Rich Piana: Why Do So Many Bodybuilders Die Young?


In August 2017, the world-famous body builder Rich Piana collapsed from a heart attack while his girlfriend was giving him a haircut.  He died after two weeks in a medically-induced coma, at the age of 46.   A search of his apartment revealed more than 20 bottles of steroids.  

In his younger years he had won several bodybuilding titles, and he continued his prodigious strength-training workouts even after he stopped competing. He was a professional bodybuilder, actor, entrepreneur and social media star who had more than a million followers of his YouTube videos. He admitted that he had taken steroids to grow larger muscles since age 18, which made him one of the few honest steroid-taking athletes today. 
How Could a Man Who Exercised So Much Die of a Heart Attack?
A heart attack is usually caused by a plaque breaking off from the inner lining of an artery leading to the heart. This is followed by bleeding and clotting. Then the clot extends to completely block all blood flow through that artery.   The part of the heart muscle supplied by that artery then dies from lack of oxygen.  Exercise can stabilize plaques and help to prevent them from breaking off, but exercise does not prevent plaques from forming.   A healthful diet helps to prevent plaques, and Rich Piana’s diet was ridiculously unhealthful and heart-attack provoking.  The anabolic steroids he took would also increase plaque formation and cause a disproportionate enlargement of the heart that can result in irregular heartbeats which may have caused his death. 
Inspired by His Mother
Starting when he was six years old, Piana would go to the gym and watch his mother train to be a competitive bodybuilder.  By age 11, he began lifting weights seriously and at age 15, he started competing in bodybuilding contests. By age 18, after he started taking steroids, he began to win titles including “Mr. California.”  He continued to compete for twenty years and along the way, he appeared in bodybuilding shows, developed his own clothing line and operated bodybuilding supplement companies.  He produced a series of YouTube videos on body building and nutrition and built up a huge following.  To his credit, he honestly explained that his massive physique was developed by taking steroids, eating nine or more meals a day, taking eight-hour workouts, and drinking “protein shakes big enough to drown a toddler in.”  He correctly stated that nobody in the competitive bodybuilding industry can compete successfully without using performance-enhancing drugs. He advised his followers not to use steroids, saying, “If you have the choice to stay natural or do steroids, stay natural. There’s no reason to do steroids, you’re only hurting your body, you’re hurting yourself . . . (but if) you want to become a professional bodybuilder, guess what – you’re probably going to have to . . . do ‘em. You’re not going to have a choice.”

His Training Program
He would spend as much as eight hours a day lifting weights in the gym, doing multiple repetitions and multiple sets of weights that were well below his maximum for single lifts. On Mondays he stressed his back muscles, Tuesdays his chest, Wednesdays his upper legs, Thursdays his shoulders and upper back, and on Fridays his arms.  He usually did not do any continuous aerobic training such as riding a bike or running on a treadmill because he felt that he was getting that type of aerobic effect from the repeat lifts he was doing with weights.   His grueling workouts and steroids made him one of the strongest men in the world: 
• Bench Press: 225kg (495 lb) for 3 reps
• Squats: 265 kg (585 lb) for 2 reps
• Deadlifts: 265 kg (585 lb) for 1 reps                  
• Barbell Curl: 125 kg (275 lb) for 3 reps
Most of his workouts involved lifting and lowering a weight 16 or more times in a row before resting and repeating each set. He often did an eight-hour arm workout in which he rested frequently but continued to stress his arms for the entire workout.  He would tell his viewers that he did not recommend this for everyone because very few people would be capable of such a brutal workout.  
His Ludicrous Diet
Two hours before his day-long workouts, he would eat a massive breakfast and during the work out, he would drink 15 to 20 protein shakes full of sugar, protein and fruit,  a technique he called “Feeder Workouts.”  One of his YouTube series, “Bigger by the Day,” described how he would gain 30 pounds of muscle in 16 weeks by eating 12 meals a day in addition to taking steroids and human growth hormone.  He complained about how difficult it was to weigh over 300 pounds, shoveling in ludicrous amounts of food in increasingly shorter time intervals, in addition to sucking down his protein shakes.

How Steroids Make You Strong
Anabolic steroids are male hormones that can increase the size and number of muscle fibers in athletes to make them stronger and faster with increased endurance (Med Sci Sports Exerc, Nov 1999;31(11):1528-34).  Knowledgeable athletes train by taking an intense workout on one day, feeling sore on the next day, and then going at a less intense pace until the muscles heal and the soreness goes away so they can take their next intense workout. Just a few days after athletes start taking anabolic steroids, they notice that they recover much faster from workouts, and therefore can do more frequent and intense workouts to become much stronger.  However, taking anabolic steroids comes with a steep price including premature death from a heart attack.  
Why Steroids and Other Performance Drugs are Deadly
Taking steroids can cause the left ventricle, the main pumping chamber of the heart, to enlarge disproportionately compared to the rest of the heart. This increases chances for irregular heartbeats and sudden death (Heart, May 2004;90(5):473–475). Synthetic male hormones also increase plaque formation in arteries, lower blood levels of the good HDL cholesterol and increase levels of the bad LDL cholesterol.
Human Growth Hormones cause all muscles to grow.  They can cause the heart muscle to grow without also stimulating its nerves to grow to support the larger heart.  This increases risk for irregular heartbeats and sudden death (J Endocrinol, Oct 1997;155Suppl 1:S33-7;discussion S39).
Insulin drives sugar into cells, and it also specifically drives protein building block amino acids into cells to make muscles larger and stronger.  However, high levels of insulin can increase risk for forming arterial plaques that can break off to cause heart attacks (J Clin Invest, 2000, Aug 15; 106(4): 453–458).

Piana Thought He Knew What He Was Doing
Athletes who take drugs to make themselves stronger are risking their lives.  In one of his videos, Piana advised, “You need to be aware, educated, and willing to do whatever it takes to remain healthy and keep the body healthy . . . We want to be doing this in our 60s, 70s, 80s and 90s. I’ll be doing this for the rest of my life . . . It’s important for me to live a long life.”  On his use of steroids, he said, “Is this a road I think you should take? Absolutely not. But in doing this for 25 years of taking anabolic steroids, obviously I know what the f— I’m doing.”   Obviously, he was wrong.  
September 26, 1971 – August 25, 2017