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Creatine: More than a sports nutrition supplement
Muscle Building Nutrition Diet Supplements Revealed
Creatine and neuromuscular diseases 
One of the most promising areas of research with creatine is its effect on
neuromuscular diseases such as MD. One study looked at the safety and efficacy
of creatine monohydrate in various types of muscular dystrophies using a double
blind, crossover trial. Thirty-six patients (12 patients with
facioscapulohumeral dystrophy, 10 patients with Becker dystrophy, eight patients
with Duchenne dystrophy and six patients with sarcoglycan-deficient limb girdle
muscular dystrophy) were randomized to receive creatine or placebo for eight
weeks. The researchers found there was a "mild but significant improvement" in
muscle strength in all groups. The study also found a general improvement in the
patients' daily-life activities as demonstrated by improved scores in the
Medical Research Council scales and the Neuromuscular Symptom scale. Creatine
was well tolerated throughout the study period, according to the researchers.1Another group of researchers fed creatine monohydrate to people with neuromuscular disease at 10 grams per day for five days, then reduced the dose to 5 grams per day for five days. The first study used 81 people and was followed by a single-blinded study of 21 people. In both studies, body weight, handgrip, dorsiflexion and knee extensor strength were measured before and after treatment. The researchers found "Creatine administration increased all measured indices in both studies." Short-term creatine monohydrate increased high-intensity strength significantly in patients with neuromuscular disease.2 There have also been many clinical observations by physicians that creatine improves the strength, functionality and symptomology of people with various diseases of the neuromuscular system. Creatine and neurological protection/brain injury If there is one place creatine really shines, it's in protecting the brain from various forms of neurological injury and stress. A growing number of studies have found that creatine can protect the brain from neurotoxic agents, certain forms of injury and other insults. Several in vitro studies found that neurons exposed to either glutamate or beta-amyloid (both highly toxic to neurons and involved in various neurological diseases) were protected when exposed to creatine.3 The researchers hypothesized that "… cells supplemented with the precursor creatine make more phosphocreatine (PCr) and create larger energy reserves with consequent neuroprotection against stressors." More recent studies, in vitro and in vivo in animals, have found creatine to be highly neuroprotective against other neurotoxic agents such as N-methyl-D-aspartate (NMDA) and malonate.4 Another study found that feeding rats creatine helped protect them against tetrahydropyridine (MPTP), which produces parkinsonism in animals through impaired energy production. The results were impressive enough for these researchers to conclude, "These results further implicate metabolic dysfunction in MPTP neurotoxicity and suggest a novel therapeutic approach, which may have applicability in Parkinson's disease."5 Other studies have found creatine protected neurons from ischemic (low oxygen) damage as is often seen after strokes or injuries.6 Yet more studies have found creatine may play a therapeutic and or protective role in Huntington's disease7, 8 as well as ALS (amyotrophic lateral sclerosis).9 This study found that "… oral administration of creatine produced a dose-dependent improvement in motor performance and extended survival in G93A transgenic mice, and it protected mice from loss of both motor neurons and substantia nigra neurons at 120 days of age. Creatine administration protected G93A transgenic mice from increases in biochemical indices of oxidative damage. Therefore, creatine administration may be a new therapeutic strategy for ALS." Amazingly, this is only the tip of the iceberg showing creatine may have therapeutic uses for a wide range of neurological disease as well as injuries to the brain. One researcher who has looked at the effects of creatine commented, "This food supplement may provide clues to the mechanisms responsible for neuronal loss after traumatic brain injury and may find use as a neuroprotective agent against acute and delayed neurodegenerative processes." Creatine and heart function 
Because it is known that heart cells are dependent on adequate levels of ATP to
function properly, and that cardiac creatine levels are depressed in chronic
heart failure, researchers have looked at supplemental creatine to improve heart
function and overall symptomology in certain forms of heart disease. It is well
known that people suffering from chronic heart failure have limited endurance,
strength and tire easily, which greatly limits their ability to function in
everyday life. Using a double blind, placebo-controlled design, 17 patients aged
43 to 70 years with an ejection fraction <40 were supplemented with 20 grams of
creatine daily for 10 days. Before and after creatine supplementation, the
researchers looked at:1) Ejection fraction of the heart (blood present in the ventricle at the end of diastole and expelled during the contraction of the heart) 2) 1-legged knee extensor (which tests strength) 3) Exercise performance on the cycle ergometer (which tests endurance) Biopsies were also taken from muscle to determine if there was an increase in energy-producing compounds (i.e., creatine and creatine phosphate). Interestingly, but not surprisingly, the ejection fraction at rest and during the exercise phase did not increase. However, the biopsies revealed a considerable increase in tissue levels of creatine and creatine phosphate in the patients getting the supplemental creatine. More importantly, patients getting the creatine had increases in strength and peak torque (21%, P < 0.05) and endurance (10%, P < 0.05). Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine (P < 0.05). After just one week of creatine supplementation, the researchers concluded: "Supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance. This new therapeutic approach merits further attention."10 Another study looked at the effects of creatine supplementation on endurance and muscle metabolism in people with congestive heart failure.11 In particular the researchers looked at levels of ammonia and lactate, two important indicators of muscle performance under stress. Lactate and ammonia levels rise as intensity increases during exercise and higher levels are associated with fatigue. High-level athletes have lower levels of lactate and ammonia during a given exercise than non-athletes, as the athletes' metabolism is better at dealing with these metabolites of exertion, allowing them to perform better. This study found that patients with congestive heart failure given 20 grams of creatine per day had greater strength and endurance (measured as handgrip exercise at 25%, 50% and 75% of maximum voluntary contraction or until exhaustion) and had lower levels of lactate and ammonia than the placebo group. This shows that creatine supplementation in chronic heart failure augments skeletal muscle endurance and attenuates the abnormal skeletal muscle metabolic response to exercise. It is important to note that the whole-body lack of essential high energy compounds (e.g. ATP, creatine, creatine phosphate, etc.) in people with chronic congestive heart failure is not a matter of simple malnutrition, but appears to be a metabolic derangement in skeletal muscle and other tissues.12 Supplementing with high energy precursors such as creatine monohydrate appears to be a highly effective, low cost approach to helping these patients live more functional lives, and perhaps extend their life spans. Conclusion 
Creatine is quickly becoming one of the most well researched and promising
supplements for a wide range of diseases. It may have additional uses for
pathologies where a lack of high energy compounds and general muscle weakness
exist, such as fibromyalgia. People with fibromyalgia have lower levels of
creatine phosphate and ATP levels compared to controls.13 Some studies also
suggest it helps with the strength and endurance of healthy but aging people as
well. Though additional research is needed, there is a substantial body of
research showing creatine is an effective and safe supplement for a wide range
of pathologies and may be the next big find in anti-aging nutrients. Although
the doses used in some studies were quite high, recent studies suggest lower
doses are just as effective for increasing the overall creatine phosphate pool
in the body. Two to three grams per day appears adequate for healthy people to
increase their tissue levels of creatine phosphate. People with the
aforementioned pathologies may benefit from higher intakes, in the 5-to-10 grams
per day range.About the Author - William D. Brink Will Brink is a columnist, contributing consultant, and writer for various health/fitness, medical, and bodybuilding publications. His articles relating to nutrition, supplements, weight loss, exercise and medicine can be found in such publications as Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Penthouse, Women’s World and The Townsend Letter For Doctors. He is the author of Priming The Anabolic Environment and Weight
Loss Nutrients Revealed. He is the Consulting Sports Nutrition Editor and a
monthly columnist for Physical magazine and an Editor at Large for Power
magazine. Will graduated from Harvard University with a concentration in the
natural sciences, and is a consultant to major supplement, dairy, and
pharmaceutical companies. See Will's ebooks online here:
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Although creatine offers an array of benefits, most people think of it simply as
a supplement that bodybuilders and other athletes use to gain strength and
muscle mass. Nothing could be further from the truth.
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