The “Real Deal” About Creatine, Despite Recent Accusations Made Regarding Injured High School Athletes in Oregon
In late August, ABC News reported that 19 high school football players in Oregon were diagnosed with Compartment Syndrome, which involves intense pressure on blood vessels in muscles and leads to severe pain (cramping) and swelling. The 19 players all had elevated levels of the enzyme kinase (creatine kinase) which is released by muscles when they are injured, and these athletes had all just participated in a pre-season football camp. Doctors were investigating whether creatine may be the culprit in causing this condition, although none of the athletes indicated they took creatine (or any other supplement or drug). This of course would be an easy scapegoat for school officials (and possibly for inexperienced and/or negligent coaching staff) to shift the blame.
A sports supplement related site, T-Nation http://www.t-nation.com posted a number of facts in rebuttal to the accusations made, blaming Creatine as the leading cause for this condition, while also including some quotes from an expert in the field, Richard Kreider, PhD, who has researched creatine since 1993. Dr. Kreider commented:
“Isn’t it interesting how people always speculate that a supplement is the problem when they miss the obvious: overtraining in hot and humid environments? Train kids in a 115 degree room so they dehydrate during an ‘immersion camp’ where they no doubt were training excessively (raising CK levels) all day long for several days leading to more dehydration, and the problem is creatine?…It would be nice if coaches (and the media) didn’t blame their poor and potentially dangerous coaching and training methods on a supplement like creatine that research has shown to be safe and effective in a number of populations for years.”
Due to articles like this in the media, there has been a common misconception among parents and academic institutes categorizing creatine as a harmful and illegal supplement. As a result of the media’s false reporting at times, along with a mix of bad eggs (supplement companies who have been ill-willed or careless in the manufacturing and marketing of their products), parents have repeatedly been misguided about the safety and dangers of creatine. This is not a big surprise, since there is no consistent regulation of dietary supplements to this day. However, creatine is actually a safe and legal sports supplement that high school and collegiate athletes are allowed to take. According to the NCAA guidelines, an institution may provide only non-muscle-building nutritional supplements, provided the supplements do not contain banned substances. Creatine is not on the “banned” substance list, rather creatine is on the “Impermissible Supplement List”. What that means, is that institutions may not purchase/provide these supplements to student-athletes but it is permissible for them to use as long as the institution did not make the purchase.
The International Society of Sports Nutrition (ISSN), the leading professional organization in the field of sports nutrition, also responded to the accusations made in the media, stating that “It is well known that excessive exercise in hot and humid environments can promote dehydration, muscle breakdown, and result in marked elevations in muscle CK levels. In severe instances, this may lead to exertional rhabdomyolysis, particularly in athletes who have been engaged in intense exercise in hot and humid environments for several days and who become chronically dehydrated. Additionally, excessive exercise in individuals unaccustomed to heavy training bouts can promote anterior compartment swelling, pain, and pressure. It is well known that dehydration and/or heat illness can exacerbate this clinical course.”
This was the case for these 19 football players at McMinnville High School in Oregon, engaged in a several day “immersion” camp. According to press reports, the athletes began to complain about swelling in their arms after performing a series of push-up and chair dip exercises in 30-second alternating bouts of repetitions for over 20 minutes until exhaustion in a hot and humid wrestling room. Temperatures in the room were reported as high as 115-120°F. Moreover, the athletes were reported to have to start a repetition scheme over again if all of the athletes did not complete their repetition goals. Further, the athletes were not allowed to drink water during the training session. These factors all led to the dangerous medical conditions experienced by the 19 athletes.
Creatine is one of the most widely used and safest supplements known, and is essential in providing functional energy to all living cells in the body, not just muscle, but heart and brain tissue. Most people don’t realize the body can only synthesize half of daily creatine needs. Eating from natural creatine enriched foods like red meats, fresh seafood and poultry fulfills the balance, but is not always practical. A certified strength coach said, “I often tell parents, it is not that your child is over worked or over trained, it’s that the child is always under-recovered.” You don’t solve recovery with a drink and power bar, it requires a solid diet and rest, and creatine when supplemented correctly provides the body with the necessary energy when diets fail to fulfill the gap. One other critical fact is the role creatine has in assisting protein synthesis, a critical process for building muscle mass.
The primary purpose of Creatine is to recharge ATP, by donating a phosphate to the used up ADP. This splitting of ATP to ADP is what is required for cellular energy. Creatine Phosphate, which is made in the body from creatine is used to donate that phosphate to the ADP molecule, making it available for energy production once again. Therefore Creatine is most beneficial for athletes performing high-intensity workouts, while also helping with increased strength and aiding in muscle recovery.
As a matter of fact, based on research, the ISSN reported that creatine may improve the athlete’s ability to tolerate intense exercise in hot and humid environments and lessen the incidence of injury. Athletes have been using creatine on a widespread basis as a dietary supplement since the early 1990’s. No clinically significant side effects have been reported and a number of potentially beneficial medical uses are being studied. It is the opinion of the ISSN that “the suggestions of creatine having caused this incident in Oregon is inconsistent with the scientific literature and implausible.”
One problem though is that not all Creatines have efficient solubility to make the molecule bio-available. Monohydrate for years has been the most tested creatine, but it comes with some side effects, such as cramping, water retention and bloat. However a new molecule recently created is creatine hydrochloride (HCl) that has proven increased solubility and bio-availability in a smaller dose, avoiding loading phases that creatine monohydrate requires. Creatine HCl appears to be the solution for the problems facing athletes today.
With the competitive pressures that young athletes face today to stay ahead of their game, it’s only logical that High School and College athletes are going to turn to supplements to enhance their performance and gain a competitive edge. Therefore it’s paramount that teens be educated on which supplements are safe for them to take, so they do not fall for the marketing hype of individual manufacturers that taint their products to be the best, when actually they include extra ingredients, such as preservatives, stimulants, additives, binders, fillers, excipients, extenders and potentially harmful substances, to enhance the claims and results that are being advertised.
No, the supplement industry is not regulated, but there are companies who are following strict testing and safety guidelines, and are making products that are pure and have no additives or stimulants, are safe and compliant and can offer a young athlete rewarding benefits for his or her sport. So although this very unfortunate incident has occurred to these high school athletes in Oregon, it gives us an opportunity once again to help educate the marketplace on the reality of Creatine as a beneficial, safe and legal sports supplement for men and women, young and old.






