Monday, February 25, 2013

Stretch marks and the bodybuilder. By Vic Goyaram


Stretch Marks And The Bodybuilder
By Veeraj Goyaram

"As a kid, I had this itch that I couldn't scratch. I was fat and uncomfortable in my own skin. So I dropped 70 pounds by hitting the pavement and busting my ass. I wore out the "fatboy" nickname and wore my old skin like a loose coat. I turned to the iron, learned to push and press... Forward and up. With time, my skin grew taut - it began to pull and tear. It itched... And I scratched. Scratched my way up to where I stand today. These scars. These stretch marks. I'll have them for life. I'll wear them with pride. They are a reminder of who I was, where I came from, and where I'm going", 
IFBB Pro Evan "Ox" Centopani
Stretch marks are the battle scars. Wear them with pride
My personal story with stretch marks
Stretch marks can be a frustrating topic in bodybuilding and indeed one which can mess a lot with your mind.  I had stretch marks even before I started bodybuilding and they bothered me for a long time. My stretch marks mainly run across my chest and my back and later they came on my arms too, especially on the lower biceps and forearms. I went on to build a very good body in my teens but sometimes I would feel hesitate to take off my shirt because of the stretch marks.

I later found that I wasn't alone as almost every bodybuilder has stretch marks. Some may have one of two on their delts-chest tie ins or biceps while others may have it all over. I got massive relief when I met pro bodybuilders (the same guys who look perfect in magazines and videos) and see that they have even more stretch marks that I do. On some people the marks may be quite visible while on others it can blend in with the skin tone and can be seen only on close inspection or from certain angles. 

I have personally done a lot of research on stretch marks and spoken to numerous skin specialists and dermatologists on the topic. I will share this information with you. In this article, the causes of stretch marks and available treatments will be discussed. Unfortunately, there is nothing that can completely reverse stretch marks and our best bet is to understand and try to prevent and minimize them.
The causes of stretch marks
Stretch marks are due to the tearing of the dermis layer of the skin (see picture below).  The dermis layer is a highly resilient layer and it gives the skin its shape. It is in a constant state of regeneration as it has cells called "fibroblasts" that produce materials called collagen and elastin which gives elasticity to the skin. When the skin stretches, the dermis layer immediately adjusts to give skin its shape. However, under certain circumstances which will be discussed below the dermis layer may not be able to keep pace with the stretching of the skin and therefore cracks, leaving behind stretch marks. In French they are called "vergetures" and in medical terms they are known as stria distensea or simply striae. Stretch marks also occur during pregnancy, in which case they are called "stria gravidarum".
The skin is made up of several layers. Stretch
marks are caused by the tearing of the dermis layer

Stretch marks are caused by rapid stretching of the skin due to rapid growth or rapid weight fluctuations especially during puberty and when gaining mass in bodybuilding. Again, some people are more susceptible to develop stretch marks than others as goes the saying "Basically, if your mom had them, you're probably going to have them".

Any other causes?
As explained above, mechanical stretching is a cause of stretch marks. Moreover, I have sometimes seen people who have neither experienced weight fluctuations nor been bodybuilding previously and this prompted me to question whether there are other causes of stretch marks. As listed in the table below there are other causes besides mechanical stretching. For example, an increased level of the glucocorticoid hormone Cortisol in the body can give rise to stretch marks. This is because Cortisol is a catabolic hormone and can break down fibroblasts, the very cells that maintain skin elasticity. People undergoing Cortisol therapy or suffering from Cushing's syndrome (overproduction of cortisol) also commonly develop stretch marks. There are also reports that excessive Marijuana consumption may also causes stretch marks.
Ref: Elsaie et al. Dermatol Surg 2009;35:563–573
Furthermore, stretch marks do not look the same on every person depending on skin colour. Stretch marks appear reddish when they first start to develop and eventually assume a silvery coloration as they mature.
Stretch marks usually start with a reddish coloration which indicates that these are newly formed.  Eventually they change into a silvery colour which looks different on various skin colours.
The regions mainly affected.
Stretch marks are most common in regions where fat is stored like the abdomen, chest, hips, buttocks, the upper arm, the underarm and the legs. In bodybuilders, stretch marks occur where growth is likely to occur very fast.  A very common region is the chest-delt tie in area which, in my opinion, is because the delts and chest grow bigger simultaneously thus stretching the skin to a greater extent. Another region is the arms and the back. Stretch marks occur very rarely on the calves. If a bodybuilder has stretch marks it will most likely be on the delts or the chest-delt tie ins.
Stretch marks commonly develop in the chest-delt
tie in region in bodybuilders
Why don't the big bodybuilders have stretch marks?
I am sure many of us may be thinking how unfair life is. We gain or lose a few kilos and the skin starts cracking while the bodybuilders we see in the videos and magazines have skins so perfect without a single stretch mark although they gain and lose massive amounts of bodyweight.
"The big bodybuilders must really be blessed because they got no stretch marks", I used to think
As I mentioned in the introduction, I was wrong in thinking that the top bodybuilders don't have stretch marks because in reality MOST OF THEM DO. Their stretch marks are not likely to catch your eyes because of the tanning lotions and oil they use to pose to compete and pose for pictures. Furthermore, they benefit from specific lighting and possibly some air-brushing for photo shoots. If you see a big bodybuilder in person then it is very likely that you will see his stretch marks
Again, the chest-delt tie in region is mostly affected
Dexter has stretch marks on his chest-delt tie ins
as can be seen in this picture.
Heavy Duty training system did make the late Mike Mentzer
BIG but it also gave him stretch marks on his chest, delts,
arms and forearms. They aren't too visible because of the good
lighting for this photo shoot.
My forearms and biceps are riddled with stretch marks
but they don't appear when I flex them.
Stretch marks may also appear on the abdominal region
But tanning products go a great job to cover them
(Photo Courtesy: Kuwaitbodybuilding.com)
Furthermore, when muscles are flexed (of course depending on the muscle and the pose), the marks are less likely to appear. This may contribute to your belief that bodybuilders don't have stretch marks. I have done a little experiment (pictured above).

Prevention (and treatment?) of stretch marks
Here is the interesting part. Stretch marks cannot be reversed unfortunately. Any products claiming to reverse stretch marks are simply taking you for a ride. However, there are products that can reduce the appearance of stretch marks by promoting an even skin pigmentation in affected areas thus reducing the appearance of stretch marks. These will be discussed below. It must be noted that several modalities of treatment have been proposed but none of these have been proven scientifically but that does not mean that we must discredit these treatment options.  I have read a number of these studies and there are concerns on the experimental designs (e.g a proper control) of a number of these experiments that do not allow conclusions to be made.

Overall, stretch mark products and treatments can be classified as follows:

A. Topical therapies
This line of therapy is said to promote skin pigmentation, skin cell regeneration and skin hydration as a means to help with stretch marks. Some common examples will be reviewed in this section which will focus on the main constituents (or active ingredients) commonly found in stretch mark creams. Keep in mind that most stretch mark creams will usually contain a combination of these ingredients.

1. Tretinoin (Retinoic acid): this is a vitamin A derivative which works by improving skin cell turnover. It has been studied scientifically (using a 0.1% retinoic acid skin creams) and yielded variable but overall positive results. It must be noted that treatment must be regular and carried out for a long period of time in order to be effective. Retinoic acid is especially helpful in the early stages of stretch mark development.
Tretinoin skin creams
2. Skin hydration products
These products have been developed based on the understanding that proper hydration is essential for maintaining the integrity and barrier function of skin. However there is little conclusive scientific data for these creams. There are a few studies that have shows some effectiveness, although these must be confirmed by larger studies.

The product Trofolastin made by Novartis has been tested in one study and shown to confer some benefits in pregnant women. The plant extract of Centella asiatica found in the product was proposed to stimulate fibroblastic (skin cell) activity and exert an antagonistic effect against glucocorticoids which are catabolic hormones that also cause stretch marks.
Trofolastin is based on Centella asiatica and hydrolysed collagen
Hyaluronic acid is another compound found in many skin products including beauty and stretch mark products. If you take a look at the ingredient list of your girlfriend's skincare products chances are that you may see Hyaluronic acid listed. It is in fact an organic substance found in human skin and is very often a constituent of stretch mark creams. The Hyaluronic content stimulates fibroblast activity and collagen production to restore any inhibition and collagen loss induced by hormonal fluctuations or mechanical stretch.
Hyaluronic acid is common in skincare products
Monomethyltrisilanol Mannuronate is a skin hydratant which is present in some stretch mark creams like Simulcium G3, a favourite stretch mark cream of mine. I have personally used this cream during a mass gaining phase years ago when stretch marks were appearing like crazy. I personally made the experience and noted a rapid decrease in "new red lines" formation although I went on to gain an additional 10-12kgs.

A number of stretch mark creams are based on cocoa and shea butter.  Way before scientific studies analysed their effectiveness these have been used in several countries and there are anecdotal report that they work although scientific studies say otherwise. The use of cocoa and shea butter is very common among bodybuilders to prevent stretch marks and improve their appearance. Other products like sweet almond oil, wheat germ oil, olive oil, avocado oil, and castor oil are also used as a means to keep the skin hydrated although these have not been evaluated.
Products based on cocoa butter
Summary of topical products and their suggested mode of action 
(Click to enlarge)
B. Microdermabrasion
Microdermabrasion is a procedure that uses a mechanical process to remove dead skin cells from the epidermal layer fo the skin. This procedure is painless and can be carried out by a trained skincare specialist. The principle is illustrated in the diagram below. A typical microdermabrasion system uses a stream of inert crystals of Aluminium oxide, magnesium oxide, sodium chloride or sodium bicarbonate to abrade the skin using a pump and a vacuum system. Abrasium of the dead layer of the epidermis allows skin regeneration to take place. This technique is commonly employed in cosmetics to help decrease the appearance of lines, wrinkles, acne and acne scars and also to improve the skin penetration of skin care products and medications.
Microdermabrasion principle
Microdermabrasion has been evaluated as a means of treating stretch marks and looks very promising. I am unsure if this procedure is carried out in Mauritius and it may be of help to check with qualified skincare technicians or your dematologist. In scientific studies microdermabrasion has been shown to initiate dermal repair and increase procollagen levels which means good news in terms of connective tissue regeneration. Further studies are required to confirm these findings but there is hope. If it does not complete reverse stretch marks at least it can improve their appearance.
Microdermabrasion is painless, non-invasive and requires no
anaesthetic. It can be carried out by a trained skincare technician.
Other treatment options and concluding remarks
Laser treatment are also being used to improve stretch marks by stimulating connective tissue regeneration but their effectiveness is still subject to scientific evaluation. They hold a lot of promise, however. Again, I am unsure whether laser treatment is available in Mauritius. I have included the table below for those willing to know more about laser treatment.

Avoid rapid weight fluctuations
To conclude, I would advise to avoid gaining or losing weight too fast and rather adopt a gradual approach in order to minimize mechanical stress on the skin epidermal layer. Hormones, skin hydration or genetic factors aside I believe that rapid weight fluctuations are a major cause of stretch marks. When bulking up I would suggest to use a skin hydration cream as mentioned above containing a combination of ingredients already discussed. Apply the creams in regions where stretch marks are most likely to develop.

Secondly, if taking steroidal anti-inflammatory products like corticosteroids keep an eye on the development of stretch marks. Should they develop do not hesitate to highlight this to your doctor in order to envisage the possibility of adjusting (if possible) the dosage of hormones.

Thirdly, it may be wise to speak to a doctor, pharmacist or dermatologist before using topical creams or lotions especially those containing chemical ingredients like Retinoic acid and antagonists of corticosteroids. This is especially true if you are on certain medications (topical or systemic) whereby drug interactions may occur.

Finally, it is not the end of the world if we have stretch marks. Those who have them must learn to live with them. Those who can prevent them must do their best to prevent them. At the end of the day, a lot of people have far more serious skin complications. Therefore, a few marks on the skin as a result of bodybuilding or weight loss is not the end of the world. 

STRETCH MARKS: THEY'RE THE BATTLE SCARS. WEAR THEM WITH PRIDE

References:

1. Mohammed L Elsaie, Leslie S Baumann and Lofty T Elsaie. Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update. Dermatol Surg 2009;35:563–573

2. Buchanan K, Fletcher HM, Reid M. Prevention of striae gravidarum with cocoa butter cream. Int J Gynaecol Obstet. 2010 Jan;108(1):65-8

3. Osman H, Usta IM, Rubeiz N, Abu-Rustum R, Charara I, Nassar AH. Cocoa butter lotion for prevention of striae gravidarum: a double-blind, randomised and placebo-controlled trial. BJOG. 2008 Aug;115(9):1138-42.

4. Mahesh Masand. Physiological striae in adolescence: not physical abuse. Emerg Med J 2012;29:9 doi:10.1136/emermed-2011-200666
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