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Athletic Training

Creatine usage

01/14/2009

Question:

My parents and I have been discussing creatine usage over the past few weeks, and would like to know your opinion about it. They have three questions that they truly believe need to be answered. First, is it considered it a drug? And second, if I took it, would I be banned from Track and Field competitions? Third, should I, at the age of 16, be allowed to use this supplement? I bench press well over 200, squat more than 350. I included these figures to prove that my body is used to conditioning at a high level, and that I suffer from fatigue after my workouts. My parents would like to have a person well qualified in the physical education/ therapy/ medical field answer the questions. Thank you for your time.

Answer:

First, I'd like to applaud you and your parents for seeking guidance and trying to make an informed choice about supplement use. Far too many people don't do this.

Creatine Monohydrate is a very common supplement that is regulated in the United States as a nutritional supplement and not a drug. It is available at supplement stores (expensive), grocery stores (cheap), and even warehouse stores (usually cheapest).

Although it is common and not closely regulated, you could technically think of it as a drug. In the Pharmacology in Athletic Training class that I teach, we define a drug as any chemical compound that, when taken, causes a physiological response. Under this broad definition, creatine would be a drug ... but it is not regulated as one and most people wouldn't consider it as one.

Most sport governing bodies have not banned creatine monohydrate, so you are probably not going to be banned from competition, but that alone doesn't mean you should use this supplement.

First, let's start with what it is and why it's used. Creatine supplementation is based on an aspect of human energy metabolism known as the creatine phosphate energy shuttle. Your body's common "energy currency" is a molecule called adenosine triphosphate (or ATP for short). It is basically an adenosine molecule with 3 phosphates attached (hence the "tri-phosphate" part of the name). You use ATP to fuel virtually all of your body's cellular processes, including exercise.

Your body metabolizes food stuffs (carbohydrates, fats, and proteins) to make ATP. Normally, you make ATP through a couple of different chemical pathways that take varying amounts of time. Under the initial demands of intense exercise, when you burn a lot of ATP very quickly, your body can make small amounts of ATP by transfering a phosphate ion from a molecule called creatine phosphate onto an adenosine di-phosphate (ADP). Taking a creatine supplement is thought to give you more creatine in your body that you will make into creatine phosphate and that therefore may allow you to have more energy (i.e., more ability to make ATP) during short, high intensity exercise situations.

Creatine supplementation has been shown to improve exercise performance in VERY SHORT, VERY HIGH INTENSITY exercise (like bicycle sprinting). It also has the effect of increasing your body's mass by causing you to retain water. Weight gain is by far the most commonly reported effect of this supplement. There has been some suggestion that creatine might help with recovery between bouts of short, high intensity exercise (like recovering between sets of weightlifting). It has not been shown to improve general fatigue that accompanies exercise training. Improved exercise performance is pretty hit or miss with lots of research studies finding no exercise benefit at all and a few finding SMALL effects.  If it produced large, meaningful effects, it would have been banned already.

The question is whether it will "work" for you. Here is what I can tell you.

1. The body has what appears to be a "ceiling" for how much creatine it will store. This is why creatine supplementation regimens start with a high "loading" dose for a few days and then taper off to a much smaller "maintenance" dose. After a couple of days if you continue to take the high dose, you just urinate out the extra, putting added load on your kidneys. The creatine sellers would be more than happy for you to purchase their product in order for you to make expensive urine. The primary effect of creatine supplementation for most people is to make expensive urine and to cause weight gain in the wallets of creatine retailers.

2. The people who benefit the most from creatine supplementation are those who are not already at or close to their creatine ceiling. Mostly, these are vegetarians and those who eat very little red meat. Creatine is naturally occuring in meat, particularly red meat. If you eat an adequate amount of red meat in your diet (around 6-8 oz per day for a growing athlete), then you are probably already getting adequate creatine. Additional supplementation would probably not help you add much more.

3. Creatine supplements are typically not banned, but you should check with your sport's governing body (your state high school athletics association and possibly also your school--many have their own bans). In the NCAA, it is FORBIDDEN for coaches or athletics personnel to provide creatine supplements (or any supplements for that matter) to athletes. This is one that athletes can buy for themselves if they want, but the universities can't provide it.

4. Creatine does have some health risk, albeit a small one. Because it places a more significant workload on the kidneys to excrete the extra creatine you are taking, you risk kidney failure if you already have kidney problems. There was a case of this reported in the Lancet (an excellent British medical journal) some time back. A patient with kidney disease was taking creatine and wound up with significant problems. Another possible but unconfirmed risk is an increase in muscle cramps. There are lots of anecdotes of this happening, but we have not been able to reproduce it in the laboratory or in field studies.

My personal recommendation is that creatine is probably not going to hurt you, assuming you are young, fit, and in excellent health. At the same time, creatine is not really likely to help you all that much...if at all. The prices have come down considerably in the past 5 or 8 years after the big creatine hype of the late 1990s, but it is still a cost that you probably don't need to spend. You would do just as well, or probably better in fact, to eat a good diet that has enough red meat (not usually a problem for Americans) and plenty of vegetables and fruits. You'd do better to spend the money on a one-time consult with a registered dietitian who is familiar with sports nutrition.

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Response by:

Mark  A Merrick, PhD, ATC Mark A Merrick, PhD, ATC
Associate Professor at the School of Allied Medical Professions
College of Medicine
The Ohio State University