Creatine is nitrogenous organic acid that occurs naturally in vertebrates and helps to supply energy to muscle and nerve cells. Creatine was identified in 1832 when Michel Eugène Chevreul discovered it as a component of skeletal muscle, which he later named creatine after the Greek word for flesh, Kreas.
The enzyme GATM (L-arginine:glycine amidinotransferase (glycine amidinotransferase), EC 184.108.40.206) is a mitochondrial enzyme responsible for catalyzing the first rate-limiting step of creatine biosynthesis, and is primarily expressed in the kidneys and pancreas
The second enzyme in the pathway (GAMT, guanidinoacetate N-methyltransferase, EC:220.127.116.11) is primarily expressed in the liver and pancreas
According to the opinion statement of the European Food Safety Authorities (EFSA) published in 2004 it was concluded that "The safety and bioavailability of the requested source of creatine, creatine monohydrate in foods for particular nutritional uses, is not a matter of concern provided that there is adequate control of the purity of this source of creatine (minimum 99.95%) with respect to dicyandiamide and dihydro-1,3,5-triazine derivatives, as well as heavy metal contamination. The EFSA Panel endorses the previous opinion of the SCF that high loading doses (20 gram / day) of creatine should be avoided. Provided high purity creatine monohydrate is used in foods for particular nutritional uses, the Panel considers that the consumption of doses of up to 3g/day of supplemental creatine, similar to the daily turnover rate of creatine, is unlikely to pose any risk".
This opinion is corroborated by the fact that creatine is a natural component in mothers' milk and that creatine is absolutely necessary for brain development in the human embryo and the baby, as well as for optimal physiological functioning of the adult human body, especially the brain, nervous system, the muscles and other organs and cells of high energy expenditure, where the creatine kinase (CK) system is highly expressed and creatine levels are high.
Side effects that produce lower leg pain may be associated with the use of creatine. Creatine may be the cause of an increase in the anterior pressures of the lower leg. This is usually found in post-creatine use when at rest and after exercise. Normal at-rest pressures have been found to be highly elevated by subjects who used creatine within the prior 35 days when compared to no supplementation. This can produce an extreme amount of pain in the lower leg due to the rigidity of the anterior compartment of the lower leg and lack of fluid drainage out of the compartment. It may also be exacerbated by the increase of water content in the muscle fibers, putting more pressure on the anterior compartment. If this condition persist, check with your doctor and inform them of your creatine use and dosage. Although this condition may and usually does subside, if left untreated complications may occur that require emergency medical attention. If the levels remain high for a long period of time, irreversible damage to tissue may occur, particularly to the peroneal nerve. These conditions can further be found under Chronic Compartment Syndrome.
Two studies have indicated that creatine may be beneficial for neuromuscular disorders. First, a study demonstrated that creatine is twice as effective as the prescription drug riluzole in extending the lives of mice with the degenerative neural disease amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease). The neuroprotective effects of creatine in the mouse model of ALS may be due either to an increased availability of energy to injured nerve cells or to a blocking of the chemical pathway that leads to cell death.
Second, creatine has been demonstrated to cause modest increases in strength in people with a variety of neuromuscular disorders.
Third, creatine has been shown to be beneficial as an adjuvant treatment for several neuro-muscular and neuro-degenerative diseases (11,12) and its potential is just beginning to be explored in several multi-center clinical studies in the USA and elsewhere.
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