Fight Medicine: Tragedy in Brazil

By Jon Gelber M.D. Sep 30, 2013

Editor’s note: Jon Gelber is’s resident “Fight Doctor.”

Brazil and the mixed martial arts community over the weekend mourned the sudden passing of Nova Uniao fighter Leandro Souza. He died at the age of 28 on Thursday during the final stage of his weight cut for a bout at Shooto Brazil 43.

According to teammates and multiple outlets, Souza was still one kilogram -- about two pounds -- overweight and went to a sauna, where he subsequently fell ill. He was transported to a hospital, where he passed away. According to Yahoo! Sports’ Kevin Iole, the Institute of Forensic Medicine determined Souza suffered a stroke, though it was noted that it was “premature” to attribute the stroke to the young Brazilian’s attempts to cut weight. Other sources have stated he may have had an arterio-venous malformation, which is an abnormal connection between the arteries and the veins in the head. Ultimate Fighting Championship welterweight Thiago Alves was once afflicted with an AVM.

Of course, many in MMA circles will raise their hands and ask if Souza had any pre-existing medical conditions, and if so, why they went undetected in the pre-fight physical or brain MRI. Perhaps they were detected and declared stable. At this point, we do not know, and we may never know. What will not change is the fact that Souza died during the final weight cut, trying to make weight just 24 hours before his fight.

The amount of weight cutting before MMA bouts has become more and more extreme over the years. Fighters have been known to cut up to 20 pounds for a weigh-in merely 24 hours before their fight. Weigh-ins have been a standard for combat sports for generations. However, there is a significant difference between a steady and controlled weight cut and putting yourself in danger to come in under weight at the last minute, only to put it all back on in order to have an advantage over your opponent.

Some fighters seem to have no problem making weight. Others struggle. Weigh-ins can be daunting, and not making weight could make the difference between a chance in the UFC and not making rent. It is not unheard of for fighters to dehydrate themselves to the point of needing intravenous fluids right after the weigh-in. These drastic weight cuts, however, can sometimes lead to sub-optimal performance when the actual bout begins.

Other methods of weight loss can prove detrimental to a fighter’s health. The simplest risky weight cutting practices involve starvation or fasting. Significant enough starvation can cause your body to enter a state of emergency as it struggles to break down its own storages, leading to high levels of dangerous substances in the blood, such as lactate and ketones.

Another unhealthy method of weight loss is the use of diet pills or laxatives. Many diet pills contain substances that supposedly increase your body’s metabolism, but in reality, the real effects your body will feel are increased heart rate and/or high blood pressure, possibly even to dangerous levels. In addition, laxatives can lead to dehydration from excessive water loss; they also do not allow the body to absorb the nutrients it needs before the food is pushed through the body. In addition, some of the diet pills and laxatives contain ingredients that are banned by national and international sports organizations.

Dehydration, or sweating it out, is a result of more fluid being lost than replenished. By not consuming liquids and sweating out water, fighters will lose weight quickly, but this is a very dangerous practice. Dehydration may lead to electrolyte imbalances that can have serious health consequences. In addition, practices such as working out in garbage bags or saunas can cause your body to overheat and your blood pressure and heart rate to skyrocket, preventing your body from naturally keeping itself under control.

When your organs do not see enough fluid or electrolyte imbalances occur, the organs can begin to fail. Two-time Olympic wrestler Daniel Cormier endured a scary experience during the 2008 Summer Games in Beijing. As is customary with almost all elite-level wrestlers, Cormier was cutting water weight when his kidneys failed, forcing him to withdraw from the competition. Another UFC veteran, Marcus Davis, has told the story of when he fought for Canada’s Maximum Fighting Championship promotion at 155 pounds. Davis said the cut “nearly killed him,” leaving him unable to speak at the weigh-ins because his throat was so coarse from dehydration. He was also unable to use the bathroom for several days. A third story circulating the Internet involves Rory Markham, who reportedly cut weight so much that his body cramped severely enough to collapse a lung. What all these stories say is that there is a problem out there with dangerous weight cutting techniques and regulation.

What the sport of MMA needs is an overall governing body. Unfortunately, under the current setup, each state has its own commission that oversees contests. Even so, fighters can still fight on Native American soil without being subjected to state regulations. Many of us in the medical community are trying to find a solution to these unregulated problems. However, we cannot do it alone. We need the help of the MMA community to help identify and solve problems as the sport grows. There are unsafe practices out there, and educating yourself is step one in the right direction.

Want your question answered by The Fight Doctor in the Fight Medicine Mailbag? You can contact him by email at [email protected] or follow him on Twitter @fightmedicine. You can also read more about MMA Injuries, Health, and Training at


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