Title: Effects of Long-term Creatine Supplementation on Liver and Kidney Functions in American College Football Players.

Researchers: Mayhew DL, Mayhew JL, Ware JS

Institution: Exercise Science Program at Truman State University, Kirksville, MO 63501 and the Athletic Department at Truman State University, Kirksville, MO.

Summary: The purpose of this study was to determine the effect of long-term Cr supplementation on blood parameters reflecting liver and kidney function.

Methods: Twenty-three members of an NCAA Division II American football team (ages = 19-24 years) with at least 2 years of strength training experience were divided into a Cr monohydrate group (CrM, n = 10) in which they voluntarily and spontaneously ingested creatine, and a control group (n = 13) in which they took no supplements. Individuals in the CrM group averaged regular daily consumption of 5 to 20g for 0.25 to 5.6 years. Venous blood analysis for serum albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, urea, and creatinine produced no significant differences between groups.

Results: Creatinine clearance was estimated from serum creatinine and was not significantly different between groups. Within the CrM group, correlations between all blood parameters and either daily dosage or duration of supplementation were nonsignificant.

Conclusion: Oral supplementation with CrM has no long-term detrimental effects on kidney or liver functions in highly trained college athletes in the absence of other nutritional supplements.

Discussion: Questions about creatine's safety are probably the most frequently brought up by people who don't like (and usually don't understand) supplements. This study by Mayhew and colleagues is a welcome addition to the already growing body of creatine safety research. (1,2,3,4,5,6,7)

Most questions revolve around the effects of creatine supplementation on the liver and kidney. These are the two organs are involved in "processing" creatine once it is ingested. The Liver breaks it down and the kidneys excrete it. From this study, and others before it, we see that long term supplementation with creatine in doses usually taken by bodybuilders (5-20 grams) for extended periods of time do not lead to dysfunction of either organ, nor does it cause abnormalities in the indicators of liver and kidney function.

Considering that fact that creatine supplementation has been shown to enhance anaerobic exercise performance by increasing power output (8), muscular strength and work (9,10,11), and muscle fiber size (12), and to top it off, completely safe even with long term supplementation, its no wonder this is one of my first tier recommendation for effective and safe supplements for putting on muscle size.

Additional References:

1: Poortmans JR, Auquier H, Renaut V, Durussel A, Saugy M, Brisson GR. Effect of short-term creatine supplementation on renal responses in men. Eur J Appl Physiol Occup Physiol. 1997;76(6):566-7.

2: Poortmans JR, Francaux M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci Sports Exerc. 1999 Aug;31(8):1108-10.

3: Terjung RL, Clarkson P, Eichner ER, Greenhaff PL, Hespel PJ, Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA, Wagenmakers AJ, Williams MH. American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc. 2000 Mar;32(3):706-17.

4: Robinson TM, Sewell DA, Casey A, Steenge G, Greenhaff PL. Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function. Br J Sports Med. 2000 Aug;34(4):284-8.

5: Poortmans JR, Francaux M. Adverse effects of creatine supplementation: fact or fiction? Sports Med. 2000 Sep;30(3):155-70.

6: Schilling BK, Stone MH, Utter A, Kearney JT, Johnson M, Coglianese R, Smith L, O'Bryant HS, Fry AC, Starks M, Keith R, Stone ME. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc. 2001 Feb;33(2):183-8.

7: Benzi G, Ceci A. Creatine as nutritional supplementation and medicinal product. J Sports Med Phys Fitness. 2001 Mar;41(1):1-10.

8: Earnest CP, Snell PG, Rodriguez R, Almada AL and Mitchell TL (1995) The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition. Acta Physiol Scand 153: 207-209

9: Casey A, Constantin-Teodosiu D, Howell S, Hultman E and Greenhaff PL (1996) Creatine ingestion favorably affects performance and muscle metabolism during maximal exercise in humans. Am J Physiol 271: E31-E37

10: Vandenberghe K, Goris M, Van Hecke P, Van Leemputte M, Vangerven L and Hespel P (1997) Long-term creatine intake is beneficial to muscle performance during resistance training. J Appl Physiol 83: 2055-2063

11: Volek JS, Duncan ND, Mazzetti SA, Staron RS, Putukian M, Gomez AL, Pearson DR, Fink WJ and Kraemer WJ (1999) Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc 31: 1147-1156

12: Volek JS, Duncan ND, Mazzetti SA, Staron RS, Putukian M, Gomez AL, Pearson DR, Fink WJ and Kraemer WJ (1999) Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc 31: 1147-1156

I frequently hear comments both for and against tweaking or personalizing HST on an individual basis. This is to be expected among people who are real enthusiasts of weight training. You also find this irresistible urge to tweak among other enthusiasts such as audiophiles. An audiophile will go out and spend obscene amounts of money on the highest end exotic equipment they can find. But this isn't good enough! They must find some way to "tweak" it, some way to make it their own delectable creation. Anything from placing the turntable on a 3 inch marble slab, putting sand bags on and/or in the speakers, or using speaker wire that cost as much as the car you used to drive to the store. Whenever you find people who are really into what they are doing, they will try to find ways not only to squeeze out the last bit of performance, but also make it their own creation.

I think it comes down to a couple issues which I'll address after a short review for those new to HST.

First let me clarify that HST is based on physiologically sound principles, not numbers. In short, they are:

• Progressive load
• Training volume
• Training frequency
• Conditioning (Repeated Bout effect)/Strategic Deconditioning

So we are dealing with 4 basic issues, Load, Volume, Frequency and Conditioning. Within these basic factors we have reps, sets, and rest. HST differs from previous training methods in many aspects, but particularly in how it incorporates knowledge of how the "cell" physiologically responds to the training stimulus in its methodology. Previous methods focus on effort (A.K.A Intensity), current voluntary strength, and psychological factors such as fatigue and variety (i.e. many different exercises).

• The number of Reps is determined by the minimum effective load (this changes over time based on Conditioning)
• The number of Sets is determined by the minimum effective volume (this changes over time according to current load and Conditioning status.)
• The Rest between sets is determined by the amount of time required to regain sufficient strength to successfully achieve the minimum effective Volume.
• The Frequency (rest between workouts) is determined by the ability of the CNS to recover sufficiently to maintain baseline "health" indicators. It is also determined by the time course of genetic expression resultant from the previous workout.
• The interval of Strategic Deconditioning (SD) is determined by the time course of adaptation to the individuals maximum weight loads. In other words, SD is required to reset growth potential after plateauing. The duration of SD is determined by the level of conditioning attained during the training cycle.

Anyone who argues with these points after understanding them correctly is in error. That is a strong statement but it is true. These are principles that we "know" from research and experience. The data from this research is not theoretically based. It is based on identification, measurements, and direct microscopic observation. All future research will show us is more genetic detail, NOT that we were wrong on some sort of fundamental basis. So, anyone can with confidence apply these principles to their training and successfully induce muscular hypertrophy.

If anyone should attempt to apply these principles and not experience some degree of muscle growth, it is not because the principles are wrong, it is because the application of the principles was flawed. Once again, another strong statement, but it is true. For example, just because you plant a garden and water it does not mean you will successfully grow prize-winning vegetables. Does this mean that your garden acted by some other mysterious agricultural principles other than those based on water, sunlight and soil? Of course not! We "know" the principles of growing plants. Where we fail, is in our application of those known principles.

The application is where the details lie. Issues such as how much, how many, how fast, when and where to name a few.

Whether it be growing plants, or growing muscle, you are dealing with a moving target. Because plants are alive, or put another way, because plants are biological systems, the best application of agricultural principles to grow vegetables will change as conditions change. The same is true for the application of the principles of hypertrophy or muscle growth. The application will change as conditions change. All the while, being careful to stay faithful to the underlying "known" principles.

Why do people tweak and change HST? Well, when done haphazardly it is usually because they have no faith in the underlying principles. This almost never leads to progress, only constant tinkering and frustration. Without adequate knowledge of the principles, and faith in their effectiveness, their expectations will never be realized and their "locus of control" will move ever outwards, blaming everything but themselves for their lack of progress.

In contrast, when people tweak and change their program based on changing conditions, they almost always experience success and they gain valuable experience in the process. Their locus of control will move inwards and they will grow ever more effective at adjusting their training as conditions dictate to keep the gains coming.

If you find yourself lacking faith in your training program, you will most likely fail to reach your goals. You must first prepare yourself. Take it upon yourself to gain the required knowledge of the principles of muscle growth. Only then will you really have faith in your plan. Look up the studies and compare the traditional methods to what the research tells you. Ask questions of people who seem to have faith in what they are doing. Find out whether they are doing it because they were told to do it, or because they know it is the right way to do it. And of course, ponder your own experience and try to make sense of past periods of growth and past periods of stagnation.

This is a very good question and one that deserves to be answered, without simply zealously defending the premise that is being questioned. This makes for a very bad circular argument that can be VERY frustrating for people with skeptical, though honest, questions.

First, let's start with what isn't different about HST compared with previous training programs. The length of this list is what has raised this question in the first place, and justifiably so. Let's begin with the "concepts" and then follow with the "methods".

Pre-existing Scientific Concepts of Weight Training Found in HST

• Stimulus Leads to Adaptation (cause and effect)
• Specific Adaptation to Implied Demands (SAID) or simply "Specificity"
• Progressive Resistance
• Some relationship between Time and Tension
• Diminishing Returns

Pre-existing Methods of Weight Training Found in HST

• Traditional Weight Lifting Movements both compound and isolation (squat, bench, curls, etc)
• Training the whole body 3 times per week
• Altering weight loads used over time
• Altering the number of repetitions used over time
• Doing eccentric reps (negatives)

There has not ever been a weight training program that did not incorporate or mention at least most of these Concepts, and at least some of these Methods. Entire books (big books) have been written to explore these concepts and teach these methods. Whenever research was required, like for a textbook, you would find "strength and conditioning" research sited to support the validity of the concepts and virtues of each particular training method. The studies used "strength" and other "performance indicators" as a measure of whether the concept and/or method were valid.

This has been perfectly sufficient for nearly everybody including trainers, teachers, professors, coaches and athletes, who have ever lifted a weight. For those who this wasn't sufficient, they simply explored other methods for steadily increasing body mass, I'm referring specifically to hormones.

The exploration of the hypertrophic effects of hormones began in the 50s and has continued unabated every since. Today, a competitive bodybuilder considers himself conservative if he only uses 1 gram of Testosterone per week. Lest I digress, we are not including the effects of androgens and other drugs in this discussion. That is a different issue with concepts and methods specific to the pharmacology and endocrinology of hormones and muscle tissue.

Now let's consider the concepts and/or principles or beliefs of traditional weight training that HST refutes. These are the concepts that the new research refutes most specifically.

Pre-existing Concepts that HST Refutes:

• A muscle must be fully recovered before you should train it again.
• You should not train a muscle that is sore (DOMS, not injury).
• You must never train a muscle on consecutive days (i.e. train the same muscle everyday).
• The concept of "Overtraining" in general as it applies to bodybuilding.
• You must train with maximum "intensity" to elicit significant muscle growth.
• You should not use eccentric training on a "frequent" basis.
• You must change your exercise selection regularly in order to "confuse the muscle" into continued growth.
• You must hit a muscle at every angle in order to adequately train it.
• Muscle Fatigue is the primary indicator of having triggered the growth signal.
• You must effectively isolate a muscle in order to train it effectively.
• You can train a muscle in such as way as to change its natural shape.

Pre-existing Methods and/or practices that HST Refutes:

• Training a muscle no more than once or twice per week.
• Training less frequently as your "intensity" increases.
• Adding weight only when you can complete a certain number of additional reps at that weight (This is a fundamental difference!).
• Training to failure every set and/or workout (If you don't how would you know if you can perform additional reps at that weight yet?).
• Forced reps.
• Performing several "obligatory" exercises per body part per workout.
• Performing multiple exhaustive sets per exercise.
• Changing exercises to "confuse" the muscle.

The above erroneous concepts/beliefs and the methods/practices they engender are the cause of all the confusion and different training programs out their today. Most all of it stems from bodybuilding magazines fabricating these concepts and practices to address their ongoing need for new content each month and to conceal the use of drugs required to attain the level of mass flaunted by the sponsored models. By limiting your study of muscle growth to these magazines you will be ever learning, and never able to come to the knowledge of the truth. But that is an issue to be addressed elsewhere.

Now, there is one traditional concept with its associated methods and practices that often make HST appear to be like previous programs. That is the concept of "periodization".

We will only briefly discuss the topic of periodization, as only a brief treatise will be sufficient to show the differences between periodization and HST. For more detailed discussions of periodization you are advised to read "Super Training: Special Strength Training for Sporting Excellence" by Siff & Verkhoshansky, "Special Strength Training" by Verkhoshansky, "Fundamentals of Sport Training" by Matveyev and "Science and Practice of Strength Training" by Zatsiorski.

Traditional concepts of periodization are based on methods used to manipulate intensity (i.e. work and/or load), volume and frequency in order to manage CNS fatigue and adaptability in athletes. To date, the art of periodization has entered the mathematical age and significant progress is being made in modeling systems designed to predict CNS fatigue and changes in the individual's fitness level. (1,2,3). Once an individual familiarizes him or herself with the true concept of periodization, they will immediately see the difference between Strategic Deconditioning and Periodization for strength training.

For example, here are a few differences between SD and Periodization:

• SD is used to decrease fitness level (A.K.A. conditioning).
• Periodization is used to increase fitness level.

 

• SD is used to increase the micro trauma associated with training.
• Periodization is used to decrease the trauma associated with training.

 

• SD is used to reduce work capacity.
• Periodization is used to increase work capacity.

 

• SD is applied irrespective of the need for "rest".
• Periodization according to the need for rest.

 

• SD is not based on "peaking" performance.
• Periodization's sole purpose is to allow the athlete to peak on a specific date.

So, when people ask, "What's different about HST?", tell them plenty! And its those differences that make HST superior to any other bodybuilding training method existing today.

Additional Reading:

1: Pichot V, Busso T, Roche F, Garet M, Costes F, Duverney D, Lacour JR, Barthelemy JC. Autonomic adaptations to intensive and overload training periods: a laboratory study. Med Sci Sports Exerc. 2002 Oct;34(10):1660-6.

2: Busso T, Benoit H, Bonnefoy R, Feasson L, Lacour JR. Effects of training frequency on the dynamics of performance response to a single training bout. J Appl Physiol. 2002 Feb;92(2):572-80.

3: Busso T, Denis C, Bonnefoy R, Geyssant A, Lacour JR. Modeling of adaptations to physical training by using a recursive least squares algorithm. J Appl Physiol. 1997 May;82(5):1685-93.