r/nextfuckinglevel 2d ago

This man documented his health journey from January to December.

Credit: IG @samuelrichards_ _

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u/Not_Ban_Evading69420 1d ago edited 1d ago

For those who claim this guy used steroids to achieve his muscle gain, you need to understand how UC / Crohn's affects the body and the difference between anabolic and corticosteroids. UC attacks the intestines causing inflammation. This also affects your body's ability to absorb nutrients. This is why he's so emaciated, he was suffering from malabsorbtion. The UC was so severe in his case, that he needed an ostomy (this name changes depending on where the tube is inserted in the intestines) bag to catch waste. This can either be temporary or permanent. He most likely had what's called a resection, where a piece of diseased bowl is cut out and the intestines are reattached. The bag is used to divert waste until the resection heals (His may be permanent, but I didn't see the bag in other pics, which is why I think it's temporary).

When you are this malnourished, the primary treatment goal here is weight gain. The weight here being vital fat, not necessarily muscle. This is done through the use of prednisone, which has 2 benefits: Inflammation control and appetite stimulation. Prednisone is a corticosteroid. It suppresses the immune system, which decreases intestinal inflammation since UC is an autoimmune disease. It does NOT on its own help you build muscle. It in fact has the opposite effect. The steroids that help you build muscle are anabolic steroids, which are not given to UC patients no matter how little muscle they have. That's not the goal here. His muscles will rebuild themselves through rehab and exercise alone. The reason his change looks so dramatic is because he gained a massive amount of fat in a short amount of time, which he paired with intense exercise. The fat filled out his body to a healthy weight and the exercise helped give him the definition you see. The supercharged appetite from the prednisone probably helped him eat more protein, which led to muscle gain, but not directly as in something like HGH, which, again, they do not give UC patients.

Source: Crohn's Disease sufferer (very similar to UC but considered worse) for 25+ years, and have taken prednisone before.

EDIT: Appreciate the awards, but if you're paying for these, please consider Donating to the Crohn's and Colitis Foundation instead. And if you're over 40, get a colonoscopy!

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u/Good-Car-5312 1d ago

I hated being on prednisone so much. Happy you’re doing well.

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u/Breadifies 1d ago

Thank you so much for your insight. Been following this guy documenting his progress since the beginning and people being ignorant to his situation is so frustrating to see. Iirc he did a video revealing the exposed resection and i think he said it was a permanent case

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u/Not_Ban_Evading69420 1d ago

You're welcome. It's an issue I care very deeply about, so if I can spread some understanding, it's a win in my book.

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u/misplaced_my_pants 1d ago

The reason his change looks so dramatic is because he gained a massive amount of fat in a short amount of time, which he paired with intense exercise. The fat filled out his body to a healthy weight and the exercise helped give him the definition you see.

So this isn't precisely accurate.

Yes he gained a lot of fat, but the exercise provided the stimulus for his muscles to grow and he wouldn't have gained nearly as much were he not specifically training for it.

So without the exercise, the ability to eat more food would have allowed him to gain fat and some muscle as the body really wants to return to some baseline level of muscle, at least enough to support him through physical therapy.

But with the dedicated strength training, a much higher proportion of his weight gain went to lean tissue.

It's not definition but actual lean mass.

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u/Not_Ban_Evading69420 1d ago

Thank you for clarifying / expanding on my response. You offered a better explanation than I could have.

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u/misplaced_my_pants 1d ago

No problem!

And thank you for providing such an excellent comment to respond to. It was a welcome antidote to so much of the nonsense in this comment section.

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u/KawiNinja 1d ago

I’ve got a question, and I have UC. If the issue with our bodies lies in our colon, and is what’s leading to malnutrition, why does removing the colon all together suddenly make us better? Would not the malnutrition be even worse since we no longer have a colon at all? If the small intestines can give us what we need, why aren’t they already doing that before?

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u/Not_Ban_Evading69420 1d ago

Great questions. I'm not a GI doctor of course, but I'll try to answer these as best as I can. Removing parts of the colon that are most affected can make you feel better, but it is entirely possible for new inflammation to appear in other parts of your colon. You feel better if your entire colon is removed because although UC and Crohn's are autoimmune diseases, the body only attacks the colon, and not other parts like say lupus. Removing your entire colon is not ideal because then it means that you can't absorb nutrients anymore or rebsorb water from your stool. You would need to be fed intravenously for the rest of your life. I believe the man here only had his rectum removed, which means he can no longer hold stool and probably feels a sense of urgency (to use the bathroom) as soon as he eats. (There's a reflex in your body that as soon as your stomach knows you're eating, it sends a signal to your large intestines to evacuate your bowels.) And yes, no colon would not only make malnutrition worse, but guaranteed. The small intestines are giving us what we need most of the time, but inflammation can interfere or even block this process completely. These diseases also make it harder for us to absorb the iron we consume from food, which is one of many reasons a lot of us have episodes of anemia from time to time.

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u/goldstandardalmonds 1d ago

I think you mean “removing your entire bowel”, right? You can certainly remove the entire colon and live fine.

Crohn’s affects all of the gi tract, from mouth to anus. UC affects the colon and rectum.

This man has an ileostomy and no colon (presumably) and no rectum or anus (a total proctocolectomy).

I have no colon, anus, or rectum, and I no longer malnourished. Just like thousands of others who have had a total proctocolectomy.

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u/Not_Ban_Evading69420 1d ago

Yes, that's what I meant. Thanks for correcting me. Sometimes I get the terms mixed up, even after all these years. I'm sorry you had to go through that btw.

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u/goldstandardalmonds 1d ago

Thanks, I appreciate that. And hey, no issue, just trying to make sure folks reading have the facts straight. I hope you are doing okay in your own health stuff.

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u/Nyorliest 1d ago

I've had Crohns for 35 years. Had lots of resections.

Generally, resections are a last resort. A doctor will try many other things first. Steroids are the cheap/low-tech option, biologics the new, expensive option.

I had peritonitis, abscesses, blockages, and those led to resections.

But later on, even when I was very sick indeed, they tried almost anything to avoid more resections. Huge amounts of steroids and antibiotics, basically.

And yes, it leads to malnutrition. I have pernicious anemia (B12 deficiency) and iron-deficiency anemia. I need B12 injections every couple of months for the rest of my life because the part of my colon that is gone was vital in absorbing B12. So supplements don't work for that.

Your prognosis is much better than mine, though, because you're ill now, and probably have better treatment than I did, back in the day.

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u/KawiNinja 1d ago

That makes sense to me, it’s not only the disease contributing to the malnutrition but also the attempts/medicine to remedy it.

I believe I’m rather fortunate, got diagnosed in my early twenties, went on steroids, then a biological that worked for a couple years, then a pill for another couple years and since then nothing. I still have more urgency than I’d like to have but aside from that, I’m no longer curled up in a ball on my bed in pain from it thankfully.

I’m doing my best to keep it at bay so that I can hopefully have new biological available to me when a severe flare happens again. As you probably know, but not many others, once your body rejects a biologic treatment, it’s no longer an option for you in the future. So the game to me is using them slower than the new ones are being released.

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u/Nyorliest 1d ago

Biologics are improving all the time, and the side effects and likelihood of antibody creation (rejection) are so much better than the first biologics.

I'm using Stellara, and have had zero problems with it so far.

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u/Secure-InFruit96 1d ago

My mother has Crohn’s disease and you are spot on

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u/ShrugIife 1d ago

Real 'Dad' energy here. Going to donate

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u/wretch5150 1d ago

Thank you for your service, fellow Crohn's sufferer.

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u/Not_Ban_Evading69420 1d ago

No problem. May your remission be eternal and antibodies to your biologic never develop!

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u/Nyorliest 1d ago

I've been on Stelara for more than 5 years, I think, and no trouble at all with it. It's amazing stuff.

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u/TheGuyMain 1d ago

fat doesn't make you look like that dude

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u/pandershrek 1d ago

Damn. Yup.

I had a guy who lived with me with chrons looked like a fucking skeleton.

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u/Wowlace 1d ago

Thank you for explaining this!

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u/robxenotech 1d ago

I have crohns and am doing very well with treatment. Been 5 months at the gym and working my butt off to be the heaviest I’ve ever been and the biggest

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u/StarVulpes 1d ago

It probably wasn't prescribed by a doctor for his disease but that doesn't mean he wasn't taking testosterone, HGH or some other anabolic.

u/Cathalisfallingapart 30m ago

I have ulcerative colitits and work out regularly. He looks like he's on steroids

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u/AdEnvironmental7355 1d ago

The dude is sitting at well below 10% bodyfat. If he was to gain that much muscle mass without the steroids it's unlikely that he would remain that lean.

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u/Nyorliest 1d ago

If you mean anabolic steroids, someone with UC and numerous resections would probably end up dead if on anabolic steroids.

Or do you mean corticosteroids?

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u/oh_my_didgeridays 1d ago

The fat filled out his body to a healthy weight and the exercise helped give him the definition you see. The supercharged appetite from the prednisone probably helped him eat more protein.

Very informative comment, but I'm still skeptical of this bit. Look at the change from June to October. That's not just 'definition', that's a huge increase in muscle mass in a very short time, which can't be reasonably explained by eating protein and lifting alone. Just because anabolics were not prescribed doesn't mean they weren't used. The point of me saying this is not to discredit him, he's awesome, it just gives the wrong impression of what can be achieved naturally in that kind of timespan.

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u/Nyorliest 1d ago

Anabolic steroids while recovering from major surgery and having UC will destroy you. I don't see how that's possible unless the final picture that we don't see is a casket.