Study Typical BB stack of AASs, GH and high protein diet: serious kidney damage, disease

[alan2102]

The bodybuilding lifestyle using anabolic steroids, growth hormone and high protein diet, over years, can apparently cause a variety of dreadful kidney diseases. By "complementary" in the title I assume the authors mean "using a combination of agents", in this case the typical stack just mentioned. This is not entirely new, as there is other literature on anabolic steroids causing kidney damage.

The full text of this article is available for free, and is worth reading for a variety of details. For example, they mention that hypertension had become evident in all subjects; that's certainly an easy early warning marker. They also mention that some of the subjects were in the habit of using NSAIDS -- bad news for the kidneys, and possibly synergistically harmful along with the other stuff.

There are some glaring inaccuracies. The only mention of testosterone dose is in relation to what they indicate is a typical therapeutic dose in hypogonadism of 250 mgs per three weeks; they say that some of their subjects were using 100 times this amount! (I doubt it! Perhaps 10 times, or 20.) Growth hormone doses were not mentioned. Protein quantity mentioned in the full text is clearly a typo: 30-50 grams/kg/day, an impossible amount. They must have added the zero in error, and meant 3-5 grams/kg/day (a high but imaginable protein intake for a bodybuilder). They mention that up to 2.8 grams/kg/day appears to be safe (reference is given).

Anyway, back to the main theme, which is that the kidney damage and disease resulting from the described programs is terrifying.

Many high level BBers die young from cardiovascular disease, kidney disease or cancer; these are the high-profile cases that you hear about; lists are often posted on the internet. It is likely however that many more do NOT die, but quietly develop end-stage renal disease at rather young ages (perhaps in 40s or 50s) and have to live out their lives going in for dialysis.

It is clear that anyone considering such a program would be insane: 1) to do it at all, probably; or 2) if electing to do it anyway, to fail to protect their kidneys with an array of renoprotective drugs and supplements, starting with ACE inhibitors or receptor blockers (ARBS) (harmless and beneficial drugs commonly used in hypertension), and continuing with a battery of protective nutrients such as taurine, fish oils, niacin/niacinamide, vitamin A, magnesium, and arginine, just to name a few of the main ones off the top. Also, shift at least partially from animal source to vegetable source proteins (less kidney stress), and increase potassium and keep sodium low. I should write an article about this, since I've been collecting literature on it for years.

Anyhoo, here's the article:

https://www.ncbi.nlm.nih.gov/pubmed/29657200

Saudi J Kidney Dis Transpl. 2018 Mar-Apr;29(2):326-331. doi: 10.4103/1319-2442.229269.
Complementary bodybuilding: A potential risk for permanent kidney disease.

El-Reshaid W1, El-Reshaid K1, Al-Bader S2, Ramadan A2, Madda JP3.
Author information

1Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.2Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait.3Department of Histopathology, Al-Amiri Hospital, Kuwait City, Kuwait.

Abstract

We report our experience of renal disease associated with bodybuilders who had been on high-protein diet, anabolic androgenic steroids (AASs), and growth hormone (GH) for years. A total of 22 adult males who volunteered information about use of high protein diet and AAS or GH were seen over a six-year period with renal disease. Kidney biopsy revealed focal segmental glomerulosclerosis (FSGS) in eight, nephroangiosclerosis in four, chronic interstitial nephritis in three, acute interstitial nephritis in two, nephrocalcinosis with chronic interstitial nephritis in two, and single patients with membranous glomerulopathy, crescentic glomerulopathy, and sclerosing glomerulonephritis. Patients with FSGS had a longer duration of exposure, late presentation, and worse prognosis. Those with interstitial disease had shorter exposure time and earlier presentation and had improved or stabilized after discontinuation of their practice. There is a need for health education for athletes and bodybuilders to inform them about the risks of renal disease involved with the use of high-protein diet, AAS, and GH.

PMID: 29657200 DOI: 10.4103/1319-2442.229269
Free full text

...............

For further context and examples:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515889/
Clin Kidney J. 2015 Aug; 8 (4): 415419. doi: 10.1093/ckj/sfv032
Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders

 

[Jaredborgetti]

Ace inhibitors can cause kidney failure and they damage the kidneys themselves, they would be excellent for kidney protection if not but unfortunately they are nephrotoxic, I have researched this thoroughly, the biggest risk is high blood pressure over several years or decades for the kidneys, which is bound to happen with AAS and GH, blood pressure control is important but Ace inhibitors should be a last resort. I dont believe high protein diets damage healthy kidneys.

 

[alan2102]

ACE Inhibitors and ARBs are generally renoprotective.

These drugs do have the potential to harm the kidneys, mostly in special circumstances which likely apply to no one reading these words, (circumstances that would likely have you horizontal, in the hospital):
https://www.ncbi.nlm.nih.gov/pubmed/8879974

Meanwhile, there are literally hundreds of studies documenting the renoprotective actions of this class of drugs. Sometimes very long-term (15 years) studies in large numbers (~55,000) of humans, e.g.:
https://www.ncbi.nlm.nih.gov/pubmed/28505194

If ACE inhibitors or ARBs were causing kidney function deterioration, or significant other risk, why are we not seeing it? Where are the bodies? There aren't any, to speak of.

There was a scare-story a few years back about ACE inhibitors and ARBs increasing the risk of acute kidney injury. However, even the original authors later admitted that the risk is slight and the association was dwarfed by other factors:
https://www.ncbi.nlm.nih.gov/pubmed/28003286
Interestingly, the people with worst kidney function were at lowest risk!

In people who had been hospitalized for acute kidney injury, the use of ACE inhibitors or ARBs after discharge was associated with reduced one-year mortality:
https://www.ncbi.nlm.nih.gov/pubmed/29766216
and, similar:
https://www.ncbi.nlm.nih.gov/pubmed/28406186

Also, it seems that ACE inhibitor over-dosing, and/or dehydration, might be the main factors in increased acute kidney damage risk, and that ARBs might be a generally safer choice:
http://www.ncbi.nlm.nih.gov/pubmed/27080620

Contrast, however, the item cited above -- 28505194 -- suggesting that the ACE inhibitors are more effective for renal protection than ARBs. It is also possible to use both classes of drugs in reduced dosage. Indeed this combination appears to be highly effective in preserving kidney function:
https://www.ncbi.nlm.nih.gov/pubmed/28577742

I am prepared to be proved wrong about this (or anything else!) when/if compelling evidence comes to the fore. But for now, the renoprotective effects of the ACE inhibitors and ARBs is a much better bet, in my estimation, than refraining from use of these drugs because of slightly increased risk of acute renal injury -- that risk possibly being down to reckless dosing and/or poor hydration and/or atherosclerotic renal arterial stenosis.

I am sure that the last pages have not yet been written in this story, and I look forward to future developments.

And btw I personally would not use ACE inhibitors or ARBs as a FIRST resort. My first resort would be the nutrients and other practices that I mentioned. The drugs would be an add-on. (Or in my case actually ARE an add-on. I take modest doses of captopril for general preventive purposes, including not only renal protection, but possible prevention of cancer, and probable muskuloskeletal benefits including reduced risk of sarcopenia.)

I do thank you for reminding me to stay on top of this and check the literature at more-frequent intervals.

 

[CFC]

Thanks for posting this study up alan2102, interesting read.

 

[alan2102]

You bet.

I think there should be a lot more discussion of KIDNEY PROTECTION by AASR users. I rarely see any mention of it, but it is super-important.

One of my more-recent faves in this regard is plain old niacinamide, vitamin B3, which has been found to lower blood phosphate levels, and phosphate is a kidney stressor; see here for background: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884106/

B3 is the hot new thing in nephrology, for chronic kidney patients, because of this action. There's a bunch of literature on it. And I figure: why wait until my kidneys start failing (if that is in the cards for me)? B3 is harmless and cheap, so why not start now? So I take a few hundred mgs, several times per day. Super-cheap from bulksupplements.com. Just one element in my CKD-prevention stack. (I am also giving it in small doses to my cats. I've lost several cats to kidney disease, and I would like to prevent that.)

BTW, doing some followup research I ran into this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720528/
.... regarding testosterone and renal function. Read the discussion section, very interesting details.
It seems that low-dose testosterone is protective in some models; higher doses may cause renal perfusion (circulatory) problems which cause reversible kidney function changes (and maybe not-so-reversible on continued exposure). This is still a rather foggy area. But I think it wise for anyone using these compounds to be pro-active with renal protectants, perhaps especially ones that enhance endothelial function and circulation, e.g. arginine. Keep those blood vessels OPEN, guys! Niacin might be better than niacinamide, having a 1-2 punch: 1) B3 to lower phosphate, and 2) anti-atherosclerotic action and circulatory enhancement.