What is the cause of Bubble gut?

In today's article, we will discuss the root cause of abdominal distension often seen in bodybuilding, colloquially known as GH gut, Bubble gut, or Palumboism.

This term refers to a condition characterized by excessive abdominal distension in bodybuilders not related to excess body fat. Various hypotheses exist regarding the cause, including absurd theories and oversimplified conclusions. One hypothesis, popularized by A.L. Rea's book "Chemical Muscle Enhancement," suggested that gastrointestinal hypertrophy caused this condition. He supported his claim by stating that there were more IGF-1 receptors in the gastrointestinal tract than in the musculoskeletal tissue. Unfortunately for him, the regulation of gastrointestinal hypertrophy/hyperplasia is strictly controlled, and any overstimulation will be counteracted in a short time through homeostatic mechanisms such as the downregulation of IGF-1 receptors.

Another hypothesis suggests that massive visceral fat accumulation, related to insulin resistance, is the cause. However, this idea is flawed, as androgen use significantly reduces visceral fat accumulation and increases its mobilization even in insulin-resistant conditions.

Causes of Palumboism include:
  • High-calorie diet
  • Chronic GH abuse
  • Excessive use of anabolic steroids

Individually or combined, these factors can cause significant insulin resistance or elevated blood sugar, leading to gastroparesis, a condition where stomach muscles don't function correctly.

GH abuse can indirectly cause distension, but the mechanism is different from what people believe. Bodybuilders often consume 6,000-8,000 kcal daily, leading to high blood sugar levels throughout the day. An overabundance of food can cause bacterial overgrowth in the small intestine (SIBO), leading to abdominal bloating and gas, which results in obvious abdominal distension.

Long-term exposure to high blood sugar levels can slow gastric emptying and impair intestinal contractions, causing gastroparesis. To diagnose gastroparesis, tests measuring gastric emptying and upper gastrointestinal endoscopy are performed. The main causes of gastroparesis include endocrine, neurological, and metabolic factors.

To treat gastroparesis, identifying the root cause is essential. For example, if the cause is pre-diabetes or diabetes, the focus should be on restoring blood sugar control. Symptomatic improvement typically involves a low-FODMAP diet, prokinetic agents, and antiemetics if necessary.

For bodybuilders, treatment involves:
  • Improved blood sugar management
  • Prokinetic agents
  • Low-residue diet
  • SIBO detection tests
  • Reduced anabolic load

In summary, excessive abdominal distension in bodybuilders is not linked to massive visceral growth due to increased IGF-1 or drastic visceral fat accumulation. Instead, it is associated with intestinal health issues and gastroparesis related to worsening insulin resistance from overeating and GH abuse. Prevention and treatment involve a digestible, low-FODMAP diet, careful blood sugar management, and avoiding GH and excessive anabolic steroid use.