CREATINE A STATE-OF-THE-ART PERFORMANCE ENHANCER

To perform optimally, muscles need energy. The body provides the energy needed in situations requiring immediate, high-intensity actions as in exercise, in the form of ATP, or adenosine triphosphate. Since the body has only a limited supply of ATP, usually to last only a few seconds of intense exercise, ATP is continuously produced to supply energy in order for the muscles to function. The burst of energy is produced by the breakdown of ATP when one phosphate group is released, which packs considerable metabolic energy. The body uses creatine phosphate to quickly replenish ATP. The more energy the muscles store, the better they can perform in events, which require intense, immediate energy, such as weightlifting, sprinting, jumping, football, hockey and soccer. Since creatine is stored in the muscle as creatine phosphate, intake of supplemental creatine can increase the production of energy enabling muscles to perform at higher intensity. While the body produces its own supply of creatine, it is not sufficient to supply the muscle with the added energy necessary for intense performance. The benefits of creatine supplementation for endurance athletes have been actively researched. This research has established that creatine can, in fact, extend endurance at a relatively high dose of 20 grams per day. Creatine increases the muscle mass and muscle girth if taken along with a sustained exercise regimen. Initially, it may also increase weight due to gain in the muscle mass, which may slow down some people, especially swimmers. The "slowing down" may be due to the highly aerobic nature of this exercise, and should be reversible after sustained exercise. The ergogenic, or performance-enhancing, effect of creatine is best achieved by creatine monophosphate. Ideally, the increase of creatine in the body is achieved by a five- to seven-day "loading" period followed by a maintenance period. Since more stored creatine will produce more energy, it is best to optimize its uptake into the muscle during the maintenance phase by supplementing it with carbohydrates. Carbohydrates increase creatine uptake into muscle and reduce its excretion in the urine. Creatine is a power- and performance-enhancing nutrient, and should be ingested with an exercise regimen in place. By helping the muscle release energy during exercise, it increases the muscle mass and strength.

SELECTED REFERENCES 1.      Burke et al., "Effect of Oral Creatine Supplementation on Single-Effort Sprint Performance in Elite Swimmers," Int. J. Sports Nutr.: 6,222, 1996 2.      Green et al., "Creatine Ingestion Augments Muscle Creatine Uptake and Glycogen Synthesis During Carbohydrate Feeding in Man," J. Physiol.: 491, 63, 1996 3.      Hultman et al., "Muscle Creatine Loading in Man," J. Appl. Physiol.: 81, 232, 1996 4.      Kreider, R., "Creatine Supplement: Analysis of Ergogenic value, Medical Safety and Concerns," J. Exer. Physiol. Online: 1, 1, 1998 5.      Ternlion et al., "The Effect of Creatine Supplementation on Two 700-meters maximal Running Bouts," Int. J. Sports Nutr.: 7, 138, 1997 6.      Alamada et al., "Impact of Chronic Supplementation on Serum Enzyme Concentrations," FASEB J.: 10, A4567, 1996

FREQUENTLY ASKED QUESTIONS 1.      What is the Creatine Dosage During the Loading Phase? A total of 20 to 25 grams per day of creatine are usually recommended during the loading phase. Since this is a large amount to be taken in one sitting, it should be broken down into four or five servings of 5 grams each, which is equivalent to roughly a tablespoon full. 2.      How Should Creatine Be Taken? Creatine is best ingested with a nutritious fluid in generous amounts. 3.      What Are the Side Effects of Creatine? Creatine does not have any adverse side effects per se if taken in optimal doses tailored to a reasonable exercise regimen. In large amounts, it can, however, cause gastrointestinal distress. If this situation presents itself, the intake of creatin should be reduced to individual comfort levels. 4.      Doesn't Creatine Initially Decrease Performance? Not necessarily! Creatine intake, however, does increase weight because the muscle gains mass. Therefore, in intensely aerobic exercises, such as swimming and trail running, an athlete's performance may not be up to the par. This can be reversed, however, with increasing the endurance training, which is also stimulated by creatine over time. 5.      How Does Creatine Compare with Androstenedione? Both creatine and androstenedione are taken by athletes to help build bigger, stronger muscles. Androstenedione and creatine have some similarities but they also differ from each other considerably. Androstenedione and creatine are both found in the body. Whereas androstenedione is a prohormone, creatine is an amino acid that the body uses to generate energy for muscle function. Androstenedione is a steroid hormone used to raise testosterone levels which, in turn, stimulates the production of proteins that are the building blocks of muscle, bone and other lean body tissues. Creatine, on the other hand, is not a steroid, but its anabolic properties are being increasingly understood. Creatine helps make more "fuel" available to the muscle in the form of ATP. This extra fuel ensures that the muscle works faster and longer and recovers faster after intense exercise or sustained physical activity. This also means that there is less muscle soreness and enhanced endurance. Numerous studies support the use of creatine for increasing endurance, building muscle mass and improving athletic performance.

THE PHONY FRENCH
CREATINE SCARE

News Reports of Creatine's Evils are Sensationalized Fiction

Written by Jim Schmaltz

First the facts. Creatine is safe. It is produced naturally from amino acids in the body and stored in muscles. Creatine in supplement form works as a training aid for many athletes. Creatine has never been proven to be carcinogenic or a health risk. And creatine has nothing to do with any perceived decline of Western civilization.

Unfortunately, news stories published around the world Wednesday claimed otherwise. These alarming bulletins of a creatine-cancer link were based on a report posted on the Web site of the French Agency of Medical Security for Food (AFSSA) that demonized the popular sports supplement. In its report, the AFSSA contends that creatine supplements present "a potential carcinogenic risk," offer little if any benefit to athletes, and should be banned by all sports governing organizations.

The French officials' statements were based on their interpretations of a smattering of old data of questionable relevance - not on any new research. Not only is there no new information released by the AFSSA report, its assertions are simply wrong. In fact, many of the studies listed in the bibliography of the AFSSA report actually confirm creatine's safety and effectiveness.

Some of these studies have been cited in FLEX magazine. FLEX Science Editor Jim Wright, PhD, has written extensively on creatine supplements, and as recently as the December 2000 issue, Wright cited several dozen studies published last year in peer-reviewed journals that verified creatine's safety. "Creatine is one of the most scrutinized sports supplements in history," says Wright, "and it continues to be proven safe in scientific research."

So, how did last Wednesday's creatine scare story get its legs? How could respected news organizations accept these sensationalized findings by a French government agency and circulate them all over the world?

Blame it on a variety of factors. First, there are the now familiar excesses caused by the increasingly competitive need to be the first to run breaking news. Combine that with the immediacy of the Internet, and the first casualty is the cherished journalistic practice of carefully verifying stories and contacting corroborating sources.

Then there are the factors peculiar to this issue. Clearly, some of the finer points of the French report were lost in translation, and we don't mean in the language differences. Rather, the conversion from scientific data to practical layman's vernacular was once again irresponsibly mishandled by a media unprepared to carefully judge scientific reports. The result led to the AFSSA's faulty conclusions going unexamined and unchallenged by news organizations before being distributed over the wires.

As culpable as the mainstream media is in this situation, the worst culprit in this fiasco by far is the AFSSA with its groundless assertions of a supplemental creatine-cancer link. Where the French officials went awry is in their extrapolation of data from a single review (M. Wyss and R. Kaddurah-Daouk, "Creatine and Creatine Metabolism," Physiological Reviews, 80 [3], 2000) in which researchers determined if creatine in meat could be converted into cancer-causing agents by heat during cooking (see "Meat the Data" below for more details on this study). Inexplicably, the French health authorities implicated supplemental creatine as having the same harmful effects that carcinogenic substances found in charred meat are suspected of having! That's the only support the AFSSA offers for its cancer-creatine claims. That leaves the French report with zero real data even remotely suggesting that supplemental creatine has any cancer-causing or cancer-promoting properties.

Even more damning to the French findings is the response from Dr. Markus Wyss, the lead author of the review at the center of the French report. Wyss was contacted by FLEX Contributing Editor Jeff Feliciano, and the researcher strongly refuted the AFSSA conclusions: "At present, there is absolutely no indication that creatine supplementation is carcinogenic," Wyss informed FLEX (for Dr. Wyss's full comments, see below).

So, not only is the AFSSA report based on weak evidence, the proof they cite supporting their conclusions is contradicted by the very researcher whose work supposedly provides the smoking gun for the creatine-cancer allegations. Of course, you wouldn't know it by the screaming headlines claiming that creatine may cause cancer. The result was needless hysteria, fear and confusion among the many athletes who use supplemental creatine.

The news reports on the creatine-cancer link that permeated the media Wednesday offered little perspective at all, and gave no explanation of the properties or many well-documented benefits of creatine. The accuracy and relevance of the AFSSA's information were never questioned. We call on all news organizations that distributed this sensationalized story to clarify the facts of this important subject.

DR. WYSS REFUTES FRENCH FINDINGS

FLEX:
Dr. Wyss, recently a report from the French Agency of Medical Security for Food (AFSSA) stated that there is evidence that creatine monohydrate is carcinogenic. They base their statements on information taken from your recent creatine review ("Creatine and Creatinine Metabolism," Physiological Reviews, 2000; 80[3]:1107-1213.). Is it your opinion that dietary creatine monohydrate taken in supplement form poses a potential cancer risk?

Dr. Markus Wyss:
To give a straight answer right at the beginning: definitely not (based on current knowledge).

The rumor of French "experts" linking creatine to a potential cancer risk is a typical example of over- and misinterpretation of scientific data. In a recent scientific review, Rima Kaddurah-Daouk from the Dana Farber Cancer Institute in Boston, Massachusetts, and I have tried to provide an objective picture of almost all aspects of creatine metabolism known to date. We mentioned all the potential benefits of creatine and of creatine analogues, but also indicated in which areas our knowledge is still not sufficiently complete, and where, therefore, additional studies are required to evaluate any kind of potential side effects.

However, the cancer risk mentioned by the French food safety experts is definitely the lowest possible risk. We've mentioned in our review that during the cooking of meat, potential carcinogens may be formed from creatine - although in such a low concentration that it is still not clear whether they contribute to any significant extent to our overall cancer risk. Since human beings are not supposed to be(come) cannibals, this mechanism is irrelevant in the present context.

It's true that there is one reference in the scientific literature that reports formation of these carcinogenic metabolites also at 37 °C. However, this is a single isolated report that could not be reproduced by others, definitely is not representative, and in which - again - only very low concentrations of these metabolites were formed. It is therefore highly questionable whether these in vitro findings (under artificial conditions) have any relevance at all for people ingesting creatine.

The conclusion from the above pieces of evidence must be:

1. At present, there is absolutely no indication that creatine supplementation may be carcinogenic in humans.

2. There must be a balanced evaluation of all possible benefits and risks of creatine and its analogues. At present, clearly, the (scientific) literature is in favor of the benefits. However, to be perfectly sure about the safety of creatine supplementation, the still open questions are worthwhile to be answered in an educated, scientific way.

    

3. Scientific literature is not to be confounded with a popular science report and needs careful and critical evaluation. Rather than creating a lot of confusion and rumours, it would have been a wiser approach by the French authorities to consult the true experts in the field for a balanced opinion.

I sincerely hope that we can continue to build on the many favourable effects of creatine supplementation in health and disease.

MEAT THE DATA

What the Wyss and Kaddurah-Daouk Study Really Says

Wyss and Kaddurah-Daouk go on to state that creatine is not the only component required for the production of AIA in charred meat. Heat, amino acids and sugar are also required. Omission of any one component from the mixture greatly reduces mutagenicity. And despite the potential for charring creatine/creatinine to produce AIA, food-borne mutagens are not restricted to cooked creatine/creatinine-containing foods. AIA are also found in beer, wine, and roasted coffee beans to name only a few other potential sources.

 

RESEARCH MEMO
DATE: 31 January, 2001

SUBJECT: CREATINE CANCER SCARE UNTRUE

After careful investigation into the issue of creatine and cancer, we have concluded that the report from the AFSSA in France constitutes unscientific characterizations about creatine causing cancer.

At issue is the formation of heterocyclic amines by creatine, which are known as probable cancer-causing agents. The key issue is that to form these compounds, creatine must be heated in the presence of amino acids, sugars and acid. These situations are not encountered with creatine supplements, a fact not stated by the French report. Thus, there is no risk of cancer formation from creatine supplements.

We contacted Dr. Markus Wyss, from Hoffman-LaRoche in Basel, Switzerland, lead author of the review (which we have in our possession), on formation of carcinogens referenced by the French report. He stated to us that there is "definitely not" any risk of cancer from creatine supplements. He also goes on to claim his article was misinterpreted by the French report. He emphatically stated that "At present, there is ABSOLUTELY NO indication that creatine supplementation is carcinogenic." [emphasis his]

There was one report that the compounds in question were formed at body temperature (37°C), and the French report used that single article to base their dire estimations. According to Dr. Wyss, the results of that article have never been reproduced or seen by anyone else. In addition, the conditions were very specific, only trace amounts were formed and the study conditions do not correlate with real-life situations.

The issue of heterocyclic amine formation in cooked foods is not new, and has been a very large field of research for many years. Accordingly, many papers have examined this issue. Cooked foods (meats) are the source. Creatine supplements are not cooked, and thus, there is NO risk that carcinogens can be formed from creatine supplements at any dose.

The French report called for a ban on creatine supplements because of an unproven and unlikely link to cancer. If we follow their logic, then first, all meats should be banned immediately, since there is extensive and probable evidence that eating cooked meat is associated with higher rates of cancer. Putting reality into perspective makes the French position ludicrous.

Bottom line: There is no evidence or risk of cancer from creatine supplements.

Luke R. Bucci, PhD, CCN C(ASCP) CNS

Curriculum Vitae

A Postdoctoral appointment to the Department of Experimental Radiotherapy at M.D. Anderson Hospital and Tumor Institute (University of Texas System Cancer Center) followed.

Next, Dr. Bucci was Director of Research for Biotics Research Corporation, a nutritional supplement manufacturer.

In 1991, Dr. Bucci formed InnerPath Nutrition, a practice in clinical nutrition, and a nutritional consulting and educational company.

In 1992, Dr. Bucci became Director of Science and Quality for SpectraCell Laboratories, Inc., a clinical laboratory specializing in functional nutrient assessment by lymphocyte growth responses in a series of serum-free media.

Dr. Bucci continues to conduct medical education and relicensing seminars on nutritional topics, be featured on national television and radio news programs, and has been invited to speak at the US Olympic Center, National Institutes of Health, and meetings in Europe and Asia.

Dr. Bucci is the inventor on several patents concerning dietary supplementation and clinical laboratory testing.

Dr. Bucci has authored Nutrients as Ergogenic Aids for Sport and Exercise (1993) and Nutrition Applied to Injury Rehabilitation and Sports Medicine (1994) for CRC Press, and Pain-Free (1995) and Healing Arthritis the Natural Way (1997) by The Summit Group to educate health care practitioners and the public about benefits of nutrients.

Dr. Bucci has published several books, chapters and scientific articles in a diverse array of prestigious journals, and is an Adjunct Assistant Professor at the University of Utah.

In 1994, Dr. Bucci received the CCN of the Year Award from the IAACN.

Dr. Bucci is a Member of the Clinical Nutrition Certification Board, which certifies Clinical Nutritionists.

Dr. Bucci is a Certified Clinical Nutritionist, a Certified Nutrition Specialist, and a Certified Chemist in Medical Technology, reflecting his major interests in nutrition and clinical laboratories.

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