Nutrition & Health OnLine Magazine

CREATINE: The Real Story

By Shawn Sales

A lot has been written about Creatine that is both positive and negative. On the positive side it has been reported that users have experienced large increases in strength and muscle size. On the negative side there appears to be some potential side effects including cramping, increased kidney function and gastrointestinal disorders. In order to make an informed decision on whether or not to use Creatine it is necessary to look at all the research data both pro and con.

Creatine is an ergogenic aid(performance enhancer) that has gained great popularity in the decade of the 1990's. Creatine is a supplement that is currently being used by professional athletes, recreational athletes and many individuals involved in fitness and sports all over the world. Preliminary research undertaken in the 1800's focused on oral creatine supplementation and possible ergogenic benefits. After clinical studies were published in 1990, creatine exploded onto the international sports scene and has become the craze of athlete's worldwide. Creatine gained even greater acclaim at the 1992 summer Olympics when the 100-meter gold medal winning sprint champion was found to have been supplementing with creatine.

Creatine is found in different sources of foods in the diet. The daily requirement of creatine is about 2 grams, either from the diet or from endogenous synthesis(produced by the body). In the diet creatine is found in steak, milk and in some fish, and stored in the body tissues. There is also an endogenous synthesis of creatine in some of the organs in the body.¹ Some endogenous sources in the body where creatine is synthesized include the Liver Pancreas and Kidney.²

Creatine supplementation is used as a way of replacing ATP used in the body after muscle contraction has taken place. Creatine is an amino acid that in it's phosphorylated form transfers phosphate to adenosine diphosphate (ADP) to maintain high levels of adenosine triphosphate (ATP) in muscle and thus provide energy for muscle activity. ³

While creatine helps to regenerate ATP from ADP from the phosphate molecule of creatine, this added benefit has been found to be only beneficial in anaerobic activity. Studies have shown that Creatine supplementation does not enhance aerobic exercise performance. While creatine supplementation will likely increase high-intensity strength performance (i.e., powerlifting) in many athletes, there is little data to support its use by endurance athletes ⁴

Current research has shown creatine to be effective in enhancing exercise performance with the added benefit of muscle hypertrophy(growth in muscle size). This muscle hypertrophy has been associated with an increase in water retention of the cell. One of the consistent findings associated with creatine supplementation is an increase in body mass, as much as several kilograms within a week. By attracting water, creatine may increase intramuscular water stores, which may be an explanation for the rapid increase in body mass.⁵

Numerous studies in recent years have been undertaken in regard to creatine improving muscular strength. In one study, subjects who received creatine produced and maintained statistically higher levels of peak torque compared with pre-dose performance.⁶ Based on available literature, short-term creatine supplementation improves maximal strength/power by 5 to 15%, work performed during sets of maximal effort muscle contractions by 5 to 15%, a single effort sprint performance by 5 to 15%. Moreover, long-term supplementation of creatine or creatine containing supplements (15 to 25 g/d for 5 to 7-d and 2 to 25 g/d thereafter for 7 to 84-d) has been reported to promote significantly greater gains in strength, sprint performance, and fat free mass in comparison to matched-paired controls. ⁷

I can attest to the ergogenic value of creatine from personal experience. During the summer of 1998, I supplemented with creatine from June 14 until a bench press competition I entered in the last week of August. During this time, I stayed on the same training regimen that I had previously trained under prior to creatine supplementation. After about one week of oral supplementation, I noticed not only was my bench press increasing, but I also experienced weight gain. I found that using creatine gave me the ability to do more reps in a set and that it increased my maximal bench press by 40 pounds in two months.

Other research has shown similar experiences to my own personal experience. A study was carried out at Penn State University to show the influence of creatine monohydrate and the effects of supplementation on repeated bouts of high intensity resistance exercise. In this study, creatine supplementation resulted in a significant improvement in peak power output during all 5 sets of jump squats and a significant improvement in repetitions during all five sets of bench presses. ⁸ Richard B. Kreider, Ph.D., associate professor and assistant chair in the Department of Human Movement Sciences at the University of Memphis had similar findings in his own research. "Athletes can gain 1 to 3 pounds the first week," he says. "Then at two weeks, there are significant increases in lean mass-in the 4- to -5 pound range above baseline. At 6 weeks, there's an average 10 pound gain in lean mass". Kreider is also quoted as saying that strength gains are equally as dramatic. ⁹

While creatine is currently being used as an ergogenic aid, some research has focused on the potential health benefits of creatine supplementation. A study was conducted in Dallas Texas by a team of researchers to measure the effects of 5 grams of creatine monohydrate ingestion in the blood lipid profiles of the test subjects. The results of the study indicated significant reductions in plasma total cholesterol, triglycerides, and very low-density lipoproteins in the creatine monohydrate group. Additionally, the trend for lower blood glucose in subjects receiving creatine monohydrate indicates the possibility that creatine enhances insulin sensitivity, which could prove helpful for some diabetics.¹⁰ Creatine is also being researched in the medical community to look at potential therapeutic benefits of oral supplementation of the product. Creatine might play a role in the energy transduction of vision and may be synthesized locally in the retina. This action may be involved in the pathophysiology of gyrate atrophy, a form of blindness that is genetically determined. Doses of 1.5 g creatine/day for 1 year resulted in improvement of the skeletal muscle abnormality that accompanies this disease.¹¹

When athletes discovered the ergogenic value of creatine, many flocked to their local nutrition store to buy the product. While research has proven the ergogenic effect of creatine, only now is research being undertaken to look at the possible side effects of oral supplementation. Side effects of oral creatine ingestion are now being reported in literature. Side effects have ranged from kidney distress to Muscle cramping to GI disorders.

Some of the side effects of creatine may be related to the dosage used in supplementation. Creatine supplementation does cause an increase in urinary creatinine excretion, which is often used as an indicator of kidney function, but this increase correlates well with the increased rate of muscle creatine degradation to creatinine rather than any abnormality of renal function.¹² Many athletes as well as the general public always believe that more is better. Athletes who start taking creatine start with a loading phase of the supplement. The supplement is taken orally with 4 doses a day at 5 grams a serving. This amount is the equivalent of 1 heaping teaspoon of the product.

After the loading phase, the amount of creatine is reduced to 2 grams a day for a 70-kg person. The 2 gram per day "maintenance dose" of creatine ingestion currently advocated to maintain muscle creatine concentration during chronic periods of creatine supplementation after five to six days of creatine loading is perhaps no greater a quantity of creatine than that found in a meat eaters diet. ¹³

Dr. Ray Sahelin M. D. who is a creatine user and author of Creatine: Nature's Muscle builder has found in his own research that using smaller amounts of creatine for maintenance purposes has in his own clinical studies been proven to be safe and effective. Sahelian said that there is no research to indicate that creatine is safe to use in the 10 to 20 grams a day dosage some athletes are currently using. However in his own clinical experience he has not come across any problems when patients use his recommended doses. " I recommend to my patients low dosages of 3 to 5 grams every other day with one week off each month, and one full month off every three months. The worst side effects reported thus far on dosages greater than 5 grams a day include nausea and Diarrhea. Muscle strains and tendon strains are possible if individuals increase their exercise intensity too quickly".¹⁴

Most studies that have examined creatine supplementation have been short term. These studies of creatine have found that Serum creatinine levels have been reported to be either not affected or slightly increased following 28 days, 56 days and 365 days of creatine supplementation.¹⁵ The existing research on acute hematological, hepatic and renal responses to creatine supplementation is limited but does not indicate any problems.¹⁶

In one study of creatine usage, 20 grams of creatine was supplemented orally for 5 days. In the study, the kidney reacted normally to the short-term ingestion of creatine. The estimated glomular filtration rate and the urine excretion rate of total protein and plasma albumin remained within normal range of a healthy population. ¹⁷

While short term studies of creatine supplementation have found no potential side effects to exist, cases of renal distress have been reported in several publications. In another study, the patient was treated for transient renal insufficiency. The patient came to the hospital complaining of nausea, vomiting and bilateral flank. After the patient was questioned it was found that he had been using creatine in his diet. The patient was hospitalized. During hospitalization, his blood pressure rose to 160/100mm Hg and his serum creatinine concentration rose to a peak value of 2.3 mg per deciliter. Urinary protein excretion was 472 mg per day. A renal biopsy revealed acute focal interstitial nephritis and focal tubular injury. Electron microscopy revealed effacement of glomular foot process and focal thickening of the basement membrane.¹⁷

While cases of renal insufficiency have been reported, the long-term effects of creatine ingestion are still unknown. Concerns about possible long-term health problems are usually centered on sites of endogenous creatine production and / or clearance as well as down-regulation of tissue uptake transporters. The existing research on acute hematological, hepatic, and renal responses to creatine supplementation is limited but does not indicate any problems.¹⁸ Research in the future should focus on other areas of the body where creatine is synthesized such as the liver, kidneys and pancreas because these are areas of the body that synthesize creatine when it is taken orally.

If an athlete is going to supplement with creatine, he should be made aware that current research has shown that there are no added benefits of consuming more than 5 grams of creatine a day after the loading phase of 20 grams a day. A maintenance dose of 2 grams has proven to be beneficial in creatine resynthesis of the muscle. Studies carried out have shown creatine uptake in muscle to be heightened by supplementing creatine with a high carbohydrate drink. Some liquids are better than others for creatine consumption. Glucose polymer drinks or those with dextrose or maltodextrin are good choices. This is because the shuttle system used to transport creatine into the muscle fibers involves insulin, and these forms of "simple" sugars activate this mechanism quickly.¹⁹

Overall creatine has been shown to be safe and effective for short term use. While the jury is still out as far as the safety of using creatine longterm there appears to be no compelling reason to avoid using creatine to enhance athletic performance. As is the case with all ergogenic aids, caution should be taken to utilize the supplement properly and with discretion. If any of the above side effects are encountered it is advisable to discontinue use and look for another alternative. In the vast majority of cases however, creatine will prove to be a great aid in boosting size and strength with little in the way of negative side effects.

¹Greenhaff PL, et al: "Creatine supplementation: recent developments". British Journal of Sports Medicine, Vol. 30 1996 pg. 276-281
²Toler SM, et al: "Creatine Is an Ergogen for Anaerobic Exercise". Nutrtion Reviews, Vol. 55, No. 1 January 1997: pg. 21-25.
³Feldman EB, M.D. et al: "Creatine: A Dietary Supplement and Ergogenic Aid". Nutrtion Reviews Vol. 57, No.2 February 1999 pg. 45-50.
⁴Toler SM, et al: "Creatine Is an Ergogen for Anaerobic Exercise". Nutrtion Reviews, Vol. 55, No. 1 January 1997: pg. 21-25.
⁵Greenhaff PL, et al: "Creatine supplementation: recent developments". British Journal of Sports Medicine, Vol. 30 1996 pg. 276-281
⁶Feldman EB, M.D. et al: "Creatine: A Dietary Supplement and Ergogenic Aid". Nutrtion Reviews Vol. 57, No.2 February 1999 pg. 45-50.
⁷Kreider R.B., et al: "Creatine supplementation: analysis of ergogenic value, medical safety and concerns". Journal of Exercise Physiology online Vol. No 1 April 1998 pg. 1-11.
⁸Volek JS, Kraemer WJ. et al: "Creatine supplementation enhances muscular performance during high-intensity resistance exercise". Journal Of The American Dietetics Association Vol. 97 No. 9 July 1997 pg. 765-770.
⁹Schnirring L, et al: "Creatine Supplements Face Scrutiny, Will Users Pay Later"? The Physician And Sportsmedicine Vol. 26 1998 pg. 15-23.
¹⁰C.P. Earnest, A.L. Almada, and T.L. Mitchell, et al: "High Performance Capillary Electrophoreses-Pure Creatine Monohydrate Reduces Blood Lipids in Men and Women". Clinical Science Vol. 91 1996 pg. 113-118.
¹¹Feldman EB, M.D. et al: "Creatine: A Dietary Supplement and Ergogenic Aid". Nutrtion Reviews Vol. 57, No.2 February 1999 pg. 45-50.
¹²Greenhaff PL, et al: "Creatine supplementation: recent developments". British Journal of Sports Medicine, Vol. 30 1996 pg. 276-281
¹³Greenhaff PL, et al: "Creatine supplementation: recent developments". British Journal of Sports Medicine, Vol. 30 1996 pg. 276-281
¹⁴Health World Online - Ray Sahelian, M. D. et al: "Creatine: How Much to Take and When". Available at: http:www.healthy.net/library/books/sahelian/creatinehow.html. pg.1-4.
¹⁵Kreider R.B., et al: "Creatine supplementation: analysis of ergogenic value, medical safety and concerns". Journal of Exercise Physiology online Vol. No 1 April 1998 pg. 1-11.
¹⁶Plisk SS, Kreider R, et al: "Creatine Controversey"? National Strength & Conditioning Association Vol. 21, No.1: February 1999. Pg. 14-23.
¹⁷Schnirring L, et al: "Creatine Supplements Face Scrutiny, Will Users Pay Later"? The Physician And Sportsmedicine Vol. 26 1998 pg. 15-23.
¹⁸Pritchard NR, Karla PA, et al: "Renal dysfunction accompanying oral creatine supplements". The Lancet, Vol. 351 April 25,1998.
¹⁹Health World Online - Ray Sahelian, M. D. et al: "Creatine: How Much to Take and When". Available at: http:www.healthy.net/library/books/sahelian/creatinehow.html. pg.1-4.

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