CREATINE'S PLACE IN SPORTS AND FITNESS

Amid scandals involving sports stars using steroids and other illicit¹ performance - enhancing drugs, a safe, natural alternative to such drugs is the holy grail² for athletes who want an edge. Since its appearance on the market in the 1990s, creatine has been welcomed as a valuable fitness tool, if not the holy grail. Reports on its effectiveness have varied considerably, but the overall consensus is that it does have some effect, and most importantly, it's safe. As with most relatively new products, however, that second part continues to be questioned.

Creatine is an amino acid³ produced in the body, and it is also present in small amounts in meat and fish. According to the Food and Drug Administration (FDA), a healthy person requires only two grams of creatine per day, half of which is produced in the body by the liver, kidneys, and pancreas. Among other roles, creatine helps cells utilize energy. Increasing creatine levels has been shown to improve the body's energy use, especially during short but intense bursts of strenuous⁴ exercise. This discovery led to the development of high-dose creatine supplements (up to twenty grams daily) as a performance enhancer and workout aid.

Creatine supplements are designed to enhance athletic performance by making more energy available to muscles during exercise. It can be effective for increasing short-term muscular stress endurance in contact sports like football and, especially, in weight training. In addition to facilitating cell metabolism, it draws water into muscle cells, which can help the production of muscle fiber. Creatine was first introduced to Olympic athletes to maximize muscle energy output. It has since enjoyed wide use among professional and amateur athletes.

But the supplement attracted criticism shortly after its introduction. Early studies questioned creatine's effects on endurance. The gains were only observed in bursts of activity of thirty seconds or less, and these findings curbed⁵ the enthusiasm of informed athletes hoping to increase their energy throughout long periods of exertion⁶, as are typical in most sports. Nonetheless, the effect remained relevant for certain sports, such as powerlifting. And studies confirmed that extra repetitions in workouts translated into greater muscle mass gains-provided those taking the supplements worked out regularly and ate an otherwise balanced diet.

Another cause for concern has been water retention. Athletes "loading" creatine at high doses tend to take on extra water weight-as much as five pounds' worth in the first week. But the retention occurs inside the muscle cells themselves, so rather than the bloating normally associated with water retention, creatine retention actually just makes the muscles larger-without any added muscle mass or strength. This effect has been found to be neutral at worst, and some research suggests it has a positive effect on motivation. Creatine's muscle-pumping effect can be a placebo⁷ of sorts, which provides an illusion of success that motivates athletes to work harder. Eventually, this translates into increases in muscle mass as well-but as a result of the extra exercise, not the water.

The debate on creatine supplement safety, however, has gone back and forth since the beginning. Mild side effects like abdominal discomfort and diarrhea⁸ are well established but not major concerns. Some early studies caused concern about links to kidney problems. Continued study, however, revealed no direct link between creatine and any known kidney disorder. Kidney disorders that involve tissue swelling, however, can be made worse by high doses of creatine, which increases tissue swelling even more. In simple terms, creatine won't cause kidney problems, but it can worsen existing ones. Early concerns about liver damage were not borne out by subsequent research. As with its effect on the kidneys, creatine won't cause liver problems, but it can swell liver tissue. A 2015 study by the Harvard School of Public Health linked creatine use to testicular⁹ cancer in young adults, finding that those who used the supplement were more likely to be diagnosed with the cancer. However, no additional studies have confirmed this finding, and a 2019 study actually found that creatine can help fight cancer.

Several public-health institutions, like the National Institutes of Health, conclude creatine is possibly effective for certain groups (excluding the elderly and already highly trained athletes). But they advise against creatine use for those under the age of eighteen, in part because its effects on the endocrine-or hormonal¹⁰—system are not yet well understood.

• muscle fiber
• kidney problems
• metabolize energy
• testicular cancer
• periods of exertion
• water retention

• abdominal 
• dose
• effectiveness
• illusion
• maximize
• metabolism

Drug Testing

Random drug testing is used by professional sports associations to catch athletes who are illegally trying to enhance their performance. In 1995, the US Supreme Court ruled that it was also legal for high schools and middle schools to randomly test student athletes for drugs. In 2002, the Supreme Court ruled that random drug tests could also be given to any student participating in any school-related competitions.

In an online survey conducted by the National Federation of State High School Associations (NFHS) and other groups in 2003, it was determined that thirteen percent of the nation's high schools had a general drug-testing policy in effect. A 2016 study determined the rate had increased to thirty- eight percent. But according to the US Anti-Doping Agency, very few of these programs include testing for sports-related drugs. Meanwhile, a survey conducted by the Partnership for Drug-Free Kids determined that steroid use has been increasing at a steady rate of five to ten percent per year and that the use of human growth hormone (HGH) has risen from five to seven percent. In other words, performance-enhancing drug use is on the rise. But testing is not.

There are several reasons for the relatively low rate of implementation of drug-testing programs in US public schools. The American Civil Liberties Union (ACLU) and other groups have argued that the Supreme Court decisions are an invasion of privacy and a violation of the Fourth Amendment to the Constitution, which protects individuals from unreasonable searches. Additionally, drug-testing programs may be considered too expensive in schools with limited budgets.