Dark urine is a sign of rhabdomyolysis, which damages the kidneys
With the popularity of exercise-to-exhaustion programs, such as CrossFit and P90X, there’s a sudden rise in a condition called rhabdomyolysis that is gaining a lot of attention.
Rhabdo, as it’s known, has 3 main symptoms that people need to be aware of because they can be life-threatening if left untreated.
Today, I had the chance to visit in-studio WAKR morning show host Ray Horner to discuss this topic. I also answered questions from callers about body-building supplements and what side effects ingredients like whey protein or creatine can cause.
Below is an audio file and transcript of our discussion.
HORNER: Joining us live right now is Dr. Joe Congeni from Sports Medicine Center at Children’s Hospital. Joe, where do you want to start with us this morning?
DR. CONGENI: Well, Ray, one of the things that’s being talked about a lot here recently is people are working to get themselves in shape.
HORNER: This is the time of year, Joe.
DR. CONGENI: This is the time of year. You know, this is college kids, adults. But, there is a lot of discussion of cases where people go on to a thing called rhabdomyolysis.
I don’t know if you’ve heard of this, but it’s become something that a significant segment of people who enter programs like CrossFit, or P90X or Insanity — or they are going into the military and there’s no real buildup to their training — get the big triad of rhabdo. This is called rhabdo.
A significant number of people wind up in the hospital, even with life-threatening symptoms. I just want to talk about what some of these symptoms are. They call it the triad of symptoms.
That is muscle pain, muscle weakness — the muscles after you’re building them up and everything, you wake up one day and they just feel like Jell-O. They can just barely get out of bed and get around. And, the third that’s really key is dark urine. Looks like Coca-Cola or tea-colored urine.
Don’t wait a long time if you have those symptoms. So, if you’re in a new exercising program and you have muscle pain, muscle weakness — Jell-O-like muscles — and dark-colored urine, you have to get in to see a doctor.
Dr. Joe Congeni
HORNER: What’s the big picture? What is that telling you? I mean, you see the dark urine. What’s happening?
DR. CONGENI: Yeah, here’s what’s happening, Ray. I’ve seen it in our practice here recently, not infrequently. There’s a lot being talked about nationally that it may be in very high numbers of people who start these packaged programs.
The muscles break down and this myoglobin that gets into the urine is a protein, a muscle-breakdown protein, and what it does is it overloads the kidneys. These people will go into kidney failure.
Now, fortunately, much of the time it’s acute kidney failure, which means that it is reversible and people do okay.
But, the longer you wait, the [higher the] chance you could get into more prolonged kidney failure, more significant kidney damage. Some people even end up needing to be on dialysis and [others] have recurrent kidney problems after this.
So, rhabdo is a big deal. And, [you’ll see] a lot of people even on the websites and blogs talk about rhabdo as being a real concerning event.
HORNER: Joe, in bringing this on, we’re just doing too much, too fast, not paying attention to body warning signs? What brings this on?
DR. CONGENI: Exactly. You know, too much, too fast, or a significant jump in your training program. You know that many of these programs are set up as exercise-to-exhaustion.
That’s the way they’re made. To really get a significant gain, you have to exercise to the point of total exhaustion. That’s the end point from what I’m told about CrossFit and P90X and perhaps a few of the other packaged programs. Or, just people getting on a program and saying, you know, I’m gonna exercise to total exhaustion.
CC Photo/Flickr by CherryPoint
Then, they wake up one day and they feel like Jell-O and they have this dark-colored urine. Don’t wait a long time. Get in to see somebody if you see that triad of symptoms.
HORNER: You know, from the sports medicine side of things, if you are looking to get in better shape and better health, walk before you run, [right]?.
DR. CONGENI: Exactly. Minimum, Ray, and you know this, [people should give themselves] 6 to 8 weeks to build up a program. You know, doing it by 20 percent intervals might be a reasonable thing to do.
But, we live in a society where we want it all now and people start right on day one, or in the first week, with this exercise-to-exhaustion mentality. And, what’s gonna happen is the body isn’t going to tolerate that very well and we’re gonna end up with a pretty big crash.
HORNER: Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital, in our studio. Hey, Joe, we’ve got a caller that’d like to talk to you for a moment. Good morning, you’re on WAKR. Go ahead with your question.
CALLER: Good morning. Dr. Congeni, [I have a question about] young people in their 20s, in their 30s, that are really into the body-building mode and they’re taking, you know, that whey or different body-building supplements. What is it that you look for in the ingredients that you need to be concerned about?
DR. CONGENI: Well, you know, that’s a great question and it’s a perfect segue from what we were talking about today.
First of all, many of those supplements now have many different products in them. So, it’s not as simple as the old days where it was just creatine or just whey protein.
You mentioned whey protein. Whey protein is what a lot of our high-school and 20-year-old kids take because proteins are the building block of muscle. So, the thought process is if you take a lot of the building block, you’re gonna build more muscle when you’re working out.
The deal is, though, that your body can only absorb so much protein. If you have a pretty good, well-balanced diet, really the excess you take is not going to add more muscle, it’s going to be peed out.
The problem is with kids taking high percentages, high amounts of these supplements is we worry about the kidneys again. So, like what Ray and I were just talking about, damage to the kidney, or kidney failure.
The biggest thing we’ve seen with creatine and whey protein is if kids are taking too much. We have seen kids with kidney failure. Luckily, it’s usually been transient kidney failure, acute failure, that people recover from. But, that’s our biggest worry about the supplements is the injury to the kidneys.
HORNER: Is there something they should be leery of when they see it on the side of the can, Joe, or are there just too many ingredients?
DR. CONGENI: There are just so many ingredients. And, really, I don’t want to overly sound the alarm bells. Creatine and whey protein overall, I’m not sure it’s worth fighting the battle with your 20 year olds and 30 year olds. There really isn’t a lot of bad side effects, unless they’re really overtaking [them].
But, the combination of using those supplements and going into one of these exercise-to-exhaustion programs, I wonder if that isn’t like a double hit to the kidney.
HORNER: Okay, you’ve got something going on with the concussion education again.
DR. CONGENI: Yeah, you know, the Austen BioInnovation Institute in Akron here is trying as much as they can to get the word out about different things. We’ve [worked together] on a program that is actually this afternoon, “Bridging the Gaps for Concussion,” for people that want and need to know more about this.
We have a program today at 4:30 p.m. at Austen BioInnovation. There are still some openings. I think I was told there are 80 or 100 people signed up. It’s open to anyone.
HORNER: Okay. Joe, as always, thanks for coming in. Good education, good call as well. Thank you.
DR. CONGENI: Thanks, Ray.
HORNER: Alright. Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital, joining us in studio.
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