Does creatine cause venous thrombosis?

There's an old saying to the effect that when you get to the top, plenty of people will try to bring you down. This certainly seems to be the case with creatine. Creatine is an amino acid-based compound that is synthesized in the liver, kidneys, and pancreas from the amino acids, glycine, arginine, and methionine. The primary function of creatine is to help supply phosphate to ATP. ATP, or adenosine triphosphate, is the immediate energy source of the body. It provides energy when one of its three phosphate bonds is broken off. With creatine around to add the missing phosphate from ATP, ATP is immediately regenerated. The Russians and East Germans first provided creatine phosphate supplied in vials to their athletes in the early 1960s. In the late 80s, creatine hit the commercial supplement market. But it didn't become popular until the early 90s, after extensive research showed that creatine is an effective ergogenic aid, with the ability to boost performance in both sports and exercise. Since then, it has become perhaps the best-selling sports supplement available.

But creatine still has its critics. Various anecdotal reports have emerged linking creatine with kidney problems, bloating, muscle cramps, and gastrointestinal illness. When subjected to the hard light of science, however, these reports of creatine side effects rarely, if ever, hold up. One report from France a few years ago even suggested that creatine was a carcinogen. But it turned out that the possible carcinogenic effects of creatine occurred only when creatine was subjected to extreme temperatures, such as in very well-done meat. Since no one was known to heat their creatine supplements prior to ingestion, this was a definite non-issue for most people. Meat is the richest natural source of creatine, but a single teaspoon of creatine monohydrate, the most popular supplemental form, contains as much creatine as over two pounds of meat.

The latest study implicating creatine with potentially serious health problems came in a letter published in the American Journal of Medicine. In that letter, A group of physicians from the Department of Hematology at the Singapore General Hospital reported on two cases involving previously healthy young men who experienced Venous thrombosis after ingesting creatine supplements. Neither of these two men had ever experienced this, or any other clotting problem prior to using the creatine. Venous thrombosis involves the development of a blood clot in a vein. Venous thrombosis (VT) comes with a long list of possible causes or risk factors that include old age, surgery, immobilization, such as sitting too long without moving, as can occur during a long flight, obesity, inherited clotting diseases,  and many others. But neither of these two men showed any of these risk factors, their only commonality being their use of a creatine supplement.

The first case involved an 18-year-old man who tried creatine in an effort to boost his canoeing activity. He initially complained . . .