French Kiss of Death to Creatine?

[Guest guest]

I received this from Dave Greenwalt's mailing list and thought it would be

of interest with all the noise about the creatine thing...

French Kiss of Death to Creatine

With permission I am reprinting a newsletter I received

today from Will Brink. It addresses the ridiculousness of

the recent French slam on creatine. Enjoy.

Greenwalt CSCS - President

http://www.thepowerstore.com

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

Hello all. As many of you may know, there is a new report

out of France linking creatine to increased cancer risk.

According to the French " experts " creatine may lead to

increased rates of cancer. As always, the " don't confuse us

with the facts " media has taken up the story as if it were

fact. This is irresponsible journalism at it worse. For

example, see ESPN's coverage at:

http://espn.go.com/gen/news/2001/0124/1036782.html

As expected, I have gotten a lot of email from panicked

people asking about this report. I was going to write up a

response, but Dr. Tarnopolsky ( a noted researcher in the

field) was nice enough to write up a full rebuttal. I think

you will find it useful when you are faced with the wave of

ignorance sure to follow this report from France.

________________________________________

From: Mark Tarnopolsky

RE: Creatine and Cancer

To whom it may concern:

There has recently been a rash of misinformation that

has been spread around the world that has arisen from a

statement made by a Mr. ? Dr. ? Husch for the French

Agency of Medical Security for Food (AFSSA), claiming a link

between creatine monohydrate supplementation and cancer.

This is not supported by the literature and it is

unfortunate that medical misinformation can be spread

throughout the world so rapidly. This agency claims to have

reviewed the literature using nutritional experts (yet does

not list them so we can judge their credentials), and the

author has not published a single paper in a peer reviewed

journal (at least none that have appeared in PubMed). I

found the statement to be somewhat inaccurate in several

areas (with the exception that it states that creatine

increases muscle cell water (10 %) - this is high and it is

more likely 3 - 4 %)). The MAJOR problems come when they/?he

tries to make a comment about the potential side effects:

1. approximate translation of the AFSSA statement on cancer

" considering that creatine and creatinine under certain

circumstances, particularly in the presence of simple sugars

and elevated amino acids, could have carcinogenic effects

based on preliminary experimental arguments in vitro and in

vivo have been equivocal " .

[i am not aware of any studies showing that creatine taken

with sugar and amino acids is carcinogenic - especially

when taken in physiological amounts - any compound, even

amino acids may be carcinogenic in high doses (see MSDS

label on leucine!)]. The real issue comes with the

statement that " with the potentially carcinogenic

effects... " - this is unfounded and certainly the jump to

stating that epidemiological studies have shown a link is

complete fabrication and misinformation. This sort of

misinformation is as bad as the health care fraud that some

folks claim regarding unproven agents.

I do agree that we need to concern ourselves about

impurities in creatine and any unregulated substances (ie.

Problems previously with tryptophan and eosinophilic

myositis) and I am all for creatine and other

neutraceuticals being exposed to rigorous purity testing by

federal agencies - I do know that most of the creatine for

the neurology studies is exposed to careful testing for

impurities and other chemical standards - Many of the large

reputable companies in the US and Canada buy their creatine

from high quality sources.

It then goes on to say that the effects of high levels of

creatine ingestion has not been studied in the short or long

term (yet they claim there have been epidemiological

studies). They quote that there are epidemiological studies

showing difficulties with digestion, muscle cramps and

apparently cardiovascular problems (??? - not sure

where this comes from - there are in fact 2 studies in

humans with congestive heart failure showing benefits to

performance and studies in animals showing cardioprotective

effects and we have shown that it does not affect blood

pressure (Mihic, et al, Med Sci Sports Exerc, 2000)).

There are other issues with this - firstly there have been

no true epidemiological studies of creatine use and papers

are suggesting from this article that epidemiological

studies show a possible risk - THIS IS ABSOLUTELY INCORRECT.

In the final summary they state that supplementation with

creatine constitutes a risk, but it has been insufficiently

evaluated, particularly in the long-term. With the

potentially carcinogenic effects, it would be necessary for

the regular reevaluation of studies.

I am shocked that this amount of misinformation can be

placed on the internet by such an agency claiming legitimacy

and trying to advocate for the good of people. This type of

speculative misinformation does not serve the interests of

anyone. Our group and others are carefully evaluating the

risks and benefits of creatine monohydrate ingestion in

patients with neuromuscular and neurometabolic disorders as

well as in human aging - Patients reading this stuff in the

papers have already called to drop out of studies.

Creatine may be very helpful in a number of medical

conditions and thanks to this inaccurate statement we will

all have difficulty in recruiting and retaining subjects.

Unfortunately, it is very difficult for the lay public to

evaluate the quality of the information and the AFSSA

statement violates many of the key factors to look for in

judging legitimacy:

1. The person signing their name to the statement does not

list their credentials.

2. The supposed scientists who evaluated the literature are

not listed.

3. There is no evidence of external review of the statement.

4. The statement has internal inconsistencies (medium and

long term studies not done and yet concludes that

epidemiological studies show their may be a cancer risk).

5. There are no references to peer reviewed studies to

support the statement.

THERE ARE NO STUDIES IN HUMANS EVEN SUGGESTING AN INCREASED

RISK OF CANCER WITH CREATINE.

There are many papers showing an anti-cancer effect of

creatine in animals:

Jeong KS, Park SJ, Lee CS, Kim TW, Kim SH, Ryu SY,

BH, Veech RL, Lee YS.Effects of cyclocreatine in rat

hepatocarcinogenesis model. Anticancer Res 2000

May-Jun;20(3A):1627-33

sen CA, Askenasy N, Jain RK, Koretsky AP. Creatine

and cyclocreatine treatment of human colon adenocarcinoma

xenografts: 31P and 1H magnetic resonance spectroscopic

studies. Br J Cancer 1999 Jan;79(2):278-85

Schiffenbauer YS, Meir G, Cohn M, Neeman M. Cyclocreatine

transport and cytotoxicity in rat glioma and human ovarian

carcinoma cells: 31P-NMR spectroscopy. Am J Physiol 1996

Jan;270(1 Pt 1):C160-9

Ara G, Gravelin LM, Kaddurah-Daouk R, Teicher BA Antitumor

activity of creatine analogs produced by alterations in

pancreatic hormones and glucose metabolism. In Vivo 1998

Mar-Apr;12(2):223-31

EE, AE, Cohn M. Inhibition of rate of tumor

growth by creatine and cyclocreatine.Proc Natl Acad Sci U S

A 1993 Apr 15;90(8):3304-8 There are several reviews of

creatine so people can get their facts straight: Casey A,

Greenhaff PL Does dietary creatine supplementation play a

role in skeletal muscle metabolism and performance? Am J

Clin Nutr 2000 Aug;72(2 Suppl):607S-17S

Tarnopolsky MA Potential benefits of creatine monohydrate

supplementation in the elderly. Curr Opin Clin Nutr Metab

Care 2000 Nov;3(6):497-502

Terjung RL, son P, Eichner ER, Greenhaff PL, Hespel PJ,

Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA,

Wagenmakers AJ, MH American College of Sports

Medicine roundtable. The physiological and health effects of

oral creatine supplementation. Med Sci Sports Exerc 2000

Mar;32(3):706-17

Wyss M, Kaddurah-Daouk R. Creatine and creatinine

metabolism. Physiol Rev 2000 Jul;80(3):1107-213

There are several reviews of safety: Poortmans JR, Francaux

M Adverse effects of creatine supplementation: fact or

fiction? Sports Med 2000 Sep;30(3):155-70

Mihic S, Mac JR, McKenzie S, Tarnopolsky MA. Acute

creatine loading increases fat-free mass, but does not

affect blood pressure, plasma creatinine, or CK activity in

men and women. Med Sci Sports Exerc. 2000 Feb;32(2):291-6.

Terjung RL, son P, Eichner ER, Greenhaff PL, Hespel PJ,

Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA,

Wagenmakers AJ, MH American College of Sports

Medicine roundtable. The physiological and health effects of

oral creatine supplementation. Med Sci Sports Exerc 2000

Mar;32(3):706-17

I would hope that Reuters, ESPN, National Post,

Associated Press, etc. would get their facts straight before

they put out misinformation. I know that a flashy

inflammatory and inaccurate statement is better for press,

but please think of the patients who are involved in the

studies and those who may stand to benefit from carefully

controlled evaluation of the risks and benefits of creatine

supplementation. Yes, there may be some side effects, but

please, let the researchers evaluate what these are and the

incidence so that people can evaluate the risks and benefits

of supplementation in an unbiased manner.

Sincerely,

Mark Tarnopolsky, MD, PhD, FRCP©,

Neuromuscular Disease Unit,

4U4 Neurology,

McMaster University Medical Center,

Hamilton, Ontario, CANADA, L8N 3Z5

- Will Brink

Industry consultant, author, and columnist.

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