Me at 40 years old, all-natural at 194 lbs, competing on stage. Photo by Bill Comstock, courtesy of Muscular Development.

Introduction

Bodybuilding epitomizes physical discipline, with athletes sculpting physiques that seem to radiate peak health. Yet, a tragic pattern haunts the sport: young bodybuilders, often in their 20s and 30s, are dying from sudden cardiac events. Despite appearing in "the best shape of their lives," many succumb to the devastating effects of anabolic-androgenic steroid (AAS) abuse, which ravages their hearts. As a natural bodybuilder with over 30 years of experience, I’ve built significant muscle without steroids, relying on precise nutrition, training, and rest. A 2022 study, Dead Bodybuilders Speaking from the Heart by Escalante et al., exposes the cardiac toll of AAS. This article delves into the lethal risks of steroids, outlines how a slight caloric surplus and strategic nutrition can safely build muscle, and shares my proven methods to grow size without compromising heart health.

The Deadly Cost of Steroid Abuse

Anabolic steroids, synthetic testosterone derivatives, deliver rapid muscle gains but exact a severe toll on the cardiovascular system. The Escalante et al. study analyzed autopsies of six male bodybuilders under 50 who died from heart-related causes, revealing:

• Cardiomegaly: Mean heart weight was 575 g, 73.7% heavier than the reference man’s 332 g.
• Left Ventricular Hypertrophy (LVH): All cases showed LVH, with a mean left ventricular thickness of 16.3 mm, 125% above normative data.
• Atherosclerosis and Drug Use: 80% of cases with atherosclerosis had positive toxicology for illicit drugs, and 67% confirmed AAS use.
• Causes of Death: Included steroid-induced cardiomyopathy, sudden cardiac dysrhythmia, and hypertensive cardiovascular disease, with AAS as a key factor.

Supporting cases amplify these findings. A 2007 study of a 20-year-old bodybuilder who died of cardiopulmonary arrest noted a hypertrophic heart (515 g) linked to AAS. A 2022 case of a 34-year-old bodybuilder’s heart failure death showed LVH and AAS in toxicology. Steroids enlarge the heart, elevate blood pressure, and accelerate atherosclerosis, leading to fatal arrhythmias or heart failure. They disrupt lipid profiles, raising LDL and lowering HDL, hastening arterial plaque buildup. Autopsies often reveal myocardial fibrosis and necrosis, increasing sudden cardiac death (SCD) risk, particularly during intense exercise. X posts echo these warnings, citing high blood pressure, kidney failure, and liver damage from AAS.

Why Young Bodybuilders Are Vulnerable

Young male bodybuilders, typically 20-40, face elevated risks due to:

• High Doses and Polypharmacy: Competitive bodybuilders use AAS doses 10-100 times therapeutic levels, often combining them with diuretics, clenbuterol, or insulin, intensifying heart strain.
• Extreme Contest Prep: Dehydration, caloric deficits, and rapid weight cuts disrupt electrolytes, heightening arrhythmia risk. A 2022 Washington Post report tied diuretic-induced cramps to deaths like Alena Kosinova’s.
• Lax Oversight: Some federations, like the IFBB Pro League, have weak drug testing, enabling AAS use. Unqualified coaches often supply steroids, pushing dangerous protocols.
• Cultural Pressures: Social media and competition standards glorify extreme muscularity, normalizing AAS. A 2013 review estimated 1-5% global AAS use, higher among aesthetic-focused bodybuilders.

Safer Alternatives: Nutrition, Rest, and Minimal Caloric Surplus

With over 30 years as a natural bodybuilder, I’ve proven that significant muscle growth doesn’t require steroids—or massive calorie surpluses. A slight daily increase of just 20 calories above maintenance, paired with optimal training, nutrition, and rest, can yield 10 lbs of lean muscle in 8-12 months for those following a disciplined program. The key is precise macronutrient ratios—50% protein, 30% carbs, and 20% fat for most meals, shifting to 50% protein and 50% high-glycemic index (GI) carbs with minimal fat in the 3-hour post-workout window, where one-third of daily calories fuel muscle growth across three meals. Here’s how to build size safely:

1. Macronutrient Ratios and Post-Workout Nutrition

Macronutrients should be tailored to optimize muscle protein synthesis (MPS) and recovery:

• Daily Meals (Non-Post-Workout): Target 50% protein (1.6-2.2 g/kg body weight), 30% carbs (3-5 g/kg), and 20% fat (0.5-1 g/kg) to support energy, hormone production, and muscle repair.
• Post-Workout (3-Hour Window): Consume one-third of daily calories across three meals—a protein shake immediately after training, followed by two meals—aiming for 50% protein and 50% high-GI carbs (e.g., dextrose, white rice, or juice) with minimal fat to ensure rapid digestion and nutrient uptake.
  • Immediate Post-Workout (Protein Shake): 20-40 g protein (e.g., whey) and 20-40 g high-GI carbs for an insulin spike.
  • Second Meal (1-2 Hours Later): 15-25 g protein and 20-30 g high-GI carbs, low fat.
  • Third Meal (2-3 Hours Later): 15-25 g protein and 20-30 g high-GI carbs, low fat.
• Daily Totals: Spread protein and carbs across 5-6 meals, with post-workout meals driving MPS and glycogen replenishment.

2. Modest Caloric Surplus for Muscle Gain

A 20-calorie daily surplus above maintenance fuels muscle growth without excess fat. This adds ~7300 calories annually, roughly 2-3 lbs of muscle (1 lb muscle ≈ 2500-3500 kcal, depending on water and glycogen). With optimal training and recovery, 10 lbs of lean mass in 8-12 months is achievable for intermediate lifters:

• How It Works: The surplus supports training intensity and muscle repair, minimizing fat gain.
• Adjustments: Track progress monthly. Reduce carbs if fat gain occurs; increase by 10-20 calories if strength stalls.

3. Rest and Recovery

Muscles grow during recovery, not just training. Prioritize:

• Sleep: 7-9 hours nightly to boost growth hormone and testosterone.
• Rest Days: 1-2 rest or active recovery days weekly to support repair.
• Progressive Overload: Gradually increase weights or reps to stimulate growth without overtraining.

4. Sample Nutrition Plan for a 180-lb Bodybuilder

For a ~2600 kcal diet with a 20-calorie surplus, with ~870 kcal (one-third) in the post-workout window, using 50% protein (325 g, ~1300 kcal), 30% carbs (195 g, ~780 kcal), 20% fat (58 g, ~520 kcal) daily:

• Immediate Post-Workout (Protein Shake): 1 scoop whey protein, 10 oz grape juice (25 g protein, 25 g high-GI carbs, 0 g fat, ~200 kcal; 50% protein, 50% carbs).
• Post-Workout Meal 1 (1-2 Hours Later): 3 oz chicken breast, 2/3 cup white rice (20 g protein, 20 g high-GI carbs, 1 g fat, ~170 kcal; ~50% protein, ~48% carbs, ~2% fat).
• Post-Workout Meal 2 (2-3 Hours Later): 3 oz turkey breast, 2/3 cup white rice (20 g protein, 20 g high-GI carbs, 1 g fat, ~170 kcal; ~50% protein, ~48% carbs, ~2% fat).
• Breakfast: 4 oz egg whites, 1.5 scoops whey protein, 1/2 cup oats, 1 tbsp almond butter (40 g protein, 25 g carbs, 10 g fat, ~350 kcal; 50% protein, 31% carbs, 19% fat).
• Lunch: 5 oz chicken breast, 1/2 cup quinoa, 1/2 avocado (35 g protein, 20 g carbs, 10 g fat, ~350 kcal; 50% protein, 29% carbs, 21% fat).
• Snack 1: 1 scoop whey protein, 1/2 cup berries, 10 almonds (25 g protein, 15 g carbs, 7 g fat, ~230 kcal; 50% protein, 30% carbs, 20% fat).
• Snack 2: 4 oz tuna, 1/2 cup sweet potato, 1 tsp olive oil (25 g protein, 15 g carbs, 7 g fat, ~230 kcal; 50% protein, 30% carbs, 20% fat).
• Dinner: 5 oz salmon, 1/2 cup brown rice, 1 cup broccoli (30 g protein, 20 g carbs, 10 g fat, ~330 kcal; 50% protein, 30% carbs, 20% fat).
• Totals: 220 g Protein (880 kcal, 50%), 160 g carbohydrates (640 kcal, 30%), 46 g (414 kcal, 20%), ~2600 kcal, with ~870 kcal post-workout.

5. Supplements for Natural Growth

• Creatine Monohydrate: 5 g daily (with water or juice) for strength and muscle volume.
• BCAAs: 5-10 g pre/intra-workout to support MPS.
• Omega-3s: 1-2 g daily to reduce inflammation and support hormones.

This approach, refined over my decades of natural bodybuilding, builds size without the cardiovascular devastation of AAS.

4 weeks out from competition.

My Journey and Guidance

For over 30 years, I’ve built a competitive physique naturally, rivaling many AAS users, through disciplined training, precise nutrition, and recovery. At 40 years old, weighing 194 lbs, I achieved this all-natural physique (see Figure 1), proving that significant size is attainable without steroids. My blog, strongist.co, shares my proven methods, emphasizing that a 20-calorie daily surplus and one-third of calories in the 3-hour post-workout window—starting with a protein shake and followed by two high-GI carb, low-fat meals with 50% protein—can yield 10 lbs of muscle in 8-12 months. Unlike steroids, which enlarge and damage the heart, my approach prioritizes longevity. I coach bodybuilders to achieve their best size safely. Contact me at matt@strongist.co to learn how to grow without risking your health.

Conclusion

The tragic deaths of young bodybuilders, as detailed in Escalante et al.’s 2022 study, reveal the lethal cost of steroid abuse—enlarged hearts, thickened ventricles, and clogged arteries beneath sculpted exteriors. The bodybuilding community needs stricter regulations, better education, and a shift from extreme muscularity. My 30 years of natural bodybuilding prove that a 20-calorie surplus, 50% protein, 30% carbs, and 20% fat daily, with 50% protein and 50% high-GI carbs post-workout, and proper rest build significant muscle without heart risks. Visit strongist.co to discover a safer path to your strongest self. Choose health over fleeting gains—your life depends on it.

References

• Escalante G, Darrow D, Ambati VNP, Gwartney DL, Collins R. Dead Bodybuilders Speaking from the Heart: An Analysis of Autopsy Reports of Bodybuilders That Died Prematurely. J Funct Morphol Kinesiol. 2022;7(4):105. doi:10.3390/jfmk7040105.
• Fineschi V, Riezzo I, Centini F, et al. Sudden cardiac death during anabolic steroid abuse: morphologic and toxicologic findings in two fatal cases of bodybuilders. Int J Legal Med. 2007;121(1):48-53. doi:10.1007/s00414-005-0055-9.
• Lusetti M, Licata M, Silingardi E, Reggiani Bonetti L, Palmiere C. Post-mortem investigation into a death involving doping agents: the case of a body builder. Drug Test Anal. 2022;14(8):1520-1525. doi:10.1002/dta.3309.
• Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. Am J Cardiol. 2010;106(6):893-901. doi:10.1016/j.amjcard.2010.05.013.

Contact

For coaching, resources, or to share your story, reach out via:

• Blog: strongist.co
• Email: matt@strongist.co