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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
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1 7 - 1 1 - 2 0 0 4 Creatine: Uncertainty factor doesn't stop high-school athletes
Like a genie in a bottle, it gives athletes what they wish for now, but no one knows if there are long-term effects
BY DARRYL SLATER
While it is widely accepted that college and professional athletes use creatine, even its most ardent supporters question whether high school kids should.
"They have such a big window to improve that they don't really need these extra supplements to help that," said Jeff Volek, an assistant professor of kinesiology at the University of Connecticut. "Not that it would be dangerous or that it may not even work. I just don't think that it's really needed or should be encouraged."
Regardless, high school athletes do use creatine.
The Wisconsin Medical Journal reported in 2002 that 17 percent of the 4,011 Wisconsin high school athletes it surveyed said they had used creatine. Thirty percent of the football players surveyed said they had tried it.
When Hampton University strength coach Shaun Huls was a competitive weightlifter at Nebraska in the late '90s, he worked clinics at high schools.
"They used to have it in weight rooms like nothing," he said.
Huls used creatine at Nebraska, from age 18 to 24. He said he felt stronger in workouts and recovered better. Still, he said he wouldn't recommend creatine to high school athletes because they'll get stronger just by lifting. Pro athletes who are closer to their physical peak benefit more from it, he said. The Virginia High School League discourages coaches from giving athletes creatine. So does the National Federation of State High School Associations (NFHS), the prep version of the NCAA. Fairfax County Public Schools went a step further a few years ago by creating a rule that states coaches cannot supply, endorse or encourage nutritional supplements.
But if creatine works, if it is, as Volek said, "benign" in regard to side effects, what's all the fuss about? In a word: uncertainty.
THE DOWN SIDE The latest study on creatine's long-term effects tracked users for only five years, Volek said. Plus, because the FDA does not regulate creatine, "There's just no guarantee that what's in there is what's on the bottle," said Vito Perriello, a pediatrician in Charlottesville and chairman of the VHSL and NFHS Sports Medicine Advisory Committees.
Said Volek: "There could be some mom-and-pop shops out there that are making this stuff in their backyard, and you don't know what it is."
Experts say mainstream products like GNC, Cell-Tech and Met-Rx are safe. The "backyard" stuff sells mostly on the Internet.
The uncertainty factor and the VHSL's position are why area coaches discourage creatine use.
Said Denbigh coach Tracy Harrod: "If we see (a player) doing it, then we'll cut him. Ultimately, when a kid passes out on the field, we're responsible for it."
Harrod is hinting at creatine's most-publicized, short-term effects: dehydration and cramps. But Volek and Perriello said that all short-term effects have occurred only anecdotally.
No one in Virginia has published a scientific study on creatine's short-term effects, Perriello said. It's too difficult to find enough kids for such a study, which would require ideal situations of test and placebo groups, Perriello said. Carl Nissen, an assistant professor in UConn's department of orthopedic surgery, conducted a 2001 survey that said the University of Tennessee's football team stopped using creatine after its players suffered cramps in the fourth quarter of a 1998 game at Syracuse.
Perriello said he saw something even more alarming when two of his high school patients received results from liver tests that they underwent because they were about to start taking Acutane, an acne medicine. [ErGs] The tests showed the kids' liver enzyme levels were as high as those of someone with hepatitis, which may have been because they were taking creatine, Perriello said.
"I don't think there's a cause and effect there," Volek said.
Earlier this year, Volek published a review of about 24 studies on how creatine affects training. Volek examined all the studies and reached the conclusion that "there's probably more scientific evidence supporting the positive effects of creatine than any other dietary supplement. There's just a natural tendency to bring up controversy related to it. Not that we shouldn't be concerned about side effects, but study after study has been done, and they've shown few side effects."
THE BOTTOM LINE As long as experts issue statements like that and as long as creatine's proven short-term effects continue to appear only as a cramp here or there, kids will keep dipping into their creatine powder to find that edge.
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