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Is it a big deal if your teenage son or daughter comes home with a jar of creatine, the most popular sports supplement in the United States? After all, the performance-enhancing, dietary supplement is legal, inexpensive and it works, according to the collegiate and professional athletes who use it, such as baseball slugger Mark McGuire.
But health experts say the long-term effects of creatine are unknown. Manufacturers are not required to prove its purity, safety or effectiveness before marketing the powdery substance. Though creatine is available at stores and through the Internet, it's not subject to the same safety evaluations as prescription drugs and food products because the U.S. Food and Drug Administration (FDA) classifies it as a dietary supplement, not a drug.
"We don't recommend any supplements for kids. Even though these supplements are sold over the counter, there is no law that oversees how pure they are," says Eric Small, M.D., who teamed with three other doctors to study creatine use among athletes in grades six to 12 in Westchester County, N.Y.
The study found that 6 percent of the males and females surveyed - even some in sixth grade - were using creatine to try to improve their performance in sports, such as field hockey, gymnastics, tennis, lacrosse, football and cheerleading.
"They are willing to try anything to give themselves an advantage," says Small, an assistant professor of pediatrics and orthopaedics at Mount Sinai Medical Center in New York. "I get weekly calls from parents of 11- and 12-year-olds that their kids want to use creatine."
Non-athletes are also using creatine to try to improve their physique and self-confidence and to boost their performance in sports they play for fun, says John Acquaviva, Ph.D., associate professor of education, health and human performance at Roanoke College in Salem, Va.
In 2004, the government announced it is cracking down on companies that make, market and distribute products containing androstenedione, or andro, which acts like a steroid once it is digested by the body and can have similar health risks as steroids.
These products are advertised as dietary supplements that enhance athletic performance based on the claim these can stimulate muscle growth and increase testosterone levels. Long-term problems in men include testicular atrophy, impotence and the development of female characteristics such as breast enlargement. Women may develop male pattern baldness, deepening of the voice and increased facial hair. Women may develop abnormal menstrual bleeding and blood clots. Warning letters were sent to companies.
Risks and benefits
Prohibiting your child from using creatine can be difficult. "Telling a teenager they can't do something is not the easiest thing in the world," says Ronald Feinstein, M.D., of the University of Alabama at Birmingham School of Medicine and chairman of the executive committee on sports medicine and physical fitness for the American Academy of Pediatrics.
If your teen insists on taking this trendy supplement, here are some suggestions on what you can do:
- Explain the pros and cons and ask where your child got the supplement. Many teens are taking creatine at the urging of their coaches, so visit the school principal or coach to hear their explanation, Feinstein says.
- Use the supplement in moderation. One of the biggest problems with supplements is that athletes usually exceed the proper dosage without thinking about the health consequences, Feinstein says. The normal dosage for the odorless, tasteless white powder is 20 grams each day for the first five to six days and then 2 grams to 5 grams per day, Acquaviva says.
Instead of building muscle tissue like anabolic steroids, creatine helps your muscles work for a longer period, Acquaviva says. Your body naturally makes creatine to aid in muscle contraction. Supplementing your body's natural supply of creatine can help when your muscles need energy for stressful exertion, such as weightlifting, cycling or running, Acquaviva says.
"If you lift heavy weights one or two more times every time you work out, it will help you grow stronger quicker," says Acquaviva.
There's no scientific evidence that creatine supplements are harmful. Yet, the Blue Cross and Blue Shield's Healthy Competition Foundation says anecdotal and single-case evidence from trainers, physicians, coaches and athletes suggests a link between creatine and cramping, diarrhea, nausea, dizziness, dehydration, muscle strains, high blood pressure, incontinence, and abnormal liver and kidney function.
"To ignore the potential concerns that surround this supplement could place athletes on the path to serious health problems," the foundation's position paper says. "Creatine is an unregulated substance that is marketed to and used in large doses by teenagers without proper medical supervision."
Be certain to check with your doctor before trying any supplement.
This article was reviewed and updated June 2007.
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