Creatine update: Its use in rugby Posted on Tuesday, September 09, 2003 - 00:00 The culture of Creatine use by sportspersons may be relatively new to South Africa but certainly not to the U.S.A where it has been used for the last 10 – 15 years. This culture was introduced into SA Rugby about 5 years ago and rugby players have on numerous occasions been quoted in the media about this issue. It is my belief that all rugby players, their clubs and their provinces should carefully evaluate the literature on the use of Creatine and objectively decide on their position. In so far as the studies conducted on Creatine are concerned, very little has been published on the long-term use of Creatine. Almost all the information about Creatine has been derived from the short-term use (less than 8 weeks) and from anecdotal reports from sportspersons who had been using the product. What is Creatine? Creatine is an Amino Acid (protein) which occurs naturally in ones body, mostly in skeletal muscle. It is considered a nutritional supplement and is therefore not on the List of Prohibited Substances and Methods of WADA and the IOC, nor is it an illegal substance in terms of the law. It is therefore readily available on the supermarket shelves, pharmacies and health food stores. Creatine occurs naturally in foods, mostly in meat, fish and other animal products. A person consumes an average of 1-2 grams of Creatine daily in his normal diet: Vegetarians obviously consume much less Creatine. The role of Creatine in the body lies mostly in skeletal muscle where it forms an integral part of an energy system causing muscle contraction. What are the effects of Creatine/Are there any benefits? The effects of Creatine include increased power and strength and increased muscle mass, giving rugby players a distinct advantage. By decreasing the recovery time between repeated bouts of exercise Creatine allows the player to train more intensely and for a longer period of time hence becoming bigger and stronger. However, Creatine in isolation without a good exercise program and an adequate high carbohydrate diet will have no effect at all on muscle building. Although in some studies Creatine Supplementation appears to enhance performance in repeated short bursts of activity such as stationary cycling (in laboratory) and weight lifting, there is not enough evidence to show that it works outside a laboratory setting. Who uses Creatine? Improved performance has been recorded in activities of short duration and high intensity e.g. repeated short sprints such as occur in rugby.Rugby players have therefore been using Creatine mostly for this reason. It has not, however, been found to be useful in endurance sports such as marathon running and long distance cycling. Creatine use is common among professional athletes. Its use has now spread among college athletes, recreational athletes and even children. Its use by children is of growing concern because of the potential damage that can occur to growth plates and the imbalance that will exist with the increase in muscle mass and muscle strength There are “responders and non-responders”. Creatine intake (loading) of 2 gram per day for 3 or more days has resulted in significant increase in Creatine levels of some individuals and not others. Individuals with initial low Creatine levels appear to respond much better to Creatine loading eg. vegetarians. What are the side effects? Anecdotal reports have linked Creatine Supplementation with: · Cramping ( muscle and/or stomach ) · Dehydration · Diarrhea · Dizziness Recent research done at the Sports Science Institute of South Africa has shown increased blood pressure in a number of individuals following Creatine use of a loading dose of 20g per day for 5 days and maintenance dose of 2g per day for 6 weeks The April 25 1998 issue of The Lancet reported a case of kidney failure following Creatine use. The patient denied the use of any other medication apart from Creatine, loading dose 5g three times a day for 1 week and maintenance of 2g per day. A second case report also describes kidney failure in a 20 year old man who was previously healthy prior to using Creatine 5g, 4 times per day for approximately 4 weeks before his onset of symptoms. It must however be emphasised that it cannot be stated unequivocally that Creatine is harmful to the kidneys because no studies have been done to date on the long-term (more than 8 weeks) use of this product. It would however be prudent to avoid Creatine supplementation in all players with impaired kidney function. Scientific evidence suggests that Creatine Supplementation up to 8 weeks has not been associated with any major health risks. The safety profile in its more prolonged use has to be established. Weight gain as a result of water retention has been reported. What is the dosage of Creatine? It is generally agreed that there should be a “loading” period of 3-7 days of 20gram per day and thereafter a maintenance dose of 2g per day. Any extra Creatine intake is simply excreted via the urine. Advice to Players. · Creatine builds muscle bulk and muscle strength but not in all users. · There are certain advantages to the rugby player when using Creatine as prescribed viz. increased muscle mass and the ability to exercise more intensely and for longer periods. · It has yet to be established that Creatine causes major improvement in performance in endurance exercise such as marathon running though in short duration exercises lasting less than 10 seconds such as short sprints in rugby, some improvement has been reported. · Any dose above the prescribed dose is simply excreted via the urine. · The prescribed dose of Creatine should not be exceeded. · Should not be used by children under17 years of age · Creatine is classified as nutritional substance and therefore not regulated in the USA by the Food and Drug Administration nor by the Medicines Control Council in South Africa. · Creatine’s long term use safety profile has not been established. · Creatine use is to be avoided in cases of renal impairment and/or elevated Blood pressure. · Players using Creatine should stop immediately when side effects occur · Players take Creatine at their own risk. Recommendation to controlling bodies in rugby I have attempted to be objective in my approach to Creatine. There are the reported benefits in rugby players such as weight gain, increased muscle mass, increased power and improved performance in repeated short sprints with the short-term use thereof. However, there are also the anecdotal reports of major side effects, which I feel, cannot simply be ignored. The Medico Legal concerns need to be addressed. It is our duty to let players decide for themselves whether to take Creatine or not. We should endeavor to educate the players and assist them to make their own informed decision. We should not freely distribute Creatine at training camps and elsewhere for fear of potential litigation should adverse effects occur or should all the anecdotal evidence of these adverse effects be confirmed. DR. ISMAIL JAKOET GENERAL MANAGER:MEDICAL SA RUGBY (PTY) LTD. 18 AUGUST 2003