General - Creatine is an amino acid which is used as the phosphate contributor in the phosphorylation of ADP to ATP. The typical daily necessity of creatine is about 2 grams, half of which is obtained in a natural diet, the rest synthesized in the liver, pancreas, and kidneys. 95% of the creatine is stored in skeletal muscle, with a total pool of around 120 g in a 70 kg individual.
Standard Amount - 20-25 grams / day for 5to 7 d. then 2-25 g. / d. thereafter.
Expense - Five dollars - 60 dolars / month defferent depending on on dose and source.
Proposed Mechanism of Action- Consuming the above dose results in 15 to thirty % growth in total creatine. Amplified creatine pool outcomes in greater ATP synthesis. Note- twenty to 30 % of people do not respond to creatine supplementation.
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Effects on Physical Performance - No improvements in aerobic ability. Positive effects are only seen in high intensity, intermittent activities. Greater than 25 studies have been executed, with the great majority showing increase in strength, power, and sprint performance of 5 to fifteen%. Improvements in ability are most likely caused by a combination of improved metabolic efficiency and enhanced quality of training.
Adverse Effects- There are no long term ( > a year) studies obtainable. Recent studies have not demonstrated any adverse effects other than weight gain and dehydration with short term use (under 4 weeks) in youthful fit athletes. Anecdotal reports include rash, muscle cramping, dyspnea, vomiting, diarrhea, anxiety, fatigue, migraine, myopathy, seizures, polymyositis and atrial fibrillation. No long term studies have been performed.
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Frequency of Use - NCAA poll indicates over 30 % of college athletes use it. A athletes poll estimates 60 percent of MLB players use it.
Legal Problems - Non-prescription. Not FDA permitted. Allowed by International Olympic Group or any other athletic group. American College of Sports Medicine has no position papers on creatine but calls for more research.
Conclusion:
Based on current literature, creatine improves sports performance by unique mechanisms in specific situations. The most momentive factor is probably enhanced strength training which leads to increased strength and power. Based on this information alone, many athletes will choose to supplement with this agent in spite of the risks involved. As a doctor, the best approach in working with athletes is not to be judgmental, but insted be a source of reliable information, and let the athlete make their own decision.
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