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Insulin As A Physique Enhancer: Friend Or Foe?
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Posted by: Robert
Insulin As A Physique Enhancer: Friend Or Foe?
by Dan Gwartney, MD
Time changes perspective. Take for example the persons of Arnold Schwarzenegger and Jesse Ventura. Mention the two together and many people would assume the conversation is in regard to politics, as both have ascended to be prominent governors. It is possible that some might think the topic is action movies, as both have enjoyed success as actors; the two appeared together in several movies: “Predator” (1987), “The Running Man” (1987) and “Batman & Robin” (1997). It would surprise many people to hear the two referred to as former athletes, as Schwarzenegger won his first Mr. Olympia title in 1970 and Ventura’s wrestling career ended in the mid-1980s. This shouldn’t be such a surprise, given that it has been stated that fewer people know George Foreman as the greatest heavyweight fighter of his time, perhaps all time, than recognize him as the spokesman for the George Foreman Grill.
Insulin is a hormone that has passed through as many careers as the Austrian Oak. First discovered in 1921, insulin became an immediate miracle drug, as it offered a cure to a prevalent disease (type 1 diabetes mellitus) that had previously been a death sentence.1 Initially, insulin was sourced by extracting the protein from the pancreas of cattle or pigs. Unfortunately, the extraction process was not pure, carrying several other proteins. These impurities and slight molecular differences between animal and human insulin caused some patients to rapidly clear the drug, with some even developing allergic reactions. Fortunately, recombinant technology was developed, which allows biotechnology companies to create pure insulin products that are identical to human insulin.2
The Evils Of Insulin
Fast-forward to the 1990s…innovative ideas in dieting are spearheaded by Barry Sears (Zone Diet) and Dr. Robert Atkins (Atkins Diet). Diabetes has become a mundane disease, more thought of as a consequence of a lifestyle of sloth and gluttony as the prevalence of type 2 diabetes (non-insulin dependent) eclipses that of type 1 diabetes (insulin dependent). The epidemic facing the American public and threatening to collapse the health care system was, and continues to be, obesity. Suddenly, a full-frontal assault was led against the evils of insulin and high-glycemic carbohydrates. Obesity, type 2 diabetes, hypertension, the Metabolic Syndrome, cardiovascular disease, etc.— all were suddenly the wages of the sin that is hyperinsulinemia.3
Yet, rumblings were being heard from the athletic realm that insulin was being used by elite athletes. Insulin use by track athletes was an unspoken secret during the 1980s; reports of insulin use by bodybuilders and power athletes appeared in medical journals during the early to mid-1990s.4-8 By the late 1990s and early in the 2000s, it was becoming increasingly known that insulin was being used by many athletes and bodybuilders to improve training and increase muscle mass. Yet, this was taking place during the glory days of the low-carbohydrate diets, which clearly explained that high insulin levels led to increased body fat and poor health. The third “career” of insulin as a physique and performance enhancer was lost in the lynch-mob mentality of the public to hang all their image and health woes on insulin. Note there have also been some more colorful “careers” for insulin as a murder/suicide weapon and sexual experience enhancer.9 These misuses of the drug have led to numerous cases of brain damage, organ failure and even death.
Physique Enhancer
How is it possible that insulin is a physique or performance enhancer? Much of the confusion lies in trying to apply the physiologic understanding of insulin in situations where insulin is used as a pharmacologic agent. In the absence of using exogenous insulin (injected or other forms of pharmaceutical insulin) and in a healthy person, the hormone acts to regulate blood sugar (glucose) levels and inhibit (reduce) the use of non-sugar molecules to generate cellular energy.8 All cells of the body function through the continuous generation of ATP, the energy molecule. ATP is much like the electricity that runs a computer; if the electricity is shut down, the computer shuts down. The easiest way for cells to generate ATP is to “burn” glucose. This sugar comes from the circulating blood that surrounds the cells and from stores of sugar inside the cell, called glycogen. In normal circumstances, the vast majority of a healthy person’s ATP is produced from sugar. However, when blood sugar levels drop, the stores of sugar are depleted (through exercise or starvation), or the rate of ATP needed to meet metabolic demand is sharply increased (such as in high-intensity exercise), other sources are used to generate ATP. These sources come from certain Amino Acids and fatty acids. Note the time that the use of Amino Acids and fatty acids occurs is when insulin levels would be low.
In the opposite situation, when there is a high blood sugar concentration, insulin helps shuttle sugar into the cell, but more importantly acts to shut down the use of Amino Acids or fatty acids for ATP production.10,11 If a healthy person balances his/her caloric intake with metabolic demand, the body functions in a state of good health. Unfortunately, the American society has reached a global state of caloric imbalance and the continued excess of consumption with a near-absence of exercise or labor has led to an epidemic of pre-diabetes, the Metabolic Syndrome and similar maladies.3
However, in the athlete, insulin holds possibilities that make it an attractive drug to many athletes. Before another word is spoken though, it is vital that anyone using this drug for medical or enhancement purposes realizes that insulin is so powerful that if it is overdosed, coma can quickly set in before help can be called and death is a very real possibility.9-12 Overdosing with insulin can happen quite easily, as several factors can alter the body’s response to the drug; some forms of insulin are fast-acting, others release slowly, starting blood sugar or food availability can vary, etc. Using insulin outside the direction of a physician, in the absence of immediate aid and without monitoring for signs or symptoms of hypoglycemia is extremely dangerous and not advised. This has been clearly documented in innumerable patient experiences. More relevantly to readers of this publication, cases of hypoglycemic shock in bodybuilders have been reported in the medical literature.4-8 One case reported in the British Journal of Sports Medicine exemplifies the presentation and treatment of a 31-year-old bodybuilder who entered into a coma after using a fast-acting insulin rather than his routine insulin.13 This previously healthly man was fortunate to be discovered at home in time to be treated successfully and was discharged with no long-term effects. Had he not been discovered in a timely manner, he certainly could have suffered long-term disability or even died. The article estimated 10 percent of bodybuilders use insulin.
Nonetheless, many people misuse insulin in the hopes of gaining an edge. In performance athletes, recovery is a major issue that determines training intensity over the long-term. One factor that can limit later physical performance, particularly in events or conditions that require high-intensity or long-duration effort daily, is glycogen replenishment. Glycogen is the amount of stored carbohydrate present in muscle or the liver. Along with circulating glucose, this is the most important source of immediate energy, used in explosive events such as sprinting. Track athletes train compulsively and in order to excel at the highest levels of competition, push themselves to the point of overreaching and overtraining. At the end of a training session, muscle glycogen stores are fairly depleted and there is a short post-exercise window during which the exercised muscle may rapidly take up sugar and essential Amino Acids.14,15 Much of the increased absorption is not dependent upon insulin, as other exercise-related factors also increase the glucose uptake into muscle, such as interleukin 6.16 However, ingesting a high-glycemic carbohydrate, along with a rapidly assimilated source of branched-chain Amino Acids and related nutrients (i.e., Creatine) immediately post-exercise can result in a greater increase in lean mass and a quicker replenishment of glycogen.17 Even greater benefits may be obtained by consuming the Amino Acids or protein pre-exercise.18
Exercise physiologists have closely examined the post-exercise uptake period and find that a delay over three hours may result in losing much of the exercise-induced benefit. However, it has been found that a sharp increase in insulin, induced by an excessively high sugar load or administering insulin as a drug, increases the post-exercise influx to an even greater degree, but it is vital to have ample Amino Acids available in the bloodstream.19,20 This is the mechanism manipulated by athletes and their trainers to improve recovery and prevent overreaching. As insulin misuse is currently undetectable by drug-testing labs, many athletes use the drug despite it being on the banned substance list for most professional and amateur organizations. However, recent advances suggest that a test for illicit insulin use may be developed in the near future.21
Bodybuilders And Insulin
Bodybuilders also take advantage of the insulin-supplemented increase in post-exercise nutrient uptake. However, as bodybuilding is not a drug-tested sport at the elite level, insulin’s anabolic effects are desired for longer durations than the short post-exercise period. Insulin can also increase net protein accretion (lean mass gain) in muscle during rest.22 Further, many bodybuilders who use insulin include the drug as just one of a plethora of drugs used to maximize muscle hypertrophy while fighting fat gain, particularly growth hormone.7,8,13,23 In order to maximize the benefits of insulin, the drug is used daily or on training days only for weeks-to-months at a time.23 However, one aspect of increased insulin activity is an increase in stored fat, as insulin inhibits the breakdown and release of stored fat and promotes the enzymes the pulls fat into the fat cell to create more fat. To combat this, concurrent use of growth hormone, thyroid hormone and beta-agonists is common. Further, as insulin is used in the most aggressive bulking cycles or to preserve fat during precontest dieting, the concurrent use of anabolic steroids is nearly universal.
Obviously, insulin would not be used by athletes or bodybuilders if it were not effective. Despite the continued head-in-the-sand approach taken by sports organizations who are struggling to curtail insulin’s use while stating there is no evidence of it improving performance, insulin has become a “must-use” drug in the mentality of elite competitors. Certain bodybuilders have achieved the status of being “insulin gurus” and this drug is one of the reasons the builds and mass of elite bodybuilders have changed so dramatically from the golden era of Arnold. Clearly, in the hands of these individuals, insulin use appears to promote muscle gain without leading to an increase in subcutaneous fat. Unfortunately, recreational bodybuilders will be attracted to insulin, having learned of its widespread use among the elite. In this group, it is highly unlikely that insulin will provide the same degree of benefit for risk involved. Few recreational bodybuilders have access to the same level of instruction and supervision as their elite counterparts; ancillary drug use is more limited; dietary practices are less strict; motivation and support is relatively lacking; and a lower training intensity are among the reasons the casual user will not see the gains in mass noted among professionals. Instead, recreational bodybuilders run the risk of actually increasing fat accretion by maintaining insulin levels above physiologic demand.
Pre-diabetics and type 2 diabetics tend to have high levels of insulin, as compared to people with healthy blood sugar control.8 This is associated with a higher lean mass, which may surprise many people, but it is also associated with a much higher fat mass. In the absence of extreme metabolic demand, whether it be due to rigorous and extended training or drug-induced stimulation of fat burning, exogenous insulin may serve only to increase whole-body anabolism rather than the more specific lean mass gains. Whole-body anabolism means that fat stores will increase similarly or at a greater rate than lean mass, resulting in a less-desirable physique, not to mention the risks to health.
Does insulin hold a place in physique or performance enhancement? At the highest levels of training, it has provided increases in mass or quicker recovery rates. However, the cost can be high— not financially, as this drug is relatively cheap— but in terms of health. The number of hospital admissions due to insulin misuse are not accurately reflected in the literature, as the FDA does not consider insulin to be a drug of abuse. However, many emergency room physicians in cities with a bodybuilding community will have experienced calls or admissions of hypoglycemic shock or coma induced by insulin misuse. The final message on insulin is that to derive its potential benefits requires one to be well-instructed, disciplined and willing to take great risks. Unfortunately, many people will take these significant risks, overestimating their level of understanding and suffer serious consequences. Insulin’s risks are not justified; brain damage or death are distinct possibilities with every injection.
References:
1. Goldfine ID, Youngren JF. Contributions of the American Journal of Physiology to the discovery of insulin. Am J Physiol, 1998;274:E207-9.
2. Johnson IS. Human insulin from recombinant DNA technology. Science, 1983;219:632-7.
3. Fonseca VA. Early identification and treatment of insulin resistance: impact on subsequent prediabetes and type 2 diabetes. Clin Cornerstone, 2007;8 Suppl 7:S7-18.
4. Reverter JL, Tural C, et al. Self-induced insulin hypoglycemia in a bodybuilder. Arch Intern Med, 1994;154:225-6.
5. Elkin SL, Brady S, et al. Bodybuilders find it easy to obtain insulin to help them in training. BMJ, 1997;314:1280.
6. Dawson RT, Harrison MW. Use of insulin as an anabolic agent. Br J Sports Med, 1997;31:259.
7. Rich JD, Dickinson BP, et al. Insulin use by bodybuilders. JAMA, 1998;279:1613.
8. Sonksen PH. Insulin, growth hormone and sport. J Endocrinology, 2001;170:13-25.
9. Marks V, Richmond C. Insulin Murders. Royal Society of Medicine Press Ltd, London, 2007.
10. Brozinick JT Jr., Berkemeier BA, et al. "Actin"g on GLUT4: membrane & cytoskeletal components of insulin action. Curr Diabetes Rev, 2007;3:111-22.
11. Karlsson HK, Zierath JR. Insulin signaling and glucose transport in insulin resistant human skeletal muscle. Cell Biochem Biophys, 2007;48:103-13.
12. Kaminer Y, Robbins DR. Insulin misuse: a review of an overlooked psychiatric problem. Psychosomatics, 1989;30:19-24.
13. Evans PJ, Lynch RM. Insulin as a drug of abuse in bodybuilding. Br J Sports Med, 2003;37:356-7.
14. Hargreaves M. Muscle glycogen and metabolic regulation. Proc Nutr Soc, 2004;63:217-20.
15. Rasmussen BB, Tipton KD, et al. An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise. J Appl Physiol, 2000;88:386-92.
16. Al Khalili L, Bouzakri K, et al. Signaling specificity of interleukin-6 action on glucose and lipid metabolism in skeletal muscle. Mol Endocrinol, 2006;20:3364-75.
17. Borsheim E, Cree MG, et al. Effect of carbohydrate intake on net muscle protein synthesis during recovery from resistance exercise. J Appl Physiol, 2004;96:674-8.
18. Tipton KD, Rasmussen BB, et al. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. Am J Physiol Endocrinol Metab, 2001;281:E197-206.
19. Biolo G, Williams BD, et al. Insulin action on muscle protein kinetics and amino acid transport during recovery after resistance exercise. Diabetes, 1999;48:949-57.
20. Biolo G, Wolfe RR. Insulin action on protein metabolism. Baillieres Clin Endocrinol Metab, 19937:989-1005.
21. American Chemical Society (2007, March 5). First Urine Test To Detect Insulin Doping In Athletes. ScienceDaily. Retrieved March 19, 2008, from http://www.sciencedaily.com¬ /releases/2007/03/070305092152.htm.
22. Biolo G, Declan Fleming RY, et al. Physiologic hyperinsulinemia stimulates protein synthesis and enhances transport of selected Amino Acids in human skeletal muscle. J Clin Invest, 1995;95:811-9.
23. Llewellyn W. Insulin. Anabolics 2005. Body of Science Press, Jupiter, FL;2005:301-3.
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Insulin As A Physique Enhancer: Friend Or Foe?
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