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Supplements discussion on Creatine, within the Bodybuilding Forum; So went to my Doc today, and we were talking quite a bit. So when he was ordering the blood ...


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Old 10-19-2006, 05:17 PM   #1
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So went to my Doc today, and we were talking quite a bit. So when he was ordering the blood work I noticed they check for creatinine levels. I asked if taking creatine would make an affect on the reading and he went on to tell me to be carefull w/ creatine mono he said it never fails every year he gets 2 kids w/ kidney fail from it. I was like yea right, but he busted out a book(he was planning to go into sports med when he was studying) and it showed how it should be used basiclly load up to 25gr for loading phase then back down to 5gr a day for 2months then STOP for 6 months He said if I did want to use it he would like me to have kidney test before, during,, and when done.

Any comments?

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Old 10-20-2006, 05:41 AM   #2
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Yes, most likely those kids if he is not exagerating had preexesting kidney problems. OR, they simply had elevated kidney values which MANY doctors insist on believing point to kidney problems or failure when in fact it just points to properly functioning kidneys. For creatinine you can look at the levels of a really muscular person and see huge levels even when they don't take creatine.

I don't want to put down your doctor. He's probably doing what he thinks is right. But one doctor getting two kids A YEAR from creatine...not only does it go against the fact that there are no reported cases of kidney failure from creatine in otherwise healthy persons, it is simply statistically improbable. If he had that many there must be A LOT of cases. Apparently nobody is reporting them? Curious. The book with the loading suggestion was just that: a book. An opinion. Another book (newer) is just as likely to say the opposite. The last info I saw there was two documented cases of kidney damage from creatine use. No info as to dosage or pre-existing kidney problems. There are other individual cases of side-effects.

The jury is still out and it simply hasn't been around long enough. But enough of ANYTHING can hurt you and people have a tendency to overdo sups....the more is better thing.

There is no clinical evidence backing up creatine loading phases. The only difference is that you would reach saturation levels more quickly but either way you'll reach the same level and then maintain that level easily with normal doses. There was never any real reason to load or cycle except that bodybuilders were used to doing that. Certainly nothing wrong with stopping creatine sometimes but likewise there is not evidence that this is needed or that creatine will shut down normal production in the body after prolonged use.

The kidney tests are not a bad idea but a regular panel just gets a baseline value. Elevated levels in and of themselves do not automatically mean kidney disease but may call far further testing. Chances are that after you went on creatine for a while something may be elevated above baseline and to your doctor that would be a panic button "proving" that creatine was hurting your kidneys when in fact it proves nothing of the sort.

I would say don't worry about it. I've been on creatine for probably 7 years in which time I've gotten kidney values taken MANY times with no problems.

Last edited by EricT; 10-20-2006 at 01:01 PM..

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If you act sanctimonious I will just list out your logical fallacies until you get pissed off and spew blasphemous remarks.
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Old 10-20-2006, 01:06 PM   #3
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Here are some explanations provided by verbatimreturned. I don't know how perfectly accurate all this is.

BUN (Blood Urea Nitrogen)

This test measures the amount of urea nitrogen that's present in the blood. When protein is metabolized, the end product is urea which is formed in the liver and excreted from the bloodstream via the kidneys. This is why BUN is a good indicator of both liver and kidney function. Increased levels can stem from shock, burns, dehydration, congestive hear failure, myocardial infarction, excessive protein ingestion, excessive protein catabolism, starvation, sepsis, renal disease, renal failure, etc. Causes of a decrease in levels can be liver failure, overhydration, negative nitrogen balance via malnutrition, pregnancy, etc.

Normal range:

Adults
10-20 mg/dl

Creatinine

Creatinine is a byproduct of creatine phosphate, the chemical used in contraction of skeletal muscle. So, the more muscle mass you have, the higher the creatine levels and therefore the higher the levels of creatinine. Also, when you ingest large amounts of beef or other meats that have high levels of creatine in them, you can increase creatinine levels as well. Since creatinine levels are used to measure the functioning of the kidneys, this easily explains why creatine has been accused of causing kidney damage, since it naturally results in an increase in creatinine levels.

However, we need to remember that these tests are only indicators of functioning and thus outside drugs and supplements can influence them and give false results, as creatine may do. This is why creatine, while increasing creatinine levels, does not cause renal damage or impair function. Generally speaking, though, increased levels are indicative of urinary tract obstruction, acute tubular necrosis, reduced renal blood flow (stemming from shock, dehydration, congestive heart failure, atherosclerosis), as well as acromegaly. Decreased levels can be indicative of debilitation, and decreased muscle mass via disease or some other cause.

Normal range:

Adult Male
0.6-1.2 mg/dl

Adult Female
0.5-1.1 mg/dl

BUN/Creatinine Ratio

A high ratio may be found in states of shock, volume depletion, hypotension, dehydration, gastrointestinal bleeding, and in some cases, a catabolic state. A low ratio can be indicative of a low protein diet, malnutrition, pregnancy, severe liver disease, ketosis, etc. Keep in mind, though, that the term BUN, when used in the same sentence as hamburger or hotdog, usually means something else entirely. An important thing to note again is that with a high protein diet, you'll likely have a higher ratio and this is nothing to worry about.
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Old 10-21-2006, 01:00 PM   #4
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Wll Brink: Creatine safety issues: fact or fiction?
After the first article in Life Extension magazine on the many potential medical and anti-aging uses of creatine, I received several letters and many e-mails that basically said "I would like to use creatine for the various reasons stated in the article, but I am worried about its safety." This fear over the safety of creatine was usually generated from some hysterical news report or poorly researched article. It's odd, but predictable that the media and conservative medical establishment have desperately tried to paint creatine as an inherently dangerous or "poorly researched" dietary supplement. The fact is, creatine may be the most extensively researched performance-enhancing supplement of all time, with a somewhat astounding safety record.

True to form, the "don't confuse us with the facts" media and anti-supplement conservative medical groups have had no problems ignoring the extensive safety data on creatine, or simply inventing safety worries where none exists. A perfect example of this was the news report that mentioned the deaths of three high school wrestlers who died after putting on rubber suits and riding a stationary bike in a sauna to lose weight. Amazingly, their deaths were linked to creatine by the media, rather than extreme dehydration! Even more amazingly, on further examination, it was found that two of the three wrestlers were not using creatine!

Creatine has been blamed for all sorts of effects, from muscle cramps to dehydration, to increased injuries in athletes. However, these effects have been looked at extensively by researchers without a single study reporting side effects among several groups taking creatine for various medical reasons over five years.5-8

In some, but not all people, creatine can raise a metabolic byproduct of creatine metabolism known as creatinine. Some people-including some medical professionals who should know better-have mistakenly stated that elevated levels of creatinine could damage the kidneys. Elevated creatinine is often a blood indicator, not a cause, of kidney dysfunction.

That's a very important distinction, and several short- and long-term studies have found creatine supplements have no ill effects on the kidney function of healthy people.9,10 Though it makes sense that people with pre-existing kidney dysfunction should avoid creatine supplements, it is reassuring to know that creatine supplements were found to have no ill effects on the kidney function of animals with pre-existing kidney failure, showing just how non toxic creatine appears to be for the kidneys.11 Bottom line, creatine safety has been extensively researched and is far safer than most over-the-counter (OTC) products, including aspirin.

Conclusion
Though additional research is warranted regarding the pathologies outlined in this article, creatine has a substantial body of research showing it is an effective, safe and worthwhile supplement in a wide range of pathologies and may be the next big find in anti-aging nutrients. Although the dose used in the studies was quite high, recent studies suggest lower doses are just as effective for increasing the overall creatine phosphate pool in the body. The dose of 2 to 3 grams per day appears adequate for healthy people to increase their tissue levels of creatine phosphate.
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Old 10-21-2006, 03:29 PM   #5
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Joker, btw, after I posted all this stuff I realized that I forgot to say that I don't think you need to take creatine if you don't feel comfortable with it. I think it helps a lot and there are a lot of potential benefits to it but in the end it's a supplement.This was all just to speak to the information about it being so dangerous so that your decision would be based on more than one opinion. I wanted to say that because I realized that it may look like I am pounding my viewpoint on using creatine in the dirt which is not my intention .
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Old 10-21-2006, 03:40 PM   #6
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Quote:
Originally Posted by Eric3237 View Post
Joker, btw, after I posted all this stuff I realized that I forgot to say that I don't think you need to take creatine if you don't feel comfortable with it. I think it helps a lot and there are a lot of potential benefits to it but in the end it's a supplement.This was all just to speak to the information about it being so dangerous so that your decision would be based on more than one opinion. I wanted to say that because I realized that it may look like I am pounding my viewpoint on using creatine in the dirt which is not my intention .
O.K O.K I'm sorry for bad talking about creatine!!!


J/k I guess I should have mentioned that those views expressed by my Doc are not the same as mine.

I just havent taken creatine for about 2 months because I ran out and havent bought any yet again
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Old 10-21-2006, 03:47 PM   #7
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Quote:
Originally Posted by Joker
O.K O.K I'm sorry for bad talking about creatine!!!


Well you did ask for comments I'm always good for that.

LOL, that's why I posted that. It's not like creatine has religous significance . In the end I could care less if a person takes creatine or not, you know? People say, I don't like creatine all the time, and I say, "ok".

I was just thinking, for me, it's the difference between someone saying "I don't like you because you're a serial killer" vs saying "I don't like your cuz your an asshole..."

Last edited by EricT; 10-21-2006 at 04:03 PM..
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Old 10-25-2006, 05:28 AM   #8
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One the loading and cycling article there is no scientific basis for this. I will say that loading will likely cause you to reach saturation levels quicker (a lot quicker) but you won't get any more in. The side effects of a loading stage are one of the things that most likely have many people complaining of side effects. Especially since people tend to overdose most supplements. Going off any supplement for a period of time I think makes sense but and organized "cycle" in terms of creatine has no real basis.

The idea of taking creatine several times a day to maintain blood levels is also likely baseless. Once creatine is loaded into the muscles it can take up to 30 days to return to baseline. Daily "blood levels' being elevated cannot logically have any further effect of benefit. It is possible to maintain levels with only 2 to 3 grams of creatine mono a day and 5 to 10 grams is enough during active work. Three teaspoons a day (15 grams) will likely result in the extra creatine being pissed away.

Also, the best "time" to take creatine is preworkout, as your journal states, but for post workout it would be best to take it immediately post along with your post workout beverage not two hours later. The idea is to get creatine inot the muscles not to increase blood levels. The post workout window is an ideal time.

Creatine mono most definitely is going to need a carrier for most people to get much in to their muscles. If someone has a problem with acne and suspects it's from the carbs then CEE would be a much better choice than mono with plain water. You can take it pre or post or half and half.

Last edited by EricT; 10-25-2006 at 05:41 AM..
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Old 10-26-2006, 09:08 AM   #9
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I thought I may as well put up a relevant part of this article I linked in the Creatine FAQ:

http://www.mesomorphosis.com/articles/kreider/creatine.htm#Does%20Creatine%20Enhance%20Exercise% 20Performance?

Clinical Effects of Creatine Supplementation

When someone takes a 5 g dose of creatine, serum creatine levels typically increase for several hours.7,47,72 This is why during the loading phase creatine should be ingested every 4 to 6 hours (4 to 5 times per day). Creatine storage into the muscle primarily occurs during the first several days of creatine supplementation.47,91 Thereafter, excess creatine that is ingested is primarily excreted as creatine in the urine with small amounts converted to creatinine and urea.7,17,47,91 Serum creatinine levels have been reported to be either not affected 2,25 or slightly increased 64,95 following 28-d, 64 56-d 2,25 and 365-d 95 of creatine supplementation. The increased serum and urinary creatinine have been suggested to reflect an increased release and cycling of intramuscular creatine as a consequence of enhanced muscle protein turnover in response to creatine supplementation and not of pathologic origin.7,25,47,59 Yet, these increases have been a source of concern by some physicians in case reports of an athlete68 or a patient with renal disease88 taking creatine. The reason for this is that large elevations in serum and urinary creatinine levels are basic markers of tissue degradation and/or kidney stress. However, these reports have been criticized because intense exercise and dehydration increases serum and urinary creatinine levels.41 Consequently, in people who exercise, these increases reflect a greater breakdown of muscle protein and are completely normal. It makes sense then that if creatine supplementation allows an athlete to train harder, creatinine levels may be slightly elevated as the athlete may experience greater net protein degradation. Some studies which have administered creatine to athletes during training have reported slight increases in serum creatinine (e.g. 1.2 to 1.4 µmol/L).64 Interestingly though, several studies which involved creatine supplementation without training have found no effects on serum or urinary creatinine levels.75 These findings provide some indirect evidence that the elevations in creatinine are related to a greater ability to train harder rather than of pathological origin.

Along these same lines, several studies have evaluated the effects of creatine supplementation on muscle and liver enzyme levels. Muscle and liver enzymes increase in response to exercise training. These enzymes may also be elevated in response to degenerative muscle and/or liver disease. Studies show that creatine supplementation either has no effect 2,95 or may moderately increase creatine kinase (CK), 2,64 lactate dehydrogenase (LDH),64 and/or aspartate amino transferase (AST)64 levels following 28-d and 56-d of supplementation. The increased CK, LDH and AST levels reported following creatine supplementation were within normal limits for athletes engaged in heavy training and may reflect a greater concentration/activity of CK and/or ability to maintain greater training volume.7,59,60,121 Interestingly, in studies in which creatine was administered in subjects not undergoing intense training, creatine supplementation does not appear to affect serum muscle enzyme efflux.2,69,70,75

Creatine supplementation has also been reported to positively affect lipid profiles in middle-aged male and female hypertriglyceremic patients 25 and trained male athletes.64 In this regard, Earnest and colleagues 25 reported that 56-d of creatine supplementation resulted in significant decreases in total cholesterol (-5 and -6% at day 28 and 56, respectively) and triglycerides (-23 and -22% at day 28 and 56, respectively) in mildly hypertriglyceremic patients. A similar response was observed with very low density lipoproteins (VLDL). In addition, Kreider and coworkers 64 reported that 28-d of creatine supplementation increased high density lipoproteins (HDL) by 13%, while decreasing VLDL (-13%) and the ratio of total cholesterol to HDL (-7%). Although additional research is necessary, these findings suggest that creatine supplementation may posses health benefit by improving blood lipid profiles.

An extensive amount of research has been conducted on the potential medical benefits of intravenous PCr administration and oral creatine supplementation. In this regard, intravenous PCr administration has been reported to improve myocardial metabolism and reduced the incidence of ventricular fibrillation in ischemic heart patients.3,19,20,83,93,118,119 The reason for this is that PCr appears to enhance the viability of the ischemic cell membrane thereby minimizing injury cell during ischemia. Consequently, there has been interest in determining the effects of oral creatine supplementation on heart function and exercise capacity in patients with heart disease. Gordon and associates 38 reported that creatine supplementation (20 g/d for 10-d) did not improve ejection fraction in heart failure patients with an ejection fraction less than 40%. However, creatine supplementation significantly increased one legged knee extension exercise performance (21%), peak torque (5%) and cycle ergometry performance (10%).

Creatine supplementation has also been used to treat patients with mitochondrial cytopathies (a condition which reduces exercise capacity) and infants with in-born errors in creatine synthesis. For example, Tarnapolosky et al.107 reported that creatine supplementation (5 g/d for 14-d followed by 2 g/d for 7-d) significantly increased anaerobic and high-intensity aerobic exercise capacity in patients with mitochondrial cytopathy. Moreover, several case reports have been published in the medical literature which indicate that creatine supplementation (4 to 8 g/d for up to 25 months) allows infants with inborn errors in creatine synthesis to develop more mentally and physically normal.4,34,99-103 Collectively, these findings suggest that intravenous PCr administration and/or oral creatine supplementation for up to 25 months in duration is safe and may posses some therapeutic value to certain patient populations.

What’s the bottom line? If you take creatine your serum and urinary creatine levels will increase for several hours after supplementation. Without training, there appears to be little if any impact on serum and urinary creatinine, muscle and liver enzymes, or blood pressure.75,84 However, if you take creatine during training you may observe an increase in serum creatinine, CK, LDH and possibly AST. These elevations appear to be related to excess creatine being excreted and/or due to a greater ability to train harder following creatine supplementation. You may also experience some positive effects on your blood lipid profiles. Although additional research is necessary to evaluate the long-term effects of creatine supplementation on medical status, available studies suggest that creatine supplementation for up to 2 years is medically safe and may provide health benefit for various populations when taken at dosages described in the literature.

Side Effects

The only side effect reported from clinical studies investigating dosages of 1.5 to 25 g/d for 3- to 365-days in preoperative and post-operative patients, untrained subjects, and elite athletes has been weight gain.7,59,60,121 However, a number of concerns about possible side effects of creatine supplementation have been mentioned in lay publications, supplement advertisements, and on Internet mailing lists. It should be noted that these concerns emanate from unsubstantiated anecdotal reports and may be unrelated to creatine supplementation. There is no evidence from any well-controlled clinical study indicating that creatine supplementation causes any of these side effects. However, one must also consider that although researchers are required to report side effects in scientific publications, few long-term studies on creatine supplementation have been conducted. Consequently, discussion about possible side effects is warranted.

Some concern has been raised whether creatine supplementation may suppress endogenous creatine synthesis. Studies have reported that it takes about four weeks after cessation of creatine supplementation for muscle creatine 32 and phosphocreatine 115 levels to return to normal. While it is unclear whether muscle creatine or phosphocreatine content falls below normal thereafter, there is no evidence that creatine supplementation causes a long-term suppression of creatine synthesis.7,50

Since creatine is an amino acid, it has been suggested that creatine supplementation may increase renal stress or cause liver damage. However, no studies have reported clinically significant elevations in liver enzymes in response to creatine supplementation.2,64 Further, Poortmans and colleagues 86 reported that short-term creatine supplementation (20 g/d for 5-d) does not affect markers of renal stress. Moreover, preliminary results reported at the 1998 American College of Sports Medicine annual meeting from this group indicate that longer term creatine supplementation (9 weeks) does not affect markers of renal stress. Consequently, there is no evidence that creatine supplementation increases renal stress when taken at recommended dosages.

There have also been some anecdotal claims that athletes training hard in hot or humid conditions may experience a greater incidence of severe muscle cramps and/or muscle injury when taking creatine. However, no study has reported that creatine supplementation causes cramping, dehydration, changes in electrolyte concentrations, or increases susceptibility to muscle strains/pulls even though some of these studies have evaluated highly trained athletes undergoing intense training 14,36,45,48,57,61,63-66,73,78,91,104,110,116 in hot/humid environments. 36,61,63,65,104 For example, data that we recently presented at the 1998 National Strength and Conditioning Association indicated no reports of muscle cramping or injury in athletes involved in our previous creatine studies.67 Most creatine researchers feel that these observations are overblown.

Finally, concern has been expressed regarding unknown long-term side effects. While long-term (> 1 year) well-controlled clinical trials have yet to be performed, it should be noted that athletes have been using creatine as a nutritional supplement since the mid 1960s. Yet, this author is not aware of any significant medical complications that have been directly linked to creatine supplementation. Additionally, preliminary data presented at the 1998 American College of Sports Medicine Annual Meeting from Dr. Mike Stone’s laboratory indicate that long-term creatine supplementation (up to 2 years) does not result in any abnormal clinical outcome in comparison to controls. Consequently, from the literature currently available, creatine supplementation appears to be medically safe when taken at dosages described in the literature.


--------------------------------------------------------------------------------

Summary and Conclusions

Based on available research, short-term creatine supplementation may improve maximal strength/power by 5 to 15%, work performed during sets of maximal effort muscle contractions by 5 to 15%, single-effort sprint performance by 1 to 5%, and work performed during repetitive sprint performance by 5 to 15%. Moreover, long-term supplementation of creatine or creatine containing supplements (15 to 25 g/d for 5 to 7-d and 2 to 25 g/d thereafter for 7 to 140-d) may promote significantly greater gains in strength, sprint performance, and fat free mass during training in comparison to matched-paired controls. However, not all studies have reported ergogenic benefit possibly due to differences in subject response to creatine supplementation, length of supplementation, exercise criterion evaluated, and/or the amount of recovery observed during repeated bouts of exercise. The only side effect from creatine supplementation reported in the scientific literature from studies lasting up to two years in non-athletes, athletes, and patient populations has been weight gain. Consequently, creatine supplementation appears to be a safe and effective nutritional strategy to enhance exercise performance and promote muscle hypertrophy.

Please send us your feedback on this article.

Richard B. Kreider, PhD, FACSM
rkreider@memphis.edu
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