Creatine and Teens

In sports circles, it's known as "the power powder." It's a popular muscle builder that many college athletes and even some pros believe is the secret to their success. Now, it's trickled down to the high school level -- with many an aspiring jock "power loading" the crystalline substance before every big game.

If you're thinking illegal street drugs -- guess again. The item in question is the nutritional supplement creatine, a "natural" product that increases athletic performance, much like anabolic steroids without the documented risks.

But just because creatine is sold in health food stores, don't believe it's problem-free. While some health experts say there's not enough evidence to call for a ban of its use, creatine is a supplement we know relatively little about -- and therein may lie the danger.

"From the medical standpoint, there remains confounding literature that both supports and refutes negative side effects of creatine supplements -- including the possibility of liver and kidney damage," says Dr. Robert Gotlin, the director of the Orthopedic and Sports Rehabilitation Program at Beth Israel Medical Center in New York City. "We just don't know what long-term use will do."

"For me," he cautions, "it's not safe until it's proven safe, and it should not be used, particularly by young athletes."

But using it they are. According to the Mayo Clinic Sports Medicine Center in Rochester, Minn., an anonymous survey of 300 teen athletes revealed that 8 percent are using creatine, often knowing little about it. The results, say the study's authors, are probably indicative of the national trend.

"We have no reason to believe the group of kids we surveyed is any different from any group of teen athletes around the nation. So the figures are probably pretty accurate in terms of depicting not only use, but the lack of knowledge about it by those who use it," says Dr. Jay Smith, a sports medicine physician at the Mayo Clinic, and one of several doctors who oversaw the study.

It's also not hard to figure how the creatine craze landed on the steps of America's high schools. A 1997 survey of National Collegiate Athletic Association (NCAA) athletes found almost one-third were using creatine supplements, while estimates for use by pro athletes, particularly football players, have run as high as 75 percent. All this despite the fact that creatine and other over-the-counter supplements, although legal, have been banned by the National Football League, the NCAA and the International Olympic Committee

The creatine attraction

Creatine monohydrate is an amino acid that's produced by the liver, and is also available via high-protein foods like red meat and poultry. It increases the production and availability of ATP, adenosine triphosphate, the fuel the body uses for quick bursts of energy -- the kind required in football, wrestling and power lifting, for example.

"Creatine appears to enable athletes to maintain a high training volume, so they can recover more quickly from the high-power activity and go again, which is why it is believed to improve performance," reports Ellen Coleman, a registered dietitian who counsels athletes at the Sports Clinic in Riverside, Calif.

Creatine also adds bulk to muscles -- almost immediately, increasing their size usually within seven days.

But the benefits are not without risk. Muscles that bulk too quickly are more subject to injury, Gotlin notes. And weight gain and gastrointestinal upset are frequently cited short-term side effects of creatine use, along with dehydration and a potentially dangerous imbalance of electrolytes, the minerals the body needs to regulate heart rhythm.

"Since athletes sweat a great deal, their natural potential for dehydration is greater than normal, and those risks increase with creatine use, which holds water in the muscles and pulls it away from the rest of the body," Coleman says.

There is also at least some suspected risk of long-term damage to the liver, and particularly the kidneys, which help filter excess creatine from the body.

"The studies are more anecdotal reports, not necessarily well-designed follow-up studies. So the unanswered question is, if you are taking this stuff in greater amounts than what is made by the body naturally, and it's excreted, what, if anything, is it doing to your kidneys?" Smith asks.

Needed: More research

The potential effects of creatine use, particularly in young athletes, prompted the American College of Sports Medicine to convene a special roundtable of experts to examine data on the supplement's effectiveness. Their conclusion, recently published in the journal Medicine and Science in Sports and Exercise, stated:

"The fact that creatine is a naturally occurring compound does not make supplementation safe, as numerous compounds are good, even essential in moderation, but detrimental in excess. Further, the lack of adverse effects does not equal safety since unending research must be performed to eliminate the possibility of all theoretical complications."

So, while we may not have much in the way of proven evidence against creatine use -- in fact one five-year study found no problems with regular use at all -- at least some experts believe that what we still don't know about creatine could harm us.

"Based on what we know now, I would not recommend it," Gotlin says.

Others, however, believe the best plan is simply to "approach with caution."

"If we know the kids are going to be taking it anyway, it's better that we at least be there to counsel them on the correct way to use the supplement, and in the correct amounts, and in that way, help reduce the likelihood of at least some potential problems," says Coleman.

Smith agrees: "We don't encourage use. But if the kids say they really want to take it, we tell them what we know and what we don't know and, with the parents involved, let them make their own decision. Because, right now, we don't have any grounds to come out strongly against it."

If your teen athlete insists on using creatine, it's imperative that you and your child talk to his or her doctor first.

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