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Creatine safety issues

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  • Marco Cardinale
    Dear Sport Science list, I am writing here to raise further discussion on the Creatine Issue. In Italy these days is very hard to work with supplements since a
    Message 1 of 5 , Aug 1, 2000
      Dear Sport Science list,
      I am writing here to raise further discussion on the Creatine Issue.
      In Italy these days is very hard to work with supplements since a lot of
      investigations have been conducted following the calim that in soccer there
      were health hazards due to the abuse of some doping and non-doping
      substances.
      Creatine has been indicated as the most dangerous substance between
      supplements.
      On the big daily newspapers big claims have been made, supplement companies
      have been suited for putting on their labels indications of using doses of
      10 g per day.

      A judge is investigating on this issue, and on the doping existing in
      Italian sport. However, looks like this investigation is only working
      towards "destroying" the use of supplements in top sports.

      We all agree that doping is a serious issue, and health comes first when
      dealing with supplements, but, how can it be possible that people get suited
      for giving 10 grams of creatine to their athletes and companies put on
      labels 10 grams as the suggested amount when all the available scientific
      literature does not suggest side-effects even with doses up to 20grams per
      day ?

      All the claims are based upon the attached paper, which has been written by
      one of the experts of the Italian Judge which started this big
      investigation.

      In Italy the situation now is that giving creatine with amounts bigger than
      5 grams per day can lead to lawsuits....
      what is your opinion about it ?


      ----Reference--------
      Benzi G. Pharmacol Res 2000 Mar;41(3):255-64

      Is there a rationale for the use of creatine either as nutritional
      supplementation or drug administration in humans participating in a sport?


      Even though no unambiguous proof for enhanced performance during
      high-intensity exercise has yet been reported, the creatine administration
      is charged to improve physical performance and has become a popular practice
      among subjects participating in different sports. Appropriate creatine
      dosage may be also used as a medicinal product since, in accordance with the
      Council Directive 65/65/CEE, any substance which may be administered with a
      view to restoring, correcting or modifying physiological functions in human
      beings is considered a medicinal product. Thus, quality, efficacy and safety
      must characterize the substance. In biochemical terms, creatine
      administration enhances both creatine and phosphocreatine concentrations,
      allowing for an increased total creatine pool in skeletal muscle. In
      thermodynamics terms, creatine interferes with the creatine-creatine
      kinase-phosphocreatine circuit, which is related to the mitochondrial
      function as a highly organized system for the energy control of the
      subcellular adenylate pool. In pharmacokinetics terms, creatine entry into
      skeletal muscle is initially dependent on the extracellular concentration,
      but the creatine transport is subsequently down-regulated. In
      pharmacodynamics terms, the creatine enhances the possibility to maintain
      power output during brief periods of high-intensity exercises. In spite of
      uncontrolled daily dosage and long-term administration, no research on
      creatine safety in humans has been set up by specific standard protocol of
      clinical pharmacology and toxicology, as currently occurs in phase I for the
      products for human use. More or less documented side effects induced by
      creatine are weight gain; influence on insulin production; feedback
      inhibition of endogenous creatine synthesis; long-term damages on renal
      function. A major point that related to the quality of creatine products is
      the amount of creatine ingested in relation to the amount of contaminants
      present. During the production of creatine from sarcosine and cyanamide,
      variable amounts of contaminants (dicyandiamide, dihydrotriazines,
      creatinine, ions) are generated and, thus, their tolerable concentrations
      (ppm) must be defined by specific toxicological researches. Creatine, as the
      nutritional factors, can be used either at supplementary or therapeutic
      levels as a function of the dose. Supplementary doses of nutritional factors
      usually are of the order of the daily turnover, while therapeutic ones are
      three or more times higher. In a subject with a body weight of 70 kg with a
      total creatine pool of 120 g, the daily turnover is approximately 2 g. Thus,
      in healthy subjects nourished with a fat-rich, carbohydrate-, protein-poor
      diet and participating in a daily recreational sport, the oral creatine
      supplementation should be on the order of the daily turnover, i.e. less than
      2.5-3 g per day, bringing the gastrointestinal absorption to account. In
      healthy athletes submitted daily to high-intensity strength- or
      sprint-training, the maximal oral creatine supplementation should be on the
      order of two times the daily turnover, i.e. less than 5-6 g per day for less
      than 2 weeks, and the creatine supplementation should be taken under
      appropriate medical supervision. The oral administration of more than 6 g
      per day of creatine should be considered as a therapeutic intervention
      because the dosage is more than three times higher than the creatine daily
      turnover and more than six times higher than the creatine daily allowance.
      In this case, creatine administration should be prescribed by physicians
      only in the cases of suspected or proven deficiency, or in conditions of
      severe stress and/or injury. 2000 Academic Press@p$hr Copyright 2000
      Academic Press.

      Publication Types:
      Review
      Review, tutorial
    • Annelie Shield by way of Will Hopkins
      Whilst we have much to learn about creatine and its long term effects when employed as a supplement, surely it is appropriate to urge caution regarding it use?
      Message 2 of 5 , Feb 13, 2001
        Creatine safety issues
        Whilst we have much to learn about creatine and its long term effects when employed as a supplement, surely it is appropriate to urge caution regarding it use? I would prefer to mistakenly suggest that creatine is  not safe than to mistakenly suggest that it is.
         
         
        Those interested in a thorough review of creatine, its metabolism and potential impact on health may wish to read...
         
        Wyss and Kaddurah-Daouk (2000). Creatine and creatinine metabolism. Physiological Reviews, 80(3):1107-1213.
         
         
        This a very thorough review of creatine metabolism with reference to both potentially positive and negative effects that creatine may have on health. (It also contains a section on the ergogenic effects of creatine).
         
        The authors cite evidence suggesting that creatine or creatine analogs have potentially positive effects on a number of diseases. For example, there are preliminary studies (mostly using animal models) suggesting that cyclocreatine (an analog) displays anti-tumour, anti-viral and anti-diabetic effects.There is also the suggestion that creatine and cyclocreatine may have a protective effect in several animals models of neurodegenerative disease. Nevertheless, high creatine intake may also increase the production of methylguanidine (a uraemic toxin), whilst cooking foods which contain creatine (ie meat) results in the production of mutagens that are carcinogenic in certain tissues of rodents and monkeys. 
         
         
         
        Tony Shield
         
         
      • James William Krieger by way of Will Ho
        While cooking meat may result in the production of some carcinogens, this is irrelevant to creatine supplementation. I do not know of anyone who cooks their
        Message 3 of 5 , Feb 13, 2001
          While cooking meat may result in the production of some carcinogens, this
          is irrelevant to creatine supplementation. I do not know of anyone who
          cooks their creatine powder.

          James Krieger
          Graduate student, exercise science
          Washington State University

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