How To Use Creatine by David Hill

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It's a classic case of guilt by association. Average people, including many of your athletes and their parents, have no easy way to wade through media hype surrounding steroids and other illegal performance enhancers. Every week seems to bring new accusations and innuendo about who's doing what, leaving the impression that all performance-enhancing substances are the same and anything beyond milk is suspect.

As a result, many people are wary of creatine, not sure exactly what it does or how it does it. Even though it's a naturally occurring compound, found in human and animal muscle tissue, some people simply lump it in with the steroids and other banned substances that make headlines. For this reason, it's up to strength coaches and sports-medicine professionals to offer guidance and separate fact from supposition.

"I meet misinformed people every day who think there are documented cases of devastating side effects associated with creatine, when this is not the case," says Eric Rawson, PhD, CSCS, Assistant Professor in the Department of Exercise Science and Athletics at Bloomsburg University and a leading researcher on the substance. "There's a great deal of literature documenting the performance-enhancing effects of creatine. And a huge number of people are using it with very few reports of serious side effects."

Rawson is among a sizable number of researchers, clinicians, and sports-performance specialists who say creatine doesn't deserve its murky reputation. Creatine's effect is so well accepted, Rawson says, that research into it has largely switched from the sports-performance area to clinical use in treating diseases of the muscles, such as muscular dystrophy.

The issue, however, is which athletes should use creatine? And given the sensitivity of the times to anything that isn't straight from the grocery aisle or restaurant menu, how should a strength and conditioning or sports-medicine program navigate this sensitive issue?

SAFETY & EFFECTIVENESS
There is a strong consensus among researchers that creatine is both safe and effective when used appropriately in recommended doses and protocols, says Robin Meiggs, MS, Assistant Director of the Human Performance Lab at Humboldt State University and a member of the NCAA Competitive Safeguards and Medical Aspects of Sports Committee. Meiggs has reviewed many studies into creatine and has conducted or overseen studies at her own lab. One study, which used members of the women's rowing team she coaches at Humboldt State as test subjects, supported the theory that creatine helps athletes train harder and longer by donating phosphate ions to replenish stores of the cell fuel adenosine triphosphate (ATP) in short bouts of high-intensity, power exercise.

Rawson draws an analogy to carbohydrate loading among endurance athletes. "If you ingest creatine from a dietary supplement, you'll increase the amount of creatine in your muscle," he says. "Then, we would expect performance in any sport that relies on the creatine phosphate energy system to be enhanced a small amount. Typically that's in sports consisting of brief, repeated, intense bouts of activity.

"But the real benefit seems to come in the weightroom," he continues. "The most consistent finding in the literature is that individuals who lift weights and take creatine make more progress in the weightroom than those who lift weights and take a placebo. It's more of a training aid than a performance enhancer, though the benefits received in the weightroom can translate to on-field performance gains."

The distinction between training aid and performance enhancer is an important one that is often lost on athletes. For example, Bob Seebohar, MS, RD, CSCS, Director of Sports Nutrition at the University of Florida, says a linebacker might think that using creatine will help him play hard longer, but that isn't so. "Creatine can increase lean muscle mass by helping him push on heavier weights, but by itself, that's not going to help him on the field," he says. "An athlete can be very successful in increasing lean body mass and muscle composition, but not have the energy to use it during games."

As for weight gain, the research is unsettled but seems to suggest any perceived increase in bulk from creatine use results more from water retention than increased muscle mass. Rawson says some research has suggested that increased water content in cells might affect protein synthesis and in theory muscle building, but the link is far from definitive. "Over the short term," he says, "it just seems to be water gain."

Even when used properly, creatine doesn't work equally well for everyone. One main reason is that some people begin with greater amounts of creatine in their muscles, usually because of genetics or diet. Creatine is naturally present in the muscles of animals, so it's in meat and fish. Thus, athletes with low base levels of creatine, such as vegetarians, often make the greatest gains in strength when using creatine.

"If you have a quarter tank of gas in your car, you can add a lot more to it than a person who's starting with the tank three-quarters full," Rawson says. "That's how skeletal muscle is—some people have lower amounts, some have higher amounts. Those with the lowest amounts receive the greatest increase in muscle creatine following supplementation, and subsequently receive the greatest improvement in performance."

OTHER CONSIDERATIONS
Athletes expecting creatine to be a magic elixir that solves their strength-training problems are in for a rude awaking. For all of its positive attributes, creatine offers no quick fix. This can be a tough message to get across to athletes who simply want to get bigger, stronger, or faster.

"It's not what athletes hear that matters, but what they actually listen to," says Mickey Marotti, MS, MA, CSCS, MSCC, Director of Strength and Conditioning at the University of Florida. "We tell our athletes, ‘Lift right, train hard, get plenty of rest and recovery, eat right, and drink plenty of fluids. Maximum effort equals maximum results.' Then an athlete reads something and thinks, ‘This guy says creatine is good, so I should be taking it.' But they don't remember all the guidelines that go along with it. They just remember in some cases it works.

"So we're really careful about what we tell our athletes about supplements, because the majority of them aren't eating right, and they're not training properly," he continues. "But if they are doing all those things and creatine is something they want to look at, we'll gather all the information we can, and then make the right choice for each individual situation."

The first point to make with athletes is that creatine is a supplement—something extra to be used after other, more basic steps to increase performance are exhausted. When athletes approach Seebohar about using creatine or other supplements to gain weight or strength, he first wants to make sure they are getting enough calories and nutrients. Often, they simply aren't eating enough, so he helps them change their diet to gain more calories from wholesome food—especially meats—simply by eating greater amounts and more often. Next might come energy and protein additions, often in liquid form to reduce the chance of spoiling the appetite for regular meals.

"You shouldn't lead off with creatine," says Seebohar. "Creatine should be in the dugout, the third or fourth batter in the lineup."

Some people are concerned that even with a cautious, first-things-first approach, creatine use could lead to more potent and dangerous, banned ergogenic aids. The idea is that once athletes use a supplement like creatine, they will be more receptive to other, more questionable, substances.

"Encouraging the use of supplements can lead young people to believe there is a magic bullet they can take that will make them faster and stronger and more likely to win," says Kay Hawes, Director of Media Relations for the National Center for Drug Free Sport. "There is a concern that young people might not understand the difference between taking a creatine supplement and taking a steroid."

Others, though, see no hard evidence to support the slippery-slope argument. "Anything is possible," says Mike Nitka, MS, CSCS, Director of Human Performance and Health and a Physical and Health Education Teacher at Muskego (Wis.) High School, "but I don't think I can refer to any study that says the use of creatine supplements may lead to consideration of anabolic steroids."

Another concern, especially in the NCAA and other settings where athletes can be tested for use of banned substances, is the risk of contamination. Unlike drugs, nutritional supplements are not highly regulated, so it's largely buyer beware. As part of her duties on the Medical Aspects Committee, Meiggs hears appeals from athletes who have tested positive for banned substances.

"We hear, ‘The only things I took were nutritional supplements,'" she says. "Student-athletes think if something is being sold in a store, it must be okay. But sometimes these supplements are made in the same location as banned substances, and they're tainted in the production process."

At Florida, Seebohar goes so far as to call manufacturers to ask about their production practices. "Athletes will come to me and say ‘I just bought this,' and I'll look at the label," he says. "I'll cross-reference ingredients with the NCAA and IOC lists of banned substances, and then call companies myself. It's hit or miss whether they're helpful, but I ask whether they prepare supplements with possibly pre-steroidal components, and if they wet-wash their equipment between supplements."

MAKING IT WORK
While NCAA schools are not allowed to supply creatine to their athletes, its use violates no NCAA rules. As a result, athletes may look to you for help when deciding whether to take it. This decision should include many factors, because there is no pat answer.

A primary consideration is the sport the athlete plays. Since creatine helps increase power and explosiveness, endurance athletes will receive little benefit from its use. Football falls at the other end of the spectrum because power and explosiveness are so valued. But what about the sports in the middle?

"Basketball would be classified as a power sport because, for example, in a sprint for the ball, it comes down to who gets there first, and if everything else is equal, it will be the person who has worked on developing power," Nitka says. "In baseball, can you make that one throw from the outfield to third base or maintain a powerful swing? When I talk about power, it's one maximal effort followed by a period of recovery and repeating that effort."

To get the maximum benefit, athletes also need to understand how to properly use creatine. Two major points are that loading isn't necessary and that many athletes take far more creatine than they need.

The established dosage guideline is 0.3 grams per kilogram of body weight per day for loading, and 0.03 grams for maintenance, Rawson says. For an 85-kilogram (187 pound) athlete, that's 25 grams in loading or 2.5 grams in maintenance.

"You can either take a low dose of creatine for about a month or a high dose of creatine for about five days, and the changes inside your muscle will be identical. One just happens more quickly than the other," Rawson says. "But if athletes choose to do a loading dose, beyond five days they should be on a very low-dose maintenance level. The important message to get to the athletes is that they don't need to take excessive amounts. Everyone has a ceiling on how much their muscles can take, and after that, it doesn't help."

Bottom line, the question of whether athletes should be using creatine is best answered with more questions. "It's like if you asked me, ‘Hey, Bob, are peanuts good?'" says Seebohar. "The answer is generally yes, but what if you're allergic or you're trying to lose weight? You need to know more about their personal scenario before even indulging in an answer."

A QUESTION OF AGE
Although creatine is generally considered to be safe and effective when used properly, many people believe proper use does not include high school athletes, since almost all of the studies on it have involved people of college age and older. This doesn't mean that creatine is not safe for younger athletes, including those in high school, only that its effects have not been thoroughly examined in that age group.

"Some of our kids do use it, but we discourage them from doing so," says Sean Cox, ATC, Head Athletic Trainer at Salem (N.H.) High School. "Our reasoning is that there is no valid study on the use of creatine in the high school population. We're worried that kids are using a substance that may at some point be found to cause harm."

A cautious approach for high school athletes appears reasonable to Rawson. "Most scientists do not support the use of any dietary supplements in teenagers and adolescents," he says. "We really have just two studies that have examined creatine supplementation in young athletes, and no papers that have directly examined kidney function and other related questions. So the question becomes, can we use our information on adults for younger athletes? The conservative answer would be no, we should not. We should just say it hasn't been researched, so we don't know the answer."

That lack of definitive information has prompted some high schools to steer clear of the subject. "Our procedure is that we—as a school system, as coaches, and as an athletic program—will not recommend any food supplement," says Charles Meagher, Athletics Coordinator for Gwinnett County (Ga.) Public Schools. "It's just not the school's business."

Not all high schools are silent on creatine, however. Whenever athletes raise the subject, Cox approaches it as a chance to educate them. He encourages athletes to do their own research, stressing that creatine is appropriate only in certain sports and only as an addition to proper nutrition and training.

At Muskego, Nitka will often first analyze the athlete's diet—many skip breakfast or subsist on nutrient-deficient processed food—and their rest and recovery, in order to drive home the message that creatine is no shortcut. He'll also bring parents and family physicians into the mix, insisting that athletes consult them before making any decisions.

Rawson says that simply leaving athletes to make decisions about using creatine on their own may not work out well. "There was a paper published in 2001 that reported 70 percent of high school athletes who used creatine took more than the recommended amount," he says. "Whether we have information about adverse effects or whether we do not, and even if you believe that the excess is simply excreted, 70 percent of high school athletes ingesting above what's recommended on the label is something we need to address. We can do a better job educating our athletes."

Sidebar: Watered Down
A common concern about creatine is that it can lead to dehydration in athletes. But Eric Rawson, PhD, CSCS, a leading researcher of creatine, says that belief comes not from research but from inferences and coincidence. Athletes may begin using creatine just as they're beginning intense preseason conditioning, often in summer heat, and they connect dehydration to creatine.

"I don't understand why this is still an issue," says Rawson, Assistant Professor in the Department of Exercise Science and Athletics at Bloomsburg University. "We understand that creatine increases the water content of the muscle, so why do we keep talking about dehydration? Several studies that have tracked the effects of creatine supplementation in hard-training athletes on a variety of measures of muscle dysfunction, such as cramps and muscle strains—things that you would associate with changes in body water—have found similar incidence in athletes who ingest creatine and those who do not.

"Researchers have also addressed this in clinical trials where they've dehydrated athletes ingesting creatine or a placebo, and examined a variety of different physiological changes, including temperature regulation," he says. "They've found creatine supplementation does not have any dehydrating effects whatsoever."

Still, concerned that creatine, like other supplements, can increase demands on the kidneys, Bob Seebohar MS, RD, CSCS, Director of Sports Nutrition at the University of Florida, is wary of adding it at a time when hydration levels may be stressed, such as during preseason football camp. "It's really hot and humid in Florida, and the players don't always hydrate well to begin with," he says. "So if they're going to use creatine, I would prefer it be after the bowl season and through the spring semester."

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Submitted by DMorgan on Mon, 05/21/2007 - 10:00am.

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