We discuss some of the unspoken dangers of female bodybuilding and fitness competition prep and post-show on a woman’s physical health, mental health and metabolism.
If you missed part one of this series on female bodybuilding, I discussed the typical recommendations when it comes to diet for competition prep. Before getting into part two on the effects of bodybuilding, I want to say that this post is in no way attempting to shame the bodybuilding community or the sport itself. The reality is, there are dark sides to any sport, especially sports where achieving an optimal weight is desired. I am in no way saying that these dangers will happen to anyone attempting a career as a bodybuilder or fitness competitor, however, I feel it is my duty to mention some of the potential risks, especially when this is done without proper supervision. I know when a bodybuilder has the right supervision and has an understanding of these dangers, they are better suited for not only a successful career in bodybuilding and fitness competitions, but also the ability to live a long and healthy life.
Let’s get into it.
Physical Dangers of Female Bodybuilding and Fitness Competition Prep
One of the concerns with bodybuilding and fitness competition prep is the risk for micronutrient deficiencies because of the tendency for some bodybuilders to severely restrict certain foods in their diet and only include a small range of repeated “safe” foods on their plan. Some studies on dieting bodybuilders observed deficiencies in micronutrients such as vitamin D, calcium, zinc, magnesium and iron. Having said that, a lot of this evidence is from the early days of bodybuilding, and it’s possible that these micronutrient deficiencies were more common due to the very premature understanding of bodybuilding nutrition and the drastic elimination diets. Fast forward twenty years later, it is currently unclear whether there is a prevalence of micronutrient deficiencies among competitive bodybuilders. Having said that, especially for women, it may still be useful to take a micronutrient supplement if you’re severely restricting calories or certain types of foods. Speak to a sports registered dietitian to determine your unique needs.
Fluid and Electrolyte Imbalances in female bodybuilding
In the final days and hours before a fitness competition (also known as “peak week”), many bodybuilders will attempt to manipulate their fluid and electrolyte levels to improve their muscularity and lean physique. In order to define their muscularity, during the final week, bodybuilders will dramatically increase their water intake – sometimes to as much as 10 L per day while also taking diuretics. Then a day before the competition, bodybuilders will dramatically cut their water intake in order to dehydrate the body- sometimes getting no water for 24 hours before showtime while continuing on their diuretic supplements. The goal of dehydrating before a competition is to increase vascularity so that a bodybuilder’s veins and muscles are clearly seen by the judges to achieve that “ripped” appearance.
Drinking excess amounts of water and then severely restricting water can cause a dangerous shift in a person’s fluid and electrolyte balance.
I know we’ve been conditioned to believe that more water is better, but drinking 10 L of water a day, and then flushing it out with diuretics can easily cause water intoxication, hyponatremia and hypokalemia, which taken together can be fatal.
Common signs and symptoms include:
- Irregular heartbeat
- Gastrointestinal distress
- Muscle cramping (which is a problem on stage when you’re flexing and posing)
- Muscle weakness
Another side effect that bodybuilders may not be aware of is that in certain scenarios, an “imperfect” shift in electrolytes and fluid may actually impair their performance on stage and even their muscle size. Before going on stage, a common practice by bodybuilders is “pumping up”. This is where a bodybuilder will perform repetitive weight lifting prior to stepping on stage to increase their muscle size and definition. This practice of “pumping up” could be compromised if a bodybuilder is dehydrated or is experiencing an electrolyte imbalance. In other words, they may look “too flat”. Further, some studies have found that dehydrating prior to a competition will result in a decrease in muscle water content, meaning a decrease in muscle size which will negatively impact the appearance of muscularity once they hit the stage. Bottom line, you may be playing with fire from the perspective of your health (and it might not even benefit your results).
Risky Female Bodybuilding Supplements
While the supplement industry’s market is worth as much as $37 billion a year, most researchers and health professionals caution their use because there isn’t clear evidence that they even work and are beneficial to our health. On top of that, because supplements are not regulated, there are a ton of illegal substances that make their way on store shelves and have killed people. According to a 2016 study, it is estimated that 23,005 emergency room visits a year were linked to supplements. Because of the lack of regulation, consumers don’t really know all of the ingredients in supplements and dosages could even vary from pill to pill. That’s really scary, and regulation needs to be done to prevent further deaths.
As mentioned in part one of this post where we discussed in more detail some of the major supplements used in female bodybuilding and fitness competitions, a lot of the supplements women take to get in shape come with real risks. From anxiety, insomnia, kidney and liver damage, infertility and even death, you have to really trust your “coach” to “prescribe” these cocktails of supplements and drugs in appropriate doses for you.
Psychological Dangers of Female bodybuilding and fitness competition prep
Body Dissatisfaction and Disordered Eating in Female bodybuilding
When combine with some of the psychological issues that evidence suggests are more prevalent in female fitness competitors, it’s not uncommon for bodybuilders to experience “post competition blues” or even depression after a competition.
In one study, 1/3 of a group of bodybuilders reported anxiety, short tempers or anger during competition prep. Furthermore, 81.5% of them in the group reported a preoccupation with food, , a precursor of course to disordered eating. Because of the pressure to meet goal weights and physique goals, bodybuilders may become dissatisfied with their body and resort to unsafe weight loss methods like unregulated “fat burning” supplements or anabolic steroids.
This is especially a concern among female fitness competitors, as one study found that among female competitive bodybuilders, 42% used to be anorexic, 67% were terrified of becoming fat and 50% experienced uncontrollable urges to eat. Further, research gathered from the National Eating Disorders website found that among female high school athletes, 41.5% reported disordered eating while 62% of female athletes in aesthetic weight class sports reported disordered eating.
Anecdotally, I have been told by personal trainers in the industry that they often see young female fitness competitors bring suitcases of cookies, cupcakes, donuts and more “off limits” foods to their competition, and then once they get off the stage, fall into an uncontrollable binge.
This research (and the stories I’ve heard) is very concerning, and I feel this is a topic that needs to be communicated more openly in female bodybuilding and fitness competitor circles. It is clear from this research that competitors and coaches need to be aware of the signs and symptoms of unhealthy behaviours and ideally there needs to be more specialists that are trained in this area to help athletes in need.
Fertility Risks and Dangers of Female Fitness Competitions & female bodybuilding
Any time you’re severely restricting calories or increasing activity, you put a woman at high risk for hormonal imbalance which may in turn impact her fertility and overall health. This could lead to a medical condition known as Female Athlete Triad.
Female Athlete Triad
Female athlete triad is a medical condition that is observed in physically active females and involves these three components:
- Low energy availability with or without disordered eating
- Menstrual dysfunction
- Low bone density
Restrictive diets, excessive exercise, low body weight and nutritional deficiencies from bodybuilding may be possible causes of female athlete triad.
Research has also found that both resistance training and energy restriction are associated with alterations in key reproductive hormones. Some of these alterations include an increase in estradiol and beta-endorphin which results in a decrease in gonadotropin releasing hormone and luteinizing hormone, and ultimately can cause estrogen deficiency.
In one study, 25% of female bodybuilding competitors reported abnormal menstrual cycles while another study reported that women complained of menstrual irregularity within the first month of competition prep. The researchers found that caloric restriction led to a decline in fat and body mass which resulted in a cessation of menses. In many cases, thankfully, their period returned over a year following the competition.
Low Bone Density
Healthy athletes tend to have higher bone mineral density than non-athletes, however female athletes with female athlete triad may be at risk for low bone density, stress fractures and even osteoporosis. Women with amenorrhea (lack of menses) have low levels of estrogen and estrogen is needed to inhibit osteoclast activity. Basically, without enough estrogen, this may cause a disruption in bone remodeling and may cause an acceleration in bone resorption. Sadly, because of the disruption in hormone activity from intense physical activity, female athletes may not be able to reap the beneficial effects of physical activity on bones.
Not surprisingly as a result of these hormonal shifts, female athletes are also at risk for infertility. This is due to lack of ovarian follicular development, anovulation or luteal phase defects.
Metabolic Dangers of Female Fitness Competitions & female bodybuilding
In bodybuilding, the goal is to achieve low levels of body fat while retaining lean body mass. In some cases, bodybuilders are able to reduce their body fat to less than 5% of total body mass. Depending on the division a female bodybuilder is in, there are different body fat percentage ranges. Bikini bodybuilders are generally in the 10-14% body fat range. Figure bodybuilders are generally in the 8-12% body fat range. Physique bodybuilders are generally in the 8-10% body fat range. Finally, a female athlete in the bodybuilding division will aim for 6-10% body fat.
To strike that balance, many bodybuilders must make significant manipulations and put their body through significant metabolic stress. Undergoing those changes may pose a physiological challenge and potentially lead to metabolic damage. A 12 month case study tracked a male bodybuilder for 6 months before and after a competition to examine the physiological changes that occur. Sadly, I could only find this data for a male bodybuilder, so keep in mind that these numbers may be different in a female bodybuilder. For now this is the best data we have, and it does give us a small understanding of what might be going on in an athlete’s body at a cellular level.
The 12 month case study found that an athletes heart rate decreased significantly from 53 to 27 beats per minute during preparation and then increased to 46 beats per minute within one month after competition. Blood pressure dropped from 132/69 to 104/56 mmHg during preparation and then returned to 116/64 mmHg at 6 months after competition.
Not surprisingly, the bodybuilder’s percent body fat decreased from 14.8% to 14.5% during preparation and returned to 14.6% during recovery.
The researchers found that strength decreased during preparation and did not fully recover during the 6 months of recovery. Researchers believe the decline in strength and increase in fatigue was due to the energy deficit. The fatigue and decline in strength could be explained by a decrease in glycogen stores due to the decreased energy intake. The researchers also found that athletes may have difficulty returning to their exercise abilities and could take some significant time after the competition.
The last element measured was the athletes testosterone levels. The case study found that testosterone declined from 9.22 to 2.27 ng/mL during preparation and returned back to baseline level, 9.91 ng/mL after competition.
One of the main criticisms of rapid weight loss/low calorie diets is that it may slow down a person’s metabolic rate. This is turn makes it difficult (potentially even virtually impossible) to keep the weight off once a person stops dieting and resumes to normal eating – even if their normal eating is still very balanced and healthy. This could explain why a lot of bodybuilders experience extreme fluctuations in their weight and find it difficult to keep their weight off once the competition is over. While not exactly meant to be a bodybuilding or fitness competitor situation, we can learn from the participants for whom the amount of calories they would burn at rest after their weight loss was calculated to be 500 calories lower than what would be expected from their weight loss alone. In other words, they would have to continue to consume the extremely low calorie diet they were eating to get to their goal weight, minus another 500 calories, just to maintain that weight. An explanation for changes in a person metabolic rate could be due to the hormonal responses when weight loss takes place.
Hormonal Dangers of Female bodybuilding
There are a number of hormones that play a role in regulating body composition, energy intake and energy expenditure, all of which may be negatively impacted by fitness competition prep and restriction.
Thyroid Gland Hormones
Triiodothyronine (aka T3) plays a direct role in regulating metabolic rate. Studies have found that a low calorie diet may decrease thyroid hormone levels which can decrease a person’s overall metabolic rate.
Leptin in primarily synthesized in the adipocytes and tells us when we’re full. When we restrict food in the short term and lower our body fat levels, leptin levels are decreased. When there are high levels of leptin, a person will experience increased satiety and energy expenditure. Studies have shown that a low calorie diet with an effort to promote fat loss, may decrease leptin levels which results in former competitors always feeling hungry and never satisfied.
This hormone plays opposite to leptin and stimulates appetite and food intake. Ghrelin is typically increased in the body when we fast and decreases after we eat. When we restrict, high levels of ghrelin circulate in the body screaming for food. A study found that a low calorie diet increased ghrelin which stimulated participants appetite and made them want to eat more.
Testosterone plays an important role in increasing muscle protein synthesis and muscle mass. It may even play a role in regulating adiposity. One study found that a low calorie diet decreased testosterone levels, ultimately interfering with protein synthesis.
Cortisol is a glucocorticoid that influences metabolism and has been shown to induce muscle protein breakdown. A low calorie diet can also increase cortisol which has been shown to increase proteolysis (protein breakdown) in healthy subjects.
It is clear that any attempt to severely manipulate body weight can cause unfavourable changes in our circulating hormone and these changes may remain even when the dieting ceases.
So why are our hormones responding this way to dieting?
Well, our body doesn’t like change. Especially sudden change, like rapid weight loss or suddenly restricting calories. Our body believes we’re in starvation mode and reacts by conserving energy through the action of these hormones so that we can get back to our preferred set point. The result? It slows our metabolism which lowers our energy expenditure and ultimately promotes weight regain.
Is there anything that female fitness competitors can do to reduce the risk of this happening?
Reverse Dieting to Prevent Metabolic Damage
I want to finish up this post by discussing a post-show dieting trick that has become popular among physique athletes. It’s called reverse dieting. After a competition, some bodybuilders will be coached to do something called “reverse dieting” in an effort to restart their metabolism and increase their energy expenditure gradually again to prevent significant weight regain. I’ve already done a comprehensive video review of . For those of you who aren’t familiar with reverse dieting, it’s an eating plan that involves gradually increasing your caloric intake over a period of several weeks or months. This style of eating is popular among bodybuilders because it’s designed as a recovery diet after a heavily restricted diet like a bodybuilder’s pre-competition diet. Like I mentioned in the metabolism section of this post, bodybuilders are looking to normalize their eating patterns and prevent gaining excessive weight due to their slowed metabolism.
Here’s how it looks.
It starts by increasing a person’s calorie intake by 50-100 calories per week above your competition prep baseline until you’re back to your pre-competition baseline. This will last four to ten weeks. Another reason this diet has become popular among bodybuilders is to reduce the risk of binge eating, which is a common issue experienced by some bodybuilders.
Does Reverse Dieting Work?
The thing with reverse dieting is that in theory it sounds like it should help reduce the metabolic damage. Adding a small surplus of calories to your diet may restore circulating hormone levels and normalize your energy expenditure to ultimately (slowly) recover your existing metabolic rate. However, is that really the case? Sadly, we have very little evidence to support its use and the only evidence we do have are anecdotal reports, which have led to its increase in popularity. For now, we still need actual research to evaluate its efficacy.
Bottom Line on the Dangers of Female Bodybuilding and Fitness Competition Prep
Like I said at the beginning of this post, I by no means am trying to say that you shouldn’t become a female fitness competitor or bodybuilder. My job as a dietitian is to try to understand this athletic trend, dive into the culture and explore the possible concerns with following this type of lifestyle to give you the tools to do whatever you’re going to do in the safest way possible. While many sports can be demanding on the body and require you to fit into a certain weight class or reach optimal body composition, bodybuilding is a unique case because it involves making dramatic changes in a short period of time.
I whole heartedly believe that when done safely and in a responsible way, bodybuilding can probably be a rewarding sport for some people. Especially in the right hands with an experienced trainer, I can see how bodybuilding can make a person feel strong and in control of their body. That being said, there’s a dark side to this sport and coming from a background of orthorexia, I know that I would never be able to participate in a sport like this. Any sport that is centered around a preoccupation with food and weight carries significant physical and psychological risks that are ultimately not worth it for a lot of people.
I hope that these two posts gave you a better idea of what bodybuilding really is, and some of the psychological, physical and metabolic effects of this sport. If you’re a bodybuilder or was one reading this, please share your experience with the sport and why you love it or why it wasn’t for you.
Sofia Tsalamlal, RD