Creatine is an ergogenic aid. As a supplement, it improves athletic performance. Numerous studies have proven that effect. It's never been shown to have a negative effect, in the short-term or long-. And yet, anti-creatine messages persist, largely due to mythology, misinterpretation, and misunderstanding. It's frequently confused with creatinine, a metabolic waste product that sometimes indicates kidney disease; it's also sometimes mistaken for a hormone, because it appears pharmacological. Neither are true.
First, some history: Creatine was originally popularized by Bill Philips (Body For Life, EAS, Met-Rx.) As the legend goes, Philips regularly received "new" supplements from pharma companies, which he kept in a big box under his desk. They were almost exclusively junk. One day, he tossed the bottle of "phosphocreatine" to Dan Duchaine (then, a very popular steroid guru) and Duchaine was amazed: here was a mere protein – NOT a steroid – with volumizing and strength-enhancing results! Creatine originally appeared as "Phosphagen," sold by EAS, in the form of white powder. It's still produced primarily by a lab called CreaPure, and resold by different supplement companies under a thousand different names.
The study that built the bad press: In France, researchers were studying the effects of eating charred meat. They wanted to understand whether barbecueing, if overdone, could cause renal damage. When you break down a protein, creatinine is produced as a waste product; typically, the kidneys would filter the creatinine. But if you're taking in excess protein that's already been broken down before ingestion (ie, burned) or your kidneys aren't functioning normally, creatinine passes straight through into the urine. The French study of charred meat did, indeed, find elevated levels of creatinine in the urine, suggesting renal failure. Unbelievably, the term 'creatinine' was mistranslated when the study was published in an English medical Journal, and since bad news travels much faster than good…..well, many medical professionals are still advising parents that creatine causes kidney damage, though the authors of the original French study have publicly corrected their translation error.
Creatine works by improving the pool of available PhosphoCreatine in the muscle cell. Phosphocreatine is necessary for the creation of ATP, which is the most basic form of energy available. When ATP runs out, more is synthesized from ADP and phosphocreatine, which loses its phosphagen ion to the ADP (adenosine DIphosphate,) which creates adenosine TRIphosphate (ATP.) Increase the pool of phosphocreatine available, and you can rebuild more ATP more quickly. And it works: users generally improve their strength in only a few days. Yes, they still have to work hard, but if they train properly, creatine will help.
Creatine also has a fun side effect: it attracts water to itself, wherever it is in the body. If it makes its way through the digestive system and into the muscle intact, it can hyperhydrate the muscle, creating a swelling effect. This can happen very quickly – in a day or so – leaving many to believe that it's just too effective to be healthy. On the downside, if too much creatine is ingested, it will attract water to itself while still in the digestive tract, which leads to gastrointestinal cramping. Piles of research has shown that 5g daily shouldn't cause any cramping, but that water intake should be increased; if there's no extra water available, creatine WILL pull water into the muscle from elsewhere in the body.
Creatine occurs naturally in fish AND in humans. If there isn't enough available, it's easily produced in our systems by combining a few other amino acids (glycine, arginine, and methionine.) A 70kg human has about 120g of creatine stored in his muscles, with a turnover rate of about 2g daily; introduce an extra 5g, and the body has the ability to store extra in the muscle. And that's how it works. (For more science, including some great graphs, click here.)
Conversely, steroids work by increasing hormonal output (or suppressing other hormone output.) They're effective because they tip the scales toward the more aggressive hormones (testosterone) and away from the testosterone-cancelling ones (estrogen, progesterone.) They also suppress cortisol (a hormone released by either physical or mental stress,) which would normally hamper recovery, except that steroids also assist in metabolising nitrogen (protein.) They can help a neural impulse travel faster from the nervous system to the individual muscle cell, and help muscle recruit its fibre in a better neural pattern. Some steroids are androgenic (sounds a lot like ergogenic, as used above, right?) – they cause either a suppression of female characteristics, or an exaggeration of male characteristics. These are the substances responsible for the facial hair in women, the square jaws, and the shrinking testes in males. Some, though, are merely anabolic: they trigger the nitrogen absorption and CNS recruitment improvements, without the heavy testosterone dosage. How these work is beyond the scope of this article, but they're more frequently used in the athletic world. It's important to note that steroids need not be androgenic: think of a female runner using a progesterone-based birth control. There's a distinct hormonal advantage, but no one questions the usage because she doesn't grow a mustache.
Creatine works. Does it work well enough to deserve a ban? This is the question currently in front of the NCAA, WADA, and the FDA. Unfortunately, since natural levels of creatine (120g/day) can vary widely, even in the same person during a 24-hour span, it's nearly impossible to regulate. 2g/day turnover is normal; 5g/day is the recommended supplemental dosage. More than 5g is excreted by the urine. A hard-training athlete may naturally vary by 5-6g/day….you get the picture.
Does it deserve the negative stigma? No. 5 extra grams, out of 120, isn't going to send the body into a state of non-production, as steroids do. It's not going to rewire the nervous system; not going to produce secondary sex characteristics, or enhance the growth of tumours (steroids have never been shown to CAUSE cancer, but they can increase tumour size along with everything else.)
The best way to take creatine: on an empty stomach, with a small insulin spike. So a half-teaspoon in fruit juice will work best. Make sure it's completely dissolved before ingesting to avoid drawing water into the gastrointestinal tract. And don't bother "cycling" on and off creatine – there's no need.