Peak week recommendations for bodybuilders: an evidence based approach
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Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68
https://doi.org/10.1186/s13102-021-00296-y
REVIEW Open Access
Peak week recommendations for
bodybuilders: an evidence based approach
Guillermo Escalante1, Scott W. Stevenson2, Christopher Barakat3,4, Alan A. Aragon5 and Brad J. Schoenfeld6*
Abstract
Bodybuilding is a competitive endeavor where a combination of muscle size, symmetry, “conditioning” (low body
fat levels), and stage presentation are judged. Success in bodybuilding requires that competitors achieve their peak
physique during the day of competition. To this end, competitors have been reported to employ various peaking
interventions during the final days leading to competition. Commonly reported peaking strategies include altering
exercise and nutritional regimens, including manipulation of macronutrient, water, and electrolyte intake, as well as
consumption of various dietary supplements. The primary goals for these interventions are to maximize muscle
glycogen content, minimize subcutaneous water, and reduce the risk abdominal bloating to bring about a more
aesthetically pleasing physique. Unfortunately, there is a dearth of evidence to support the commonly reported
practices employed by bodybuilders during peak week. Hence, the purpose of this article is to critically review the
current literature as to the scientific support for pre-contest peaking protocols most commonly employed by
bodybuilders and provide evidence-based recommendations as safe and effective strategies on the topic.
Keywords: Bodybuilding, Competition, Contest, Peaking
Background muscle glycogen content as a means to enhance muscle
Bodybuilding is a competitive endeavor where a combin- “fullness” (i.e. volume), (2) minimizing subcutaneous
ation of muscle size, symmetry, “conditioning” (low body water (in an effort to look “dry” as opposed to “watery,”
fat levels), and stage presentation are judged. To be suc- thus enhancing muscularity), and (3) minimizing
cessful, competitors must present their best physique abdominal bloating to maintain a smaller waistline and
during the day (or days) of the competition. Body- optimize physique proportion and overall aesthetics
builders typically employ periods of 8–22 + weeks of [11, 12, 14–17]. While competitors may use natural
preparation where diet and exercise programs are modi- methods to achieve these goals, self-prescription of po-
fied from the off-season in an effort to lose body fat and tentially hazardous drugs such as insulin and diuretics
gain or maintain skeletal muscle mass [1–10]. In the have been widely reported [8, 18–21].
final days of preparation, competitors have been re- An observational study gathered information on nutri-
ported to implement interventions to “peak” their body tional peak week and competition day strategies among
in an effort to maximize contest day aesthetics [11–14]. 81 natural bodybuilders (Males = 59, Females = 22) via a
The interventions often used include altering their 34-item questionnaire; the survey listed commonly
exercise regimens as well as their macronutrient, water, utilized peaking strategies and provided additional space
and electrolyte intake with the goals of: (1) maximizing for qualitative information [11]. The vast majority of the
participants (93.8 %) reported employing a peaking strat-
egy the week prior to the competition (referred to as
* Correspondence: brad@workout911.com
6
Health Sciences Department, Lehman College, NY, Bronx, USA “peak week”), with the manipulation of carbohydrate
Full list of author information is available at the end of the article (CHO), water, and/or sodium most commonly reported
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Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 2 of 24
[11]. The primary stated goal of CHO manipulation was derived from studies of rat liver [29, 30]. However, the
to maximize muscle glycogen concentrations by utilizing resultant muscle glycogen levels after glycogen loading is
principles similar to classical CHO loading [11]. Add- highly variable [31], perhaps due to the complexity
itionally, competitors manipulated water and/or sodium underlying intramuscular glycogen storage [25]. Simi-
intake in an effort to induce a diuretic/polyuria effect to larly, while it is clear that glycogen loading can increase
flush out superfluous water [11]. intracellular water content [31], muscle thickness [15],
In another study, researchers conducted in-depth and lean body mass (LBM) estimates [32], the relative
interviews to identify and describe different dietary extent of intracellular hydration in grams of water per
strategies used by seven natural male bodybuilders gram of glycogen may vary so greatly that it is not statis-
during the off-season, in-season, peak week, and post- tically correlated with glycogen content [30].
season [14]. During peak week, six participants re- Although controlled research on the topic is limited
ported using a modified carbohydrate loading regimen for what is optimal for bodybuilders, current evidence
to attempt to increase glycogen content. Furthermore, does appear to indicate a potential benefit of carbohy-
all participants reported manipulating water intake drate manipulation as a peaking strategy. A case series
while three simultaneously manipulated sodium intake by Bamman et al. comprising six male bodybuilders pro-
in an attempt to reduce body water in hopes of creat- vided initial support of a beneficial effect [1]. The body-
ing a leaner look [14]. builders reportedly engaged in a carbohydrate-loading
Although many peak week protocols exist that attempt protocol three days prior to competing (mean intake of
to enhance aesthetics, research is lacking in regards to ~ 290 g/day). Ultrasound measurements taken 24–48 h
the efficacy and safety of the methods commonly used into this carbohydrate loading period showed a 4.9 % in-
by bodybuilders. Among enhanced bodybuilders, the crease in biceps brachii muscle thickness when com-
self-prescription of drugs such as insulin and diuretics pared to measures obtained six weeks earlier. While
have been reported with potentially dangerous outcomes these findings seem to suggest that the carbohydrate
[18–21]. The purpose of this article is to: (1) review the loading protocol was effective in acutely enhancing
current literature as to the peaking protocols most com- muscle size, it should be noted that the long gap be-
monly employed by bodybuilders; (2) provide evidence- tween testing sessions makes it impossible to draw infer-
based recommendations as to pre-contest peaking strat- ences as to causality in this regard. Moreover, the
egies for competitors and coaches. authors of the study did not assess carbohydrate intake
during the carbohydrate depletion phase, further cloud-
Main Text ing the direct effects of the loading protocol. Thus, while
Carbohydrate Manipulation results are intriguing, the level of supporting evidence
Manipulation of carbohydrate intake is a popular pre- can be considered low.
contest peaking strategy among bodybuilders [11, 12, A recent quasi-experimental trial by de Moraes et al.
14]. The strategy, generally employed during the week [15] sheds more objective light on the topic. Twenty-
prior to competition, involves substantially limiting four high-level amateur male bodybuilders were strati-
carbohydrate intake for several days (often referred to as fied based on whether or not they manipulated carbohy-
depletion phase) followed by a brief period of high- drate as a peaking strategy; the group that manipulated
carbohydrate consumption, with the goal of achieving a carbohydrate employed a three day depletion phase
supercompensation of glycogen levels when carbohy- (leading immediately up to the weigh-in day) followed
drate is “loaded” [22]. Resting muscle glycogen levels by a 24-hour loading phase (leading up to competition
with a mixed (normal) diet are ~ 130mmol/kg muscle day). Muscle thickness was measured both at weigh-in
(wet weight) in trained individuals (a bit higher than and the day of competition. In addition, photos of the
sedentary subjects) [23], or roughly 23 g of glycogen competitors taken at these time points were shown to a
(glucosyl units) per kilogram of muscle tissue. Muscle group of federated bodybuilding judges, who subjectively
glycogen is organized in the cell in subcellular fractions assessed their physiques; of note, judges were blinded to
[24] and stored as a glycogen-glycogenin complex the competitors’ nutritional practices. Results showed a
(“granule”) [25] which creates an osmotic effect of pull- 3 % increase in muscle size of the upper arms for those
ing water into the cell as glycogen is stored [26, 27], who manipulated carb intake prior to competition versus
thereby increasing muscle cell volume. Early research no change in those who did not. Moreover, only the
suggested that each gram of muscle glycogen stored is group that manipulated carbohydrate intake showed im-
accompanied by approximately 3–4 g of intracellular provements in subjective aesthetic measures as deter-
water [28]. This is higher than the commonly referenced mined by visual inspection of photos. A potential
value of 2.7 g of water per gram of glycogen, sometimes limitation of the study is that subjects were not drug-
rounded to 3 g of water per gram of glycogen, which is tested prior to competition; thus, it remains unknown asEscalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 3 of 24
to whether the use of anabolic steroids and/or other syn- Although water and sodium are two separate dietary
thetic substances (i.e., synthol) may have influenced re- components, it is critical to comprehend that manipula-
sults. Future studies should ascertain via self-report, tion of one variable influences the other; hence, we will
polygraph and/or blood testing the drug-free/enhanced review these two variables together.
status of subjects and exclude or compare results based In a previously referenced survey on peak week and
on subject steroid use as well as use of other drugs that competition day strategies used by natural bodybuilders,
may influence water balance (e.g., caffeine - see below). water manipulation was the second most popular strat-
Recently, members from our group (Schoenfeld and egy implemented (behind carbohydrate manipulation)
Escalante) carried out a case study where we followed a [11]. Researchers reported that competitors imple-
high-level natural bodybuilder over the course of his mented water loading (65.4 %), water restriction (32.1 %),
contest preparation [33]. Beginning 1-week prior to the or both (25 %) to achieve a “dry” look. The amount of
date of competition, the competitor markedly reduced water consumed during the loading phase ranged from 4
carbohydrate intake to < 50 g/day for 3 days (Sunday, to 12 L per day and was typically followed by water re-
Monday, Tuesday) and then loaded carbohydrate to > striction 10–24 h prior to the competition. In addition
450 g/day over the ensuing 2-day period (Wednesday to water manipulation, researchers also reported that
and Thursday). Similar to previous research, ultrasound competitors utilized sodium restriction (13.6 %), sodium
assessment showed that the peaking strategy acutely in- loading (18.5 %), or both (6.2 %) with no consistent tem-
creased muscle thickness. In this particular case study, poral order for the sodium loading/restriction regimen;
increases were 5 % in the upper extremities and ~ 2 % in however, sodium manipulation was generally practiced
the lower extremities; due to the limited available evi- three to four days prior to competing. The use of dande-
dence, it is difficult to provide a rationale as to why there lion tea was also reported due to its purported diuretic
was a difference between the muscle groups. Given the properties (see dietary supplementation section below).
subjective findings reported by de Moraes et al. [15], it In the previously discussed study by Mitchell et al.
can be inferred that these results likely were practically [14], researchers reported that 100 % of participants (n =
meaningful from a competition standpoint. 7) utilized the practice of water loading and water cut-
When considering the totality of current research, evi- ting during peak week. This strategy involved drinking >
dence suggests that carbohydrate manipulation is a vi- 10 L of water per day early in the week and then redu-
able peaking strategy to enhance muscle size on contest cing the intake each subsequent day leading up to the
day; however, the evidence should be considered prelim- competition. The theory behind this practice was to con-
inary given the relative dearth of published studies on sume superfluous amounts of water to naturally increase
the topic. Moreover, the strategy may bring about an in- fluid excretion in an attempt to preferentially excrete
crease in gastrointestinal symptoms such as abdominal subcutaneous water; however, the participants reported
pain, heartburn, constipation, and diarrhea [15], which that the results of this strategy were largely ineffective
in turn may negatively affect the ability to perform opti- [14]. Out of the seven participants that manipulated
mally on contest day. Thus, competitors should experi- water during peak week, three (42.8 %) also manipulated
ment with the strategy at least 2–4 weeks in advance to sodium to help remove subcutaneous water [14]. They
determine its effects on an individual level and make reported greatly increasing sodium intake for the first
relevant adjustments as needed. three days of peak week followed by a complete restric-
tion of salt intake for the three days prior to the compe-
Water and Sodium Manipulation tition; however, results were inconsistent and the
Water and sodium are frequently manipulated by body- participants stated they would not manipulate sodium in
builders, either independently or concurrently, employ- the future [14]. Note that the participants’ unanimous
ing a variety of strategies involving “loading” and decision to abandon these water and sodium manipula-
restricting both [11], with the goal of minimizing sub- tion strategies suggests they had likely neither performed
cutaneous water to maximize the underlying skeletal nor refined them previously (e.g., as a trial run or during
muscle definition [8, 11, 12, 14, 19, 20]. Bodybuilders peak week for another competition).
have been reported to self-prescribe potentially danger- Other research supports the findings of the aforemen-
ous pharmaceutical diuretics to facilitate the process [8, tioned studies. Probert et al. conducted a survey of 382
19–21, 34, 35]. Bodybuilders may also employ these competitive bodybuilders along with personal interviews
strategies to drop down to lower weight classes, which of 30 of the participants and reported that bodybuilders
can provide a competitive advantage if the competitor is frequently engaged in the practices of sodium depletion
able to regain some of weight in the form of intramyo- and dehydration in the days prior to competing [12]. Al-
cellular volume (“filling out” via glycogen and/or intra- though participants acknowledged the risks of these
myocellular triglyceride storage) prior to competition. strategies, they downplayed them as temporary butEscalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 4 of 24 necessary practices [12]. Indeed, case reports document Hence, from a bodybuilder’s perspective, minimizing the potentially life-threatening conditions due to extreme extracellular interstitial fluid that surrounds the myo- practices of water and sodium manipulation [19, 20]. In cytes, specifically subcutaneous water, while preserving one case, a 35-year-old male bodybuilder reported to the or increasing the intramyocellular ICW represents the emergency room after feeling weak, dizzy, and experien- ideal scenario for a “full and dry” appearance, i.e., cing painful muscle cramps while posing during a body- whereby the appearance of muscularity is maximized. building competition; tests revealed peaked T-waves on While this concept may seem like a simple task to ac- the electrocardiogram (ECG), hyperkalemia (high potas- complish by manipulating water and sodium alone, other sium levels), hyponatremia (low blood sodium levels), strategies focused on optimizing intramyocellular vol- water intoxication, and rhabdomyolysis [20]. The body- ume (i.e., those targeting intramyocellular glycogen, tri- builder reported drinking 12 L of water per day for glyceride, and potassium content) may need to be seven days prior to the competition along with 100 mg considered along with the manipulation of water and so- daily of spironolactone (a potassium-sparing prescription dium for the appearance of muscularity to be enhanced. diuretic) and salt depletion for two days prior to compe- During normal fluid-electrolyte homeostasis, the extra- tition; he was successfully treated, stabilized, and dis- cellular compartment contains most of the sodium (Na+ charged [20]. In another case, a professional 26-year-old ), chloride (Cl−), and bicarbonate (HCO3−), whereas the male bodybuilder was transported to the emergency intracellular compartment contains most of the water, room the day after a competition as a result of heart pal- potassium (K+), and phosphate (PO43−) [39]. Although pitations and an inability to stand due to difficulty in both compartments contain all of the aforementioned moving his extremities [19]. He reported oral intake of compounds, the quantity of each varies between the 2 × 80 mg of furosemide (a prescription loop-diuretic) compartments such that the total concentration of sol- 24- and 48 h before the competition with the goal to en- utes (osmolarity) is the same [39]. Homeostatic mecha- hance muscle definition; he lost 5–6 kg of bodyweight nisms control water and electrolyte balance to ensure due to nocturia [19]. Tests revealed severe hypokalemia TBW and total body osmolarity (TBO) remain balanced (low potassium levels; as opposed to hyperkalemia in the and water redistributes itself between the intracellular previously discussed case study likely due to the use of a and extracellular compartments such that the osmolarity loop-diuretic vs. a potassium sparing diuretic), hypergly- of bodily fluids approximates TBO [37]. Indeed, Costill cemia (high blood glucose levels), hyperlactatemia (high et al. investigated muscle water and electrolyte losses blood lactate levels), and sinus tachycardia with pro- while participants cycled in a hot environmental cham- nounced U waves on ECG consistent with hypokalemia ber to lose 2.2 % (stage 1), 4.1 % (stage 2), and 5.8 % [19]. Although hypokalemia is a potentially life- (stage 3) of their body weight over an estimated 5.5 h threatening condition, the bodybuilder was treated suc- period [40]. When participants lost 2.2 % of their body cessfully and discharged the next morning [19]. weight within the first ~ 1.5 h in stage 1, 30 % of the Despite the various strategies reported by bodybuilders water lost was ICW while 70 % was ECW [40]. However, to manipulate water and sodium for the purposes of the ratio of ICW to ECW lost became 52 % ICW/48 % looking “full and dry,” current evidence does not indicate ECW at stage 2 (~ 3.5 h mark) and 50 % ICW/50 % that these practices are specifically effective and/or safe. ECW at stage 3 (~ 5.5 h mark) [40]. The authors stated Additionally, although several water and sodium ma- that the large loss of ICW in muscle at stage 1 may be nipulation strategies have been published by a number explained by the significant loss of muscle glycogen con- of bodybuilding coaches who have worked with highly tent (which contains water) from pre-dehydration at 115 successful bodybuilders [16, 17, 36], neither the efficacy mmol/kg down to 76 mmol/kg; however, muscle glyco- nor safety of these varying methodologies have been sci- gen content levels dropped at a much lower rate to 73 entifically evaluated. Hence, physiological principles of mmol/kg at stage 2 and 61 mmol/kg at stage 3 as the ra- body fluid regulation must be considered when attempt- tio or ICW:ECW stabilized [40]. Hence, the ratio of ing to formulate strategies to promote a “full and dry” ECW to ICW loss appears to stay close to 1:1 as glyco- appearance, and these strategies may be discordant with gen levels stabilize over time and higher levels of dehy- those currently used by bodybuilders and/or suggested dration are reached. Thus, it seems that retention of by their coaches. muscle glycogen, by avoiding exercise that relies heavily Total body water (TBW) content accounts for ap- on glycogen usage, may be important if methods of proximately 60 % of an average person’s body weight water loss are to effect a favorable loss of ECW relative and is made up of intracellular water (ICW) (~ 67 %) to ICW (ECW > ICW) such that muscle size is retained and extracellular water (ECW) (~ 33 %). ECW is further while interstitial ECW is preferentially lost, enhancing compartmentalized into interstitial fluid that surrounds the appearance of muscle “definition.” Relatedly, storage the cells (~ 25 %) and blood plasma (~ 8 %) [37, 38]. and retention of muscle glycogen is highly dependent on
Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 5 of 24
potassium availability (a primary intracellular cation - on acute weight loss in combat sport athletes by com-
see above) [41–46], so ensuring adequate potassium in- paring a water loading strategy for three days where the
take during both carbohydrate loading and dehydration experimental group consumed 100 ml/kg/day of water
procedures seems paramount to optimizing stage compared to a control group that consumed 40ml/kg/
appearance. day of water [55]. During the subsequent day of dehy-
Importantly, if alterations in plasma osmolarity (via dration with both groups consuming 15ml/kg/day of
changes in total body water and electrolytes) reach a water, the ADH levels in the water loading group rose
physiological threshold, then a complex neuroendocrino- from ~ 2.3 pmol/L to ~ 3.8 pmol/L at the 13th hour and
logical network throughout the body in the brain, blood ~ 5 pmol/L at the 24th hour of fluid restriction, at which
vessels, kidneys, and endocrine glands will respond to time body mass losses exceeded those of the control
stabilize it [47]. Plasma osmolarity is affected by changes group by 0.6 % (~ 2.5 vs. 3.1 % compared to baseline)
(increase or decrease) in the concentration of solutes [55]. Thus, despite the increased total fluid output from
(i.e., sodium) in the blood as well as changes in fluid vol- 3 days of water loading combined with one day of dras-
ume; fluid volume is affected by total body water (TBW) tic fluid restriction, ADH levels were still climbing over
[48]. Plasma osmolarity can increase by an excessive loss 24 h of dehydration [55]. In another study, investigators
of water or a significant increase in sodium intake; con- reduced sodium intake to extremely low levels (10 meq/
versely, plasma osmolarity can decrease with insufficient day) for ~ 6 days in 16 healthy men and measured the
electrolyte consumption or excessive water intake [49]. RAAS, plasma aldosterone, urine sodium, and serum so-
Plasma osmolarity and blood pressure are regulated such dium levels at 24 h, 48 h, and ~ 6 days after the inter-
that increasing plasma osmolarity results in decreased vention [53]. Although serum sodium levels remained
blood pressure and vice versa [49]. Additionally, blood fairly consistent between 137.6 and 139 meq/l for the ~
pressure changes mediated by shifting plasma osmolarity 6 day period, researchers reported that the RAAS activa-
are countered by arterial and renal baroreceptors [50]. tion was evident within 24 h and decreased urine so-
During dehydration, as might be employed during dium output from 217 meq/24 hr down to 105 meq/24
peak week, plasma osmolarity increases, blood pressure hr [53]. Furthermore, it took 48 h to observe a sharp in-
decreases, and the renal baroreceptors in the juxtaglo- crease in plasma aldosterone levels to further decrease
merular apparatus (JGA) release the hormone renin; in urine sodium output to 59 meq/24 hr and another ~ 4
turn, this activates the renin-angiotensin-aldosterone days for urine sodium output to stabilize at 9.9 meq/24
system (RAAS) [51]. When RAAS is activated, the hr [53]. Hence, there is a temporal lag in establishing
process of maintaining fluid, electrolyte, and blood pres- fluid and electrolyte homeostasis during which water
sure homeostasis is initiated [51] and eventually releases and sodium manipulation may be implemented to in-
the hormone aldosterone from the adrenal glands to fur- duce diuresis before the protective homeostatic mecha-
ther fine tune homeostasis [52, 53]. The baroreceptors nisms fully manifest to halt water loss.
in the aorta and carotid arteries also detect a decrease in While bodybuilders often manipulate water and/or so-
blood pressure and signal the release of antidiuretic hor- dium by altering their intake [8, 11, 12, 14, 19, 20], an-
mone (ADH, also known as vasopressin) from the pituit- other viable strategy may also be considered to increase
ary gland to conserve water, increase blood volume, and diuresis. The literature on disuse atrophy and cardiovas-
increase blood pressure [48]. Conversely, if blood pres- cular adaptations to weightlessness during space flight
sure increases due to increased arterial blood volume, [56] reveals a previously described strategy [36] that
the heart atria sense a stretch and release the hormone physique competitors may employ to promote diuresis
atrial natriuretic factor (ANF) to increase sodium excre- during the ~ 24 h before competition. Resting and/or
tion, inhibit renal vasoconstriction, attenuate renin se- sleeping with a “head down tilt” (HDT) position (typic-
cretion, and ultimately decrease blood volume and blood ally − 4 to -6˚ whereby the entire sleeping surface is
pressure [54]. downsloping [57, 58] simulates the increase in cardiac
Collectively, if water and sodium are not carefully ma- venous return (and loss of orthostatic pressure) that oc-
nipulated and timed, these physiological mechanisms curs during microgravity. This results in diuresis and
that work to keep the body in homeostasis may not cardiovascular responses similar to those observed
bring about the desired effect of selectively reducing acutely during space flight [57, 59], mediated in part by
fluid in the extracellular/subcutaneous space. Although an increase in atrial natriuretic peptide (released from
these mechanisms are in place to keep the body in bal- the heart) and reduced plasma renin [60, 61]. Mauran
ance, not all hormones released have an immediate ef- et al., for instance, demonstrated that these hormonal re-
fect on the body when plasma osmolarity is altered. For sponses and the associated diuresis and natriuresis re-
example, a study displayed a delayed effect of ADH turn to baseline within 24 h [62], evoking a body weight
when investigators examined the effects of water loading loss of approximately 1.0-1.3 kg without changes inEscalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 6 of 24 resting heart rate or blood pressure [58, 60, 61]. Short competitive bodybuilder’s attempts to reduce body periods of more severe HDT up to -30 % evoke graded water, especially in extreme cases of pre-competition increases in central venous pressure beyond those of anxiety. The authors recommend performing a practice -6 % HDT [63], although the diuretic responses to HDT run of the peak week strategy ~ 2–4 weeks before the ac- angle less than − 6 % have not been studied to our know- tual competition, in part to reduce anxiety and assure ledge. Brief (≤ 2 h) periods of HDT up to -40˚ seem well the competitor that the peak week strategy is both man- tolerated [64, 65], but prolonged HDT at angles ≤ -12 % ageable and effective. Although beyond the scope of this increases intracranial and intraocular pressure signifi- article, stress management is acknowledged as an im- cantly [66]. Additionally, sufferers of gastric reflux portant aspect of sport psychology [83, 84] and is very should be aware that HDT could conceivably worsen likely important for competitors who find the final days symptomatology, given that elevating the head above before competition so stressful that it negatively affects bed level (the opposite of HDT) is an effective remedy on-stage appearance. [67–70]. This is likely not an issue for those who do not Based on these principles of water-electrolyte balance normally experience gastric reflux [71]. Thus, competi- and the current evidence available, it appears that the tors could conceivably employ HDT when resting and manipulation of water and sodium should be carefully sleeping during the 12-24 h before competition to fur- considered, planned, and practiced in conjunction with ther encourage diuresis as needed. carbohydrate manipulation if they are to be utilized. Another consideration when manipulating water and While there appear to be some potential benefits to sodium intake is the important roles they play in carbo- implementing these strategies to enhance the hydrate absorption. Sodium-glucose dependent cotran- competition-day physique, potentially detrimental effects sporters (SGLTs) are proteins found in the small may occur if these variables are miscalculated and/or intestine that allow for glucose to be transported across mistimed that may cause bodybuilders to miss their peak the cell membrane; strong evidence suggests that the de- and/or incur health problems; thus, leaving these vari- livery of carbohydrate transport is limited by the trans- ables alone may be a better option for some competitors. port capacity of SGLT1 [72–75]. Since carbohydrate Since bodybuilders have been reported to view sodium loading appears to have potential benefits for body- and water manipulation as temporary but necessary builders to appear “full,” availability of sodium for co- practices while downplaying the potential risks involved, transport of glucose across the cell membranes is im- caution must be practiced as extreme measures have portant. Interestingly, the study by de Moraes et al. re- been reported that led to life-threatening conditions [12, ported that carb loading induced various gastrointestinal 19, 20]. The practical applications sections of this article symptoms in competitive bodybuilders [15]. Although will further outline how these variables may be safely sodium intake was not reported in this study, some of manipulated based on the current evidence available. the symptoms may have been due to a lack of dietary so- dium since bodybuilders have reported minimizing so- Dietary Fat dium intake as they approach contest day [11, 14, 20]. In addition to glycogen, muscle cells also store energy as Additionally, since each gram of glycogen draws ~ 3–4 g intramuscular triglycerides (IMT). Indeed, nearly as water into the muscle [31] and this is a potassium much energy is stored in muscle cells as IMT as is dependent process (see above), a lack of water and po- stored as glycogen [85]. However, IMT stores vary con- tassium intake may also reduce the effectiveness of siderably in humans, in part as a function of training sta- attaining a “full” appearance. tus, muscle fiber type, insulin sensitivity, gender, and Contrary to the typical goal of reducing (extracellular, diet [85]. IMT may amount to ~ 1 % of muscle weight subcutaneous) body water, psychological disturbance/ [86, 87], but because fat is less dense than skeletal emotional stress can cause the retention of body fluids muscle [88], the volume of IMT in a fully “fat-loaded” [76] via the actions of catecholamines (particularly dopa- muscle cell could exceed 2 % of muscle volume [89, 90]. mine) [77–79] and adrenocortical hormones, including In rats (17), a single exercise bout can decrease muscle both cortisol [80] and aldosterone [81]. Water retention IMT content by 30 %, and three days of a high fat diet during experimental stressful conditions requiring com- can boost IMT storage by ~ 60 % above baseline [91]. In petition is subject to inter-individual variability, perhaps humans, the dietary replenishment of IMT may be due in part genetic differences [82]. In extreme cases, slower when glycogen restoration is also a priority [89, emotionally stressful situations can evoke polydipsia and 92–94]. Still, IMT stores are increased by dietary fat in- alter fluid homeostasis such that increases of up to 9 kg take [91, 95] and reduced during resistance [96] and en- (~ 20lb) of body mass can accrue in as little as 48 h [78, durance exercise [85]. 79]. Thus, there is support for the common empirical Although fat loading has been a known strategy in observation that psychological stress may counteract the bodybuilding circles for many years [97, 98], to our
Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 7 of 24
knowledge the strategy has not been studied directly in a [107] estimated the protein requirements of resistance-
bodybuilding peak week context (e.g., in combination trained men to be 2.0-2.38 g/kg.
with other dietary strategies such as glycogen supercom- A systematic review by Helms et al. [108] reported that
pensation). In the rodent study mentioned above [91], 2.3–3.1 g/kg of fat-free mass (FFM) was appropriate for
three days of a high fat diet followed by three days of a resistance-trained subjects in hypocaloric conditions.
high carbohydrate (CHO) diet resulted in supercompen- However, out of the six studies included in the review,
sation of both IMT and glycogen; however, 6 days of only two involved highly-trained competitive athletes,
only a high CHO produced the expected glycogen load- and only one study examined competitive bodybuilders.
ing effect but failed to elevate IMT levels above baseline. The latter study was conducted by Mäestu et al. [109],
In humans, high CHO/low fat diets may actually precipi- who tracked the body composition and hormonal profile
tate a reduction of IMT stores [92–94], perhaps because of national and international level bodybuilders during
IMT is used preferentially to cover the energetic costs of the final 11 weeks of contest preparation. The competi-
post-exercise cellular repair and glycogen-glycogenin as- tors self-reported being steroid-free for a minimum of
sembly [94, 99]. Considering that a large (e.g., heavy- two years prior to the study. Protein intake was 2.68 g/
weight male) bodybuilder may carry over 60 kg of kg (2.97 g/kg FFM) at baseline and 2.48 g/kg (2.66 g/kg
muscle [100, 101], increasing IMT stores from a rela- FFM) at the final assessment point (3 days pre-contest).
tively “depleted” to a “loaded” state could conceivably in- Chappell et al. [2] reported that in high-level drug-free
crease muscle volume by > 1 % [85]; hypothetically, this bodybuilders, end-of-preparation protein intakes of men
translates to adding ≥ 0.6 kg of fat free mass. Hence, fat and women who placed in the top-5 were 3.3 g/kg and
loading appears to be a promising strategy to be used in 2.8 g/kg, respectively. Body composition was not re-
conjunction with CHO loading during peak week for ported in this study. Based on typical body fat percent
bodybuilders, and thus warrants future study in a con- ranges at the end of preparation, adding 4–6 % to the
trolled setting. men’s intake and 13–15 % to the women’s intake would
provide an estimate of grams of protein consumed per
kg of FFM. A case study by Kistler et al. [3] on a high-
Dietary Protein level drug-free champion bodybuilder reported a protein
In conjunction with carbohydrate and fat intake during intake of 3.4 g/kg (3.6 g/kg FFM). While the descriptive
peak week, optimizing protein intake warrants discus- nature of these studies precludes the ability to draw in-
sion, as it is a major and indispensable component of ferences as to whether the observed level of intake was
the diet. The U.S. Recommended Dietary Allowance beneficial, neutral or detrimental from a physique stand-
(RDA) for protein for adults is 0.8 g/kg [102], and has point, they appear to converge upon similar protein dos-
remained unchanged since ~ 1980, despite ongoing ex- ing in the final stage of the pre-contest period.
posure of its inadequacy. In a call to re-evaluate and re- A potential consideration for protein dosing during
vise the RDA, Layman [103] contended that protein peak week is whether to keep protein intake static or
requirements are inversely proportional to energy intake. alter it during the carbohydrate depletion and loading
The latter point applies to dieters in general, but it has phases. While no concrete evidence currently exists as
special significance for athletes in prolonged hypocaloric to what is optimal to our knowledge, the study by de
conditions, epitomized by pre-contest physique competi- Moraes et al. [15] that reported an increase in muscle
tors. In light of mounting evidence, a daily intake of 1.2– volume and enhanced physical appearance as a result of
1.6 g/kg has been proposed as optimal for the general a carbohydrate-loading protocol provides some evidence
population aiming to optimize health and longevity that bodybuilders alter their protein intake during peak
within a physically active lifestyle [104]. Toward the week. In this study, the depletion/loading protocol was
more athletic end of the spectrum, in the most compre- three days of a low-carbohydrate (1.1 g/kg) and high-
hensive meta-analysis of its kind, Morton et al. [105] protein (3.2 g/kg) diet followed by only one day of a
found that a protein intake of ~ 1.6 g/kg (upper 95 % CI high-carbohydrate (9.0 g/kg) and low-protein (0.6 g/kg)
of 2.2 g/kg) maximized muscle hypertrophy and strength diet. It seems likely that similar increases in muscle vol-
in non-dieting recreational resistance trainees. In a study ume would have occurred if protein was kept static.
more representative of bodybuilders, Bandegan et al. However, despite the decreased protein intake (46.6 g on
[106] assessed whole-body protein synthesis via the indi- the carbohydrate-loading day versus 252.4 g on the
cator amino acid oxidation (IAAO) method and deter- carbohydrate depletion days), gastrointestinal distress
mined an Estimated Average Requirement of 1.7 g/kg/d was still significantly greater than the non-carb-loaded
with an upper 95 % confidence interval of 2.2 g/kg/d to control group. This points to the possibility that keeping
be near their maximal attainable muscularity. In a simi- protein intake high during the loading day would have
lar protocol using the IAAO method, Mazzulla et al. further worsened gastrointestinal symptoms, potentiallyEscalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 8 of 24 due to excessive food intake. An alternative would be to error, as will be further discussed in the practical ap- keep protein static, but lessen the carbohydrate load plications section, and warrants further scientific (which in this case was ~ 714 g), allowing more than investigation. 1 day for carbohydrate loading. This seems a more prac- tical approach (see above), such that an even greater Dietary Supplementation total carbohydrate intake could be consumed but with The consumption of sport supplements is common less risk of gastrointestinal issues. among bodybuilders and is often manipulated through- A potentially viable strategy of altering protein in- out their training phases (i.e. off-season, pre-contest) [2, take during peak week is to keep protein intake rela- 3, 5]. Although it is well understood that physique ath- tively high at ~ 2.5–3.5 g/kg/day during the initial ~ 3 letes utilize supplements such as protein powder, proc- days of glycogen depletion portion of a glycogen essed carbohydrates, pre-workout stimulants and super compensation strategy, followed by a relatively ergogenic aids, creatine, vitamins/minerals, omega-3’s, lower protein intake of ~ 1.6 g/kg/day during a high thermogenics, diuretics and much more [2, 7], there is a carbohydrate diet for 1–3 days (see above), finishing paucity of data on how these supplements affect the ath- at least 24 h before the scheduled competition. lete’s peaking process to enhance their physique. Hence, Thereafter, a strategy for inducing diuresis and (fur- we will discuss the potential benefits of utilizing refined ther) elevating IMT stores during the day preceding food supplements (i.e. protein/carbohydrate powders, competition by following a high protein, low carbohy- fatty acids), creatine, and herbals during peak week. drate (high fat) diet for a short period (~ 12–24 h) Energy yielding food supplements like protein and could be employed. As previously discussed, when carbohydrate have been regularly reported by other re- carbohydrate loading using a low fat approach, IMT searchers examining bodybuilders [2, 3, 5]. Chappell levels may decline, but elevated glycogen levels persist et al. [2] examined fifty-one (35 male & 16 female) nat- for several days in lieu of glycogen-reducing, demand- ural bodybuilders and found that ~ 75 % of males and ~ ing contractions (e.g., resistance exercise or excessive 89 % females supplemented with protein powders. posing). High levels of intramuscular glycogen and Carbohydrate supplementation was less popular, with the associated intracellular water would thus prevent just ~ 37 % of the male competitors and no female com- the loss of ICW that typically accompanies diuresis. petitor reporting their use. Bodybuilders may utilize Increasing protein intake consumed the day before these nutritional supplements as a means to manipulate the show, or simply consuming protein at the high and consume specific macronutrient quantities. As pre- levels typically employed by pre-contest bodybuilders viously mentioned in the carbohydrate and water/so- (~ 3.0–3.5 g/ kg / day; see above) and shown recently dium sections, bodybuilders seek to maximize muscle to be generally safe over longer periods [110], will en- glycogen and its associated osmotic effect as a means to courage greater oxidative deamination of amino acids increase total muscle volume. Thus, it is common to and ureagenesis [111] that approximate the maximal supplement with various carbohydrate powders (e.g. rates observed in healthy individuals [112, 113]. Clear- dextrose, highly-branched cyclic dextrin, etc.). Carbohy- ance of blood urea in turn requires an osmotic gradi- drate characteristics such as osmolality, gastric clearance ent during its renal excretion, thus causing diuresis rate, and glycemic index are some of the variables phys- [114, 115]. Additionally, reverting back to a lower ique athletes should take into consideration as these can carbohydrate diet (e.g., one similar to that used early significantly vary between sources and may impact in the week to fat load in preparation for carbohy- gastrointestinal symptoms (e.g. bloating, cramping, diar- drate loading) would also promote loss of body water rhea, constipation, etc.) [119–121]. Furthermore, the gly- [116, 117]. Thus, increasing or maintaining a high cemic index of different carbohydrate sources have been protein intake while lowering carbohydrate and con- shown to impact glycogen synthesis rates [122, 123]. comitantly increasing fat intake during the day before This may be of greater importance for bodybuilders who competing would reverse unwanted gains in extracel- are aiming to refill glycogen stores in a short time lular/subcutaneous water experienced during carbohy- window (e.g. after making weight), as high glycemic car- drate loading [118]. It would also complement other bohydrates have demonstrated superior glycogen resyn- strategic measures designed to induce diuresis such as thesis rates [122]. However, over a longer timeframe (i.e. manipulation of water/sodium/potassium intake, diet- 8 + hours), glycogen stores can be replenished similarly, ary supplementation, and body positioning (e.g., regardless of feeding frequency [124], when consuming HDT) that would also afford a second opportunity for an adequate total amount of carbohydrates [125]. Add- fat loading during peak week. Uncertainty of the ef- itionally, data have demonstrated that combining protein fectiveness of modifying the de Moraes et al. and with carbohydrates can enhance glycogen resynthesis other protocols can only be mitigated by trial and [126]. However, it seems prudent that athletes do not
Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 9 of 24 “experiment” during peak week with new CHO, protein As discussed previously, the use of diuretics has been sources, or other supplements not integral to peak week commonly reported in the competitive bodybuilding specific strategies to reduce the risk of experiencing space [8, 19–21, 34, 35]. Bodybuilders often use diuretics negative gastrointestinal symptoms or any other deleteri- (both herbal and synthetic drugs) to increase urine out- ous consequences. put and excrete sodium in an effort to alter fluid volume, There is substantial evidence supporting the use of enhance body composition, and present a more aesthetic creatine supplementation for bodybuilders. Chappell physique [142]. Moreover, some may use diuretics to re- et al. reported that ~ 48 % of males and ~ 51 % of fe- duce total body mass with the aim to make a specific males supplemented with creatine during their contest weight class [8, 19–21, 34, 35, 143]. For example, Cald- preparation [2]. Creatine has been shown to improve well et al. [143] investigated the effects of a prescription body composition (i.e. increase lean body mass, decrease diuretic (furosemide 1.7 mg/kg) on athletes of various fat mass) [127, 128] and increase intracellular hydration sports (e.g., weightlifters and martial artists) and re- status [129, 130]. Ziegenfuss et al. [129] demonstrated ported a significant reduction in total body mass (-3.1 ± that a three day creatine loading phase increased intra- 0.8 kg) over a 24-hour period. However, due to the po- cellular fluid volume by ~ 3 % without impacting extra- tential health dangers and their ability to mask the use cellular fluid. The use of multifrequency bioelectrical of performance enhancing drugs, prescription diuretics impedance analysis (MBIA) caused some to initially in- have been banned by the World Anti-Doping Agency terpret the data with some skepticism. However, a [144]. While these drugs are presumably not used by follow-up study employing the same three day creatine natural bodybuilders, they have been employed by en- loading scheme observed a 6.6 % increase in thigh hanced non-tested competitors [19, 20]. Interestingly, muscle volume among elite NCAA power athletes as de- some herbal supplements that are not banned have dem- termined by the gold-standard magnetic resonance im- onstrated a diuretic effect and may be employed by en- aging [131]. Creatine supplementation has also been hanced and natural bodybuilders alike. For example, shown to aid in glycogen synthesis and supercompensa- taraxacum officinale (dandelion) has been shown to sig- tion [132]. Additionally, consuming CHO with creatine nificantly increase urine frequency and excretion output increases creatine loading [133], which increases cellular in an acute fashion (i.e. within a 10 h window) [145]; hydration as noted above [32, 129]. Finally, muscle creat- however, to our knowledge, no research has directly ex- ine levels decline very slowly after loading [134], so cre- amined its impact on intracellular vs. extracellular fluid atine intake after peak week glycogen loading is not shifts or on its effectiveness during peak week. needed except perhaps in small amounts to potentially Vitamin C (ascorbic acid) is water-soluble and consid- accelerate last minute, competition day carbohydrate de- ered non-toxic even in high amounts [146]. Since it re- livery into skeletal muscle. Thus, creatine supplementa- quires renal filtration for excretion, it also brings about tion may be a potentially effective tool during peak-week osmotic diuresis [147]. Research supports a diuretic ef- for acutely expanding muscle size. However, it should be fect of both oral and IV vitamin C [148], with daily doses noted that not all individuals will respond to exogenous as low as 11 mg/kg producing diuresis in children [149], creatine intake vis-à-vis significantly increasing muscle although a 500 mg IV dose failed to induce diuresis in creatine content [135, 136]. In particular, “responders” adult males [150]. A study of both healthy subjects and tend to be those who have a larger type II muscle fiber vitamin C deficient patients demonstrated that urinary area (i.e., those with an innate proclivity for sprinting Vitamin C losses (and accompanying diuresis) occurs and/or strength/power sports) [137, 138] and/or those only above threshold blood concentrations of ~ 14 mg/L with lower initial creatine levels, perhaps due to lack of (which corresponds to tissue saturation levels). These intake (e.g., those who have not been supplementing data suggest that reaching diuresis-promoting vitamin C with creatine or who are non-supplementing vegetar- blood concentrations varies as a function of rates of ab- ians) [139]. sorption and uptake/deposition into tissues [151] (3). Omega-3 fatty acid [eicosapentaenoic acid (EPA), doc- Given its common usage, relative safety, and potential osahexaenoic acid (DHA)] supplementation has also effectiveness as a non-pharmacologic diuretic, the use of been observed in bodybuilders [2, 3]. Chappell et al. re- ascorbic acid in a peak week scenario (including dosing ported that 39 % of males and 47 % of females consumed patterns to minimize GI distress and optimize blood an omega-3 supplement (e.g. fish, krill, flax-oil) [2]. Al- concentrations in the context of meal timing and other though substantial data in many population demograph- factors that may influence absorption) warrants of fur- ics supports the use of EPA & DHA as a means to ther research. Indeed, due to the paucity of research reduce systemic inflammation and improve insulin sensi- available on the subject, it is difficult to make definitive tivity [140, 141], it remains unknown if this can enhance recommendations on usage and dosage during peak the peaking process. week. However, based on the evidence available,
Escalante et al. BMC Sports Science, Medicine and Rehabilitation (2021) 13:68 Page 10 of 24
repeated dosing (every few hours) of 500–1000 mg of restriction periods (as short as two days) to be effective
vitamin C is a viable strategy to be utilized during the at emptying/clearing the gastrointestinal tract [162].
12–24 h before competitive stage appearance to poten- Thus, the rationale to reduce fiber intake before the
tially accelerate body water loss with minimal side effects competition is typically to minimize the risk of bloating/
(e.g., gastrointestinal distress). Please note that caution is water retention [11], and for some, may be an effective
warranted as excessive vitamin C consumption may strategy for making a weight class.
cause osmotic diarrhea [152]. Although research is limited on the topic, Chappell
Caffeine use is another supplement of special mention et al. [11] reported that the bodybuilders they observed
due to its diuretic properties. Doses of at least ~ 250- severely reduced their fiber intake primarily by redu-
300 mg caffeine (2–3 cups of coffee) can be taken to cing/omitting fibrous vegetables during peak week.
promote diuresis acutely in those who are not caffeine- Additionally, it is well understood that fermented oligo-
tolerant due to chronic use [153]. On the other hand, saccharides, disaccharides, monosaccharides, and polyols
several days of abstinence can restore sensitivity to caf- (FODMAPs) are poorly absorbed, draw fluid within the
feine’s diuretic effects (although the diuretic effect is still GI tract, and increase the likelihood of bloating/gas
only present at these larger doses) [154]. Caffeine’s diur- [163]. Thus, it may be advisable for bodybuilders to limit
etic, mood-improving [155] and performance enhancing high FODMAP food sources during peak week. This
effects [156] should also be considered in the context of may be one reason why dairy/lactose and gluten rich
potential sleep disturbances if taken acutely to promote food sources are also anecdotally restricted in this period
diuresis to make weight and/or the night before compe- as well. On the other hand, fiber sources such as guar
tition, as well as withdrawal effect if use is abruptly dis- gum [164] and psyllium [165], which have been shown
continued [157]. One potential peak week strategy to reduce symptoms of irritable bowel syndrome domi-
would be to limit caffeine early in the peak week process nated by both constipation and diarrhea, might be
(especially in chronic users, to restore sensitivity), em- employed on an individual basis to offset gastrointestinal
ploy it early in the day as a diuretic (e.g., on the day be- distress, as noted above in the study by de Moraes et al.
fore competition) to limit adverse effects on sleep [15]. Despite the lack of data within this demographic,
quality, and continue its use thereafter (e.g., upon rising dietary fiber is likely a variable that can impact a body-
the day of competition) to prevent withdrawal effects on builder’s peaking process and should be considered on
both fluid homeostasis and/or mood and arousal [157]. an individual basis in context with the other aspects of
It has been noted that caffeine can be employed (3- the peak week approach.
8 mg/kg) as an agent to speed glycogen loading [158], al-
though data are sparse and equivocal as to this effect Training
[159]. Thus, athletes who might choose to include caf- Since bodybuilders invariably train primarily with resist-
feine to enhance carbohydrate loading in the middle of ance exercise (RE), the extent to which RE in particular
the peak week may potentially also be forfeiting its use- reduces glycogen and IMT warrants consideration. In an
fulness as a diuretic during the days thereafter (i.e., when early study of fuel use during RE in trained bodybuilders,
“drying out” the ~ 24 h before stepping on stage). Essen-Gustavsson and Tesch [96] found that a high vol-
ume, lower body RE session reduced both vastus lateralis
Fiber and FODMAPs glycogen and IMT by ~ 30 %, and that both resting levels
Dietary fiber is indigestible plant matter of carbohydrate and the extent of depletion correlated to the
sources that can be categorized as water-soluble or in- energetically-related enzymes hexokinase and 3-
soluble (i.e. fermentable) and plays a vital role in gastro- hydroxy-Co-A dehydrogenase, respectively. In another
intestinal health and bowel-movement regularity [160]. study, just three sets of arm curls (80 % 1RM or ~
Bodybuilders who are aiming to reduce total body mass 12RM) was enough to reduce biceps brachii glycogen by
during peak week as a means to make a particular 24 % and elevate muscle lactate ~ 20 fold in trained
weight class may benefit by intentionally reducing fiber bodybuilders [166]. Similarly, Robergs et al. [167] found
intake. For example, Reale et al. [55] investigated the ef- that 6 sets of knee extensions (~ 13 reps/set; 2 min rest
fect of dietary manipulations (i.e. macronutrient, fiber, intervals) reduced muscle glycogen by approximately
sodium, and water intake) on acute weight loss for com- 40 % in resistance trained males, but glycogen levels re-
bat athletes and prescribed 10-13 g of fiber to reduce covered 50 % of losses during 2 h of fasting rest, presum-
total gut content and body mass. Different food sources ably due to the immediate post-exercise assimilation of
impact fecal bulking characteristics and those high in glycogenolytic metabolites (e.g., lactate) [168]. The same
fiber tend to increase water in the interstitial space and group also found that an external workload-matched re-
stool bulk [161]. Data have shown a direct relationship gime (employing double the load such that sets averaged
between fiber intake and bowel contents with acute only ~ 6 reps to failure) produced a nearly identicalYou can also read
