Crazy for Creatine

By Ian K. Smith, M.D.

Muscles are back in style. Just pass by any magazine stand, and you'll notice the explosion of fitness magazines. Shiny, muscle-bound men and women smile at you while gigantic veins course under their tanned, oiled skin. If you're old enough to remember the 1980s television character the Incredible Hulk, played by Lou Ferrigno, you'll be as amazed as I am that these days almost any guy seems able to develop a body as brawny as his. Welcome to the world of unregulated muscle-building supplements, where creatine is king.

Creatine--more accurately, creatine monohydrate--is one of the country's most popular nutritional supplements. Almost as easy to buy as a pack of gum, it's available as capsules, powder or liquid at health-food stores, drug stores and on the Internet. The packaging promises to maximize your strength, endurance and muscle size. Last year an estimated $400 million worth was sold. Most buyers are adults looking to get a better pump at the gym, but there are signs that users are getting younger.

A survey of more than 1,000 students found kids as early as sixth grade turning to creatine for its supposedly magical powers. That's not hard to believe, considering that such sports heroes as home-run hitters Mark McGwire and Sammy Sosa have admitted taking the stuff. In the same survey, 44% of high school seniors said they regularly use creatine, mostly to enhance athletic performance, especially in football, wrestling, hockey, gymnastics and lacrosse.

There's no doubt that creatine can help you build up your biceps. Increasing your energy, it enables you to carry out a longer and more strenuous workout. Normally manufactured by the liver, kidneys and pancreas, it's used by the muscles and other organs as an energy source. Still, there can be too much of a good thing. While creatine is a natural compound, created out of three amino acids, doctors are concerned by reported side effects from apparent overdoses, including dehydration, muscle and ligament tears, diarrhea and kidney failure.

So how much can be safely taken as a supplement? And for how long can it be used without causing irreparable damage, especially to young bodies? Unfortunately, there are no scientific studies to guide us. Nor can we expect advice from the Food and Drug Administration. As a nutritional dietary supplement, creatine remains beyond the FDA's regulatory reach. I recommend you avoid creatine entirely. At the very least, users should not exceed dosages recommended by its manufacturers.

But many users are likely to throw caution to the winds. Competition within sports is so intense that athletes seem willing to try almost anything to improve performance. Half of surveyed athletes, many of them Olympians, admitted recently that they'd be willing to take a drug even if it was sure to kill them eventually, so long as it would let them win every event they entered five years in a row.

I can empathize with them. As an 11-year-old, I tried desperately to hit that monster home run. But my teammates and I got our advantage with aluminum bats. Now youngsters who haven't even reached puberty are looking for that extra power with untested supplements consumed at levels that could cause untold physical consequences down the road. This is one instance when I'll take the good old days.

E-mail Ian at ianmedical@aol.com