Ben Wadham

20057136

Critically evaluate the use of Creatine in strength and conditioning

Word Count = 2,381

Ben Wadham

20057136

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Professional and elite athletes have used many such drugs widely for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing. Creatine is an amino acid, like the building blocks that make up proteins. Creatine in the form of phosphocreatine (creatine phosphate) is an important store of energy in muscle cells. During intense exercise lasting around half a minute, phosphocreatine is broken down to creatine and phosphate, and the energy released is used to regenerate the primary source of energy, adenosine triphosphate (ATP). Output power drops as phosphocreatine becomes depleted, because ATP cannot be regenerated fast enough to meet the demand of the exercise. It follows that a bigger store of phosphocreatine in muscle should reduce fatigue during sprinting. Extra creatine in the muscle may also increase the rate of regeneration of phosphocreatine following sprints, which should mean less fatigue with repeated bursts of activity in training or in many sport competitions (Kreider., 1998). Creatine is formed from glycine, arginine, and methionine and is naturally produced by the liver, kidneys, and pancreas. After production, creatine is transported to muscle, heart, and brain, with 95% of bodily stores remaining in muscle. The body synthesizing creatine from amino acids provides about half of the daily needs of creatine. The remaining daily need of creatine is obtained from the diet. Meat or fish are the best natural sources. For example, there is about 1g of creatine in 250g of raw meat. Dietary supplementation with synthetic creatine is the primary way athletes "load" the muscle with creatine. Daily doses of 20g of creatine for 5-7 days usually increase the total creatine content in muscle by 10-25%. About one-third of the extra creatine in muscle is in the form of phosphocreatine (Harris., 1992; Balsom et al., 1995). The daily requirement of creatine is 2g, with this amount provided half from endogenous production and half from normal diet (Balsom et al., 1994). Muscle creatine stores are in a balanced equilibrium with creatine and phosphocreatine interconverted via creatine kinase. Phosphocreatine provides energy to the muscle via its dephosphorylation, which donates a phosphate to adenosine diphosphate producing adenosine triphosphate (Fig 1). Aerobic recovery time then allows for the restoration of phosphocreatine.

Ben Wadham

20057136

Phosphocreatine availability is considered the limiting factor in short, highintensity activities, as it provides muscle with the major energy source over the first 10 seconds of anaerobic activity after free adenosine triphosphate is consumed in the first 1 second of action (Fig 2) (Clark., 1997). Figure 1. Interconversion of phosphocreatine and creatine producing adenosine triphosphate

Figure 2. Time-dependent, dominant energy source for muscle activity

Investigations into the tissue level effects of oral creatine seem to show several changes. Supplementation can cause an 20% increase in muscle phosphocreatine stores, quicken the replenishment of phosphocreatine during recovery, and buffer lactic acid as hydrogen ions are consumed during the dephosphorylation of phosphocreatine, which potentially delays fatigue onset (Fig 2) (Harris et al., 1992). Dosing Creatine is first recommended to be taken in a loading phase, with athletes consuming 5g, 4 times per day for the first 4 to 6 days. The standard dosing then is 2 g/day for the next 3 months. Creatine taken in excess of this amount seems to be excreted via the kidneys (Clark., 1998). A month of abstinence is standard practice after each use cycle. The Physician's Desk Reference notes that athletes should consume 6 to 8 glasses of water per day while taking creatine to prevent dehydration. Absorption of oral creatine does vary with diet. Carbohydrate-rich fluids tend to increase creatine absorption, whereas caffeine impairs its uptake (Green et al., 1997).

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Effects Creatine supplementation does appear to have athletic benefits. However, nearly 30% of athletes do not see benefits with creatine use, thereby falling into a category of nonresponders who are theorized to have already maximal phosphocreatine stores (McDevitt., 2003). Most common, performance effects are seen in increasing strength and outcomes in shortduration, anaerobic events. Studies do not show improved endurance performance as expected given that prolonged muscle activity depends on aerobic glycolysis (Engelhardt et al., 1998). In a well-controlled setting, Volek et al performed a double-blinded study that examined 12 weeks of creatine use including standard loading and maintenance phases in recreational weightlifters. In those athletes who were taking creatine, significant increases in fat-free body mass; bench press maximal lift; peak power production in sets of repeated jump squats; and biopsied type I, IIA, and IIAB muscle fibers were demonstrated. Researchers first investigated the ergogenic effects of short-term creatine loading. In a typical study, a creatine dose of 5 g is given four times a day for five to seven days to ensure that muscle creatine increases. A control group is given a placebo (glucose or some other relatively inert substance) in a double-blind manner (neither the athletes nor the researchers doing the testing know who gets what until after the tests are performed). Most studies have shown that speed or power output in sprints--all-out bursts of activity lasting a few seconds to several minutes, is enhanced, typically by 5-8%. Repetitive sprint performance is also enhanced when the rests between sprints don't allow full recovery. In this case, total work output can be increased by 5-15%. There is also evidence that work performed during sets of multiple repetition strength tests may be enhanced by creatine supplementation, typically by 5-15%. In addition, one-repetition maximum strength and vertical-jump performance may also be increased with creatine supplementation, typically by 5-10%. The improvement in exercise performance has been correlated with the degree in which creatine is stored in the muscle following creatine supplementation, particularly in Type II muscle fibers (Casey et al., 1996). Researchers have now turned their attention to longer-term creatine supplementation. In these studies, a week of creatine loading of up to 25 g per day is followed by up to three months of maintenance with reduced or similar dosages (2-25 g per day). Training continues as usual in a group given creatine and in a control group given a placebo. Greater gains are now seen in performance of single-effort sprints, repeated sprints, and strength (5-15%) (Kreider., 1998). In analysis of these studies, creatine supplementation appears to be less effective in the following situations: when less than 20 g per day was used for 5 days or less; when low doses (2-3 g per day) were used without an initial high-dose loading period; in crossover studies with insufficient time (less than 5 weeks) to allow washout of the creatine; in studies with relatively small numbers of subjects; and when repeated sprints were performed with very short or very long recovery periods between sprints. It is also possible that subject variability in response to creatine supplementation may account for the lack of ergogenic benefit reported in these studies. In addition, there have been reports that caffeine may negate the benefit of creatine supplementation

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(Vandenberghe et al., 1996). Consequently, although most studies indicate that creatine supplementation may improve performance, creatine supplementation may not provide ergogenic value for everyone. Adverse Effects The use of creatine in training for sport remains controversial. Unlike anabolic steroids which have very well known and very far reaching short and long term side effects, creatine remains legal as part of an athlete's training for competition, and its side effects are generally thought to be much less serious. Certain high profile celebrities have encouraged many to take creatine, which is generally thought to increase muscle bulk, stamina and performance by up to 10 per cent. It is reported to allow muscle tissue to recover from training and repair itself more quickly. Anecdotal reports from some athletic trainers and coaches suggest that creatine supplementation may promote a greater incidence of muscle strains or pulls. Theoretically, the gains in strength and body mass may place additional stress on bone, joints and ligaments. Yet no study has documented an increased rate of injury following creatine supplementation, even though many of these studies evaluated highly trained athletes during heavy training periods. Athletes apparently adapt to the increase in strength, which is modest and gradual (Kreider., 1998). There have been some anecdotal claims that athletes training hard in hot or humid conditions experience severe muscle cramps when taking creatine, and the cramps have been attributed to overheating and./or changes in the amount of water or salts in muscle. But no study has reported that creatine supplementation causes any cramping, dehydration, or changes in salt concentrations, even though some studies have evaluated highly trained athletes undergoing intense training in hot/humid environments. In my experience with athletes training in the heat (e.g., during 2-a-day football practice in autumn), cramping is related to muscular fatigue and dehydration while exercising in the heat. It is not related to creatine supplementation. Nevertheless, athletes taking creatine while training in hot and humid environments should be aware of this possible side effect and take additional precautions to prevent dehydration (Kreider., 1998). It is the building material for muscle tissue that because it is rapidly broken down in the body, feeds the muscles more efficiently when taken in synthetic form. But there is a downside, and there are certainly side effects, which some people experience, muscle cramps are among the commonest. Muscle that grows more quickly may run out of energy supply making cramps more likely. Since this affects skeletal muscle rather than the muscle in the digestive system, these cramps are particularly likely in the legs and arms. Athletes who take creatine commonly experience early weight gain of 1.6 to 2.4 kg, which can be detrimental in purely speed-based events. It is also common for athletes to report minor gastrointestinal discomfort and muscle cramps, although these generally do not curb use (Cogeni et al., 2002). There have been 2 case reports of renal function compromise. One was an athlete who had previously diagnosed focal segmental glomerulosclerosis and experienced a transient 50% loss of glomerular filtration rate, and 1 previously healthy athlete reported transient interstitial nephritis (Pritchard et al., 1998). However, at least 1 study of self-reported use over several years did not show adverse renal effects (Poortmans et al., 1999). Three highly

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publicized deaths have occurred in college wrestlers who were known to take creatine, although official autopsy results indicated that dehydration and weight loss were at fault, not creatine Additional questions remain, as there are no data to judge the effects of supplementation on the other tissues that store creatine (heart and brain), the effects of chronic use, or the effects of creatine use in minors. Determining whether creatine supplementation has any short or long-term side effects is an area receiving additional research attention. If there are side effects from long-term creatine supplementation, an important issue will be the liability of coaches, trainers, universities, and athletic governing bodies who provide creatine to their athletes. Anyone advising athletes to take creatine should make it clear that side effects from long-term use cannot be completely ruled out, and that the athletes do not have to take the supplements. It would be wise to have a formal policy for dosages to reduce the chances of athletes taking excessive amounts (Kreider., 1998). Incidence Questioning younger populations, 1 study found 8.2% of 14- to 18-year-olds using the supplement, with 75% of those users either unaware of how much creatine they consumed or taking more than the recommended amounts (Smith et al., 2000). Meanwhile in 2001, looking at 10- to 18-year-olds, Metzl et al reported that 5.6% of that age group used creatine, with every grade from 6 to 12 involved. It was also noted that 12th-graders used creatine much like their collegiate counterparts, with that grade reporting 44% use. Current estimates of collegiate creatine use vary from 25% to 78% of athletes (Sallis et al., 1999). Ethics Creatine supplementation is not banned, but is a nutritional practice that enhances performance nevertheless unethical? Anyone pondering this question should consider that creatine supplementation is a practice similar to carbohydrate loading, which is well accepted. Some are also concerned that creatine supplementation could cause a carryover effect, whereby athletes who have learned to take creatine are more likely to use dangerous or banned substances. Proper education among athletes, coaches, and trainers regarding acceptable and unacceptable nutritional practices is probably the best way to reduce any carryover (Kreider., 1998). Conclusion Creatine is used in muscle cells to store energy for sprinting and explosive exercise. Athletes can increase the amount of creatine in muscle by taking creatine supplements. Although some studies report no ergogenic effect, most indicate that creatine supplementation (e.g. 20 g per day for 5 to 7 days) increases sprint performance by 1-5% and work performed in repeated sprints by up to 15%. These ergogenic effects appear to be related to the extent of uptake of creatine into muscle. Creatine supplementation for a month or two during training has been reported to promote further gains in sprint performance (5-8%), as well as gains in strength (5-15%) and lean body mass (1-3%). The only known side effect is increased body weight. More research is needed on individual differences in the response to creatine, periodic or cyclical use of creatine, side effects, and long-term effects on endurance (Kreider., 1998).

Ben Wadham References

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Ben Wadham Pritchard NR, Kaira PA. Renal dysfunction accompanying oral creatine supplements. Lancet.1998;351 :1252 1253

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Sallis RE, Jones K. Dietary supplement use among college football players. Med Sci Sports Exerc.1999;31 (suppl):S118 Smith J, Dahm DL. Creatine use among select population of high school athletes. Mayo Clin Proc.2000;75 :1257 1263 Vandenberghe, K., Gillis, N., Van Leemputte, M., Van Hecke, P., Vanstapel, F., Hespel, P. (1996). Caffeine counteracts the ergogenic action of muscle creatine loading. Journal of Applied Physiology, 80, 452-457. Volek JS, Duncan ND, Mazzetti SA, et al. Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc.1999;31 :1147 1156