I don't use creatine in hot weather. Last night I was paying more attention to the tv than to what I was doing when I made up a new batch of drink mix. I pulled the wrong container out of the closet and used creatine instead of maltodextrin in the mix. It was only on a fluke that I caught it later - picking up the creatine container and noticing how light it felt.

Any speculation as to what would have happened had I drunk 150 g of creatine while riding? (recommended dose is 5 g) DrPete??

Well... nothing, really. Maybe some upset stomach...

As far as creatine goes, an exercise physiologist explained the role of creatine to me. As I remember it, creatine is the ultimate fast source of phosphate for ATP. That's very good for a quick burst of power, but it's used up in about 10-30 SECONDS. So it's a great supplement for weightlifters because it'll get you one strong burst of strength that promotes additional muscle development. For endurance athletes it really doesn't do much of anything once you leave the driveway.

The bigger problem would've been the dehydration from drinking something that thick without a lot of water, but there's no real danger to taking a mega-dose of creatine.

DrPete

Hey - those 10 secs or so getting through busy intersections are where a sudden burst of power my save my ass!

Your kidneys will shrivel into raisins.

Or, you'll have the runs and waste a bunch of creatine.

You will see blood in your urine. The stuff can mess with your kidneys. How do I know? Don't for sure, but had two less-than-brilliant patients want to get "Bigger. Faster." and so thought if a teaspoon was good that three to five tablespoons per day would really help them grow. They both started pissing blood within three days of the increased dose.

I was lifting hard in college and I misread the dosage at first and took about 10 times more than needed for about 2 days. I was fine, just a little indigestion.

Dr. #1: "nothing will happen"
Dr. #2: "you'll piss blood"
Dr. #3 (yet to reply): "you might die"
Dr. #4 (also yet to reply): "you might not die"
Dr. #5 (with degree from the back of Rolling Stone magazine): What's creatine?
Dr. #6 (stayed at a Holiday Inn Express): "you need unnecessary surgery--How's Friday sound?"

How does the title "Dr." make it any more acceptable for someone to make gross medical generalizations over the web?

Someone with a MD probably has a better idea of what an excess dose of a supplement will do to the human body than someone without one. Thats why.

If they had a specific condition or problem going to THEIR physician would probably be the best idea, but asking for advice on a one time accidental overdose of a food supplement isn't a big deal IMO, and its probably not a bad idea to share it with the rest of the group either in case someone else does it.

And for the record, creatine gives me gas like a s.o.b.....

Creatine Overdose?.....anyone remember Jan in the TDF a few years ago?...I think Phil Liggett referred to it as " a slight stomach inconvenience"!...the domestiques spent the day to-ing & fro-ing from the team car with toilet paper wiping him down!.....as I said at the time....geez ya'd wanna be getting paid well!

I very much doubt Uhllrich was using creatine for the reasons Dr Pete stated.

Grete Waitz. NYC Marathon. Pulling at her shorts the whole race. She still won.

Guess you missed my point, then. If MD's have a better idea of what might happen, then why did the two distinguished respondents not have the same answer (not even close) but each presented their case as the most likely?

They gave two completely different answers, based solely on their own experiences, not on any hard science. In other words, they did exactly what any lay person would do, and has done, on this board regarding everything from their favorite saddle, to what supplements they feel help them perform better.

And yes, you guessed right--I am completely biased against taking everything a doctor says as gospel, and it may well save my career. My own experience with doctors? My first doc said I had tennis elbow, but couldn't explain the electric shocks shooting through my arm. Didn't order any nerve tests, because "why would I do that when you have tennis elbow?"

My second doc ordered the nerve tests and found compression and degeneration in the radial nerve in both forearms, and wondered why the first doc hadn't even ordered the tests.

So, yeah, I'm a big fan of docs acting like their own experiences represent the totality of possible outcomes. It's especially funny when they do so on a public forum, within minutes of each other. Let's try a little humility.

didn't say he was...I was suggesting that the result would be much the same....creatine hasn't be shown to have an benefit to endurance athletes at all...I remain perplexed why anyone in an endurance sport would bother with it

all that tells us is that you shouldnt go back to that first doctor.

Well, I didn't see a lot of arrogance so I don't really see the need for humility. I didn't think their repsonses contradicted each other at all. One answered what the likely outcome was for a single overdose. The other cited two cases where the individuals exceeded normal dosages for an extended period of time and had similar symptoms to each other.

I have used creatine over the years a lot. I have read a fair number of studies on it as well. The bulk of these articles have stated, basically, that creatine benefits are subjective at best. The points they all agree on is that it requires about a gallon of water per day to achieve desired results. Excess creatine will overflow and wash out in your urine. Initial use does require a 'loading phase' because of the wash out factor. And it should be cycled on and off if it is to be used.

That said I, personally, wouldn't worry about it. Because the loading phase is about a week long, a single big shot should not produce any serious effects. (I'm talking internal not external. lol) For initial energy blasts I will drink N.O. Explode before a ride. This works for me.

Ok, to address the inconsistancies. I only claimed anecdotal evidence (two patients) as I have not seen anything in the literature. I was trying to be helpful with a warning. Dr. Pete never claimed that dehydration was a good thing, nor did I claim that pissing blood was going to kill you. Dr. Pete is right in saying that the Creatine itself will likely do nothing, it is the dehydration. Mild overdoses give you cramps (muscular or intestinal), but large doses of creatine (which is an amino acid) need to be cleared out by the kidneys. When there is not enough water to help out, the kidneys get strained and you get blood in the Urine. This by itself is not good, but will not kill you immediately. You just feel like someone punched you in the low back for a few days. Long term, this is bad. So, which doc is right? I would say both. So please don't start one of these "let's make gross generalizations about what two differnt doctors say so that we can prove everything that any doctor has ever said is crap." It just doesn't work like that. If you want to understand the full extent of what is said and why we say it, get the medical education and then talk to me. Thank you Dr. Pete for your response, and I am sorry to have seemingly contradicted what you said.

I believe Dr. Pete said that a one time overdose was unlikely to harm you. DrWJOdonnel said that he's seen issues after three weeks of what we may assume was daily overdosing. No contradiction. Plus, I believe I recognize the shorts in DrJ's photo as that of Westwood Velo so of course he's right.

I can say from experience that prolonged use of Creatine, 2 + months, is not the best thing you can do for your body.

"Taken together these observations show that creatine supplementation before running 30km reduces the effort-induced increment observed in markers of cell death, muscle soreness and proteolysis, what suggests a positive effect of the supplementation strategy in maintaining muscle integrity after intense prolonged exercise."

the only reason most cyclists should take creatine..

The advice I give to the moron that is myself is to stay away from supplements. I say, "Chromedome, you stupid putz, eat a diet full of fruits and vegetables, enough starches (I don't like spuds, so I hit the rice bucket pretty hard) to keep your energy level consistant during the day, and enough meat to keep strong." But then I argue that I really want dairy fat. So I say, "Pretend dairy fats are your supplements. Use them wisely." But then I ask, "What about all these fancy supplements people use?" And I reply, "Your ancestors, those thousands of generations of people that got together to create the marvel of genetic engineering that you are, ate food not supplements."

There's tons of sports med information available to the public, but I doubt if much of it is read before an athlete starts using supplements. Pro athletes have the advantage of having trainers and sports med MDs help with supplemental sources. The rest of us don't. And even if we went to a trainer at a gym--one of the most likely places we'd find one, they may not have the depth of education needed to help a cyclist, swimmer, etc, with the supplements that could be useful to them, and not harmful.

How well do you know what you're putting into your body?

Garden variety medical profession hubris. And once again, the only humility shown is to another doctor.

If it took someone like me prodding you to give a more complete answer, imagine how an actual patient feels with the standard "trust me, I'm a doctor" line. Do you honestly expect people (your patients included) to "get the medical education and then talk" to you? You must be daft.

Thanks for confirming that my point wasn't about medicine, which I acknowledge (and even insinuated) is inexact, but about doctors.

I too find it funny that doctors are accepted as experts on everything. I went to University too; want some answers on stuff we never covered? Don’t worry I am a scientist and can interpret the data far better than you.

Besides doctors don’t do much besides let your body fix itself. Your creatine overdose would be handled like this
“Do not induce vomiting, give plenty of water, treat symptomatically”

Peeing blood? I’ll run some tests to see how bad your kidneys are (creatinine, K, check BP)… then do nothing.

Exercise related problem?
“Just stop exercising, take some aspirin.” Treated the symptoms not cause, problem will return upon resumption.

Diarrhea, vomiting? Cough? <Insert any ailment here>
“It’s probably some virus” Standard answer instead of “I don’t know and I am not doing anything.”

“Let wait and see.” “That should clear up on it’s own.” “I’m sorry, we can’t do anything”

DrJW was wrong about creatine being an amino acid but coming from him it sounds right eh? We can talk about it after you attend more school. Then turn pro before we talk about cycling.

Why do these people put Doc in their nick on a cycling forum anyways? Either they want to play doc over the Internet or they define their lives by their jobs and think it makes them look cool.

Just like attempting to debunk an "expert" makes some people feel cool? I'm not sure why the sudden hatefest - seems to be a bit extreme. I'm not sure how what they said could cause you guys to get your panties in such a twist.

In case you missed it, the OP originally asked for Dr. Pete's opinion on the matter...

1. Sorry, but I DID cover it.

2. Yes, because creatine is usually cleared uneventfully through a well-hydrated kidney.

3. I don't think DrWJO said anything about doing nothing. And stopping creatine supplementation IS something...

4,5,6. Most problems are, in fact, self limited, sports-related and infectious. What do you suggest I do if you come in with a few days of diarrhea? Take you to the OR to explore your abdomen?

7. Creatine is 2-(carbamimidoyl-methyl-amino)acetic acid, i.e. an organic acid with an amino group attached, hence an amino acid.

8. I can't speak for DrWJO on this one, but 1. lots of people call me Dr. Pete as a nickname--I didn't start it, and 2. I'm pretty proud of what I've accomplished in my life. Sorry if that offends you. And no, I NEVER "play doc" over the internet, and if you review my posts you'll see that if there's ever a question about what to do with a medical problem, I'll tell that person to see their doctor. If creatine overdose were a real problem, I would've told the OP to dial 911. What scares me are the number of people who take advice from totally unqualified people who "knew a guy" or "read this thing in the newspaper about that," and I think it's wise to avoid that type of advice when it could be something serious.

There's no better place for doctor hating than the web. Funny how that all goes away when we're needed...

DrPete