The Creatine and Andro Controversy

By Jim Kotorac, D.C.

Androstenedione and creatine have exploded on the health and fitness scene, and unfortunately it will be several years to a decade or more until we know the whole truth about these supplements. The available literature is confusing, the positive claims are exaggerated and few proponents who don't actually own a piece of them will give them a clean bill of health.

Androstenedione, referred to generally as andro, is being classified more frequently today by health professionals in the know in the same class of anabolic steroid that it so closely mimics. Anabolic steroids are all synthetic forms of the male hormone testosterone. The chemical structure of andro differs from testosterone by only a solitary hydrogen atom.

Besides the buzz created by Mark McGuire taking andro during his 70-home run season, the early studies related results of increased muscle strength and size, as well as increased recovery speed from exercise. The early studies were manufacturer-driven.

A recent independent study found that there was no measurable increase in muscle strength. Negative effects were reported including lowering of HDL (the body's good cholesterol) and more importantly increases in estrogen. The female hormone estrogen also rises in the bodies of anabolic steroid users. In males this can lead to activation and enlargement of mammary glands (breasts), pancreatic cancer and heart disease.

The list of those wishing to ban the supplement is steadily growing. From researchers like Dr. Charles Yesalis at Penn State, to Dr. Robert Gotten, director of orthopedic and sports rehabilitation at Beth Israel Medical Center. From federal drug czar Barry McCaffrey even to Dr. Scott Connelly, owner of creatine-laced Met-Rx who says:

"Teenagers should stay away from it. The interplay of an adolescent's hormones is highly sophisticated and regulated in the body. Using androstenedione is potentially very disruptive." Connelly predicts that even- tually it will fall out of favor with athletes because it is not an efficient muscle-builder.

Creatine is an amino acid that is present naturally in food and is also synthesized within the body. Humans have an estimated daily requirement of two grams. Generally one gram is ingested through food (mainly meat and fish, but also to a lesser extent in plants) and the other is synthesized via the liver, kidneys, and pancreas from three amino acids: arginine, glycine and methionine.

Creatine phosphate is the useful form inside the body. The supplemental source is creatine monohydrate, which is converted in the body to creatine phosphate. Early manufacturer-driven studies report an increase in body weight and strength. Independent studies have shown gains to be present, but less dramatic and only in up to 70 percent of subjects tested.

The strong physiological changes with creatine use were not as clearly understood as those with andro, but researches are looking at kidney and liver damage from long-term use. When the creatine phosphate gives up its phosphate to recycle ATP, the resultant creatine is then transported to the kidneys and excreted in the urine as creatinine. High output of this byproduct can be damaging.

Users of creatine have reported diarrhea, dizziness, and headaches. Perhaps, most alarming to athletes is a high correlation of muscle strains, tears and cramping. This is most likely caused by dehydration, as the body is forced to expend fluids to filter out the end product creatinine.

Sports teams and trainers are very mixed on the creatine use. The Cincinnati Bengals and Tampa Bay Buccaneers ban the supplement, while the Denver Broncos have designated it their official supplement. St. Johns and the Los Angeles Lakers supply their players with it. Syracuse and Cornell barred their athletes from using it, and many trainers sit on the fence, leaving it up to their players without the benefit of solid proof to give a definitive statement. New York Mets trainer Fred Hina stated, "We felt the risks outweighed the benefits."

Logic would dictate that since the body can synthesize it from three amino acids, and there have been side effects reported with creatine monohydrate, it is better to take the aminos instead. A blend of 20-plus freeform amino acids is your best bet, as many amino acids have been found to be valuable in a muscle growth and repair via different chemical and physiological pathways. While nutritional supplementation has played a huge role in creating stronger, faster and more durable athletes, caution must also be exercised a choosing the right supplement and taking any potential long-term effects into consideration.

Ed. note: After a losing battle with the Federal Trade Commission, California-based MET-Rx USA Inc. and Colorado-based AST Nutritional Concepts & Research Inc. agreed to include safety warnings in their ads and on their labels for supplements that contain androstenedione. (The Washington Post - click for complete story)