Q: Milos, I know that you competed more than any other professional bodybuilder and that you assist many other athletes in their contest preparation. I entered two shows in my life and both times got myself in serious trouble by getting myself severely dehydrated. First time I was experiencing painful cramps and I was told to take extra potassium. I eat two bananas and my cramps went away. However, in my second contest those extra bananas didn’t help. I believe I had at least five bananas and with each one - I was only getting worse. Finally, after the contest my wife had to take me to the hospital and doctors told me that I am lucky to be alive! My potassium levels were so high that I could have experienced a heart attack.
Also, they told me that my kidneys were failing and all that scared me so much that I decided to never compete again. Interestingly, two weeks after the show I checked with my doctor again – and he told me that I couldn’t be healthier!?
I remember that doctors in a hospital told me that I had‘ hyperkalemia’ and I was wondering if you are familiar with that term. Also, why do you think I had that problem and should I compete again?
Sincerely,
Jonathan
A: Dear Jonathan I am glad that you’ve asked me that question. In the last fifteen years I have seen with my own eyes and heard from others - really horrific stories about dehydrated bodybuilding competitors that had to be taken to the hospital. To be completely honest – even I got myself in similar situation during my competitive career. Let’s face it – to be competitive in the bodybuilding contest we have to achieve that lean, hard, DRY look that judges seem to like and award.
To be “dehydrated” is expected and accepted ONLY in the sport of bodybuilding!
While medical community would point out to us dangers of even moderate dehydration, we (the bodybuilders) being extremists - would not settle for just moderate and instead we would go “all out” and try for the extreme. Well, extreme is case of dehydration could be – deadly!
Doctor in the hospital did not exaggerate when he told you that you are lucky to be alive.
Your diagnosis was HYPER (too much) Kalemia (potassium) and that is serious medical condition that can lead to cardiac arrest.
Because I am certain that many competitors nowadays get themselves in this “hyperkalemic” state it is very important for me to explain to you HOW DANGEROUS this might be.
I have witnessed more than once (in US and Europe) that when paramedics are called to treat dehydrated bodybuilder – immediately they tend to believe that dehydrated bodybuilder is also hypokalemic (state of potassium deficiency). Many times after asking just a few “diagnostic” questions they would administer IV (intravenous) electrolyte solution or (even worse) IV potassium on the way to the hospital…
If that ever happen to you or someone you know – STOP THEM before is too late!
Putting extra potassium directly into the blood stream of hyperkalemic patient (bodybuilder) could be FATAL!
Unfortunately, physical symptoms of LOW (hypo) or HIGH (hyper) levels of potassium are quite similar.
Hyperkalemic patient (bodybuilder) would experience weakness, fatigue, dizziness, muscle cramps, nausea, vomiting, numbness, confusion, difficult breathing, and increased thirst – all signs of hypokalemia as well!
Paramedics are humans that could make honest mistakes - especially during emergency calls, when they’re rushed to make decisions and sometimes easily influenced by a common practice.
Again, commonly dehydrated patients with all of the above mentioned symptoms would be categorized as hypokalemic and therefore treated as such.
Many of us (in emergency situations) would also overlook the fact that manifestations of hypo and hyperkalemia are so similar. So remember to request for ECG – electrocardiographi c test as this test could distinctively show the difference between the two (and if they do that test ask to see “T- wave” which is flattened in “hypo” and peaked in “hyper” and “P- wave” that shows exactly the opposite). In the hospital doctor would order a blood test to determine levels of potassium. Once established – level of potassium is going to dictate appropriate treatment but I guarantee you – doctor will be grateful that you prevented paramedics in their intentions. For the reference normal values of potassium are 3.5 – 5.3 mmol/L or mEq/L (where serum potassium level under 3.5 is considered HYPOKALEMIA and over 5.3 is HYPERKALEMIA).
Now, you asked - why did you have that problem?
Of course, I cannot be certain but my first guess would be that you (more than likely) used some kind of diuretic (and I would bet – potassium sparing one), continued to eat high potassium containing foods while avoiding sodium and finally – restricted your water intake!
Chronic hyperkalemia (or hyperpotassemia) is serious illness usually caused by renal failure! You said that two weeks after the show you were back to your healthy self – so obviously your condition (high levels of K) was just acute (temporary on the day of your contest) caused by something that you did.
Very, very common potassium-sparing diuretic that bodybuilders use in their contest preparation is “Aldactone” or spironolactone. This particular diuretic became very popular in bodybuilding circuit for its inhibitory action on aldosterone (a hormone in our body that regulates body’s salt and potassium levels).
Last 2-3 days before the show many competitors drastically reduce their sodium intake (some almost completely eliminate it) with hope to lose extracellular water. At the same time they use this prescription diuretic with hope to block aldosterone, which would help them keep intracellular potassium while excreting sodium and water. This way they would be able to achieve that “dry and full” look (winning combination).
This year, after the finals of the Mr. Olympia contest I was having peaceful dinner with my close friends when I received disturbing phone call. It was no other than Shawn Ray who urged me to drop what I was doing and come immediately to Mustafa Mohammed’s room.
Mustafa is my dear friend whom I love like a true brother and when I got that call I was beside myself.
I run as fast as I could hoping that he is OK…Still, I couldn’t help but think that something terrible happened to him.
While I was running I remembered that during his posing routine at the finals he just wasn’t himself.
He is phenomenal poser who always brings breathtaking routines. More often than not – he gets a standing ovation from the audience for a true masterpiece…but this night he just didn’t deliver it.
I saw it on his face (that something might be wrong) but I didn’t really read into it.
As soon as I got there I saw Mustafa on his bed cramped up, dizzy, weak, throwing up…and he told me: “Milos, I feel bad. I mean - very, VERY BAD.”
Medical personal of Mandalay Bay Hotel came to the room and their “medical expert” concluded that Mustafa is severely dehydrated and needs fluids. So, he suggested a Gatorade (NOT a good idea as Gatorade contains potassium). I got in argument with that guy to the point that I yelled at him so laud – he run away from the room.
“Great!” said Shawn “what are we going to do now?”
“Call the ambulance – he needs to go to the hospital. This is SERIOUS!”
In 1992 I witnessed a tragedy when another IFBB pro bodybuilder got himself in the similar situation.
Mohammed Benaziza died that night and I was not going to take a chance with Mustafa.
Paramedics that came shortly after - did EXACTLY what I told you (warn you about it) here.
They also assumed that Mustafa is hypokalemic due to his severe state of dehydration. While they were taking him to the ambulance they were already planning to put him on the “IV electrolytes”.
I jumped in requesting that they absolutely cannot do that – as he was more than likely already hyperkalemic! Mustafa told me that he indeed used “Aldactone” so I was certain that this is the case.
Needless to say – I had to argue with both paramedics and I insisted to get into the ambulance with him.
[To get hydrated (on the way to the hospital) he did receive natrium-chloride and that is OK, but absolutely nothing that contains even smallest amounts of potassium should be used.]
When we arrived into the hospital I had to talk to a doctor who also wasn’t too responsive on my idea that their patient is “hyper” and not “hypo”-kalemic…
Doctors just don’t understand that somebody (we – the bodybuilders) would do that to ourselves. So, they don’t expect it.
Fortunately, in the hospital they would first check the blood, before they would do anything else.
When Mustafa’s result came (8.8 mmol/L) doctor realized that he doesn’t have a “normal situation” and he did admit that such a high amount of potassium could be fatal!
Doctors had to bring his levels of potassium down in a hurry and thankfully – they were very successful.
I must mention that Mustafa’s trouble alarmed a lot of people. Vince Scalissi from the Weider office and IFBB pro chairman Jim Manion were immediately available. Following the ambulance and spending a lot of time in the hospital were also Kris Dim, Kevin Levrone, Shawn and Kristy Ray and a pastor of the Shawn’s church. They all showed great concern and support and Mustafa was very happy to see them.
Talking to many competitors throughout the years I realized that this (“Aldactone”, low sodium and restricted water intake) is a common practice. Also (in the last two or three days) during the “carb loading” phase many competitors would choose carbohydrates that are also very high in potassium (bananas, dry fruits, potatoes, other fresh fruits, nuts, some vegetables and meats). One baked potato can have as much as 1000 mg of potassium, banana over 500 mg, cup of peanuts or almonds (for guys on low carb diet) also over a 1000 mg etc, etc
But, what some of the competitors fail to realize is that even the “normal” diet meals like fish, broccoli, chicken breast, asparagus and avocado (for example) can also have thousands of milligrams of potassium per serving!
Average protein portion (10 oz / 300 grams) of chicken is about 700 mg, while the same amount of fish would exceed 1000 mg of potassium per portion! Can you believe that the most common choice of the contest vegetable for most bodybuilders – broccoli has almost 500 mg of K per cup!?
Considering all that bodybuilders should think twice before they reduce their sodium and water intake while they’re reaching for the Aldactone – it is a bomb ready to explode!
In your first contest you probably didn’t use that (or any) diuretic and possibly tried to dehydrate yourself with more conventional (natural) methods. In that case you reached mild level of dehydration and mineral imbalance. As you said - two bananas with merely 1000 mg of potassium solved your cramping problem!
Should you compete again?
That decision must be yours. If you are concerned about your health (and you should be) don’t experiment with something that you don’t know enough about. Follow the sound nutritional program and remember that even a slight mineral and water manipulation can get you desirable results (don’t go for the extreme).
Several weeks before your next contest start using exact foods and amounts of particular minerals every day of the week. Than try to manipulate them just enough so you can reach healthy dehydrated state (without any muscle cramps) on exact day that you would want to “peak”.
If you have several weeks to practice I am certain (or at least confident enough) that you will find safe and effective method of mild dehydration (necessary for bodybuilding competition) that would not be deleterious to your kidneys, heart or health in general.
Good luck!
Until the next time,
Milos Sarcev
