Creatine (creatine monohydrate), the most popular muscle-building supplement in history has been criticized as causing Rhabdomyolysis (rhabdo), a serious medical condition where the muscles of the body to break down. This breakdown of muscle, releases toxins into the blood which can cause very serious side effects. Some have died from rhabdo. But does creatine really cause rhabdo? In this review I'll show you the evidence so you can make your own decision.
What Is Rhabdomyolysis?
The word rhabdomyolysis (rhab-doe-my-oh-lie-sis) means muscle fiber death. As the muscles die, the cellular contents inside your muscle fibers enters the blood. Some of this stuff can result in very serious side effects such as but not limited to:
- Heart attack
- kidney failure
- liver failure
As I show you in this video I created, people can die from rhabdo:
Many things can cause rhabdo. One factor which has been on the rise is excessive exercise. When exercise causes rhabdo its called “exercise-induced rhabdomyolysis.”
I'm the top expert in the US on rhabdo and exercise. I say this with both modesty confidence because I wrote the first book on rhabdo and exercise. I've been teaching people about the dangers of this disorder for over 10 years.
Most cases of rhabdo in the gym can be traced to doing a lot of exercise you were not used to doing. Unaccustomed exercise/activities make up most of the emails and phone calls I get from people who have this condition.
What Is Creatine?
Creatine, a dietary supplement, is composed of 3 amino acids:
While it was discovered in 1832, the supplement first became popular in the US in the 1990s. Interestingly, some reports of athletes using creatine supplements date back to the 1960s.
So what does creatine do? It helps us make energy (ATP) very quickly. The very quick production of energy is power. The faster we can make energy, the faster we can sprint, the more weight we can lift and the quicker we can recover.
While most of the creatine research does involve men, the supplement probably has a similar effects in women.
When we take this supplement, it's converted to phospho-creatine (PCr) in the body. Creatine kinase (CK) is the enzyme which breaks down creatine in the body. Creatine kinase is also used as a measure of muscle damage too – and is one of the tests doctors use to determine if rhabdomyolysis occurred.
Many are under the impression they need to periodically go off of creatine – that is, to cycle it. However this is technically a myth. I'd agree though unless you're involved in power-type activities, you likely don't need to take it.
There are many different types of creatine supplements, such as creatine nitrate. Most of the clinical evidence however is on creatine monohydrate.
Creatine In Foods
We make about 1-2 grams of creatine naturally each day. This substance is also found in foods like:
Or as I often say, it's found in “any food which had a mom and a dad.”
Fruits, veggies, beans, seeds and whole grains do not contain this substance.
How To Take Creatine – Practical Advice
Companies often recommend people take two difference dosages of this supplement. They are called:
- Loading phase (20-25 g/ day for the first week)
- Maintenance phase (2-3 g/day thereafter)
Forget the loading phase. For most people it's a scam. It's been known since the 1990s that taking 2-3 grams per day for a month leads to similar muscle creatine levels as taking 25 grams for a week.
Creatine And Rhabdo Reports
Do creatine supplements cause rhabdomyolysis? Let's look at 3 reports where it has been implicated and try to make sense of them.
Creatine Report 1
As far back as the 1990s, creatine was implicated in the deaths of 3 college wrestlers. The wrestlers died from kidney failure and heart problems. Back then, rhabdo was not on anybody's radar -not even mine.
Looking back now, we can see these wrestlers probably developed rhabdomyolysis. But did creatine cause it? Well, soon after this happened,the FDA ruled creatine out as a cause of rhabdo. Therefore, the answer is no.
I remember when this first hit the news. It was just a few years after creatine started to get popular in the US. Wrestlers have to maintain a certain weight. If they gain too much, they get bumped up to a higher weight class.
These wrestlers were tying to lose weight – working out for several hours a day, wearing rubber suits and even going in to steam rooms. They were trying to lose weight while taking creatine -which causes water weight gain.
I don't think they were aware creatine supplements can cause people to gain water weight. I don't believe many realized this at the time. I believe it was the excessive exercise, dehydration and overheating which caused rhabdo. Either way, these were very sad incidents.
Creatine Report 2
A doctor reported a case of rhabdo in a 24 year old male weight lifter who was also taking creatine supplements (25 grams per day for a year). The day before he went to the emergency room, he performed 3 hours of lower body resistance training. While he was not training for a week before this, he claimed he had performed similar workouts int he past.
He developed significant swelling in his legs (compartment syndrome) which required surgery. The patient spent 22 days in the hospital. After 6 months of rehab, he had regained 60% of the strength in his legs.
While the man said he had performed similar 3 hour workouts in the past, the report does not tell us if he did similar activities. Given he was doing 3 hour workouts, if he had performed different types of exercises which he had not done before or recently, this, coupled with the 3 hour workout could have been the cause of his rhabdo.
Creatine Report 3
Parents of a college football player who died from rhabdo during a football workout, sued the college he played for. (Rice University). He collapsed after working out followed by running sixteen, 100 yard sprints.
He had been drinking a nutritional shake which contained creatine too. Creatine breaks down into another compound called creatinine. Creatinine levels give an indication of kidney functioning. Rhabdo also can reduce kidney functioning too.
So, did the creatine cause this case of rhabdo? Unfortunately, this football player also had the sicke-cell anemia trait, which is known to elevate the risk of getting rhabdomyolysis.
I could not tell if the sixteen, 100 yard sprints and the gym workout were something the players had done recently or if this was something they were doing at the start of the training season when the players were not adjusted to it.
While we cannot completely rule out creatine, if the sprints and gym workout were performed at the start of the season, then it's quite possible the newness and intensity of the exercise, coupled with the sickle cell trait were the major factors contribution to the development of rhabdo.
Creatine Safety Tips
Here are some quick reference tips if you're going to use this supplement:
- Don't do the loading phase. It's not needed.
- Don't use more than 2-3 grams per day
- Remember to consider the creatine in the food and other supplements you take
- Some supplements may contain additional ingredients which may lead to side effects
- Most human research is on creatine monohydrate – not the other versions
Who Should Not Take Creatine
With respect to rhabdo, avoid creatine supplements if (this list is not complete):
- You previously had rhabdo
- You have the sickle cell trait / sickle cell anemia
- You take cholesterol lowering statin drugs
- You take Repatha / Praluent or other PCSK9 cholesterol-lowering drugs
- You have McArdle's disease
- You have a carnitine deficiency issue
- You have Duchenne's muscular dystrophy
- You have a phosphofructokinase (PFK) deficiency
- You have any liver or kidney problems
- You have high blood pressure/ heart disease
- You've been working out consistently for less than 1 year
Remember, most studies on creatine involves healthy/ young people. If that's not you, then, avoid this supplement.
Does Creatine Cause Rhabdo?
In all the reports above, the common denominator is excessive exercise. I believe this is the underlining factor which caused rhabdo in these cases. Could dehydration and heat stress have played a role? Yes. In at least one of the cases, the sickle cell anemia trait should also be considered.
Creatine is the most highly researched supplement in history. No study has ever directly linked creatine supplements to rhabdomyolysis. In fact, most studies don't show any serious side effects. No study to my knowledge has documented rhabdo occurring either. True, clinical studies and real life are not always the same thing, but at this time, I just don't see a direct connection.
Above all else, the #1 reason why people get rhabdo is lack of education. This is the condition few want to discuss. I want to and that's why I talk about it so much.