Striving to attain the extreme aesthetic requirements of physique competitions causes both physical and psychological afflictions. These closely resemble the symptoms of starvation since the lean competition body is essentially in a state of chronic malnutrition.
Malnutrition produces various dysfunctions that affect multiple organs within the cardiovascular, gastrointestinal, endocrine, skeletal, and central nervous systems. As the body attempts to conserve energy, there is also a ‘decrease in resting energy expenditure (REE), and changes in metabolic hormone concentrations.’ These adaptations can lead to lowered respiration and basal metabolic rates; electrolyte imbalances; cardiac arrhythmias; and even place the individual at risk of cardiac arrest.
During the cutting phase, most competitors suffer from various symptoms caused by the reduction in energy availability. More, however, have difficulty coping with the decrease of one particular macronutrient. Carbohydrates are lowered in the final few weeks in order to rapidly lose retained water and fat. Fat loss is the result of several metabolic changes which occur when carbohydrates are reduced to less than 20g per day.
Since the body lacks sufficient glucose to produce energy, fat stores are catabolised, releasing ketones that can be used as fuel. When ketones accumulate within the body, however, this results in ketosis whose side effects include ‘nausea, headache, mental and physical fatigue’. In order to avoid these side effects, and maintain strength and muscle mass, competitors ‘cycle’ carbohydrates. Cycling involves enduring several consecutive ‘low’ days in which carbohydrate allowance is drastically reduced and typically limited to green vegetables. This period is followed by a high carbohydrate ‘refeed’ day to boost metabolism and ensure continual fat loss.
Even with carbohydrate cycling, however, the ‘low’ days, in addition to reduced calorie intake, trigger a multitude of physiological problems. The most common symptom is ‘constant hunger’ which competitors attempt to alleviate via behavioural methods and the frequent use of potentially dangerous food substitutions. Increasing liquid intake mutes hunger, particularly ‘ice cold water’ and ‘diet fizzy drinks.’
Chewing gum and consuming sugar-free products help to resist appetite and curb cravings. These, however, can cause toxic side effects owing to artificial sweeteners that are added to ‘diet’ foods and beverages in place of sugar. One of the most commonly used sweeteners is aspartame, an additive that is associated with 92 different side effects, including nausea, memory loss, and seizures. Furthermore, 50% of aspartame is comprised of the neurotoxin phenylalanine, a chemical that ‘excites the neurons in the brain to the point of cellular death’. Competitors who consume large amounts of sugar-free products throughout the cutting process report experiencing symptoms such as dizziness, headaches, heart palpitations and severe bloating.
Bloating during competition preparation also results from food intolerances that can develop owing to the overconsumption of certain foods. ‘Cheat meals’ or binging on ‘forbidden’ treats likewise lead to bloating since the digestive system is unaccustomed to foods containing large amounts of fat and sugar. In addition, bloating is often the product of following a low carbohydrate diet. Lack of carbohydrates means that there is also a reduced intake of the dietary fibre that is necessary for digestion. Owing to these factors, some competitors report undergoing pre-competition colonic hydrotherapy in order to remedy these bowel dysfunctions.
When hunger can no longer be evaded by using sugar-free and liquid substitutions, distraction and displacement mechanisms help avoid succumbing to ‘bad’ foods. Forbidden treats must be kept out of sight and reach. One competitor ‘wouldn’t keep Nutella in the house’ for fear that she would yield to temptation, and even had to remove bread ‘when it got close to competition time.’ Other food-avoidance techniques include going to bed early, frequently brushing teeth and remaining busy. One competitor resorted to more painful methods to stop herself eating, ‘constantly pinching [her] stomach’ and ‘pinging elastic bands on [her] wrists.’ When food substitutions and displacement mechanisms are unsuccessful, however, many competitors use appetite suppressants ‘in the form of over and under the counter preparations.’ One woman whom I interviewed took ‘endless tablets to help speed up [her] metabolism and counteract the rubbish food [she] had eaten.’
Despite these tricks however, hunger is often difficult to manage, ‘particularly in the evening’ with ‘hunger pangs’ frequently leading to insomnia. Inability to sleep can also be attributed to the competitors’ low carbohydrate diet. Carbohydrates increase insulin which allows an amino acid, tryptophan, to enter the brain. Tryptophan is important for relaxation since it is the precursor for serotonin, which aids sleep and mood regulation. Without adequate carbohydrate intake, sleep can be disrupted.
Lack of rest combined with insufficient energy availability frequently leads to fatigue. One competitor ‘felt permanently tired with no energy and collapsed on a few occasions through exhaustion.’ Another states that she ‘couldn’t even get through the day properly’ since she ‘was so physically tired and weak.’ Fatigue affects crucial training during the final weeks leading to the competition date. Loss of strength is common, particularly ‘when cutting carbohydrates.’ There is a direct correlation between muscle glycogen depletion and increase in muscle fatigue, meaning that during this period, ‘energy for lifting drops considerably.’ In addition, the reduction in carbohydrate intake lowers blood glucose which causes an increase in muscle catabolism. Since carbohydrates aid performance, recovery and muscle maintenance, a diet lacking in this macronutrient can severely influence training. Fatigue is often countered by the consumption of stimulants, which in turn creates a vicious cycle of lethargy and insomnia.
 http://emedicine.medscape.com/article/89260-overview#a0101%5Baccessed 8/01/15], anemia, chronic fatigue, increased risk of infection and illness, esophagitis, electrolyte imbalance, slowing of the metabolic rate, decrease production of growth hormone, unfavorable lipid panels, endothelial dysfunction, reduced muscle protein synthesis, unexpected pregnancy, possible long term reproductive repercussions, and depression
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