Last week we discussed the nutritional supplement creatine. It has recently generated much interest in the media and has sparked controversy in the athletic world between competitors who want to push the envelope, and the purists. What is creatine, and how does it work?
Creatine is an amino acid that occurs naturally in certain protein rich foods. Red meat and some fish contain high levels of creatine. The average adult who eats a well balanced diet will take in around 1-2 grams of creatine each day.
Creatine is a major component in the production of energy or fuel for our skeletal muscles. When we ingest creatine, it is absorbed by the intestinal tract and through a series of steps, it is carried directly into the muscle cell where it combines with a phosphate molecule to form creatine phosphate. Creatine phosphate then enters a pathway of reactions that ultimately form ATP (adenosine tri-phosphate) which is THE main source of energy for the muscle.
Studies have shown that when one ingests "extra" creatine, the levels of available creatine and creatine phosphate in the body rise. During exercise and energy expenditure, the level of ATP falls when the level of creatine phosphate falls. It is felt that by taking extra creatine, one can maintain adequate levels of ATP for the muscles, for longer periods of time. In theory, you should be able to work out harder and longer because you are providing extra fuel for the muscles.
When one exercises in short duration, high intensity work outs such as wind sprints, or running up stairs etc., the body must break down it’s glycogen stores in an "anabolic" manner to provide energy for the muscles. This is not a particularly "clean", or efficient, method of fuel production, and as a result leads to the build up of lactic acid which leads to muscle fatigue. Some people feel that taking extra creatine provides the body with high levels of creatine phosphate which can delay the need to burn glycogen which can delay the onset of fatigue.
Many body builders are convinced that creatine has helped them "bulk up" when used while they weight lift. There may be some truth to this as studies have shown that there is an increase in fluid within the muscle cells of creatine users. This does in fact increase muscle mass and bulk.
Creatine is classified as a nutritional supplement by the Federal Drug Administration so there is little regulation of it. It can be purchased at any health food store. It’s use among athletes has sky-rocketed in the past 5 years. One source reports that 25-50% of professional baseball, football and hockey players use creatine. This number is rising among Olympic and college athletes as it is not a banned or tested substance.
It is difficult to say at this time exactly how safe creatine is because there are not a lot of well designed studies to look at this. It does have side effects which include dizziness, diarrhea and muscle cramps. In 1997, three collegiate wrestlers who had been taking creatine regularly died suddenly. Creatine was implicated at first, but after a lengthy review, it was felt that the cause of death was dehydration and excessive weight loss.
There are some concerns about adverse effects that creatine use may have on kidney function. There was a case reported in which a young male developed kidney problems while taking creatine. The kidney problems resolved when he stopped taking the supplement. This particular individual however, had a predisposition to kidney disease. The exact role that creatine may have played in all of this is unclear.
There are certainly a number of question regarding the long term safety of creatine use. These will take time to answer, so we will have to be patient.
When a parent asks about their teenager using creatine, all that I can do is make sure that they are properly informed, and supply them with all of the facts. The American Academy of Pediatrics has not taken a formal stance of the use of creatine...at least not yet. What I try to convey to the parents is that there is no substitute for hard work and good work ethic, with proper supervision and training. This, coupled with optimal nutrition, should be more than ample for ANY athlete at the high school level to reach their maximum potential. But we live in a society where we want the easier, softer way...instant gratification. We stare impatiently at the microwave because it wont "bake" our potato fast enough in 8 minutes.
It might be old-fashioned, or old-school, but until further evidence, convincing evidence, is presented that can show that creatine is SAFE in teenagers, and that it is a good SUPPLEMENT to hard work, I would have to reserve any recommendation for its blanket use.