When discussing anabolic steroid use and its known side effects, it is not uncommon to see bodybuilders express concern over potential liver injury or other cardiovascular health issues. However, we are now starting to see a much larger contingent of our community suffering from an equally serious, although less frequently recognized side effect in kidney disease/failure. This is a fairly recent phenomenon, which started in earnest about 10-15 years ago. Although there were certainly documented cases of kidney disease/failure prior to this, they were not nearly as prevalent as they are today. Although there are many potential causes of kidney failure, in this article we are going to limit ourselves to those most often attributed to the bodybuilding lifestyle.
Unfortunately, there is no single cause associated with kidney failure in bodybuilders. Often, it is an accumulative effect brought on by the presence of multiple stressors affecting the body at one time, but before we can pinpoint these causes, we must first understand how steroids affect the body, as well as possess a basic understanding of how the kidneys work to protect the body from toxins.
The kidneys are two bean-shaped organs which sit below the ribcage; one on each side of the spine. Their primary job is to filter the blood of toxins, which they do at a rate of roughly 120-150 quarts of blood per day. From this, they produce about 1-2 quarts of urine, which is then transported from the kidneys to the bladder for disposal.
The kidneys do not work as single, large filtering mechanism. Rather, each one contains about 1 million tiny filtering units called nephrons, which work to purify the blood at a microscopic level. Each of these nephrons contains a tubule, as well as its own filter (called a glomerulus). Just as the digestive system works in a multi-step process to break down food for absorption, nephrons also work through 2–step process to filter the blood. As blood moves through the glomerulus, it allows fluid and waste products to pass through it, while preventing large molecules, such as blood cells and proteins, from doing so. Afterward, this pre-filtered fluid is then sent through the tubules, which further refines the blood by separating toxins from beneficial substances, such as minerals. Ultimately, everything useful is sent back into circulation, while the final concentrated waste product becomes urine.
Let’s pause there for a second and transfer our attention over to a common side effect associated with anabolic steroids use—high blood pressure. Anabolic steroids have been thought to increase blood pressure through a variety of possible mechanisms, but it is their sodium retaining properties which are the primary cause of high blood pressure in most users. When anabolic steroids are administered they inhibit an enzyme known as 11-beta hydroxylase, which leads to the increased production of deoxycorticosterone and the subsequent retention of sodium and water. While anabolic steroids can vary substantially in their ability to influence this enzyme, as a general rule, the higher the dose employed, the more this enzyme is inhibited. Therefore, high dose users are more likely to experience elevated blood pressure compared to low-dose users.
High blood pressure is frequently implicated as a risk factor in cardiovascular disease and rightly so, but what about its effect on renal (kidney) function? Unfortunately, high blood pressure is a direct cause of renal stress and a leading contributor in the development of kidney failure. In fact, high blood pressure is the #2 cause of kidney failure in the United States right behind diabetes, being responsible for a full 28+% of documented cases and this number has only continued to grow over the last decade. With high blood pressure being one of the most common side effects associated with anabolic steroids use, one might think that it would garner more attention among the drug using community, but sadly, it does not.
When blood pressure is high, blood vessels stretch so that blood can flow more easily. This chronic stretching eventually weakens and scars the blood vessels of the kidneys, damaging them and impairing their ability to work properly. Once damaged, they become inefficient at waste and fluid removal. On top of the resulting toxin build-up, the inability to remove excess fluid can elevate blood pressure even more, resulting in a dangerous cycle.
Although anabolic steroids use alone is a potentially significant contributor to kidney disease/failure, as mentioned above, there are usually multiple causes involved in its development. Another potential risk factor is the use of nephrotoxic agents, such as NSAID’s. With anti-inflammatory drugs like Ibuprofen being routinely implicated in the development of kidney disease/failure and with many bodybuilders regularly using these drugs to treat various aches and pains, this risk factor should not be ignored. For anabolic steroids using bodybuilders, the over-use of NSAID’s may be all it takes to enter stage 1 kidney failure, followed by entrance into the later stages if not addressed. Therefore, nephrotoxic drugs should be used sparingly and only as needed. In cases of chronic pain and inflammation, one should seek speak with their physician regarding alternative treatments.
If you have been around the bodybuilding nutrition scene for any length of time, you will be familiar with the warnings associated with a high protein diet. While numerous studies have demonstrated the relative safety of a high protein diet, excess protein intake will still place additional strain on the kidneys. While this is not an issue in otherwise healthy people, it is like throwing gasoline on a burning fire in those with already compromised kidney function.
This is good reason to rely on the protein-sparing effects of carbohydrates and fats in the off-season, rather than using excess protein to meet one’s caloric demands. There has yet to be any published research demonstrating the benefits of a very high protein diet for the purpose of muscle growth, but perhaps we should first define the term “very high protein” diet. Among bodybuilders, 1-2 grams of protein per pound of bodyweight is considered to be typical in terms of daily protein intake.
In my opinion, this amount is ideal for optimizing muscle growth, assuming that adequate carbohydrate and fat is consumed in order to meet energy requirements. I see no need to go beyond this amount and at times have even questioned the validity of 2 grams. Obviously, there are instances in which a bodybuilder will need to consume more than the standard 1-2 grams per pound, such as during pre-contest prep, when carbs & fats have been reduced in an effort to shed bodyfat, but during the off-season, when muscle growth is the objective, I have yet to see a bodybuilder experience measurably greater growth when venturing beyond this pre-determined amount.
The take home message here is that there is no clinical evidence to suggest that protein consumption beyond the standard range supplies additional muscle building benefits, but we do know that the kidneys are responsible for processing protein, with larger amounts increasing the work-load on the kidneys. In those with normal kidney function, excess protein consumption does not appear to contribute to a decline in kidney function, likely because the stress generated by a high protein diet alone is not great enough to produce such an effect. However, in combination with other risk factors, very high protein diets (above 1-2 grams/pound) are associated with a worsening of kidney function. Therefore, it does not make any sense to follow a potentially injurious diet in the absence of documented benefits.
Excess protein is not the only dietary consideration in the management of high blood pressure. Sodium also plays a role. Unlike anabolic steroids, which indirectly increase sodium retention as a consequence of use, we have no excuse for ignorance when it comes to the deliberate consumption of excess sodium. This is something that is easily within our control and while not all pre-made foods list sodium content on their packaging, as a bodybuilder you shouldn’t be eating many of these foods anyway. When attempting to manipulate sodium to our advantage, there are 2 primary factors we need to concern ourselves with. They are total intake and consistency of intake. Most bodybuilders will require slightly more sodium than a sedentary individual of equal bodyweight, due to the sodium loss that occurs during training via perspiration. Those bodybuilders who work in hot environments and/or have manual labor jobs will need to make further adjustments according to need.
The body is constantly regulating sodium levels in order to maintain/establish homeostasis (balance), as the proper balance of electrolytes is critical for the preservation of life. Aldosterone, a anabolic steroids hormone produced by the adrenal glands, plays a key role in maintaining this balance through the regulation of sodium levels within the body. When sodium levels are low aldosterone levels increase, causing the body to excrete less sodium. When sodium levels are high, aldosterone levels decrease, causing the body to excrete more sodium. The body is in a constant state of evaluation, with even the slightest changes in sodium levels initiating a change in aldosterone concentration.
By maintaining a fairly consistent sodium intake, the body is only required to make subtle adjustments in order to maintain homeostasis, but when it is exposed to large fluctuations in sodium due to an ever-changing diet, aldosterone concentrations are altered dramatically. This can cause substantial increases in water retention and as a consequence, significant elevations in blood pressure. Therefore, a bodybuilder would likely be better off consistently consuming slightly more sodium than needed, rather than eating low sodium on most days, but high sodium on others. In some cases it can take the body several days to restore proper water balance after a sodium splurge, during which times blood pressure can remain elevated.
Another risk factor associated with kidney disease/failure, and which is heavily connected to the first, is the unwillingness to go off anabolic steroids for a prolonged period of time. Fearing the loss of muscle tissue, many of today’s bodybuilders remain on anabolic steroids 365 days a year. Now, most of the side effects associated with anabolic steroids use are transient, and kidney stress is no exception (in most cases), but when these stressors remain in place indefinitely, the affected organ(s) never get a chance to rest. For those who have already entered into Stage 1 kidney failure or worse, this has potentially dire ramifications, as the body never has a chance to normalize itself and may be pushed into later stages of kidney failure. Needless to say, a little prudence in matters such as this can go a long way in making a positive impact on one’s health.
Finally, dehydration can have a negative effect on kidney function by reducing blood flow to the kidneys. As a result, the kidneys are unable to properly remove toxins from the bloodstream, resulting in toxin build-up; a condition known as azotaemia. The kidneys require adequate blood flow in order to perform their job properly and nothing reduces blood flow more quickly than dehydration (aside from extensive blood loss). In fact, if water is completely withheld, death can result in as little as 2-3 days.
Kidney damage is not uncommon among pre-contest bodybuilders who frequently utilize diuretics in an effort to present a dry appearance onstage. Due to the potent nature of these drugs, one can simulate a state of severe water deprivation within days and in some cases mere hours. With protracted and/or repeated use, and depending on the dose administered, kidney damage can and often does occur to varying degrees.
Regardless of the cause(s), high blood pressure leading to kidney damage is a very real concern among anabolic steroid-using bodybuilders. The relative scarcity of outwardly discernible symptoms has earned it the moniker “the silent killer”, as many of those afflicted with the condition are unaware of its existence. This makes it potentially more dangerous than many other side effects, which manifest themselves openly.
As mentioned above, excessive protein & sodium intake, the use of NSAID’s, inadequate water consumption, and a refusal to take periodic breaks from anabolic steroid use, all serve to further compound the problem. With most bodybuilders being exposed to one or more of these risk factors, it makes sense to take steps to minimize their deleterious effects on the body, especially in those who individuals who have already entered into the beginning stages of kidney failure.
Supplementation is also a viable option in the prevention of kidney disease/failure. One of the most common classes of kidney support supplements are those which help reduce blood pressure. Fortunately, there are several clinically validated OTC supplements which have proven effective in the alleviation of this malady. Hawethorn berry is one of the most heavily researched of the bunch and at optimal dosage is quite effective at reducing blood pressure. Co-Q10, as well as celery seed extract, have also been shown to provide considerable benefit in this area. Other classes of supplementation include detoxifiers, antioxidants, and alkalinizers, as well as single compounds, such as vitamin B-6 and L-Carnitine, although not all of these products may be beneficial in every case. Underlying causes, as well as disease progression, should be taken into consideration when designing a kidneys support program.
Without doubt, ignorance is the #1 cause of kidney dysfunction in drug-using bodybuilders today. Often, it doesn’t take more than a few simple adjustments to mitigate further damage and bring things under control. I encourage all bodybuilders to regularly evaluate their kidney health through physician monitored bloodwork, as the kidneys do not possess the same self-rejuvenating capabilities as the liver. Once damage is sustained, it is oftentimes permanent. Therefore, preventative action is a must.
