Creatine: More than a sports nutrition supplement

Creatine: More than a sports nutrition supplementCopyright 2005 Internet PublicationsAlthough creatine offers an array of benefits, most peoplethink of it simply as a supplement that bodybuilders andother athletes use to gain strength and muscle mass.

Nothing could be further from the truth.A substantial body of research has found that creatine mayhave a wide variety of uses. In fact, creatine is beingstudied as a supplement that may help with diseasesaffecting the neuromuscular system, such as musculardystrophy (MD).Recent studies suggest creatine may have therapeuticapplications in aging populations for wasting syndromes,muscle atrophy, fatigue, gyrate atrophy, Parkinson'sdisease, Huntington's disease and other brain pathologies.

Several studies have shown creatine can reduce cholesterolby up to 15% and it has been used to correct certain inbornerrors of metabolism, such as in people born without theenzyme(s) responsible for making creatine.Some studies have found that creatine may increase growthhormone production.What is creatine?Creatine is formed in the human body from the amino acidsmethionine, glycine and arginine. The average person's bodycontains approximately 120 grams of creatine stored ascreatine phosphate.

Certain foods such as beef, herring andsalmon, are fairly high in creatine.However, a person would have to eat pounds of these foodsdaily to equal what can be obtained in one teaspoon ofpowdered creatine.Creatine is directly related to adenosine triphosphate(ATP). ATP is formed in the powerhouses of the cell, themitochondria.

ATP is often referred to as the "universalenergy molecule" used by every cell in our bodies. Anincrease in oxidative stress coupled with a cell'sinability to produce essential energy molecules such asATP, is a hallmark of the aging cell and is found in manydisease states.Key factors in maintaining health are the ability to: (a)prevent mitochondrial damage to DNA caused by reactiveoxygen species (ROS) and (b) prevent the decline in ATPsynthesis, which reduces whole body ATP levels. It wouldappear that maintaining antioxidant status (in particularintra-cellular glutathione) and ATP levels are essential infighting the aging process.

It is interesting to note that many of the most promisinganti-aging nutrients such as CoQ10, NAD, acetyl-l-carnitineand lipoic acid are all taken to maintain the ability ofthe mitochondria to produce high energy compounds such asATP and reduce oxidative stress.The ability of a cell to do work is directly related to itsATP status and the health of the mitochondria. Hearttissue, neurons in the brain and other highly activetissues are very sensitive to this system. Even smallchanges in ATP can have profound effects on the tissues'ability to function properly.

Of all the nutritional supplements available to uscurrently, creatine appears to be the most effective formaintaining or raising ATP levels.How does creatine work?In a nutshell, creatine works to help generate energy. WhenATP loses a phosphate molecule and becomes adenosinediphosphate (ADP), it must be converted back to ATP toproduce energy. Creatine is stored in the human body ascreatine phosphate (CP) also called phosphocreatine.

When ATP is depleted, it can be recharged by CP. That is,CP donates a phosphate molecule to the ADP, making it ATPagain. An increased pool of CP means faster and greaterrecharging of ATP, which means more work can be performed.This is why creatine has been so successful for athletes.

For short-duration explosive sports, such as sprinting,weight lifting and other anaerobic endeavors, ATP is theenergy system used.To date, research has shown that ingesting creatine canincrease the total body pool of CP which leads to greatergeneration of energy for anaerobic forms of exercise, suchas weight training and sprinting. Other effects of creatinemay be increases in protein synthesis and increased cellhydration.Creatine has had spotty results in affecting performance inendurance sports such as swimming, rowing and long distancerunning, with some studies showing no positive effects onperformance in endurance athletes.

Whether or not the failure of creatine to improveperformance in endurance athletes was due to the nature ofthe sport or the design of the studies is still beingdebated.Creatine can be found in the form of creatine monohydrate,creatine citrate, creatine phosphate, creatine-magnesiumchelate and even liquid versions.However, the vast majority of research to date showingcreatine to have positive effects on pathologies, musclemass and performance used the monohydrate form. Creatinemonohydrate is over 90% absorbable.

What follows is areview of some of the more interesting and promisingresearch studies with creatine.Creatine and neuromuscular diseasesOne of the most promising areas of research with creatineis its effect on neuromuscular diseases such as MD. Onestudy looked at the safety and efficacy of creatinemonohydrate in various types of muscular dystrophies usinga double blind, crossover trial.Thirty-six patients (12 patients with facioscapulohumeraldystrophy, 10 patients with Becker dystrophy, eightpatients with Duchenne dystrophy and six patients withsarcoglycan-deficient limb girdle muscular dystrophy) wererandomized to receive creatine or placebo for eight weeks.

The researchers found there was a "mild but significantimprovement" in muscle strength in all groups. The studyalso found a general improvement in the patients'daily-life activities as demonstrated by improved scores inthe Medical Research Council scales and the NeuromuscularSymptom scale. Creatine was well tolerated throughout thestudy period, according to the researchers.1Another group of researchers fed creatine monohydrate topeople with neuromuscular disease at 10 grams per day forfive days, then reduced the dose to 5 grams per day forfive days.

The first study used 81 people and was followed by asingle-blinded study of 21 people.In both studies, body weight, handgrip, dorsiflexion andknee extensor strength were measured before and aftertreatment. The researchers found "Creatine administrationincreased all measured indices in both studies." Short-termcreatine monohydrate increased high-intensity strengthsignificantly in patients with neuromuscular disease.

2There have also been many clinical observations byphysicians that creatine improves the strength,functionality and symptomology of people with variousdiseases of the neuromuscular system.Creatine and neurological protection/brain injuryIf there is one place creatine really shines, it's inprotecting the brain from various forms of neurologicalinjury and stress. A growing number of studies have foundthat creatine can protect the brain from neurotoxic agents,certain forms of injury and other insults.Several in vitro studies found that neurons exposed toeither glutamate or beta-amyloid (both highly toxic toneurons and involved in various neurological diseases) wereprotected when exposed to creatine.

3 The researchershypothesized that "? cells supplemented with the precursorcreatine make more phosphocreatine (PCr) and create largerenergy reserves with consequent neuroprotection againststressors."More recent studies, in vitro and in vivo in animals, havefound creatine to be highly neuroprotective against otherneurotoxic agents such as N-methyl-D-aspartate (NMDA) andmalonate.4 Another study found that feeding rats creatinehelped protect them against tetrahydropyridine (MPTP),which produces parkinsonism in animals through impairedenergy production.The results were impressive enough for these researchers toconclude, "These results further implicate metabolicdysfunction in MPTP neurotoxicity and suggest a noveltherapeutic approach, which may have applicability inParkinson's disease.

"5 Other studies have found creatineprotected neurons from ischemic (low oxygen) damage as isoften seen after strokes or injuries.6Yet more studies have found creatine may play a therapeuticand or protective role in Huntington's disease7, 8 as wellas ALS (amyotrophic lateral sclerosis).9 This study foundthat "? oral administration of creatine produced adose-dependent improvement in motor performance andextended survival in G93A transgenic mice, and it protectedmice from loss of both motor neurons and substantia nigraneurons at 120 days of age.Creatine administration protected G93A transgenic mice fromincreases in biochemical indices of oxidative damage.

Therefore, creatine administration may be a new therapeuticstrategy for ALS." Amazingly, this is only the tip of theiceberg showing creatine may have therapeutic uses for awide range of neurological disease as well as injuries tothe brain.One researcher who has looked at the effects of creatinecommented, "This food supplement may provide clues to themechanisms responsible for neuronal loss after traumaticbrain injury and may find use as a neuroprotective agentagainst acute and delayed neurodegenerative processes."Creatine and heart functionBecause it is known that heart cells are dependent onadequate levels of ATP to function properly, and thatcardiac creatine levels are depressed in chronic heartfailure, researchers have looked at supplemental creatineto improve heart function and overall symptomology incertain forms of heart disease.

It is well known that people suffering from chronic heartfailure have limited endurance, strength and tire easily,which greatly limits their ability to function in everydaylife. Using a double blind, placebo-controlled design, 17patients aged 43 to 70 years with an ejection fraction were supplemented with 20 grams of creatine daily for 10days.Before and after creatine supplementation, the researcherslooked at:1) Ejection fraction of the heart (blood present in theventricle at the end of diastole and expelled during thecontraction of the heart)2) 1-legged knee extensor (which tests strength)3) Exercise performance on the cycle ergometer (which testsendurance)Biopsies were also taken from muscle to determine if therewas an increase in energy-producing compounds (i.e.

,creatine and creatine phosphate). Interestingly, but notsurprisingly, the ejection fraction at rest and during theexercise phase did not increase.However, the biopsies revealed a considerable increase intissue levels of creatine and creatine phosphate in thepatients getting the supplemental creatine. Moreimportantly, patients getting the creatine had increases instrength and peak torque (21%, P (10%, P Both peak torque and 1-legged performance increasedlinearly with increased skeletal muscle phosphocreatine (Pthe researchers concluded: "Supplementation to patientswith chronic heart failure did not increase ejectionfraction but increased skeletal muscle energy-richphosphagens and performance as regards both strength andendurance.

This new therapeutic approach merits further attention."10Another study looked at the effects of creatinesupplementation on endurance and muscle metabolism inpeople with congestive heart failure.11 In particular theresearchers looked at levels of ammonia and lactate, twoimportant indicators of muscle performance under stress.Lactate and ammonia levels rise as intensity increasesduring exercise and higher levels are associated withfatigue.

High-level athletes have lower levels of lactate andammonia during a given exercise than non-athletes, as theathletes' metabolism is better at dealing with thesemetabolites of exertion, allowing them to perform better.This study found that patients with congestive heartfailure given 20 grams of creatine per day had greaterstrength and endurance (measured as handgrip exercise at25%, 50% and 75% of maximum voluntary contraction or untilexhaustion) and had lower levels of lactate and ammoniathan the placebo group.This shows that creatine supplementation in chronic heartfailure augments skeletal muscle endurance and attenuatesthe abnormal skeletal muscle metabolic response to exercise.It is important to note that the whole-body lack ofessential high energy compounds (e.

g. ATP, creatine,creatine phosphate, etc.) in people with chronic congestiveheart failure is not a matter of simple malnutrition, butappears to be a metabolic derangement in skeletal muscleand other tissues.Supplementing with high energy precursors such as creatinemonohydrate appears to be a highly effective, low costapproach to helping these patients live more functionallives, and perhaps extend their life spans.

ConclusionCreatine is quickly becoming one of the most wellresearched and promising supplements for a wide range ofdiseases. It may have additional uses for pathologies wherea lack of high energy compounds and general muscle weaknessexist, such as fibromyalgia.People with fibromyalgia have lower levels of creatinephosphate and ATP levels compared to controls.13 Somestudies also suggest it helps with the strength andendurance of healthy but aging people as well.

Though additional research is needed, there is asubstantial body of research showing creatine is aneffective and safe supplement for a wide range ofpathologies and may be the next big find in anti-agingnutrients.Although the doses used in some studies were quite high,recent studies suggest lower doses are just as effectivefor increasing the overall creatine phosphate pool in thebody.Two to three grams per day appears adequate for healthypeople to increase their tissue levels of creatinephosphate. People with the aforementioned pathologies maybenefit from higher intakes, in the 5-to-10 grams per dayrange.

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