Creatine, The Great Debacle

Dietary supplements include vitamins, minerals, protein, botanicals, herbal products, amino acids and other chemical/biological substances.  Throughout this blog many of these will be brought up and discussed.  Kevin and Jake from Michigan brought up the topic of today, creatine. 

Energy Metabolism

Naturally, through energy metabolism our bodies create energy in the form of adenosine triphosphate (ATP).  The process of energy metabolism can get incredibly complicated. This article will give you a quick synopsis. Creatine production starts in the kidney, biologically transforms in the liver, then moves to muscle cells for ATP regeneration. Our bodies utilize creatine in the form known as creatine phosphate (CrP).  This is an energy reserve of phosphate to assist with ATP regeneration during muscle use (contraction).  Creatine phosphate yields enough energy for about 5-10 seconds of explosive, high intensity anaerobic work (Example: sprinting the last bit to the finish line). Although CrP is used during high intensity short interval exercise, it can also be regenerated relatively quickly through recovery.

Image 1: Creatine giving a phosphate to adenosine for energy, ATP.

Health Claims Of Supplemental Creatine

Creatine is classified as an ergogenic aid due to being used for work enhancement. Athletic performance health claims include increasing muscle strength, muscle size, and short interval repetitive anaerobic exercise.  There have been studies reporting effective increase in muscle size, however, it is not known whether this is attributed to an increase in water holding capacity or lean body mass. Additional factors affecting creatine effectiveness include fitness level, age, type of sport, and the dose.  Studies based on the National Library of Medicine conclude creatine may improve short interval anaerobic threshold but does not seem to improve aerobic performance or benefit those greater than age 60.  Creatine also does not seem to affect a highly trained athletes overall performance.

Greater results have been seen from supplemental use in those who are not consuming meat and fish (vegetarians) due to not meeting their creatine needs by diet. The Journal of the International Society of Sports Nutrition indicated a 20-40% increase in creatine muscle storage versus 10-20% in those who are regularly consuming creatine rich foods. This further supports the power of food and dietary choices.

Risks of Supplemental Creatine

Studies remain to be conflicted on the overall safety of creatine.  Risks commonly stated include decreased kidney and liver function, stroke, dehydration, muscle cramps, and gastrointestinal complaints.  There are currently no strong evidence based studies suggesting a change in kidney or liver function.  With this being said those with renal insufficiency or risk of renal disease (Example: diabetes) should not use this product. Dehydration is a common concern related to the supplement causing your muscles to draw more water from the rest of your body.  Be weary of your fluid intake.  Recommendations of about 64 fluid ounces per day, equal to, four 16 fluid ounce water bottles.  There has been one report of a stroke related to supplemental creatine use with added caffeine.

Creatine and Food:

Creatine comes primarily from meat (beef) and fish sources in our diet.  Current studies are assessing the effects of combining a form of carbohydrate plus creatine.  Results show a positive relationship.  (oatmeal anyone? Check the healthy recipe page).

Creatine Use and Dosage:

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Number one: Understand that all people are different and may find different results with the product use and dosage.  I am also not including this information as an end all be all but for a general understanding of the product usage. Number 2: Do not over supplement! Too much creatine can stress your body in attempt to cleanse of the excess.  Creatine monohydrate dosages range from 2-20g per day for an average male (170lb).  An average male should not take more than 20g per day. There are three phases of creatine use often addressed known as loading, maintenance, and wash out.  The loading phase is usually about 5 days of  5-20g per day. Spread the 20g intake throughout the day.  It is believe the body cannot utilize more than 5-10g of creatine at one time.  After 5 days of loading, the maintenance phase begins for a month with roughly 3-5g per day. Following the maintenance phase begins the wash out phase.  A Wash out period of 2-4 weeks is utilized to allow time for your body to cleanse of any excess creatine.  Creatine is best utilized immediately post workout.

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Disclaimer: These are just general guidelines and I am not a doctor.  The periodization pattern is not the only method of use but provides a safety washout period to cleanse the body. The loading phases is also not necessary, it is a jump start to muscle cells, however, it is during this time you may find greatest gastrointestinal upset and can be decreased at any time. Lastly, ALWAYS read labels.  Check your product for purity, type of creatine, and amount (per scoop...2 scoop...grams...milligrams?).  Image 2 shows it contains 5g of creatine monohydrate per scoop.  Image 3 shows it contains 6,119mg of a "triple creatine matrix" or 6.119g of a monohydrate, ester phosphate, and ethyl ester mix.

Supplemental Creatine Names You May See in the Market

• Creatine Monohydrate
• Creatine Ethyl Ester
• Creatine Ester Phosphate
• Creatine Hydrochloride Salt
• Creatine Malate
• Creatine Citrate

Creatine Monohydrate is currently the most studied and inexpensive form of supplemental creatine.  Additional types are still being studied for effectiveness, quality, and purity. The overall interest in additional variations are for increased muscle cell permeability.  ADDITIONAL STUDIES ARE STILL BEING DONE ON ALL OF THESE SUPPLEMENTAL PRODUCTS. Always in regards to supplements, it is important to keep in mind there are currently no federal safety and quality standards established for supplements. In 1994 The Dietary Supplement Health and Education Act (DSHEA) was established to provide a legal definition for the term dietary supplement. But this did not provide a law for safety or product effectiveness. 

Creatine and Athletes

The NCAA’s stance on creatine indicates athletes can use the substance but it can not be provided by coaches.  They state “in general vitamin and mineral supplements are not required if a student athlete is consuming adequate energy from a variety of foods to maintain body weight.” For more information on banned drugs in the NCAA look at  NCAA Banned Drug List

References

1. American Dietetic Association “National Collediate Athletic Association (NCAA): Supplement Regulations” SCAN Sports Nutrition Care Manual, Nutritioncaremanual.org
2. Medline Plus “Creatine” 10 Janruary 2011, HYPERLINK "http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html" http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html
3. Buford T., Kreider R., South J., Greenwood M., Campbell B., Spano M., Ziegenfuss T., Lopez H., Landis J., Antonio J., “International Society of Sports Nutrition position stand: creatine supplementation and exercise” Journal of the International Society of Sports Nutrition 30 August 2007, 4:6 1550-2783
4. Francaus, M., Poortmans JR., Side Effects of Creatine Supplementation In Athletes, International Journal of Sports Physiology and Performance, December 2006, 311-323
5. American Dietetic Association “Creatine Phosphate: CRP” SCAN Sports Nutrition Care Manual, NutritionCareManual.org
6. Vandenberghe K., Goris M., Van Hecke P., Van Leemputte M., Vangerven L., Long-term creatine intake is beneficial to muscle performance during resistance training, Journal of Applied Physiology, 30 July 1997