CREATININE AND ANABOLIC-ANDROGENIC STEROID USE IN LEBANESE BODYBUILDERS AND EFFECT ON KIDNEY FUNCTION- A PILOT CROSS-SECTIONAL STUDY.

Body building is a popular sport pursued to improve physical fitness and appearance through the systematic development and shaping of the muscles of the body by weight training. In addition a planned approach to nutrition is an important component to support muscle growth and repair. However, some nutrition and non-nutritional practices used by bodybuilders can be harmful. This is particularly important in Lebanon where there is no regulation or oversight of such practices. One popular practice in Lebanon is the consumption of large amounts of creatinine and protein supplementation, with recent practices also seeing the introduction of anabolic-androgenic steroids (AAS) to increase muscle growth and lean body mass.

While previous studies focused on the effect of creatinine/protein supplementation on kidney health, to date no study examined both creatinine/protein supplementation and AAS use on kidney health in body builders. We therefore set out to conduct a pilot study to determine overall kidney health by comparing bodybuilders who consume both creatinine and AAS (C/AAS) to those who do not. 

A descriptive cross-sectional study was conducted in male body builders, <40 years of age, who have been training for >1 year and who have no active medical issues. Controls were body builders who have not consumed creatinine supplements for more than one year. Participants who consumed creatinine and AAS (C/AAS) were enrolled if they consumed creatinine supplements for more than a year and last consumed AAS less than a week ago. We compared baseline kidney functions including urine protein and routine blood tests. 

Twenty participants were enrolled, 9 controls and 11 who consumed C/AAS. In the C/AAS group all took creatinine supplementation seven times weekly in the form of creatinine monohydrate and protein supplementation in the form of whey protein. All participants in C/AAS group used testosterone intramuscularly, and some also added masteron, nandrolone, boldenone, metenolone, clenbuterole or proviron.

The mean age was 30.6 years (SD 4.2) and mean BMI 29.8 kg/m2 (4.1). Mean training duration was 11.1 (7.9) years with an average of 6.3 (3.0) hours of training per week. There was no difference in the demographic profile except for hours of training per week which was higher in the C/AAS group (7.5 vs 4.9, P=0.05). In blood tests the C/AAS group, compared to controls, had a higher haemoglobin (16.4 g/dl vs 15.7), SGPT (45 vs 25) and SGOT (40 vs 19) and a lower albumin (4.5 g/L vs 4.7) [P<0.05 inclusive]. The estimated glomerular filtration rate (eGFR) adjusted for body surface area was slightly lower in the C/AAS group, however this did not reach statistical significant (112.5 vs 122.6, P=0.1). Despite taking creatinine and protein supplements, the 24-hour urine creatinine was similar between the control and C/AAS group (126 mg/dl vs 129, P=0.9). Similar to the eGFR, the 24 hour creatinine clearance was lower in the C/AAS group, but not statistically significant (126.4 vs 144, P=0.1). Urine protein excretion was also higher in the 24 hour collection in the C/AAS group compared to controls (119 mg/day vs 89, P=0.05). 

The C/AAS achieved more training hours per week. However, there is a trend towards a lower eGFR, lower creatinine clearance and a higher urine protein. While only a pilot study, these findings are concerning and support a larger study.