Home run king Mark McGwire may have given new meaning to the term "team chemistry" with his revelation that he uses the testosterone-enhancing pill androstenedione, but the debate over use of muscle-building supplements figures to remain largely one about the powdered form.
High-profile players from all the major professional sports use it. Many college and high school athletes are trying it. Doctors, trainers and parents wonder about it.
The questions center on the safety and effectiveness of creatine, a compound of three amino acids that are produced naturally in the human body to help build lean muscle mass. The synthesized version has been touted as a healthful, legal alternative to anabolic steroids, and its use is so widespread that it would be hard to find a high school athlete who hasn't heard of it or doesn't know someone who uses it.
Creatine entered the mainstream after the 1992 Summer Olympics in Barcelona, Spain, when 100-meter gold medalist Linford Christie and 400 hurdles gold medalist Sally Gunnell credited it with helping them prepare for victory. Now, with sales reaching $100 million per year -- and doubts about health temporarily overshadowed by the "andro" controversy -- creatine appears to have the sports world in its muscular grip.
Athletes such as McGwire, Orioles outfielder Brady Anderson, Dallas Cowboys quarterback Troy Aikman and Denver Broncos quarterback John Elway swear by creatine, even as more and more doctors caution that they are working out in uncharted territory.
McGwire, whose chase of Roger Maris' single-season home run record has put him at the center of the nutritional supplement debate, was a proponent of creatine long before anyone outside of the bodybuilding community had heard of androstenedione.
Both supplements are used to magnify the effect of training and help athletes recover faster after workouts. "Andro" does it by triggering hormone production, creatine by fueling increased muscle endurance and -- by some accounts -- assisting in converting fat to lean muscle mass.
Creatine's lack of effect on hormone production has allayed some fears about long-term health risks. But its growing popularity -- particularly among teen-age athletes -- has raised red flags in the medical community. Creatine has hit the market like an avalanche, but because it is a dietary supplement and not a pharmaceutical, it is not subject to federal scrutiny.
"We field reports that come in on supplements, but it's basically a free-for-all. These things are not really regulated," said Don Leggett, a compliance officer in the Food and Drug Administration's Center for Drug Evaluation and Research.
He noted that Congress removed most nutritional supplements from government oversight "unless there is a clear cause and effect or we can show imminent danger. The burden of proof is on us, where, in the case of a new drug, it would be on the manufacturer."
Instead, the FDA issues its standard advisory to consult a physician or health professional before beginning a dietary supplement regimen.
The FDA has received only 12 adverse event reports concerning creatine, compared with hundreds of complaints about other products, such as the diet pills popularly known as fen-phen.
"That is a relatively small number, and some of the people making the claims were using multiple products," FDA spokesman Arthur Whitmore said. "If there is a safety problem, it's something that is not yet substantiated."
Baltimore's Anderson, whose well-cut body has become a marketing tool for a major producer of synthesized creatine, said he has read much of the available research on creatine and is convinced it is safe.
He scoffed at comparisons with steroids, which allow bodybuilders to increase muscle mass with less effort. Creatine, he said, simply allows athletes to work out more frequently and effectively.
"Creatine helps muscle endurance," Anderson said. "It makes sense why it works. There's no magic. A guy who works out hard and doesn't use it is still going to do better than a guy who doesn't work out hard and does use it."
Anderson, who obtains his creatine from EAS (Experimental and Applied Sciences), said he began using it regularly three years ago as part of a comprehensive dietary regimen. "I use a multi-vitamin, a multi-mineral, some creatine and a good quality protein powder every day.
"Ideally, you'd like to get all that stuff from regular food, but to get additional creatine, you'd have to eat about 10 pounds of meat and fish a day," he said. "You want to gain lean body mass, but you can't do that with a regular diet."
Anderson's success using creatine has led some of his teammates to try the supplement.
"I didn't know about it until Brady started bringing it in," said catcher Chris Hoiles, who takes creatine to help him recover from the rigors of his position.
Pitcher Scott Erickson uses it as part of his off-season training regimen. First baseman Rafael Palmeiro said he has used it to enhance his weight training.
An estimated 25 percent of major-league players take creatine regularly, though detailed survey information is not available.
"Creatine is a compound that has developed enormous popularity before there has been any organized research on the positive and negative effects of it," said Orioles orthopedist Dr. Michael Jacobs. "The companies that manufacture it have pushed it without the [scrutiny] that goes with pharmaceuticals.
"This clearly creates a potential downside, because we're learning about it while people -- and young people -- are using it aggressively," he said.
The short-term side effects associated with creatine are muscle cramping and stomach discomfort, which apparently can be controlled with intake of fluids.
"Based on what I know now, the side effects seem to be limited to those that are mild or minor," said Ravens team physician Dr. Andy Tucker. "We don't have information on what it can do over a longer period of time."
Much of the research disseminated about the product has been funded by the companies that make and distribute it.
The NCAA has funded three studies on the effects of creatine on college athletes, but none of them will be complete until mid-1999. It could be another decade before there is enough data to assess the effect of creatine loading on the body's major organs.
"It's after-the-fact research," the FDA's Leggett said. "Hopefully, it's not a situation like steroids, where the most serious effects go unrecognized for years."
"From talking to players, I think it does have the effect of increasing muscle bulk," the Orioles' Jacobs said. "I'm just concerned that it may have negative effects that could affect a player's health and ability to perform. I think it's too widely used prior to clinical research assessing its potential risk-benefit ratio."
Anderson isn't concerned. He has done his own personal three-year study and has experienced no negative side effects.
"In my opinion, I don't think creatine is dangerous at all," he said. "But, for the sake of argument, let's say it is and let's rate it next to the other things you put in your body like alcohol, cigarettes, saccharin, animal fats, whatever. This isn't even in that category."
Athletes get results
There is little question that it works. Creatine users get bigger faster, because it helps muscles recover from exercise and that allows athletes to get quicker results from intense activity.
"I use it frequently," said Ravens linebacker Jamie Sharper, "but only when I'm training hard and weightlifting. I've heard about some of the problems, like muscle pulls, so I don't do it during the season. I drink a lot of water when I get on it, and usually I can add 3 to 5 pounds during the off-season."
Bucknell University freshman Jeremiah Albright, who won a state wrestling title at Bel Air High last year, said that creatine helped him add 30 pounds of muscle before the 1998 season.
"I felt major increases with it," he said. "It's not overnight, but over about two months, you see gains if you use it right and do it every day."
High school and college usage is widespread, but growing controversy over a variety of nutritional supplements has prompted some coaches and athletic directors to back away from their previous endorsements of creatine.
Hereford High School football coach Steve Turnbaugh said earlier this summer that upward of 10 percent of his players were creatine users -- enough to prompt him to bring in a nutritionist to educate last year's team about the supplement -- but said last week that he knew of none this year.
Towson University football coach Gordy Combs counts himself among early proponents of creatine whose enthusiasm has cooled. "When it was the in thing to do, we encouraged our players to do that," he said. "I've taken a different stance in the last six months. I've advised our players not to do it anymore. There's not enough research.
"We emphasize the weight program, getting enough rest and eating properly," he said. "If you follow those three things, you're going to improve physically."
The University of Maryland football team conducted a six-week creatine trial last spring, but coach Ron Vanderlinden said last week that the athletic department has prohibited university personnel from distributing the supplement because of uncertainty about health risks.
"As of last July, we are not permitted to use creatine," Vanderlinden said. "There is nothing that has proven to be detrimental. However, it's a new enough substance that long-term results still aren't really clear. So our athletic administration and medical community has said, 'Let's not do it until the results are long-term.' "
That's the conventional wisdom coming out of training rooms nationwide. In the absence of hard information that creatine might be harmful over the long term -- or safe, for that matter -- trainers and team doctors are taking a wait-and-see approach.
"We don't know what the outcome will be 20 years down the road. That's the one thing that makes me cautious," said Orioles trainer Richie Bancells. "Be careful. Be sure you are doing it under supervision. Take all the precautions that you can. There are some things that we know, but a lot more that we don't know."
Anaheim Angels trainer Rick Smith agreed. "We let them make their own decisions," he said, "but we ask them if they are taking it, to take it in low doses."
He added that he prefers the old-fashioned method of building a strong body. "I like three square meals a day. Good eating. Lots of fluids. Lots of rest and exercise."
Even if long-term use of creatine and protein powder prove to be safe to the major organs, the benefits of abnormal muscle mass to certain kinds of athletes -- particularly baseball players -- remains in question.
The use of anabolic steroids has faded because of the serious health problems associated with it, but even before conclusive evidence emerged that steroids were life-threatening, there was anecdotal evidence the muscle mass was leading to a higher incidence of soft-tissue injuries.
It's only logical that added pounds of muscle are going to put extra strain on the skeletal system.
There is also concern that the heightened kidney and liver functions necessary to process the protein-like substance will have adverse effects.
The Association of Professional Team Physicians reported that 85 percent of its members recommend against creatine pending further studies. The Tampa Bay Buccaneers have banned it from the locker room, and the San Diego Padres discouraged use late last season after a string of hamstring and groin injuries.
Perhaps the best testimonial against the use of creatine and protein supplements comes from a guy who doesn't use either. Orioles iron man Cal Ripken said he does not use any muscle-building supplements -- other than milk, for which he is a paid spokesman -- and who can argue with his record of athleticism, endurance and durability?
"I guess I'm a little bit old-school," said Ripken. "It just seems like the development of all the nutrition and sports enhancement was a little after my time. I've always done things a certain way -- eaten certain foods, gotten proper rest. The old way is the right way for me."
A look at creatine
What is creatine? A natural compound found in meat and fish, creatine is also created by the human liver and kidneys. Athletes take supplemental doses of it to increase energy.
Pros of creatine: Creatine builds muscle mass, adds energy, reduces rehabilitation time. Athletes believe it allows them to run faster and lift heavier weights.
Cons of creatine: It can cause cramps, dehydration, muscle xTC strains and pulls. Overuse of creatine can cause dizzy spells and stomach pains.
Routine creatine program: Consists of 20 grams per day during a loading phase of at least one week, then three to five grams per day during training. Creatine can be taken as powder, liquid or pills.
Who can take creatine: Only those who are working out should take creatine, and nobody who has yet to hit puberty.
Long-term side effects: None is reported and confirmed.
Where is creatine sold?: Wherever dietary supplements are sold, such as gyms, health-food stores and some grocery stores. You also can purchase creatine via the Internet.
How much does it cost? Between $11 and $44 per month.
Professional league policies on creatine: MLB, NBA, NHL have no official policy. NFL has a "cautionary general policy."
Pub Date: 8/31/98