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Creatine is a naturally occurring substance that plays an important role in the production of energy in the body. The body converts it to phosphocreatine, a form of stored energy used by muscles.
In recent years, many athletes have tried supplemental creatine as a performance enhancer. If you're a U.S. baseball fan, you probably know that Mark McGwire, the all-time single-season home run champ, takes creatine (along with many other supplements).
Although the evidence for creatine is not definitive, of all sports supplements, it has the most evidence behind it. Numerous small double-blind studies suggest that it can increase athletic performance in sports that involve intense but short bursts of activity.
The theory behind its use is that supplemental creatine can build up a reserve of phosphocreatine in the muscles, to help them perform on demand. Supplemental creatine may also help the body make new phosphocreatine faster when it has been used up by intense activity.
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Sources
Although some creatine exists in the daily diet, it is not an essential nutrient because your body can make it from the amino acids L-arginine, glycine, and L-methionine. Provided you eat enough protein (the source of these amino acids), your body will make all the creatine you need for good health.
Meat (including chicken and fish) is the most important dietary source of creatine and its amino acid building blocks. For this reason, vegetarian athletes may potentially benefit most from creatine supplementation.
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Therapeutic Dosages
For bodybuilding and exercise enhancement, a typical dosage schedule starts with a "loading dose" of 15 to 30 g daily (divided into 2 or 3 separate doses) for 3 to 4 days, followed by 2 to 5 g daily. Some authorities recommend skipping the loading dose. (By comparison, we typically get only about 1 g of creatine in the daily diet.)
Creatine's ability to enter muscle cells can be increased by combining it with glucose, fructose, or other simple carbohydrates;1,2 in addition, prior use of creatine might enhance the sports benefits of carbo-loading.3
Caffeine may block the effects of creatine.4
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Therapeutic Uses
Creatine is one of the bestselling and best-documented supplements for enhancing athletic performance, but the scientific evidence that it works is far from complete. The best evidence we have points to benefits in forms of exercise that require repeated short-term bursts of high-intensity exercise, such as soccer and basketball.510 It might also be helpful for resistance exercise (weight training).34,35,55
Creatine has also been proposed as an aid to promote weight loss and to reduce the proportion of fat to muscle in the body, but there is little evidence that it is effective for this purpose.11 Better evidence exists for chromium in this regard.
Preliminary evidence suggests that creatine supplements may be able to reduce levels of triglycerides in the blood.12 (Triglycerides are fats related to cholesterol that also increase risk of heart disease when elevated in the body.)
Creatine supplements might also help counter the loss of muscle strength that occurs when a limb is immobilized, such as following injury.24,54
Finally, preliminary studies, including small double-blind trials, suggest that creatine may be helpful for various muscle illnesses, including amyotrophic lateral sclerosis (Lou Gehrig's disease), congestive heart failure, Huntington's disease, McArdle's disease, mitochondrial illnesses, and muscular dystrophy.1323,56 Although the evidence is still not strong, creatine seems to be able to reduce fatigue and increase strength in these conditions.
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What Is the Scientific Evidence for Creatine?
Exercise Performance
Several small double-blind studies suggest that creatine can improve performance in exercises that involve repeated short bursts of high-intensity activity.25
For example, a double-blind study investigated creatine and swimming performance in 18 men and 14 women.26 Men taking the supplement had significant increases in speed when doing 6 bouts of 50-meter swims started at 3-minute intervals, as compared with men taking placebo. However, their speed did not improve when swimming 10 sets of 25-yard lengths started at 1-minute intervals. It may be that the shorter rest time between laps was not enough for the swimmers' bodies to resynthesize phosphocreatine.
Interestingly, none of the women enrolled in the study showed any improvement with the creatine supplement. The authors of this study noted that women normally have more creatine in their muscle tissue than men do, so perhaps creatine supplementation (at least at this level) is not of benefit to women, as it appears to be for men. Further research is needed to fully understand this gender difference in response to creatine.
In another double-blind study, 16 physical education students exercised 10 times for 6 seconds on a stationary cycle, alternating with a 30-second rest period.27 The results showed that individuals who took 20 g of creatine for 6 days were better able to maintain cycle speed. Similar results were seen in many other studies of repeated high-intensity exercise, although there have been negative results as well.2833
Isometric exercise capacity (pushing against a fixed resistance) also may improve with creatine.34,35,55 In addition, two double-blind placebo-controlled studies, each lasting 28 days, provide some evidence that creatine and creatine plus HMB (beta hydroxymethyl butyrate) can increase lean muscle and bone mass.36 The first enrolled 52 college football players during off-season training, and the other followed 40 athletes engaged in weight training.
However, studies of endurance or nonrepeated exercise have not shown benefits.3740 Therefore, creatine probably won't help you for marathon running or single sprints.
High Triglycerides
A 56-day double-blind placebo-controlled study of 34 men and women found that creatine supplementation can reduce levels of triglycerides in the blood by about 25%.41 Effects on other blood lipids such as total cholesterol were insignificant.
Congestive Heart Failure
Easy fatigability is one unpleasant symptom of congestive heart failure. Creatine supplementation has been tried as a treatment for this symptom, with some positive results.
A double-blind study examined 17 men with congestive heart failure who were given 20 g of creatine daily for 10 days.42 Exercise capacity and muscle strength increased in the creatine-treated group. Similarly, muscle endurance improved in a double-blind placebo-controlled crossover study of 20 men with chronic heart failure.43 Treatment with 20 g of creatine for 5 days increased the amount of exercise they could complete before they reached exhaustion.
These results are promising, but further study is needed.44
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Safety Issues
Creatine appears to be safe, at least in healthy athletes, although large, systematic, long-term safety studies have not been performed.45 No significant side effects have been found with the regimen of several days of a high dosage (15 to 30 g daily) followed by 6 weeks of a lower dosage (2 to 3 g daily). A placebo-controlled study of 100 football players found no adverse consequences during 10 months to 5 years of creatine supplementation.46 Creatine does not appear to adversely affect the body's ability to exercise under hot conditions.47
However, there are some potential concerns with creatine. Because it is metabolized by the kidneys, fears have been expressed that creatine supplements could cause kidney injury, and there are two worrisome case reports.48,49 However, evidence suggests that creatine is safe for people whose kidneys are healthy to begin with, and who don't take excessive doses.50,51 Nonetheless, individuals with kidney disease, especially those on dialysis, should avoid creatine.
Another concern revolves around the fact that creatine is metabolized in the body to the toxic substance formaldehyde.52 However, it is not clear whether the amount of formaldehyde produced in this way will cause any harm. Three deaths have been reported in individuals taking creatine, but other causes were most likely responsible.53
As with all supplements taken in very high doses, it is important to purchase a high-quality form of creatine, as contaminants present even in very low concentrations could conceivably build up and cause problems.
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References
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5. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998;17:216234.
6. Balsom PD, Ekblom B, Soderlund K, et al. Creatine supplementation and dynamic high-intensity intermittent exercise. Scand J Med Sci Sport. 1993;3:143149.
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8. Mujika I, Padilla S, Ibanez J, et al. Creatine supplementation and sprint performance in soccer players. Med Sci Sports Exerc. 2000;32:518525.
9. Finn JP, Ebert TR, Withers RT, et al. Effect of creatine supplementation on metabolism and performance in humans during intermittent sprint cycling. Eur J Appl Physiol. 2001;84:238243.
10. Volek JS, Kraemer WJ, Bush JA, et al. Creatine supplementation enhances muscular performance during high-intensity resistance exercise. J Am Diet Assoc. 1997;97:765770.
11. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998;17:216234.
12. Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci (Colch). 1996;91:113118.
13. Gordon A, Hultman E, Kaijser L, et al. Creatine supplementation in chronic heart failure increases skeletal muscle creatine phosphate and muscle performance. Cardiovasc Res. 1995;30:413418.
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25. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998;17:216234.
26. Leenders N, Sherman WM, Lamb DR, et al. Creatine supplementation and swimming performance. Int J Sport Nutr. 1999;9:251262.
27. Balsom PD, Ekblom B, Soderlund K, et al. Creatine supplementation and dynamic high-intensity intermittent exercise. Scand J Med Sci Sport. 1993;3:143149.
28. Mujika I, Padilla S. Creatine supplementation as an ergogenic acid for sports performance in highly trained athletes: a critical review. Int J Sports Med. 1997;18:491496.
29. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998;17:216234.
30. Balsom PD, Ekblom B, Soderlund K, et al. Creatine supplementation and dynamic high-intensity intermittent exercise. Scand J Med Sci Sport. 1993;3:143149.
31. Mujika I, Padilla S, Ibanez J, et al. Creatine supplementation and sprint performance in soccer players. Med Sci Sports Exerc. 2000;32:518525.
32. Gilliam JD, Hohzorn C, Martin D, et al. Effect of oral creatine supplementation on isokinetic torque production. Med Sci Sports Exerc. 2000;32:993996.
33. Finn JP, Ebert TR, Withers RT, et al. Effect of creatine supplementation on metabolism and performance in humans during intermittent sprint cycling. Eur J Appl Physiol. 2001;84:238243.
34. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998;17:216234.
35. Volek JS, Kraemer WJ, Bush JA, et al. Creatine supplementation enhances muscular performance during high-intensity resistance exercise. J Am Diet Assoc. 1997;97:765770.
36. Kreider RB. Dietary supplements and the promotion of muscle growth with resistance exercise. Sports Med. 1999;27:97110.
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38. Burke LM, Pyne DB, Telford RD. Effect of oral creatine supplementation on single-effort sprint performance in elite swimmers. Int J Sport Nutr. 1996;6:222233.
39. Mujika I, Chatard JC, Lacoste L, et al. Creatine supplementation does not improve sprint performance in competitive swimmers. Med Sci Sports Exerc. 1996;28:14351441.
40. Cooke WH, Grandjean PW, Barnes WS. Effect of oral creatine supplementation on power output and fatigue during bicycle ergometry. J Appl Physiol. 1995;78:670673.
41. Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci (Colch). 1996;91:113118.
42. Gordon A, Hultman E, Kaijser L, et al. Creatine supplementation in chronic heart failure increases skeletal muscle creatine phosphate and muscle performance. Cardiovasc Res. 1995;30:413418.
43. Andrews R, Greenhaff P, Curtis S, et al. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Eur Heart J. 1998;19:617622.
44. Schaufelberger M, Swedberg K. Is creatine supplementation helpful for patients with chronic heart failure? Eur Heart J. 1998;19:533534.
45. Juhn MS, Tarnopolsky M. Potential side effects of oral creatine supplementation: a critical review. Clin J Sport Med. 1998;8:298304.
46. Kreider R, Rasmussen C, Melton C, et al. Long-term creatine supplementation does not adversely affect clinical markers of health. Poster presented at: American College of Sports Medicine 2000 Annual Scientific Meeting; May 31June 3, 2000; Indianapolis, Ind.
47. Volek JS, Mazzetti SA, Farquhar WB, et al. Physiological responses to short-term exercise in the heat after creatine loading. Med Sci Sports Exerc. 2001;33:11011108.
48. Pritchard NR, Kalra PA. Renal dysfunction accompanying oral creatine supplements. Lancet. 1998;351:12521253.
49. Koshy KM, Griswold E, Schneeberger EE. Interstitial nephritis in a patient taking creatine. N Engl J Med. 1999;340:814815.
50. Poortmans JR, Francaux M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci Sports Exerc. 1999;31:11081110.
51. Mihic S, MacDonald JR, McKenzie S, et al. Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women. Med Sci Sports Exerc. 2000;32:291296.
52. Yu PH, Deng Y. Potential cytotoxic effect of chronic administration of creatine, a nutrition supplement to augment athletic performance. Med Hypotheses. 2000;54:726728.
53. Creatine is innocent; FDA rejects creatine role in deaths. Associated Press: April 30, 1998.
54. Hespel P, Eijnde BO, Van Leemputte M, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536:625-633.
55. Bemben MG, Bemben DA, Loftiss DD, et al. Creatine supplementation during resistance training in college football athletes. Med Sci Sports Exerc. 2001;33:1667-1673.
56. Vorgerd M, Zange J, Kley R, et al. Effect of high-dose creatine therapy on symptoms of exercise intolerance in McArdle disease: Double-blind, placebo-controlled crossover study. Arch Neurol. 2002;59:97101.
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