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Death by Muscle

Rich Piana is the latest in a long list of untimely deaths. What’s sending bodybuilders into early graves?

Dallas McCarver and Rich Piana, two of the most muscular men on the planet, died last month. McCarver, who placed second at this year’s Arnold Classic bodybuilding show and, at only 26, was likely the future face of the sport. He was said to have choked to death on food, building mass to the very last (autopsy results later told a very different story). Piana, a freakishly built 300-pound monster with a modest competition history but a huge following among fans who admired his size and charisma, died at 46 of complications related to a recreational drug overdose (police allegedly found a bag of white powder next to his bed, though his girlfriend denies this).

The two joined a long list of high-profile bodybuilders — around 30 or so major competition winners and other prominent athletes over the past three decades — who have died prematurely due to drug overdoses, heart attacks and other organ failures, and cancer. A few, such as International Federation of Bodybuilding pros Mohammed Benaziza and Andreas Munzer, collapsed immediately after competitions.

Premature death is common enough in the profession that it’s become a trope —back in the early 2000s, the popular fitness website T-Nation ran a “death pool” for star bodybuilders. Piana, who was accused by many critics of injecting oil into his muscles to inflame (and thus inflate) them as well as getting muscle implants, was a particularly extreme case. His immense build and glamorous Instagram lifestyle ensured that lines of Arnold Classic and Olympia attendees waiting to see him at his 5% Nutrition booth were longer than anyone else’s.

Many of the sport’s top personalities were killing themselves to achieve seemingly impossible physiques, pushing their bodies past the breaking point, and people like T-Nation’s readers took note. Each new chemical advance made muscles larger and rounder, but—especially when combined with hard living or unlucky genetics—this also meant more weight on joints and more pressure on hearts. The top stars kept growing well into the early 2000s, with the advent of insulin growth factor and synthetic growth hormone pushing the average competition weight of a Mr. Olympia participant from 220 pounds in the late 1970s to 250 pounds today.

The biggest-bodied stars were also the best, with 270-pound behemoths Dorian Yates (who has spoken about his growth hormone use) and Ronnie Coleman combining for 14 Mr. Olympia titles between 1992 and 2007. An arms race played out through fan gossip on bodybuilding forums: Which bodybuilder was taking the most steroids? Who could endure the longest, most grueling workouts? Who had gone too far, and how much longer would he be among the living?

From their deaths, a familiar narrative has developed: Big men are dying young because they wanted to be larger than life. In Paul Solotaroff’s 1990 Village Voice profile of former Mr. America Steve Michalik, the ex-bodybuilder articulated this idea. “Michalik wanted to walk on stage at the Beacon Theater on November 15, 1986, professional bodybuilding’s Night of Champions, and just turn the joint out with his 260 pounds of ripped, stripped and shrink-wrapped muscle,” Solotaroff writes. “And then, God help him, he wanted to die. Right there, in front of everybody, with all the flashbulbs popping, he wanted to drop dead huge and hard at the age of 39, and leave a spectacular corpse behind.”

Michalik didn’t die onstage in 1986, however. Instead, he battled until liver tumors, kidney disease and heart failure until committing suicide in 2012. He endured as the living embodiment of Solotaroff’s epic cautionary tale: One of the first truly heavy-duty, “intensity-or-insanity” bodybuilders clinging to life. “Death is no excuse” was one of Michalik’s catchphrases—but it did eventually offer a way out.

While scientists continue to debate the dangers of long-term steroid use, some scientific studies — including a 2010 article in the American Journal of Cardiology that summarizes the results of 49 studies comprising 1,467 athletes — link long-term consumption of androgenic drugs with an increased risk of cardiovascular disease. And athletes who ended up dying prematurely, such as NFL star Lyle Alzado, have spoken publicly about how they believed the drugs had ruined their lives, forever linking steroids and death in the public imagination. “So many people tried to talk me out of using steroids and growth hormone,” Alzado wrote in a memorable 1991 Sports Illustrated cover story. “And now I’m sick. I’ve got cancer — a brain lymphoma.”

Others, however, have argued that these concerns are somewhat overblown. Former National League MVP Ken Caminiti also confessed his recreational drug addictions as well as performance-enhancing steroid use in the pages of Sports Illustrated, telling Tom Verducci in 2002 that “I’ve made a ton of mistakes with drugs, [but] I don’t think using steroids is one of them” (Caminiti died two years later due to heart complications related to a cocaine overdose).

Jose Canseco, baseball’s first player to hit 40 home runs and steal 40 bases in a single season, spends part of his autobiography Juiced outing other users and the rest extolling the benefits of using a well-tolerated steroid like Equipoise on a year-round basis. Filmmaker and former powerlifter Chris Bell’s 2008 documentary Bigger Stronger Faster* examined steroid use in American culture, including by his former pro wrestler brothers Mark and Mike, concluding that many alleged steroid side effects, such as “roid rage,” are myths. In 2016, I profiled Mark Bell for Pacific Standard; he explained that his continuous steroid cycling is typical for high-level powerlifters like him who need to gain or maintain weight for their sport.

Even so, bodybuilding at its highest level is a brutal slog. In conversation with Paul Solotaroff, Steve Michalik described the process of appearing onstage as a “near-death experience”; Samuel Fussell wrote in his memoir Muscle about how the week before a competition saw him essentially incapacitated on the couch, trying to drain as much water as possible from his body. Nasser El Sonbaty, a massively muscled rising star in the 1990s who was undermined by injuries and the general deterioration of his physique during the 2000s, participated in a series of revealing interviews for prior to his death, discussing in candid detail his own physical problems (diarrhea, nausea) as well as the peccadilloes of his competitors (Greg Kovacs, another now-deceased low-level competitor who billed himself as the first 400-pound bodybuilder, was unable to reach his rear end to wipe after using the toilet).

Anesthesiologist John Pankoff, a two-time Texas powerlifting champion, agrees with Mark Bell’s assessment that steroids are a fact of life, but also believes there’s a very fine line between use and abuse. “There are proper medical uses of androgenic drugs — dealing with muscle wasting in patients suffering from conditions like AIDS — and even justifiable athletic uses of such drugs, perhaps to hasten recovery from training or gain extra weight,” he says. “However, a lot of folks who use steroids aren’t using them because they’re champion athletes; they use them because they can be part of the muscle lifestyle in gyms.”

Throughout his career, Anthony Roberts, a fitness journalist and author of Anabolic Steroids: Ultimate Research Guide, has argued that steroids can be used both as performance enhancers and as recreational drugs. “If you’re taking steroids and other drugs to maintain a particular look, and only occasionally competing in athletic activities or not at all, then it’s safe to say that you’re using them for recreational purposes,” he explains.

The idea that steroids can be used both recreationally, as a way of participating in a certain kind of gym culture, as well as to enhance one’s performance, sheds a new light on “Goldman’s dilemma” — a question posed by physician Robert Goldman about whether athletes would take a drug that assured them success in their sport but caused them to die in five years.

Goldman has discussed the idea in a number of publications, most notably in his book Death in the Locker Room: Drugs & Sports, and it is frequently cited as a way of understanding the deaths of star bodybuilders such as Nasser El Sonbaty (who died of kidney failure) and Mike Mentzer (who died of heart failure), both of whom used steroids heavily. But when applied to the recreational context, it can be misleading: Bodybuilders such as Mentzer and Sonbaty might be using these drugs to win titles, but plenty of others, like Piana, aren’t actively entering high-level contests and primarily use these drugs to maintain their enormous physiques.

“There’s no way around it: People have to use steroids to reach the highest rungs of bodybuilding,” Roberts says. “But the strangest cases, like Rich Piana’s situation, concern people who are consuming vast amounts of all kinds of drugs as part of a chemically enhanced lifestyle.”

Roberts wants people to avoid conflating the deaths of Piana and McCarver, which are linked in time but not in kind. Based on available sources, McCarver appeared to be a dedicated professional bodybuilder who died while building the mass and taking the performance-enhancing drugs needed to win major titles; Piana, by contrast, was a man who boasted about using dangerously high levels of steroids, won few bodybuilding titles of consequence, and engaged in every manner of public stupidity—such as breaking his leg while “fighting” an MMA performer.

“If we want to say that someone like Piana influenced bodybuilding, we’d have to say that influence is limited to being negative at best and perhaps dangerous at worst,” Roberts says. “The problem isn’t so much that he made absolutely ridiculous decisions with his own body, but rather that he influenced other people to make similar decisions.”

Even within ‘roided-up bodybuilding circles, Piana stood apart. No one short of Dave Palumbo, another formerly scrawny also-ran competitor who relied on heavy drug consumption to hit 280 shredded pounds, had used so much, and no one had ever been so careless with these drugs. Piana posted his steroid cycles for all to see, alarming everyone who’s ever used these drugs and attempted to be halfway careful with them. He became huge and goofy-looking in the way ex-bodybuilder and literary critic Samuel Fussell described the most notable practitioners of his sport. Were he still alive to read it, Piana would surely be happy with Chapo Trap House podcast host Felix Biederman’s fulsome Deadspin tribute to how ridiculous he was.

Not everyone sees the fun in Piana’s example. Brian Mehling, a surgeon and founder of stem cell research group Blue Horizon International, offers testosterone replacement and growth hormone treatments in his New Jersey medical office. He believes steroid abusers such as Piana serve as impediments to gaining acceptance for treatments that might curb dependence on opioid painkillers and other expensive, symptom-focused pharmaceutical drugs.

“When you’re discussing steroids and human growth hormone, what immediately comes to mind are these gross bodybuilders who are taking dangerous amounts of anabolic drugs — people who are, quite frankly, suffering from some kind of psychosis related to body image,” Mehling says. “These drugs can be beneficial in moderate doses when administered under a doctor’s supervision.”

Bob Paris, a fixture on bodybuilding magazine covers and one of the sport’s brightest stars during the 1980s, retired early to avoid having to spend years using dangerously high doses of steroids. “Some of us — meaning ‘me,’ all alone with my principles — fought the dominant paradigm and were blacklisted to boot,” he wrote to me in an email. Like other bodybuilders, Paris had used steroids, but he found the intense process of chemical preparation for these competitions to be incredibly draining and dehumanizing. “I approached it as an honest, life-saving craft ([progressing from] apprenticeship to journeymanship to mastery). But, hey, I flunked high school chemistry, ’cause I’m a poet.”

Paris’s memoir, Gorilla Suit: My Adventures in Bodybuilding, discussed how he found himself donning and then forsaking said suit. At what should have been the peak of his bodybuilding career, his story came to a rather nondescript close: “At the end of my bodybuilding rainbow, instead of a pot of gold, there was a complication; beyond that, frustration.”

Stories are, of course, what have drawn many fans to the bodybuilding and its slew of colorful personalities. “A story is what allows the person at home to connect with the [bodybuilding] characters,” veteran bodybuilder Kai Greene told me at this year’s Arnold Classic, where he was promoting Generation Iron 2, a sequel to the Pumping Iron-style bodybuilding documentary in which he played the upstart Lou Ferrigno role to reigning Mr. Olympia champion Phil Heath’s unbeatable “Ahnuld.” “If you don’t have a story, it would be very hard to develop a reason to care about why you’re following this experience.”

Considered in light of Greene’s comments, Piana’s story is indeed remarkable. Over the course of four decades, he became so big and bulky he almost defied belief. But the abrupt ending to his plus-sized narrative is surely not what he would have chosen.

“Death can be made meaningful for us but it’s meaningless for the dead,” says Pankoff, the anesthesiologist. “Given the nature of my job, I think about death a lot, about ‘turning out the lights,’ so to speak. I believe Raymond Chandler put it best: ‘What did it matter where you lay once you were dead? You were dead, you were sleeping the big sleep, you were not bothered by things like that.’ Unless we are up against some unbearable chronic pain or facing a terminal diagnosis, most of us would rather be alive than dead. I am sure all these great lifters and bodybuilders would prefer to still be with us, too.”