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Maintaining kidney health while on AAS

little slice

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Hey slice what were you referring to when you said "well if we dont develope an auto immune response?




there are autoimmune diseases that attack the kidneys (Goodpasture's syndrome, etc.)


FSGS is a pretty rare disease that appears in children and adolescents.. Flex Wheeler had it. He was leaking protein before he even set foot inside a gym.


basically, im saying to 'control what you can'


-blood pressure
-avoiding becoming a diabetic
-avoiding painkillers and NSAIDS

etc.


Marius Dohne - an IFBB pro is in end stage kidney failure IIRC..


IIRC, he:

-has a family history of kidney failure
-left his high blood pressure untreated
-abused NSAIDS
-competed frequently (used diuretics a lot)

etc..


help yourself to help yourself :eek:
 

Kaladryn

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So this is concerning.


You are stating that... regardless of drug use...
just the simple acts of hard training + being strong = kidney damage?

Hasn't it always been assumed that healthy eating, hard training, and trying to get as strong as possible are the SAFEST routes to adding permanent size? (Even natural guys do this)

If you can't do that safely, what is even the point?

What we have always assumed is always where our unknown errors are (and these always exist).

Myoglobin may be an X-factor that plays a very significant role in a perfect storm type situation that can easily happen:

1. Heavy training causing large amounts of muscle damage. Multiple sets to failure on the same exercise. Unusual exercises that you aren't used to. Etc.

2. High levels of uric acid in the kidneys from breaking down large amounts of protein (aminos, whey, etc), lets face it, most of these are being used as energy when we train.

3. Dehydration or inadequate water intake during and post-exercise (myoglobin has a half-life of 2-3 hours in the blood).

This "perfect storm" scenario isn't that far-fetched and it may be happening to a small degree and causing a small amount of kidney damage without even noticing it.

If you subscribe to HIT training (as I do) then you feel almost everyone is overtraining and some people are MASSIVELY overtraining. "All out" is different to everyone. One guy can get away with doing 10 sets to failure, another guy would be in the hospital with full rhabdo from doing 10 sets to failure.
 

1234trew

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Knowing many older bodybuilders - kidneys don't seem to be that much of an issue. Now many of these guys trained 2x a day for two hours at a time 6 days a week. The main issues that we all seem to have are heart related (clogged arteries and such which I would attribute to massive red meat intake along with the sauce).

That said, could it be something in the newer arsenal that could be causing so many of these issues? Solvents, crude orals, gh, insulin, peptides, preworkouts????
 

little slice

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Knowing many older bodybuilders - kidneys don't seem to be that much of an issue. Now many of these guys trained 2x a day for two hours at a time 6 days a week. The main issues that we all seem to have are heart related (clogged arteries and such which I would attribute to massive red meat intake along with the sauce).

That said, could it be something in the newer arsenal that could be causing so many of these issues? Solvents, crude orals, gh, insulin, peptides, preworkouts????




-oral steroids
-GH causing cardiac remodeling
-blood pressure causing cardiac remodeling
-insulin causing increased muscular growth (blood pressure, LVH, etc.)
-untreated sleep apnea

etc
 

Kaladryn

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Knowing many older bodybuilders - kidneys don't seem to be that much of an issue. Now many of these guys trained 2x a day for two hours at a time 6 days a week. The main issues that we all seem to have are heart related (clogged arteries and such which I would attribute to massive red meat intake along with the sauce).

That said, could it be something in the newer arsenal that could be causing so many of these issues? Solvents, crude orals, gh, insulin, peptides, preworkouts????

Kidney issues have long been on the radar of health issues facing bodybuilders, and kidney failure is the number 2 killer of men.

And sugar causes clogged arteries, not cholesterol.
 

Soalian

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The following is my speculation based on the above studies as well as additional information I will post along. The most likely channels through which AAs cause kidney damage are:


1) Increased blood pressure
2) Oxidative stress
3) Exacerbated myoglobin toxicity
4) Angiotensin II
5) Endothelin-1

6) Increased lean body mass
7) Increased protein consumption
8) Insufficient hydration


Let's look at each in turn and discuss what preventative measures we can take as AAS abusers.

1) Increased blood pressure

This one is pretty self-explanatory. The evidence that high blood pressure leads to kidney damage (especially over long periods of time) is overwhelming. Similarly, there is now a pretty good understanding of how AAS lead to increases in blood pressure, see this thread: http://www.professionalmuscle.com/f...42419-maintaining-heart-health-while-aas.html
The same thread also contains information on how to manage AAS induced increases in blood pressure. it is important that you regularly check your BP throughout your cycle. Just because your blood pressure is under control with certain medications while taking one anabolic steroid does not mean it will also be the case when taking other steroids. For example, extremely androgenic steroids like trenbolone may require higher dosages of BP meds in general, and higher doses of beta blockers in particular. Conversely, steroids that lead to extreme bloat may require use of a diuretic (and/or diet changes). Constantly monitor your blood pressure and adjust medication accordingly. the bodybuilder from the Gollasch et al. (2018) case studyis a good example. he was taking blood pressure meds but they failed to adequately control his BP given his cycle at the time.


2) Oxidative stress

We have seen in several animal studies above that AAS induce oxidative stress that may overwhelm the body's antioxidative capacity. Supplementation of compounds with antioxidative activity may ameliorate the damage caused by it. In particular, we have seen that Glutathione levels in both liver and kidney are depleted due to AAS administration. In order to combat this, one should take NAC. There isn't too much research on this, but one study found beneficial effects of NAC supplementation.



See https://academic.oup.com/ndt/article/19/8/1951/1918231 for a review on the potential role for Glutathione in kidney disease.

In addition to this supplementation, a healthy diet with lots of veggies (and moderate fruit) is recommended. Supplements with antioxidants, such as propolis is another promising avenue.


3) Exacerbated myoglobin toxicity


When people hear myoglobin, they probably think of rhabdomyolysis. The latter occurs when damaged muscle tissue breaks down and releases myoglobin into the blood stream, which then damages the kidneys while being filtered and excreted by them.

However, myoglobin is not just released in the case of extreme muscle damage that would lead to the condition of rhabdomyolysis. Even moderate intensity exercise causes sufficient muscle damage to increase serum myoglobin levels!


https://link.springer.com/article/10.1007/BF02343808


https://www.ncbi.nlm.nih.gov/pubmed/6861785

OK, so we know that a bodybuilding-style workout will release quite some myoglobin into the bloodstream. Here is how it then damages the kidney:


https://en.wikipedia.org/wiki/Myoglobin
https://en.wikipedia.org/wiki/Exertional_rhabdomyolysis

Thus the amount of damage done by myoglobin to the kidneys depends on the amount released, as well as the acidity of urine/the surrounding renal tissue. Rhabdomyolysis only occurs if too much myoglobin is released such that there is acute kidney failure. But even smaller amounts of myoglobin will do damage to the kidneys, in particular in case of chronic exposure.

Now, AAS abuse has a twofold impact here.

1) Increased myoglobin release. AAS allow for higher training volume and frequency. Furthermore, androgens lead to sizable strength increases, so that the mechanical tension on each set is higher, leading to more release on myoglobin per set. In addition, more sets are performed due to the ability to recover faster post exercise. Lastly, someone on juice will have less rest days to make the most of their cycle. As a result, total myoglobin load for the kidneys is higher, potentially leading to accumulated damage over time that culminates in FSGS.

2) Increased urine acidity. As described in the Aparicio et al. (2017) paper, urine acidity is increased after AAS treatment. We have also learned above that the nephrotoxicity of myoglobin depends on the acidity of the environment. Thus, i would speculate that for a given serum level of myoglobin, AAS induced acidity increases the damage done to the kidneys.
Note that there is also a potential interaction between AAS-induced antioxidant depletion and kidney damage due to myoglobin. In fact, all the channels are likely to interact in various ways and potentially exacerbate each other's effects.

In any case, this proposed increased myoglobin toxicity due to AAS abuse would lead to an accumulation of damage over time that could culminate is FSGS. Note that FSGS has only been observed in the human studies, whereas the animal studies showed more global glomerulosclerosis. This difference could be explained by the absence of resistance exercise in the animal subjects. This is pretty wild speculation on my part though.

So what can we do about this as AAS abusing bodybuilders? Unfortunately not much. My main recommendation would be to have at least some rest days and to not go ape shit on the volume. Occlusion training should be avoided. Similarly, forced reps, drop sets etc. should be used sparingly (so not almost every set). A good gauge of whether your training is too intense would be creatine kinase levels ~12 hours post exercise, given that serum CK is likely correlated with exercise induced myoglobin release. i'd say that your CK should not be above 3000 12 hours post exercise.

As mentioned before, there is an interaction between channels 1-8. For example, you can probably ameliorate myoglobin induced kidney damage by maintaining proper hydration around workouts, ensuring sufficient antioxidant activity, etc.

I will continue with the remaining points later.

I really appreciated your comprehensive contribution here, it sets the record straight and clear things up regarding the interactions of steroid use and kidney damage in bodybuilders. I've been trying to find as much info as possible about the subject and ended up reading through dozens of disparate threads on pm and other forums. I'd also be interested in a continuation of this post with research (If you have any?) backing up points 4 to 8 to complete the research. Thank you
 

nothuman

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Is Jeff perma banned or is he coming back?
 

Elvia1023

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Is Jeff perma banned or is he coming back?

I was going to ask (start a thread) but assumed it was a 3 day ban so left it. But it's been nearly a week now so not sure what happened. It would be good if a mod could confirm he is coming back. Thanks
 

danieltx

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Wait! Why'd he get banned?

Sent from my Pixel XL using Tapatalk

I figured it was due to some aggressive comments he made in a thread last week. I forget which one, but we all know he can be very passionate with his views.

I hope he returns given his scientific knowledge but not sure if he will given he's been banned a few times in the last couple months.
 

thethinker48

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I figured it was due to some aggressive comments he made in a thread last week. I forget which one, but we all know he can be very passionate with his views.

I hope he returns given his scientific knowledge but not sure if he will given he's been banned a few times in the last couple months.
He's shared some very insightful stuff on this board. Hope it's temporary and gets worked out.

Sent from my Pixel XL using Tapatalk
 

tokon

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My observations: they keep mentioning creatine supplementation as if creatinine (a metabolite of creatine) is difficult for the kidneys to process, research shows it is not. Creatinine is only significant as a marker of kidney filtration rate, high creatinine isn't significant on its own. These studies take this into account by doing 24-hour urine collections and getting real creatinine clearance rates. BUT most people who get bloodwork done don't do this, and they get estimated GFRs based on estimated creatinine clearance rates from a single blood draw. This is going to cause panic.

I take 10g of creatine per day, which results in the following creatinine level:

CREATININE, 24 HOUR URINE - 4.86g/24h

normal range: 0.63-2.50g/24h

Now that same test without the creatine (done a week later):

CREATININE, 24HR URINE - 2.82g/24h

Neither of these values are significant, in fact the tests were just done automatically alongside other urine tests I needed to get done, there is no reason to think they impact kidney function.

When taking creatine, here is my creatinine clearance:

CREATININE CLEARANCE (mL/min) 214
normal range: 85-125

The point I'm trying to make is that creatinine itself isn't something that stresses the kidneys, it's just a marker used to measure kidney function. Jeff and many good doctors probably know this, but lots of people (and doctors) who don't do clearance testing and who just look at serum creatinine levels are going to panic when they see very high creatinine levels, unnecessarily.


I have a theory on kidney damage in bodybuilders. I think it's myoglobin. I think most of these guys are massively overtraining (as do the majority of bodybuilders, PED use keeps them from seeing symptoms) and large amounts of myoglobin are being released from the resulting muscle damage. Not enough to cause full rhabdomyolysis, but enough to cause some kidney damage. This is where excessive amounts of protein intake come into play, creating a more acid environment in the kidneys. In an acidic environment, myoglobin is more likely to crystallize in the renal tubules and cause damage (scaring). It might not even require overtraining, it could just be from being excessively strong. If muscle is being damaged, some myoglobin is being released.

Fantastic info, thanks.

Do you have any suggestions how to minimise damage?
 

Kaladryn

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The two ways to maximize your kidney's ability to process myoglobin is to hydrate and minimize acidity (protein breakdown is probably the main source of acidity in the kidneys).

The other trick would be to minimize muscle damage, ultimately we are all trying to get the most adaptation with the minimal muscle damage to do so. We all probably overtrain a little but massively overtraining may be dangerous.
 

Bser1776

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The two ways to maximize your kidney's ability to process myoglobin is to hydrate and minimize acidity (protein breakdown is probably the main source of acidity in the kidneys).

The other trick would be to minimize muscle damage, ultimately we are all trying to get the most adaptation with the minimal muscle damage to do so. We all probably overtrain a little but massively overtraining may be dangerous.

Is there anything to do to counteract the acidity of protein? Would something as eating greens with your protein (alkalize) help?
 

Cinder

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So much great knowledge here...

What's your guys thoughts on low phosphorus levels.

1.5 vs normal 2.5 ish...
 

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