Contrary to certain rumors that animal-based protein is more suitable to trigger muscle growth than plant-based protein, a study by Mangano et al. (2017) could not provide any evidence for this. In contrast, if combined properly, plant-based protein can even have a higher biological quality. A combination of one part wheat protein (e.g. seitan) and two parts soy protein (e.g. tofu) has thus been favored by many bodybuilders. Some bodybuilders, such as Patrik Baboumian and Robert Cheeke, follow a strict vegan diet.
In natural contests, the testing protocol ranges among organizations from lie detectors to urinalysis. Penalties also range from organization to organization from suspensions to strict bans from competition. It is also important to note that natural organizations also have their own list of banned substances and it is important to refer to each organization's website for more information about which substances are banned from competition. There are many natural bodybuilding organizations; some of the larger ones include: MuscleMania, Ultimate Fitness Events (UFE), INBF/WNBF, and INBA/PNBA. These organizations either have an American or worldwide presence and are not limited to the country in which they are headquartered.
Sandow organized the first bodybuilding contest on September 14, 1901, called the "Great Competition". It was held at the Royal Albert Hall in London. Judged by Sandow, Sir Charles Lawes, and Sir Arthur Conan Doyle, the contest was a great success and many bodybuilding enthusiasts were turned away due to the overwhelming amount of audience members. The trophy presented to the winner was a gold statue of Sandow sculpted by Frederick Pomeroy. The winner was William L. Murray of Nottingham. The silver Sandow trophy was presented to second-place winner D. Cooper. The bronze Sandow trophy — now the most famous of all — was presented to third-place winner A.C. Smythe. In 1950, this same bronze trophy was presented to Steve Reeves for winning the inaugural NABBA Mr. Universe contest. It would not resurface again until 1977 when the winner of the IFBB Mr. Olympia contest, Frank Zane, was presented with a replica of the bronze trophy. Since then, Mr. Olympia winners have been consistently awarded a replica of the bronze Sandow.
Some bodybuilders use drugs such as anabolic steroids and precursor substances such as prohormones to increase muscle hypertrophy. Anabolic steroids cause hypertrophy of both types (I and II) of muscle fibers, likely caused by an increased synthesis of muscle proteins. They also provoke undesired side effects including hepatotoxicity, gynecomastia, acne, the early onset of male pattern baldness and a decline in the body's own testosterone production, which can cause testicular atrophy. Other performance-enhancing substances used by competitive bodybuilders include human growth hormone (HGH), which can cause acromegaly.
Carbohydrates play an important role for bodybuilders. They give the body energy to deal with the rigors of training and recovery. Carbohydrates also promote secretion of insulin, a hormone enabling cells to get the glucose they need. Insulin also carries amino acids into cells and promotes protein synthesis. Insulin has steroid-like effects in terms of muscle gains. It is impossible to promote protein synthesis without the existence of insulin, which means that without ingesting carbohydrates or protein—which also induces the release of insulin—it is impossible to add muscle mass. Bodybuilders seek out low-glycemic polysaccharides and other slowly digesting carbohydrates, which release energy in a more stable fashion than high-glycemic sugars and starches. This is important as high-glycemic carbohydrates cause a sharp insulin response, which places the body in a state where it is likely to store additional food energy as fat. However, bodybuilders frequently do ingest some quickly digesting sugars (often in form of pure dextrose or maltodextrin) just before, during, and/or just after a workout. This may help to replenish glycogen stored within the muscle, and to stimulate muscle protein synthesis.
Many people choose to forgo food from animal sources to varying degrees (e.g. flexitarianism, pescetarianism, vegetarianism, veganism) for health reasons, issues surrounding morality, or to reduce their personal impact on the environment, although some of the public assumptions about which diets have lower impacts are known to be incorrect. Raw foodism is another contemporary trend. These diets may require multivitamin supplements to meet ordinary nutritional needs.
In recent years, the related areas of fitness and figure competition have increased in popularity, surpassing that of female bodybuilding, and have provided an alternative for women who choose not to develop the level of muscularity necessary for bodybuilding. McLish would closely resemble what is thought of today as a fitness and figure competitor, instead of what is now considered a female bodybuilder. Fitness competitions also have a gymnastic element to them. A study by the Clinical Journal of Sport Medicine found that female bodybuilders who are taking anabolic steroids are more likely to have qualified for substance dependence disorder, to have been diagnosed with a psychiatric illness, or to have a history of sexual abuse.