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



Side Effects of Creatine Use

Creatine supplementation is accompanied by relatively mild side effects, which are primarily associated with the intake of high doses of creatine.  Specific side effects include weight gain, nausea, diarrhea, muscle cramps, dehydration, and kidney problems.[1-4]

Weight Gain
Weight gain is the most commonly reported side effect of creatine supplementation.[3,4]  In particular, an individual may experience an increase in weight of 1 to 3 pounds within the first week of creatine use.[5]  This weight gain, however, is not actual muscle mass but is the result of water retention, 80% of which is intracellular water.[4,5]  Although this side effect may be desirable to some athletes such as body builders, it may be unwanted by endurance athletes including swimmers and distance runners.[4]

Nausea and Diarrhea
Nausea and diarrhea are other common side effects of creatine usage.  As with the other side effects, nausea and diarrhea are associated primarily with the consumption of large amounts of creatine and are most likely due to undissolved creatine drawing water into the intestine.[1,2,5]

Muscle Cramps and Dehydration
Muscle cramps and dehydration are also associated with creatine use.[1-4]  In fact, the Association of Professional Team Physicians has warned that creatine use may result in “dehydration and heat-related illnesses, reduced blood volume, and electrolyte imbalances”.[3]  Like other side effects of creatine supplementation, dehydration results from the intake of large doses of creatine.  Dehydration occurs because a large portion of the body’s water content follows creatine into the skeletal muscle, thereby reducing urination and potentially leading to impaired thermoregulation and subsequent heat exhaustion.[1,2]

Kidney Problems
Finally, a few cases of kidney problems, or renal dysfunction, in association with creatine use have been reported.[1-4]  In addition to the healthy 24-year-old weight lifter in the CASE STUDY, Houston Astros outfielder Derek Bell was hospitalized twice in 2000 for kidney complications that he associated with creatine use.[3,4]  Furthermore, creatine supplementation may have been the cause of kidney damage in three other cases:  an asthmatic athlete, a patient with a preexisting kidney condition, and a weightlifter.  Each of these people experienced cramping after 28 days of continuous creatine supplementation and displayed elevated creatinine levels, which were as much as 40% above normal.  Creatinine results from the degradation of creatine; elevated levels of creatinine in the urine serve as an indicator of kidney damage.[2]  (Read more about the CREATINE-CREATININE EQUILIBRIUM, and the CREATININE TEST FOR KIDNEY FUNCTION.)  Another example of kidney trouble caused by creatine use was reported in the April 25, 1998 issue of the Lancet.  According to this report, a 25-year-old male receiving cyclosporine for steroid-resistant focal segmental glomerulosclerosis (FSGS) experienced renal complications after beginning creatine supplementation.  FSGS is a relatively common form of kidney disease in the United States.[6]  One month after terminating creatine supplementation, the patient’s renal function returned to normal.[3]/  Finally, renal complications resulting from creatine use were reported for a 20-year-old male with no preexisting health conditions.  The man had been consuming high levels of creatine supplements (5 grams of creatine 4 times a day) for 4 weeks when he was hospitalized for nausea, vomiting, dehydration, and bilateral flank pain.  Testing revealed that he was suffering from acute focal interstitial nephritis (inflammation of the kidney).  When he stopped using creatine, his symptoms normalized.[7] Although some studies have indicated that creatine is safe if taken in recommended doses, these incidences of renal dysfunction associated with creatine supplementation suggest that further studies should be conducted to establish the safety of creatine.

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[1] Juhn, Mark S. “Oral Creatine Supplementation: Separating Fact from Hype.” The Physician and Sports Medicine. 1999, 27(5).
[2] Kreider, Richard B. “6 Creatine Fears: Real Concern or False Alarm?” Joe Weider’s Muscle and Fitness. 1999, 60(11), 160-161.
[3] Graham, Angie S.; Hatton, Randy C.  “Creatine Studies.” Journal of the American Pharmaceutical Association. 1999, 39(6), 803-810.
[4] Murphy, Dee. “What You Should Know About Creatine.” Current Health 2. 2000, 26(6), 13.
[5] NutraSense. (accessed April 2002).
[6] Focal Segmental Glomerulosclerosis (FSGS). UNC Kidney Center. (accessed April 2009).
[7] Koshy, K. M.; Griswold, E.; Schneeberger, E. E. “Interstitial Nephritis in a Patient Taking Creatine.” New England Journal of Medicine. 1999, 340(10), 814-815.