National Emergency Medicine Assoc. (NEMA)



a special program of the National Emergency Medicine Association (NEMA)

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Week: 604.6

Guest: Richard Kreider, PhD., Exercise and Sport Nutrition Lab, University of Memphis

Topic: Argument for creatine supplementation

Host/Producer: Steve Girard

NEMA: A couple of weeks ago, we brought up the subject of the supplement creatine ...what it is, its history, and how it has been shown to enhance athletic performance. It is the most used supplement of its kind in the world, appearing on training tables in pro, college, and even high school athletic development programs. In talking with Dr. Mark Juhn of the University of Washington, we heard his position that creatine could be contributing to athletic injuries, and possibly play a role in other systemic problems. But that position has not been supported by research, while the creatine basic amino acid complex has been shown to work effectively and harmlessly for athletes everywhere. Today we’re lucky to have Dr. Richard Kreider of the University of Memphis exercise and sport nutrition lab, who is a proponent of creatine. What do we know about creatine? What do we know about what it is and how it works?

GUEST: Creatine is, in history, found in the eighteen hundreds. In the early 1920's some initial research on dietary impact of creatine and creatine phosphate was being conducted, and then it kind of died down a little bit. The reason is that the body produces it, synthesizes it, and there is certain foods primarily meat and fish which have higher concentrations of creatine. It was difficult, until the last twenty years or so, to refine or synthesize creatine in large enough doses to be an affordable type of supplement. In the mid to late 1970's they've Dr. Eric Holtman out of the Karolinski Institute in Sweden started looking at creatine as a means to increase muscle stores of an important energy source, which is called phospho-creatine. Phospho-creatine is important to help the body restore energy used during sprinting or explosive exercise tasks. And what their theory was; that if you increase dietary availability of creatine, you would be able to enhance the energy system for sprinting and recovery from sprinting exercise. Similar to how carbohydrate loading is important for endurance athletes...where athletes eat lots of extra carbohydrate before a competition. It loads the muscle up and then they have more energy in the muscle. A a lot of research was done in the early mid-eighties...towards the end of the 1980's. A lot of athletes, particularly in Europe, were taking it as nutritional supplement and believed it to improve performance. Most of the initial studies that came out in peer-reviewed publications, hit in the late 1980's and early 1990's - and showed that it did indeed increase muscle storage of creatine, phospho-creatine, improved recovery from intense bouts as well as improved exercise performance in a number of exercise type of trials.

NEMA: I understand it became more available, or plentiful...just a few years ago, which has spurred its popularity....

KREIDER: There are several manufacturers that have found ways to produce it, in large quantities, to make it affordable to athletes. And that's what's really caused the explosion of creatine since the early nineties. Right now creatine is the probably the most popular nutritional supplement among athletes who do weight lifting, sprinting, all types of sporting competitions. Just about every major football team in the United States has creatine, or provides creatine to their athletes. Most weight lifters take creatine-containing compounds or supplements. So it's really been an explosion of not only the research, but use. Right now there’s over one hundred clinical trails to have looked at creatine, the effects on the body, on performance in healthy athletes as well as in diseased populations. There are studies that shows it improves heart function in heart failure patient's and helps reduce problems after a heart attack, for example. Reducing arrhythmia and things. There is not only an athletic use, but there is a significant amount of research in the clinical uses of creatine in various disease populations.

We don't know all of the potential medical applications. For example it has been shown to increase muscle mass in healthy individuals and studies are now being undertaken a look wasting populations. One study in aids patient's showed that it did increase strength and muscle mass. So, there is interest in osteoporosis elderly to help increase strength and prevent falls, injuries a lot of that is just being started to be done.

NEMA: Let’s talk about how creatine works...

GUEST: Well there is still some mystery on how the muscle increases size. There are two thoughts. One is that there is increased water retention, which may increase total mass. The other is that it enhances protein synthesis, and most of the studies that have looked at those have shown that there is not an increase in water out of proportion to the weight gain. So, your body is about sixty five to seventy percent when you gain ten pounds, you gain about that much in water. Most of the other studies have really looked at the protein factor, have indicated that it affects protein synthesis and may even alter hormonal profiles, like growth hormonal it looks more promising in that area. But that is an area that still needs to be found out - what are the mechanisms? How does it improve strength, as well as lean body mass?

NEMA: Some remnants of the steroid problems of the 80’s are good...I think we’re a bit more concerned about products that enhance muscle size or performance. So, for parents out there who want to be involved in their athlete’s development...can we talk about recommended dosing of creatine, so we have a base of information about it’s use?

GUEST: We usually like to wait until after puberty when they start really getting some size and things before we would do allot of heavy weight lifting and heavy supplementation. We suggest if you want to just maximize your performance capacity and increase the levels in your muscle kind of like glycogen loading. Take it for five to seven days fifteen to twenty grams or so per day we take it with glucose because study shows that enhances creatine uptake in the muscle as well as your carbohydrates stores the muscle. So we usually try to recommend they put it in grape juice or get a supplement sold that has it in glucose. And then after that the muscle is saturated and they really need to take it once every day or every other day. If you want to really put on some muscle mass and size the we have the athletes take up to twenty, twenty five grams per day and take that until they get to where there want to get in their body composition...and then they back off and take maintenance doses thereafter. We do recommend that since we've only studied up to about thirty grams per day, that people don't take more then thirty grams per day.

NEMA: Sometimes, athletes can believe that if this product is good, then more of it must be better. We would have to guard against that attitude...

GUEST: Yes, there is some concern of that, and also be careful when you are getting nutritional supplements out there. A lot of them now have creatine in them...and make sure that you look on the label how much creatine they’re getting. A lot of athletes are taking higher doses. You know, we don't recommend it because it hasn't been studied at this point. And also some of the studies show that you can get pretty effective gains in only ten to fifteen grams per day.

NEMA: What’s your point of view on any increased potential for injury...which some are saying should be looked a possible side effect of creatine...

GUEST: Well the biggest side affects you hear...anecdotal...are a potential for cramping when exercising in the heat and also some folks have wondered whether muscle strains or pulls maybe related to creatine. We have not experienced that at all. We have had our athletes at the University of Memphis involved with creatine in several studies as well as now provided to that you wanted through out the season. And we have not seen any relationship what so ever with muscle strain pulls, cramping. The first two years that we did it, we actually felt that there was less incidence, and that the athlete recovered faster after injury because they were able to be stronger, and the muscle may have been able to recover faster. Many of the studies involve intense training up to twenty hours per week for up to twelve weeks in time taking up to twenty five grams of creatine and none of them report any problem. So I think that yeah we need to be cognizant of it but we need to have some data before we start making recommendations that athletes shouldn't take it especially in light of all the data that sows that there is benefit with creatine supplementation.

NEMA: And a it hasn't any long term or any noticed affect of using the creatine as far as liver activity or function goes.

GUEST: No, no that's another one...that I think anytime amino acids are used... which creatine is an amino acid...a lot of people say, "well how does that affect the liver?" There's been no data to suggest any adverse affect on muscle, liver enzymes or any liver profiles

NEMA: There are a lot of people who have kids that are teenage years -seventeen, eighteen and they don't' really know what’s going on at the training table in their own high school sports programs. And I just wanted to give them an idea what creatine is about, so in case they hear in broadcasts, or see an article somewhere, that they had a little bit of background on it.

GUEST: The main thing is that I would make sure that any time you have a supplement that is recommended for people that you check out whether there is research to support it. Does it make sense. Is there documented evidence to show that it works in athletes during training to improve there performance. And when you put that level of information out there you know. Do they have references, do they have studies to support the use of this particular supplement. Most of the things sold to athletes don't hit that level. Creatine on the other hand has been showed to improve exercise performance in about two thirds of the studies being done. None a very few there's only one study that I can think of that shows any negative affect and that would be in endurance runners because of the weight gain that may actually slow you down, be detrimental. But all other athletes sprinters, swimmers, and football players track and filed athletes almost all the studies show a beneficial effect. We have almost seen no change at all in any clinical symptoms or any problems or side effects with creatine supplementation, on the other hand we some tremendous affects that our athletes get. And not only do we do the research there but we have done over five studies with creatine we also have a very involved sport nutrition programs with athletes so we have been involved with all types of athletes and have seen some pretty good effects with creatine supplementation.

NEMA: Our thanks to Dr. Richard Kreider, of the Exercise and Sport Nutrition Lab at the University of Memphis.

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NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at:

...for a look at transcripts of this or past programs, or to find out more

about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.



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