The case study (out of Austrailia) describes a 35 year old white male who checked into a hospital after dealing with cramps, diarrhea, nausea, and itchy skin (jaundice). Simply by appearance the doctors knew he was a bodybuilder, and after some questioning he admitted to using steroids. Upon searching his home they found everything a serious bodybuilder might have including injectable testosterone, nandrolone, oral anabolics, fat loss agents like clenbuterol and T3, selective estrogen receptor modulators (SERMs), and human Growth Hormone. They also noted two unlabeled small bottles. The researchers were unable to identify what exactly the small unlabeled bottles were, but they sound similar to peptides. Still it’s unclear. Why am I discussing these two unlabeled bottles vs. all the other anabolics? I’ll explain later, but first the bodybuilder’s health.

Bodybuilder’s Health Rapidly Deteriorates
When this man entered the hospital he had no signs of significant danger. But his blood work painted an ugly picture. Take a look at these values:

ALT (alanine aminotransferase) - 8750 IU/L (normal range, 5–55)
AST (aspartate aminotransferase) – 5400 IU/L (normal range, 5–55)
Bilirubin – 5.1 mg/dL (normal range, 0.1–1.2)
Gamma-glutamyltranspeptidase – 382 IU/L (normal range, 60)
Alkaline phosphatase – 148 IU/L (normal range, 20 –120)
Amylase - 2300 IU/L (normal range, 20 –120)
Lipase – 215 IU/L (normal range, 13– 60)

What does all that mean? It means his liver and kidneys were failing him. To make his day even worse an echocardiogram found that his heart was failing to pump blood adequately (cardiomyopathy). They put him on dialysis, breathing support, an IV to hydrate and reduce muscle cramping. Did it help? Nope, by day 8 his brain began failing and his nerves were malfunctioning at an alarming rate. Finally a toxicology screen found arsenic poisoning. They began chelation therapy immediately (removes toxic metals from the body), unfortunately he died on day 15.

Was it Arsenic or Steroid Abuse?
The researchers took 11 days to identify what the major cause of his ailments. Since arsenic poisoning is uncommon they tested his steroids. One of the two unlabelled bottles was found to contain only arsenic, and no steroids or drugs were found in the bottle. So what is it exactly that killed him? The researchers contribute most of the problems to arsenic exposure, but note the cholestatic liver damage was likely a result of both the steroids and arsenic.

A good factual read to remind us that we always need to be careful and always know what you are getting.