"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 602.7  

Guest: Dr. Mark Juhn, sports medicine physician, Univ. of Washington 

Topic: Creatine supplementation 

Host/Producer: Steve Girard 

NEMA: Today, we'll talk about a supplement that's been around for quite some time...but has really come to the front of all athletic supplement products. Creatine. Mostly, the feedback on creatine has been good...but there are some questions emerging now about possible side effects, perhaps from overuse or abuse. With us is Dr. Mark Juhn, a sports medicine physician at the University of Washington... 

JUHN: Well creatine is basically an organic compound a made by our liver and kidneys. However it is primarily found inside our muscle tissue. and typically our livers make about one gram a day of kreatin and we also consume about one gram a day in our diets. Mainly in meats and fish. Basically the reason why kreatin has been touted to be something to enhance performance so to speak or a to enhance strength so to speak is because the storage form of kreatin is what helps replenish our ATP which is our energy source. It's been used mainly for people who want to do short bursts of high intensity exercise. It is not touted to help endurance athletes, it's not touted to help one single burst activity. But repeated burst activities is where most of there positive data has been shown. 

NEMA: Is creatine derived from animal protein? 

JUHN: A well basically the kreatin that's sold commercially is really produced synthetically. A the reason is it's not really economical to extract the kreatin from meat sources or fish sources etc. So really it's a, it's a synthetically produced. 

NEMA: Which sports are likely to have either high school or college athletes or trainers looking to use the supplement. 

JUHN: Well this what I think, unfortunately allot of athletes are misled. Most of the studies that have shown kreatin to be effective involve cycling, rowing and weight lifting. Things were by the side effect of weight gain of kreatin which is agreed upon a by everybody that you do gain weight. Sports where your weight is somewhat supported. Um the studies on running, sprinting, swimming things like that are certainly much weaker and there certainly quite a few studies that show it does not help those people. So this is something where by the I think the public tends to be a little bit mislead. Because, well I can increase my muscle...the appearance of my muscle, therefore I can help almost any sport. But really it's been most studied in cycling, weight lifting, rowing those kind of things. 

NEMA: So, your high school basketball player probably shouldn't use it? 

JUHN: Right. 

NEMA: There are still some things that we don't know about why it increases our muscle mass, or about why exactly it helps performance. 

JUHN: Absolutely, it's, it's basically still a little bit unclear as to what the increase of body mass is. Basically, creatine pulls water into the muscle cells is one theory. Another theory is that the muscle mass actually increases. Because you increase muscle synthesis, you make more muscle. The people who feel that kreatin is very, very effective etc certainly would like to say that you increase your muscle mass. And that's difficult to explain the rapid increase though. It's hard a because we sometimes see these weight gains within one loading session of a week of kreatin. And that is really quick to increase your muscle mass and that's why I feel that allot of that has to be due to water build up as well which is a potential problem in it's own light. It's probably a combination of a both. 

NEMA: Ok, now you mentioned that there's. if it is water build up. Does that lead to cramping or does that lead to other problems? 

JUHN: Well this is the hypothesis, is that a because of the increase in water retention in muscle tissue that could lead to a dysfunction of your muscle. Simply meaning a cramp or a tear etc. This is all speculative, and the research unfortunately, not allot of research has been undertaken in studying side effects of kreatin. This is one of a my disappointments is that most of the research in kreatin is being spent on does it help this sport, does it help that sport etc. A I would like to see more research done on potential side effects to see if we can associate the water retention with muscle cramping or muscle tears.  

NEMA: When people are on any kind of program where they're working out...they're building muscle, they're training for something and they do gain muscle mass. Isn't there also a chance or incidence where they will either cramp or will rip a muscle while training? Or are the incidents reported with kreatin use above that? 

JUHN: Yes, I think that one of the issues here is a if they are increasing there muscle mass and able to train harder, just by the virtue of training harder, maybe theres an increased chance of having a muscle problem whether you are on kreatin or not. And so that's something that proponents of kreatin like to mention. And again a lot of it is speculative. We don't really know and I don't think we will really know until we get two groups of people willing to undergo a very detailed study and a long term study as well. Um , that's a, that's unfortunately part of the problem. 

NEMA: Are systemic problems reported with use of creatine...we try to guard, of course, against the problems caused by steroids...which were found to cause terrible systemic problems....? 

JUHN: Right, well this is exactly what worries me. There's a lot of people out there that use kreatin at a dose that I would not want them on long term. Um there is an old athlete mentality of if a little is good more is better. And a certainly we have had reports of high blood pressure, of some kidney trouble. We have had reports of gastrointestinal trouble and these are all things that I do not think can be taken lightly. Now let me say as a caveat to that, I'm not telling you that therefore it is proven that kreatin is the culprit in the kidney trouble and the hypertension that was reported or in the gastrointestinal problems, we need to more studies about it but I think the key here is that we have to take these anecdotal reports some what seriously. Because they are being reported by respected members of the sports medicine community, sports medicine physicians, athletic trainers who have absolutely nothing to gain by making these reports. This as opposed to a celebrity or somebody who is paid to a make an advertisement for some type of product that got rid of all their joint pain, for example. That's a different kind of anecdotal report. Here we're talking about respected members in the sports medicine community reporting these things and that why I believe although we haven't proven it we certainly have to take them seriously. 

NEMA: Overdosing is not something people would own up to...using too much creatine, I mean...isn't something an athlete, even one having problems, would admit.... 

JUHN: Well I don't want to say that it's a, a just restricted to people who take more then the recommended amount I believe that we can do an effective study in people who take the normal amount. But the quote, unquote normal amount of kreatin supplementation is still an enormous amount of kreatin compared to what we normally take in our regular diet. Talking 25-30 grams of kreatin a day for a week and then a maintenance of about five grams a day. When normally we eat just one gram a day in our diet. Even the so called quote unquote normal supplementation is a mega dose of kreatin.  

NEMA: Well I didn't a I should have asked about that about the dosages. Um but that puts it in prospective. Is there any thing else you want to add to his. I think we have kind of gone through the problems and the you know of course the solution or at least the start to an investigation of it would be something that you're in favor of. Anything else. 

JUHN: Um well basically I'd just like to say that a although we don't have a definite cause and effect with kreatin. The concerns need to be addressed and the long term effects of kreatin being that it's been widely used only since about 1992 are obviously unknown. We don't know the long term effects of kreatin and I want to stress that we have to ask ourselves what are we treating here. Are we treating a disease process with a medication? If we were doing that, maybe we could justify not knowing the long term side effects of giving mega doses of say, a medicine. The problem is here, what we are doing is we're giving mega doses of a supplement to people that are perfectly healthy to begin with. That's something that to me intuitively doesn't make a lot of sense. And that alone should make use advice against it. 

NEMA: Well then I guess it's kind of the nature of the beast for people who are involved in performance and increasing their already excellent attributes to try a push the envelope. 

JUHN: Right, and you know and as a side note a, um not talking about the medical aspect of kreatin but a most of the research has been done in a laboratory and I think until you can do research in actual competition maybe it's not as good as you think to begin with. Ah. 

NEMA: Yeah, I understand well thanks, I appreciate you being available so early and you know I know it's something that I guess your debate I guess in Sanantio is going kind a bring out into the open even more and hopefully more people will being talking about it. 

JUHN: Yeah I hope so and I mean if they think about it then I think that our goal has been accomplished. 

NEMA: Yeah I think that one of the things that I have heard some high school athletes talking about it is that even there coaches think of it like a vitamin rather then you know something that's unproven and I mean cause they known what it does and think that it' s ok. 

JUHN: Right. 

NEMA: I that's I guess that was the idea it'd be fine doing the story to begin with and just thinking hey it's just another vitamin or another energy supplement or something. It's a little bit different then that and we don't quite know why it , you how it builds muscle so quickly and if we do these antidotal reports we really out a kind of hold off. But that's you know my opinion I have never been an augmentation kind of a athlete. 

JUHN: Well as the old saying goes too much of a good thing and not always a good. 

Our thanks to Dr. Mark Juhn of the University of Washington Sports medicine department. Creatine is treated like a food supplement...or a vitamin, by athletes at all levels, around the world. But there are concerns about its long term effects, and while the debate may just be beginning...athletes looking to enhance or improve performance wont notice for some time that there is a debate. Next time, we'll talk with a proponent of creatine on its use, and why he believes there's not much to what the critics of the supplement say.  

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NEMA: Thanks for joining us for today's program. If you have any comments or suggestions, contact this station. Or visit our home page at: www.nemahealth.org/ ...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.