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21 Apr

Sudden cardiac death from anabolic steroids: Fatal cases in bodybuilders

In Exercise by aricsudicky / April 21, 2017 / 0 Comments

In today’s fitness industry it is easy to fall prey to the false notion that bigger is always better, and bigger comes without health consequences.

The images below are of heart tissue taken from two young bodybuilders who unfortunately passed away from sudden cardiac death. These two cases are similar to previous studies suggesting the type of cardiac tissue (cardiac myocytes) you grow while abusing anabolic steroids is scarred with fibrosis.

Case 1: 29-year-old bodybuilder

”A 29-year-old bodybuilder suddenly collapsed after dinner in his apartment. He had a weight lifting workout at the gymnasium a few hours before. Cardiopulmonary resuscitation initiated by an emergency physician was unsuccessful. According to friends of the deceased, he had been taking anabolic steroids (testosterone, nandrolone, and stanozolol) parenterally for several years mainly in an effort to improve his appearance. Several glass vials were found in his room and were labeled Winstrol (stanozolol), Deca (nandrolone), Testoviron Depot, and Andriol (testosterone) (1).”

Case 1 heart demonstrated in figure 1 below.

Case 2: 30-year-old competitive bodybuilder

“A 30-year-old male, first an amateur, and later a competitive bodybuilder, who worked out regularly at the gymnasium, suddenly collapsed at home and was pronounced dead by an emergency physician who does not start cardiopulmonary resuscitation. He had a weight lifting workout at the gymnasium a few hours before. In an ashtray near the body, a 2-ml vial of nandrolone decanoate was found along with a used 2.5-ml syringe. The apartment contained a veritable arsenal of drugs, most of which fell into the AAS category. All witnesses confirmed that the subject had started using AAS approximately 6 months prior to his death (1).”

Case #2 histopathology demonstrated in figure 2, showing focal myocardial fibrosis.

 What were they taking?

“In both cases, the morphologic findings are, in combination with the toxicologic findings, sufficient to explain the deaths as related to the cardiac effects of AAS abuse [7]. In both cases, blood and/or urine revealed the presence of nandrolone and its principal metabolite (19-norandrosterone). A thorough scene investigation documents the subjects’ use of stanozolol and nandrolone (presumably “nandrolone decanoate” as found in the ashtray). Because the metabolite was not normalized to the creatinine ratio, little can be concluded about the urine concentration, but the values found here are comparable to previously reported values (1).”

“The high testosterone/epitestosterone ratio supports our hypothesis that testosterone was the form of the abused drug (1).”

Androgenic anabolic steroids and sudden cardiac death?

There are various proposed mechanisms suggesting the pathological means by which androgenic anabolic steroids appear to increase risk of sudden cardiac death. These include coronary artery vasospasm (similar to cocaine), atherogenesis, direct injury to cardiac myocytes, and thrombosis (1).

These two case studies add support to the direct injury model. In simple terms, picture a fatty steak infiltrated with fibrosis, now picture that steak trying to expand, fill with adequate blood volume, and contract properly to perfuse the body. Unfortunately, these structural changes are a recipe for heart disease. See figure below. (Image source: Christoph Ahlgrim and Maya Guglin, 2009).

 

Conclusion:

“Our findings support an emerging consensus that the effects of vigorous weight training, combined with anabolic steroid use and increased androgen sensitivity, may predispose these young men to myocardial injury and even SCD (sudden cardiac death) (1).”

Bigger is not always better, and bigger may also come with fatal consequences.

Last year marked 20 years of lifetime drug-free lifting for me and it is a dream come true to help others as a Canadian “doc who lifts”. Safe and scientific training methods, a healthy diet full of fruits, veggies, lean proteins and no use of anabolic drugs has ensured longevity in bodybuilding.

The image below was taken prior to medical school while working as a fitness model for various magazines in Canada and the USA. (Image credit: Paul Buceta)

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References:

  1. Fineschi V, Riezzo I, et al. Sudden cardiac death during anabolic steroid abuse: morphologic and toxicologic findings in two fatal cases of bodybuilders. Int J Legal Med. 2007 Jan;121(1):48-53. Epub 2005 Nov 15.

  2. Christoph Ahlgrim and Maya Guglin, Anabolics and Cardiomyopathy in a Bodybuilder: Case Report and Literature Review. Journal of Cardiac Failure Vol. 15 No. 6 2009

 

Dr. Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity and exercise researcher, and is currently completing his residency training in family medicine. You can follow Aric via his facebook or twitter pages.

06 Apr

Vegan diet for “everyone”? Not so fast.

In Nutrition by aricsudicky / April 6, 2017 / 0 Comments

There is a troubling trend in clinical nutrition where a good thing is pushed to misinformed extremes. For example, data supports the benefits of a plant-focused diet, including for cardiovascular risk reduction. See here http://www.onlinejacc.org/content/69/9/1172 . However, this does not mean everyone, including the frail elderly and high-performance athletes, must follow a one-size-fits-all strict vegan diet (ie zero animal sources).

Equally concerning is when one-size-fits-all diet beliefs turn into fear mongering entire food groups that do not fit into dogma. For example, I received a tweet from a “vegan for everyone” social media influencer suggesting a strong association between dairy consumption and cancer. The weight of data suggests dairy benefits, but in 2017, social media personalities tweeting anti-dairy is a form of health misinformation some people will unfortunately believe. See dairy benefits here https://www.ncbi.nlm.nih.gov/pubmed/27882862 and here https://www.ncbi.nlm.nih.gov/pubmed/25757894 .

Furthermore, vegan for all approaches omit strong data supporting health benefits of milk protein consumption, including whey, in multiple populations (female, male, elderly, and athletes). Animal proteins of any source are a no-no if you are strictly vegan. See milk protein benefits, including whey here https://www.ncbi.nlm.nih.gov/pubmed/23645387 for healthy aging here https://www.ncbi.nlm.nih.gov/pubmed/26980369 and for athletes here https://www.ncbi.nlm.nih.gov/pubmed/22150425 .

There is currently no single “best” diet every human should consume, see here https://www.ncbi.nlm.nih.gov/pubmed/25182101 . Certain general patterns of feeding, including fruits, vegetables, plant fats, whey protein, and fatty fish are reasonable options to consider. However, the best type of healthy diet is the one that works for the individual. This includes a vegan approach, which I continue to support for those individuals who prefer it.

Pick what works for you and try not to fear monger those preferring their own customized variant of healthful eating patterns.

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Dr. Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity and exercise researcher, and is currently completing his residency training in family medicine. You can follow Aric via his facebook or twitter pages.

17 Sep

20 Years of Drug-Free Lifting

In Exercise by aricsudicky / September 17, 2016 / 0 Comments

Have you ever wondered what is possible if you pushed your natural genetics to the limit? It is hard to believe I have been enjoying drug-free fitness and bodybuilding for 20 years. You can find health tips and training photos via my instagram page.

 

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@draricsudicky

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Dr. Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity researcher, and is currently completing his residency training in family medicine. You can follow Aric via his Instagram, facebook, or twitter pages.

06 Jul

Walking Lunges = Glute Development

In Exercise by aricsudicky / July 6, 2016 / 0 Comments

When done properly, walking lunges are an excellent exercise for glute development.

Watch training video => HERE

Walking lunges for glute development:
1. Pull with your front leg for glute/hamstring activation instead of pushing with the rear leg. Quality of muscle contraction matters. I would recommend slowing your pace if you find it difficult to activate your glutes through each rep.

2. Maximize hip extension range of motion with each rep by safely lowering your rear knee as close to the ground as possible. For me, this means the trailing knee gently touches the floor each rep. Maximizing resisted hip extension and flexion allows for greater glute activation. Glutes are powerful hip extenders.

3. I often pre-exhaust performing 5-6 high volume sets of leg press (feet high) for glute activation prior to lunges.

4. Frequency for hypertrophy: 1x/wk does not cut it for most people when it comes to hypertrophy. A recent systemic review suggests training major muscle groups 2x/wk provides superior results compared to 1x/wk.

5. Breathing: If you listen carefully to the training video linked above, you can hear me exhaling forcefully during the drive phase of each step.

6. Nutrition: Simply put, without consumption of adequate quality proteins, your glutes will not grow. In clinic I snack every 3hrs between patients including a protein source with each meal.

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Dr. Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity researcher, and is currently completing his residency training in family medicine. You can follow Aric via his facebook or twitter pages.

18 Apr

#docswholift

In Exercise by aricsudicky / April 18, 2016 / 0 Comments

One of the most common questions in medicine: “Doctor, can you help me lose weight and keep it off?”

It is motivating to see the amount of drug-free muscle my medical school training partners Ammar and Sam have grown while earning their MD’s (bottom 2013, top April, 2016). I could not be more proud of these two future Canadian surgeons. Not only did they match to competitive specialties (ophthalmology and urology), they refuse to accept their first excuse. Throughout the demands of medical training we have pushed one another in the gym and in the classroom. This included showing up to lift after 26hr sleepless shifts while lighting up our phones with “EAT” text messages between 2am hospital consults.

Without question a three year condensed medical school curriculum is demanding, however, there is always time for fitness…if you make that time.

Whether you are a surgeon or family doctor, the bottom line is many of your patients will suffer from obesity. With obesity and weight-related disease being the number one cause of premature and preventable death in Canada, it is imperative that more doctors provide actionable exercise and nutrition prescriptions. Furthermore, evidence suggests doctors who exercise are more likely to coach patients to be physically active.

This is not only about science. This is about fundamental belief systems and creating a medical culture where lifestyle prescriptions are essential in clinical practice.

Exercise is medicine. 

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Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity researcher, and is currently finishing his Doctor of Medicine degree at the University of Calgary. You can follow Aric via his facebook or twitter pages.

09 Nov

A lunch box is not just a “lunch box”

In Nutrition by aricsudicky / November 9, 2015 / 0 Comments

This lunch box is not just a lunch box. It symbolizes what is important in preventive medicine, including the habits that form the foundation of a healthful lifestyle.  Every patient encounter is an opportunity to emphasize the importance of each individuals “lunch box”; the habits, the skills, and the lifestyle that comes with having one.

Included is a photo of my go-to lunch box for the last five years, a “sport model” if you will.  It has smooth contours, a sturdy handle, and a shoulder strap for carrying into the emergency room and hospital wards.  It features two large compartments with a bottom for heavier items such as frozen lunches and protein shakes, and a top for fruit sliced each morning.  Most clinic days this fruit includes a sliced apple and pear with a small container of mixed nuts. I carry this lunch box everywhere.  It has been an absolute lifeline for the last 2.5yrs of medical school and will be essential as a practicing doctor.

Sustainable lifestyle changes do not include fad diets or fat burners.  They are founded on habits, hard work, and motivating reinforcement from healthcare providers.  It goes without question that within my first week of practice as a doctor, I will be asked for health advice regarding sustainable weight-loss.  The cornerstone of this advice will be a story about a lunch box and what it represents for preventive health care.

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Aric Sudicky is a former Canadian Fitness Professional of the Year, senior medical student, and researcher in lifestyle-related disease.  Current projects include the Prevention Rx public health initiative and innovative Canadian medical education curriculum in exercise and nutrition. You can follow Aric via his facebook or twitter pages

27 Oct

Docs who cook?

In Nutrition by aricsudicky / October 27, 2015 / 0 Comments

This was tonight’s healthy medical school snack.  Priority #1 was preparing a balanced, time efficient snack to recover from yesterday’s weight training that is also suitable for a sedentary night studying.

Prep time 5 minutes:

HIGH PROTEIN BASE:

2 tbsp Cottage cheese

2-3 Heaping tbsp plain Greek yogurt

2/3 Scoop (20g) banana whey isolate protein powder

1 tsp ground chia and flax seeds

**Mix well in bowl prior to adding toppings

NUTRIENT-DENSE TOPPINGS:

1 Medium orange chopped

½ Cup fresh raspberries

1 tbsp pepitas

1 tbsp dried cranberries

ANTIOXIDANT-RICH FINISH:

1/2 tsp cinnamon

1/2 tsp cocoa

One of the most important aspects of preventive medicine is helping patients develop personalized, sustainable habits of meal preparation that promote healthful eating.  This recipe makes a delicious morning or afternoon snack while I am in hospital or clinic.

Aric Sudicky is a former Canadian Fitness Professional of the Year, senior medical student, and researcher in lifestyle-related disease.  Current projects include the Prevention Rx public health initiative and innovative Canadian medical education curriculum in exercise and nutrition. You can follow Aric via his facebook or twitter pages

19 Oct

Fat Burners, Social Media, and Biased Health Advice

In Nutrition by aricsudicky / October 19, 2015 / 0 Comments

Guess how many emergency department visits are related to the adverse effects of dietary supplements?

A new study in the New England Journal of Medicine collected data from 63 emergency departments over a span of 9 years, and estimates the number to be near 23,000.  With this in mind, it is concerning seeing the following biased health advice in today’s news feed: “When I prepare for photoshoots and want to get my leanest, I take these (insert “fat-burning” supplement list) made by my sponsor…”

Unfortunately, this statement is untrue and not supported by good science. Weight-loss supplements with little to no evidence did not make the difference and are among the leading culprits for causing harm.  A significantly lowered caloric intake focused on reduced carbs + high protein combined with increased cardio made the difference.

Concerning is this sponsored message is coming from a well-known name in fitness with faithful followers keen to emulate their health choices. People read it, buy the pills expecting the same physique, when in reality, it is genetics combined with consistent HABITS and NUTRITION achieving results.  Years and often decades of diligent work is the foundation of an elite physique, not an over-the-counter supplement.  Keep in mind that in addition to having little efficacy, there are multiple reports of fat-burning supplements causing organ failure, for example here, here and here.  Even high doses of seemingly benign substances such as green tea extract have been shown to cause harm.  The positive effects are not nearly as clear as promoters claim and are still subject to debate in the literature.  An industry driven fast growth rate, combined with few regulations leaves many fat-loss supplements with little to no evidence to back up their claims.

I would rephrase the above advertisement with: “My fat-loss heavily relies on previously established habits of meal preparation and regular exercise.  When I need to shed fat while preserving muscle, I reduce my caloric intake, mainly by reducing carbohydrate consumption outside of training, combined with a high protein diet, and efficient strength training.  There are many ways to shed fat and keep it off, this is simply the approach that works best for me.  The supplements I list here have little science to support they do anything, however, my sponsor has asked me to promote them via social media.”

If health advice finishes with a sales pitch for a “quick-fix” supplement and sounds too good to be true, it is too good to be true.

 

Aric Sudicky is a former Canadian Fitness Professional of the Year, senior medical student, and researcher in lifestyle-related disease.  Current projects include the Prevention Rx public health initiative and innovative Canadian medical education curriculum in exercise and nutrition. You can follow Aric via his facebook or twitter pages.

24 Apr

“You cannot out exercise your fork”

In Nutrition by aricsudicky / April 24, 2015 / 0 Comments

There is a new editorial in the BJSM today emphasizing the theme “you cannot outrun a bad diet” and the importance of nutrition over exercise for fat loss. I may not agree with all of the statements in this BJSM editorial, for instance the lack of emphasis that inactivity has contributed to the obesity epidemic. However, having not performed a minute of cardio in 10 years of fitness modeling, I do agree that for initial weight loss nutrition appears to be superior to exercise. Training changes minimally the day I receive word of an upcoming photoshoot. It is our diet that plays a vital role in initial fat-loss.

=>NUTRITON – Studies suggest it is most important for initial weight LOSS, which is associated with a significant reduction in-all cause mortality.  Exercise certainly plays a role in weight loss, however, reducing energy intake appears to be the more superior method of achieving sustained caloric deficits.

=>EXERCISE – Becomes increasingly important for weight MAINTENANCE and avoiding weight regain. Evidence suggests exercise is less important for initial weight loss. However, lost in this articles’ argument is the long list of exercise-related benefits outside of fat loss such as cardio-respiratory fitness and growing/maintaining functional lean mass with age, not to mention inactivity contributing to bulging waistlines. Remember, there is a significant difference between losing 30lbs of “weight” that includes lost muscle, and 30lbs of fat while preserving muscle through focused strength training and adequate protein consumption. By no means am I suggesting exercise is not important for optimum health, as there are many lean individuals with weak hearts and hypertension, and conversely, many obese individuals with high levels of aerobic fitness.

=>TAKE HOME MESSAGE: If you have time, exercise (including strength training) with a safely elevated heart rate from day one. If not, it should eventually be integrated into your lifestyle.

WHICH IS THE PRIORITY: EXERCISE OR NUTRITON FOR INITIAL FAT-LOSS?

If a client insists, “I have only time for one thing, meal prep OR exercise”, encourage them to prepare home-cooked meals, while making a point to mention that exercise should play a role in healthy lifestyles long-term. Integrating regular exercise will help individuals sustain weight-loss in the long term. Regarding sugar, the priority is to reduce liquid calories in general, which for most clients are predominately composed of sugar and fat.

TIPS TO: REDUCE PORTIONS AND CRAVINGS

1: Protein – Very underrated. Evidence suggests those with higher protein breakfasts have a greater feeling of fullness.

2: Fiber (soluble and insoluble) – Apples, berries, bran buds, pears, oranges (think seeds or skin that you consume).

3: Whole-foods fats – Almonds, walnuts, pepitas etc. (portioned)

OBESITY-RELATED: PUBLIC HEALTH POLICY

Lost in this discussion is the importance of public health initiatives in relation to curbing obesity rates. Specifically, “changing the food environment” as is appropriately mentioned in this new BJSM editorial. This is precisely why the systematic approach to communities using the Prevention Rx exercise and nutrition prescription pads I have created includes community integration and advocacy. For instance, patients are rewarded with discounted healthy meal items at local restaurants when they present with a doctor-signed nutrition prescription. The only foods discounted are ones that meet the lofty standards of the Prevention Rx program. Improving the quality of food available in our communities combined with renewed emphasis on obesity-related public health policy is vital for Canadians to see improvements at a population level.

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Aric Sudicky co-founded London, Ontario’s first medically integrated personal training and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity researcher, and is currently finishing his Doctor of Medicine degree. You can follow Aric via his facebook or twitter pages.

22 Feb

Bad science, butter coffee, and liquid calories

In Nutrition by aricsudicky / February 22, 2015 / 0 Comments

Sharing my thoughts after reading yet another article recommending adding butter to your coffee that reeks of bad science…

BAD SCIENCE EXAMPLE #1:

The first link within the article leads readers to a website that promotes the butter-coffee product being pushed to followers .  This makes the article a credible source of UNbiased data…right?  The info-graphic within the article should have had “SALES” written across it. The author goes so far as to use “less heart disease in 1910” as a way to link more butter consumption to improved cardiovascular health.   Again I ask, good science?  Or perhaps in 1910 North Americans had significantly less access to calorie-dense food supplies while expending far more daily calories.  Yet it had to be the butter…right?

BAD SCIENCE EXAMPLE #2:

Link 2 used as “evidence” in this pro butter-coffee article brings you to a blog written by a student from Iceland….again not a systematic review or randomized trial.  The hyperlinked blog is an opinion piece with strong language suggesting bias.  Good scientists rarely and almost never use absolute terms.  Science is about discussion, those who refuse to participate in healthy debate are in what some experts call “parallel science” as their path never crosses mainstream research.  Author popularity often does not correlate with expert opinion.  This is why it is important to critically appraise what you read…

One comment in this student’s blog:  This study “examined the effects of Vitamin K2 on heart disease, those who had the highest intake had a 57% lower risk of dying from heart disease”. (Desperately trying to link butter vitamin K2 levels to preventing heart disease)  I read the study.  What did they fail to mention in their blog? THIS IS A RELATIVE RISK REDUCTION, NOT ABSOLUTE.

Why does this matter?

Number of people consuming higher levels of vitamin K2 who died of CHD? 23/1624 = 1.4%

Number of people consuming lower levels of Vitamin k2 who died of CHD? 41/1578 = 2.6%

What was the ABSOLUTE CHANGE? Only 1.2%. Furthermore, this data came from a SINGLE study with WEAK controls at best.  Did they randomize participants into one group receiving a high dose vitamin K2 diet comparing them to another randomized group consuming a low dose vitamin K2 diet? They did not.  I agree that at a population level, well controlled studies have shown 1.2% changes to be significant and retrospective observational studies can provide insightful data.   However, in this situation it is difficult to make strong claims based on a poorly controlled study in which butter is not discussed.  Pooled results in the form of systematic reviews with meta-analysis that combine data from multiple observational studies are preferred.

The foods mentioned in this study that may” be beneficial for reducing cardiovascular disease include:  Curds and low-fat cheese.  Notice the appropriate language from researchers: “may”.  Nowhere in this entire study do the researchers mention butter specifically, let alone grass-fed butter.  Yet promoters of butter-coffee have included this study to back up their claims.  Again I ask, good science or a biased sales pitch?

WHAT SCIENCE SAYS

In this case, the truth was in the literature.  Unfortunately, even guys that blog about being experts can manipulate scientific data to make it sound more sensationalistic for readers.  An absolute change of 1.2% from one study is NOT a reason to start prescribing butter in coffee.  I am sure there is other scant data to support it, but again, no major reviews specifically talking about recommending butter in coffee, or single nutrients like vitamin K2 (variable K2 levels in butter depending on the source).  Yes, we know saturated fat may not be as bad for us as previously thought, yet even here, one must be careful about using strong, sensationalist language.  Few things in science are absolute, especially when it comes to nutrition data that seems to change with the weather…

DANGERS OF SOCIAL HYPE AND FAD DIETS

The real danger here is found in the thousands of vulnerable readers unquestionably following this blogger and other popular fitness and health personalities who promote biased claims (often promoting their sponsor).  We must be critical of ourselves when promoting products of any kind, especially ones backed by questionable science.  Excess calories, through a plethora of health consequences, kill thousands of Canadians annually.  From a preventive medicine perspective, it is irresponsible to recommend adding butter to coffee, increasing liquid calories that are often the crutch of sustainable weight-loss.

What about those not gaining weight and sometimes losing weight drinking butter?  Elite athletes and serious exercisers can often “out-exercise nutrition” focused on butter-coffee as a result of significantly higher daily caloric expenditures.  One may question the sustainability of this approach to weight-loss.  The other 95% of the population has no use for empty liquid-butter calories, with levels of vitamins that are surpassed by those found in whole foods.

 

Aric Sudicky cofounded Southwestern Ontario’s first medically integrated exercise and nutrition program. He is a former Canadian Fitness Professional of the Year award winner, an obesity researcher, and is currently finishing his Doctor of Medicine degree. You can follow Aric via his facebook or twitter pages.