Wednesday 24 May 2017

Neil Francis on Jonah Lomu: A life lost needlessly

Jonah Lomu passed away at the age of 40 last week
Jonah Lomu passed away at the age of 40 last week
All Blacks legend Jonah Lomu
Neil Francis

Neil Francis

And so a day that all in the rugby community was hoping could be postponed for another 30 years came to pass. "The glories of our blood and state are shadows, not substantial things. There is no armour against fate; death lays his icy hand on kings; early or late they stoop to fate."

The mere act of getting on an airplane and travelling anywhere was an act that put Jonah Lomu's life at risk. It doesn't matter how you punctuate the trip. A flight from London to Auckland for somebody with chronic kidney disease will in itself put that person's life at risk.

Lomu is the visual personification of the Rugby World Cup. His presence was required in England and he was a busy boy at the competition. Yes, financially and commercially it would have been good for him but having a World Cup without Jonah was like having Christmas without Santa. His benign presence and a much improved corporeal self was reassuring, he did look much better than he did in 2003/2004. See you in Japan so. I am sure there are medical protocols to be observed if you are on dialysis several days a week. Heading away from his medical team in Auckland for the guts of six or seven weeks would require planning.

If you are susceptible to clotting you take some form of blood thinner and you move around the plane and remain active. His death has all the classic symptoms of DVT - a heart attack within a day of arriving back on a long-haul flight. Even if you follow all the guidelines there are no guarantees when you are ill.

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It is never too soon to ask the question: How did this tragedy happen. How did he acquire Nephrotic Syndrome? How did it progress to renal failure and what can we learn?

Some of the media pointed to the fact that Polynesians are predisposed to the disease, but that is not necessarily true. There is just as high an incidence per capita in Australian Aboriginals, Africans and African Americans. You can't just assume racial predisposition. Neither do you just wake up in the morning and suddenly discover that you just have it. It is a disease of gradual onset. So what caused it?

This is where I can only speculate. In the mid-'90s when Creatine became the new wonder supplement, it was embraced by New Zealand rugby. Without engaging in a systematic supplementation programme, the Kiwis at provincial level actively promoted and recommended the product. The Auckland Blues squad used Creatine heavily as part of its programme. It is well recognised that Creatine was a major component in most of New Zealand's provincial squads' dietary and supplementation programmes.

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AUCKLAND, NEW ZEALAND - JUNE 27: All Black Joeli Vidiri breaks through an England tackle during the 2nd and final test between England and the All Blacks.The All Blacks won 4010. (Photo by David Hallett/Getty Images)

Is it a coincidence that two players from the same team, Jonah Lomu and Joely Vidiri, both should acquire Nephrotic Syndrome and even if they had or had not taken Creatine can we link Creatine and Nephrotic Syndrome?

What is Creatine for a start? Creatine is a compound that can be made in our bodies or taken as a dietary supplement. The chemical name is methylguanidine - acetic acid. It is made up of three amino acids - Arginine, Glycine and Methionine. Our livers can combine these three amino acids to make Creatine. Creatine in the main is stored in your major muscle concentrations and is essentially muscle fuel.

I'm not surprised that the product took off. It has the same effect as taking anabolic steroids without having the same properties because it is naturally occurring within the body and it's legal. It allows you to train for longer without lactic fatigue and it genuinely does bulk you up. Before the FDA or any regulatory body could analyse Creatine it had become a billion-dollar industry. Nobody had a clue about any long-term effects. It just came onto the market in the early 1990s and demand ballooned. There were side effects of course - there are in every product.

The Tampa Bay Buccaneers, a Super Bowl-winning franchise in the NFL, produced a position paper on Creatine to all their players. I can synopsise the more pertinent points for you on the side effects:

1) Creatine can cause an electrolyte imbalance which causes tetanic muscle cramping, muscle strain and ligament tear.

2) Creatine reduces blood plasma volumes which adversely affect your ability to perform and dissipate heat - dangerous for the heart.

3) No longitudinal studies or research and federal legislation has reversed consumer protection regulations of the Food Supplementation Act back to the 1905 Food and Cosmetic Act standards. As a result, quality and purity is highly suspect and potentially dangerous.

They conclude by saying "current evidence suggests that Creatine supplementation may be advantageous to a bodybuilder interested in 'ornamental' muscle development; however, disadvantageous for football players interested in 'functional' muscular development. As a result, the Tampa Bay Buccaneers do not endorse Creatine supplementation as a training adjunct to our players."

So you are beginning to get a flavour; an organisation like the Tampa Bay Buccaneers won't use it.

What about the IRFU? Liam Hennessey the former IRFU Physiological Fitness Co-ordinator is fairly succinct. He doesn't like the product and the IRFU's view is fairly clear that they do not want their players using it. He pointed to the Cologne study which stated that 14.9 per cent of Creatine is contaminated and would produce a positive result under WADA criteria. Recently IRFU nutritionist Ruth Wood Martin advised against players, particularly anyone under 18, taking nutritional aids and in particular Creatine.

Let's get to the bones of it.

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Jonah Lomu runs behind the posts to score a try during the All Black v Ireland rugby test at Lansdowne Road in November 2001

Like most products, you have got to read the small print. Most of the products I picked up in my local health store stated that before you take Creatine you should consult a medical doctor, particularly if you have been taking other medications including Anabolic Steroids or have certain conditions which might trigger a negative interaction. Most instructions state 5g a day for a four- to six-week programme and then a 10- to 14-day break.

Yes indeed, but what happens if you are a mutton head and don't read the instructions and take three or four times the dosage without a break? Will you get three or four times bigger? Any Creatine your body does not use is excreted as a waste product called creatinine. If you take 20g a day of Creatine your body will not be able to use most of it and will have to excrete the excess. Over time this constant excretion of creatinine can put a lot of work on your kidneys and liver. If you force them to work too hard that can lead to serious problems.

Quite apart from a number of medical people who would voice concern over Creatine and its effect on your liver and kidneys, all you have to do is go on the internet, input Creatine and Nephrotic Syndrome and lo and behold 93,300 hits, many of them medical papers and studies linking the two. I randomly chose one of many for the purposes of demonstration, this is one from the National Library of Medicine;

"Authors report a case of diffuse membranoproliferative glomerulonephritis Type I in a 22-year-old who had been taking continuously methandion in a large quantity and 200 grams of Creatine daily, and was sent to the outpatient nephrologic unit with typical clinical signs of nephrosis syndrome. They also call attention to the role of the continuously consumed Creatine in the renal failure."

If you're bored check out a few of these sites.

Another link gave details on a report by the French Ministry of Health on Creatine. The report received a lot of adverse reaction from various sources but the French Government took it seriously enough to ban the sale of Creatine.

As for Ireland, well you can get the stuff anywhere you want. I would suggest that maybe the legislators might consider a ban on the sale of Creatine to anyone under the age of 21. And missus, if Little Johnny, or more likely Big Johnny, is taking the stuff, take it from him and throw it in the bin. The simple reason is you don't know what you are taking.

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NEW YORK, NY - MARCH 25: NBA legend Alonzo Mourning Visits AOL Build at AOL Studios In New York on March 25, 2015 in New York City. (Photo by Chance Yeh/FilmMagic)

Alonso Mourning, a basketball player with the New Jersey Nets and a member of the American dream team in the '90s, was a big user of Creatine and his doctors went on record as saying that it was a major contributory factor in his acquiring Nephrotic Syndrome, his subsequent renal failure and kidney transplant. The link is, as far as I am concerned, indisputable.

Joely Vidiri had a kidney transplant recently and has made a good recovery from that procedure. Maybe he reflects on his team-mate and friend's death, the vagaries of life and death and the thin line between the two. The former Auckland Blue freely admitted he consumed large amounts of Creatine. Jonah denied taking it - but as an 18/19-year-old coming from the wrong side of the tracks into a regulated and professional environment, you'd wonder about that. Did Jonah need to get bigger? Vidiri was bigger than Lomu and he didn't see a problem getting bigger.

If you have an underlying or existing medical condition you do not take Creatine. Never. This product and its unrestricted use in many countries needs a serious pharmacological audit.

The poster boy for rugby union and its World Cup generation has left this world prematurely and needlessly. We get a snapshot of the stresses and torsions of people who need to undergo transplant surgery and their tenuous grip on everyday life and the grim struggle it entails.

Meanwhile, the platitudes and eulogies from all the finest players on the planet in recognition of Lomu's greatness and the respect that everyone, Mike Catt included, had for him is touching. It reaffirms the bond rugby people have for each other.

Me? I subscribe, but I am asking questions too.

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