INTERNET SALES OF CREATINE
by Dr. W. David Currie

Recently, this author attempted to determine from how many websites one could obtain the dietary supplement creatine.  Within minutes, over 60 websites offering creatine, "better" creatine, "newer improved" creatine, "more easily absorbed" creatine, "more readily available" creatine, and the "best yet" creatine were found and the search was abandoned; no doubt there are dozens more websites through which creatine can be purchased.  Creatine is a dietary supplement subject to only a few simple packaging and labeling regulations, and virtually anyone may sell creatine.

Creatine is widely used by amateur and professional athletes, alike.  Creatine is a simple and naturally occurring compound in the body.  Muscles contain enzymes capable of adding high energy phosphate bonds to creatine when muscle cells are well rested.  These high energy phosphate bonds can be broken later, for example during powerful exertion of muscles, in order to provide an additional short burst of "reserve" power (measurable in seconds) during muscle exertion.  While there can be no denial of the marginal benefits of creatine supplementation to athletes training for power events, there are mixed claims regarding the potential dangers of creatine.

Many of the reported dangers of creatine are anecdotal, often arising from clinical observations of individuals, rather than from widespread epidemiological studies.  Purveyors of creatine make many of the claims touting the safety of creatine supplementation.  A major criticism of such case-by-case anecdotal evidence, even when arising from clinical sources, is that such evidence does not represent a major, long-term, objective study statistically examining large numbers of observations.  Those who sell creatine are generally not qualified to assess (or to realize) the value of such case-by-case anecdotal evidence to the general scientific and clinical community.  Unfortunately, the clinically uninitiated have seized this type of evidence by the throat, and incorrectly deemed it to be of no value.  The purveyors of creatine do correctly point out that health risks (dehydration related electrolyte and pH imbalances, kidney damage and connective tissue injuries) are increased with dose and time used.  If you are taking creatine, stay within recommended amounts, and drink plenty of fluids.

An understanding of some of the potential dangers of creatine among physicians and physiologists, for example, is intuitive.  Creatine supplementation quickly provides beneficial effects in terms of power generation by muscle, but supplementation does not provide any parallel benefit to the connective tissues.  Interestingly, individual muscle cells, bundles of muscle cells (called fascicles), and muscles themselves are wrapped in intertwining connective tissue layers.  These layers fuse at the ends of the muscle and are continuous with the connective tissues (tendons), which join muscle to bone.  When we exercise, connective tissues develop in some degree of synchrony with muscle.   When creatine is added to the equation, connective tissue development lags behind muscle development (particularly where the muscles are being used in the maximal power generation range).  This dichotomy of developmental rates often results in tears and pulls in the connective tissues.

Students frequently ask me why there are not more scientific documents extolling the dangers of athletic "augmentation" techniques, such as anabolic steroid abuse, creatine supplementation and blood doping.  Sports physiologists are already well aware of the performance enhancing effects of steroids and creatine; and they have all too frequently seen the pathological effects of abuse of these substances.  Put more simply, too much sugar can lead to diabetes mellitus, but diabetes researchers are not studying sugar.  Can creatine be abused?  The answer is an emphatic yes!  Human nature suggests that a portion of persons who derive benefits from a supplement will believe that the more they take, the better the result, and they will forego certain health risks for a chance at improved athletic performance or physical appearance.

More information on creatine is available at the following sites:

Dr. W. David Currie