations in hematocrit. Prior to the arrival of EPO, Anadrol was the primary treatment for anemia—a condition characterized by a failure to produce adequate red blood cells. Even moderate steroid use has the potential elevate hematocrit into a dangerous range, so this is not something we can afford to ignore.

In comparison to blood pressure and lipids supplements, we are left with a relative lack of hematocrit modulating products on the OTC market. Fortunately, the few that are available are backed with clinical support. One of these is naringin, the flavonoid found in grapefruit that is responsible for imparting its characteristic bitter taste.
In clinical trials, naringin was shown to reduce hematocrit levels in those with elevated hematocrit, but in those with normal levels, it has no effect. This inherent ability to be selective in its actions depending on need is unique and something prescription drugs can’t offer. Its lack of side effects further increases its appeal over prescription drugs.
As a final consideration, users of naringin should be aware that the compound is capable of slowing the metabolic breakdown of certain drugs by interfering with enzymatic activity in the intestines. This can potentially result in higher than intended blood levels of prescribed medications, including calcium channel blockers and cholesterol-lowering drugs, as well as certain medications used to treat allergies and AIDS.

Ingestion of grapefruit lowers elevated hematocrit in human subjects.

Robbins RC, Martin FG, Roe JM.

Food Science and Human Nutrition Department, IFAS, University of Florida, Gainesville.


This study was based on in vitro observations that naringin isolated from grapefruit induced red cell aggregation and evidence that clumped red cells are removed from the circulation by phagocytosis. The effect on hematocrits of adding grapefruit to the daily diet was determined using 36 human subjects (12 F, 24 M) over a 42-day study. The hematocrits ranged from 36.5 to 55.8% at the start and 38.8% to 49.2% at the end of the study. There was a differential effect on the hematocrit. The largest decreases occurred at the highest hematocrits and the effect decreased on the intermediate hematocrits; however, the low hematocrits increased. There was no significant difference between ingesting 1/2 or 1 grapefruit per day but a decrease in hematocrit due to ingestion of grapefruit was statistically significant at the p less than 0.01 level.

A Step in the right Direction

While PED use is a fairly safe practice when engaged in responsibly (meaning low-moderate dosages at infrequent intervals), those who choose to engage in heavy, chronic, long-term use (a near necessity for a competitive BB’rs at the national level and above) run a much greater risk of developing serious cardiovascular side effects, including heart attack and stroke. We are seeing the result of this abuse right now, with new names being added to the deceased list on a regular basis. Dying or being disabled in your 30’s, 40’s, or even 50’s, especially when it could have been prevented by taking a few simple steps, should be completely unacceptable to every steroid user. For those with wives and/or children, consider how your premature departure or disablement would affect your family.

The bottom line is that anyone who is trying to maximize his development is going to be at risk…and it is not only the drugs which can hurt you. The excessive bodyweight of many steroid users, whether it is fat or muscle, further increases the stress on the heart. With all this working against you, does wisdom not call for at least a modicum of preventative care? It does not cost much to use the supplements I listed above…and even a few of them are better than none at all.
In Advanced Cycle Support, IML offers a comprehensive product designed specifically for steroid users, which has been formulated to provide cardiovascular, liver, kidney, and prostate support in the form of hawthorne extract, co-enzyme Q10, grape seed extract, milk thistle, N-acetyl-cysteine, celery seed concentrate, and saw palmetto—all in clinically proven dosages. IML’s “Essence EFA” is a concentrated fish oil product produced under the most stringent standards to ensure you get the purest & freshest product available. When used in combination with Advanced Cycle Support, you will be getting over a half dozen of the most effective on-cycle protection products money can buy.