One indirect gauge of the effectiveness of sports
supplements is the amount of criticism directed at them. Supplements
that work as advertised seem to attract more attention. Examples include
ephedrine-and-caffeine combinations that were banned for one year by
the FDA due to often dubious adverse-effect reports, then restored to
the market by a federal judge because of a lack of sufficient scientific
evidence concerning their potential dangers to health when used in
suggested doses, only to be banned again soon afterward. Another example is the pro-hormone supplements, which
fell victim to the ongoing hysteria about anabolic steroids. The final
versions of them were remarkably effective and produced few or no side
effects when used as directed. Their biggest problem was that they
attracted too much attention—and because a few of them actually were
anabolic steroids or contained so-called designer steroids. That last generation of prohormones, officially banned in 2005, did prove to be toxic in many cases, especially to the liver. Small wonder they many turned out to be old, discarded steroids that were developed by drug companies, but never released.
It was perhaps only a matter of time before creatine was
accused of endangering health. That’s evident in reports that it is
linked to kidney failure, muscle cramps and
liver damage, none of which are even remotely true.
Some reports to the FDA have even claimed that using
creatine led to heart problems. Since creatine is a natural constituent
of the human body, synthesized from amino acids in the liver, pancreas
and kidneys, it’s hard to justify an accusation like that. Nevertheless,
a recent case report linked the use of supplemental creatine to
atrial fibrillation, a disturbance of heart rhythm.
1
Atrial fibrillation involves a disturbance in the
contraction of the atrial, or upper chambers of the heart. The
incidence of this disorder doubles with each decade of life, so it’s far
more common in older people. The most frequent cause is long-term
hypertension, or high blood pressure,
which may damage the heart. The errant heart rhythm may lead to more
clots being released into the blood—embolisms that may then travel to
the brain, inducing stroke. Doctors prevent that effect by providing
anticoagulants, such as Warfarin, to those afflicted with the condition.
When atrial fibrillation occurs without any evidence of
structural heart damage, it’s called lone atrial fibrillation. While
it’s rare in younger people, it can be produced by scar tissue forming
in the atrial chambers of the heart, hypersensitivity due to neural
stimulation of the heart or an inflammation in the heart. The most
common causes, however, are drug use, including excessive caffeine
intake, acute alcohol intoxication and using too much thyroid drugs
(many bodybuilders have experienced it after using excessive amounts of
the thyroid drug Cytomel).
In the case study, a 30-year-old man without any prior
evidence of heart problems reported to a hospital emergency room,
complaining of heart palpitations and rapid breathing, both of which had
occurred abruptly within the previous 48 hours. An electrocardiogram
indicated atrial fibrillation. The man denied using any drugs, and none
showed up in his medical tests.
He did, however, admit to using creatine supplements. He’d begun by
taking 20 grams a day for five days, a loading phase, followed by a
maintenance dose of 2.5 grams daily for one month.
That much creatine produced cramping and diarrhea, so he
curtailed it for a month, then switched to a capsule form. He developed
the heart symptoms while taking a loading dose of the creatine
capsules. He was treated with intravenous drugs to prevent clot
formation and to stabilize his irregular heart rhythm. That proved
effective, as his heart returned to normal rhythm in eight hours. He was
discharged within 24 hours and told to take aspirin and a beta-blocking
drug for his heart.
In discussing this man’s case, the author asserts that
since creatine is known to cause dehydration and diarrhea, that may have
caused an electrolyte, or mineral, imbalance that led to the atrial
fibrillation. Yet the man’s primary electrolytes, potassium and
magnesium, were within normal values. While it has been frequently
reported anecdotally that creatine causes dehydration, there’s no
documented evidence in the medical literature that points to it. Since
creatine may promote a shift of water from extracellular to
intracellular compartments in the body, it may adversely affect
electrolyte balance that way, but that would happen only during
restricted fluid intake. The odds that creatine would cause an effect
significant enough to produce a lone atrial fibrillation are remote at
best.
So why did the man in the study experience atrial fibrillation
after he took creatine? He may have had an inherent sensitivity to
creatine, or the creatine may have induced a neural stimulation of his
heart. The latter effect is more likely, since the man was a vegetarian,
and vegetarians have lower creatine stores in their bodies. The loading
dose may have had a druglike effect on him. The solution would be to
avoid the creatine load, which is a dubious technique anyway, and take
no more than five grams, or one teaspoon, a day. In 30 days that will
result in the same level of creatine storage in muscle as a one-week
load, minus any possible side effects.
One other aspect to consider is that if anything,
creatine would be beneficial for the heart. A feature of heart failure
is the lack of production of energy compounds, such as ATP. Anything
that boosts ATP production in the heart would aid heart function.
Several supplements, such as coenzyme Q10, ribose and creatine, have all been shown to do just that.
1 Kammer, R.T. (2005). Lone atrial fibrillation associated with creatine monohydrate supplementation. Pharmacotherapy. 25:762-764.
©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.
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