July 2011 - Creatine Controversies: Safety, Effectiveness, and Novel Applications

In natural bodybuilding, 99% of the battle is won in the gym and the kitchen. Without the use of anabolic drugs and hormones, natural bodybuilders must do with what they have. Although the vast majority of focus should be on diet and training, there are a few nutritional supplements that cannot be easily obtained through diet alone that will give a natural bodybuilder an edge. Creatine monohyrdate is one of those supplements; it is the most widely researched, used and effective supplement available to natural bodybuilders and being educated about it is essential before use.

Creatine is a naturally occurring compound found and made in the body that is most abundant in human skeletal muscle. It is a non essential amino acid compiled from L-arginine, methionine and L-glycine. Creatine is found in animal products with the highest amounts found in fish and beef. However, the impracticalities of eating enough meat to provide adequate amounts of creatine makes supplementation a necessity if one desires its ergogenic effects.  That being said, before one commits to utilizing creatine as a dietary supplement, an investigation of its safety, effectiveness and application (both traditional and novel) should be undertaken.

Creatine monohydrate is the gold standard. 5g/day is all that’s needed

Creatine is one of the most studied nutritional ergogenic aids of the modern era, and it was known in the early 20th century that creatine was used in skeletal muscle metabolism through the ATP Creatine Phosphate pathway (Folin et al 1912). Despite its early discovery and investigation, it was not until the 1990’s that it became popular (and subsequently controversial) as a sports performance aid and dietary supplement. Initially theorized to simply aid in anaerobic power production by providing more fuel to the phosphocreatine pathway to ATP generation, it has since been discovered that creatine supplementation has a number of additional mechanisms by which it exerts ergogenic effects.

Creatine does enhance anaerobic power output, increasing creatine phosphate stores by as much as 20% in muscles. Aerobic endurance is not affected by creatine supplementation, however short term aerobic power is increased.  Performance is improved not only in repeated bouts of high intensity power production, but also in maximal attempts in weight lifting. Strength on one to two rep maximum effort-lifts increases by 1 to as much as 5 percent in the majority of studies (Branch 2003). There is also significant evidence that creatine enhances performance in other ways. Fat free mass increases by as much as one to three pounds in one to two weeks of using creatine, and although this is mostly water retention in the muscle cell due to increased glycogen and phosphocreatine stores, it has also been shown that creatine activates satellite cell signaling and local growth factors which up-regulate muscular hypertrophy. Thus some of this weight gain (and likely more in the long term) is from increased muscle mass. Another important consideration is that creatine may indirectly cause muscle growth because of its ergogenic effects allowing users to lift heavier weights and perform greater volumes of training (Rawson et al 2007).

This year coach Jeff Alberts IFPA Pro, is coming in at his biggest and fullest to date, and while his training and nutrition has been further perfected, he also decided to give creatine a shot during his prep…not too shabby.

Another possible, but not nearly as well studied or supported, mechanism by which creatine imparts its anabolic effects is through endocrine response. Not a hormone itself (although frequently mislabeled as a steroid in the media), it does appear to have minor but significant impacts on the body’s endocrine system and the hormonal response to weight training. Creatine increases the conversion of testosterone to DHT (Dihydrotestosterone) in small but significant amounts, but it has not been shown that this in and of itself causes any of the ergogenic benefits that creatine provides (Van der Merwe et al 2009). It has also been shown that creatine increases the hormonal response to resistance training, and although possibly significant with regards to anabolism, it was concluded by the researchers that this is caused indirectly by creatine allowing subjects to perform greater workloads of training. Meaning that it is not the creatine causing the increased hormonal response to training, but the increased training volume and loads that creatine allows lifters to perform (Rahami et al 2010). Another study done on sprinters found that creatine enhanced 100 meter sprint times, but not 200 meter sprint times, and had no significant impact on hormonal levels (Faraji et al 2010). Although the research is not conclusive and there is more to study with regards to creatine and endocrine response, it seems that the effects are minor and likely don’t contribute significantly to creatine’s ergogenic effects.

So while it is well established that creatine is a potent nutritional ergogenic for strength, muscular hypertrophy and anaerobic power production, it is also true that creatine may confer some cognitive, therapeutic and neurological benefits. With regard to degenerative neurological diseases such as Lou Gehrig’s disease (ALS) and others, creatine has been shown to offer neuroprotective benefits, essentially slowing the degeneration of neurons and helping patients to maintain strength and motor control (Krcitochvil et al 2004). Studies also suggest that creatine may play a therapeutic role in the treatment of muscular dystrophy and other neuromuscular diseases and tissue atrophy maladies (Pearlman et al 2006). It was also found that creatine supplementation increased cognitive function in vegetarians (Rae et al 2003) and the elderly (McMorris et al 2007), but not in young adults (Rawson et al 2008). This points to the likelihood that creatine supplementation among vegetarians and elderly populations is simply correcting a deficiency, not imparting ergogenic cognitive effects. Vegetarians have lower levels of creatine in their diets due to not eating meat, and the elderly have increased protein requirements as their bodies’ ability to process amino acids degrades with age.  So although creatine does not likely cause direct cognitive improvements, it is important to note that a diet low in creatine may cause decreases in cognitive function and creatine supplementation may correct this deficiency.

Vegetarian bodybuilders who eat dairy, eggs and supplement with creatine are at no disadvantage compared to meat eaters

With the benefits, both proven and potential having been discussed, it is important to address the safety concerns of using creatine. Many potential side effects and risks have been suggested with regards to creatine usage, but almost none have actually been proven to exist when studied. It has been postulated that creatine can negatively impact the liver, the kidneys, dehydrate the user, cause GI distress, and cause muscle cramping. However, it has been shown that creatine supplementation has no negative impacts on liver, muscle or kidney function and that reports of cramping, dehydration and GI distress remain anecdotal. However, in conclusion one group of researchers suggested that since there was little long term data, one should still exercise caution when using creatine (Poortmans et al 2000). A more recent review also found no safety concerns or side effects, but pointed out that the biggest concern in creatine supplementation is the purity of the product. The authors also mentioned that one should never exceed recommended levels of creatine supplementation, and that regular doctor checkups should be used to asses renal function in those with prior renal dysfunction. It is important to note that this 2006 review (which was published 5 years ago) was written by the same authors who wrote the prior study in 2000. In their second review they did not feel the need to caution creatine users due to a lack of long term studies of its use, and now in 2011 it seems even more likely that long term use of creatine is safe.
Despite these studies showing the safety of using creatine, a stigma still exists. This is likely due to the media craze in the 90’s when Mark McGwire claimed his muscle size and increased hitting strength was due to his creatine usage (along with other supplements). Since then McGwire has admitted that he used steroids at that time, but nonetheless the damage was done and the stigma remains. This is evidenced by the common misconception that creatine is hormonal in nature and also by the NCAA rule that bans school officials from providing creatine to athletes, despite it not being a banned substance. While this rule may have ethical merit and purpose completely unrelated to creatine’s safety, it serves to add to the lasting stigma that creatine is akin to anabolic steroids, instead of the reality that it is naturally occurring in our bodies and in animal products.

“It’s all from the creatine I swear”

In conclusion, it has been clearly established that creatine can improve strength, anaerobic power, muscle size, and may impart cognitive benefits to those who are deficient in creatine. It is also known that creatine can play a therapeutic role in atrophy related diseases and neuromuscular disorders, improving both the quality of life and functional capacity of patients. Athletes and gym goers have been using creatine without issue for two decades and so far the only potential side effects are anecdotal and likely related to the purity of the commercial product and not the compound itself. As with any dietary supplement, one should confer with their health professional before use, and also make sure not to exceed the recommended dosage.

References

Branch, J. D. (2003). Effect of creatine supplementation on body composition and performance: a meta-analysis. International Journal of Sport Nutrition & Exercise Metabolism, 13(2), 198-226.

Faraji, H., Arazi, H., Vatani, D., & Hakimi, M. (2010). The effects of creatine supplementation on sprint running performance and selected hormonal responses. South African Journal for Research in Sport, Physical Education & Recreation (SAJR SPER), 32(2), 31-39.

Folin O., & Denis W. (1912). Protein metabolism from the standpoint of blood and tissue analysis. Third paper, Further absorption experiments with especial reference to the behavior of creatine and creatinine and to the formation of urea. Journal of Biological Chemistry 12 (1): 141–61.

Francaux, M., & Poortmans, J. R. (2006). Side Effects of Creatine Supplementation in Athletes. International Journal of Sports Physiology & Performance, 1(4), 311-323.

Krcitochvil, C. J., Greenhill, L. L., March, J. S., Burke, W. J., & Vaughan, B. S. (2004). The Role of Creatine in the Management of Amyotrophic Lateral Sclerosis and Other Neurodegenerative Disorders. CNS Drugs, 18(14), 967-980.

McMorris T, Mielcarz G, Harris R.C., Swain J.P., & Howard A (2007). Creatine supplementation and cognitive performance in elderly individuals. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition 14 (5): 517–28.

Pearlman, J. P., & Fielding, R. A. (2006). Creatine Monohydrate as a Therapeutic Aid in Muscular Dystrophy. Nutrition Reviews, 64(2), 80-88. 

Poortmans, J. R., & Francaux, M. M. (2000). Adverse effects of creatine supplementation: fact or fiction? Sports Medicine, 30(3), 155-170.

Rae C, Digney A.L., McEwan S.R., & Bates T.C. (2003). Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. 270 (1529): 2147–50.

Rahimi, R., Faraji, H., Vatani, D., & Qaderi, M. (2010). Creatine supplementation alters the hormonal response to resistance exercise. Kinesiology, 42(1), 28-35. 

Rawson E.S., Lieberman H.R., Walsh T.M., Zuber S.M., Harhart J.M., & Matthews T.C. (2008). Creatine supplementation does not improve cognitive function in young adults. Physiology & Behavior, 95 (1-2): 130–4.

Rawson, E. S., & Persky, A. M. (2007). Mechanisms of muscular adaptations to creatine supplementation. International SportMed Journal, 8(2), 43-53. 

Van der Merwe J, Brooks N.E., Myburgh K.H. (2009). Three Weeks of Creatine Monohydrate Supplementation Affects Dihydrotestosterone to Testosterone Ratio in College-Aged Rugby Players. Clinical Journal of Sport Medicine 19 (5): 399–404.

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