Here's what you need to know...

Becoming a top level bodybuilder requires the use of powerful drugs which have been linked to organ failure and early death. While anabolic steroids are obviously used heavily, other drugs may contribute more to health issues, such as insulin, HGH, and diuretics. There is use, misuse, and abuse when it comes to bodybuilding drugs. We're now seeing the consequences of the latter on bodybuilders from the 90s and early 2000s.

Dead in 5 Years

In the 1980s, Dr. Robert Goldman began asking top-level athletes if they'd accept a proverbial deal with the devil that guaranteed victory in every competition they entered... but also guaranteed their death within five years.

Goldman consistently found that the majority of athletes would eagerly accept the deal. It become known as "Goldman's Dilemma."

Would you accept this deal? Many competitive bodybuilders and even non-competitive lifters have.

Lean and Muscular Corpses

Champion bodybuilders are known only to the relatively-small community who follow this fringe sport. So you have to wonder why so many seem eager to risk their lives and health for success.

Is it for money? Fame? Or do they roll the dice just to build more muscle and drop more fat than the next guy?

Gross abuse of anabolic steroids (AAS), growth hormone, insulin, and diuretics are some of the major factors believed to be responsible for a disproportionate number of lean and muscular corpses.

In a sport that, at its core, requires eating well, losing fat, and exercising, why do we see so many bodybuilders dying from similar causes at unusually-young ages?

The Goal is Muscle, Not Health

"Most guys think nothing bad will ever happen to them. But you watch. You'll be seeing more and more serious heart problems, and worse, once these guys hit 40."

– Mike Matarazzo, pro bodybuilder

Matarazzo had triple-bypass open heart surgery at 38, a heart attack at 41, and died at age 47 while waiting for a heart transplant.

He was at his competitive peak in his early-30s, when "mass monsters" dominated bodybuilding, and he claimed to eat up to seven pounds of red meat per day at his biggest.

But in the years prior to his drastic physical decline, Matarazzo was one of the few pros who talked openly about what he felt was the underlying cause – the level of anabolic steroids and related drugs necessary to become a top-ranked pro.

Matarazzo's public callout of the negative effects of drug use may sound far fetched to some, but there's anecdotal and scientific evidence to support his belief.

It's an undeniable fact that numerous top-level bodybuilders have died from some variation of "natural causes" – often a heart attack or some form of organ failure – before they hit 40 years old.

A handful never even saw 35. Some top pros almost reach 50, but even less get to 55 without a major health scare. Try to find a dozen healthy IFBB pros who successfully competed in the '90s. You won't have much luck.

Kneejerk Response

When a bodybuilder dies at an early age from organ-related failure, this is the kneejerk response you'll hear from bodybuilding fans:

"He had a preexisting condition and would've had that same problem whether he was a bodybuilder or a school teacher!"

But the big question is, are preexisting conditions made worse by excessive drug use? And would these competitors have lived much longer without using them?

Or is it the heavy use of these drugs combined with the rigors of bulking and cutting for multiple contests that eventually leads to health issues?

There certainly may be cases where underlying natural causes were a key factor in a death, but it seems to be a common and unfortunate go-to excuse whenever a physique athlete dies.

Rewarding the Extremes

Bodybuilding began to separate from physical fitness in the 1950s. Building muscle gradually became a greater goal than athleticism, strength, and power. The fact that anabolic steroids were finding their way into gyms in the 1960s was no coincidence.

Achieving lower body fat with a higher body weight meant packing on more muscle. And the more that look was rewarded, the more competitors pursued it. Health became an afterthought.

It may be more accurate to say steroids don't kill people, abusing steroids kills people. It's probably even more true that other bodybuilding-related drugs bring higher risks than anabolic steroids.

Insulin, HGH, and various diuretics supposedly gained traction in the '90s, and they tend to have a greater risk-to-reward ratio.

The Consequences of Leaner and Bigger

In the early '90s, bodybuilding saw a significant shift in "the ideal" physique.

Dorian Yates set a new standard and his contemporaries tried to follow suit as the sport was introduced to the term "mass monster," describing never-before-seen massive bodyweights and the same deep definition that comes with extremely low body fat.

The long term results of the era are what we've been seeing over the past couple decades: consequences that are catching up with more and more bodybuilders as reports of health issues – from mild to fatal – have appeared.

No, not every pro has had issues. And it's not always the biggest guys or only the top-ranking pros who struggle, but their drug use is consistent enough to draw some conclusions.

The Studies

A 2014 study looked into a connection between anabolic steroids and cardiovascular function. The results suggest that heavy steroid users are more likely to have irregular heart function and a higher mortality rate compared to natural lifters.

A 2012 report from the American Journal of Cardiology reviewed nearly 50 different studies looking at the effects of anabolic steroids and cardiovascular/metabolic function. It came to a similar conclusion: Steroid use can be a valid and significant factor in heart-related death.

Another study in the Journal of the American Society of Nephrology looked into the prevalence of kidney disease among steroid-using bodybuilders over two years and found signs of disease in the majority of lifters, some of it irreversible and irreparable.

Pro Bodybuilders Vs. Other Athletes

Unlike bodybuilding, the deaths of other professional athletes aren't as strongly linked to performance enhancing drugs. Physical wear and tear such as collisions in contact sports or recreational drug use are said to be greater contributing factors.

Performance enhancing drugs (PEDs) is the term the public associates with anabolic steroids, even though it's a general category that can include anything from insulin to EPO, a blood "doping" endurance booster, and various non-steroid stimulants.

We know that PEDs are widespread in professional sports like baseball, football soccer, and MMA. But even non-traditional sports like cricket, NASCAR, cycling, and pro-wrestling "entertainment" sports have all made headlines with various reports of PED use.

Professional athletes seeking every possible advantage and recovery method shouldn't surprise us, even when it's directly prohibited by their sport's rules and the law.

In 2014, the Public Library of Science published a report investigating the mortality rate among active pro wrestlers. Data was collected from 1985 to 2011 and demonstrated that wrestlers were three to four times more likely than the general population to die between 30 and 50 years old.

Cardiovascular disease and drug overdose were found to cause an overwhelming majority of the deaths, with wrestlers being 15 times more likely to experience a cardiovascular-related death and a shocking 122 times more likely to die from drugs compared to non-athletes.

In the last 15 years, roughly one in five wrestler deaths were connected to recreational drug overdose.

A 2012 study in the American Journal of Cardiology investigated mortality rates among NFL players and actually saw that they were, overall, almost half as likely to die as comparably-aged non-athletes.

Though the football players were, not surprisingly, associated with significantly higher rates of neurological and musculoskeletal disease.

Use, Misuse, and Abuse

Thirty years ago, the average non-professional athlete was uninterested in using steroids. But today, if you walk into most weight rooms you're likely to be standing around a handful of AAS users, whether they look the part or not.

A quick browse online will show you tons of recreational lifters discussing plans for their first, second, third, or fourth steroid cycle. These guys aren't trying to earn a paycheck with their muscle, nor are they trying to win any contests. They're just average lifters wanting to look better.

With steroids, there's use, there's misuse, and there's abuse, and they're very different things.

Those who misuse AAS are those who'd get results from healthy eating and lifting. Those who abuse AAS are the ones stacking eight compounds a week like they think their 290-pound idol does. The latter are the lifters who generally end up as statistics.

The Last Callout: The Dead

In the 1960s, Iron Man publisher Peary Rader wrote an editorial to address the issue of steroids in bodybuilding and to warn readers not to get involved with the drugs.

In the 50+ years since his article, plenty of bodybuilders have misused or abused steroids and other PEDs and have paid the ultimate price:

Mike Matarazzo: Frequent top 10 IFBB pro from 1992 to 2001. Four-time top 5 finisher at the Night of Champions. Died from a heart attack in 2014, age 47. Dan Puckett: 1st place 2006 NPC Collegiate National Heavyweight. Died from heart failure in 2007, age 22. Scott Klein: Four-time NPC Heavyweight competitor (1995 and 1997), two-time NPC super-heavyweight competitor (1998 and 2000). Died from kidney failure in 2003, age 30. Robert Benavente: Competed in multiple NPC shows from 1994 (teen division) to 2003 (1st place in Southern States). Died from a heart attack in 2004, age 30. Trevor Smith: Bodybuilding writer and coach. Never competed, but weighed over 400 pounds. Died from a heart attack in 2004, age 30. Andreas Munzer: 13 top-five placings from 1986-96. Considered a "pioneer" in the use of diuretics for a super-peeled look. Died from multiple organ failure in 1996, age 32. Mohammed Benaziza: Seven total Grand Prix wins in 1990 and 1992, 1st place at the 1990 Night of Champions (beating Dorian Yates), two top 5 Mr. Olympia showings (1989 and 1992). Died from heart failure hours after winning the Grand Prix Holland show in 1992, age 33. Daniele Seccarecci: IFBB competitor from 2007 to 2013. 2010 Guinness World Record Holder for "heaviest competitive bodybuilder" at 297 pounds. Died from a heart attack in 2013, age 33. Luke Wood: IFBB competitor from 2001 to 2008, often breaking into the top 10. Died from complications following a kidney transplant in 2011, age 35. Chris Janusz: Amateur competitor, nutrition coach, and contest prep consultant. Died from undisclosed causes in 2009, age 37. Art Atwood: Consistent top 10 finisher in IFBB shows from 2002 to 2004, including 1st at the 2002 Toronto Pro. Died from a heart attack in 2011, age 37. Mat Duvall: Four-time top 3 finisher in NPC Super-heavyweight division (1999, 2001, 2002, 1st in 2003). Died from a heart attack in 2013, age 40. Ed Van Amsterdam: European champion in the mid-1990s, frequent top 10 IFBB finisher in 2002 and 2003. Died from a heart attack in 2014, age 40. Fannie Barrios: Two-time Jan Tana winner (2001, 2002). Three top 8 placings at Ms. Olympia (3rd place in 2002). Died from a stroke in 2005, age 41. Charles Durr: Six top 5 NPC and IFBB finishes from 1988 to 1999. Competed in the 2004 IFBB North American Championships. Died from a heart attack in 2005, age 44. Anthony D'Arezzo: Three-time top 10 NPC Heavyweight (1993, 1994, 1995). 1st at NPC New England in 1997. Died from a heart attack the night before a contest in 2006, age 44. Greg Kovacs: Competed in several IFBB shows from 1997 to 2005. Known in the industry as one of the largest off-season bodybuilders, regularly weighing over 400 pounds. Died from heart failure in 2013, age 44. Ron Teufel: 1978 IFBB Mr. USA. Runner-up to Samir Bannout at 1979 World Amateurs. Top 10 IFBB competitor in 1981 and 1982. Died from liver failure in 2002, age 45. Hans Hopstaken: NPC Masters competitor in 1998 and 1999. IFBB competitor in 2000 and 2001, including two top 5 placings at the Masters Olympia. Died from heart failure in 2002, age 45. Frank Hillebrand: Light-heavyweight champion (1987, 1989), several top 10 IFBB finishes from 1990 to 1993. Died from a heart attack in 2011, age 45. Alex Azarian: NPC competitor from 2002 to 2009, including a total of five 1st place wins. Training, nutrition, and contest prep consultant. Died from undisclosed causes in 2015, age 45. Ray Mentzer: IFBB competitor from 1979 to 1982 including 1st place 1978 Mr. USA, and several top 3 placings. Died from kidney failure in 2001, age 47. Nasser El Sonbaty: Frequent top 8 IFBB competitor from 1990 to 1992, consistent top 4 finisher in shows from 1993 to 1998, including 2nd at the 1997 Mr. Olympia and 3rd at the 1995 and 1998 Olympias. Died from complications from heart and kidney failure in 2014, age 47. Don Ross: Amateur competitor from 1965 to 1972, pro bodybuilder from 1973 to 1980 with 10 top 5 placings. Died from a heart attack in 1995, age 49. Mike Mentzer: Consistent top 3 IFBB pro from 1975 to 1979, including 2nd in the 1976 and 1977 Mr. Universe, 1st place 1976 Mr. America, and 1st place 1979 heavyweight Mr. Olympia (lost the Overall to Frank Zane). First pro bodybuilder to be awarded a perfect score in a contest. Died from heart complications in 2001, age 49. Don Youngblood: NPC and IFBB Masters competitor from 1994 to 2002. 2nd place at the 2001 Masters Olympia and winning 1st in the 2002 Masters Olympia. Died from a heart attack in 2005, age 49. Stoil Stoilov: NPC and IFBB Masters competitor from 2005 to 2014. Died in 2014 one week after placing 2nd at a National show, age 49. Terri Harris: Frequent top 5 finisher in NPC and IFBB shows from 2002 to 2012, including several 1st place wins in 2011 and 2012. Died from a heart attack two days after a contest in 2013, age 50. Ed Kawak: 5-time Mr. Universe (1982-1985, 1993). IFBB competitor in 1996 and 1999. Died from a heart attack in 2006, age 51. Vince Comerford: Amateur competitor from 1984 to 1986. 1st place Middleweight at 1987 NPC Nationals (lost the Overall to Shawn Ray). IFBB competitor in 1989 and 1990. Died from a heart attack in 2014, age 52. Greg DeFerro: 1979 IFBB Mr. International, five top 4 placing in IFBB shows from 1981-1984, including 2nd to Lee Haney at the '83 Night of Champions. Died from heart disease in 2007, age 53.

The Dead Pool?

These bodybuilders are thankfully still alive at the time of this writing, but have suffered major health issues.

Tom Prince: NPC competitor from 1995 to 1997, including 1st place at the 1997 Nationals. IFBB competitor from 1999 to 2002. Suffered kidney failure during contest prep in 2003, age 34. Retired in 2004, eventually received a kidney transplant in 2012. Don Long: NPC Light-heavyweight (1992) and Heavyweight (1993 to 1995). Frequent top 10 IFBB pro from 1996 to 1999. Suffered kidney failure in 1999, age 34. Received a kidney transplant in 2002, which failed in 2003. Competed in several IFBB shows from 2006-2009. Received another kidney transplant in 2011. Flex Wheeler: NPC competitor from 1989 to 1992. One of the best IFBB pros from 1993 to 2000 with a total of 17 first place wins. He made 2nd place at the Mr. Olympia three times ('93, '98, '99) and two-time top 4 at the Olympia ('96 and '00). Suffered kidney failure and "officially" retired in 2000, age 35. Competed twice more, 7th place at the '02 Mr. Olympia (supposedly drug-free) and 3rd at the '03 Ironman. Received a kidney transplant in 2003. Orville Burke: NPC Heavyweight in 1996 and 1997 and Super-heavyweight in 1998. Frequent IFBB top 10 competitor from 1999 to 2002, including 1st at the 2001 Night of Champions and 1st at the '01 Toronto Pro. Two-time top 10 at the Mr. Olympia. Fell into a six-week coma after complications during surgery in 2002, age 39. Mike Morris: NPC competitor from 1990 to 1997. IFBB pro from 2001 to 2005. Retired in 2005 after developing signs of kidney problems, age 35.

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