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"Numerous well-designed studies have demonstrated that creatine supplementation has an ergogenic potential.".....The Physician and Sportsmedicine (June 1997)
"The data on creatine is becoming abundantly clear. It definitely works."
Conrad P. Earnest, Ph.D., pioneer creatine researcher, quoted in Creatine: Nature's Muscle Builder
Knowing that most supplements are more sizzle than substance, I was skeptical. But when creatine kept popping up in the muscle magazines and we began to get a flood of queries, I decided to see for myself. That was a year ago. My training diary reflects the excitement as the results began to unfold.
"Started creatine loading dose today." Four days later: "Weight up 1 3/4 pounds; could creatine have caused?" One week: "Snatches were snappier." Eleventh day: Weight up another 2 3/4 pounds. Wow! Something is definitely happening here. Futrex [body fat computer] says I've gained 4 lbs. muscle." Day 14: "Power cleans went up like a dream. Could feel it from 1st set. Creatine definitely helping."
A few days later Carol and I visited our friends Carl Miller, the former United States Olympic weightlifting team coach, and his wife Sandra in Santa Fe. I couldn't wait to tell Carl that I had made three reps in the power snatch with a weight I'd been struggling with for singles - after less than three weeks on creatine monohydrate. I don't think he believed me and who can blame him. I wouldn't have believed it myself.
Actually, my first inkling that creatine might really work came after only five days on the supplement, when John North, the 70-year-old "Superstar of Aging" featured elsewhere on this site, came for a visit. Carol and I had for some time been telling John about the wonderful hiking trails in our area, and he was anxious to stretch his legs at our mile-high altitude. We took him up Tres Pistoles Trail, one of our favorites. It's a strenuous hike with a glorious view at the top. What I like best about Three Pistols is the relentless nature of the climb. You gain elevation from almost the first step; it starts with a gradual slope and ends with a heart-pounding segment best suited for a mountain goat. I've tested myself on this trail numerous times and remember being pleased to reach the top in under one hour the previous year, 59 minutes and nine seconds according to my diary.
Well, this time I made it in 51:26.37, a new record by more than seven minutes! "A really good climb!" I wrote in my diary. I didn't write anything about creatine - I guess I was still a doubting Thomas - but I remember thinking later, after the effect was clear, that creatine helped me motor up that trail in high gear.
Fast forwarding to the present, I've gained a total of 13 pounds after one year on creatine, most (but not all) of it muscle. My strength has also increased substantially. My power snatch and power clean are both up 10 kilos, or about 22 pounds. Interestingly, these gains were made without any conscious increase in calorie intake. I've continue to follow the same eating style described in my books.
But I've gotten way ahead of myself. What is creatine? How does it work? Will it work for everyone? What's the optimum dose? Are there any side effects? Briefly, here are the answers as I understand them.
What & How
Creatine is an amino acid found primarily in the skeletal muscles. The human body gets most of its supply from meat and fish in the diet; it is easily absorbed from the intestinal tract into the blood stream for transport to the skeletal muscles. When the dietary supply is inadequate the body can make a limited amount of creatine from a combination of the amino acids arginine, glycine and methionine.
Creatine plays an important role in muscle contraction. It helps replenish ATP, a chemical which is the immediate source of energy for all muscle contractions. In spite of its vital role, ATP is in short supply in the body; there is only enough available at any one time to provide energy for about ten seconds of explosive contractions. ATP, therefore, must be constantly replenished.
ATP provides energy to the muscles by releasing a phosphate molecule; it then becomes another compound called ADP. That's where creatine comes to the rescue. Creatine transfers phosphate to ADP, recreating ATP. The resynthesized ATP can then be used again to fuel more muscle contractions. Creatine, consequently, is a limiting factor in the resynthesis of ATP. The more creatine in the muscle, the more times ATP can be quickly regenerated.
The availability of creatine also delays the production of lactic acid, the substance which causes the famous "burn" and can eventually shut down the muscle. When creatine is present the muscles don't have to switch to a second energy system called glycolysis. But when glycolysis kicks in the muscles rely primarily on glycogen (muscle sugar) to generate more ATP. Lactic acid is a by-product of glycolysis. Lactic acid inhibits glycolysis and blocks the resynthesis of ATP through the combination of ADP and creatine. By delaying the accumulation of lactic acid, creatine allows the muscles to continue working with less pain and fatigue.
Admittedly, this is a bare-bones simplified explanation. The bottom line is that more creatine in your muscles allows them to contract harder and longer, especially in activities involving short bursts of explosive energy, such as weightlifting, bodybuilding and sprinting.
The Vegetarian Connection
Does creatine work for everybody? Nothing works for everyone and creatine is apparently no exception.
According to The Physician and Sportsmedicine (June 1997), creatine concentration in human skeletal muscle has a normal range between 90 and 160 mmole/kg-dm. The mean concentration is 125, which means that approximately half of people have less than that amount and the other half more. Strict vegetarians tend to be substantially lower than the mean. I'm a near-vegetarian. (I eat dairy products and small amounts of meat, chicken and fish.) That's probably why creatine worked so well for me.
Published studies show that athletes with concentrations below the mean respond positively to creatine supplementation, while athletes with elevated levels show little or no ergogenic effects. Apparently, the muscles of some people already carry a maximum load of creatine. In addition, others may have an inefficient creatine-uptake mechanism. For whatever reason, some people don't seem to be able to absorb supplemental creatine. My impression, however, is that most people get some benefit.
Most athletes start with a five-day loading dose of about 20 grams (4 teaspoons), and then maintain on one or two teaspoons per day. That's what the label on the product I take suggests and that's what I took initially.
Once you've filled your muscles with creatine, it remains for weeks. Taking a maintenance dose is similar to topping off your gas tank. You wouldn't keep pumping gas after your tank is full, and there's no point in taking more creatine than necessary to keep your muscles fully loaded. The amount required for maintenance varies with your exercise level and muscle mass. If you weigh 225 and train six days a week, you probably need more creatine (loading and maintenance) than a 150 pound person who exercises 2 or 3 times a week.
I currently weigh about 165 and take 1/2 teaspoon of pure creatine monohydrate every morning before breakfast. On workout days, I take another 1/2 teaspoon immediately after training. I take the second dose as soon as possible after my workout, because the most sensitive time for carbohydrate and protein uptake is within an hour after exercise.
Creatine should be taken with a sweetened drink, because the sugar stimulates an insulin response which helps the body absorb the creatine. I take mine in a glass of skimmed milk with a teaspoon or two of sugar added, but fruit juice or something like Gatorade would serve just as well.
Although it's still early - the first creatine products were introduced in 1993 - no serious side effects have been scientifically verified, according to The Physician & Sports Medicine. I've had two minor problems, however, which I believe are relatively common: stomach discomfort and muscle cramping. Others have apparently experienced diarrhea, usually when taking more than one teaspoon at a time or otherwise overdosing.
Shortly after starting creatine to save money I switched to a cheaper product which was available in bulk. This proved to be a mistake, because I soon began having pains in my stomach, a burning sensation. On closer inspection, I observed that the cheaper product was more granular and coarse, gritty to the touch. In contrast, the brand I took initially was a very fine powder, much like table sugar. I believe the less refined product irritated my digestive system. Anyway, I switched back to the more expensive and refined product and have had no more discomfort.
The muscle cramps were more disturbing and apparently not unusual. The Physician & Sports Medicine says, "There are anecdotal reports of a dramatic increase in muscle cramps associated with the use of creatine monohydrate."
I began to have cramps in my calves during the night or shortly after awakening. The cramps went away after a little massage, but they were definitely no fun. I put up with it for a while, but when the cramps began coming on during the day something obviously had to be done. I stopped taking creatine for a few days, until the cramping went away. When I started up again I began taking only 1/2 teaspoon on rest days. Reducing the dosage did the trick; I've had no more cramps.
Except when having the stomach and cramping problems, I've taken the creatine continuously for a full year. My experience, however, especially with the cramping problem, suggests that it may be a good idea to stop taking creatine for a few weeks from time to time. Remember, no one really knows the long-term effects of creatine supplementation. Most of the studies have been for relatively brief periods, usually less than 4 weeks, and probably no one has taken creatine for more than a few years.
Obviously, we've still got a lot to learn about creatine supplementation, but so far so good.
If you want more information about this supplement: Creatine: Nature's Muscle Builder by Roy Sahelian, M.D., and Dave Tuttle (Avery Publishing Group, 1997) -it's available in bookstores or from Ironman books, 1-800-447-0008 or Creatine, The Power Supplement, which we offer (now on sale) for $15.95 + $4 shipping fourth class or $6.00 shipping first class.
The Soreness Connection: In the article on soreness (#23 on this site), I reported that I get very sore after once-a-week weight workouts, but not after hard aerobic sessions. I wondered if my infrequent training was the cause, but discounted that connection after Dr. Lucille Smith seemed to agree with my contention that it is not advisable to train again until soreness subsides. She expressed surprise, however, that I experience soreness after every hard weight session.
That left me to speculate that some other factor might be involved. I wondered if my regular use of creatine might be involved in some way. New research suggests that may be the case.
The latest issue of Hard Training (P.O. 19446, Cincinnati, OH 45219 (513) 221-2600) carries the results of a study by D. Burke et al published in the Canadian Journal of Applied Physiology (23 (5):471, 1998) which found a strong correlation between soreness and oral ingestion of creatine monohydrate. After three weeks of either creatine or placebo supplementation, 40 male varsity athletes were interviewed and filled out a questionnaire detailing all side effects during the double blind study. Two side effects showed the greatest difference between the creatine and placebo group: sleep irregularity (creatine 47%, placebo 7%) and muscle soreness (creatine 53%, placebo 14%).
The researchers didn't attempt to explain how creatine might cause soreness, but my speculation is that muscle fibers packed with creatine may be more subject to damage as a result of heavy weight training. It also seems logical to assume that muscle soreness might cause restless sleep. Personally, I don't sleep as well when I'm sore after a hard training session.
The next question, of course, is whether the resulting soreness is harmful. I doubt that anyone knows the answer at this point. This does, however, strengthen my resolve not to train again until a few days after soreness subsides. Remember, Dr. Smith believes soreness "occurs to reduce activity during a critical time of healing."
Supplemental creatine monohydrate is finding its way out of gyms and athletic athletic arenas and into hospitals, nursing homes and beyond. The March 22, 1999 Newsweek reported that two new studies found that creatine may help people with neuromuscular diseases have a better quality of life. One study, reported in the journal Neurology, found that daily does of 5 to 10 grams improved muscular strength by 10 to 15 percent in patients with debilitating illnesses like amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease. The second study, published in Nature Medicine, found that creatine not only improved endurance in mice with an animal form of ALS, but also extended their lives. In that study creatine worked twice as well as riluzole, the only drug currently approved for ALS.
Creatine may also combat muscle loss and improve mobility in the elderly. I haven't read the report, but a family nurse practitioner told me recently that a study published in the Scandinavian Physiological Society Journal reports on the use of creatine in adults 67 to 80 years of age.
This is good news indeed. Beyond the benefit to people who really need it, findings such as these will encourage researchers to do peer reviewed, double blind studies on the efficacy and long-term safety of this widely used muscle building supplement. The ad hoc experiments of bodybuilders and other athletes may turn out to have more widespread application than anyone dreamed possible when the supplement arrived in health food stores only a few short years ago. At minimum, the recent findings confirm that creatine works, at least for people with less than optimum levels in their muscles.
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