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Discussion in 'Ask The Experts' started by Irish Beast, May 7, 2014.

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  1. Irish Beast

    Irish Beast Beast

    Its great that we now have Dr Angell and Dr Waktare on board to answer some of the more complicated questions regarding the heart. effects of steroids and in Dr Waktare's case some questions about general medicine. So I have created this new subforum

    Johan (Dr Waktare) has said in his introduction what he is happy to guide us on and Pete (Dr Angell) is the oracle on all things relating to steroids and their effects on the heart. Having been a guinea pig for him I can tell he is quite thorough!

    Again can I stress not to ask questions which can easily be googled. What we are really hoping to achieve is to dispell myths out there about training and steroid use on the heart using the guys knowledge and research and not hearsay and media crap.
    Last edited by a moderator: May 19, 2014
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  2. Pip

    Pip Elite Member

    This will be invaluable once I can start training again.
  3. Arterial Dan

    Arterial Dan Administrator Staff Member

    @Dr Angell

    Cardio/PED related

    1. What are the medically verified method(s) by which steroid use damage the heart? LDL/HDL ratios? Muscular Atrophy/Hypertension?  Other?

    2. Do medical means exist to repair the damage after it has been caused?

    3. Do medical means exist to prevent the damage while steroids are being administered?

    @Dr Waktare

    Cardio/Diet related, more general

    Ketogenic diets have been shown to be corrective of LDL/HDL ratios in obese patients.

    1. Do the benefits extend to non-obese individuals? i.e. corrective action despite no BMI adjustment

    2. Would lifelong maintenance of a ketogenic diet preserve healthy ratios (assuming no other external factors) 

    3. What medically verified negative health consequences are associated with a prolonged/lifelong ketogenic diet?

    4. Is there a correlation between Low Fat Diets and Heart damage?

    [i realise an educated guess may be all that is available, but interested to hear educated opinions on the matter].

    Thank you
    Last edited by a moderator: May 7, 2014
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  4. Irish Beast

    Irish Beast Beast

    Dan I am assuming the first party is for Dr Angell and the second for Dr Waktare?
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  5. Dr Angell

    Dr Angell Senior Member

    @Arterial Dan

    Thanks for the questions! I'll do my best to answer as comprehensively as I can.

    In truth, nothing has been 'medically verified' as you say, as the real large scale data isn't available to be honest. Much of the work is in small data sets and with some many confounding factors it is hard to give a concrete yes or no. I apologise if that sounds a bit of a cop-out but unfortunately it's the truth. From my own research we have definitely seen a reduced relaxation of the heart and negative alterations in the HDL:LDL ratio. From some limited data I have gathered looking at on/off cycle it does appear that things start to normalise a bit after a period of abstinence but this was only in a small data set so is hard to say for sure. The real question is the long-term effects of these changes but this is really hard to achieve as we need to follow a relatively large group over a long period to know for sure and we would also need to test people before they had ever taken anything to be able to determine the true effects of the AS. My own thoughts are that over a substantial length of time, continual use and regular increases in LDL and reduced relaxation of the heart would undoubtedly have some sort of negative impact on cardiovascular risk. This is mainly based on the fact that Testosterone is positively associated with CV disease (men have higher incidences of CVD) and that LDL is also associated with CVD and therefore if they remain elevated for long enough or are elevated regularly enough then this would cause an increase in risk. 

    In terms of repairing damage to the heart, this is something of a 'holy grail' in medicine. Once damage is done to the myocardial cells (the cells of the heart) then there is not much that can be done to repair them. Stem cell research holds probably the most positive outlook for being able to achieve this but this could be some way off unfortunately. Although I'm sure within our lifetimes this will change, or at least I hope! There are some other methods of cardiac repair that are being trialled but it's dependent on the type of damage and most of these trials are a little way off of being ready to roll out on a large scale. I could go into more depth on this but we could be here for a while. @Dr Waktare may be able to add a bit more on this topic from a more general perspective though.

    With regards to preventative measures there is also little known. The main way to avoid damage is just to not do the things that we know cause damage to the heart, bad diet, smoking etc. In terms of AS use, I think there are some things that can be done to minimise any possible damage that may occur. These mainly focus on the dose and length of use as well as the post-cycle therapies. By this I mean sensible usage. I'm sure for most here I don't need to say this but I'll say it anyway for those who might not be as well read as the majority I've encountered on this site or are maybe just starting out. By sensible usage I mean using as minimal a dose as possible for as short a time as possible so as to keep testosterone levels elevated for as short a time as possible (hard to hear for people trying to add muscle I now!) and also ensuring a comprehensive PCT in order to normalise test levels quickly and establish normal hormone levels.

    Apologies for going on a bit but wanted to be as thorough as I could and hopefully it's answered your questions.
  6. Pip

    Pip Elite Member


    This just isnt possible Dr Angell because the nature of these relms is to push the boundaries until irreversible damage has been done for the person to lift off the gas.

    A lot of people push high dose, shorter periods. Sometimes super physiological doses.

    What are your thoughts on this method, clinically?
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  7. Irish Beast

    Irish Beast Beast

    Dr Angell was speaking in an ideal world. Unfortunately the reality is that most people will push and push til they damage themselves. Most of us start out with good intentions. Short cycle, PCT etc but before long its heavier longer cycles, with some people never coming off.

    Daz Ball being a prime example as a Pro. He will push himself til he dies. Kidney failure, put on dialysis yet won't throw in the towel. Very sad that steroids have taken over the life of a young man in such a way that he will not stop, no matter what. If he has a heart attack? What next?

    On a local level I know someone who had heart failure who was on 6G of testostertone a week. Came off the gear completely but has recently started training again so wonder if he will be able to withstand the urge. Although he is still a big guy he has masses of muscle which is physchology destroyed him. He told me which makes me worry he will 'just do a small cycle' and then it all begins again
    Last edited by a moderator: May 19, 2014
  8. Irish Beast

    Irish Beast Beast

    Just for the record guys we probably need to start a new thread for every different discussion or this could become long. Obviously not if its related to the original question though
  9. Arterial Dan

    Arterial Dan Administrator Staff Member

    Not going on at all - Well answered and well written. Appreciated.

    Just as a few tail questions to your answer: @Dr Angell


    This was the answer I had partially expected.

    This was actually (and possibly still is) part of the defence that many PED users resorted to over the last 2 decades, when there appeared to be correlation between steroid usage and heart maladies. i.e.. Steroids do not kill directly like alcohol or amphetamines, there is no LD50, 'show me the bodies' etc.


    This defence hasn't been used for about 2 years now, It seems now there is too much circumstantial evidence (and indeed too many bodies have accumulated) to deny that they kill do indirectly, eventually, like tobacco.

    But general usage of steroids among the population across the British Isles has, allegedly, increased substantially, almost to epidemic proportion in some areas


    So my question in light of this:

    1) Is there a sense of urgency in the medical community about steroid use? Is it a hot topic/emerging concern, or does it fall under the umbrella of a larger category within Cardiology or Endocrinology?

    It appears to me - on the outside looking in - that while the media love to slop out some salacious stories from time to time, it doesn't seem to have a terribly high priority by any metric within the actual health system, and the general lack of data is a symptom of that. (I realise there are certain difficulties with research, as you outlined with confounding factors, but this factor applies equally to other areas of medical research I imagine.)

    Assuming a new mechanism became generally available for achieving Performance/Image enhancement, such as a Myostatin Inhibitor.

    This med had no impact on LDL:HDL ratios, no dramatic effects on blood pressure or the typical cardiac complications associated with steroids.

    It's likely cardiac problems would still present themselves, simply due to the increased body mass.

    My question is:

    2. Are there any conceptual ranges (the Bodybuilder Mass Index?) within which x amount of muscle presents y% increased strain on the heart? (along the lines of the BMI chart, but dealing with muscle rather than fat/mass)


    Fouad Abiad Out of all the docs I've seen in my time only one thing was a common thread amongst all of them. 300lbs of muscle is much harder on the heart than 300lbs of fat. Our hearts are not meant to pump blood for 300lbs of muscle.


    Is there consensus on wheter a) the PEDs, or b) the increased muscle mass are a larger culprit in cardiovascular damage? 
    Last edited by a moderator: May 7, 2014
  10. Irish Beast

    Irish Beast Beast

    Remember to keep tagging the docs as they will only visit the forum  when prompted and not sit around on it all day like us!
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  11. Arterial Dan

    Arterial Dan Administrator Staff Member

    Apparently he has cut down significantly (209lbs) and has returned to generally good health:
  12. Irish Beast

    Irish Beast Beast

    I read that yesterday Dan but what is 'generally good health' and how long do you think he will be happy like that instead of being a mass monster? Playing with fire if he gets back on the big dosages but its his life!
  13. Pip

    Pip Elite Member

  14. Irish Beast

    Irish Beast Beast


    @Dr Waktare is aware of the questions and assures me he will answer when he gets the time. We just need bare with him due to the demanding nature of his work
  15. Gator

    Gator Elite Member

    Firstly, just want to say thank you to both you guys for taking the time out to answer questions on here - a true asset to the board.

    @Dr Angell

    My question is regarding HDL/LDL ratios.

    You mentioned earlier that based on your own research, AAS cause negative alterations in these ratios and was wondering if you could perhaps expand on that point a little bit....

    As I understand it, there are many types of lipoproteins - Chylomicrons, IDL, VLDL, HDL and LDL...etc. with LDL being the one most people consider to be "the bad guy" so to speak.

    However, I'm aware that most LDL lab tests do not show the size of LDL particle, or how many particles there are specifically which changes the way cholesterol is deposited and transported..etc.

    I was curious to know that in your experience/research/opinion - do AAS specifically raise the smaller LDL particles (the potentially harmful ones)? or do the negative alterations mainly come from the fact that AAS tend to lower the HDL which in turn puts you into an unfavorable HDL/LDL ratio?

    I guess in a nutshell my question is - do most AAS actually tend to RAISE LDL (and if so specifically what type - the smaller or larger particles) or is it that they tend to depress HDL? 

    Also, I'd be curious to know a little bit more why higher testosterone levels specifically contributes to a higher CVD risk?

    I know that men in general statistically have higher rates of CVD - but I did wonder how testosterone specifically plays a part in this and how it correlates to potential CVD.  

    Would you say that men with higher natural test levels for example, have potentially a greater change of developing CVD? or are you mainly referring to high testosterone in the sense of someone using it for the purpose of performance enhancement?  

    I appreciate that might not be a simple black and white answer though - just something I wondered about - is the risk associated with the hormone itself or correlated to other factors...etc.

    Many many thanks
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