What was the real cause of death of social media celebrity Rich Piana?
The world of body building was left reeling by the death at just 45 of Rich Piana. Tributes have been pouring in from friends and family and others around the world who wanted to pay their respects to this popular athlete.
The body builder was the winner of many awards and a former Mr California. But the pressure to stay big and keep competing forced him to indulge some dangerous practices which in the end proved fatal.
Official Autopsy said Cardiac Arrest
OK so we know that it was a heart attack that killed him but what caused the heart attack? After all although its not impossible to succumb to heart disease at age 45 it isn’t probable. It definitely was not clogging of the heart by cholesterol the coroner confirmed this. Rich Piana always ate healthily anyway so it would have been a great surprise if cholesterol had caused his myocardial infarction.
So what did cause his heart to give out?
Rich Piana started taking steroids from an early age

Rich Piana came clean a few years ago about taking steroids. He admitted he had been doing them since the age of 18. It probably came as no big shock to anyone but the extremely naive. After all nobody gets that big without some help.
Steroid use can enlarge the heart and cause problems for the liver but there has never been been a case of someone overdosing on steroids to the point where they collapse and ultimately die.
So if it wasn’t steroids was it growth hormone?
Human growth hormone is even less likely to have caused Rich Piana to collapse with a heart attack. HGH is well known to have fewer and less potent side effects than steroids and in fact is quite good for the heart. The only way for excess HGH to cause heart problems is when the body grows so big (ie tall) the heart is not strong enough to pump it around.
This certainly wasn’t the case here.
A white powder and a straw was found in the house but his girlfriend denies it was cocaine
As you can see she says it was pre-workout which is also called ECA which consists of Ephedrine, Caffeine and Aspirin. This is used by bodybuilders to numb pain and get the “pump” going during training. Its used to get a lift before training. The only thing was that it’s quite unusual for people to snort it but as his girlfriend says Rich Piana was an unconventional guy.

The number one suspect is Insulin
Its known that Rich Piana was taking Insulin as he has admitted to in the past. Insulin really is the last taboo for body builders because it’s so dangerous. It works by converting all the free sugars in the blood to glycogen then using it as fuel for the muscles.
Insulin abuse is also suspected in professional sport as an alternative to anabolic steroids – which can be detected by testing.
In contrast, an insulin injection is virtually undetectable
The dangerous thing about using insulin is it can deplete blood sugar to zero if you get it slightly wrong. You must have enough sugar in your blood to have some left over after the Insulin has done its work. You have to get it spot on. If you get the dosage and blood sugar levels wrong you could get into serious trouble.
Insulin and ECA pre-workout interacted with disastrous effect
So the medical reason turns out to be a combination of depleted blood sugar which caused him to fall into a diabetic coma and the unconventional snorting of the pre-workout powder which caused erratic palpitations of the heart.
At autopsy Rich Piana was also found to have an enlarged heart through years of excessive steroid use and this also contributed to his death.
So neither one of these factors by themselves would have caused the heart attack but combined they caused Mr Piana’s untimely death.
The real cause of Rich Piana’s death
The ultimate cause of Rich Pianas death wasn’t really the cocktail of drugs he was taking but the never ending chase for perfection which lead him to lose sight of what was safe. He often said he thought of himself as skinny and so body dysmorphia probably played a part. A kind of reverse anorexia. He just let go of reality and in the end paid the full price.