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Creatine Supplementation in High School Athletes

Based on their recently completed survey of high school athletes, Mayo Clinic doctors are recommending a large-scale study on the use and long-term effects of creatine, a supplement used by athletes who believe it enhances athletic performance. The survey of high school athletes completed at the Mayo Clinic Sports Medicine Center showed that users of creatine usually rely on friends for their information about the supplement and most either aren’t aware of the dosages they take or take more than the recommended amounts.

The Mayo Clinic authors used anonymous surveys returned by male and female high school athletes during the August 1999 pre-participation examinations to determine the level of use and knowledge about creatine. Of the 328 students surveyed (182 males and 146 females), 27 athletes (26 male, 1 female) or 8.2 per cent, reported creatine use. Most of the users were high school football players, who received their information about it from friends. And most of them reported they did not know how much creatine they were taking or reported taking amounts that were more than the recommended doses.

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The article “Creatine Use Among a Select Population of High School Athletes,” appears in the December issue of Mayo Clinic Proceedings, and is among the first to look at the use of creatine among users in the 14 to 18-year-old age group.

Creatine users in this population reported relatively minor side effects, such as diarrhoea, cramps and loss of appetite. Multiple studies have failed to document performance enhancement with creatine supplementation, the authors report.

Both the Food and Drug Administration (FDA) and the National Collegiate Athletic Conference (NCAA) have expressed concern about creatine supplementation practices. Anecdotal reports of muscle cramping, strains, dehydration, gastrointestinal distress, nausea and seizures have emerged, but long-term prospective population-based studies are lacking.

Creatine use has generally outpaced scientific study and athletes at all levels may feel that it is a “safe” alternative to anabolic steroids. A 1997 survey of NCAA athletes found almost one-third reporting the use of creatine, while the use of creatine by American professional football players has been estimated from 25 to 75 percent.

“Given the uncertainties regarding effects and side effects of creatine supplementation in the high school population, healthcare professionals should strive to become unbiased sources of information for athletes regarding the use of creatine,” the authors write. The authors also stressed that further study of larger groups of high school athletes is warranted.

Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 120,000 nationally and internationally.

Creatine Supplementation in High School Athletes

There is a growing concern within the sports medicine community about the use of performance-enhancing supplements by high school athletes. Often, nutritional supplements are specifically marketed to young athletes with claims that are not substantiated with sound research. In some cases, the use of nutritional supplements may even pose a health risk to young athletes.

Unfortunately, sports medicine professionals and educators do not truly realize the scope of supplementation use in young athletes. Therefore, Jude Sullivan and Tim McGuine, two researchers at the UW Health Sports Medicine Center in Madison, Wisconsin, surveyed student-athletes to study usage patterns and knowledge regarding the popular supplement, creatine. This study was funded by the Sports Medicine Classic Research Fund and the Wisconsin Athletic Trainers Association.

Creatine is a nutritional supplement used to enhance performance and has been widely used for years by professional and collegiate athletes. National media have reported on how creatine supplementation has enhanced the performance of well-known professional athletes in baseball, football and track.

It is not surprising then, to recognize that high school athletes use creatine in an effort to emulate these professionals. Recently, several Wisconsin newspapers reported that high school athletes are increasingly turning to supplements in an effort to gain weight and build strength.

Creatine is found naturally in meat products and is used by the body to supply energy to muscle cells during high-intensity exercise. It is a legal substance that is sold in most health food stores and through numerous internet sites.

Despite its widespread use, research offers conflicting reports on the effectiveness of creatine. Reports of mild, adverse health effects with short-term use have been anecdotal. These include increased risk of dehydration, muscle cramping and gastric upset.

The health risks associated with long-term creatine supplementation are unknown. Recently, sports governing bodies such as the Wisconsin Interscholastic Athletic Association and the National Federation of High Schools have issued statements that denounce the use of creatine in high school athletes.

To determine the prevalence of creatine supplementation in high school athletes, the UW research team surveyed 4011 athletes from 37 high schools across Wisconsin during the 1999-2000 school year. The surveyors asked questions regarding the age, grade level and type of sport participation. The athletes were asked whether they have used or are currently using creatine. In addition, the athletes were asked about their perceptions of the benefits and risks associated with creatine use. Finally, the respondents were asked who encouraged or discouraged them from using creatine.

While not all the results have been analyzed, some preliminary findings are:

Twenty-five per cent of males and 3.5 per cent of female athletes reported using creatine.

Most athletes started using creatine when they were 16 years old.

Participants in all sports reported using creatine. The highest rates (20% – 30%) were found in track, football, baseball and hockey athletes. The lowest rates were in softball and gymnastics (
3%).

The rate of creatine use was lowest for freshman (7%) and highest for seniors (24%).

Athletes listed friends as most likely to encourage creatine use while parents and coaches were listed as providing information that discouraged creatine use.

As a result of this research, Ryan Berry, an athletic trainer and health educator at the UW Health Sports Medicine Center has developed instructional materials on creatine supplementation. This packet provides factual information and encourages students to think critically about the issue of nutritional supplementation. Coaches and health educators can use this information as part of a health education curriculum for young athletes.

In the future, researchers will expand the study and continue to explore the use of nutritional sports supplements by high school athletes.

CREATINE USE AMONG HIGH SCHOOL ATHLETES: AN EPIDEMIOLOGICAL SURVEY J.Smith, D.L.Dahm. Mayo Clinic, Rochester, MN (Sponsor: E. Laskowski, FACSM)

The purpose of this study was to determine the frequency and patterns of creatine (Cr) use among high school varsity athletes. All 327 high school varsity athletes (179 males, 148 females) aged 14-18 years (mean 15.2±1.3) attending a single day of the 1999 preparticipation examination program completed an anonymous questionnaire regarding Cr use (100% response rate). Twenty-seven of 327 athletes (8.3%) reported Cr use (creatine users), including 26 males and 1 female (mean age 16.4±1.3 years). Fifty-two pecent of this group (4.3% of 327 athletes) reported current Cr use. Among Cr users, football was the most commonly reported primary sport (78%). Seventy percent of users took Cr daily or weekly, 55% were unaware of the dose they were taking, and of those who reported their dosing, 50% took more than 5 g/day when using Cr. Seventy-four percent of users listed friends as the primary source of Cr information, and 86% obtained Cr at a health food store. Seventy-nine per cent believed Cr improved performance; however, 20% reported side effects.

Side effects included appetite loss, diarrhoea, and cramps. Seventy per cent had used other nutritional supplements, while none had used anabolic steroids. Eighty-two per cent knew others who used Cr, and 11% knew others who use steroids. Twenty-nine per cent of Cr users suggested that they would like more information regarding Cr supplementation. These are the first data reporting Cr use patterns among high school athletes, an age group not included in previously published scientific studies pertaining to Cr use.

The data indicate that approximately 8% of the high school varsity athletes in our area use Cr. The typical user is a 16-year-old male football player who believes Cr improves performance, uses Cr regularly at an unknown or higher than the recommended dose, receives Cr information primarily from friends, and purchases Cr at local health food stores. Side effects appear to be relatively uncommon. Further research and education regarding Cr use are necessary among high school athletes.

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