Creatine Case Study

Case Study

History

Learning Goals /
Concept Map


Creatine and Related Compounds

Structure

Amino Acids

Creatine in the Body

Equilibrium

Creatine-Creatinine Equilibrium

Creatinine Test for Kidney Function

Detection

Regulation and Ethics

Amine & Nitrile Chemistry

Laboratory Synthesis

Chemical Analysis

Creatine-Phosphocreatine Equilibrium

Uses & Side Effects



Creatine Case Study 1[1]

In college Kevin[2] was a member of the baseball team and was an avid weightlifter and runner. During his senior year, he noticed that he was becoming weaker during weight training and was also losing weight. He was subsequently diagnosed with myasthenia gravis (MG; “grave muscle weakness”), an autoimmune disease with a variety of symptoms including muscle fatigue and weakness, as well as eye problems (drooping eyelids and blurred or double vision)[3], all of which Kevin experienced[1].


Drooping eyelid (ptosis) resulting from MG[4]

It is believed that MG is caused by decreased signal transmission between nerve fibers and muscle fibers at the neuromuscular junction and by decreased amounts of phosphocreatine in muscle.[1,3]


Destruction of neuromuscular connection in MG[5]

One month before his diagnosis, Kevin could bench press 300 pounds, but at the time of his diagnosis, he was unable to do a single push-up. At this point he weighed 187 pounds and had 5-6% body fat. During the four years following his diagnosis, Kevin took medication to treat MG and underwent surgery twice. During this time he started medical school and was able to continue to exercise but was unable to improve his strength and muscle mass. Three months after his second surgery, he began a 15-week regimen of strength training three times a week and supplementing his diet daily with creatine (5 g/day). By the end of this period, he had increased his weight from 171 to 184 pounds and had increased his fat free mass by 4.3%. Strength in both his upper and lower body had also improved by 8-41%, depending on the exercise. Kevin has since finished medical school and is now a practicing physician. While it is impossible to know whether the strength training or the creatine supplementation had a greater effect on Kevin’s increased body weight and strength, this approach shows promise for treating people with MG. Further studies should be carried out on more people, so this approach can be further evaluated[1].

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[1] Stout, Jeffrey R.; Eckerson, Joan M.; May, Eric; Coulter, Cynthia; Bradley-Popovich, Greg E. “Effects of resistance exercise and creatine supplementation of myasthenia gravis: a case study.” Medicine & Science in Sports & Exercise, 2001, 33(6), 869-872.
[2] Name has been changed.
[3] What is Myasthenia Gravis (MG)? Myasthenia Gravis Foundation of America, Inc. <http://www.myasthenia.org/amg_whatismg.cfm> (accessed April 2009).
[4] Born, Kathryn (Illustrator). Myasthenia Gravis — The Dana Guide. The Dana Foundation. <http://www.dana.org/news/brainhealth/detail.aspx?id=9844> (accessed April 2009).
[5] Myasthenia Gravis. The Children’s Health Encyclopedia. Children’s Hospital Central California. <http://www.childrenscentralcal.org/HEALTHE/P02461/P02433/Pages/P02434.aspx> (accessed April 2009).

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Creatine Case Study 2[1]
Hugo[2] is a healthy 24-year-old weight lifter who trains for three hours a day, five times a week[1].

For the past six months, he has been taking a variety of dietary supplements, including creatine (15 g/week—a normal dose), amino acids, vitamins, minerals, and herbs, in order to enhance his performance as a bodybuilder[1]


One day Hugo ends up in the emergency room due to acute abdominal pain. He also has polydipsia (excessive thirst) and polyuria (excessive passage of urine). When he is admitted to the hospital, tests show that he has hypertension (high blood pressure) and proteinuria (an abnormal amount of protein in the urine—an indicator of kidney damage)[3]. Other tests confirm that he is experiencing acute renal (kidney) failure—in particular, acute interstitial nephritis (AIN)[1]

Hugo is hospitalized for five days; during this time he is taken off all of his supplements and is monitored closely. After he is released from the hospital, his kidney function returns to normal, and he no longer has proteinuria. His doctors conclude that out of all the supplements Hugo was taking, creatine is the most likely culprit for his kidney failure, noting that AIN does not depend on dose and that certain people may be more susceptible than others due to differences in drug metabolism and genetics. Further studies need to be conducted in order to determine the safety of creatine and other dietary supplements[1].

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[1] Thorsteinsdottir, Bjorg; Grande, Joseph P.; Garovic, Vesna D. “Acute renal failure in a young weight lifter taking multiple food supplements, including creatine monohydrate.” Journal of Renal Nutrition, 2006, 16(4), 341-345.
[2] Name has been changed.
[3] Proteinuria. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. <http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/> (accessed April 2009).
[4] Acute Interstitial Nephritis (AIN): Overview, Causes, Symptoms, Diagnosis, Treatment. Nephrology Channel. <http://www.nephrologychannel.com/ain/index.shtml> (accessed April 2009).