I will use Rich Piana as an example for many elite bodybuilders, who died suddenly over the last decade. Other cases include Dallas McCarver (died at the age of 26), Aziz Shavershian (died at the age of 22), and so many others.
Rich was one of the most famous bodybuilders out there. He was more freak than human, his arms had a legendary circumference of 60 cm (more than my head haha). However, at the age of 46, he passed away . This is what took his life.
Disclaimer: I took a look at the pathological report. The cause of his death is undetermined. Those are assumptions I don't have proof of. Nevertheless, there is a list of drugs he took before he died. The mechanism of action behind the drugs can give us a hint of what might have happened in his body.
What did Rich take? 
Rich used a combination of:
- Trenbolone (an anabolic steroid)
- Human Growth Hormone
Basics: All of these hormones (except for trenbolone) are naturally produced in our body. They are tightly regulated. Why? Any increase or decrease will lead to devastating effects on your body's physiology. In the following, you will see how.
1. Testosterone enhances your ability to build muscle, recover from training and improves mood. Sounds great. Why don't we all take it then? That said, elevated testosterone can cause: aggression, increased risk for certain cancers, male-pattern baldness and increased risk for cardiac arrhythmias (i.e., the heart is beating too fast, too slow or irregularly) .
Fun Fact: When testosterone is excessive it gets converted into estrogen. For this reason, most Testosterone Replacement Therapies get coupled with estrogen blockers.
2. Trenbolone is widely used in veterinary medicine. Trenbolone has been shown to improve muscle mass, feed efficiency, and mineral absorption in cattle. Due to its anabolic (i.e., building) effects, many bodybuilders take it.
3. Human Growth Hormone has two major effects. It stimulates muscle synthesis and improves fat breakdown. So where is the problem here? If you have too much, your organs enlarge (e.g., heart, liver) and you can develop diabetes mellitus.
4. Insulin is another popular hormone in bodybuilding. It inhibits muscle breakdown and stimulates amino acid (i.e., building blocks of muscle) and sugar uptake in muscles, thereby improving stamina and muscle growth. Excessive Insulin will cause hypoglycemia (i.e., low blood sugar levels). Since the brain is almost entirely dependent on your blood sugar levels, this can lead to brain damage, coma and death.
Many patients overdose on Insulin in a suicide attempt.
How did his organs shut down?
Let's review normal first:
In a normal human, the action potential (i.e., an electrical signal) starts at the upper part of the heart. This electrical signal travels down to the tip of the heart (Fig. 1). This stimulus triggers the heart muscle to contract. At that moment blood gets pushed forward. This mechanism repeats itself until we die.
What happened to Rich?
Both his heart and liver were found to weigh over twice the amount of the average adult male.
He had Cardiomegaly (i.e., large heart) and Hepatosplenomegaly (i.e., large liver and spleen) . This is a side effect of too much Human Growth Hormone and Testosterone (see earlier). Likewise, his autopsy report mentioned mild coronary atherosclerosis (i.e., plaque build-up in arteries) and right and left ventricular enlargement, which could have led to cardiac arrhythmias and sudden death .
In other words: His heart became so large that this electrical signal couldn't travel normally anymore. This led later to cardiac arrest (i.e., his heart stopped beating, Fig. 2). When there is no blood being pushed through the body, the brain starts suffering from hypoxia (low oxygen presence in the blood). The damage to the brain was irreversible, leading to coma. After two weeks of coma, he passed away and was buried at Forst Lawn Memorial Park in Hollywood Hills, California .
There were further signs of liver failure . After all, part of your liver's business is to keep the blood clean from any toxic substances, such as Bilirubin. If it can't be removed from your circulation, it deposits into your skin and sclera. Bilirubin is yellow by nature. Rich's skin and sclera were found to have yellowish discolouration, which is typical for jaundice (i.e., a sign of liver failure, Fig. 3). We know that his liver shutting down also led to ascites (i.e., the abnormal build-up of fluid in the abdomen).
Regardless, he was found to be free of any significant injury and there is no evidence that he took recreational drugs before his death. Therefore, it is unlikely that he was murdered or died from an acute drug overdose.
Did Bodybuilding kill him?
Although he was one of the biggest humans on earth, he still considered himself small in the mirror. Bigorexia (i.e., a health condition that can cause you to think constantly about building muscle on your body) was the real reason for his extensive drug abuse and death later on. Solely bodybuilding on its own is highly unlikely to be fatal unless you throw drugs into the mix. So no, bodybuilding can not kill you. Do not take steroids until medically necessary and don't take this as an excuse not to hit the gym.
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- FL Medical Examiner: Rich Piana’s Autopsy. (2017, September 29). MuckRock. https://www.muckrock.com/foi/pinellas-county-10455/fl-medical-examiner-rich-pianas-autopsy-44032/
- Sexualhormone. (2021, April 21).Amboss. https://next.amboss.com/de/article/zo0reS?q=testosteron#Zd8af7bfc02d73117787cbdd093cd18b3
- Melhem, A. J., Jr, Araújo, A. C., Figueiredo, F., & Figueiredo, D. (2020). Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature. The American journal of case reports, 21, e924796. https://doi.org/10.12659/AJCR.924796
- Wikipedia contributors. (2021, May 3). Rich Piana. In Wikipedia, The Free Encyclopedia. Retrieved 20:40, May 8, 2021, from https://en.wikipedia.org/w/index.php?title=Rich_Piana&oldid=1021264440