J Am Board Fam Pract: first published as 10.3122/15572625-13-2-150 on 1 March 2000. Downloaded from

Does Creatine Supplementation Increase the Risk of Rhabdomyolysis?

The case report by Robinson 1 in this issue of The recommend a healthy fluid intake while on creatine Journal represents the most serious published re­ supplements. port to date of an adverse effect in a person taking Rhabdomyolysis has been reported in athletes oral creatine supplements. In light of its severity, it who were not taking creatine supplements. There is prudent to speculate on the likelihood that this are factors, however, that suggest creatine was at man's creatine consumption contributed to his least a contributing factor. First, as do many ath­ rhabdomyolysis. letes who believe more is better, this patient was Rhabdomyolysis results from a breakdown of the taking a very high dose for an extended time. Such muscle cell wall, which leads to cell necrosis. It is high doses and long periods are not only contrary thought to be the result of a plasma membrane to recommendations, but they are also unstudied. defect or a disturbance in the sodium-potassium Second, he was previously healthy and had been body building for 5 years; only during the last year pump that allows an influx of calcium into the cell, was he taking creatine supplements. Third, he was which triggers a cascade of events leading to cell not taking any other supplement that could be a necrosis.2 Robinson speculates that intracellular contributing factor. water retention led to increased skeletal muscle Advocates of creatine supplementation often compartment pressures, which placed the patient at state there is no direct evidence of a causal relation risk for cellular wall breakdown. between oral creatine supplementation and any ad­ Such a hypothesis is simplistic yet worthy of verse side effect. Such a statement is often misin­ consideration. It is accepted that oral creatine sup­ terpreted as proof that creatine is safe. Establishing plementation results in a rapid weight gain, easily a statistically significant relation, however, between 3 noted within 24 hours. ,4 Clearly, 24 hours is not a catastrophic event such as rhabdomyolysis and enough to induce skeletal muscle hypertrophy; the any type of supplement is unrealistic, particularly gain is the result of intracellular and extracellular when using human subjects. fluid retention. Although no studies have evaluated As clinicians, we need to evaluate such cases by creatine supplementation and its effect on muscle incorporating a balance between healthy skepticism http://www.jabfm.org/ compartment pressures, anecdotal evidence of ath­ and open-mindedness. Given the metabolic and letes feeling "tight" or "cramped" abounds. Muscle physiologic changes that occur with oral creatine cramping remains one of the most common side supplementation, combined with the excessive dos­ 5 effects reported by those taking creatine. ,6 ing, Robinson's case adds support to the hypothesis Risk factors for rhabdomyolysis include dehy­ that the use of oral creatine supplements can lead to dration, alcoholism, illicit drug use, trauma, stren­ serious adverse effects. More importantly, it brings on 29 September 2021 by guest. Protected copyright. uous exercise, hypophosphatemia, and a hyperos­ to mind the question that has been plaguing many molal state.2,7,8 Robinson's patient had exercised for years about the role of ergogenic aids for sport: the day before Robinson saw him, though his fluid Is it really worth it? and electrolyte status were not known. It has been Mark S. ]uhn, DO hypothesized that creatine supplementation in­ Seattle creases the risk of dehydration from intravascular volume depletion. Even creatine manufacturers References 1. Robinson S]. Acute quadriceps compartment syn­ drome and rhabdomyolysis in a weight lifter using high-dose creatine supplementation. J Am Board Submitted 5 November 1999. From the Hall Health Primary Care Center, Family Fam Pract 2000;13:134-7. Medicine and Sports Medicine Clinics, University of Wash­ 2. Poels PJ, Gabreels FJ. Rhabdomyolysis: a review of ington, Seattle. Address reprint requests to Mark S. Juhn, the literature. Clin Neurol Neurosurg 1993;95:175- DO, Hall Health Primary Care Center, Family Medicine 92. . and Sports Medicine Clinics, University of Washington, Box 354410, Seattle, WA 98195-4410. 3. Hultman E, Soderlund K, Timmons JA, Cederblad

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G, Greenhaff PL. Muscle creatine loading in men. 6. LaBotz M, Smith BW. Creatine supplement use in J Appl PhysioI1996;81:232-7. an NCAA Division I athletic program. Clin} Sport 4. Vandenberghe K, Goris M, Van Heeke P, Van Leem­ Med 1999;9:167-9. putte M, Vangerven L, Hespel P. Long-term creatine 7. Knochel }P. Mechanisms of rhabdomyolysis. Curr intake is beneficial to muscle performance during re­ Opin RheumatoI1993;5:725-31. sistance training.J Appl PhysioI1997;83:2055-63. 5. Juhn MS, O'Kane JW, Vinci DM. Oral creatine 8. Singhal PC, Kumar A. Desroches L, Gibbons N, supplementation in male collegiate athletes: a survey Mattana J. Prevalence and predictors of rhabdomy­ of dosing habits and side effects. J Am Diet Assoc olysis in patients with hypophosphatemia. Am} Med 1999;5 :593-5. 1992;92:458-64. http://www.jabfm.org/ on 29 September 2021 by guest. Protected copyright.

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