There are at least three traditional bodybuilding drugs or supplements that ought to be used routinely in clinical settings to treat various conditions or maladies:
- Nandrolone (deca durabolin)
- Growth Hormone
The first is, of course, an anabolic steroid. In a sane world, it and possibly other steroids would be used to combat the muscle wasting seen in a host of diseases or conditions such as cancer, AIDS, celiac disease, congestive heart failure, and multiple sclerosis, to name a few.
Nandrolone should also receive strong consideration to serve as an adjunct to testosterone in hormone replacement therapy as it has restorative effects on joints and has far fewer effects on hair loss and prostate growth than that of the various testosterone esters.
The second, growth hormone, should be used routinely to hasten the recovery of muscle, tendon, or bone injuries. Athletes who ruptured tendons or who underwent Tommy John surgery might be back in action in half the time.
Average folk who suffer orthopedic injuries could get back to work a lot quicker and stop the financial drain. Growth hormone could also be used to help burn patients heal more quickly.
Lastly, creatine should be used or at least considered in the treatment of a whole host of diseases ranging from spinal cord injuries to cardiopulmonary disease.
The first two drugs have a steep hill to climb. Too much stigma. Too much disinformation. Creatine, however, is relatively free of infamy and as such might still be adopted as a treatment for various diseases or conditions.
That, at least, is the contention of a team of scientists from the University of Central Florida that reviewed the body of literature on the supplement's possible role in treating muscle wasting from immobilization, injury, neurodegenerative disease, cardiopulmonary disease, and other muscular disorders.
Creatine? You Mean the Stuff That's in My Weight Gainer 12000?
The gist of their argument is this: A great number of maladies that affect humans result in some sort of physical dysfunction, muscle disuse, or even immobilization, any or all of which might lead to the subsequent loss of muscle mass.
This dysfunction, disuse, and/or immobilization also occurs in cardiovascular disease, neurodegenerative conditions, or even myopathies. In these cases, this disuse and subsequent loss of muscle mass can lead to earlier death, especially in older people.
But creatine, suggest the authors, with its pro strength, pro endurance, pro muscle properties might "effectively attenuate and possibly enhance rehabilitation" in a number of these diseases or disorders.
That was their guess, anyhow, but they needed to do a comprehensive review of all the studies that had ever been done on the use of creatine during rehab, during immobilization, for muscle disuse atrophy, for neurodegenerative diseases, for cardiopulmonary disease, and for mitochondrial diseases.
What they found was a bit of a mixed bag. Creatine did indeed appear to be useful as a rehabilitative tool in many diseases and conditions, but it struck out in a few others that one might have thought were a sure bet.
Here's a quick rundown of their findings related to various conditions
Category 1: Creatine Likely Helps in the Following
Recovery from Exercise
The scientists found 16 studies that described the effects of creatine on markers of muscle damage resulting from resistance exercise or "unaccustomed exercise challenge."
Virtually all of the studies found that creatine reduced traditional markers of exercise-induced muscle damage like post-exercise levels of muscle serum proteins, reduced inflammatory compounds, and reduced oxidative stress markers while speeding up recovery of strength and reducing DOMS (delayed onset muscle soreness).
Spinal Cord Injury
Obviously, people or animals with spinal cord injuries can suffer from extreme deconditioning and impairments in muscle strength. Although there hasn't been a lot of research on the use of creatine in these circumstances, what has been done is promising.
A creatine-supplemented (20 grams a day) group of SCI (spinal cord injury) patients developed greater upper body strength and improved muscle cross-sectional area.
Studies on SCI rats have shown equally promising results with treated rats demonstrating significantly improved locomotor capacity than control rats.
A randomized, double blind, placebo-controlled study of women with knee osteoarthritis found that creatine supplementation (20 grams a day for 7 days followed by 5 grams a day for 11 weeks) led to improved physical function and lower-limb lean mass.
Another study of rheumatoid arthritis patients found that creatine supplementation improved muscle strength despite the absence of any training program.
Creatine supplementation definitely seemed to help young boys with Duchenne muscular dystrophy and Becker's muscular dystrophy. Supplementation led to significant increases in strength and time to exhaustion. Another study found that a four-month course of supplementation led to significant improvements in grip strength and fat-free mass.
However, creatine didn't seem to help adults with muscular dystrophies that much, at least not by any objective measures. That being said, adults with muscular dystrophies who supplemented with creatine experienced subjective improvements. In other words, they reported improvements in activities of daily living.
Category 2: Creatine Possibly Helps in the Following
Immobilization and Disuse-Induced Atrophy
Nothing leads to muscle protein breakdown like having a limb or limbs immobilized (such as having an arm or leg in a cast), but 7 studies have shown the creatine supplementation mitigated muscle loss in such situations. The same thing happened in rat studies where rats had their hind legs immobilized.
That being said, a few other studies found no real benefit to creatine supplementation in preventing atrophy in immobilized rats. These studies did, however, find some positive changes in protein metabolism and a slight attenuation of total muscle loss, but it wasn't enough to prevent muscle atrophy or strength loss.
Still, the preponderance of evidence seems to support the use of creatine in such situations.
Muscle and nerve damage can impair function, mobility, and physical activity, naturally resulting in muscle atrophy. While there hasn't been much research on the use of creatine in those situations, what there is looks promising.
Scientists severed the spinal cords of rats and let atrophy set in. They then repaired the damage of some of them surgically while placing all of them on creatine (except for those in the control group).
In both the surgically repaired rats and the permanently injures rats, creatine supplementation significantly improved recovery, at least based on walking analyses, pinch strength, limb circumference, and toe contracture.
No such studies have been done on humans yet (with obvious reason), but it's not crazy to assume the results would be similar.
If your ticker or vascular system in general is weak, diseased, or compromised in some way, you're likely in the same atrophy boat as those who have been injured or suffer from neurological diseases.
Now, as the scientists point out, creatine in general plays a role in cardiac function and vascular health, but how that pans out when you use it to treat patients with cardiopulmonary disease has shown inconsistent results (in the very few studies that address the topic).
While there are at least a couple of studies that show how COPD patients used creatine to improve muscular strength and endurance without exercise interventions, another study found no benefit.
Regardless, it makes sense that atrophy, whether caused by injury, disuse, or COPD is roughly similar and should, common-sensically at least, respond to creatine also.
These kinds of diseases are pretty rare but they're genetic disorders that affect the electron transport chain (which negatively affects the production of ATP).
One study showed that creatine supplementation resulted in an 11% increase in dorsiflexion strength and a 19% increase in handgrip strength in afflicted patients. They also gained 0.6 kilograms of lean mass, but that wasn't enough to reach statistical significance.
Two other studies showed zilch.
The verdict? It's a jump ball at best whether creatine would work in such situations, but the theory and the mechanisms behind it suggest that it should.
Category 3: Creatine Was Largely a Bust in the Following
Five studies compared creatine supplementation to placebo in treating Parkinson's patients. Two studies tested the supplement's effectiveness in ameliorating the progress of multiple sclerosis. Three studies were conducted on creatine and amyotrophic lateral sclerosis (ALS). None showed any measurable impact of creatine on these neurodegenerative diseases.
Exactly why it didn't work isn't known because, theoretically at least, based on the nature of these diseases and their biochemical causes/repercussions, creatine should have worked at least in some small capacity.
On a Final Note
I'll let the authors say it:
"Given the encouraging findings regarding the role of creatine supplementation throughout recovery from exercise, rehabilitation from immobilization of injury, and therapeutic support during various chronic conditions, creatine monohydrate demonstrates promise as a rehabilitative aid."
Now if you've ever read a representative number of research studies on any drug, supplement, or medical modality, you'd know that recommendations of any kind, at least ones that aren't hopelessly vague and smothered with a hefty dollop of cover-our-asses, is rare.
As such, a statement by authors like the one above is tantamount to Tom Cruise standing on a couch and shouting out his love for his ex-wife. It's rare.
Nevertheless, the authors conclude their paper, as is de rigueur among researchers, with the caveat that "more work is needed to gauge creatine's role as a medical and rehabilitative aid."
Sure. Nothing they found out about creatine's role in treating various medical conditions is definitive. Still, if someone I cared about were suffering from any of the conditions described in categories 1 and 2 above – especially since creatine has such a strong safety record – I'd hammer on them to use creatine.
It likely can't hurt and it could possibly make life a lot easier for them.
- Harmon KK et al. The Application of Creatine Supplementation in Medical Rehabilitation. Nutrients. 2021 May 27;13(6):1825.