Experts’ Best Advice to Creatine Users: Proceed With Caution

Some athletes call it “muscle candy” and consider it a legal alternative to steroids. Some physicians call it potentially harmful and worry that little is known about long-term use.

Yet despite heated controversy, creatine has become the hottest sports nutrition product in the $11.5-billion dietary supplement industry. In football, baseball, weightlifting and other sports requiring explosive power, athletes whose scholarships, contracts and egos are on the line are swallowing the powder in skyrocketing amounts.

“Competitive athletes, from high schools to the pros, are the main consumers of creatine,” says Grant Ferrier, editor of the San Diego-based Nutrition Business Journal. Some top athletes have publicly acknowledged using the supplement, including Baltimore Orioles outfielder Brady Anderson and St. Louis Cardinals slugger Mark McGwire. These high-profile users have prompted a growing number of recreational athletes to try it, notes Ferrier, who says sales have soared from $30 million in 1995 to $100 million in 1997. Sales for this year are projected to reach $180 million.

A naturally occurring substance produced in the liver and kidneys and found in meat, creatine has been used for more than 20 years. Its potential as a performance enhancer was spotlighted when British athletes used it in the 1992 Olympics.

Creatine is just one of countless products in the super-hyped, little-regulated world of dietary supplements. “Aggressive marketing has led millions of recreational and elite athletes to use nutrition supplements in hopes of improving performance,” reports the Physician and Sportsmedicine journal. “Unfortunately, these aids can be costly and potentially harmful, and the advertised ergogenic [performance-enhancing] gains are often based on little or no scientific evidence.”

Amid this dubious array of pills, potions and powders, creatine is attracting cautious optimism from some exercise scientists. A growing body of research suggests that creatine can produce significant improvements in strength and power, and boost performance in activities requiring short-term, maximum effort such as sprinting (running, cycling and swimming) and throwing (discus, javelin, hammer).

Little is known about long-term use, but in short-term studies, “no . . . negative side effects have been documented in the scientific literature,” the American College of Sports Medicine said in a recent statement.

Creatine use does seem to promote weight gain, the American Dietetic Assn. reports in a new fact sheet. This makes it appealing to some--mainly male--athletes and less appealing to others.

Both the ACSM and the ADA mention anecdotal reports of some health problems associated with creatine, including gastrointestinal distress, nausea, muscle cramping and increased blood pressure.

“The verdict is still out on the safety of creatine supplementation, especially over long periods of time,” says the ACSM statement, which lists numerous unanswered questions about creatine use.

Many sports teams are leaving the issue to the discretion of players, while others are discouraging use of the supplement.

“No coach should be telling a player to take a supplement,” says Dan Riley, strength coach for the NFL’s Washington Redskins. “That’s the job of a registered dietitian.”

Healthy habits such as eating breakfast, drinking plenty of water and consuming a balanced diet are the best performance-enhancers, Riley says. “It’s a wrong message, especially for our young people, to say they’re better served by opening a bottle of pills.”

Some exercise scientists, on the other hand, say creatine offers an important natural alternative to dangerous, banned drugs, while being no less ethical than drinking sports beverages or loading up on carbohydrates.

“Athletes and exercisers who ‘load’ their bodies with carbohydrate stores want to build endurance,” says Jeff S. Volek, a nutritionist and physiologist at the Penn State Laboratory for Sports Medicine and co-author of the ACSM statement. “Those who ‘load’ with creatine want short bursts of explosive energy for such activities as weightlifting and sprinting.”

“Creatine seems to be effective and relatively safe,” adds Penn State physiology professor William Kramer, lead author of the ACSM statement.

“You feel the difference,” says Kramer, whose strength and power increased “a little” on the supplement. But he’s not taking it now, he says, “because I’m not a competitive athlete, and it’s too expensive.”

Creatine prices have been dropping as manufacturers battle for shares of the burgeoning market, so that a week’s supply during the initial “loading phase” now costs about $20. “Creatine supplementation does not build muscle directly,” notes Seattle sports nutritionist Susan Kleiner in her book, “Power Eating” (Human Kinetics, 1998). “But it does have an indirect effect. You can work out more intensely, and this translates into muscle gains.”

Athletes need to eat food first, she says, because “popping pills or powders won’t be a shortcut to fast results.”

Creatine is not a magic muscle maker, but a supplement that may enhance strength and certain kinds of sports performance in combination with a good diet and proper training.

While some experts say creatine appears safe in recommended doses, they fear that many users exceed these amounts thinking “more is better.” In addition, they express concern about the purity of supplements, which can be marketed without undergoing a safety review by the Food and Drug Administration.

“Unlike drug manufacturers, supplement makers do not have to prove safety and efficacy,” notes sports medicine specialist Gary Wadler, an associate professor of clinical medicine at New York University School of Medicine.

“You go into these supplement stores and the salesmen make outrageous claims. The reality is that young kids are taking them, and people often take many different kinds. There’s a lot of poly-supplement abuse going on in an industry that is loosely regulated.”

People considering creatine supplementation should examine their motivation, says Richard B. Kreider, an exercise physiologist at the University of Memphis who has done extensive studies on creatine. “You’ve got to decide why you want to take a supplement and what your goals are,” he says. “If you just want to look good, that’s not enough. But if you’re an elite junior swimmer trying to make national competition cuts and you’ve put in all your training, that may be a good enough reason.”

Although creatine is legal, “its presence creates other concerns, such as an uneven playing field and the promotion of the ‘play sports to win’ philosophy,” notes Nancy Clark, a Brookline, Mass., sports nutritionist. “What happened to the idea of playing sports for fun?”

* Fitness runs Monday in Health.