Since the 1990s, creatine has been a popular supplement used mainly to increase exercise performance. In our body, creatine is made from three amino acids: arginine, glycerine and methionine. And it’s made in three places: the kidneys, liver and pancreas. About one to two grams are made each day. We also get another gram or so from an average day’s intake of meat and fish.
Around 95% of the creatine in our body is found in skeletal muscle. One-third of this is free creatine and the other two-thirds exist as energy-rich phosphocreatine. When your body needs energy, phosphocreatine creates ATP—that is the source of energy for all the body’s cells. Creatine also increase the rate at which muscle protein is used, making muscle fibers bigger and helping with lean body mass. Supplements of creatine can actually prevent tissue damage by strengthening the membranes around each cell.
There are many articles about creatine’s impact on exercising. But only in the last 15 years have scientists looked at how creatine might help reverse the muscle weakness and fatigue caused by so many diseases. To that end, let’s take a look.
Affect on Heart and Lungs
Heart failure (CHF) and Chronic Obstructive Lung Disease (COPD) are common diseases in the U.S. A symptom of both is shortness of breath when moving around. This is caused by impaired skeletal muscle function. Your muscle function depend on several factors: blood flow, amount of muscle mass, type of muscle fiber, and energy burned in the muscle. Changes in any factors plays a key role in weakened muscles.
Muscle performance consists of two parts: strength and endurance. Strength is the force it can exert and endurance is its ability to sustain a certain force over a certain period of time. Losing either results in muscle weakness. Now, both diseases here involve muscle weakness—especially those in your limbs and any involved in breathing. One of the major reasons why CHF or COPD patients stop exercising is because their leg muscles are tired.
Several things cause this weakness:
• Low oxygen levels or reduced blood flow
• Oxidative stress
• Deficiencies in nutrients
• Medications (e.g. steroids)
• Muscle not used enough
People have used, with variable success, exercise training, nutritional supplements, anabolic steroids, and anti-inflammatory drugs to help their muscles. Since it is known that the creatine levels are low in both the heart and skeletal muscles, there are several studies that’ve used creatine for CHF and COPD. Here’s what they found:
1. In 17 CHF patients, 20 g of creatine/day was used for 10 days. It increased muscle strength and endurance. It made available more energy-rich phosphates in the muscles.1
2. In 20 CHF patients, 20 g a day was used for five days. Creatine improved skeletal muscle endurance and the muscle’s response to exercise.2
3. In 20 CHF patients, 20 g was used for six weeks. It led to increased body weight and improved muscle strength.3
4. In 38 patients with COPD, daily creatine increased fat-free muscle mass, improved limb muscle performance, improved muscle strength and endurance at the knee, and improved general health status.4
Affect on Parkinson’s
Roughly one million Americans have Parkinson’s disease. Another two million may have it but not know it yet. Last year, a promising study had 200 patients taking 10 g/day of creatine mixed with 200 mg a day of an antibiotic (“minocycline”).5 It came back with good results on creatine’s ability to help with the muscle problems experienced by Parkinson’s patients.
And as a result, a government study is now underway with more than 1,700 patients in 51 clinics across the country. Researchers are comparing the effects of creatine on the quality of life, ability to walk, cognitive function, and the ability to carry out activities of daily living.
Affect on Joint Pain
About 2.5 million Americans have rheumatoid arthritis. It’s a chronic kind of joint pain with no great cure. In it, patients loose body cell mass—mostly muscle. The average loss among these patients is between 13 and 15%. Even five percent can affect muscle strength, raise risk of infection, and mess with the use of energy.
The causes of this loss are thought to be fourfold: 1) more inflammatory chemicals causing this destructive joint disease; 2) patients burning through more energy; 3) muscle proteins breaking down in the face of inflammatory chemicals; and 4) reduced physical activity due to joint pain, and thus loss of muscle strength.6
Could creatine help? In a Swiss study,12 patients were treated first with 20 g a day (five days) and then with 2 g a day (16 days).7 Creatine resulted in increased muscle strength for eight out of 12 patients, including a rise in blood and skeletal muscle levels. Although promising, this was a small study. Future better-designed, large clinical trials are needed to confirm the positive results in this study.
What about creatine for a variety of musculoskeletal diseases? Here’s a look at some notable findings where it’s been found promising:
• Spinal cord injury8
• Duchene muscular dystrophy9
• Hereditary muscle diseases10.
• Dermatomyositis or polymyositis11
• Age-related loss of muscle strength and muscle mass12
1. Gordon A et al: Creatine supplementation in chronic heart failure increases skeletal muscle creatine phosphate and muscle performance. Cardiovasc Res 1995; 30:413-8
2. Andrews R et al: The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Europ Heart J 1998:19:617-622
3. Kuethe F et al: Creatine supplementation improves muscle strength in patients with congestive heart failure. Pharmazie 2006;61:218-22
4. Fuld JP et al: Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 2005;60:531-7
5. A randomized, double-blind, futility clinical trial of creatine and minocycline in early Parkinson disease. Neurology 2006;66:664-71
6. Rall LC and Roubenoff: Rheumatoid cachexia: metabolic abnormalities, mechanisms and interventions. Rheumatology 2004;43:1219-23
7. Willer B et al: Effects of creatine supplementation on muscle weakness in patients with rheumatoid arthritis. Rheumatology 2000;39:293-8
8. Jacobs PL et al: Oral creatine supplementation enhances upper extremity work capacity in persons with cervical level spinal cord injury. Arch Phys Med Rehabil 2002;83:19-23)
9. Tarnopolsky MA et al: Creatine monohydrate enhances strength and body composition in Duchene muscular dystrophy. Neurology 2004; 62: 1771-7
10. Kley RA et al: Creatine for treating muscle disorders. Cochrane Database Syst Rev 2007;24: (1):CD004760
11. Chung YL et al: Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment: Six-month, double-blind, randomized, placebo-controlled trial. Arthritis & Rheumatism May 15, 2007;57:694–702
12. Rawson ES et al: Effects of 30 days of creatine ingestion in older men. Eur J Appl Physiol Occup Physiol 1999; 80:139-44; Chrusch MJ et al: Creatine supplementation combined with resistance training in older men. Med Sci Sports Exerc 2001;33: 2111-7; Gotshalk LA et al: Creatine supplementation improves muscular performance in older men. Med Sci Sports Exerc. 2002; 34: 537-43