As with anything, once it reaches the point of being "high profile", conflicting reports begin to emerge. On the one hand, Blue Cross, Blue Shields Health Competition Foundation is warning against the use of the supplement. They describe Creatine as "an unregulated substance that is marketed and used in large doses by teenagers without proper medical supervision".
However, all they have to offer as an inducement to abandon its use is "anecdotal, single-case reports and preliminary evidence suggest that Creatine may be linked to cramping, diarrhea, nausea. dizziness, dehydration, incontinence, muscle strain, high blood pressure and abnormal liver and kidney function. There is no conclusive scientific evidence suggesting that Creatine use predictably causes any of these problems."
Probably their attitude is influenced by three tragic incidents where young wrestlers died during training. The FDA became aware that they had been using Creatine to enhance their work-outs, and understandably issued a warning about its use until the problem had been resolved. The agency ultimately determined that Creatine had NOT been a factor in these sad cases.
Additionally, a recent 6 week study at the University of Nottingham Medical School concluded that rational use of Creatine at recommended levels posed no risk to healthy athletes.
In another study, a research team (Med. & Science in Sports & Exercise, 31(8):1,108-1,110, 1999) compared 10 people in a control group who had never used Creatine to a group of 13 football players who had used Creatine for periods ranging from 3 months and 4 years. The highest amount used was 10 gms per day for 5 years. They did blood tests which showed no difference in chemical markers of liver and kidney function.
Two studies at Arkansas State University tracked 61 Creatine using baseball and football athletes , with a control group of 50 non-supplementing athletes, and found no difference in incidents of muscle cramps, injury or illness. I want to point out that this study and others determine Creatine to be safe in its PURE form: as usual, when there is money to be made there are people who try to profit unethically, and some Creatine on the market now is cut with cheap fillers, or contaminated in other ways which are bound to pose health risks. Make sure the product you buy is from a reputable company: don't take risks with your health for the sake of a few dollars, it just isn't worth it. Also, there is a possibility that Creatine might be harmful to someone with a pre-existing kidney condition or weakness.
The first time I heard Creatine mentioned in connection with sports, some British friends of mine told me that the British 1992 Olympic Gold medalist, Linford Christie, used it to enhance his training. Soon thereafter, some Swedish and British researchers collaborated on a number of studies published in 1993, and the rest is (for body builders and athletes, at least) history. From the one company that first put Creatine on the market we have reached the point where ALL the companies that promote sports nutrition sell it! Does it deserve this intense interest? In my opinion, yes.
Creatine is naturally present in our bodies, our supplies coming mostly from meat and fish: since Creatine is stored in muscle tissue, this makes perfect sense! It's main function is to regenerate ATP, which feeds the energy cycle used to provide us with short, sharp bursts of intense energy. When your muscles are in use, they use approximately one hundred times more ATP than they do when they are at rest. The more Creatine you have present in your body, the more ATP can be regenerated, and the more extensive your potential energy supply.
Does supplementing with additional Creatine actually work? There can be no doubt. I do occasionally run across a person who says that it made no difference to them, but almost always this is because they have not used it in the most effective way: Creatine needs help to be carried into the cells to do its work, and this help is provided either by taking it in conjunction with a simple carbohydrate such as can be found in fruit juice, or by using it after a loading cycle has been carried out, where greater than usual amounts are taken for a short period of time, and then reduced to a maintenance amount. The dose usually recommended is 20 grams to be taken daily in 4 divided doses for 5 days: after that, a maintenance amount of 2 to 5 grams per day is usually sufficient to keep the level in the body at optimum.
What results are people experiencing? Athletes taking part in sports that require intense but brief spurts of exertion, such as in martial arts, sprinting, cycling, tennis, swimming, and perhaps boxing, report more explosive power and endurance, and quicker reaction times. This is certainly supported by Dr. Greenhaff's 1993 study, showing the benefits of Creatine on intense exercise performance.
Bodybuilders report that they have more strength, and greater lean body mass. The studies of Earnest in 1995 and of Kreider in 1997 confirm this.
All athletes appear to feel that fatigue is staved off by the use of Creatine, together with a decrease in muscle soreness and stiffness, and Dr. Hultman's 1993 study agrees with this claim.
Certainly a plus for some athletes - a 2003 Australian study found that it increased intelligence significantly in young adult vegetarians..
So, what of those who are neither boxers, cyclists or body builders, but weekend warriors or would be workers-outers? That, to me, is the truly interesting part. As some of you may know, I run. My aim, which I sometimes fall short of but usually fulfill, is to run 2 miles or so about 5 times a week. Those of us who may be getting older (which counts me out, of course!) may experience a situation where exercise actually causes muscle loss - well, the newest research is turning up really beneficial aspects of Creatine for us. It enables the older physique to build muscle with exercise, and I feel this finding will also have really exciting applications for the truly Senior Citizens, who are experiencing wasting of their muscles. At the present time, medical science is experimenting with the use of steroids - growth hormone injections: but these have major side effects, whereas Creatine does not. Perhaps even MORE interesting for ladies of a certain age, like myself, worried about osteoporosis, is that researchers in Tokyo are finding preliminary evidence in rat studies that Creatine may promote healthier bones: more calcium was absorbed from the gut, and bone mineral density was found to be higher. It might be wise to make sure you are getting adequate levels of calcium when using Creatine, thereby turning this into a truly positive benefit.
Creatine is also present in heart muscle, where its role in regenerating ATP could turn out to be of extreme importance. Those of you who have been following my articles on the importance of methyl donors to heart health via homocysteine levels (recently, incidentally, also found to be a factor in Alzheimer's Disease) will be interested to know that the chemical name for Creatine Monohydrate is Methyl Guanidine-Acetic Acid. It may certainly be worth adding to such supplements as CoQ10 and L-Carnitine where cardiomyopathy or congestive heart failure is present.
Does Creatine have any side effects? There have been cases reported of athletes overexerting themselves to the point of cramps and muscle tears, and using more of it than is recommended has resulted in temporary diarrhea, which goes away when the dosage is reduced. That is all. Creatine is, after all, a chemical naturally present in the body and excreted routinely through the kidneys on a daily basis. Certainly it is a essential to make sure you are drinking a sensible amount of water when using Creatine.
If your workout is not giving you quite the results you look for, or if working with weights is making you smaller rather than bigger - Creatine may be the answer to your problem. I use it before my runs, and have found it makes a big difference!
Something new to athletes which may become a "side-kick" for Creatine is D-Ribose. This is a simple sugar which is needed to synthesize ATP, ADP and AMP, all energy nucleotides. Trials are showing that the effect of ribose on human performance and energy recovery are very positive, with increases of almost 10% in mean power per kg of body weight, peak power per kg and total power per kg for ribose users. So far, no side effects have been noted for Ribose, and some interesting research is being done on its supportive role in cardiovascular health and in suppressing inflammation.
New research on Creatine is pretty impressive. Supplementation with it is being used in cases of neurodegenerative diseases, (one interesting study in Med. Sci. Sports Exerc.,33:869-872, 2001, found it effective in myasthenia gravis) in tumors, high blood glucose levels, congestive heart failure and even a rare retinal atrophy that ends in blindness, and most results show preliminary promise. In actual fact, it was treating the eye disease with Creatine that led to its discovery as a muscle supplement, since this was the side effect noted with treatment. Perhaps the most exciting studies are indicating that Creatine is protective against the risk of stroke-related neurological damage . Granted the first studies were in mice, but a 56% reduction in damage related to stroke in Creatine supported rodents is very promising.
The National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health (NIH), is conducting a new clinical trial to examine Creatine as a treatment for Parkinson's disease. Researchers believe that Creatine may act as an antioxidant, preventing damage to brain cells.
The latest medication for diabetes is a biguanide called Metformin, which increases tissue sensitivity to insulin, allowing entry of glucose. Creatine also contains guanidine, and experiments have shown that very high doses of Creatine can cause low blood sugar. On this theory, fasting insulin dependent type 1 diabetics were given a 3 gram dose of Creatine, and it was found that there was a significant reduction in blood glucose levels without changing blood insulin. In 1999, the American Diabetes Association got much the same results in type 2 diabetics.*
Now it seems that Creatine can also help control cholesterol levels: At the Cooper clinic in Dallas, they put 34 patients who had blood levels of cholesterol (fasting) between 220 and 250mg/dL on 10-20 mg of Creatine a day, and after 8 weeks discovered a 20% lowering of triglycerides and 5% of total cholesterol. HDL was not affected, and these effects lasted for four weeks after the study was finished. Dr. Almada, who was part of this double blind, placebo controlled study, points out that the Stockholm study in the 1980s showed that where triglycerides are lowered by 30%, the risk of dying from a secondary coronary event was halved.
* Hill RM. The effect of the administration of creatine on the
blood sugar. J Biol Chem 1928;78:iv.
.Beisswenger PJ, et al. Metformin reduces systemic
methylglyoxal levels in type II diabetes. Diabetes 1999;48:198-202.
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