Physician Led • Outcomes Centered • Patient Focused

Is Creatine something I should be taking?

What is Creatine?

Creatine is a naturally-occurring substance that is found in muscle, and is one of the necessary components of the Creatine Phosphate Energy Shuttle.

What is the Creatine Phosphate Energy Shuttle?

When we begin exercise, there is a short period between the time that muscle contraction begins and delivery of the extra oxygen necessary to power this muscle exercise occurs.  The Creatine Phosphate energy system bridges this gap by functioning as an immediate short-term energy source that does not require oxygen.  Most people have enough reserves in the muscle to power intense exercise for about five to ten seconds.   This system is able to recharge over a short period of time, so that athletes who are participating in high-intensity stop-and-go activities continually use their muscle creatine, in conjunction with the aerobic (oxygen) energy system, which predominates.

Why do some people take Creatine as a supplement?

The naturally-occurring levels of creatine in human muscle vary from person to person, and can only be measured through muscle biopsy.  People whose baseline levels are to the lower end of average can usually increase their muscle creatine concentration either by eating more foods that are naturally high in creatine,or by taking an oral creatine supplement. When the concentration of intramuscular creatine is increased, the net result is better muscle delivery of ATP (the energy source that both oxygen and non-oxygen pathways ultimately produce to make muscles work).  When creatine levels are high, there is also enhanced recovery of the creatine phosphate energy shuttle back to baseline. This means that for sport or exercise that involves short bursts of high-power activity (such as weightlifting, wrestling, high jump, etc.) there is a possible performance improvement that occurs when creatine levels are optimal.

Does Creatine work?

Studies that have looked at athletes using creatine have shown mixed results. There is no question that taking creatine regularly will result in weight gain of between one and ten pounds.  This could be due to an increase in lean body mass or to increased body water content.  Studies looking at weightlifters who use creatine do show that as a group, those taking creatine are able to achieve more repetitions, and get to a higher maximum lift than those who are not taking the supplement.  Studies that have looked at timed races in rowing or sprinting,which are heavily reliant on the creatine phosphate system, do not show a consistent performance benefit from taking creatine (if “benefit” is defined as improvement in race time).  Measurement of “benefit” in other sports such as soccer, wrestling or football, all of which are reliant on short bursts of high intensity activity would be both hard to define and nearly impossible to measure.
Another consideration with Creatine is that the purity of the product that is sold commercially varies widely, with studies showing high degrees of variation in the amount of actual creatine per unit weight,not only from brand-to-brand, but from lot-to-lot for many manufacturers. This is because the supplement industry is not FDA-regulated and is not required to meet the same standards as drug manufacturers– something to keep in mind anytime you are considering taking a supplement,or evaluating the claims of a supplement manufacturer.

Is Creatine safe?

The safety of creatine in people over the age of 18 without pre-existing kidney disease is well-established at this point.  There is not enough data to be able to warrant it’s safety in younger age groups, though there also is no anecdotal evidence that there have been problems in adolescents who take it.  Initially,there was thought to be a higher rate of muscle cramping/muscle strain among users of creatine, based on clusters of anecdotal reports from training rooms around the country where use of creatine is common.  Controlled follow-up studies looking at this have not shown a consistent link.  In people with established kidney disease, consistent use of creatine does have the potential to worsen the problem, since high levels of creatine ultimately will cycle through to the kidneys as protein-based waste products, which can be hard on kidneys’whose filtering function is already compromised.  This is almost never relevant to the athlete population.

Is Creatine something I should be taking?

Nobody needs Creatine, because it is something that is present in food products, and because your body makes about half of your total creatine from other dietary amino acids.  Adolescents who eat a rounded non-vegetarian diet will consume a significant amount of creatine on their own.  Red meat, fish, and poultry are naturally high in creatine.  Keep in mind that only people with naturally low creatine levels will even have a chance at responding to creatine supplementation, and that there is no way of separating out people with “high”and “low” intramuscular levels short of muscle biopsy – something that is done in the research lab, not in the doctor’s office.  People who do respond to creatine supplementation (with elevation of their intramuscular creatine concentrations)won’t be guaranteed to achieve a performance improvement that can be measured.  The type of activity an athlete is participating in also is a consideration.  It makes no sense whatsoever for endurance athletes to consume creatine for a performance advantage.  Similarly, sports such as soccer or basketball, which are stop-and-go sports, but which also rely heavily on the aerobic energy system are unlikely to benefit from creatine use.  If there is one use for creatine that can be justified based on both theoretical grounds and on evidence from clinical studies, it would be in athletes who are resistance training, and using creatine fora defined (less than 12 week) period of time in order to maximize gains in the weight room.  Any other use would be based on theoretical benefit.  Every athlete that is considering taking something like Creatine should ask themselves the question “Why?”  Creatine is not a magic pill – something that many athletes in modern society seem to be looking for.  It’s important for athletes to maintain proper focus on the hard things that must be done in order to achieve both personal mastery over their bodies and success in their sport. Reliance on pills or powders to achieve this usually sacrifices the first for the second.  Our advice to you is simply this:  Don’t sacrifice control of yourself, or lose your sense of proper perspective in what it takes to succeed in sport by overly focusing on things that are peripheral.  Keep the bigger picture in mind,stay educated, and then make decisions for yourself that are grounded in common sense.



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