Changes in plasma homocysteine values after thirty days of creatine supplementation

Introduction: Hyperhomocysteinemia is associated with elevated risk for the development of cardiovascular disease. Biosynthesis of creatine occurs in enzyme-driven reactions with the second reaction involving the transfer of a methyl group to form creatine and S-adenosylhomocysteine (SAH). SAH is then hydrolyzed to adenosine and homocysteine. Consequently there have been a few researchers that have studied the effect of creatine supplementation on homocysteine levels. Therefore this study was undertaken to discover if oral supplementation of creatine would affect levels of plasma homocysteine in End-Stage Renal Disease (ESRD) patients. Methods: ESRD patients (N=21) who had elevated homocysteine levels and were undergoing chronic hemodialysis volunteered to participate in the study. Patients were followed prospectively for 30 days while supplementing 5g/day of creatine monohydrate. Homocysteine levels were measured at baseline and 30 days. All patients were instructed to follow the same diet they had followed the previous 30 days. Patients also consumed vitamin supplements which contained 15 mg of B6, 12 mg of B12, and 2.5 mg of Folic Acid, which is considered standard medical care for controlling homocysteine levels. Results: Homocysteine levels significantly increased (t=-2.194, p=.040) in ESRD patients with pretest values of19.00 mg/dL (SD=15.12) and posttest values 27.35 mg/dL (SD=10.67). Conclusions: Previous literature suggests that homocysteine can be lowered through the supplementation of creatine in apparently healthy populations. One study in ESRD patients reported no changes in homocysteine values. Our study contradicts these findings suggesting that supplementing creatine in ESRD patients may cause an increase in homocysteine levels. ESRD patients have significantly elevated homocysteine values and novel approaches to controlling these levels are warranted. Our study suggests the creatine supplementation may lead to an increase in plasma homocysteine levels suggesting its use in ESRD patients should be limited or eliminated.