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W6
CREATINE: A PARENT'S NIGHTMARE
By Debra Gordon, InteliHealth Correspondent
It was a warm spring afternoon when Danny Stuben (name changed for privacy) approached home plate and stepped into the batter's box. As he swung the bat around, loosening up his muscles, the talented left fielder's mind should have been on helping his suburban Denver, Colo., high school team win the game. But he was focused on only one thing: Don't throw up. For that's all he wanted to do — had wanted to do for the past three days — since he'd started drinking a mixture of apple juice and creatine, a white, grainy powder. Creatine (KREE-a-teen) is an amino acid naturally produced in the body by the liver, pancreas and kidneys and then stored in muscles. Taken in powder form in doses larger than the human body produces, it is one of the most popular over-the-counter nutritional supplements on the market. Some people believe that it gives the body quick bursts of energy to boost performances in workouts and some athletic endeavors.Stuben had bought it at the local nutrition store after reading that his hero, Mark McGwire, the St. Louis Cardinals' first baseman who set the Major League record for home runs in a season, used it. A competitive kid, he figured the supplement would help him gain an edge, improve his speed and build up his upper body to add power to his swing. It was easy to buy, and he knew plenty of kids his age who used it, so he didn't even think to first check with his parents. Today, however, he felt nauseated, like he had the flu. He thought it might be the type of juice he was mixing the creatine in. Although he had switched to orange juice and then grape, he still felt sick. The salesman at the nutrition store didn't warn him about side effects, nor did the label on the large jug he'd purchased. Still, he kept drinking the creatine, carefully following the directions, hoping the sick feeling would diminish and the higher energy level would kick in. It never did. Stuben barely finished the game. With the last out, he ran for the locker room and vomited into the toilet for what felt like hours. Fearing more serious side effects, he stopped taking the creatine mixture. He feels betrayed, even a little embarrassed about how easily he bought into the promise of quick muscles and super performance from a product he says he really knew nothing about.What's more, Stuben's mother says she, too, knew nothing about creatine and didn't monitor Danny's use. Because it was a nutritional supplement, she assumed it was safe. Creatine is used by millions of Americans. Despite its popularity, scientists and medical doctors still know little about the substance and its effects on the human body. And this is especially true when it comes to teen-agers, who represent the fastest-growing segment of creatine users. Supplement manufacturers are trying to meet this demand. Today, in health and nutrition stores, on the Internet and through mail order, young people looking for products that promise better-looking and better-performing bodies have more than 50 different creatine products to pick from. "You can get it everywhere, even at [some] smoothie stores," says Joseph Chorley, M.D., who specializes in adolescent and sports medicine at Baylor College of Medicine in Houston. "You go in for a shake and there are 15 different supplements they're selling."Because it's considered a "natural" product, the U.S. Food And Drug Administration does not regulate creatine. As a result, creatine products don't have to undergo the same rigorous testing and approval process as other health-related products. "There's no other drug — and this is a drug — on the market that's ever given to a child before very comprehensive testing is done through the FDA," says Jordan D. Metzl, M.D., medical director of the Sports Medicine Institute For Young Athletes at Hospital For Special Surgery in New York. "And none has been done with creatine."Although there are no figures on the percentage of creatine purchased by kids, a 1999 Blue Cross-Blue Shield Association survey found nearly one in three youngsters aged 12 to 18 knew someone who used performance-enhancing substances, with more than half of those saying they knew someone using creatine.And a 1999 survey of 1,103 middle- and high-school athletes in Westchester County, New York, found that 44 percent of high school seniors admitted using creatine. "The most surprising thing is that we had kids taking this stuff at every grade level, even girls," Metzl says. Why the concern? There is evidence that creatine leaves teens more prone to muscle strains, and concern that long-term use may lead to kidney damage. Plus, since natural creatine is found not only in muscles but in the heart, brain and reproductive tract, there are questions about what taking supplements may mean for those organs in the long run. The FDA has received reports of more severe side effects, including seizures and even one death. Doses Larger Than Recommended
Typically, most manufacturers call for "loading doses" of 20 to 30 grams a day for one week — about the daily equivalent of eating 10 pounds of raw steak — followed by maintenance doses of 2 to 5 grams a day. There is no safe dose for teen-agers. In fact, researchers found that athletes tend to take more than the manufacturer's recommended dose, with 39 of 52 athletes in one study taking more than the recommended maintenance dose. Take too much and your body simply excretes what it doesn't need, putting unnecessary strain on your kidneys. It's this strain that is suspected of causing kidney damage in an otherwise healthy, 20-year-old man, a case reported in the New England Journal Of Medicine (March 11, 1999). He reportedly took 20 grams of creatine daily for four weeks.Even the manufacturers of creatine products have noticed that teen-age users want to get the maximum out of the supplement. When creatine manufacturer Muscle Marketing began selling a special creatine supplement just for teens called Teen Advantage (in wild cherry and grape flavors), it found teens ignored it. Company president and CEO Amir Zeibak suspects they feared it was a "low-dose" form of the supplement. Instead, the kids turned to a product the company markets to serious body builders, Xtra Advantage.Other Ingredients Added To Mixture
The potential for overdose aside, many of the manufactured creatine products that are marketed to kids include other natural or herbal supplements. Muscle Advantage's Teen Advantage, for instance, also contains the herb ginseng. "I'm not in favor of kids taking ginseng," says Andrew T. Weil, M.D., director of the program of integrative medicine and a clinical professor of medicine at Arizona College of Medicine in Tucson. "We don't know much about its effects on children, and it has hormonal effects.""If any of these kids were walking down the street and saw a candy bar, they wouldn't pick it up and eat it," says Edward Krenzelok, Pharm.D., director of the Pittsburgh Poison Center at Children's Hospital Pittsburgh, which has seen a dramatic increase in reports of children taking herbal and other "natural" supplements in the past year. "But they go to the gym and get stuff from their friends in a plastic bag or a jar and have no idea what they're dealing with."Donald J. Harnum, director of athletics and physical education at Susquehanna University, worries about the muscle and weight gain many kids exhibit when they start taking creatine. "Some of these kids aren't built to handle 280 or 300 pounds," he says. "It only makes sense that the increased muscle on a developing bone structure will lead to greater muscle and joint injury."There are other effects. A number of professional football teams use creatine to help their players increase their workout time. The University of Tennessee football team followed suit, letting their young players take the substance to bulk up. But that all changed when more than a dozen UT players were unable to finish even the first game of the 1999 season. Each was severely dehydrated, requiring intravenous fluids. Today, UT strongly discourages its athletes from taking creatine as part of their training program. Represents Loss Of Sportsmanship
Sometimes it's the parents themselves who push creatine, says Dick Katte, athletic director and basketball coach at Denver Christian High School in Denver. "If they see this [creatine] will enhance their kid's chances of having a bigger body, and therefore being recruited, they won't come across very strongly against them [using it]," he says. Metzl is concerned about not only the tacit condoning of creatine he sees from parents and coaches, but about the message it sends to teen athletes that winning is everything. Metzl thinks that this "just-win-at-all-costs" mentality starts to change sports from being fun and encouraging skills that will be important as kids grow up, like leadership, and instead, focuses on winning as the only objective. "I think that's wrong," he says. What's A Parent To Do?
Just saying "no" won't work, says Metzl, especially with teens. He recommends the following:· Keep the lines of communication with your teen always open. Get involved with your kids' athletics. This enables you to open a discussion about creatine and similar substances. · Let youngsters know that while these substances don't work, weight training does. "Basically, kids are looking to get better in sports and it's important to respect and encourage that. The key is to redirect that energy to weight training, because that's what's going to make them stronger," he says. · Encourage practice, patience, and striving to be the best that your teen can be. · Get to know the coach and athletic director, and the other kids and parents on the team. Teens need to appreciate the value of being part of a team. "These problems tend to travel in flocks; if a lot of kids are doing it at school or on a team, then your kid at least knows about it."
W6
CREATINE: A PARENT'S NIGHTMARE
By Debra Gordon, InteliHealth Correspondent
It was a warm spring afternoon when Danny Stuben (name changed for privacy) approached home plate and stepped into the batter's box. As he swung the bat around, loosening up his muscles, the talented left fielder's mind should have been on helping his suburban Denver, Colo., high school team win the game. But he was focused on only one thing: Don't throw up. For that's all he wanted to do — had wanted to do for the past three days — since he'd started drinking a mixture of apple juice and creatine, a white, grainy powder. Creatine (KREE-a-teen) is an amino acid naturally produced in the body by the liver, pancreas and kidneys and then stored in muscles. Taken in powder form in doses larger than the human body produces, it is one of the most popular over-the-counter nutritional supplements on the market. Some people believe that it gives the body quick bursts of energy to boost performances in workouts and some athletic endeavors.Stuben had bought it at the local nutrition store after reading that his hero, Mark McGwire, the St. Louis Cardinals' first baseman who set the Major League record for home runs in a season, used it. A competitive kid, he figured the supplement would help him gain an edge, improve his speed and build up his upper body to add power to his swing. It was easy to buy, and he knew plenty of kids his age who used it, so he didn't even think to first check with his parents. Today, however, he felt nauseated, like he had the flu. He thought it might be the type of juice he was mixing the creatine in. Although he had switched to orange juice and then grape, he still felt sick. The salesman at the nutrition store didn't warn him about side effects, nor did the label on the large jug he'd purchased. Still, he kept drinking the creatine, carefully following the directions, hoping the sick feeling would diminish and the higher energy level would kick in. It never did. Stuben barely finished the game. With the last out, he ran for the locker room and vomited into the toilet for what felt like hours. Fearing more serious side effects, he stopped taking the creatine mixture. He feels betrayed, even a little embarrassed about how easily he bought into the promise of quick muscles and super performance from a product he says he really knew nothing about.What's more, Stuben's mother says she, too, knew nothing about creatine and didn't monitor Danny's use. Because it was a nutritional supplement, she assumed it was safe. Creatine is used by millions of Americans. Despite its popularity, scientists and medical doctors still know little about the substance and its effects on the human body. And this is especially true when it comes to teen-agers, who represent the fastest-growing segment of creatine users. Supplement manufacturers are trying to meet this demand. Today, in health and nutrition stores, on the Internet and through mail order, young people looking for products that promise better-looking and better-performing bodies have more than 50 different creatine products to pick from. "You can get it everywhere, even at [some] smoothie stores," says Joseph Chorley, M.D., who specializes in adolescent and sports medicine at Baylor College of Medicine in Houston. "You go in for a shake and there are 15 different supplements they're selling."Because it's considered a "natural" product, the U.S. Food And Drug Administration does not regulate creatine. As a result, creatine products don't have to undergo the same rigorous testing and approval process as other health-related products. "There's no other drug — and this is a drug — on the market that's ever given to a child before very comprehensive testing is done through the FDA," says Jordan D. Metzl, M.D., medical director of the Sports Medicine Institute For Young Athletes at Hospital For Special Surgery in New York. "And none has been done with creatine."Although there are no figures on the percentage of creatine purchased by kids, a 1999 Blue Cross-Blue Shield Association survey found nearly one in three youngsters aged 12 to 18 knew someone who used performance-enhancing substances, with more than half of those saying they knew someone using creatine.And a 1999 survey of 1,103 middle- and high-school athletes in Westchester County, New York, found that 44 percent of high school seniors admitted using creatine. "The most surprising thing is that we had kids taking this stuff at every grade level, even girls," Metzl says. Why the concern? There is evidence that creatine leaves teens more prone to muscle strains, and concern that long-term use may lead to kidney damage. Plus, since natural creatine is found not only in muscles but in the heart, brain and reproductive tract, there are questions about what taking supplements may mean for those organs in the long run. The FDA has received reports of more severe side effects, including seizures and even one death. Doses Larger Than Recommended
Typically, most manufacturers call for "loading doses" of 20 to 30 grams a day for one week — about the daily equivalent of eating 10 pounds of raw steak — followed by maintenance doses of 2 to 5 grams a day. There is no safe dose for teen-agers. In fact, researchers found that athletes tend to take more than the manufacturer's recommended dose, with 39 of 52 athletes in one study taking more than the recommended maintenance dose. Take too much and your body simply excretes what it doesn't need, putting unnecessary strain on your kidneys. It's this strain that is suspected of causing kidney damage in an otherwise healthy, 20-year-old man, a case reported in the New England Journal Of Medicine (March 11, 1999). He reportedly took 20 grams of creatine daily for four weeks.Even the manufacturers of creatine products have noticed that teen-age users want to get the maximum out of the supplement. When creatine manufacturer Muscle Marketing began selling a special creatine supplement just for teens called Teen Advantage (in wild cherry and grape flavors), it found teens ignored it. Company president and CEO Amir Zeibak suspects they feared it was a "low-dose" form of the supplement. Instead, the kids turned to a product the company markets to serious body builders, Xtra Advantage.Other Ingredients Added To Mixture
The potential for overdose aside, many of the manufactured creatine products that are marketed to kids include other natural or herbal supplements. Muscle Advantage's Teen Advantage, for instance, also contains the herb ginseng. "I'm not in favor of kids taking ginseng," says Andrew T. Weil, M.D., director of the program of integrative medicine and a clinical professor of medicine at Arizona College of Medicine in Tucson. "We don't know much about its effects on children, and it has hormonal effects.""If any of these kids were walking down the street and saw a candy bar, they wouldn't pick it up and eat it," says Edward Krenzelok, Pharm.D., director of the Pittsburgh Poison Center at Children's Hospital Pittsburgh, which has seen a dramatic increase in reports of children taking herbal and other "natural" supplements in the past year. "But they go to the gym and get stuff from their friends in a plastic bag or a jar and have no idea what they're dealing with."Donald J. Harnum, director of athletics and physical education at Susquehanna University, worries about the muscle and weight gain many kids exhibit when they start taking creatine. "Some of these kids aren't built to handle 280 or 300 pounds," he says. "It only makes sense that the increased muscle on a developing bone structure will lead to greater muscle and joint injury."There are other effects. A number of professional football teams use creatine to help their players increase their workout time. The University of Tennessee football team followed suit, letting their young players take the substance to bulk up. But that all changed when more than a dozen UT players were unable to finish even the first game of the 1999 season. Each was severely dehydrated, requiring intravenous fluids. Today, UT strongly discourages its athletes from taking creatine as part of their training program. Represents Loss Of Sportsmanship
Sometimes it's the parents themselves who push creatine, says Dick Katte, athletic director and basketball coach at Denver Christian High School in Denver. "If they see this [creatine] will enhance their kid's chances of having a bigger body, and therefore being recruited, they won't come across very strongly against them [using it]," he says. Metzl is concerned about not only the tacit condoning of creatine he sees from parents and coaches, but about the message it sends to teen athletes that winning is everything. Metzl thinks that this "just-win-at-all-costs" mentality starts to change sports from being fun and encouraging skills that will be important as kids grow up, like leadership, and instead, focuses on winning as the only objective. "I think that's wrong," he says. What's A Parent To Do?
Just saying "no" won't work, says Metzl, especially with teens. He recommends the following:· Keep the lines of communication with your teen always open. Get involved with your kids' athletics. This enables you to open a discussion about creatine and similar substances. · Let youngsters know that while these substances don't work, weight training does. "Basically, kids are looking to get better in sports and it's important to respect and encourage that. The key is to redirect that energy to weight training, because that's what's going to make them stronger," he says. · Encourage practice, patience, and striving to be the best that your teen can be. · Get to know the coach and athletic director, and the other kids and parents on the team. Teens need to appreciate the value of being part of a team. "These problems tend to travel in flocks; if a lot of kids are doing it at school or on a team, then your kid at least knows about it."
