The use of creatine and steroids is dealt with here in response to two questions received.
I have muscular dystrophy. Friends have suggested using the supplement creatine to build muscles. Is there any recommended protocol or dosing regimen for the use of creatine?
Creatine is a substance produced naturally in the body that helps to supply energy to muscle and nerve cells. It is taken in our diet and produced in our bodies. Bodybuilders and other athletes have taken creatine supplements for many years to build muscle mass and boost athletic performance. Its use is allowed by amateur and professional sporting organizations. In addition, people with muscular dystrophies have been shown to have low levels of natural creatine, so it has been thought that raising these levels with creatine supplements could help improve muscle function by strengthening the weakened muscles of people with muscular dystrophy.
Studies have shown some modest effects of creatine supplements in people with muscular dystrophy as it improves muscle strength in the short to medium term. Responses may be variable in different individuals and in different muscular dystrophies. Treatment with creatine monohydrate is not recommended routinely for treatment of DMD. No studies showing effects longer than one year are available. In studies of up to six months in duration there did not appear to be any significant side effects.
Creatine is sold as “creatine monohydrate” in pharmacies and health food stores. The dosing should be decided by your doctor – it is based on the weight of the person. If you are taking creatine supplements you should make sure you drink plenty of liquid throughout the day. If you are taking any supplements, you should always discuss this with the doctor treating you.
Why are steroids used in Duchenne muscular dystrophy (DMD)?
The steroids used in DMD are corticosteroids, different from the steroids that body builders use. Steroids have been shown to improve strength and motor function in children with DMD, although not all boys respond. If they are used in boys who are still walking, they may have an effect in stabilising or even improving muscle strength for a period of time. Steroids may delay the development of breathing difficulties, and boys on steroids have fewer scoliosis problems. It is unknown exactly how the steroids work but they are thought to reduce muscle cell breakdown by stabilising cell membranes and reducing inflammation.
Different dosage regimens have been tried and you should be advised by your treating doctor what is best for your son. There are published guidelines to assist. The optimal age to begin treatment with corticosteroids or the optimal duration of such treatment is still not known and needs to be individualised. Corticosteroid therapy remains the treatment of choice for boys affected with DMD between the ages of 5 and 15 years. They should be started as soon as a plateau or a decline in motor skills is noted. Corticosteroid therapy is not recommended in children under the age of 2 years.
As the side effects can be significant, these need to be balanced against the positive effects. It is important to monitor boys’ growth and bone strength and for the development of diabetes and cataracts. There is an increased risk of bleeding from the stomach, and it is important not to take anti-inflammatory medication simultaneously. Boys tend to gain weight, so diet and exercise are important. Steroids cannot be stopped instantaneously; they need to be tapered off. Also, the dose may need to be increased if a boy is unwell or requires surgery.