Rhinestones, the contraceptive pill and performance...

It was a tough choice deciding what to write about this week. Having just paid a visit to Alex Davey the official costume designer for the WBFF show I'm competing in, I could write about how distraught I was at the realisation of how much "rhinestoning" I'm going to have to do and the COST of these things. A bikini will set you back £350 and with themewear can be up to £800. My dad loves a bit of DIY so perhaps I shall turn this into a family project with the glue gun. In my head, I have grand images of embellished designs and Mardi Gras; then....the reality where I look like the Tin man out of the wizard of Oz.
Believe you me there will be a rant coming on this. Interpret the selfie how you will, but in this particular case there was no one else around to document my DIY experiment. Thank goodness I don't rely on this for a living!

Sainsbury's push up bra and tin foil: £8.50

Proper WBFF themewear: £ a lot more!!

But for now....something a little more academic but useful.

The Oral contraceptive pill and performance

I've just spent the last few weeks sweating over my MSc project proposal. I'm very interested in the endocrine system and effects of training on hormone levels and vice versa, so I'm curious about the effects of the oral contraceptive pill on performance. Does it have an "enhancing" effect or a "negating" effect? Women choose to take the pill for a variety of reasons, so it isn't just for contraceptive purposes. My experience of taking the combined pill Dianette, was rather a lot of weight gain! Unfortunately that's not an uncommon problem, which is meant to be because it increases appetite. I'm not so sure it's that simple....Cyproterone one of the active ingredients is an anti-androgen. It prevents testosterone binding, which we know is implicated in decreasing production of adipocytes (fat cells) and promoting lean muscle mass. Had I have been better informed, I may have chosen a better variety, of which there are many.
My hormones are the bane of my life! My mood and physiology change much more than I would like; whether this is perceived or not, it feels very real and makes life and training sometimes a bit tricky! I also feel it's one of those unspoken miseries that many women silently deal with. This is part of the reason for my curiosity and why I want to do this study. I'm lucky I have some good people at Imperial College helping me; so I shall be standing on the shoulders of giants and all that!


My research questions

• Do women using the oral contraceptive pill (OCP)and non users (non-OCP) athlete groups differ in their testosterone profiles (baseline levels, dynamic changes within a training session and across the menstrual cycle)?

• Is testosterone related to functional performance and/or behaviour in the OCP and non-OCP groups, therefore providing a marker of readiness in athletes? 

From scouring the published literature, it would seem fair to conclude that the oral contraceptive pill reduces absolute levels of estradiol (the predominant form of oestrogen during reproductive years), progesterone and testosterone. (I haven't looked at the effects on other hormones such as Cortisol). It also minimises fluctuations of these hormones. Testosterone especially is known to modify protein synthesis in skeletal muscle and connective tissue, enhance muscle contraction signalling, and shift stem cell differentiation pathways away from forming adipocytes (fat cells); so it's effects on building lean muscle mass is important. Current opinion also favours testosterone being implicated in "motivation" and readiness to train, allowing one to push harder. This last point is increasingly being given weight and viewed as an indirect cause of increased muscle mass. If one can train harder, positive muscle growth adaptations are more likely to occur.  

Mean endogenous concentrations of estradiol and progesterone in non-users and users of OCP during follicular, peri-ovulatory and luteal phases of the menstrual cycle, units pmol/ml (Casey et al, 2014). 

The figure above shows the hormone profiles of estradiol and progesterone in women that use the pill and those that don't. There are few consistencies in data when it comes to endocrine research but this change in magnitude of hormone levels does seem to be one of few things that is repeatable amongst the research. In terms of testosterone, baseline levels in women are very variable but ranges of 0.42-2.94nmol/L are not uncommon to find cited in the literature. Most hormones will be bound to another protein. Testosterone is no exception, so there are different fractions you can measure: free testosterone (0.5-3%), albumin-bound (30-35%) and sex hormone binding globulin (SHBG)-bound (65-70%). It is hypothesised (and now argued) that only the "free" or bioavailable fraction are useable by the body. 

In women that use the OCP, there is often a documented decrease in circulating levels of total testosterone and free testosterone and an increase in the main binding protein SHBG. Contraceptive pills with second generation progestins and/or lower oestrogen doses have less impact on SHBG levels. 

The link below is a reference to a meta-analysis of 42 studies of 1495 healthy young women aged 18-40. 

The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.

I've always wondered at the magnitude of effect endogenous hormones can have on performance and mood. The data would certainly suggest that it could have a knock on effect to psychology and physiology.

Reading between the lines with the studies

However, there is no strong evidence to suggest that the OCP does affect strength levels and other performance indicators. You can search the literature over and over again but results are not conclusive. This is where the scientific method may not always hit the mark. Looking at the differences in methodology is vast and you can see:

•  There are many ways of quantifying performance and fitness; aerobic and anaerobic fitness, muscle strength and power, flexibility, body composition.

• There are many ways of quantifying strength and many different types of strength; maximum strength, speed strength (power), strength endurance, etc. Not all of these "lab" based tests are relevant to a sport.

There is also the issue of a "motivational" bias that goes along with doing a test. The very nature of being watched or doing a "test" for a study, means motivation is going to be slightly higher compared to a standard training environment. 

In addition how you measure hormones has big implications for how you interpret these studies. 

There are many ways to measure hormone levels using a variety of methods and sample types (mainly blood and saliva). The use of saliva sampling is peaking in popularity for measuring hormone levels because it is easy to use and saliva is thought to contain the "free" useable fraction of testosterone. 

However with all things scientific, nothing is ever simple!!! The "free" testosterone hypothesis is now being challenged, as it is thought there are definite but unclear roles for the SHBG-bound testosterone. 

Another good review, if interested:

Circulating androgens in women: exercise-induced changes.

All the studies I looked at had fairly variable methodologies and protocols so of course it makes comparisons very difficult. But it is worth noting, if you do pubmed this topic, to look closely at the methodology and what and how they looked at hormone levels and performance indicators. 

Common sense

My challenge with science is always trying to understand what papers can and can not say, what the common themes are and where there is no commonality. 

In fact because of inconsistencies in methodology, subject group, age, level of sport played, performance measure taken, fatigue, overtraining etc etc, it's really quite hard. This is where perhaps common sense has to be factored in.

I find most women that are into Sport or Fitness are relatively in tune with their bodies. They know when something is not quite right. Most understand their unique pattern of mood and physiology over the month... and er probably men understand this "coding"; PMS = xbox time. 

There are many different varieties of pill with different doses of oestrogen and progestin type and they may all work a little differently in an individual. Quality unbiased information is good, it allows you to make an informed decision, but then it's just trial and error. 

I lose the battle of control against my hormones, but there is something rather nice knowing they are mine; they are part of my slightly batty, eccentric personality. It also reminds me of a very important lesson; for every action there is an equal and opposite reaction. Manipulation of these things, will ultimately have a less good component that goes with it. Mother nature always wins in the end. 

Reference: CASEY, E., HAMEED, F. & DHAHER, Y. Y. 2014. The Muscle Stretch Reflex throughout the Menstrual Cycle. Med Sci Sports Exerc, 46, 600-9.

Is being self obsessed a necessary requirement for success?

I've started to read a lot of articles and overhear people's dialogues where it is stated that "self obsession" and selfishness is a requirement for success in Sport. As a woman in my mid thirties and having the benefit of retrospect! I thought I would share my opinion.


I have in my past been horrifyingly single minded and overly driven to the detriment of everyone and everything else. Despite achieving some goals, the feeling of emptiness that accompanied those successes was overwhelming. I found it extremely easy to eliminate people and things from my life that didn't support my goal. So yes...selfish I most definitely was.
My lesson about balance came from a rather unfortunate head injury during a Thai boxing fight. It culminated in 2 years out of Sport and a complete loss of confidence and identity. Personally and physically it was a really hard time and it was the loyalty and steadfastness of good friends and family that got me though it. So I learnt that the inclusion of good people in your life, really is the meaning of life and considering we are the average of those we choose to hang out with, it is important to choose wisely!

I like to think with age and the hard lessons learnt, I have acquired a little more balance in my life and I am also greatly inspired by those that are successful but still maintain some degree of perspective and harmony in their lives because it's harder to do.

Sport to some degree is self selecting. Genetics with respect to anthropometrics plays a big role in certain sports. I'm a big believer in the impossible but running an elite marathon time, if you're built like a 20stone rugby player in all honesty is not going to be that easy. So, what attracts a person to a certain sport is complicated but usually involves a unique combination of physiology and mind set. However the "selfish mind" that is deemed essential to sporting success, I'm not convinced. Being determined and disciplined, yes I agree but overly self obsessed I'm not so sure.
One argument is self-obsession is really a consequence of not having enough other really good stuff in your life that actually matters.

Witnessing the "greats" in action

I had the privilege of training with some top athletes in a training camp in Kenya in 2012, before the London Olympics. Usually these camps are hard and shows someones true colours! Mo Farah was my room neighbour on one side and Paula Radcliffe on the other. Quite how I landed myself in that demographic I don't know. Mo Farah, married with an adopted daughter and now 2 new twins, was an absolute legend. Away from cameras and the media, you get a little glimpse into these peoples lives. Dining was communal and he would always make sure he shared meal times with a different table and group of people in the camp, including the er "less elite"!! like myself. He was relaxed, jovial and really encouraging to everybody. In fact he even let a fellow Somali, who couldn't find anywhere to stay, sleep in his room for weeks.
The same was true for Paula, although a little more reserved. In fact I can think of numerous examples who manage their life in a way that exudes perspective and giving. My dad is another. Extraordinarily bright and hard working but yet always managed to make time for his family.

It is a choice not a requirement

I'm going to use bodybuilding as an example because this is the Sport I'm doing at the moment and it is also one that has the reputation for being the most "narcissistic"! In terms of total training time - perhaps 2 hours a day during contest prep. Time to prepare food - this can be done in a day; shopping, cooking, prepping food for the week and taking supplements (my kitchen now looks like a meth lab).
That leaves quite a lot of hours left in the day. Granted there is a certain lack of energy that goes with the training, dieting, working and whatever other family and social duties one has, but there is a choice there....how you choose to spend it. What you choose to occupy your mental space and what you choose to prioritise.

Of what I have observed of recreational athletes right through to top level Olympic Gold winners, is those at the very top, seem to have it right but those in the middle quite often don't! And so one could argue whether actually a sense of balance and the right supportive people around you are in fact a necessary requirement for success. Consistency and time (yrs) spent in sport is a necessary requirement and usually that goes hand in hand with resilience - being able to come back from disappointments, illness and injury. Having a good support group or partner is part of instilling resilience. And of course there is a comfort of sorts from being in a sport so long, so mentally switching on and off may become much more easy.

I would probably fall under the "middle road athlete" category but it has been a choice to learn the lesson and value those that are important to me. The number 1 reported regret of top coaches and athletes that I have spoken to, is that they didn't balance life better. So, perhaps there is something in that. My life is better for balance and in many ways it makes me feel more successful. Because so much of success is subjective anyway.... whether you think you can or you think you can't - you're right. "Feeling" successful is just as important as "being" successful!

One member of my inner circle - my geriatric labrador who has now taken to "shop lifting" all my contest diet food. Including salad. 

The bodybuilding diet and moods

As promised, I vowed to communicate the truth of these "experiments", after all, that is the point of all this; to put aside confirmation bias and every other bit of hard wired human bias and tell it how it is.

Bodybuilding Training = Fine. Hard. Physically very demanding. Weights are heavy. Fairly varied and actually quite enjoyable.
Diet = Fine. A lot of pedantic measuring, cooking, food preparation, Tupperware, turkey is dry, chicken is boring, but it is manageable.

Bodybuilding + Diet = Er Wow........  a cataclysmic onslaught to the senses.

Alexithymia and Acatalepsy

These are two new words I learnt the other day.
Alexithymia; An inability to describe emotions in a verbal manner.
Acatalepsy; Incomprehensibleness, or the impossibility of comprehending or conceiving a thing.

Together, I think they describe the situation beautifully.

I can't quite describe the range of emotions that hard training and a calorie restrictive diet is having, but I'll start with a list of monosyllabic and disyllabic words for emphasis; lassitude, fatigue, illness, flat effect, listlessness, desperate desire to lie down -anywhere........I'll stop there as I think you get the picture. It is more a profound "lack" of mood rather than a torrent of mood swings and it is made worse by a particularly nasty bout of bronchitis at the time of writing. This is certainly a test for any functional relationship, mine is no exception. My superbly supportive boyfriend is a Psychiatrist, who has to deal with desperately unwell people everyday. He simultaneously despairs and is proud of me. But what I have realised is very rarely do people do anything of note on their very own, there is always someone who serves as a pillar of strength, close or far away and they most definitely deserve credit.

I suspect that I haven't quite got the diet right, but other competitors all seem to report the same thing. I don't know whether doing this contest "clean" i.e without the use of anabolic steroids makes it better or worse. I don't have to put up with the joys of "female virilization" but the flatlining of my natural endogenous hormones makes me feel like I've had a lobotomy.

What we do and don't know about endogenous Testosterone 

Interestingly I'm looking at doing my MSc research project in collaboration with Imperial College. I want to monitor endogenous Testosterone in physically active women who use oral contraception and those who do not, over one menstrual cycle.
The role of natural testosterone in men and women is still unclear, however research suggests that it has more of a behavioural role effecting motivation and readiness to train. This indirectly affects muscle adaptation through the ability to "push" harder in training. Other suggested roles are in muscle contraction signalling and cognition.
One study (link below) looked at the comparison of baseline free Testosterone (T) and Cortisol (C) concentrations between elite and non elite female athletes. The pooled free T of the elites was (87pg/ml) compared to non-elites (41pg/ml), so over twice as high. What impact this has is uncertain but is suggestive that this higher level of Testosterone could indicate a greater capacity for performance at higher work rates, as well as influencing motivational behaviour.

The study: Comparison of baseline free testosterone and cortisol concentrations between elite and non-elite female athletes; American Journal of Human Biology, 2012

Of course you can't elucidate which is cause and which is effect, but Testosterone does seem to be involved in modifying behaviour, which increases work capacity and indirectly induces physical adaptation. The direct effect Testosterone has on muscle mass within "natural" ranges, I don't know.

Which points me in to the direction of another study in the International Journal of Sports Physiology and Performance about what happens when BodyBuilders Diet.

The Study: Natural Bodybuilding Competition Preparation and Recovery: A 12-Month Case Study, by Rossow, Fukuda, Fahs, Loenneke and Stout, in International Journal of Sports Physiology and Performance, 2013

This is an interesting study, although very limited because it only monitors a single bodybuilder through his 6 month pre-competition preparation. But the figure below shows the endocrine profile and the dwindling Testosterone levels, coupled with rising Cortisol (through increased lipolysis rather than muscle catabolism because lean body mass did not decrease significantly).

Changes in hormone levels during pre and post competition dieting in a bodybuilder, Rossow 2013. 

Other parameters which changed over the 6 months were: decreased insulin, increased ghrelin, decreased leptin and a decrease in thyroid function (T3 and T4 levels).
Of course this is a study of n=1, so these sets of results will only apply to this particular individual. All hormone levels returned to pre-preparation levels after 3 months, apart from ghrelin and leptin the "hunger regulators".

I definitely feel like my Testosterone levels have dropped and every other hormone I had!! Of course this is confirmation bias because I don't know what contributes to "mood",  but dwindling natural anabolic hormones from hard dieting and training is yet another "tick" for the rational use of "enhancing" through a shot of 'Winstrol' or 'Anavar'. Alas, I won't succumb; It will have to just be another chicken breast. Ah the delights.

On second thought.... this will do the trick, much better for morale.

Resilience

The oxford dictionary definition of Resilience: "The capacity to recover quickly from difficulties; toughness"

A particularly topical subject at the moment is the third disqualification of Team GB's speed skater Elise Christie in Sochi for the Winter Olympics. Now this is someone who is going to have to demonstrate resilience to make her come back. It is a characteristic of huge importance to Sporting success as it is pretty much a given that any long term ambitious sporting goal will inevitably include failure. It is a necessary requirement for success.

Professor Sir Michael Rutter is Professor of Developmental Psychopathology at the Institute of Psychiatry, Kings College, London. He set up the Medical Research Council Child Psychiatry Research Unit in 1984 and the Social, Genetic and Developmental Psychiatry Research Centre 10 years later. He talks intelligently on the subject of resilience, proposing the foundations of coping are laid down in childhood.
This idea that stress is harmful or bad is not the full story. Stress and exposure to stress is very necessary for positive adaptation, both physically and mentally. This was one of the fundamental ideas written in the book: The stress of Life by Hans Selye (1956); that appropriate stress is good.
You don't develop good physical health by avoiding all contact with germs, you develop good health by being exposed and coping. The same thing applies to mental health, where stress is a necessary part of growing and evolving. This is one disadvantage for the "cushy" life. The more cushioned your life is, the more surrounded you are by "groupies" and people that will dote on you, so the more distressing any intrusion on that comfort will seem.

A distinct Lack of resilience and coping after discovering "Greens" in my diet 

Some people seem inherently better than others with coping with stresses of life and loss, whereas others do not fare so well and often turn to less healthy methods of coping, which can often include drug and alcohol abuse.

My point is, most people have a breaking point. I have seen professional athletes retire from sport, become ill or injured; some deal with that loss well and others not so well. There are numerous heartbreaking examples of alcoholism and drug abuse in many of the great sporting hero's.
http://drugabuse.com/30-famous-athletes-who-have-battled-drug-addiction-and-alcoholism/
There are also numerous examples of those that experience similar mental anguish that are not in the limelight. It made me really think about drugs and alcohol as a coping mechanism and in the general arena of Sport, where it seems the two unfortunately go hand in hand. This thought process tied in nicely with a talk by Professor David Nutt at The University of Westminster on Thursday 20th March. He is a  British psychiatrist and neuropsychopharmacologist who was famously sacked from the Advisory Council on the Misuse of drugs for downplaying the harmfulness of Class A drugs, saying Alcohol was more dangerous than Ecstasy and LSD. He has since set up the Independent Scientific Committee on Drugs (ISCD) and has written a book: Drugs - Without the Hot air: Minimising the harms of legal and illegal drugs.

Drugs -Without the Hot Air

When asked the question "why are you so interested in drugs"? he replied ""perhaps we need to rephrase the questions to....how can you not be interested in drugs?"
I think that sums it up pretty nicely. Drugs are interesting for so many reasons. Robust evidence based science on drugs also contributes to the fascinating question of how the brain works. This becomes hard to do when drugs are illegal. The documentary "The Ecstasy Trial", a live trial of MDMA (3,4-methylenedioxy-N-methylamphetamine) was funded by Channel 4 money. Without that, it is unlikely the scientific research that emerged from that would have happened.
David Nutt's quest is to inform the general public on the relative risk of drug taking and to make sure research continues into these drugs which may have beneficial effects for treating mental illness.

How can you quantify how harmful a drug is?

This to me is an interesting question. When the UK's Misuse of Drugs Act became law in 1971, drugs previously controlled under the Poisons Act were categorised into 3 classes; A, B and C. The intent of this system was to reflect the harm the substance would cause. It was also meant to be flexible so these substances could move up and down the tiers depending on what evidence emerged. The Advisory Council on the Misuse of Drugs (ACMD) was also created by the act to examine the science and produce government recommendations. It's not hard to believe that these recommendations don't get followed. Politics and the media have a wonderful way of distorting and cherry picking facts to enhance a story.

It is extremely difficult to measure harm, but Prof. Nutt has made a stab at it using a model based on multi criteria decision analysis of the below factors. A panel of experts subjectively "weighted" the importance of each of these criteria and the outcome was illustrated in figure 1. By his own admission it is not a full proof model, it is more an "interpretation" of science rather than "pure" science but it is certainly an improvement on the current classification system.

Different sorts of harm

Harm to users

• Drug specific mortality
• Drug related mortality
• Drug specific harm
• Drug related harm
• Dependence (Addiction)
• Drug specific impairment of mental functioning
• Drug related impairment of mental functioning
• Loss of Tangibles
• Loss of relationships. 

Harms to others

• Injury
• Crime
• Economic Cost
• Impact on family Life
• International damage
• Environmental damage
• Decline in reputation of the family

Figure 1: The 20 drugs considered in the ISCD's 2010 report, ranked by overall harm. 

What's the point?

There are several conclusions one could make from the above figure. The take home message to me is not the harmlessness of the drugs towards the right of the figure but quite how harmful alcohol is. I think one crosses over into dangerous territory if assuming drugs like LSD and Ecstasy are not harmful. Granted, LSD has a low addiction risk and has even been attributed to the creative success of many famous people, including Francis Crick (co-discoverer of DNA). One of my favourite quotes below is from Kary Mullis, the Nobel Prize winner who invented the polymerase Chain Reaction (PCR), a molecular Biology tool to amplify DNA.

"Would I have invented PCR if I hadn't taken LSD? I seriously doubt it....[having taken LSD] I could sit on a DNA molecule and watch the polymers go by. I learnt that partly on psychedelic drugs"

The problem is, a good experience is also to do with dose, the takers mental state and their environment. This seems to be a common theme with most drugs where you can limit damage by controlling dose and taking them sensibly. How that translates into "reality" I'm not so sure.
This new classification scheme is complex; like all things, it is rarely black and white but shades of grey. Natural, and consequently synthetic drugs have been around since the beginning of mankind and I can only predict they will be around until we cease, so learning to co-exist is necessary. Understanding what they can and cannot do. their absolute and relative risk is essential and how they can enhance our understanding of brain science is essential.
Nutt comes to it from a point of interest of finding and using drugs that can treat mental illness but  that is not the same as taking drugs recreationally. He continues the debate of the harmfulness or harmlessness of drugs. He suggests through evidence based science that some drugs if regulated and taken sensibly for certain groups are beneficial e.g LSD or Ecstasy for Post Traumatic Stress Disorder (PTSD). He may have a point. Surely regulated and well advised use of LSD is better than over consumption of alcohol as a short term pharmacological coping strategy? I don't advocate drug use and I think legalising them can come with all sorts of problems as people generally will not take them sensibly. Perhaps this is the reason why alcohol, which is readily available is so dangerous.

I brought up this topic because in an ideal world people would turn to holistic meditative strategies to deal with stress, but in reality it doesn't work like this and so to broach pharmacologic substances as a "tool" is important. But what comes with that is an essential requirement to know just how dangerous or not they are and to interpret data with care!!

Bodybuilding: The diet....the end of life as you know it!

This week was not good for morale. I received my pre contest diet for the next 16 weeks. This was then compounded by having to get down on my knees to get my "face fat" callipered, amongst other body parts. None of this seemed particularly dignified. After a major chocolate fest and accompanying postprandial dip of colossal scale, I am now 48 hours in, with a lot more hours to go.

The diet came in the form of multiple sheets of menu plans, supplement lists and just more lists inside of lists; a lot of precise weighing to be involved. One of the traits of human nature seems to be the existence of completely opposing and conflicting behaviours, which unfortunately makes understanding others and indeed oneself really rather difficult.

One of my main conflicting characteristics is the ability to be quite obsessive compulsive with routine, yet I have a distinct aversion to weighing things. Having worked in Molecular Biology labs, you would think I could weigh out a substance to some degree of accuracy, yet my weighing or measuring of volumes was quite often done on visual estimation and my complete disregard for health and safety issues was not commendable. However, extraordinarily my success rate for experiments was quite high. I fear times are changing as I may not be able to get away with that kind of maverick attitude with this diet.

EVERYTHING on my menu list has precise measures and it sends me into a cold shiver.

Staying "Clean"

I made the decision to compete naturally (i.e no drugs) in my first show in June, but it was not an easy decision. I will fully admit to being tempted and I think that temptation is sometimes a product of the environment you are in. I train in a proper bodybuilding gym, so it is completely accepted as a means to an end. I don't even think it is a short cut, as you still have to train hard but you also have to tolerate even more unpleasant side effects. I laughed at the below quote:

Somehow the rationale to take drugs just because others are doesn't seem to sit very well with me. This whole experience is most definitely an experiment and I think I would be more interested to see what my body can do naturally. I also have a distinct feeling that some side effects from taking anabolic steroids may not be reversible. I wonder if you could ever be truly certain whether your body would "regress" back to pre-steroid physiology. The other more serious element of taking steroids is the psychological impact. Keeping a sense of perspective and fun is important, but it becomes increasingly difficult when hormones are on the run, as any PMS-ing female can contest. The body on "roids" also becomes a very unsustainable physique. I fear that will not bode well for long term confidence, so I think I will be veering from this path. I'd also like to keep on good terms with my loved ones!! One of my criteria for success is to give my all, but retain friendships and balance and not lose everything I have in the process. So I think I owe it to myself to stay true to my designated standards.

This decision does however mean,  I will probably have to follow this wretched food plan to the letter T. This sport is by far the hardest that I have done. Physically there are no easy days and psychologically it is relentless. Because the transformation required is so extreme, it also requires an extreme accompanying diet. Precision in amount and timing of food is really important to success.
Ten years ago, I could train hard, not eat very well and get away with it. My recoverability was good and if any weight loss or gain was required for weight divisions, it didn't really matter where that "mass" came from. It could have been fat, muscle, water or all. Body building is about manipulating body composition extremely precisely; to get as lean as possible and retain as much muscle as possible to almost unhealthy limits. It is not a sustainable appearance and will be limited to 1-2 days either side of the show.

Carb Cycling

Looking at the many different diets out there, carb cycling seems to be the most sensible and effective route for obtaining this goal and is advocated by pretty much all the competitors that I have spoken to.
According to "wiki" :

"A cyclic ketogenic diet is a low-carbohydrate diet with intermittent periods of high or moderate carbohydrate consumption. This is a form of the general Ketogenic diet that is used as a way to maximize fat loss while maintaining the ability to perform high-intensity exercise"

For my particular diet plan, we have incorporated low, medium and high carb days. An example of the split, illustrated by my very average Excel skills!

Carbohydrate (blue) Protein (Red) and Fat (green). All in (g) per kg body weight

Carbohydrate Level:
Monday - Low
Tuesday - Low
Wednesday - High
Thursday -Low
Friday - Low
Sat -Medium
Sun - High

Roughly speaking this is: (all measures (g) per kg body weight.
Low days: 1.0g carb: 3.9g protein: 1.2g fat
Medium days: 1.5g carb: 3.5g protein: 0.96g fat
High Days: 2.9g carb: 3.1g protein : 0.63g fat

There are some fairly good apps and on-line calculators for working this out such as "my fitness pal".

The supplements

What gets me however is the the list of supplements. It's endless!!!! I am not an authority on nutrition. Unfortunately I think it is a very tricky discipline to do proper evidence based science and therefore much information does end up being anecdotal. Its also a trial and error experiment to work out what works for the individual.
My opinion on the value of supplements and in fact nutrition as a whole is not fully formed yet. I am presently of the school of thought that they are of little more use than eating a plastic bag. I also believe diet should reflect the goal. Just as a very crude categorisation, there are different levels of functioning and health: survival, basic functioning so you can get to and from work! good health, peak performance/ fitness. I do believe there is a difference between surviving and performing well. From looking at global nutrition studies, we know people can survive and function on a terrible diet without any supplements. The issue with the body building diet is the goal is actually an unhealthy level of body fat and a high level of dehydration, so consequently the diet is restrictive. Getting in enough nutrition then becomes a challenge and this is the rationale of incorporating a bucket load of supplements. It is a way of minimising the bodies rebellion to the process.
I have to just put faith into that being the rationale for inclusion of a lot of very expensive supplements which I would not be taking if I was on a normal healthy balanced diet. There is however strong evidence that caffeine and creatine have ergogenic effects (Pubmed!). I will most definitely be taking these! but to the best of my knowledge the jury is out on most other things. One of the other compounding factors of nutritional studies and personal nutritional interventions is of course placebo effect. So herein lies my conclusion to survival: Ruminate less and get more into the spirit of things!!

Anabolic steroids: the dark side or just the real side.

Would you like a Dianabol with your chicken? 

Of course, it was an inevitability that this topic was going to come up. Steroids to bodybuilding is about as relevant as wheels to a car. There are many federations and categories you can compete under for bodybuilding and also "natural" vs "non-tested" shows. The latter to me makes perfect sense, if you decide to enter a non-tested show, then you have free reign over what you want to take, because it's a level playing field. So I guess there are two questions here; 1) ethically, how do you stand taking performance enhancing drugs? 2) the associated health issues. 

Question no. 1 seems easier to answer considering the categorization of the shows. Entering a "non-tested" show implies you understand the rules. (We'll get onto "natural" later!) People will be taking illegal banned drugs to increase muscle mass and decrease body fat far below what is probably attainable naturally. Like most spectator sports, the focus is taken away from talent. People want to see a show, they want to see freaks and the unobtainable. I am a complete newcomer to the sport (being only 3 months in), so at best all I can do is convey how I feel about steroid taking at this point in time. I am 15 weeks out to my first non-tested competition so the prep and diet has started. (The way I feel about protein right now, is enough to turn me vegetarian).

Training in a bodybuilding gym obviously keeps you in touch with others competing but probably also completely out of touch with the rest of reality. It is excellent anthropology. Bodybuilding is an aesthetic sport and scoring/winning is about direct comparison to others in your category. If all the others are taking steroids, it is going to put you at a significant disadvantage. I think it is imperative to be very clear about your own values when doing a show, because this will ultimately change how you view your placement in the show. Is it enough to get up on stage looking the best you can be?  or do you want to be competitive? For a few I think the answer is yes but probably the majority, that is not enough. Answering that question honestly, at least gives you some control over how you are going to feel about the outcome.

Unfortunately I'm hardwired to be competitive, sometimes that's a good thing and sometimes not so good. I think in truth, I would be disappointed to place low in an amateur show and so you can see how the temptation initiates. Most sports seem to be self selecting, so those even interested in doing a show will have to have certain genetics and a certain psychology to tolerate the routine and the diet. From observation, I expect part of the drive and motivation also comes from deep insecurities. I personally don't think insecurities are bad at all and everybody has them. If used as a motivator, they can be very useful.

This show is a pure physiological and psychological experiment. It is unlikely I will do another one, but even so, the temptation to take "something" is certainly there, because I know I will stand up on stage in June looking the best I can, but it won't be comparable to the others in my division (Fitness). I was naive to think "bikini" and "fitness" categories are devoid of chemical enhancement. I assumed these physiques were attainable naturally but I think perhaps I was wrong!
The ethical issue of steroid taking when everyone else is taking I have no problem with, but the health issues, I do most definitely have a problem with.

What exactly are you taking?

What has really come to light from a little bit of "street" research I have done, which is mainly talking to competitors and trainers, is how hard it is to get hold of legitimate product, because most of these are sold on the black market. There really is no way of knowing what you are going to get. The side effects of most androgenic anabolic steroids for women, is virilization effects; deepening voice, hair growth where you don't want! hair loss where you do! clitoris enlargement, acne..... There are some less androgenic female friendly steroids like Anavar (Oxondrolone) and Winstrol, which are only mildly anabolic, hence with correct dosing are not meant to illicit such severe side effects. They are used as more of a hardening drug in the "cutting or fat stripping" phase before competition. The idea, is to maintain lean muscle mass whilst reducing fat mass, something that is hard to do in a period of calorie restriction and certainly as women start to get below a threshold body fat %. So, that all sounds fine in theory other than getting hold of legitimate Anavar is actually extremely difficult. It is also one of the most expensive steroids to produce and buy, hence even more opportunity for reducing quality control. (As far as I am aware, there is only one laboratory in Mexico now producing high quality Anavar, labelled Xtendrol). This then creates a problem of dose control as you just don't know what is in each tablet, furthermore there may not be uniform distribution of active ingredient in a single tablet, presenting problems if you want to half or quarter doses.

Dosing: Use or abuse

Once you make the decision to take steroids, dosing is key. I believe that if you are smart and adhere to sensible guidelines using a quality product the damage maybe reversible once you stop a cycle, depending on how many drugs are being stacked or cycled. Again, this is purely an opinion based on my belief about the bodies ability to regenerate if looked after and allowed to regenerate. Many people get good results on anabolic steroids, but they are using them sensibly and not abusing them.
Where I stand on it at the moment is I'm not prepared to take the risk when I can't be sure what and how much I'm taking. I certainly don't judge those that do, I can see how easy it is to take them. Side effects and duration of side effects experienced is very individual, some experience no side effects but I'd rather not take my chance. So it adds another complexity to this already complex sport, where I believe it is a given that you will NEVER feel you are ready before you go up on stage even if you are stacked up to the eyeballs on gear and cutting agents. I'm game for the challenge and believe me, it is one, but the best I can do is prepare myself for that feeling of inadequacy.

It does make me question where the reward comes into it. I can't answer for others, but I hugely enjoy the training and the camaraderie. I enjoy the graft and the hard work. I expect this may well be linked to the dopamine-reward system. There is a nice paper about the role of dopamine in the journalNature.
A selective role for dopamine in stimulus-reward learning.

It makes me wonder how much control you really have over behaviour or are you at the mercy of your own biochemistry. I'm not going to have the debate on "free will" here but there is something very compelling about training for this, something very addictive. I have to keep "logical" check on maintaining a healthy perspective a lot more than I had thought.

My understanding so far is drug use is rife under pretty much all federations and all categories from the less muscular categories (bikini, fitness) through to full on bodybuilding physique. It is used in both natural and non-tested shows. Those competing in "natural" may just be clean for a few weeks before the show date. The loopholes continue to astound me. The drug cocktails also continue to astound me. Perhaps I won't be so shocked in another 4 months. Whether the motivation to use is a short cut to hard training and hard dieting or the fact that these physiques are simply unachievable or both, I don't know. In the larger, more muscular divisions that much is obvious, the amount of muscle mass that needs to be displayed for men and women and what people want to see is beyond what can be done naturally; but in the less muscular categories like "bikini" and "fitness" I had hoped these were physiques that were attainable on a bit of fish oil and chicken. I think I was just being naive. Genetics will take you so far and then its "nurture" through synthetic compounds!

Be clear about the goal

Satisfaction and disappointment seem to be intrinsically linked to the goal, so being very clear about that can help to at least offset some mental anguish created from extreme tiredness and calorie restriction! My goal is to compete "roid" free in a non-tested show and to use it as a platform to see just what my limits are physically.  I think in reality, mistakes will be made (many) in terms of training and diet and also what the judges want to see so I won't even feel that I am at my best. What outcome would I be pleased with.... I think to be honest, just RELIEF that its over!!! and then maybe a bigMac.

Anabolic Hormones and Bad Science

The timing of my visit to see Dr. Keith Stokes, an Exercise endocrinologist at the University of Bath coincided with reading the book, Bad Science by Ben Goldacre. I like this book and will often read it again every 6 months or so and it makes me unfortunately rather aware of how hardwired I am to regress to the mean of not very systematic thinking. The chapter is called: Why clever people believe stupid things.

He sums up the following observations about how the human mind is  hardwired to be biased.
It's interesting, funny and quite true, so I shall quote him!

• We see patterns where there is only random noise

•  We see causal relationships where there are none. 

•  We overvalue confirmatory information for any given hypothesis. 

• We seek out confirmatory information for any given hypothesis. 

• Our assessment of the quality of new evidence is biased by our previous beliefs. 

I also love this quote by Darwin:

Whenever a new observation or thought came across me, which was opposed to my general results, to make a memorandum of it without fail and at once; for I had found by experience that such facts and thoughts were more apt to escape from the memory than favourable ones. 

I am probably one of the worst people to make assumptions. I do it all the time, making split second judgements on people or cherry picking facts to strengthen an argument, omitting those that don't. That's survival in the real world, when time pressures mean you can't always compile all the facts, but I am still a scientist at heart and I balk sometimes at my own ability to draw really bad conclusions because I want to believe it. My education was in Microbiology and Molecular Biology to MSc level and I confess that does not make me a good scientist, in fact I was dreadful at the practical stuff and had more success in killing things than I did keeping them alive. In spite of this, the process and practical experience does teach you to be critical.
The scientific method isn't perfect and there are many questions it can't answer, but it is a good start. It's a systematic approach which is a good one and even in a field like strength and conditioning research where people often defy all scientific principle there is an essential place for it. These results contribute to a knowledge base for the coaching process, based on some combination of: what you know(5%), what you think you know (75%) and guess work! (20%)

Dr. Stokes, whom I went to see has been working in the field of exercise endocrinology (study of hormones) for the over a decade. It was a fantastic opportunity to get a more scientific viewpoint and a really different opinion to mine, which is I believe it has large implications to training adaptations.

Another Opinion

The really interesting take home message from talking to Dr. Stokes, is he has found no strong evidence to suggest altering anabolic hormone profiles within their "normal" range has an effect on building and maintaining muscle mass. There is no doubt that extreme levels of hormones below or above the normal range do bring about physiological change but there doesn't appear to be a dose - dependent response within the norm; whatever that is! In addition, how these hormones work and what exactly they do is unknown as well. Growth hormone, for example is often touted as the elixir of life for its cell regeneration capacities and increase in muscle mass and fat metabolism, but yet there is no strong evidence that it does increase muscle mass. It's primary role is thought to increase the cell turnover in collagen and hence increase mass of connective tissue; tendons etc. This increase in collagen is a possible reason for why it increases size of muscle. Jury is out on its role in fat metabolism.

Whether these findings or lack of, is because of flaws in the methodology or because that is genuinely the reality, who knows and I think that is where we start to see the limitations of exercise endocrinology. It is very difficult to identify causality, which is what athletes, coaches, practitioners and scientists want to know. The new direction for trying to illicit answers is looking to molecular biology in the muscle itself (rather than circulating blood), gene regulation and proteomics. In terms of practical implications, nutrition and timing is proving efficacious too. Dr. Stuart Phillips has done some interesting work with timing and dose of protein. It is worth a read; Protein consumption and resistance exercise: maximising anabolic potential.

The problem of causality

The question is then, what can exercise endocrinology actually show us in relation to anabolism of muscle? The best one can hope to do is create associations and correlations but causality is really really difficult to deduce. A good example of this, is the following study looking at testosterone and cortisol levels in elite and non-elite women.
Comparison of baseline free testosterone and cortisol concentrations between elite and non-elite female athletes. (Cook, CJ, 2012).  The elite women had significantly higher (over twice as much) resting testosterone (87pg/ml) compared to the non elite women (41pg/ml).  Cortisol was also higher in the elites (2.90ng/ml) than the non-elites (2.32ng/ml) P<0.01.

Determining why this may be is really tricky to answer. Perhaps these elite women genetically had higher baseline levels anyway? or is this a consequence of a training effect? Again, we see these differences in hormone profiles in trained versus non-trained women with regards to growth hormone. Trained women have the ability to lift heavy weight, thus creating an adequate stimulus to illicit an increase in anabolic hormone. Untrained women simply can't lift enough absolute weight to bring about these adaptations. So..these correlations are really interesting but what actually can they tell you about how to train subject groups.

To add more confusion about how to view hormones and put them in context, Dr. Stokes thinks there maybe an alternate hypothesis about testosterone. Rather than it being an anabolic hormone in the direct sense, it may increase "readiness" to train, focus and therefore the ability to maximise a strength training workout. It is the hard effort which then brings about muscle catabolism and anabolism. Rather like how pre-workout supplements are designed to work.

Everything has a place

In conclusion, manipulating certain hormones through training, may not produce as much of a stimulus for muscle growth and strength gains as previously thought because the upper limit that can be produced naturally just may not be enough. (However, I expect there are super responders that defy that law).
There is no doubt that chemical enhancement beyond these limits i.e injections of a lot of exogenous hormone, do produce big gains in muscle mass and conversely medical conditions that cause very low hormone levels also result in big physiological changes. I can contest to this after a concussion caused a malfunctioning anterior pituitary, plummeting growth hormone levels and a loss of 10kg of muscle mass in a very short space of time.  So, it seems hormones and their effects are easier to study at their extreme ranges but within a normal range it's a damn sight more tricky.

Of course there are others who advocate that training does and can alter hormone profiles dramatically but again can we ever really know what is causing what?
I don't know if my opinion of the importance of hormones has been swayed but what I have realised is I need to be a little more critical of what I read, knowing that there is a limitation to what certain studies can and can not tell you; that people are humans and not muscle cells or rats and consequently complex and very difficult to study!! I also believe I fall prey to bad science  because I am  admittedly biased, probably attributed to from a very unpleasant personal experience. It is amazing at how powerful belief is and how easily it can override rational thought. Placebo effect for a start can verify that.
And then it is a matter of knowing when the scientific method is essential to apply and when it is not. Dealing with people is not always scientific at all and trying to answer questions of the heart and motivational issues are not best by applying logical thought.
So I think, forming good conclusions requires thought of what is the best system or systems to answer it. Deciding whether to give credit to scientific information for incorporation into a coaching method requires scientific reasoning but how you convey that information to a person probably requires a very different approach- sometimes even telling them the opposite of what you want them to do!!