Still another case of death by polypharmacy, or multiple drug
use, is reported in the International Journal of Legal Medicine
1998;111:261-264. This particular death involved a 23-year-old
German bodybuilder, who had apparently used a variety of anabolic
drugs for 9 months prior to his death. One night, he decided to
go out dancing, which turned out to be his last dance. Returning
from the dance club, he went to bed at 4 a.m., but was found
unconscious 6 hours later. As to what indicated he was having a
medical emergency isn't clear, but he was nonetheless rushed to a
local hospital.
In the hospital emergency room, doctors worked on him in a
scene common on television's ER, but their efforts were to no
avail. Not long after this unfortunate young man was pronounced
dead, a search of his apartment for possible drugs disclosed a
veritable cache of various anabolic and associated substances
commonly used by athletes. This search turned up the following
substances:
1) Testex Leo- testosterone cyclopentilpropionate, 250
milligrams, an injectable form of testosterone.
2) Primobolan Depot- a 100 milligram injectable anabolic steroid
also known as methenolone enantate.
3) Proviron (mesterolone)- 25 milligram tablets. An oral anabolic
steroid often used to block gynecomastia, or male breasts. There
is, however, no evidence that it actually does this.
4) Thybon- 100 microgram tablets- a form of T3 or active thyroid
hormone comparable to another drug called Cytomel. This type of
drug is used to help oxidize fat, but can also have catabolic
effects in muscle.
5) Aldactone (spironolactone)- 100 milligrams. An oral potassium-sparing diuretic considered relatively weak in its diuretic
action. Some athletes have gotten into trouble when using this
drug concurrently with potassium supplements. Since Aldactone
blocks potassium excretion from the body, taking concentrated
potassium supplements in conjunction with the drug could result
in hyperkalemia, a dangerous elevation of blood potassium levels
that may lead to heart rhythm disturbances.
6) Clomifen- 25 milligram capsules. Clomifen, sold in the USA as
Clomid, is thought to maintain pituitary gonadatropin levels,
such as luteinizing hormone (LH) normally suppressed by anabolic
steroids. This suppression of endogenous gonadatropins often is
evident by a considerable shrinkage of the testicles. Athletes
resort to Clomifen in the hope that it will maintain their own
testosterone output while on steroids.
Another drug commonly used for this purpose is HCG
injections, although such injections have fallen out of favor in
recent years with the disclosure that this drug also increases
estrogen synthesis in males, leading to such undesired effects as
gynecomastia and increased subcutaneous fat storage.
7) Contraspasmin- 20 microgram tablets- A brand of the drug,
clenbuterol. Many bodybuilders believe that clenbuterol is a
"cutting drug" that helps them shed excess bodyfat. While
clenbuterol does offer potent thermogenic effects, these effects
are acutely ephemeral due to the exquisite sensitivity of the
beta-adrenergic cellular receptors that clenbuterol interacts
with. Thus, the drug often fails to work after only 3 weeks of
continuous usage. As I noted in a recent column, clenbuterol can
have adverse effects on the heart, particularly when combined
with thyroid drugs--as was apparently the case in the death
reported here.
The dead bodybuilder stood 6-foot-2, and weighed 207 pounds,
not obese at all. The autopsy revealed findings, however, that
indicated that this man was anything but healthy. His heart was
enlarged, which itself is common among people who exercise
regularly (the heart, like other muscles, increases in size with
exercise stimulation). The right ventricle of his heart was
dilated, and the innermost layer of the heart muscle itself
appeared to have localized hard spots. The supporting tissue
structure of his liver was unusually soft and fragile, as if it
had been chronically swollen. His brain was also swollen, and he
showed acute vascular congestion in his liver, spleen, and
kidneys.
A closer cellular study of his heart showed that much of his
cardiac cells were damaged, with several areas of dead tissue
throughout the organ. His lungs, liver, and kidneys showed
localized blood clotting and bursting of capillaries, the
smallest blood vessels. A careful examination of his liver cells
showed the presence of peliosis hepatis, blood-filled liver cysts
that are considered the precursor of liver failure.
A postmortem urine test showed no evidence of central
nervous system-stimulants (such as cocaine), but did reveal 4
anabolic steroid drugs, including two not found in his apartment
(Dianabol or methandrostenolone, and nandrolone or Durabolin).
The test also proved positive for clenbuterol. His ratio of
testosterone to epitestosterone was 64:1, an enormous amount. To
get a positive testosterone test in athletic drug testing
requires a ratio of only 6:1.
The extensive scar tissue present in the bodybuilder's heart
was thought to result from a lack of blood supply due to
extensive heart enlargement. I would disagree with this, however,
and suggest that the scar tissue may have resulted from either a
direct effect of anabolic steroids on the heart cells or the
combination of using steroids, clenbuterol, and thyroid
simultaneously. The fact that no evidence of arteriosclerosis or
prior heart attack was evident in this man underscores the fact
that the heart damage must have resulted from a direct toxic
effect of the combination of drugs he took.
The excess clotting effect observed in this man may result
from the stimulation of erythropoietin (EPO), a substance made in
the kidneys whose synthesis is promoted by anabolic steroids. EPO
promotes the increased production of both red blood cells and
platelets in the bone marrow. Excessive blood viscosity and a
high platelet count could promote extensive clotting effects.
Clomifen is also known to promote platelet aggregation that
results in clots, while the diuretic Aldactone, by decreasing the
water content of his blood may have added to the thickness
produced by heightened EPO synthesis.
Based on the physical and chemical findings of the autopsy,
the cause of death was listed as sudden cardiac arrest. This case
illustrates the dangers inherent in combining various drugs
thought to induce bodybuilding "progress." While all such drugs
have known side effects, combining them could lead to unexpected
effects that--as this case shows--could prove fatal. Several
deaths of well-known professional bodybuilders have likewise been
linked to their multiple drug usage.
Ephedrine: an aphrodisiac in women?
Ephedrine, an active component of the herb, Ma haung, is
most commonly used for weight-control purposes. This effect is
due to its structural similarity to epinephrine, a hormone that
among other functions, activates fat-cell enzymes that result in
the release of free fatty acids into the blood. Ephedrine
interacts with adrenergic cellular receptors, and also promotes
the release of both epinephrine and norepinephrine.
While fat-burning is the most common reason for using
ephedrine supplements, according to a study published in the
Archives of General Psychiatry 1998;55:652-656, the drug may have
value in promoting female sexual arousal. The study focused on
the effects of providing either 50 milligrams of ephedrine
sulfate or a placebo in a double-blind, crossover design, to 20
"sexually functional" women. The ages of the women ranged from
19-44, and they took no other medications. Their sexually
functional state was evident by the fact that all of them were
currently involved in heterosexual relationships; 3 were married.
The study authors decided to test the effects of ephedrine
because of the established involvement of the sympathetic nervous
system (SNS)in eliciting female sexual arousal. Since ephedrine
mimics the effects of natural SNS stimulants, such as
epinephrine, the idea wasn't unfounded. In fact, older studies of
men exposed to perceived danger showed that the heightened
epinephrine response that results (epinephrine is secreted under
stress conditions, and is also known as the "fight or flight"
hormone) made women look more attractive to them.
This study featured both self-reported or subjective effects
and physiological responses. The latter effect was determined by
the insertion of a phallic-like device into the women's vaginas,
which measured the amplitude of blood flow. Increased blood flow
into that area under specific conditions is considered a measure
of positive sexual response.
When taking the active substance--ephedrine sulfate--the
women took the pill 45 minutes prior to looking at 3
presentations. The first "show" consisted of looking at the word
"relax" flashed on a screen for one minute. This was followed by
a 3-minute neutral travelogue film, or a 5-minute erotic film,
presumably x-rated.
While the women viewed all 3 presentations after taking the
ephedrine, only the erotic film promoted an increased sexual
response. This was apparent by increased blood flow into the
vagina during the film. The travel film, in contrast, led to no
differences in the women's sexual response, whether on ephedrine
or a placebo. Although the women noted no subjective measures of
arousal while on the ephedrine, the authors note that in women,
physical arousal leads to subjective mental perception. I've
always believed the opposite, however: in women, the mental
aspects of arousal first occur, followed by the physical
responses. In men, they occur at about the same time.
The authors further speculate that ephedrine may provide a
boost to already increased sexual arousal in women. They also
note that whether ephedrine can jump-start a flagging libido in
women remains to be determined. None of the women showed any side
effects from the drug. Based on the responses observed in the
study participants, the study authors concluded that,"Ephedrine
can significantly facilitate the initial stages of physiological
arousal in women."
©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.
