Creatine Monohydrate: Fact, Myth, & Misconception

Posted in: Sports Nutrition  on Tuesday, January 24, 2012
Cailan Gray, B.A., M.Ed.

To most, winning is the only reason to participate in athletics. When not only the pride, but also the salaries, scholarships, and employments depend on the success of competition, the focus on winning is elevated to the highest priority.  The pressure to win at these levels is so high that people’s jobs, organization’s budgets, and many other factors are based on a team’s success.

With so much pressure to win, coaches and athletes alike are consistently looking for distinct ways to gain an advantage over their competition. The use of creatine monohydrate and other supplements to enhance athletic performance have become a characteristic part of the typical team training program.  The common athlete has become bigger, stronger, and faster over the past decades.  To keep up with competition, science has undergone lengths to try and match that of the playing field. 

Creatine monohydrate has grown to be the most widely used performance-enhancing supplement used today.  Annual sales of supplemental creatine exceeded serval hundred million dollars in the United States alone (Rawson, Conti, & Miles, 2007). Mixed reports indicate that at a range of 13 to 44 percent of collegiate athletes have used creatine with this number elevating rapidly. Additionally, a range of seventeen to 30 percent of high school athletes, 57 percent of health club members, and 74 percent of power sport athletes have reported using creatine monohydrate. (Rawson, et al., 2007)

About 25 years ago, Dave Ellis of the University of Nebraska observed how athletes could train harder and builds muscle faster with the use of creatine supplementation (Storlie, 1997). Observations such as this have led to the rampage of research being focused on the effectiveness and safety of this supplementation.  Thus, the supplement’s popularity grew dramatically in the 1990’s.

Paul Greenhaff, PhD and leading creatine researcher from Nottingham, England, described it by saying, “Its ingestion is a means of producing immediate, significant performance improvements to athletes involved in explosive sports” (Storlie, 1997).  “Creatine monohydrate continues to attract considerable attention as a supplement potentially capable of improving high intensity exercise performance” (Kelly & Jenkins, 1998).  Each year more research supports this shared viewpoint.
Accordingly, timeline research has upheld this argument. From the pass of ten years, creatine is still attributed to intramuscular mass gains, as well as, performance attributions when dosed properly (Grande & Graves, 2005).

 Creatine is made naturally in the body or can be consumed in the diet.  Meat and other animal byproducts are shown to be a good source of creatine in the diet.  The liver, pancreas, and kidneys synthesize creatine by the use of glycine, arginine, and methionine.  Ninety-five percent of the creatine the body uses is consumed by skeletal muscle.  The other five percent is used in the heart, brain, and testes.  The major role of creatine is to maintain the levels of energy in the form of adenosine triphosphate (ATP), the primary fuel for energy in the body (Haff, Kirksey, & Stone, 1999).  There are approximately five millimoles of ATP and 15 millimoles of creatine phosphate per kilogram of body tissue stored throughout the body. This would provide enough energy for about one minute of a brisk walk or a few seconds of a full out sprint (Prentice, 2003). Creatine phosphate is utilized via the phosphagen energy system. This system is crucial in short-term energy expenditure. As ATP is metabolized near the head of the myosin filament within the muscle cell; the  reaction yields a free radical phosphate and the spent form of ATP, adenosine diphosphate (ADP). In order to replenish energy stores within the muscle, ADP must recruit another phosphate, donated via creatine phosphate through creatine kinase. The cycle continues until creatine phosphate stores are depleted to a base-stage resulting in ATP production being limited, resulting in deplenished energy.
This is predominantly evident during muscular activations at maximal effort, where there are short rest intervals. 

Supplementary creatine phosphate increases the ability to produce energy, which in turn, increases work ability for intense activity and faster recovery rate  (Kelly & Jenkins, 1998).

Creatine supplementation can come in many forms.  The most common of which is delivered via a powder that is added to a liquid transport system. Nevertheless, it is also found in pill and injectable forms.  The most common protocol for creatine administration includes loading and maintenance cycles. “This protocol is characterized by ingesting approximately 0.3 grams per kilograms of body weight per day of creatine monohydrate for five to seven days (e.g. five grams taken four times per day) and three to five grams per  day thereafter” to maintain stored levels (Buford, Kreider, Stout, Greenwood, Campbell, Spano, Ziegenfuss, Lopez, Landis, & Antonio, 2007).  However, some have suggested that the loading phase of the cycle is not needed to collect the suggested benefits. It is suggested that a continued maintenance stage will produce in similar characteristics as the load protocol over the battery of a three to five week cycle (Wilder, Deiver, Hagerman, & Gilders, 2001).

    Most athletes use creatine supplementation as a means to increase strength and lean body mass at an accelerated rate.  Athletes participating in power sports have shown to benefit the greatest from supplementation.  Accordingly, Buford, et al., (2007) suggested that nearly 70 percent of studies have reported significant improvements in exercise capacity. Additionally, weight lifters, sprinters, and field athletes such as soccer, football, basketball, and baseball players have shown to be the athletes that benefit the most (Kelly & Jenkins, 1998).

    An increase in body mass is the main effect that creatine supplementation is suggested to have on the body.  Buford, et al., (2007) found that supplementation of creatine monohydrate can lead to approximately double the gains in fat free mass
as compared to the un-supplemented athlete respectively.  However, many classic researchers believed that retention of water and elevation in creatine stores are the major causes for the increase in body mass with short-term creatine supplementation (Haff, Kirksey, & Stone, 1999).  Therefore, it is suggested that mass gains would be lost once supplementation was ended. However, in recent research this has drawn controversy.  While most support that there is a significant increase in total body water retention with use of the supplement, many hold differentiating ideals as to whether it is attributed to lean body mass or loss of temporary supplemental stores (Powers, Arnold, Weltmant, Perrin, Mistry, Kahler, Kraemer, & Volek, 2003). Additionally, some have suggested that long-term supplementation may provide an increase in body mass that is believed to stem from the stimulation in myofibular protein synthesis rate (Haff, Kirksey, & Stone, 1999).   

Another key attribution of creatine monohydrate supplementation is an increased level of stored muscular creatine. Daily consumption of creatine supplements can increase creatine content in skeletal muscle by as much as 20 percent to 50 percent.  Nevertheless, if the athlete has  higher initial stored tissue content, the supplementation will not have as a dramatic of an effect on the athlete’s performance and mass gains. Hence, highly trained athletes do not display significant supporting benefits of supplementation (Wilder, et al., 2001). 

Accordingly, primary research has focused on and surrounded high impact, short-term, power, and strength athletes as the prime beneficiaries of creatine supplementation. However, there has been minimal research to support performance improvements for endurance athletes.  For this rationale, many suggest that there are no supported benefits for endurance athletes (Grande & Graves, 2005).   Yet, by some it is believed that endurance athletes can still benefit from creatine supplementation. “Because creatine has been reported to enhance repetitive sprint performance, muscle mass, and glycogen uptake when ingested with large amounts of carbohydrates, it is tenable that endurance athletes could benefit from creatine supplementation by virtue of improved interval training quality, muscle mass retention and/or glycogen loading (reloading)” (Plisk & Kreider, 1999). However, there has been little to no additional research to support this hypothesis.

The main concern is that there are still many valid concerns surrounding the long-term safety and proper protocol adherence of creatine use.  There is an unlimited abundance of uneducated and ignorant resources that blanket valid research to the general public. This is shown in typical fashion through leading internet search engines such as www.google.com or www.yahoo.com where questions such as, " …I am only fifteen, would it be okay for me to take it… what sports is it best for?” are followed with answers such as, “…athletes take creatine, because it really helps with performance… creatine is actually quite safe… I found it amazing…it gives you more ATP (adrenaline) so that you can perform on whole new levels, I have gained a lot of muscle mass, and you can work out longer.”  While there are parts of the statement that could be suggested to be true, there are obvious misconceptions that follow.  This would suggest that not only is the research surrounding creatine supplementation inadequate, but so to is the public education and regulation of supplementation.

The National Collegiate Athletic Association (NCAA) reports on statements issued by the Food and Drug Administration (FDA) that showed uncertainty about the long-term effects.   This uncertainty is thought of to be due to a  lack of educational research on long-term creatine use, and assumed misuse of the product.  However, some studies have been conducted show creatine to be quite safe if used properly (Buford, et al., 2007).  Yet, in many collegiate weight rooms there are unlimited unmonitored supplies of creatine monohydrate that is available for consumption at the athlete’s discretion, allowing for improper and irresponsible use.  Much of the nation’s universities are now mandating rules to try to monitor or discourage this supplement use.  However, it is not medically sound for a coach or team employee, such as an athletic trainer, to make this consent, leading way to suggest that team physicians should help in the safe and ethical use of creatine.

The reason for concern is validated from past mistakes, as well as, the trial and error with other products that have been prevalent in athletics or competition in the past.  In the late 1960’s and early 1970’s anabolic steroids were just coming onto the market.  They were thought of at the time to be miracle supplements due to there high yield in benefits with the virtually lack of side effects.  However, thirty years later we now know the dangers that these products initiate to the extensive research that has arose due to the  circumstances.  Steroid use leads to a wide array of systemic effects from sterility to death.  For this reason we now have set policies and procedures regarding these drugs and their usage.  Controversy surrounding creatine arises because of the similarities of evolution of the supplements and the array of consequences that could become.

Some reports from suggest that creatine use may, in similarity, lead to medical issues.  Some studies have suggested that muscle strains and cramps are directly linked to creatine supplementation (Greenwood, Kreider, Greenwood, & Byars, 2003). While others suggest that creatine may cause: dehydration, depression, systemic shock, heat illnesses, kidney disease, stroke, gastrointestinal distress, compartment syndrome, and blood plasma issues (Haff, Kirksey, & Stone, 1999).  However, Buford, et al., (2007) would suggest that, “while athletes who are taking creatine monohydrate may experience these symptoms, the scientific literature suggest that these athletes have no greater, and a possibly lower, risk of these symptoms than those not supplementing with creatine monohydrate.”   Additionally, many would consider that creatine would help decrease muscle cramping with its effect of water retention (Greenwood, et al., 2003).  However,  it is known that sodium is critical to the muscle’s cellular uptake of creatine therefore if the athlete does not replace electrolyte stores during and after competition, they are still susceptible to cramping (Haff, Kirksey, & Stone, 1999).  In support, it is suggested that creatine increases total body water within 24 days of supplementation (Powers, et al., 2003). Powers, et al, (2003) also suggest that the increase in total body water does not alter fluid distribution, therefore not effecting electrolyte balance within at a cellular level.  
Accordingly, this may be the rationale supporting new-coming research to suggest that creatine supplementation aids in the prevention of cramping, heat illness, and overall injury prevention (Greenwood, et al., 2003).  Greenwood, et, al., (2003) also goes on to suggest that when compared to the un-supplemented athlete, creatine monohydrate can aid in prevention of not only heat illness and dehydration, but also, muscle tightness, muscle strains, non-contact injuries, and other illnesses. 

However, like other research surrounding creatine supplementation, there has been research to counterbalance these findings.  Rawson, et al. (2007) suggested in his findings that creatine monohydrate supplementation had no effect on strength gains in pre-trained young men.  Nevertheless, his methods suggest that his protocol only spanned only though a ten day treatment, thus counteracting recommended and commonly suggested protocols for administration of creatine.  This provides only one example of conflicting results, because of the lack of mandated regulation.  However, this conflicting concern yields misconceptions and uncertainties that can lead to doubt surround the effectiveness and possible side effects of the supplement.

Conversely, the only widespread reported side effect of creatine is gastrointestinal distress.  This side effect, as well as other, may be due to the mindset of “more is better” surrounding athletes; albeit it is shown that high dosage supplementation shows no any added physiological benefit (Wilder, et al., 2001).  Examples include athletes taking excessive amounts of creatine to hypothetically gain an even greater benefit over taking the suggested dosages.  Due to the many variables involved it seems to be responsible common sense on behalf of a coach or athletic trainer to say that it is important to incorporate the guidance of a team physician to monitor intake and use of creatine monohydrate, as well as any other supplement.

In August of 2007, the Journal of the International Society of Sports Nutrition published their position statement on creatine supplementation and exercise. After an extensive review of literature, Buford, et al., (2007) conveyed nine points surrounding creatine use.  He conveyed that creatine monohydrate was the most extensively form of creatine studied and that creatine was the most effective ergogenic supplement available to athletes.  He also went on to suggest that there was no scientific research to suggest that creatine monohydrate supplementation was not only safe, with no short or long term adverse side effects, but could offer beneficial in injury prevention and management of select medical conditions.  He also advocated that, when used properly, creatine monohydrate supplementation is acceptable in young athletes to prevent use of other anabolic drugs.  The position stand also set forth suggested protocol and dose guidelines. (Buford, et al., (2007)  Accordingly, one must ask if this should be considered a cornerstone in the controversy regarding creatine monohydrate supplementation.

With creatine supplementation becoming a normal part of athletic strength training, it is important to understand its effects and concerns.  It has been suggested that it has a significant effect on the performance of power sports athletes and, to a lesser extent, endurance athletes at many levels of competition. This supplement has also been practically unanimously supported to increase total body water levels, as well as, total body mass.  The two attributes are the primary incentive for its growth of use in athletics.  It is predominantly known that creatine helps to increase strength, power, and body mass. 

Additionally, there has been research to suggest that this supplement can be greatly beneficial in injury prevention, and overall well-being in athletic populations.  Although, there are  still  many remaining  mythical undecided adverse affects that have not yet been concussively resolved  surrounding the product; thus creating doubt in the safety of it’s use.  In addition, with increasing limitations by the NCAA and FDA, as well as, the mixed verdict on the usage, dosage, and protocol, there are many questions are still left unanswered. In point of fact, there has been very little concern, development, or research since the late 1990’s surrounding creatine.  For that matter, it is growingly apparent that the little information that is in the public is well hidden behind weightlifting websites, skeptics, and people that are content with the limited information that is in the common public domain.  Thus concluding that the one reliable fact remains, there is still a need to further look at side effects, effects of long-term usage, and safety level in order to maintain a consensus surrounding the use of this widely used wonder supplement. 

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