Published in MastersSports Magazine, January 1997

No Ordinary Antacid: The Mystery of the Missing Muscles



Tom McCullough MEd., MSS


It's tough enough to bulk up when you've reached the bifocal age. But apparently it could be even tougher if you also take a commonly recommended antacid for "heartburn."

"Acid reflux" was the doctor's medical term for the burning sensation I would sometimes feel up and down my gut, especially after a big meal. But it was nothing to worry about. All I had to do was lay in a supply of the prescription version of a common, over-the-counter product, and take it as directed.

Not such bad news, surely. But as a powerlifter and athletic coach who works with the details of anatomy and physiology all the time, I pressed for a more complete explanation. What actually happens in acid reflux is that the so-called "lower esophageal sphincter," a muscle that normally keeps things flowing in the intended direction--from the esophagus into the stomach--messes up. It relaxes when it shouldn't, allowing stomach acids to seep back up where they don't belong, causing a burning sensation that can sometimes be mistaken for a heart attack. Neutralize them and the discomfort, if not the actual problem, goes away.

So after being assured my new medicine had no side effects that would interfere with my powerlifting, off I went to get filled my prescription for Tagamet, the well-known remedy made by SmithKline Beecham that goes by the generic name cimetidine. We weren't going to fool around, either. I would be getting 1,200 mg. each day--1 1/2 800 mg. tablets.

But as it turns out, I was getting something else as well: smaller. Three months after I started taking the medicine, I began noticing a slight loss of muscle and an obvious drop in strength. I'd inexplicably shed five pounds--three of them lean body mass, or muscle--and though I was shooting for a 745 deadlift to beat my 735 best, and it was just four weeks before the event, I was now having trouble with 630. That's a weight I'd previously done for 5 reps. This, despite the fact that my training had stayed precisely the same, my diet and caloric intake had remained constant, I'd gotten the same amount of rest, everything had stayed utterly status quo.

Everything but the medicine. And a little research subsequently showed cimetidine can do more than neutralize acid. It can also have what the venerable Physician's Desk Reference for 1996 describes as a "weak anti-androgenic effect," essentially working against testosterone.

No trivial detail for the weightlifting male, for whom the hormone testosterone is of more than passing importance for its anabolic (tissue building) and androgenic (promoter of masculine characteristics) powers. Exercise at high intensities, such as resistance training, has been shown to cause testosterone production to increase as much as 37%, so it is also generally accepted that increases in natural testosterone production, caused by exercise, are the first step to increasing muscle mass.

Now maybe a little anti-androgenic action wouldn't matter if we all had tanks brimming with testosterone. But we don't. In most men, production of the hormone begins to slow somewhere after we turn 30. And just as we enter the masters division and our hormonal octane is dropping off a little even as the drive for a muscle-preserving weight workout is going up, the odds of "acid indigestion" probably are also growing. So it seems to me our doctors should be able to recommend something that can solve one problem without aggravating another. Anti-androgens exert their effect by either decreasing the production of natural testosterone, or by blocking the androgen receptor sites in the cell. It is generally accepted that Tagamet manages to do both.

But I had to find this out for myself, after the Physicians Desk Reference gave me the first clue. Along the way I consulted my pharmacist and went to a second doctor, both of whom confirmed what I'd found out. Not that there's anything wrong with prescribing Tagamet, an effective and widely used preparation. And of course the over-the-counter version is much less potent than what I was taking. But wouldn't you think a fully informed physician, knowing he was dealing with someone with a high body-building priority, would have known enough to pick something else like Axid, Pepcid, Prevacid, Prilosec, or Zantac, that are not anti-androgenic?

That's not my question, by the way. It came from my second doctor.


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