Creatine is an amino acid found naturally in the body including skeletal muscle and other tissues. In the United States, creatine is considered a dietary supplement. Therefore, in accordance with the Dietary Supplement Health and Education Act of 1994, claims regarding performance and safety do not need to be substantiated by the United States Food and Drug Administration. In controlled laboratory studies, oral creatine supplementation has been shown to be ergogenic in repeated stationary cycling sprints and weight lifting. Ergogenic means tending to increase work. There are also many studies that do not demonstrate an ergogenic effect.

The typical creatine supplementation protocol begins with a loading dose of 20g/day (or 0.3g/kg) for 5 days, followed by a maintenance dose of 2 g/day (or 0.03 g/kg) for 28 days. Although a 5-day loading period is typical, 2 days of loading has been shown to yield similar muscle creatine concentration and performance results. Without loading, 3 g/day for 28 days results in muscle creatine concentration similar to 5 days of loading.

Skeletal muscle has a creatine storage capacity of 150 to 160 mmol/kg (normal is 125 mmol/kg). This is important information for those who think that more is better. Excess creatine ingested will not increase muscle creatine but will increase urinary creatine. Creatine supplementation results in an average weight gain of 2.2 kg. The weight gain is initially due to water retention. After one year of use, muscle accumulation may occur, although this is unproven and still under investigation.

Adverse effects of creatine supplementation have not been extensively studied, though concerns have been prevalent in the media and athletic training rooms. It is common to hear reports from athletic trainers about muscle cramping or strains in athletes taking creatine. Dehydration is also a concern due to water retention and fluid shifts. Therefore it is important to stay properly hydrated to reduce this risk. Two published case reports of renal dysfunction, in subjects taking creatine, have raised concern about effects on the kidneys. Diarrhea and gastrointestinal pain have been reported anecdotally. The greater concern lies in the unknown effects of creatine supplementation on various organ systems, particularly the kidneys, liver, heart, brain, and reproductive organs.

Here is some information for patients taking creatine and those who are considering it: Creatine may or may not help a person achieve their goals.After the loading phase of 20 g daily for 2 to 5 days, maintenance should be 2 g/day (0.03 g/kg) for 28 days. Any extra will be urinated out. Creatine users will gain weight because of water retention, which may impair performance. Creatine is not regulated by the FDA. A person taking creatine does so at their own risk.

For more information regarding supplementation, contact The Women's Sports Medicine Center at 410.337.5311.

Ephedrine is a drug derived from the plant Ephedra equisetina. A synthetic form of the drug, pseudoephedrine, is a common ingredient in over-the-counter and prescription cold and allergy products. Similar to amphetamines, it increases blood pressure and heart rate.

Ephedrine claims to increase body fat loss, improve athletic performance, and improve concentration.

The following are the results of research studies down on Ephedrine: research has found no effect of ephedrine on strength, endurance, reaction time, anaerobic capacity, or recovery time after prolonged exercise.

Ephedrine products have been found to contain from 0% to 100% of the amount listed on the label. Side effects vary and do not correlate with the amount consumed. Caffeine potentiates the effect of Ephedrine and the combination can be dangerous.

Ephedrine is banned by the NCAA and the IOC. The FDA has documented 40 deaths and more than 800 side effects linked to Ephedrine use. Side effects of Ephedrine include irregular heart rate, elevated blood pressure, dizziness, headache, heart attack, stroke, seizure, psychosis, and death.

Ma huang is an herbal form of ephedrine called ephedra that is contained in many herbal products available at health food stores. Recent changes in FDA regulations excuse the makers of nutrition supplements from fully identifying the contents of their products.

Ma huang has been blamed for the deaths of several high school students who used it as a stimulant. The deaths presumably resulted from central nervous system bleeding or cardiac arrhythmia.

The National Football League (NFL) has recently become the first major professional sports league in the United States to forbid the use of ephedra.

Chromium has been marketed to athletes for years, promising everything from enhanced endurance to increased muscle tissue. Research from the United States Department of Agriculture on chromium supplementation discovered that it had no beneficial

effects on body composition change or strength gain in men. Most research indicates that chromium does not build muscle tissue or enhance athletic performance.

This drug is well known for its claims to burn fat. Scientific research has been largely

unsupportive of the appealing claims of chromium picolinate's ability to significantly aid weight loss.

New evidence shows that chromium picolinate damages chromosonal DNA, causing an increased risk of cancer.