Congestive Heart Failure (CHF) and Creatine

Creatine is a naturally occurring substance that plays an important role in the production of energy in the body. Easy fatigability is one unpleasant symptom of congestive heart failure (CHF). Creatine supplementation has been tried as a treatment for this symptom, with some positive results.

Creatine is a naturally occurring substance that plays an important role in the production of energy in the body. The body converts it to phosphocreatine, a form of stored energy used by muscles. The effects of creatine on general athletic performance are probably the same effects that make it a useful treatment for congestive heart failure. The theory behind its use is that supplemental creatine can build up a reserve of phosphocreatine in the muscles to help them perform on demand. Supplemental creatine may also help the body make new phosphocreatine faster when it has been used up by intense activity.

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A double-blind study examined 17 men with congestive heart failure who were given 20 g of creatine daily for 10 days.⁴² Exercise capacity and muscle strength increased in the creatine-treated group. Similarly, muscle endurance improved in a double-blind, placebo-controlled crossover study of 20 men with chronic heart failure.⁴³ Treatment with 20 g of creatine for 5 days increased the amount of exercise they could complete before they reached exhaustion.

These results are promising, but further study is needed.⁴⁴

Although some creatine exists in the daily diet, it is not an essential nutrient because your body can make it from the amino acids L-arginine, glycine, and L-methionine. Provided you eat enough animal protein (the principal source of these amino acids), your body will make all the creatine you need for good health. Meat (including chicken and fish) is the most important dietary source of creatine and its amino acid building blocks. For this reason, vegetarian athletes may potentially benefit most from creatine supplementation.

Twenty grams (20 g) was the daily dose of creatine used in studies on cogestive heart failure. By comparison, we typically get only about 1 g of creatine in the daily diet.)

Creatine's ability to enter muscle cells can be increased by combining it with glucose, fructose, or other simple carbohydrates.^11,12 Caffeine may block the effects of creatine.¹⁴

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Safety Issues

Creatine appears to be relatively safe. ¹ No significant side effects have been found with the regimen of several days of a high dosage (15 g to 30 g daily) followed by 6 weeks of a lower dosage (2 g to 3 g daily). A study of 100 football players found no adverse consequences during 10 months to 5 years of creatine supplementation. ² Contrary to early reports, creatine does notappear to adversely affect the body's ability to exercise under hot conditions and might even be beneficial. ³ Dividing the dose may help avoid gastrointestinal side effects (diarrhea, stomach upset, and belching). In one study of 59 male soccer players, two separate 5 g doses was associated with less diarrhea than a single 10 g dose. ⁴ However, there are some potential concerns with creatine. Because it is metabolized by the kidneys, fears have been expressed that creatine supplements could cause kidney injury, and there are two worrisome case reports. ⁵ However, evidence suggests that creatine is safe for people whose kidneys are healthy to begin with, and who don't take excessive doses. ⁶ Furthermore, a 1-year, double-blind study of 175 people with amyotrophic lateral sclerosis found that use of 10 g of creatine daily did not adversely affect kidney function. ⁷ Nonetheless, prudence suggests that individuals with kidney disease, especially those on dialysis, should avoid creatine supplements.

Another concern revolves around the fact that creatine is metabolized in the body to the toxic substance formaldehyde. ⁸ However, it is not clear whether the amount of formaldehyde produced in this way will cause any harm. Three deaths have been reported in individuals taking creatine, but other causes were most likely responsible. ⁹ It has also been suggested that use of oral creatine would increase urine levels of the carcinogen N-nitrososarcosine, but this does not seem to be the case. ¹⁰ A few reports suggest that creatine could, at times, cause heart arrhythmias . ¹¹ As with all supplements taken in very high doses, it is important to purchase a high-quality form of creatine, as contaminants present even in very low concentrations could conceivably build up and cause problems.

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