Creatine: The Urban Myths Live!
Sunday, June 20, 2010
In another position statement published by the International Society of Sports Nutrition (Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M. et al. (2007). International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int.Soc.Sports Nutr, 4, 6.) they listed a number of persistent myths about creatine, including:
1. All weight gained during creatine supplementation is due to water retention.
2. Creatine supplementation causes renal distress.
3. Creatine supplementation causes cramping, dehydration, and/or altered electrolyte status.
4. Long-term effects of creatine supplementation are completely unknown.
5. Newer creatine formulations are more beneficial than creatine monohydrate (CM) and cause fewer side effects.
6. It's unethical and/or illegal to use creatine supplements.
Bottom line of the article was that these are indeed myths that have been refuted in numerous scientific articles. In fact it is one of the most extensively studied nutritional supplements for athletes (and us sub-athletes as well). Consistently the findings have been very positive for creative supplementation, yet these myths persist. In fact I was recently a recipient of one of myth number 1. In a visit to a sports injury clinic this winter I asked about creatine as a supplement to aid in building muscle. The response was all it did was store water in your muscles. So I never looked into creatine until recently when I started conducting some more systematic research into sports nutrition. I’ll summarize the findings of this review of the research by the International Society of Sports Nutrition. But you can just read the Creatine Coles Notes below and save yourself the longer read.
Just as a caveat, I’m not a trained nutritionist, medical expert etc. Since I don’t claim to be an expert in any of this so I’d suggest you use the information to stimulate ideas, but check things out for yourself. I always provide references to the material I’m using for that people can help inform themselves.
Creatine Coles Notes:
1. Creatine monohydrate (CM) is the most effective nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and
lean body mass during training.
2. Creatine monohydrate supplementation is safe and may have benefits in terms of preventing injuries.
3. There is no rigorous evidence to suggest short-term or longer-term negative effects of CM supplementation.
4. CM supplementation is safe for young athletes (but proper coaching and training is necessary to ensure ethical use of all forms of supplements in this age group).
5. CM is the most studied from of creatine supplement although others have been tested (e.g. creatine ethyl ester and creatine with cinnulin extract) their superiority to CM is not clearly established. Probably more research is needed before on should consider switching to newer creatine products. Even if shown to be superior, CM is cheaper than most alternatives so for those of us who aren’t elite athletes this may be just fine. There is evidence, however, to suggest that adding B-alanine to CM may result in greater gain in strength, lean mass in addition to delaying muscle fatigue. You can add this yourself to your nutritional supplement strategy.
Creatine – The Longer Version
Now first a few basic facts. Creatine a natural non-protein nitrogen (it contains nitrogen but is not protein). By natural I mean that it is produced in the body by the liver and panaceas from amino acids and it also is found in foods such as meats. Virtually all of the body’s creatine is stored in muscles – about two thirds is stored as phosphocreatine (PCr) and the remainder is just stored as creatine in the muscle. When we exercise the energy provided to our muscles comes from ADP and ATP and both are dependent on the amount of PCr stored in the muscles. As PCr is depleted from intense exercise it becomes more and more difficult for the body to resynthesize ATP needed for the muscles to function.
So basically PCr, the stored form of creatine in our muscles, is essential for the energy to undertake intense exercise.
So while you can find creatine in foods such as fish and meats a large amount needs to be consumed to obtain even a single gram of creatine, hence the search for a means to supplement creatine stores (and the desire to make huge profits I suspect). Creatine monohydrate (CM) is one of the most inexpensive and most researched forms of creatine supplement available. Based on several hundred peer-reviewed research studies the benefits of CM, 70% of the studies reported a significant increase in exercise capacity. For example, short-term supplementation increased maximal power during weight sets by 5 % to 15%, sprint performance increasing in the same range. Longer-term CM supplementation also increased strength and performance gains by 5% to 15%. Nearly all studies show increased in body mass by about 1 to 2 kg in the first weeks. Longer-term supplementation shows CM results in twice as much gain in lean body mass in the range of 4 lbs within 4 to 12 weeks compared to subjects who exercise but take no CM supplement (placebo). Sure there are studies showing no significant gain but a large majority show substantial improvements. Those familiar with the concept of statistical power in a research design know that sample sizes will often be too small to find a statistically significant result even when there is real impact. So a non-significant study result only means the researchers cannot reject the null hypothesis that there is no difference between two groups. It does not mean one can definitely claim there was no impact. Repeated studies showing no impact would lead one to that conclusion but in the case of the CM research much the opposite occurs, the large majority of research finds a significant and positive benefit of CM supplementation.
There are many new forms of creatine in the marketplace that claim to be superior to CM. Most have been shown to be no better than the old school CM in terms of strength of performance enhancement. More research is required on creatine ethyl ester and creatine with cinnulin extract before any reliable conclusions can be reached. There is evidence to suggest that adding B-alanine to CM may result in greater gain in strength, lean mass in addition to delaying muscle fatigue.
The article points out that the only clinically significant side effect in the literature is weight gain. The literature does report anecdotal occurrences of dehydration, cramping, liver damage, muscle injuries, but this evidence is from athletes who are often undergoing intensive training and the evidence shows no difference with or with CM supplementation. These problems will arise in a certain percentage of athletes regardless of their nutritional habits. In fact some of the literature showed a lower risk of these symptoms with CM supplementation.
On the negative effects of CM on renal function, this apparently arose from early case studies with no scientific validity. Later research supporting these concerns is based on increases in serum creatinine levels in urine. But carefully controlled studies suggest no difference between groups with CM and control groups without CM supplementation in healthy individuals.
What about the longer term impacts? What do we know? This has been a concern often raised. So far there has been no long term impacts on athletes monitored over five years. One study tracked a group of individuals since 1981 who had been taking 1.5 to 3 grams of CM per day. No significant side effects were reported (compared to comparable groups without CM supplementation). On the contrary, some research suggests benefits of creatine supplementation for some patient groups.
Keep it away from children? Despite what you may have heard, the studies of CM among younger population shows no adverse effects in children/adolescents, although admittedly there are fewer studies researching the impacts of CM in these age groups. However, as will all forms of supplementation with younger athletes, proper coaching and training is necessary to ensure ethical use of supplements, including CM.
Based on the research reviewed in this research article (Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M. et al. (2007). International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int.Soc.Sports Nutr, 4, 6.) I think one can be more confident about what known about CM than most modern food additives we see in our food every day.