Creatine & DCS Prevention?

[SCUBA482]

I was wondering if anybody has information as to the possibility that creatine can help reduce DCS? I have used creatine during workouts and know that it helps to retain water in the muscles. If this leads to better retaining of water then can an argument be made it MAY help stave off DCS? Thoughts?

[vjanelle]

There's probably zero research into this.

Diving Medicine - ScubaBoard (http://www.scubaboard.com/forums/diving-medicine/)

Might want to ask here though.

[Bubbletrubble]

You're probably taking creatine supplements to increase muscle mass and/or enhance athletic performance. There are several studies that indicate creatine supplementation can increase strength and endurance when dosed in certain ways (loading + maintenance, etc.). However, potential side effects of long-term use of creatine supplements may include: muscle cramps, stomach cramps, diarrhea, nausea, seizures, and dehydration. There also exists a potential danger of renal toxicity when creatine is taken alone or in combination with certain over-the-counter medications (cimetidine, NSAIDs, etc.).

Interestingly, vegetarians might benefit most from creatine supplementation since they normally have lower levels of creatine than those who eat meat. In one well-controlled study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1691485/?tool=pmcentrez), vegetarians supplemented with creatine demonstrated enhanced cognitive and memory performance.

Long-term effects of creatine supplementation are unknown.

It has been hypothesized that creatine causes a fluid shift into skeletal muscle cells. There appears to be a fair amount of disagreement in the literature as to whether this actually occurs. To the contrary, Powers et al. (http://www.nata.org/jat/readers/archives/38.1/attr_38_01_0044.pdf) demonstrated that creatine supplementation increases total body water without altering fluid distribution among the body compartments. If this is the case, theoretically speaking, one could argue that creatine supplementation might guard against DCS.

Based on all of this research:
If you are a vegetarian, there might be substantial benefits to creatine supplementation.
If you are a child/young adult, you might not want to take creatine due to the unknown long-term effects of its use.
If you are an elite athlete, you are probably more concerned with the proven performance enhancement of creatine supplementation than the unknown long-term side effects.
If you are a diver, there is a potential theoretical benefit with respect to DCS (increase of total body water)...but this is mitigated by the potential risk of dehydration (unknown mechanism, perhaps fluid shift from extracellular to intracellular compartment).

It seems to me there are just too many unknowns when it comes to creatine supplementation. Why be a guinea pig?

[mafiajoe]

I was wondering if anybody has information as to the possibility that creatine can help reduce DCS? I have used creatine during workouts and know that it helps to retain water in the muscles. If this leads to better retaining of water then can an argument be made it MAY help stave off DCS? Thoughts?

Look I can tell you about my brush with creatine.Nothing to with diving but....
a few years ago I took up taking creatine like you during workouts.I can't remember exactly the doses but i took it for no more than 3-4 months.Well,I was on holiday in Spain and BANG!...I ended up in a Barcelona hospital with a kidney colic!Painful like hell!You can't imagine....a pain that changes your personality forever!I'd never suffered from kidney stones before(besides I've always been drinking plenty of water)and I've never suffered ever since.When this happened i had just stopped taking creatine just because I was on holiday.I never took it again and as I said no more problem ever since.I "passed" the stone a few months later just before I was due to surgery!THANK GOD FOR THAT!!
Coincidence?Maybe but.......:no:

[SCUBA482]

Not taking it now, have in the past....i have never had a problem as outlined above, but not saying it's not possible...curious as to use in (moderation) to load water into your cells prior to diving by a day or two would be beneficial....not too concerned about the hard core workout issue, just wether or not it's been considered a helpful supplement for loading cells to help prevent DCS...guess there could be tons of pros and cons according to personal experiences, but was trying to look at just the interest I've outlined...ill post same question in the dive medicine that vjanelle suggested or maybe the mods can move the topic there?

[Garth]

Why stop there... creatine only puts some water in your tissues. What about taking the real thing if your crazy enough. Testosterone injections when used without an estrogen blocking agent in men can aromatize into estrogen which really packs on the water (and the swollen look). Might this help reduce DCS. well, if we are only looking at water retention. others...
corticosteroids like prednisone.
I wouldn't use creatine for diving but I like the thought process your using, sorry if i took this overboard (pun).

[Web Monkey]

I was wondering if anybody has information as to the possibility that creatine can help reduce DCS? I have used creatine during workouts and know that it helps to retain water in the muscles. If this leads to better retaining of water then can an argument be made it MAY help stave off DCS? Thoughts?

FWIW, I tend to not screw with my body chemistry and reduce my risk of DCS by keeping well hydrated, staying away from the edge of the no-deco limits for no-deco dives and avoiding unnecessary exercise right after the dive as per our own Dr. Deco (http://www.scubaboard.com/forums/ask-dr-decompression/250753-post-dive-exercise.html):

It's worked so far.

Terry

[Mr Carcharodon]

I’d start by looking at the premise that hydration lowers DCS risk. Nice theory, make perfect sense, but is there any evidence that backs it up? Also remember according to DAN DCS accounts for 2% of all diving accidents. So an unproven hypothesis, multiplied by a wild guess, multiplied by a low starting probability suggests that the chance that this will help approaches nil.

[Web Monkey]

I’d start by looking at the premise that hydration lowers DCS risk. Nice theory, make perfect sense, but is there any evidence that backs it up? Also remember according to DAN DCS accounts for 2% of all diving accidents. So an unproven hypothesis, multiplied by a wild guess, multiplied by a low starting probability suggests that the chance that this will help approaches nil.

Being well hydrated makes me feel less tired and reasonable amounts of water are known to be safe.

The same cannot be said for creatine and various other substances that may or may not reduce the risk of DCS, but do have known side effects.

Terry

[Mr Carcharodon]

Being well hydrated makes me feel less tired and reasonable amounts of water are known to be safe.

The same cannot be said for creatine and various other substances that may or may not reduce the risk of DCS, but do have known side effects.

Terry

Being tired may be a sub-clinical indication of a bubble load, but still be far away from causing any lasting harm. Of course there could be any number of other things that cause fatigue. So saying fatigue is due to DCS is conjecture. I’d just ask if there is anything other than folklore that relates hydration to DCS. I suspect no one will be able to point to a study that shows a correlation. Which does not mean it does not exist. But the foundations may be far less firm than you imagine.

Reasonable amounts of water are safe? Reasonable amounts of many things are safe but not generally claimed to be preventive.

[Web Monkey]

Being tired may be a sub-clinical indication of a bubble load, but still be far away from causing any lasting harm. Of course there could be any number of other things that cause fatigue. So saying fatigue is due to DCS is conjecture. I’d just ask if there is anything other than folklore that relates hydration to DCS. I suspect no one will be able to point to a study that shows a correlation. Which does not mean it does not exist. But the foundations may be far less firm than you imagine.

Reasonable amounts of water are safe? Reasonable amounts of many things are safe but not generally claimed to be preventive.

Whether or not water prevents DCS is irrelevant. The point is that it does no harm.

Creatine has a number of known effects and side effects and no clear indication that it's safe for diving.

Terry

[Mr Carcharodon]

Whether or not water prevents DCS is irrelevant. The point is that it does no harm.

Creatine has a number of known effects and side effects and no clear indication that it's safe for diving.

Terry

The claim was relevant to this discussion. Specifically the claim was creatine equals increased hydration and that leads to decreased DCS risk. I was pointing out there is no verifiable indication that hydration decreases risk of DCS. Water may be safe, but many safe things do nothing to decrease the risk of DCS. Performing a harmless activity like drinking water and decreasing your DCS risk are not the same.

I am poking at what I believe to be unverified conventional wisdom. I'd be happy to be shown wrong. But the premise of the original post may have no foundation.

[Bubbletrubble]

I was pointing out there is no verifiable indication that hydration decreases risk of DCS.

I am poking at what I believe to be unverified conventional wisdom. I'd be happy to be shown wrong. But the premise of the original post may have no foundation.
@Mr Carcharodon: You could make a far more compelling argument if you cited some peer-reviewed papers which suggest that dehydration does not increase the incidence of DCS. Here's one:

Skogland S, Stuhr LB, Sundland H, Olsen RE, Hope A. Venous gas emboli in normal and dehydrated rats following decompression from a saturation dive. (http://www.ncbi.nlm.nih.gov/pubmed/18581939?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=1) Aviat Space Environ Med. 2008 Jun;79(6):565-9.
The methodology for this study consisted of dehydrating rats by withholding water for 2 days prior to trials. Control rats were given access to water ad libitum. The rats were subjected to a saturation dive to 5 ata and allowed to breathe heliox for 16 hrs. At the end of the dive, they ascended at a rate of 0.3 MPa/min. Bubble grade scores were actually lower in the dehydrated rats.

[Bubbletrubble]

I suspect no one will be able to point to a study that shows a correlation.
@Mr Carcharodon:


Gempp E, Blatteau JE, Pontier JM, Balestra C, Louge P. Preventive effect of pre-dive hydration on bubble formation in divers (http://www.ncbi.nlm.nih.gov/pubmed/18308884?dopt=Abstract). Br J Sports Med. 2009 Mar;43(3):224-8. Epub 2008 Feb 28.

Here's a direct link (http://bjsm.bmj.com/cgi/content/full/43/3/224) to the article on the British Journal of Sports Medicine website.

The methodology used in this study consisted of divers who, in one trial, drank a saline-glucose beverage pre-dive and, in another trial, did not engage in any pre-dive hydration. The saline-glucose beverage had a volume of 1300 mL (324 mOsm/L), and subjects drank this beverage over a time frame of 50 and 60 min. The dive profile was 30 msw for 30 min followed by a safety stop at 3 msw for 9 min.
Precordial pulsed Doppler was used to determine bubble scores (Spencer scale then converted to KISS). Divers during the pre-dive hydration trial had significantly lower bubble scores than during the trial lacking prehydration. Plasma volume was shown to be significantly higher in the prehydration trial. There was no difference in plasma surface tension between the two trials.

[Bubbletrubble]

Mr Carcharodon makes a good point, though. A look at the literature will show that there is a fair amount of disagreement as to whether adequate hydration decreases the incidence of DCI.

Perhaps instead of flooding ourselves with fluids before a dive, we should be doing a little exercise:

Claybaugh JR, Lin YC. Exercise and decompression sickness: a matter of intensity and timing (http://www.ncbi.nlm.nih.gov/pubmed/14766931). J Physiol. 2004 Mar 16;555(Pt 3):588. Epub 2004 Feb 6.

Here's a direct link (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664872/) to the editorial commentary on PubMed Central.

Here's a PubMed citation link (http://www.ncbi.nlm.nih.gov/pubmed/14755001) to the primary research article discussed in the editorial.
Here's a direct link (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664874/) to that primary research article by Dujic et al.

[Web Monkey]

Mr Carcharodon makes a good point, though. A look at the literature will show that there is a fair amount of disagreement as to whether adequate hydration decreases the incidence of DCI.

Perhaps instead of flooding ourselves with fluids before a dive, we should be doing a little exercise:

Or just staying away from the NDL.

Terry

[Mr Carcharodon]

Thanks for the links. I have only read the first one so far. The last sentence in the abstract was: "This difference was not significant". Which is to say there was no significant difference in bubble load with hydration levels.

Also bubble load does not equal DCS at least below a threshold. So about the best you can argue is that hydration might decrease bubble loads which might in turn put you over a DCS threshold in certain circumstances. I'll look forward to reading the other two. Thanks again for the links.

I’d recommend longer stops since those clearly work.

[Bubbletrubble]

Also bubble load does not equal DCS at least below a threshold.
I agree. This is something that many divers don't realize. Doppler measurement of venous gas emboli is straightforward to do...but what is the true relevance of those readings to DCS? As you point out, bubbles can be present with no overt clinical symptoms. Still, the occurrence of lots of bubbles is clearly linked to a high risk of DCS. We don't really now how to interpret this. More research needs to be done.
So about the best you can argue is that hydration might decrease bubble loads which might in turn put you over a DCS threshold in certain circumstances.
Yup. (The key word is "might"...and you used it twice!) I included links to those two citations because the detection methodologies were similar -- bubble scores generated by precordial Doppler. This highlights the discrepancy in the results/conclusions. Something that I wonder about is how reproducible Doppler measurements are in the rat model -- smaller anatomy could make consistency problematic.

In all of the papers I've read on the subject, the authors have been very responsible in discussing the limitations of correlating bubble load with DCS. We should be just as careful.

Thanks for bringing up some very good points in this thread. Hopefully others have found the info thought-provoking.

[scubadobadoo]

The claim was relevant to this discussion. Specifically the claim was creatine equals increased hydration and that leads to decreased DCS risk. I was pointing out there is no verifiable indication that hydration decreases risk of DCS. Water may be safe, but many safe things do nothing to decrease the risk of DCS. Performing a harmless activity like drinking water and decreasing your DCS risk are not the same.

I am poking at what I believe to be unverified conventional wisdom. I'd be happy to be shown wrong. But the premise of the original post may have no foundation.
I look to a whole list of things to decrease my DCS risk and those include being hydrated (because being dehydrated IS a concern and does lead to problems even if increased hydration alone can't be proven to reduce your risk of DSC) , well rested, diving within my limits, staying warm, going to the gym and being reasonably fit, slowing my ascents etc.........

Simply pick up a cup and drink baby. ;) In the end, I think DEHYDRATION is the concern. I don't think it can be proven that being well hydrated or more hydrated reduces your risk of DCS but anyone can clearly see that being dehydrated could lead to all kinds of problems on a dive. Therefore, drinking that water may in fact reduce your risk of a diving accident if it helps to keep you from becoming DEHYDRATED as we know it can.

[Mr Carcharodon]

I look to a whole list of things to decrease my DCS risk and those include being hydrated (because being dehydrated IS a concern and does lead to problems even if increased hydration alone can't be proven to reduce your risk of DSC) , well rested, diving within my limits, staying warm, going to the gym and being reasonably fit, slowing my ascents etc.........

Simply pick up a cup and drink baby. ;) In the end, I think DEHYDRATION is the concern. I don't think it can be proven that being well hydrated or more hydrated reduces your risk of DCS but anyone can clearly see that being dehydrated could lead to all kinds of problems on a dive. Therefore, drinking that water may in fact reduce your risk of a diving accident if it helps to keep you from becoming DEHYDRATED as we know it can.

By all means go ahead and drink water if you want to it will do no harm and it may help a bit (apart from the potential for a smelly wetsuit). I am just suggesting that the things we know with confidence reduce DCS risk are staying away from no decompression limits or doing conservative stops to decompress on the way back up. Dehydration may be a factor but it is a weak one at least within extremes. Three to five minutes between twenty and ten feet will do more to prevent DCS than drinking a liter of water. Please focus in the right place.

I did troll around a bit tonight in the literature and did not find a smoking gun that relates dehydration to DCS. Although I do not have subscriptions to all the relevant journals. Rubicon does have a number of citations but few things checked in. If I am am headed down a wrong path please do let me, and everyone else, know.

[SCUBA482]

While my original question was to creatine helping to hold water, and thus retain one's ability to pre-hydrate, I like the responses so far...i find it interesting that there is such debate about the link with DCS and hydration....I in no way meant that each of us should avoid the other known preventive steps such as diving within NDL and conducting SS upon a slow and safe ascent, it was just to stimulate the idea of the relation between the two.

I can say that I usually bring a large gatorade drink to have between dives, and one before i start and one after done diving...i find that being hydrated just makes me feel better. I brought this topic up because I was talking to one of my buddies about our work out and he mentioned a new creatine he was trying and it made me think...i look forward to hearing more about this topic as the thread continues...