Other Names: creatine monohydrate, creatine phosphate, creatine citrate
Definition:Creatine is nitrogenous organic acid that occurs naturally in vertebrates and helps to supply energy to muscle and nerve cells. Creatine was identified in 1832 when Michel Eugène Chevreul discovered it as a component of skeletal muscle, which he later named creatine after the Greek word for flesh, Kreas.
It is a compound that’s involved in the production of energy in the body, in the form of adenosine triphosphate (ATP). Made in the liver, approximately 95% of the body’s creatine ends up being stored in skeletal muscles and the remaining 5% is found in the brain, heart and testes. Once it’s used, creatine is converted to a waste product called creatinine and excreted in urine.
Creatine, by way of conversion to and from phosphocreatine, functions in all vertebrates and some invertebrates, in conjunction with the enzyme creatine kinase. A similar system based on arginine/phosphoarginine operates in many invertebrates via the action of Arginine Kinase. The presence of this energy buffer system keeps the ATP/ADP ratio high at subcellular places where ATP is needed, which ensures that the free energy of ATP remains high and minimizes the loss of adenosine nucleotides, which would cause cellular dysfunction. Such high-energy phosphate buffers in the form of phosphocreatine or phosphoarginine are known as phosphagens. In addition, due to the presence of subcompartmentalized Creatine Kinase Isoforms at specific sites of the cell, the phosphocreatine/creatine kinase system also acts as an intracellular energy transport system from those places where ATP is generated (mitochondria and glycolysis) to those places where energy is needed and used, e.g., at the myofibrils for muscle contraction, at the sarcoplasmic reticulum (SR) for calcium pumping, and at the sites of many more biological processes that depend on ATP.
In humans, about half of the daily creatine is biosynthesized from three different amino acids – arginine, glycine, and methionine. The rest is taken in by alimentary sources. Ninety-five percent of creatine is later stored in the skeletal muscles.
The enzyme GATM (L-arginine:glycine amidinotransferase (AGAT), EC 220.127.116.11) is a mitochondrial enzyme responsible for catalyzing the first rate-limiting step of creatine biosynthesis, and is primarily expressed in the kidneys and pancreas.
The second enzyme in the pathway (GAMT, guanidinoacetate N-methyltransferase, EC:18.104.22.168) is primarily expressed in the liver and pancreas.
Genetic deficiencies in the creatine biosynthetic pathway lead to various severe neurological defects.
Controversy:While creatine’s effectiveness in the treatment of many muscular, neuromuscular, and neuro-degenerative diseases is documented, its utility as a performance-enhancing food supplement in sports has been questioned (see creatine supplements for more information). Some have even proposed that its use as a performance enhancer should be banned. Despite this, creatine remains very popular.
In humans, approximately half of stored creatine originates from food (mainly from fresh meat). Since vegetables do not contain creatine, vegetarians show lower levels of muscle creatine which, upon creatine supplementation, rise to a level higher than in meat-eaters.
Creatine is found in small amounts in red meat and fish. However, much of it is destroyed by cooking. It’s also made naturally in the body from L-arginine, L-glycine and L-methionine, amino acids that are principally found in animal protein. Insulin is needed for creatine to enter muscles, so consuming carbohydrates with creatine may increase the amount of creatine available to muscles.
Creatine supplements are available in capsules or as a powder at health food stores, some drug stores and online. One of the most popular forms of creatine is creatine monohydrate.
In the Cochrane Collaboration analysis of 12 trials, there were no notable adverse events reported, however, research on the side effects and safety of creatine supplements is still limited.
Possible side effects of creatine include:
*Loss of appetite
Creatine may cause water to be drawn away from other areas of the body and into muscle tissue, which could increase the risk of dehydration.
High doses of creatine could potentially injure the kidneys, liver and heart. Theoretically, creatine may cause kidney damage because its by-product, creatinine, is filtered through the kidneys into urine. Although studies haven’t found adverse events in recommended doses, there have been a couple of case reports of people who have experienced kidney collapse and three deaths in people taking creatine, but there is no definitive evidence that creatine was the cause. People with kidney disease or liver disease should avoid creatine.
Creatine supplements may cause asthmatic symptoms, such as wheezing and coughing, in some people.
People with McArdle’s disease shouldn’t use high doses of creatine because it has been found to increase muscle pain.
There is some concern that oral creatine supplements are metabolized in the body to a toxic waste product formaldehyde, which could potentially damage cells, DNA molecules and blood vessels.
Pregnant or nursing women or children should not use creatine supplements.
One of the main safety concerns is that individuals using creatine to enhance athletic performance or muscle mass, particularly adolescents, may exceed recommended dosages and take it without supervision.
Short-term use of creatine in healthy individuals is generally considered safe (see Creatine supplements#Safety). , studies have not yet been able to demonstrate either long-term or short term creatine supplementation result in adverse health effects. Creatine supplementation utilizing proper cycling and dosages has not been linked with any adverse side effects beyond occasional dehydration due to increased muscular water uptake from the rest of the body. In fact, an increase in body mass because of increased muscle hydration is the most widely accepted side effect of creatine supplementation.
According to the opinion statement of the European Food Safety Authorities (EFSA) published in 2004 it was concluded that “The safety and bioavailability of the requested source of creatine, creatine monohydrate in foods for particular nutritional uses, is not a matter of concern provided that there is adequate control of the purity of this source of creatine (minimum 99.95%) with respect to dicyandiamide and dihydro-1,3,5-triazine derivatives, as well as heavy metal contamination. The EFSA Panel endorses the previous opinion of the SCF that high loading doses (20 gram / day) of creatine should be avoided. Provided high purity creatine monohydrate is used in foods for particular nutritional uses, the Panel considers that the consumption of doses of up to 3g/day of supplemental creatine, similar to the daily turnover rate of creatine, is unlikely to pose any risk”.
This opinion is corroborated by the fact that creatine is a natural component in mothers’ milk and that creatine is absolutely necessary for brain development in the human embryo and the baby, as well as for optimal physiological functioning of the adult human body, especially the brain, nervous system, the muscles and other organs and cells of high energy expenditure, where the creatine kinase (CK) system is highly expressed and creatine levels are high.
Side effects that produce lower leg pain may be associated with the use of creatine. Creatine may be the cause of an increase in the anterior pressures of the lower leg. This is usually found in post-creatine use when at rest and after exercise. Normal at-rest pressures have been found to be highly elevated by subjects who used creatine within the prior 35 days when compared to no supplementation. This can produce an extreme amount of pain in the lower leg due to the rigidity of the anterior compartment of the lower leg and lack of fluid drainage out of the compartment. It may also be exasperated by the increase of water content in the muscle fibers, putting more pressure on the anterior compartment. If this condition persist, check with your doctor and inform them of your creatine use and dosage. Although this condition may and usually does subside, if left untreated complications may occur that require emergency medical attention. If the levels remain high for a long period of time, irreversible damage to tissue may occur, particularly to the peroneal nerve. These conditions can further be found under Chronic Compartment Syndrome.
Creatine and the treatment of muscular diseases:
Creatine supplementation has been, and continues to be, investigated as a possible therapeutic approach for the treatment of muscular, neuromuscular, neurological and neurodegenerative diseases (arthritis, congestive heart failure, Parkinson’s disease, disuse atrophy, gyrate atrophy, McArdle’s disease, Huntington’s disease, miscellaneous neuromuscular diseases, mitochondrial diseases, muscular dystrophy, neuroprotection, etc.).
Two studies have indicated that creatine may be beneficial for neuromuscular disorders. First, a study demonstrated that creatine is twice as effective as the prescription drug riluzole in extending the lives of mice with the degenerative neural disease amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). The neuroprotective effects of creatine in the mouse model of ALS may be due either to an increased availability of energy to injured nerve cells or to a blocking of the chemical pathway that leads to cell death.
Second, creatine has been demonstrated to cause modest increases in strength in people with a variety of neuromuscular disorders.
Third, creatine has been shown to be beneficial as an adjuvant treatment for several neuro-muscular and neuro-degenerative diseases and its potential is just beginning to be explored in several multi-center clinical studies in the USA and elsewhere.
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