Collection of 70+ bodybuilding studies: nutrition, health, contest prep


Summary and overview

  • Many bodybuilders use anabolic steroids despite long-term health concerns
  • Protein requirements for bodybuilders are in all likelihood higher than population recommendations
  • Common supplements include protein powder, creatine, “fat burners”, multivitaminerals, fish oil, BCAAs, caffeine, and more. Some of these supplements have more evidence for benefits than others.
  • Some bodybuilders supplemented too much: “intakes of some micronutrients were excessive (~1000% of US Recommended Dietary Allowance) and above the tolerable upper limit.” (Spendlove et al., 2015)
  • Bodybuilders may be more prone to body dissatisfaction and excessive worrying about general appearance, muscle mass, and body fat
  • Muscle loss, mood disturbance, and hormonal imbalances may occur during restrictive contest prep. Especially as body fat drops to low levels (i.e. below ~5-8% in men): “severe energy restriction to extremely low body energy reserves decreases significantly the concentrations of 3 anabolic pathways despite high protein intake” (Maestu et al., 2010)
  • “Bodybuilders partake in a multitude of practices that may place them in high-risk health categories” (Kleiner et al., 1990)
  • Eating disorders can be an issue for both men and women, but the disorders might show themselves differently
  • Muscle dysmorphia is the condition where individuals “interpret their body size as both small or weak even though they may look normal or highly muscular” (Foster et al., 2015). “It remains unclear whether these characteristics are exacerbated by bodybuilding, or whether individuals with these characteristics are attracted to the bodybuilding context.” (Mitchell et al., 2016)
  • Several research groups now suggest that muscle dysmorphia may be influenced and perhaps caused by bullying, negative comments about ones body, etc.
  • Check out the recommendations section for practical tips



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Strength training (2)

  1. Effect of two- versus three-way split resistance training routines on body composition and muscular strength in bodybuilders: a pilot study (Ribeiro et al., 2015): “Significant increases (P < 0.05) in fat-free mass (G4X = +4.2%, G6X = +3.5%) and muscular strength (G4X = +8.4%, G6X = +11.4%) with no group by time interaction were observed. We conclude that 4 and 6 weekly sessions frequencies of resistance training promote similar increases in fat-free mass and muscular strength in elite bodybuilders.”
  1. Training practices and ergogenic aids used by male bodybuilders (Hackett et al., 2013): “The findings of this study demonstrate that competitive bodybuilders comply with current resistance exercise recommendations for muscular hypertrophy; however, these changed before competition during which there is a reduction resistance training volume and intensity. This alteration, in addition to an increase in aerobic exercise volume, is purportedly used to increase muscle definition. However, these practices may increase the risk of muscle mass loss in natural compared with amateur bodybuilders who reportedly use drugs known to preserve muscle mass.”


Muscle fibre characteristics (3)

  1. Contrasts in muscle and myofibers of elite male and female bodybuilders (Alway et al.,1989): “Biceps CSA was positively correlated to fiber CSA (R = 0.75) and fiber number (R = 0.55). This suggests that adaptations to resistance training may be complex and involve fiber hypertrophy and fiber number (e.g., proliferation). Alternatively, since the muscle characteristics before training are not known, these apparent adaptations might be genetically determined attributes.”
  1. Single Muscle Fibre Contractile Properties Differ Between Body-Builders, Power Athletes and Control Subjects (Meijer et al., 2015): “Fibre cross-sectional area was 67 and 88% (P < 0.01) larger in BBs than in PAs and Cs, respectively, with no significant difference in fibre cross-sectional area between PAs and Cs. Fibres of BBs and PAs developed a higher maximal isometric tension (32 and 50%, respectively, P < 0.01) than those of Cs. The specific tension of BB fibres was 62 and 41% lower than that of PA and C fibres (P < 0.05), respectively. Irrespective of fibre type, the peak power (PP) of PA fibres was 58% higher than that of BB fibres (P < 0.05), whereas BB fibres, despite considerable hypertrophy, had similar PP to the C fibres.”
  1. Skeletal muscle hypertrophy and structure and function of skeletal muscle fibres in male body builders (D’Antona et al., 2006): “In BB a preferential hypertrophy of fast and especially type 2X fibres was observed. The very large hypertrophy of VL in vivo could not be fully accounted for by single muscle fibre hypertrophy. CSA of VL in vivo was, in fact, 54% larger in BB than in CTRL, whereas mean fibre area was only 14% larger in BB than in CTRL. MHC isoform distribution was shifted towards 2X fibres in BB. Po/CSA was significantly lower in type 1 fibres from BB than in type 1 fibres from CTRL whereas both type 2A and type 2X fibres were significantly stronger in BB than in CTRL. Vo of type 1 fibres and Vf of myosin 1 were significantly lower in BB than in CTRL, whereas no difference was observed among fast fibres and myosin 2A. The findings indicate that skeletal muscle of BB was markedly adapted to HHRE through extreme hypertrophy, a shift towards the stronger and more powerful fibre types and an increase in specific force of muscle fibres “


Steroid use and hormonal profiles (10)

  1. [Review] Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review: discussion on bodybuilders inside
  1. The Misuse of Anabolic-Androgenic Steroids among Iranian Recreational Male Body-Builders and Their Related Psycho-Socio-Demographic factors (Angoorani and Halabchi, 2015): “Lifetime prevalence of AAS abuse is relatively high among recreational body-builders based on their self-report. Some psycho-socio-demographic factors including family income and sport experience may influence the prevalence of AAS abuse.”
  1. Social suppliers: Exploring the cultural contours of the performance and image enhancing drug (PIED) market among bodybuilders in the Netherlands and Belgium (van de Ven and Mulrooney, 2017): “The data indicates that [performance and image enhancing drug] dealing groups and individuals are often driven by motivations stemming from their social and cultural embeddedness in the bodybuilding subculture. Specifically, these PIED dealers are ‘over-socialized’ into the structure and culture of bodybuilding and follow the cultural scripts that come with their group affiliation and organization. As a result of the cultural context in which these transactions occur, PIED dealing networks among bodybuilders in the Netherlands and Belgium are more likely to consist of friends or ‘friends of friends’ tied together by threads of collective meaning found within the bodybuilding subculture.”
  1. Body image, disordered eating and anabolic steroid use in female bodybuilders (Goldfield, 2009): “Competitive Bodybuilding is a sport that requires participants to be exceptionally lean and mesomorphic, thus participants may be vulnerable to developing unhealthy eating and weight control practices, as well as using anabolic steroids. (…) High rates of weight and shape preoccupation, body dissatisfaction, bulimic practices, and anabolic steroid use were reported among CFBBs, and to a lesser degree, RFWTs. Differences between groups on general psychological factors were not statistically significant and effect sizes were small. CFBBs appear to share many eating-related features with women with bulimia nervosa but few psychological traits. Longitudinal research is needed to ascertain whether women with disordered eating or a history of bulimia nervosa disproportionately gravitate to competitive bodybuilding, and/or whether competitive bodybuilding fosters body dissatisfaction, disordered eating, bulimia nervosa, and anabolic steroid use.”
  1. Bodybuilders’ body composition: effect of nandrolone decanoate (van Marken Lichtenbelt et al., 2004): “The results show that the administration of 200 mg.wk(-1) of ND (intramuscularly) for 8 wk significantly increased body mass and FFM, whereas fat mass, bone mineral content, bone mineral density, and the hydration of the FFM remained unaffected. These data indicate that the changes can be attributed to an increase of muscle mass.”
  1. Body composition and anthropometry in bodybuilders: regional changes due to nandrolone decanoate administration (Hartgens et al., 2001): “In conclusion, the intramuscular administration of nandrolone decanoate (200 mg per week) during eight weeks induced an increase of body weight and bone-free lean body mass in bodybuilders that was mainly situated in the trunk and legs as determined by DEXA”
  1. The Prevalence and Characteristics of Performance-Enhancing Drug Use Among Bodybuilding Athletes in the South of Iran, Bushehr (Haerinejad et al., 2016): “RESULTS: According to this study, 234 (51.7%) of bodybuilding athletes had used PEDs. The PED users reported an average of 3.80 +/- 4.52 agents’ use in their programs and they had used PEDs for the average of 3.24 +/- 3.99 years. The most prevalent agents which had been abused by the athletes were anabolic steroids (used by 185 athletes (79.4% of athletes). Furthermore, 110 (47%) of athletes reported stimulant agents’ use during their routines. The most prevalent motivation for using PEDs was increasing muscle mass that was reported by 164 (70.1%) of PED users. In addition, sexual and dermatologic effects were the most prevalent adverse effects reported by the PED user athletes (114 (49.4%) and 103 (44.2%), respectively). CONCLUSIONS: This study showed the high rate of PED use among recreational and professional Iranian bodybuilding athletes that can expose them to the serious side effects of these agents.”
  1. Use of anabolic-androgenic steroids among body builders–frequency and attitudes (Lindstrom et al., 1990): “A total of 138 male bodybuilders who regularly attended a gym participated anonymously in a study of the use of anabolic-androgenic steroids in relation to side-effects, blood pressure, body mass index (BMI; kg m-2), training frequency, social background, occupation, knowledge and attitudes to steroid use. Fifty-three of the 138 body builders had used anabolic-androgenic steroids for a median duration of 2 years. Steroid use was linked to a higher BMI and more frequent training. Seventy-five per cent (n = 18) of those attending body building for competition, and 24% (n = 11) of those attending to improve their sense of well-being, used anabolic-androgenic steroids. Of all body builders, 94% considered anabolic-androgenic steroids to be dangerous. Of the users, 81% experienced side-effects, but 74% still intended to continue steroid medication.”
  1. Increases in ghrelin and decreases in leptin without altering adiponectin during extreme weight loss in male competitive bodybuilders (Mäestu et al., 2008): “In conclusion, ghrelin concentration significantly increases, but is suppressed in conditions of limited energy availability that is accompanied by significant body mass loss in male subjects with initial low body fat values.”
  1. Motivations for Anabolic Steroid use Among Bodybuilders (Wright et al., 2000): “Steroid use is increasing, in parallel with rising concerns about body image (…) Steroid users were less likely to be concerned about the physical side effects, and many believed that steroids are not harmful in moderation, and that only ‘ignorant people’ criticize steroid use. Their main motivations for using steroids were: wanting to excel at competitive bodybuilding; wanting to be more muscular; and feelings of enhanced confidence. The fact that steroid users in the sample were ‘stacking’ dangerously high levels of steroids (up to 15 steroids at a time) reveals the need for a detailed understanding of the motivations for steroid use in order to inform the development of effective harm minimization messages.”


Nutrition and supplementation (14)

  1. Nutrient intake, body fat, and lipid profiles of competitive male and female bodybuilders (Bazzarre et al., 1990): “These data are unique because the measurements were collected on site at the competition. Data are presented as means and standard deviations. Estimated body fat for males (6.0 +/- 1.8%) and females (9.8 +/- 1.5%) was quite low (…)”
  1. Supplementation patterns of competitive male and female bodybuilders (Brill and Keane 1994): “This study described the prevalence of supplement use by 309 male and female competitive bodybuilders. (…) Supplement use varied with training phase. Protein powder was more popular in the bulking phase, amino acids and fat burners in the cutting phase. Fifty-nine percent of respondents spent $25-100 per month; 4.9% spent over $150. The most popular reason for supplement use was “to meet extra demands of heavy training.” In the bulking phase, both weight gain and anabolic supplements were reportedly consumed more frequently by men than women. In the cutting phase, “fat burners” were reportedly consumed by a greater percentage of females than males. The information provided by this study can help sport nutritionists identify supplements most often consumed by bodybuilders and can aid counselors as they guide bodybuilders towards more healthful nutrition practices.”
  1. The risks of self-made diets: the case of an amateur bodybuilder (Della Guardia et al., 2015): “Following DIY (do it yourself) diets as well as consuming supplements exceeding by far the recommended daily intake levels, is common among athletes; these dietary habits often lead to an overconsumption of some macro and/or micronutrients, exposing athletes to potential health risks. The aim of this study is to document the development of possible adverse effects in a 33 year-old amateur bodybuilder who consumed for 16 years a DIY high protein diet associated to nutrient supplementation. (…) CONCLUSION: This study provides preliminary data of the potential risks of a long-term DIY dietary supplementation and a high protein diet. In this case, permanent abdominal discomfort was evidenced in an amateur bodybuilder with an intake exceeding tolerable upper limit for vitamin A, selenium and zinc, according to our national and updated recommendations. As many amateur athletes usually adopt self-made diets and supplementation, it would be advisable for them to be supervised in order to prevent health risks due to a long-term DIY diet and over-supplementation.”
  1. [Review] Negative Consequences of Low Energy Availability in Natural Male Bodybuilding: A Review (Fagerberg, 2017): “Energy availability (EA) is a scientific concept describing how much energy is available for basic metabolic functions such as reproduction, immunity and skeletal homeostasis. Carefully controlled studies on women have shown pathological effects of EA<30kcal/kg fat free mass (FFM) and this state has been labeled low EA (LEA) (…) The process of contest preparation in bodybuilding includes months of underfeeding, thus increasing the risk of LEA and its negative health consequences. Since no well-controlled studies have been conducted in natural male bodybuilders on effects of LEA, the aim of this review was to summarize what can be extrapolated from previous relevant research findings in which EA can be calculated. The reviewed literature indicates that a prolonged EA<25kcal/kgFFM results in muscle loss, hormonal imbalances, psychological problems, and negatively affects the cardiovascular system when approaching the lower limits of body fat (~4-5%) among males. Case-studies on natural male bodybuilders who prepare for contest show muscle loss (>40% of total weight loss) with EA<20kcal/kgFFM, and in the study with the lowest observed body fat (~4kg) major mood disturbance and hormonal imbalances co-occurred. Studies also underline the problem of body fat overshoot during refeeding after extremes of LEA among males. A more tempered approach (EA>25kcal/kgFFM) might result in less muscle loss among natural male bodybuilders who prepare for contest, but more research is needed.”
  1. Metabolic responses to high protein diet in Korean elite bodybuilders with high-intensity resistance exercise (Kim et al., 2011): “They consumed large amounts of protein (4.3 ± 1.2 g/kg BW/day) and calories (5,621.7 ± 1,354.7 kcal/day), as well as more than the recommended amounts of vitamins and minerals, including potassium and calcium. Serum creatinine (1.3 ± 0.1 mg/dl) and potassium (5.9 ± 0.8 mmol/L), and urinary urea nitrogen (24.7 ± 9.5 mg/dl) and creatinine (2.3 ± 0.7 mg/dl) were observed to be higher than the normal reference ranges. Urinary calcium (0.3 ± 0.1 mg/dl), and phosphorus (1.3 ± 0.4 mg/dl) were on the border of upper limit of the reference range and the urine pH was in normal range. (…) Increased urinary excretion of urea nitrogen and creatinine might be due to the high rates of protein metabolism that follow high protein intake and muscle turnover. The obvious evidence of metabolic acidosis in response to high protein diet in the subjects with high potassium intake and intensive resistance exercise were not shown in this study results. However, this study implied that resistance exercise with adequate mineral supplementation, such as potassium and calcium, could reduce or offset the negative effects of protein-generated metabolic changes.”
  1. Dietary intake and indicators of mineral status in male and female bodybuilders (Fogelholm, 1995)
  1. The effects of concurrent training with and without branch chain amino acids on lipid profiles and testosterone level of male body-builders (Rafiee and Rahimi, 2017): “The results show significant decrease of Triglyceride ( TG) (P=0.001), low density lipoprotein (LDL-c) (P=0 .034), total cholesterol (TC) (P=0.003) and increase high density lipoprotein (HDL-c) (P=0.001) in control group and decrease of TG (P=0.001) LDL (P=0.037), TC (P=0.025) and increases of HDL-c (P=0.002) in experimental group. Furthermore, the testosterone level of subjects did n’t change significantly in control and experimental groups.”
  1. Effects of creatine supplementation on cardiac autonomic functions in bodybuilders (Mert et al., 2017): “Conclusively, elevated parasympathetic modulation, which is favorable cardiovascular outcome of exercise, was demonstrated in bodybuilders. However, our study also revealed that creatine supplementation attenuates this favorable effect in ANS by limiting elevation of parasympathetic modulation. Although the sympathetic slight shift is attributed to creatine supplementation, it cannot be discriminated from the effects of over training”
  1. Nutritional status of nationally ranked elite bodybuilders (Kleiner et al., 1994): “The nutritional status of 11 female and 13 male elite bodybuilders at the first drug-tested USA Championship was examined through food records kept by subjects. Diets were repetitive and monotonous, and average daily energy and protein contents were relatively similar for men and women. Percent calories from protein, fat, and carbohydrate were 39%, 12%, and 48% for females, and 40%, 11%, and 49% for males, respectively. Females consumed 0% vitamin D, 52% calcium, 76% zinc (as percents of RDA) and below the Estimated Safe and Adequate Dietary Allowance amounts for copper and chromium. Males consumed 46% of vitamin D RDA. Although dietary magnesium intakes were above the RDA, serum magnesium levels in females were below reference values, which should be investigated. Serum zinc levels were high in men and women. Eighty-one percent of females reported recurrent contest-related amenorrhea for 2 +/- 1 months precontest. Dietary intakes of men were adequate but the restrictive intakes of women may place them at risk for calcium, copper, and chromium deficiencies.”
  1. Metabolic profiles, diet, and health practices of championship male and female bodybuilders (Kleiner et al., 1990): “To obtain a more complete view of their general health and health care habits, 27 bodybuilders (19 men and 8 women) competing at the 1988 National Physique Committee’s Junior USA Bodybuilding Championships participated in this study. (…) Multi-drug abuse was reported by 15% to 40% of the subjects, and 20% to 40% of subjects left the drug use questions unanswered. Severe fluid restrictions and dehydrating practices were reported by all subjects. Eleven men and two women agreed to have blood drawn. Plasma glucose values were at the low end of the normal fasting range. Hemoglobin levels were elevated, indicating hypohydration; magnesium levels were slightly low. Percent body fat, estimated by seven-site skinfold measures, was low for both sexes (men, 6.0 +/- 1.8; women, 9.8 +/- 1.5); 75% of the women reported normal menstrual cycles. The men reported high-protein, low-fat hypocaloric diet patterns. Women had a moderate zinc intake and a remarkably deficient calcium intake despite an adequate energy intake. This research demonstrates that bodybuilders partake in a multitude of practices that may place them in high-risk health categories. It is essential that healthcare workers in contact with bodybuilding athletes intervene and educate them about healthy dietary and training alternatives.”
  1. Food selection patterns of bodybuilders (Sandoval and Heyward, 1991): “Although there was not much variety in the precompetition diets of the bodybuilders, the average nutrient density of their diets exceeded the Index of Nutritional Quality for all nutrients except calcium and zinc.”
  1. [Review] Dietary Intake of Competitive Bodybuilders (Spendlove et al., 2015): “RESULTS: The 18 manuscripts meeting eligibility criteria reported on 385 participants (n = 62 women). Most studies were published in the 1980-1990s, with three published in the past 5 years. Study methodological quality was evaluated as poor. Energy intake ranged from 10 to 24 MJ/day for men and from 4 to 14 MJ/day for women. Protein intake ranged from 1.9 to 4.3 g/kg for men and from 0.8 to 2.8 g/kg for women. Intake of carbohydrate and fat was <6 g/kg/day and below 30% of energy, respectively. Carbohydrate intakes were below, and protein (in men) intakes were higher than, the current recommendations for strength athletes, with no consideration for exploration of macronutrient quality or distribution over the day. Energy intakes varied over different phases of preparation, typically being highest in the non-competition (>6 months from competition) or immediate post-competition period and lowest during competition preparation (</=6 months from competition) or competition week. The most commonly reported dietary supplements were protein powders/liquids and amino acids. The studies failed to provide details on rationale for different dietary intakes. The contribution of diet supplements was also often not reported. When supplements were reported, intakes of some micronutrients were excessive (~1000% of US Recommended Dietary Allowance) and above the tolerable upper limit.
  1. Effect of fed- versus fasted state resistance training during Ramadan on body composition and selected metabolic parameters in bodybuilders (Trabelsi et al., 2013)
  1. The acute effect of caffeine supplementation on strength, repetition sustainability and work volume of novice bodybuilders (Arazi et al., 2016)

Protein requirements (3)

  1. Macronutrient considerations for the sport of bodybuilding (Lambert et al., 2004): “There is evidence that a relatively high protein intake (approximately 30% of energy intake) will reduce lean mass loss relative to a lower protein intake (approximately 15% of energy intake) during energy restriction. The higher protein intake will also provide a relatively large thermic effect that may aid in reducing body fat.”
  1. Indicator Amino Acid-Derived Estimate of Dietary Protein Requirement for Male Bodybuilders on a Nontraining Day Is Several-Fold Greater than the Current Recommended Dietary Allowance (Bandegan et al., 2017): “The Estimated Average Requirement (EAR) of protein and the upper 95% CI RDA for these young male bodybuilders were 1.7 and 2.2 g . kg-1 . d-1, respectively.”
  1. Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders (Lemon et al., 1992): “These data indicate that, during the early stages of intensive bodybuilding training, PRO needs are approximately 100% greater than current recommendations but that PROIN increases from 1.35 to 2.62 do not enhance muscle mass/strength gains, at least during the 1st mo of training. Whether differential gains would occur with longer training remains to be determined.”


Psychology, body image, and eating disorders (14)

  1. [Review] Muscle Dysmorphia Symptomatology and Associated Psychological Features in Bodybuilders and Non-Bodybuilder Resistance Trainers: A Systematic Review and Meta-Analysis (Mitchell et al., 2016): “MD symptomatology was greater in BBs than in [non-bodybuilder resistance trainers]. Anxiety and social physique anxiety, depression, neuroticism, and perfectionism were positively associated with MD, while self-concept and self-esteem were negatively associated. It remains unclear whether these characteristics are exacerbated by bodybuilding, or whether individuals with these characteristics are attracted to the bodybuilding context.”
  1. Psychobehavioral characteristics of competitive bodybuilders : A longitudinal study (Suffolk and Dovey, 2015): “Pre-competition, CBs reported increased disordered eating and a greater commitment to exercise. Post-competition, the intensity of behaviors decreased to baseline levels. No between group differences emerged in the perceived quality of social functioning and levels of anxiety. The findings suggest that the behavioral strategies of CBs are cyclical. Consequently, conclusions drawn from cross-sectional data inferring temporally coherent impaired psychosocial functioning and eating disorder symptomatology may produce false-positives. Therefore, contextual and temporal factors are important research considerations when assessing the psychobehaviors of CBs.
  1. Competitive Bodybuilding: Positive Deviance, Body Image Pathology, or Modern Day Competitive Sport (Suffolk, 2014)
  1. Muscle as fashion: messages from the bodybuilding subculture (Cortese, 2014)
  1. Body image disturbance in 1000 male appearance and performance enhancing drug users (Hildebrandt et al., 2010): “The present study explored the heterogeneity in body image disturbance among [steroid] using men, who as a group are traditionally considered to be engaged in pathological and extreme weight and shape controlling behaviors. The results suggest that body image disturbance is more than a simple trait, but rather a mixture of subgroups that are more or less pathological (i.e., highly invested and distressed about appearance) and vary within their subgroup by level of severity.”
  1. Body image, binge eating, and bulimia nervosa in male bodybuilders (Goldfield et al., 2006): “Male bodybuilders (MBB) exhibit more severe body dissatisfaction, bulimic eating behaviour, and negative psychological characteristics, compared with male athletic and nonathletic control subjects, but few studies have directly compared MBB and men with eating disorders. This study compared men with bulimia nervosa (MBN), competitive male bodybuilders (CMBB), and recreational male bodybuilders (RMBB) on a broad range of eating attitudes and behaviours and psychological characteristics to more accurately determine similarities and differences among these groups.(…) RESULTS: High rates of weight and shape preoccupation, extreme body modification practices, binge eating, and bulimia nervosa (BN) were reported among MBB, especially among those who competed. CMBB reported higher rates of binge eating, BN, and AAS use compared with RMBB, but exhibited less eating-related and general psychopathology compared with MBN. Few psychological differences were found between CMBB and RMBB”
  1. Exercise dependence and muscle dysmorphia in novice and experienced female bodybuilders (Hale et al., 2013): “Female bodybuilders seem to be more at risk for exercise dependence and muscle dysmorphia symptoms than female recreational weight lifters.”
  1. Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood (Strother et al., 2012) “A frequent behavior among eating disordered men is excessive exercise; which can become “addictive” and is sometimes referred to as Anorexia Athleticism. Some men use exercise as a compensatory behavior for caloric intake; while others are caught in a vicious cycle of exercising for weight loss to promote better health, but find themselves in a “runaway diet,” resulting in self-starvation. Restlessness and physical over-activity result; as often seen in those with anorexia nervosa. Ultimately, other areas of the person’s life are affected, such as interference with work, social activities, or just meeting day-to-day responsibilities (Morgan, 2008).” (…) “There is another aspect of substance abuse which is specific to males: the use of steroids and growth hormones. This is common when muscle dysmorphia is present. The rate of anabolic steroid use among young males is roughly equal to that of anorexia and bulimia in young females (Schooler & Ward, 2006.) Pope et al. (2002) state that over 2 million males of all ages in the United States have used anabolic steroids at some point. These drugs produce swift changes in muscle mass and have very few initial side effects for the user. However, long-term use has been linked with many physical and psychological complications.”
  1. Bigorexia: bodybuilding and muscle dysmorphia (Mosley, 2009): “Muscle dysmorphia is an emerging condition that primarily affects male bodybuilders. Such individuals obsess about being inadequately muscular. Compulsions include spending hours in the gym, squandering excessive amounts of money on ineffectual sports supplements, abnormal eating patterns or even substance abuse (…) muscle dysmorphia may be a new expression of a common pathology shared with the eating disorders.”
  1. Muscle dysmorphia: current insights (Tod et al., 2016): “People with muscle dysmorphia engage in muscularity enhancement activities and, therefore compared with many other groups, are likely to have an increased body mass index and fat-free mass index. Rather than treating demographic and physical characteristics as individual predictors, greater understanding may result from examining how they interact with social and psychological variables. For example, muscle dysmorphia may be a reaction to physical abuse that arises from being weaker than peers or feeling vulnerable in a hostile environment, as illustrated in the aforementioned study by Gruber and Pope.”
  1. Muscle dysmorphia in different degrees of bodybuilding activities: validation of the Italian version of Muscle Dysmorphia Disorder Inventory and Bodybuilder Image Grid (Santarnecchi and Dettore, 2012): “The severity of MD was greater for competing bodybuilders than non-competing bodybuilders and controls.”
  1. Muscle dysmorphia: Could it be classified as an addiction to body image? (Foster et al., 2016): “It is argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and the use or purchase of physical exercise accessories). In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder).”
  1. Biological, Psychological, and Sociocultural Factors Contributing to the Drive for Muscularity in Weight-Training Men (Schneider et al., 2016): “Investigating MD symptoms in a sample of male bodybuilders, Boyda and Shevlin (2011) found a relation between childhood victimization, such as verbal, physical, and social bullying and MD. It was argued, that regular critique and emotional victimization by parents (Lamanna et al., 2010) and peers (Boyda and Shevlin, 2011) may lead to body image distortion and higher degrees of body dissatisfaction which, according to other studies (Pritchard et al., 2011; Mustapic et al., 2015), are related to drive for muscularity. More generally, it was found that negative appearance-based comments were associated with higher body dissatisfaction and higher driver for muscularity (Nowell and Ricciardelli, 2008). In a sample of bodybuilders childhood bullying experience were associated with higher scores in MD (Wolke and Sapouna, 2008).”
  1. Correlates of muscle dysmorphia symptomatology in natural bodybuilders: Distinguishing factors in the pursuit of hyper-muscularity (Mitchell et al., 2017): “Sixty participants (age 29.6±7.1 years) completed the survey. Eating disorder scores (β=.298), rate of pre-competition weight loss (β=.307) and number of competitions (β=-.257) were significant predictors of MD (…) The inverse association of competition experience suggests novice bodybuilders may display increased MD symptomatology.”


Misc (health, anthropometry, etc.) (6)

  1. Letter to the editor–The problem of caffeine consumption in the bodybuilding scene (Dziadosz et al., 2015)
  1. Effects of bodybuilding and protein supplements in saliva, gingival crevicular fluid, and serum (Aral et al., 2017)
  1. Muscular development and lean body weight in body builders and weight lifters (Katch et al., 1980)
  1. Characteristics of Anabolic-Androgenic Steroid-Free Competitive Male and Female Bodybuilders (Elliot et al., 1987): “In brief: Anabolic-androgenic steroids are widely used in the community of bodybuilders. We defined a group of steroid-free bodybuilders by analyzing urine for the presence of these steroids, and compared the bodybuilders with both sedentary controls and runners. Male and female competitive bodybuilders had low percentages of body fat. One third of the female bodybuilders reported menstrual abnormalities (more than three missed menses during the past 12 months). Lipid values of bodybuilders were comparable to a group of lean, aerobically trained athletes. Despite their high volume of training, the bodybuilders’ oxygen uptake during cycle ergometry was augmented only in proportion to the increase in lean body mass.”
  1. Body perceptions and health behaviors in an online bodybuilding community (Smith and Stewart, 2012): “Our results expose an extreme social reality held by a devoted muscle-building community with a fanatical obsession with muscular hypertrophy and any accouterment helpful in its acquisition, from nutrition and supplements to training regimes and anabolic androgenic substances. Few health costs were considered too severe in this muscular meritocracy, where the strong commanded deference and the massive dominated the social field.”
  1. Body composition changes in bodybuilders: a method comparison (van Marken Lichtenbelt et al., 2004): “Using the 4C model as the standard for determination of body fat and fat-free mass, this study revealed that apart from the prediction equation based on BMI and the 3Cb model, all methods gave acceptable group mean values. When accurate measurements on body composition and/or body composition changes on an individual level are needed, only the 3Cw model could serve as an alternative for the 4C method.”


Case studies and contest prep (15)

  1. Dietary Intake, Body Composition, and Menstrual Cycle Changes during Competition Preparation and Recovery in a Drug-Free Figure Competitor: A Case Study (Halliday et al., 2016) “Energy intake, body mass and composition, and energy availability decreased during the 20-week PREP period (changes of ~298 kcals, 5.1 kg, 6.5% body fat, and 5.4 kcal/kg fat free mass, respectively) and returned to baseline values by end of the 20-week REC period. Menstrual cycle irregularity was reported within the first month of PREP and the last menstruation was reported at week 11 of PREP. Given the potentially adverse health outcomes associated with caloric restriction, future, prospective cohort studies on the physiological response to PREP and REC are warranted in drug-free, female physique competitors.”
  1. Psychophysiological Tracking of a Female Physique Competitor through Competition Preparation (Rohrig et al., 2017) “The study tracked the physiological and psychological changes for a 24 year old female preparing for a physique competition (…) The participant lost 10.1kg throughout contest preparation in a strong weekly linear pattern (R2=0.97). Body fat was reduced from 30.45% to 15.85% while fat free mass was maintained. Mood for the participant remained stable until month five, when an observed variation occurred, with performance maintaining.”
  1. Physiological Changes Following Competition in Male and Female Physique Athletes: A Pilot Study (Trexler et al., 2017)
  1. Precontest strategies of a male bodybuilder (Steen, 1991): “In light of these many unhealthy practices, alternative strategies should be negotiated with the athlete that are realistic, and changes should be implemented slowly.”
  1. Nutrition and the precontest preparations of a male bodybuilder (Hickson et al., 1990) “Ergogenic drugs and a diuretic were self-administered. At the contest, the subject placed in the top three for his weight division. The strict diet enabled the subject to lose fat weight predictably in preparation for the contest. However, some weight lost was lean body tissue, suggesting the rate of loss was too fast. Blood chemistry studies revealed abnormalities, including hemoconcentration and alterations in cholesterol metabolism, which could have placed the subject at risk for thromboembolic phenomena because of increased blood viscosity. Those abnormalities could reflect the use of ergogenic drugs. For this subject, bodybuilding included diet, exercise, and drug regimens, which are common among competitive athletes.”
  1. Nutrition, Pharmacological and Training Strategies Adopted by Six Bodybuilders: Case Report and Critical Review (Gentil et al., 2017): “In general, the participants gained large amounts of fat-free mass during the bulking phase; however, much of that fat-free mass was lost during the cutting phase along with fat mass. Based on our analysis, we recommend an evidence-based approach by people involved in bodybuilding, with the adoption of a more balanced and less artificial diet. One important alert should be given for the combined use of anabolic steroids and stimulants, since both are independently associated with serious cardiovascular events. A special focus should be given to revisiting resistance training and avoiding fasted cardio in order to decrease the reliance on drugs and thus preserve bodybuilders’ health and integrity.”
  1. The Effects of Intensive Weight Reduction on Body Composition and Serum Hormones in Female Fitness Competitors (Hulmi et al., 2016) “This study shows for the first time that most of the hormonal changes after a 35-50% decrease in body fat in previously normal-weight females can recover within 3-4 months of increased energy intake.”
  1. Case study: Natural bodybuilding contest preparation (Kistler et al., 2014) “In general, this prolonged contest preparation technique helped the athlete to improve body composition and resulted in positive CV changes, suggesting that this method of contest preparation appears to be effective in natural male bodybuilders.”
  1. Anabolic and catabolic hormones and energy balance of the male bodybuilders during the preparation for the competition (Maestu et al., 2010): “Fourteen male bodybuilders took part in an 11-week energy-restricted period to reduce body fat. Changes in IGF-I concentration were significantly related to changes in insulin (r = 0.741), fat mass (r = 0.705), lean body mass (r = 0.696), and body mass (r = 0.652). Changes in insulin concentrations were significantly related to changes in fat mass (r = 0.630) and lean body mass (r = 0.725). These data indicate that severe energy restriction to extremely low body energy reserves decreases significantly the concentrations of 3 anabolic pathways despite high protein intake. Monitoring of insulin and IGF-1 concentration is suggested to prevent losses in muscle mass in energy-restricted conditions. Other nutritional strategies might be needed to prevent possible catabolic effect during preparation of bodybuilders to competition.”
  1. Changes in body composition, diet, and strength of bodybuilders during the 12 weeks prior to competition (Bamman et al., 1993) “The purpose of this study was to monitor body composition, diet, and strength in male bodybuilders (No. 6) during the 12 weeks prior to competition. The data indicate the pre-competition practices were effective in reducing subcutaneous fat stores while maintaining muscle. Finally, the onset of the pre-competition phase resulted in strength loss.”
  1. Case Study: The Effect of 32 Weeks of Figure-Contest Preparation on a Self-Proclaimed Drug-free Female’s Lean Body and Bone Mass (Petrizzo et al., 2017) “In summary, in preparation for a figure competition, a self-proclaimed drug-free female achieved the low body-fat percentage required for success in competition without losing lean mass or bone density by following a 32-week preparatory exercise and nutritional regimen”
  1. A nutrition and conditioning intervention for natural bodybuilding contest preparation: case study (Robinson et al., 2015) “This intervention shows that a structured and scientifically supported nutrition strategy can be implemented to improve parameters relevant to bodybuilding competition and importantly the health of competitors, therefore questioning the conventional practices of bodybuilding preparation.”
  1. Natural bodybuilding competition preparation and recovery: a 12-month case study (Rossow et al., 2013): “Heart rate decreased from 53 to 27 beats/min during preparation and increased to 46 beats/min within 1 mo after competition. Brachial blood pressure dropped from 132/69 to 104/56 mmHg during preparation and returned to 116/64 mmHg at 6 mo after competition. Percent body fat declined from 14.8% to 4.5% during preparation and returned to 14.6% during recovery. Strength decreased during preparation and did not fully recover during 6 months of recovery. Testosterone declined from 9.22 to 2.27 ng/mL during preparation and returned back to the baseline level, 9.91 ng/mL, after competition. Total mood disturbance increased from 6 to 43 units during preparation and recovered to 4 units 6 mo after competition.”
  1. Diet and weight changes of female bodybuilders before and after competition (Walberg-Rankin et al., 1993) “In summary, the women practiced extreme dietary control while preparing for a competition but followed the event with a higher energy and fat intake. These changes in diet and body weight may contribute to the disturbances previously observed in the menstrual cycle of these athletes.”
  1. Body composition changes in female bodybuilders during preparation for competition (van der Ploeg et al., 2001): “A significant ( P 0.001) 5.80 kg body mass loss by the bodybuilders as they prepared for competition was primarily due to a reduction in fat mass (FM; ˇ 4.42 kg; 76.2%) as opposed to fat-free mass (FFM; ˇ 1.38 kg; 23.8%). The decreases in body mass and FM over the final 6 weeks were greater than those over the first 6 weeks. Their %BF decreased ( P < 0.001) from 18.3 to 12.7, whereas the values for the control group remained essentially unchanged at 19.1 ± 19.6 %BF.”


Recommendations and guidelines (5)

  1. [Review] Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation (Helms et al., 2014): “Caloric intake should be set at a level that results in bodyweight losses of approximately 0.5 to 1%/wk to maximize muscle retention. Within this caloric intake, most but not all bodybuilders will respond best to consuming 2.3-3.1 g/kg of lean body mass per day of protein, 15-30% of calories from fat, and the reminder of calories from carbohydrate. Eating three to six meals per day with a meal containing 0.4-0.5 g/kg bodyweight of protein prior and subsequent to resistance training likely maximizes any theoretical benefits of nutrient timing and frequency. However, alterations in nutrient timing and frequency appear to have little effect on fat loss or lean mass retention. Among popular supplements, creatine monohydrate, caffeine and beta-alanine appear to have beneficial effects relevant to contest preparation, however others do not or warrant further study. The practice of dehydration and electrolyte manipulation in the final days and hours prior to competition can be dangerous, and may not improve appearance. Increasing carbohydrate intake at the end of preparation has a theoretical rationale to improve appearance, however it is understudied. Thus, if carbohydrate loading is pursued it should be practiced prior to competition and its benefit assessed individually. Finally, competitors should be aware of the increased risk of developing eating and body image disorders in aesthetic sport and therefore should have access to the appropriate mental health professionals.”
  1. [Review] International society of sports nutrition position stand: diets and body composition (Aragon et al., 2017)
  1. A nutrition and conditioning intervention for natural bodybuilding contest preparation: observations and suggestions (Gentil, 2015) (this one is a bit lightweight, but I’ve included it in the sense of fairness and comprehensiveness)
  1. [Review] Recommendations for natural bodybuilding contest preparation: resistance and cardiovascular training (Helms et al., 2015): “The anabolic effect of resistance training can mitigate muscle loss during contest preparation. In reviewing relevant literature, we recommend a periodized approach be utilized. Block and undulating models show promise. Muscle groups should be trained 2 times weekly or more, although high volume training may benefit from higher frequencies to keep volume at any one session from becoming excessive. Low to high (~3-15) repetitions can be utilized but most repetitions should occur in the 6-12 range using 70-80% of 1 repetition maximum. Roughly 40-70 reps per muscle group per session should be performed, however higher volume may be appropriate for advanced bodybuilders. Traditional rest intervals of 1-3 minutes are adequate, but longer intervals can be used. Tempo should allow muscular control of the load; 1-2 s concentric and 2-3 s eccentric tempos. Training to failure should be limited when performing heavy loads on taxing exercises, and primarily relegated to single-joint exercises and higher repetitions. A core of multi-joint exercises with some single-joint exercises to address specific muscle groups as needed should be used, emphasizing full range of motion and proper form. Cardiovascular training can be used to enhance fat loss. Interference with strength training adaptations increases concomitantly with frequency and duration of cardiovascular training. Thus, the lowest frequency and duration possible while achieving sufficient fat loss should be used. Full-body modalities or cycling may reduce interference. High intensities may as well; however, require more recovery. Fasted cardiovascular training may not have benefits over fed-state and could be detrimental.”
  1. Nutrition guidelines for strength sports: sprinting, weightlifting, throwing events, and bodybuilding (Slater and Phillips 2011)