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Creatine and Dehydration

Posted Aug 26 2010 2:47pm
If you didn't catch the recent news in the sports nutrition world, here is a short article on a recent situation at a High School in Colorado...

Creatine and dehydration in student athletes

Without getting into the details of creatine, I'd like to say that creatine has received a lot of bad press for no explainable reason. Since graduate school, I have immersed myself in creatine research and still can't find a reason for athletes not to use creatine. While in graduate school, I helped out with several (published) research studies as the "grad student" blood lactate tester. I was an expert at pricking fingers and collecting blood samples for lactate and glucose results while athletes pedaled away on stationary bikes, all while we recorded VO2, ventilation and other metabolic indicators. We mostly studied the effects on beta-alanine and creatine supplementation over a period of a time (one study was supplementation for 28 days). Fun times with my PhD buddies!! I sure miss graduate school!

Do I think every athlete needs to take creatine? Probably not. But depending on your athletic and fitness goals and individual dietary and lifestyle needs, I believe that every person can be a candidate for at least one supplement...however, that doesn't mean you have to take EVERY supplement on the market.

Here is a great article about creatine that my good friend Cassandra wrote a few years ago...although, the research and science hasn't changed. If anything, there is more research supporting creatine usage.

Creatine for Women

Here's a good read (by a RD) on a vegan diet for weight lifters...scroll down to read about creatine for vegetarians.
Vegans and weight lifting

As a vegetarian, I likely do not have as much creatine in my blood, urine and red blood cells as a meat eater. I take 5g of creatine monohydrate a day (I have never done a loading phase which is often recommended with creatine usage) for about 3 weeks and then on my recovery week from training, I cycle off creatine. Creatine is not a booster so I take it after my workouts with my glutamine (1 tsp) in water, in my oatmeal or in my smoothie. Karel does the same. There are a lot of different creatine protocols in research but 5g/day appears to be the norm and recommended amount.

I don't know about you, but I feel much better about taking creatine compared to sipping on a 5-hr energy or red bull during the day. Furthermore, there are some crazy ingredients in several sports nutrition products (specifically the pre-workout sports nutrition drinks, powders and pills) and to this day, I am still surprised that that FDA permits those products on the market.
The fact that there is 1870 mg of an 'Energy Blend' in 5-hr energy, really concerns me. Considering that a cup of coffee has around 150 mg of caffeine, we really don't know how much caffeine is in the energy blend cocktail of Citicoline, Tyrosine, Phenylalanine, Taurine, Malic Acid, Glucuronolactone, Caffeine??
The rest of the ingredients are amino acids which aren't much of a concern to me since I highly recommend taking amino acids during endurance training (I take 2 endurance amino's from Hammer every hour during my 2+ hr bike rides and runs). As for caffeine, I do recommend caffeine before training but a cup or two of coffee, 45 min before a workout or race is all you need. Most sport gels contain around 25-30mg which is also fine and may give you an extra "boost".
Based on research, more caffeine before a workout is not better and has no positive effect on performance. Typically studies use 1-5mg of caffeine per kg of body weight. A friend of mine, Jose Antonio (CEO of ISSN) is an EXPERT (and Guru) on caffeine and athletic performance. Also, research also shows that caffeine does not increase risk for dehydration during physical activity and the idea that it is a mild diuretic is not supported by very much research. Therefore...continue drinking your morning coffee before training and racing (although, in habitual coffee drinkers, the performance effects may be minimal compared to a newbie coffee drinker).

Here is an IMMEDIATE PRESS RELEASE from the International Society of Sports Nutrition...


Woodland Park, CO, August 25, 2010 - Recent media reports have suggested that ingestion of the dietary supplement creatine monohydrate may have contributed to the hospitalization of several athletes from McMinnville High School in Oregon for rhabdomyolysis (i.e., a rapid breakdown of skeletal muscle due to injury that typically presents with marked elevations in the enzyme creatine kinase [CK] in the blood) and/or anterior compartment syndrome (ACS). It is well known that excessive exercise in hot and humid environments can promote dehydration, muscle breakdown, and result in marked elevations in muscle CK levels. In severe instances, this may lead to exertional rhabdomyolysis particularly in athletes who have been engaged in intense exercise in hot and humid environments for several days and who become chronically dehydrated. Additionally, excessive exercise in individuals unaccustomed to heavy training bouts can promote anterior compartment swelling, pain, and pressure. It is well known that dehydration and/or heat illness can exacerbate this clinical course.



According to press reports, the athletes in this case were engaged in a several day "immersion" camp. The athletes began to complain about swelling in their arms after performing a series of push-up and chair dip exercises in a 30-second alternating bouts of repetitions for over 20 minutes until exhaustion in a hot and humid wrestling room. Temperatures in the room were reported as high as 115-120°F. Moreover, the athletes were reported to have to start a repetition scheme over again if all of the athletes did not complete their repetition goals. Further, the athletes were not allowed to drink water during the training session. None of the athletes indicated they took creatine (or any other supplement or drug). Nevertheless, media reports indicated officials are investigating whether creatine may have been linked to this incident.

The International Society of Sports Nutrition (ISSN) is the leading professional organization in the field of sports nutrition. In 2007, the Research Committee of the ISSN formed a team of sport nutrition researchers, dietitians, and physicians to extensively review the available scientific literature on creatine supplementation and exercise and to develop a Position Stand for the Society which was published in the Journal of the International Society of Sport Nutrition (see: http://www.jissn.com/content/4/1/6). After extensive review of the literature, the ISSN adopted the following positions relative to this issue:

1. Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training.

2. Creatine monohydrate supplementation is not only safe, but possibly beneficial in regard to preventing injury and/or management of select medical conditions when taken within recommended guidelines.

3. There is no scientific evidence that the short- or long-term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals.

4. If proper precautions and supervision are provided, supplementation in young athletes is acceptable and may provide a nutritional alternative to potentially dangerous anabolic drugs.

5. At present, creatine monohydrate is the most extensively studied and clinically effective form of creatine for use in nutritional supplements in terms of muscle uptake and ability to increase high-intensity exercise capacity.

6. Creatine monohydrate has been reported to have a number of potentially beneficial uses in several clinical populations, and further research is warranted in these areas.

Specific to the alleged association of creatine to development of rhabdomyolysis and ACS; a number of studies have evaluated the effects of creatine supplementation on dehydration, cramping, fluid retention, muscle injury, CK levels, and health status in athletes engaged in intense exercise (including football players engaged in intense training in hot and humid environments). These studies have consistently indicated that creatine supplementation does not promote cramping, muscle injury, elevations in CK, and/or heat related injuries. Conversely, studies report that creatine may improve the athlete's ability to tolerate intense exercise in hot and humid environments and lessen the incidence of injury. Athletes have been using creatine on a widespread basis as a dietary supplement since the early 1990's. No clinically significant side effects have been reported and a number of potentially beneficial medical uses are being studied. It is the opinion of the ISSN that suggestions that creatine caused this incident is inconsistent with the scientific literature and implausible.

According to noted sports nutrition scientist Richard Kreider, Ph.D., FACSM, FISSN of Texas A & M University, "Many studies have been done (since the early 1990's) that show creatine does not cause dehydration, muscle damage, or increase susceptibility to heat-related illness in athletes involved in intense training in hot and humid environments. If anything, research shows that creatine promotes hyperhydration (i.e., whole body fluid retention) leading to less thermogregulatory stress during intense exercise in the heat. It is unfortunate that individuals unfamiliar with the creatine literature are speculating that creatine caused this problem when the athletes indicated they did not take creatine and they ignore the obvious precursors: excessive and inappropriate training in a hot and humid environment."

About the ISSN: The International Society of Sports Nutrition is the only non-profit academic society dedicated to promoting the science and application of evidence-based sports nutrition and supplementation. www.theissn.org
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