Saturday, March 5, 2011

Creatine: once more falsely accused

It amazes me how often creatine is blamed for various athletic problems. These problems range from dehydration to severe muscle cramps. This is true despite the fact that numerous, well-controlled studies have shown that creatine is safe and is not the cause of these problems. The creatine hysteria peaked back in 1997, when three collegiate wrestlers who were otherwise healthy, abruptly died within a two month time frame. The actual cause of death of the wrestlers turned out to be severe dehydration and kidney failure. In an effort to make weight, the wrestlers had severely restricted their fluid intake, while also exercising vigorously in a hot environment and wearing heavy rubber exercise apparel. Several self-styled experts quickly accused creatine usage as the primary culprit behind the young wrestlers premature demise. But it turned out that there was no evidence that any of the dead wrestlers had used creatine. If anything, they likely avoided creatine shortly before their tragic deaths, because creatine is known to promote a certain level of water retention. And the wrestlers were doing everything they could to lose water.

In the latest incident, 19 high school football players from McMinnville High School in Oregon were afflicted with compartment syndrome, to the extent that most of them had to be hospitalized. Compartment syndrome is a swelling of the connective tissue or fascia that surrounds muscles. If the swelling becomes severe, it can choke off blood vessels, nerves, and destroy muscle tissue. One characteristic of this syndrome, besides pain, is an elevation of creatine kinase (CK), an enzyme found in muscle that functions to add a phosphate group to creatine, allowing the creatine to be stored in muscle. Whenever muscle is damaged, including heart muscle, CK is released into the blood. Normal levels of CK range form 200 to 2,000. The level found in the Oregon football players averaged 40,000. Since compartment syndrome is a relatively rare event in sports, the fact that 19 players on the same time all came down with it at the same time suggested that something was amiss. A finger had to be pointed somewhere, and creatine appeared to be a prominent suspect.

In fact, the players had engaged in a so-called “immersion camp,” that involved intensive pre-conditioning activity in the heat. None of the players had conditioned themselves to do high intensity exercise, much less in a hot environment. They started to complain about excessive swelling in their triceps after doing a series of push-ups and chair dips in a 30-second alternating series of reps over 20 minutes in a hot, humid wrestling room where temperatures averaged 115 to 120 degrees. If the athletes didn’t complete their rep goal, they had to start over again. In addition, they were not permitted to drink any water during the workout. All this is a classic scenario for the onset of rhabdomyolysis, or rapid destruction of muscle tissue. Rhabdo,as it’s often called, is linked to dehydration and unaccustomed exercise in a hot environment. One the primary signs of rhabdo is an extremely high release of CK into the blood. If not rapidly treated, release of a muscle iron pigment called myoglobin can jam up the kidneys, resulting in total kidney failure. There are several case studies on record of bodybuilders who suffered from rhabdo, often from trying a new intense style of training while dehydrated and in hot conditions.

In truth, none of the football players said they had used creatine prior to the disease incident. So why was creatine wrongly accused? My guess is that because creatine can promote water retention, it was thought that this caused the rapid onset of compartment syndrome in the athletes. Also, the fact that the CK levels were extremely high in the players, also pointed to creatine, since CK works with creatine in muscle. But the flaw in these suggestions is that most of the water retained by creatine is intracellular, not extracellular. Extracellular water retention can cause the familiar bloating effect, but that doesn’t happen with creatine. If anything, the extra “internal” water retention promoted by creatine would serve to prevent heat related illness, including rhabdo and the compartment syndrome. Besides, none the football players used creatine anyway. But a convenient scapegoat was needed. The truth of the matter is that the players became ill because of stupid training practices, such as doing unaccustomed intense exercise that they weren’t used to, along with not consuming any fluids. So don’t blame creatine, blame the moron coaches who pushed the players into becoming seriously ill.

Find out the truth about creatine and other popular sports supplements in my e-book, Natural Anabolics, available at