Creatine, a popular nutritional supplement used among athletes and weight lifters, is used primarily to increase muscle mass and improve recovery time. The use of creatine is a controversial issue in sports from the high school level through the professional level and even the Olympics. The International Olympic Committee and other sports regulating organizations have not banned creatine (Rouzier 526), but the effectiveness of this supplement is questioned. While some side effects are common in conjunction with creatine use, most can be prevented when the proper precautions are taken. When creatine is used for the appropriate reasons and the necessary precautions are taken it can be very beneficial to the user. Creatine is a naturally occurring compound that is produced by the liver, pancreas, and kidneys. Creatine can also be acquired through the ingestion of red meats and fish (Arnheim and Prentice 124). Supplemental creatine is a dietary supplement that is often found in powder or tablet form and is easily obtained at any nutrition store. This supplement is used mainly to increase muscle mass and enhance performance in short-duration, high-intensity exercises, such as short distance running (100-200m), weight lifting, tennis, and other various types of sports. (Rouzier 526) The basic mechanics of creatine's role in energy metabolism are uncomplicated, however they are extremely vital to the understanding of why creatine is produced in our bodies as well as why athletes take additional creatine. The two major types of creatine are free creatine and phosphocreatine. When considering supplemental creatine we are mainly interested in phosphocreatine, which is stored in skeletal muscle and used during anaerobic exercises (explosive, short-duration, burst activities) to generate adenosine triphosphate (ATP) (Arnheim and Prentice 124). When muscles contract they use ATP as their source of energy. The ATP is broken down into adenosine diphosphate (ADP) and phosphate (Pi) when energy is needed (ATP à ADP + Pi). Creatine helps turn ADP back into ATP enabling muscles to recover faster, giving them an enhanced source of energy (Rouzier 526). Due to this enhanced recovery time creatine is shown to be particularly effective in activities of repeated bursts of exercise, such as sprinting. Phosphocreatine helps increase the resynthesis of ATP, which maintains muscle contractions and therefore prolongs the amount of time before an athlete is fatigued. Due to the lengthened time before fatigue, the intensity of the athlete's workout can be increased. Another of the basic mechanics of creatine supplementation is the retention of water. The amount of water stored in muscles is increased due to creatine usage, which in turn increase muscle volume (Rouzier 526). The uptake of water is dependant on sodium; if sodium concentrations increase then osmotic properties increase the retention of water (Williams and Kreider and Branch 184). Osmotic pressure gradients strive to maintain equilibrium between the body and its outside environment. If sodium concentrations inside the body are high, water will be retained in order to attempt to dilute the concentration of sodium and establish equilibrium. Water retention in muscles causes an increase in body mass, particularly muscle mass. Body mass is a desired effect for many athletes; especially football players who wish to increase their overall size. Many athletes choose to take creatine supplements because of the increase in body or muscle
mass. Athletes want to increase body or muscle mass for competitive reasons; "either to increase inertia and resist opposing forces such as those encountered in sports like sumo wrestling, or to increase muscle mass with associated gains in strength and power for sports such as competitive weight lifting" (Williams and Kreider and Branch 170). However, one must understand that no muscle mass will be gained if the person supplementing creatine does not exercise, only body mass will be gained. While an increase in body mass is considered to be a benefit of creatine, it may also be look at as a side effect. If the proper training is not completed the person using creatine will only increase his or her size, which may decrease their athletic performance. Increased body mass with no gain in muscle may slow running speeds, which is critical in many sports. Nevertheless, most sports require a strict training programs where one would reap the benefits of creatine by increasing muscle mass. Water retention not only benefits an athlete by increasing body or muscle mass, but also helps to decrease soreness and muscle cramping. Lactic acid increases during anaerobic exercising and causes muscle cramping during exercise and soreness after workouts. Creatine causes water retention in muscles, and the water that is retained in the muscles dilutes the lactic acid being produced by exercising (Williams and Kreider and Branch 36). Creatine acts as a lactic acid buffer, and accordingly extends peak performance effort and decreases exercise recovery time during intense activities (Arnheim and Prentice124). Reducing muscle acidity causes a decrease in soreness and cramping of muscles, which allows an athlete to perform at their maximum performance and increase the duration of repetitive short-duration, high-intensity exercises (Williams and Kreider and Branch 39-40). Athletes use creatine supplementation for a number of different reasons to benefit their performance. Increasing muscle mass, decreasing recovery time, and reducing muscle acidity are the main reasons such a widespread number of athletes choose to supplement creatine. A decrease in recovery time is one of the greatest benefits of creatine use in regards to athletes. Decreased recovery time allows athletes to execute an activity to their maximum performance point, rest and recover quickly enough so that the next repetition will also be at their peak performance level. Creatine allows athletes to reach a higher training level, which enhances repetitive-interval capabilities, reduces training fatigue, and accelerates the enlargement of muscles due to increased cell size (Williams and Kreider and Branch 39-40). While there are numerous benefits to using creatine, like any other drug use, there are also a number of side effects that occur with creatine usage. The most common side effects from creatine supplementation are muscle cramps, dehydration, and the in ability to tolerate heat, in which the reasons for these side effects are altogether interrelated. Water retention could possibly disturb the normal balance of electrolytes and induce muscle cramps (Williams and Kreider and Branch 209). Most athletes train in hot, humid environments; athletes using creatine are able to perform at their maximum skill level longer, exerting more energy. Using more energy and training in high heat makes the athlete need to sweat in order to cool his or her body down, however creatine causes water retention in muscle cells and reduces the athlete's ability to sweat. Whatever water is not retained in muscle cells due to creatine usage is excreted in the form of sweat, leaving the body dehydrated. The athlete, unable to cool his or her body off is more prone to heat related illnesses. Gregory Bew, a cadet from the United States Military Academy participating in football, rugby, and
Tae Kwon Do, reports having used creatine in attempt to allow himself to workout more often, gain muscle mass faster, and enhance recovery time. While the gaining the desired effects when using creatine, he also experienced muscle cramping. However he realized that he was required to run long distances for purposes of Army training. Bew attempted to consume more water, but found it too incontinent to drink that needed amount of water while trying to keep up schoolwork as well as sports. Without the extra water consumption, his body alone could not support higher demands for water. Bew discontinued usage of creatine due to his obligation to run long distances, (which is a long-term endurance exercise, not a short-duration exercise) and his inability to consume the required amounts of water (West). Some athletes have reported experiencing gastrointestinal side effects, such as upset stomach, gas, diarrhea, and nausea, when using creatine. However, "no study has shown creatine supplementation to have caused significant GI distress when taken at the recommended doses. Reports of GI distress from creatine studies have been isolated and rare" (Williams and Kreider and Branch 208). Many such gastrointestinal side effects could simply be caused by the athletes diet, eating before exercising, exercising in high heat and for long amounts of time, etc. The long-term side effects of creatine are unknown, however "some health care providers believe that it could lead to kidney damage" (Rouzier 526). "On the basic of available scientific research findings, creatine supplementation appears to pose no serious health risks when taken at dosages described in the literature" (Williams and Kreider and Branch 214). However, additional research needs to be performed in order to evaluate and conclude the medical safety of long-term creatine supplementation. While concerns have been mentioned regarding whether creatine results in renal and liver damage, promotion of dehydration, causation of GI distress, and/or promotion of muscle cramping, there is no scientific evidence to validate these concerns in regards to long-term usage (Williams and Kreider and Branch 215). Although such side effects do exist, if the proper precautions are taken when supplementing creatine most of these side effects can be avoided. To achieve the desired effects of creatine supplementation, it is necessary for the person to exercise. In order to gain muscle mass the muscles must be worked to change fat into muscle. Without exercise, only body mass will be gained through the retention of water. Users of creatine must also realize that creatine is utilized for short-burst, high-intensity exercises, and not endurance activities. Creatine supplements increase the content of phosphocreatine in muscles and are stored by the muscle cells and become energy stores. However, the body only benefits from this source of energy during short-burst exercises (Davis), making creatine unbeneficial to long duration activities (Gerber). One of the most important precautions to taken while using creatine is to drink the necessary amount of water needed to meet the body's demands. Drinking the proper amount of water will decrease the common side effects significantly. The appropriate intake of water will eliminate dehydration, and reduce the likely hood of muscle cramping, as well as nausea. In addition to normal water consumption, at least 64oz. of extra water should be drunk per day while using creatine (Pettit 85). This however does not take into account exercising in environments of high heat and humidity, where further water intake should be consumed. Finally, when beginning creatine supplementation a loading doses should be taken for five days. A dosage of 20 to 25 grams per day should be taken, and once the loading phase is complete, a
maintenance dose of 2 to 5 grams of creatine should follow (Rouzier 526). While supplementing creatine, if the proper training is fulfilled, the necessary amount of water consumed, and the recommended dosage taken the desired effects should result, and side effects should be minimal. "Creatine supplementation, in conjunction with proper training and the maintenance of healthful eating habits, increases the manufacture of energy-producing ATP, allowing the person to work harder during exercise (ie, for short periods of high-intensity muscle activity)" (Pettit 85). Creatine has also been proven to be beneficial for other things than athletics. "Daily supplementation with creatine was shown to accelerate the recovery of leg muscle size and performance in the patient immobilized in a cast for two weeks" ("Speeds Rehab"). Creatine taken throughout the rehabilitation process speeds the healing development and helps the body return to normal appearance and function ("Speeds Rehab"). Creatine may also aid heart failure patients. The heart's myocardium stores of creatine and ATP are lower than healthy individuals. By supplementing creatine, heart failure patients may benefits by "preserving the energy stores in the myocardium, stabilizing the sarcolemma, preventing freeradical damage, and improving microcirculation in the heart" (Pettit 85). It has also been revealed that creatine can prevent ultraviolet damage. Research findings show creatine appears to "have beneficial effects on skin tissue, especially in preventing UV damage and repairing damaged skin" ("UV Damage"). The cellular energy provided by creatine speeds skin repair and healing, lessens sunburn, and protects skin from UV damage. Such processes can improve skin quality, moisture retention and elasticity ("UV Damage"). While it has been shown that creatine can aid in rehabilitation, heart failure patients, and ultraviolet damage of the skin; creatine is still primarily used to benefit athletes. Creatine has many advantages to help athletic performance, as well as a number of side effects, however the majority of these side effects can be avoided by taking the necessary precautions. While supplementing creatine always take the recommended dosage, remember more is not always better. Keep in mind that the body has a higher demand for water while using creatine, thus take into consideration activities and environmental conditions before supplementing. If the necessary precautions are taken and creatine is used for the proper reasons and in the proper manner, creatine supplementation can be very advantageous for the consumer.
Amy Bew, ATC, is a nationally certified athletic trainer. She has worked for Tidewater Physical Therapy and as the trainer for a private school in Williamsburg, VA. Currently working as a reference for http://allthingsactive.com and [http://foundithereonline.com]
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