When Size Goes Inside: Visceromegaly in Bodybuilders Is Not Attributed to High Protein Intake but More Likely Associated with the Use of Appearance- and Performance-Enhancing Drugs

BACKGROUND: Bodybuilders use progressive resistance exercise training and high protein intake diets to develop muscular physiques. Some also use appearance- and performance-enhancing drugs (APED) to further enhance their physique. It has been speculated that a high protein intake and/or APED use may induce visceral organ hypertrophy. Therefore, the primary objective of this study was to assess visceral organ volumes in natural and APED-using male bodybuilders and to compare these with recreationally active males. METHODS: Magnetic Resonance Imaging (MRI) was applied to assess skeletal muscle and visceral organ volume in 15 recreationally active males (CON; age: 29±6 y), 15 competitive male natural bodybuilders (BB-NAT; age: 30±5 y), and 15 competitive male APED-using bodybuilders (BB-USE; age: 31±4 y). In addition, Dual-energy X-ray Absorptiometry (DXA) was performed to assess total body lean mass. All participants reported their habitual food intake (via 7-day food diary) and, if applicable, their use of APED. RESULTS: Habitual protein intake was much higher in the bodybuilders (BB-NAT: 2.5±0.6 g/kg body mass/d; BB-USE: 2.9±0.4 g/kg body mass/d) compared to CON (1.4±0.3 g/kg body mass/d; P<0.001), with no differences between both bodybuilder groups (P=0.109). Total lean body mass was significantly different across all groups and was greater in BB-USE (87.8±8.0 kg) vs BB-NAT (72.7±6.4 kg) vs CON (62.8±4.8 kg; P<0.001). Muscle volumes were also different between groups, with average thigh muscle volumes of 7.1±1.0, 5.8±0.7, and 4.5±0.4 L in BB-USE, BB-NAT, and CON, respectively (P<0.001). All visceral organ volumes were greater in BB-USE compared with BB-NAT and CON (P<0.05), with no differences between BB-NAT and CON (P>0.05). Heart volume averaged 1.20±0.15, 0.89±0.14, and 0.83±0.15 L in BB-USE, BB-NAT, and CON, respectively. Liver volume averaged 2.57±0.39, 1.82±0.20, 1.79±0.21 L, respectively. CONCLUSIONS: Despite higher habitual protein intake and greater lean body mass, natural bodybuilders do not show greater visceral organ volumes compared to age-matched controls. Bodybuilders using APED show substantially greater lean mass, muscle mass, as well as greater visceral organ volumes compared to natural bodybuilders or age-matched controls. We conclude that visceromegaly in bodybuilders cannot be attributed to a high protein intake but is secondary to the use of appearance- and performance-enhancing drugs.