Creatine (Encyclopedia of Drugs and Addictive Substances)

• Overview
• Mark McGwire
• Are There Any Medical Reasons for Taking This Substance?
• Usage Trends
• Reactions with Other Drugs or Substances
• Treatment for Habitual Users
• Building Muscles without Supplements
• For More Information

What Kind of Drug Is It?

Creatine monohydrate can be found in numerous , in pill, powder, liquid, or even chewing gum form. It is a combination of three amino acidsAny of a group of chemical compounds that form the basis for proteins. that are found in the muscles of humans and all animals with backbones. Creatine provides fuel to muscles during moments of rapid exertion, working within the muscle cells as a substance called creatine phosphate. Some studies suggest that it helps to repair and restore muscles after intense physical activity.

Human beings and other animals store creatine naturally in their muscle cells. The body manufactures it in the liver, kidneys, and pancreas. Additionally, creatine can be absorbed from natural outside sources such as meat and fish during the digestion process. According to Robert Monaco and Terry Malloy in Creatine and Other Natural Muscle Boosters, "the average man has about 120 grams [or 4 ounces] of creatine in his body, with about 95 percent in skeletal muscles." New creatine is created within the body at a rate of about two grams per day.

Safety Concerns, Especially for Teens

Some athletes have begun to use dietary supplements containing creatine to build muscle mass and reduce recovery times between workouts. Creatine supplements can be found in health food stores, on the Internet, and through mail-order companies. No one breaks the law by buying or selling creatine. It is not a controlled substance. Short-term studies have proven that creatine does contribute in a small way to increased strength during short bursts of activity, such as weight lifting, shot put, or batting a baseball.

Since creatine is not regulated by the U.S. Food and Drug Administration (FDA), many questions remain not only on its true effectiveness, but also on the possible damage it can do to the body, especially with prolonged use. How it affects the growing bodies of teenagers and younger children is not known. Although it is legal, creatine should be used by adults with extreme caution, under the close supervision of a medical doctor. Children and adolescents should avoid it.

Creatine was first isolated and named in 1832 by French chemist Michel-Eugène Chevreul. Photo courtesy of the Library of Congress.

Overview

Creatine was first isolated and named in 1832 by French chemist Michel-Eugène Chevreul (1786889). By the end of the nineteenth century, scientists had determined that intense muscular activity caused concentrations of creatine to build up innd strengthenuscle tissue. Further study determined that creatine levels could be raised in the body by eating a diet rich in meat. Eating great quantities of meat is not considered a healthy habit, so in the 1950s an Illinois company named Pfanstiehl Laboratories created and marketed the first synthetic, or manufactured, creatine.

Use by Olympic Athletes

As early as the 1960s, competitive athletes in the former Soviet Union were using creatine, along with anabolic , to increase their strength and durability. (An entry on steroids is available in this encyclopedia.) In those years competitors were not tested for drugs prior to the Olympic Games. However, the apparent physical superiority of the Soviet, Eastern European, and Chinese athletes raised many suspicions. As the 1970s progressed, sports authorities in many nations, as well as the International Olympic Committee, instituted blood tests to check for performance-enhancing substances.

It is possible to test athletes for elevated levels of anabolic agentsSubstances that promote muscle growth. such as testosterone, androstenedione (ann-druh-STEEN-dee-ohn), and dehydroepiandrosterone (dee-HY-droh-epp-ee-ann-DROSS-tuh-rone). No tests, however, exist for measuring creatine levels. By the end of the twentieth century, a number of famous professional and amateur athletes and bodybuilders were using creatine supplements legally. In fact, they were even touting the substance's powers. Home run champions Mark McGwire and Sammy Sosa

Creatine is known as a bulking supplement that is used by weightlifters, bodybuilders, and other athletes. © Najlah Feanny/Corbis.

have both admitted taking creatine. Use of the supplement has been linked to former professional quarterbacks Troy Aikman and John Elway and Olympic runner Michael Johnson, to name only a few.

A June 2000 article for Time magazine discussed the safety of creatine. The writer reported that half of the athletes surveyed by the magazine, "many of them Olympians, admitted that they'd be willing to take a drug even if it was sure to kill them eventually, so long as it would let them win every event they entered five years in a row." This "win at all costs" mindset filters down from the professional and Olympic level to high school and even middle school athletes. Many youth are feeling that they will have no chance of succeeding at the highest levels if they do not use supplements such as creatine.

What Is It Made Of?

, or natural, creatine is produced from three amino acids: arginine (AHR-juh-neen), glycine (GLY-seen), and methionine (meh-THY-uh-neen). It can be found in most of the body's organs. However, the vast majority of it resides within the muscle cells that power the body's movements.

Creatine is part of a complex chemical process that creates and restores adenosine triphosphateAn important energy-carrying chemical, created with the assistance of creatine. (ATP), the fuel that muscles feed on as they contract. In quick movements, ATP converts to adenosine phosphate (ADP), releasing a burst of energy in the process. As Monaco noted in his book, "Normally, muscles contain only enough ATP to provide energy for between five and ten seconds, depending on the amount of effort required for the activity. Then, the muscles need creatine to make more ATP."

About two-thirds of the creatine in the body is creatine phosphate. This chemical comes into play when the muscle's store of ATP has been depleted, or used up. Creatine phosphate breaks down into creatine and phosphate, restoring the levels of ATP. The reason muscles ache after a difficult workout is that levels of ATP and creatine have fallen. As the body restores the chemical balance, the aches fade and the muscles become stronger.

Endogenous creatine is manufactured in the liver, kidneys, and pancreas. A normal, active human being manufactures about two grams of creatine daily, taking in perhaps one or two grams more through foods. Vegetarians tend to store less creatine in their bodies, since they do not eat meat.

How Is It Taken?

Supplemental creatine is available in pill form, as a powder dissolved into beverages, or as a gum or candy. Because it is not considered a drug, the substance is not regulated for purity in its many different products. Sometimes the dosage per unit varies from the information printed on the label. Sometimes extra ingredients are added to the pills or powders, and some of these can act as steroids in the body.

Two athletes, American bobsledder Pavle Javanovic and Norwegian wrestler Fritz Aanes tested positive for steroid use prior to the Olympic Games and received two-year suspensions. Both men claimed they used only creatine. A test of Aanes's dietary supplement revealed that it contained a banned substance called nandro-lone, which was not listed on the label. In a random test of creatine supplements conducted by ConsumerLab.com in 2003, only half of the products tested were found to have the ingredients they listed at the dosages they claimed. The other half made false claims of dosages or were found to contain other unlabeled ingredients.

Are There Any Medical Reasons for Taking This Substance?

A very small number of children are born with a condition called guanidinoacetate methyltransferase deficiency (GMAT; pronounced GWAN-ih-deen-oh-AH-suh-tate METH-uhl-TRANZ-fuh-rase). This extremely serious illness causes muscle wasting and seizures from the time of birth onward. Some of its symptoms are eased by high doses of supplemental creatine.

Small research studies show creatine supplements benefit people who have diseases that cause muscle degeneration, such as amyotrophic (ay-my-oh-TROH-fik) lateral sclerosis (ALS, or "Lou Gehrig's Disease"), myasthenia gravis (my-us-THEE-nee-uh GRAH-vuss), muscular dystrophy, Huntington's disease, Parkinson's disease, and McArdle's disease. It is important to note that creatine supplementation may slow the symptoms of these diseases, but it does not cure them.

People who face long periods in bed recovering from surgery or from multiple broken bones may speed the restoration of their muscles by taking extra creatine. Creatine also appears to improve the exercise capacity in patients suffering from heart problems. Also, there is some evidence to suggest that the supplement helps elderly people retain balance and muscle control later in life.

When Norwegian wrestler Fritz Aanes (top) tested positive for steroid use prior to the Olympic Games, he claimed he had used only creatine. © Reuters/Corbis.

Usage Trends

Since the late 1990s, there has been a huge surge in the purchase of creatine supplements. According to the Knight Ridder/Tribune Business News, Americans purchased $400 million worth of creatine in 2001. A Sports Illustrated piece claimed that over- the-counter dietary supplements for sports nutrition were a $1.7 billion industry in 2003. Most of the buyers are teenagers and grown men and women who want to build muscle. Some creatine products are especially targeting "the upmarket youth," according to Suhit Kelkar in the Asia Africa Intelligence Wire. In a survey conducted by Time magazine in 2000, 44 percent of high school seniors said they used creatine to improve athletic performance. No legal restrictions exist on the purchase of creatine, so teenagers can buy it without the advice or consent of their parents. Peer pressure, along with the desire to win in competition, can be powerful agents of persuasion for those considering creatine supplementation.

Effects on the Body

Creatine supplement use has been shown to raise the levels of stored creatine in muscles. Plus, research has revealed it does lead to modest gains in strength during . In most people, use of creatine supplements does not improve performance in aerobic exercisesExercises performed to increase heart health and stamina, such as jogging, biking, and swimming, usually lasting between twenty minutes and an hour. or sustained periods of activity. Creatine users claim that the substance helps them to "bulk up," or gain muscle mass. This is the case, but the weight gain stems only from retained water within muscle cells.

Small research studies show creatine supplements benefit people who have diseases that cause muscle degeneration, such as muscular dystrophy. © Gerhard Gscheidle/Peter Arnold, Inc.

Not Enough Information Available

The water retention is just one of the dangers of creatine use. One of the most common side effects of using creatine supplements is dehydration, or a drying-out of body tissues. Taking creatine mixed in a caffeinated beverage, such as coffee or some soft drinks, increases the risk of dehydration. Athletes who work out briskly at higher temperatures risk and, ultimately, kidney damage due to dehydration. Other reported side effects of high doses of creatine include nausea, diarrhea, indigestion, and an increased risk of muscle strain.

Whether muscle strain is linked to creatine use is highly debated. Some studies suggest that creatine use encourages athletes to work out harder and longer, while their bodies reap little benefit from the extra creatine. This psychological component of creatine use can be a factor in painful muscle strains or cramping.

How does using creatine affect children and teens who are still growing? As of 2005, no answers were available. Long-range studies of creatine use had not been completed. Doctors recommend that children and teens avoid all use of creatine, no matter how tempted they might be to "bulk up." A Sports Illustrated story on sports supplements quoted Dr. Arthur Grollman of the State University of New York at Stony Brook. He observed: "Basically, anyone who uses these products is a human lab rat."

Case in point: In the Journal of Toxicology: Clinical Toxicology, Christine A. Haller and her colleagues discussed whether seizures are linked to dietary supplements. They noted that although creatine has not been linked with seizures in published studies, "the California Poison Control System has received a few reports of seizures in young athletes who were allegedly taking only creatine. This potential association between creatine use and seizures requires further investigation."

Reactions with Other Drugs or Substances

Creatine and caffeine do not mix well. Both tend to dehydrate the body. Taken together, they can lead to heat stroke. Few studies have been done about the body's reaction to creatine supplements when taken with prescription medications, over-the-counter medications, or even other dietary supplements. Some fitness magazines warn against mixing creatine powder with drinks that are high in sugar or glucose content. Sweetened beverages carry their own dangers, including encouraging and weight gain.

Although the purchase of creatine is legal, the substance has not been proven safe, even for adults. Before taking creatine supplements, adults should first consult a licensed doctor and carefully review any other medications that they are using daily. People with kidney problems should never take creatine supplements. Doctors will take periodic blood tests to make sure that creatine use is not damaging internal organs such as the liver and kidneys. Coaches, personal trainers, and sports nutritionists are not qualified to recommend creatine supplementation. They do not have the extensive medical education and training that licensed medical doctors have.

Treatment for Habitual Users

The use of creatine supplements has not been shown to cause the human body to stop making its own endogenous

Home run champion Mark McGwire was photographed with a bottle of creatine in his locker in 1998. In 2005 he appeared before Congress to discuss steroid use in baseball. The use of performing-enhancing products by star baseball players is a subject of much debate. AP/Wide World Photos.

creatine. Also, creatine monohydrate is not a habit-forming substance. Withdrawal from creatine supplements does not plunge the user into a period of muscle weakness or other difficulties. Still, users can develop a on the drug and become convinced that extra creatine will make them better athletes. This may cause them to use the substance longer, or in higher doses, than anyone would recommend.

As of 2005, no studies had been done on the long-term use of creatine supplements. Experts suggest that young athletes never begin using creatine supplements at all. Those who have already begun should consult a doctor about continued use.

Consequences

Are creatine supplements safe? As of 2005, the bodybuilding industry and its periodicals claimed creatine was safe. However, various medical journals offered a different opinion. They noted that nothing was known about the long-term effects of creatine use, particularly for young people. Plus, since creatine was already available on the market and fairly inexpensive, drug companies have been reluctant to conduct trials to prove the medical benefits of taking the supplement.

What this means is that those using creatine supplements in the early twenty-first century will provide the only long-term data on creatine's possible ill effects, since these users were the first to buy the supplement in great numbers. Because the long-term effects of creatine are not yet known, users could learn one day that the substance has various health risks.

The Law

Anyone of any age can buy creatine supplements and use them. They are legal. The burden of keeping them out of the hands of growing children and young adults falls on parents, doctors, coaches, and the young people themselves. Nutritional supplements have not been proven to turn an average, or even above-average athlete, into a sports star, like Mark McGwire. The odds of receiving a contract to play professional sportsn any sportre very slim. A study published in NCAA News Online in 2000 stated that only 2 percent of college football players go on to play professional football. The percentage of high school players who win pro contracts is far smaller than that.

Since the long-term effects of creatine use are unknown, experts suggest that young athletes never begin using the supplements at all. Hard work and exercise should be used instead. © Jose Luis Pelaez, Inc./Corbis.

See also: Diuretics; Ephedra; Melatonin; Steroids