Ephedrine and creatine remain two of the most popular bodybuilding supplements, and for good reason: They work for most people. Ephedrine is a derivative of the herb mahuang and has been used for more than 5,000 years, primarily for bodyfat loss, although some people take it before workouts for its energizing effect. Creatine increases energy stores within muscle by helping to restore depleted ATP, the immediate energy source of all muscular contractions. It also appears to have anabolic effects due to an interaction that results in upgraded muscle protein synthesis.
Many medical professionals, however, have reservations about recommending ephedrine and creatine. Among other reasons they cite certain idiosyncratic reactions that can lead to serious medical problems and that have been experienced by some trainees. While their concerns appear to make sense, their proof is often dubious at best.
An example is a recent case study of three athletes who suffered serious medical problems after their workouts.1 All three men had engaged in rigorous exercise, and all were diagnosed with a condition called rhabdomyolysis, an accelerated breakdown of muscle protein. Two also showed signs of compartment syndrome in their thigh muscles’characterized by expansion of muscle so rapid that it exceeds the ability of fascial-enclosing tissues to support it, leading to a constriction effect. It’s usually treated by surgical loosening of the constricting tissue.
Since all three men were taking ephedrine, creatine and amino acid supplements’and they were otherwise healthy’the physicians who wrote the report feel that the supplements might have played a role in causing the medical problems. They note that the men slipped into kidney failure’not common when rhabdomyolysis is linked to excessive exercise’and they cite one previously reported case of a soldier who experienced compartment syndrome and rhabdomyolysis after using ephedrine. Creatine, the doctors suggest, may also contribute to kidney problems, especially if taken with ephedrine. But they also note that ‘it is not possible to conclusively implicate ephedrine or creatine in the development of acute renal failure.’
The problem with the report is that the doctors didn’t clearly identify the men’s fluid intake during their training. Because the symptoms the men experienced can also be caused by not consuming enough water while exercising in a hot environment, that’s highly significant, especially when you consider that dehydration is the primary cause of rhabdomyolysis during exercise.
Countless bodybuilders around the world use some combination of ephedrine and creatine yet experience no medical problems, so it’s logical to assume that the men in the case study were extremely dehydrated, which probably had nothing to do with the supplements.
The renal-failure cases are similar to an account of three collegiate wrestlers whose deaths were widely reported in the media a few years ago. Initial indications were that they’d used creatine, which was suspected of playing a role in their early demise. Further investigation, however, revealed that the wrestlers had resorted to extreme measures to lose weight before competitions, including totally restricting fluid intake. It turned out, they’d died from the complications of extreme dehydration. What happened had nothing to do with creatine or any other supplement.
Can Growth Hormone Cause Exercise Fatigue?
Growth hormone is a popular injectable anabolic drug among athletes for several reasons. GH, as it’s known, is thought to increase muscle mass and possibly aid in healing injured tissues. It also promotes the use of fat as fuel while sparing carbohydrate stores in the body. Unlike the situation with other anabolic drugs, such as steroids, we don’t have an accurate drug test for GH at present, so athletes can use it with impunity.
The truth is, however, there’s little actual evidence that GH either promotes muscular growth or aids athletic activity. A new study even suggests that taking a large GH injection before exercise may lead to premature fatigue.2 Seven highly trained young men cycled for 90 minutes four hours after receiving a GH injection containing 7.5 I.U., or 2.5 milligrams, of the hormone. Some of them got a placebo in place of the actual GH, then later were switched to the real stuff. That’s known as a crossover study design. In addition, neither the subjects nor the researchers initially knew who was getting the real hormone and who the placebo.
The subjects ate a meal two hours before exercise to rule out any blood-sugar-related effects. The researchers conducted blood tests when the subjects were at rest and during exercise, recording levels of GH, IGF-1, glucose, glycerol and fatty acids. During the 90 minutes the men spent riding a stationary bike, using moderate to high levels of intensity, all in the placebo group completed the exercise bout, while two men in the GH group had to drop out before the end of the session. A third man nearly didn’t make it.
Blood tests revealed higher-than-normal levels of lactate in the GH group. Lactate is a by-product of muscle fatigue and usually signals the onset of total muscle fatigue, although other factors are also involved. The GH group had blood fatty acid and glycerol levels that were three times higher than what is produced by exercise alone, indicating that GH has a synergistic effect with exercise in promoting fat release into the blood. Even so, the GH group’s total bodyfat oxidation didn’t increase. As for blood glucose levels, the GH group’s were an average of 9 percent higher during exercise than the placebo group’s.
Other effects in the GH group included a greater feeling of leg fatigue and a higher heart rate, but the researchers didn’t know the cause of the latter. Given those findings, they suggest that GH use before exercise may promote increased muscle fatigue. The surprising aspect of this study, however, is that while GH clearly promoted the release of fat, fat-oxidation rates didn’t increase during exercise. Perhaps the body can only burn a limited amount of fat during exercise. On the other hand, earlier studies showed that as lactate levels rise during exercise, fat burning declines, so the decreased fat oxidation may be related to the higher lactate levels that come from GH use.
Are Steroids Muscle Destroyers?
The scientific community has suggesed a number of causes for rhabdomyolysis, or excessive muscle breakdown, ranging from the patients’ having done unaccustomed exercise, particularly in a hot environment, to such infections as the flu and mononucleosis, to the use of such drugs as cocaine, alcohol and barbiturates, to the use of creatine and ephedrine supplements (see the item on page 92). One published report suggests that another popular class of drugs be added to the list: anabolic steroids.3
An unidentified 25-year-old man showed up at a local hospital emergency room complaining of red-brown urine and general severe muscle aches. He told attending doctors that three days earlier he’d performed an unusually intensive bench press routine at the gym, using 100 pounds more than he usually did. Where had he gotten his newfound strength?
The patient said a friend from the gym had given him anabolic steroids, which he took for two weeks prior to the intense training session. Amazingly, this fellow did not bother to find out either the name of the drug or the dosage he used. He knew only that he took two pills daily and that within two weeks he had increased appetite, weight gain, muscle mass, strength and muscular endurance, as well as increased aggression.
He first began noticing muscle pain during the intensive workout, three days before he arrived at the hospital. The day after the workout his muscle pain was so severe that he couldn’t get out of bed. He treated it with over-the-counter pain medication similar to Tylenol, but panicked and went to the emergency room when the bloody pissing began. Various tests yielded a diagnosis of rhabdomyolysis, for which he was treated successfully and released four days later.
The immediate danger of rhabdomyolysis is that breakdown muscle products, such as the muscle-oxygen-delivery protein myoglobin, can lead to constriction of renal blood vessels. That, in turn, can foster inadequate blood delivery and consequent destruction of kidney tissue, ending in total kidney failure. The main treatment involves maintaining urine output to keep the kidneys working.
The case is curious from several angles, however. First, the notion that a guy would take drugs that are supposedly anabolic steroids from another person in the gym without even asking what they were is ludicrous at best. Second, this guy not only didn’t know what he took, but he also didn’t know the dosage. Third, whatever steroid it was, taking two pills a day for two weeks would be highly unlikely to cause rhabdomyolysis.
So what actually happened to this man? One thing was clear: He did have rhabdomyolysis. Based on the known causes of rhabdo, I’d venture a guess that it was not any steroids he took but the unaccustomed workout he engaged in, featuring considerably heavier weights than he’d ever used, along with what was probably increased exercise intensity.
The authors never make a clear cause-and-effect association between steroid use and rhabdomyolysis. Instead, they list other side effects associated with steroid abuse, none of which remotely relates to the condition in question. Drugs such as alcohol can cause rhabdomyolysis because they directly destroy muscle. Yet steroids, if anything, not only promote muscle gains, but, according to other studies, also help athletes train harder and recover faster than those who don’t use them. That’s hardly a scenario relating to excessive muscle breakdown.
1 Sandhu, R.S., et al. (2002). Renal failure and exercise-induced rhabdomyolysis in patients taking performance-enhancing compounds. J Trauma. 53:761-64.
2 Lange, K., et al. (2002). Acute growth hormone administration causes exaggerated increases in plasma lactate and glycerol during moderate-to-high-intensity bicycling in trained young men. J Clin Endocrinol Metab. 87:4966-4975.
3 Braseth, N.R., et al. (2001). Exertional rhabdomyolysis in a bodybuilder abusing anabolic androgenic steroids. Eur J Emerg Med. 8:155-57. IM