Ramalamadingdong

I live in the greater Washington DC area; thus, Im subjected to Redskins football talk, which has been dominated all summer by the saga of the huge defensive lineman Albert Haynesworth. I have no idea if big Albert takes dietary supplements, but I do know that the latest reason why he isnt practicing or playing was something called rhabdomyolysis, a difficult to pronounce condition marked by rapid breakdown of muscle fibers that results in the release of breakdown byproducts into the bloodstream. These chemicals can eventually become toxic to the kidneys.

This condition is often caused by muscle injury or strain, and it often occurs in athletes who have undergone rigorous training in hot and humid environments. Some degree of muscle breakdown always occurs in workouts, but when it becomes excessive, this type of condition can develop. On the street, Rhabdo is not uncommon amongst bodybuilder and endurance athletes (especially preseason football squads) that push themselves too hard and/or are not sufficiently hydrated while working out intensely in hot, humid environments. However, it is curious how a relatively rare condition begins to make big news from various circles, in the same season.  Perhaps the mild cases just go unnoticed or reported.

One recent case has ruffled some supplement feathers, as 19 football players from McMinnville High School in Oregon developed rhabdo at the same time after preseason workouts. Craig Winkler, MD, practicing physician from the town of McMinnville told CBS News many of the boys, who were treated at a local hospital, tested for high levels of creatine kinase (CK), an enzyme released when the muscle breaks down. Dr. Jennifer Ashton, CBS Medical correspondent, added these boys exhibited not only rhabdo, but also compartment syndrome, which causes extreme muscle swellingin this case, in their tricepsand soreness. She said compartment syndrome is very rare and usually only develops after crushing trauma to the limbs.

Winkler noted the boys had all worked out,as a part of an immersion camp,  in their high schools wrestling room, which was about 115 degrees; the heat coupled with dehydration may have contributed to the rhabdo.  He further reported officials were still looking at any hydration products the boys might have used and were awaiting tests to see if any took creatine supplements. Steroids were ruled outdrug use is a non-phyiscal risk factor for rhabdobecause it was unlikely so many high school athletes would have access to such drugs, Winkler added. However, two players reportedly acknowledged supplements were not a factor, claiming neither they nor the other boys involved took supplements or performance enhancers.

The International Society of Sports Nutrition (ISSN) took issue with all the attention and suspicion of creatine supplements in this case. They noted all the obvious factors in the case, from extreme workouts performed repetitiously and without proper hydration.  They also reminded of the safety record and supporting science on creatine monohydrate, noting 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. Their review resulted in an official position stand for ISSN: in a nutshell, creatine monohydrate is the most extensively studied and clinically effective form of creatine effective for increasing high-intensity exercise capacity and lean body mass during training; is both beneficial and safe when used as recommended; has no detrimental effects on healthy individuals; is safe for young athletes when used with proper precaution and supervision; is a viable nutritional alternative to dangerous anabolic steroids; and is used clinically.

Relative to rhabdomyolysis and compartment syndrome, creatine has undergone a number of studies evaluating its effect 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), according to ISSN. These studies have consistently indicated that creatine supplementation does not promote cramping, muscle injury, elevations in CK, and/or heat related injuries, the group reported, noting the studies showed creatine may actually improve athletes ability to tolerate intense exercise in hot and humid environments and lessen the incidence of injury. It is the opinion of the ISSN that suggestions that creatine caused this incident is inconsistent with the scientific literature and implausible.

Sports nutrition scientist Richard Kreider, Ph.D., FACSM, FISSN of Texas A & M University, further stated, "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.

It will be interesting to see what the investigation into the McMinnville rhabdo case reveals as possible causes. Until then, creatine supplements are under scrutiny by officials and the media, seemingly for uneducated reasons. Based on the known factors and the hospital reports of CK levels found in several of the boys, it seems plausible that something ingested could have greatly contributed to the condition, but word is out on what that ingestible could have been. It just figures the finger is immediately pointed at supplements, which has become so common a reaction in the sports world.