Creatine Supplementation Do The Benefits Outweigh The Risks Biology Essay

creatin Supplementation Do The Benefits Outweigh The Risks biological science Essaycreatin is a north ground organic increment that is natur eithery synthesised in the dead bole by the kidney, liver and pancreas. oer the byg wizard 2 decades creatin, ordinarily in the manikin of creatin monohyd valuate, has become one of the closely popular ergogenic upkeeps ingestiond by amateur and skipper athletes alike. A 2001 get word involving everywhere 600 last-pitched school students completing who complete surveys regarding the use of creatin. Over 75% of students had know leadge of creatin and its uses, 16% of whom admitted to utilise creatin as an ergogenic wait on to improve athletic motion (Tracy et al,2001). creatin combines with a phosphate to radiation diagram creatin phosphate which is a vital charge in which cells argon equal to store energy in the puzzle out of adenosine triphosphate (ATP). This is via the reversible creatin kinase reaction, so c wholeed as it is catalysed by the enzyme creatin kinase (Sweeney, 1994). creatine monohydrate supplys are most beneficial in bypass term, high durability deeds lasting less than 30 seconds. The phosphocreatine is broken down to its dowery elements and ATP is resynthesised allowing for improved postful performance. Taking creatine as a sports postscript is beneficial because it step-ups the total amount of phosphocreatine stored in resting brawnyitybuilder cells allowing for great ATP resynthesis in intense activities. As come up as cosmos a normally utilise sports supplement creatine is a widely look intoed heterogeneous delinquent to its potential difference social welfares in various areas of medicine. Studies watch suggested that creatine whitethorn provide neuroprotective benefits, lots via a similar mechanism, by delaying the invasion of motor symptoms and ameliorate pick order in conditions much(prenominal) as Huntingtons indisposition and Parkinsons disease (Wyss and Schulze, 2002). Creatine has oerly proven its benefits in early(a) neuro sizable diseases where muscular dystrophy is common by improving authority of muscular contractions in key musclemans used in public usages such as walking and lifting (Kreider, 1998) . Some explore has led scientists to gestate that creatine plays a role in atherosclerotic protection against cardiovascular based conditions (Wyss and Schulze, 2002). This might be caused by ad-lib creatine supplement decreasing levels of the amino acid homocysteine in the blood plasma. Homocysteine is a comm single known gamble compute for atherosclerotic disease so this may be the reason creatine crapper offer atherosclerotic protection. on that point are risk of exposures associated with employ creatine as a supplement which could be as minor as trouble with acne or muscular cramping to nephritic dysfunction or even failure. This is a controversial area with opinions often split on whether creatine does cause renal disorders as thither are m all studies make concluding opposing outcomes. Further research motivatings to be done into this area to fully assess the risk factor for using creatine as many of the studies support been comparatively short term in their nature.What is creatine?Creatine is a nitrogen based organic compound that is most commonly associated with sports supplement. It is believed to construct been graduation identified by a French chemist named Michel Eugene Chevreul in 1835 (Hultman et al,1996). Chevreul was subject to identify the presence of creatine in a meat extract. The compound is non generally regarded a protein but is made up of 3 amino acids and consists of 32% nitrogen (Poortmans and Francaux, 1999). The chemical social organisation of creatine discount be seen in Figure 1.Figure 1 Chemical social organisation of CreatineThe figure shows the chemical structure of creatine. The molecular formula of creatine is C4H9 N3O2.The amino acids comprise in creatine are arginine, glycine and methinione. Over the past twenty years creatine has become one of the most popular ergogenic aids taken in the world of sport . An ergogenic aid is defined as any means of enhancing energy utilisation, including energy production, aver and efficiency (Silver,2001). It is now known that increase the amount of regimenary creatine available leads to an increase in total muscle creatine TCr. As easily as this, on that point is also record that or so(prenominal)(prenominal) total intramuscular creatine increases levels rise as intimately as levels of phosphocreatine PCr (Martini,2006).During intense lesson phosphocreatine is broken down to creatine and inorganic phosphate (combines with ADP to form ATP) which is the fastest source for the re-synthesis of ATP molecules during the freshman 10 seconds of high intensity exercise (Mougois,2006). As intense exercise continues and phosphocreatine stores become dep leted, ATP is not resynthesised at the same rate and performance levels drop. This is where certainty suggests that creatine stomach suffice to increase performance by delaying the inevitable depletion of phosphocreatine stores. Creatine, as a sports supplement, has only been shown to be beneficial during such short duration exercises. These range from sprinting to power lifting so an array of athletes take advantage of the compound including sprinters, rugby players and pack lifters. Creatine is synthesised naturally in the body but only at a rate of 1 to 2 grams per day (McArdle, 2009). This takes place primarily in the liver, pancreas and kidneys. It is in that locationfore principal(prenominal) to eat foods rich in creatine as part of a healthy, balanced diet. Such foods include poultry and angle which discipline around 5g of creatine per kg of food weight (McArdle, 2006). or so half of the creatine used by the body is replaced through and through the diet with the ear ly(a) half replaced via endogenous synthesis. Approximately 95% of stored creatine is name in skeletal muscle (Spillane et al,2009). As only meat foods contain creatine it is often difficult for vegetarians to obtain ample exogenous creatine via the diet. As a sports supplement, creatine is usually taken in the form of creatine monohydrate (CrH2O). Creatine monohydrate is taken in either capsule or powder form and, nowadays, is readily available online and in high roadway shops (Kreiber, 1998).When did creatine become popular?Creatine first came into the public snapper after the 1992 Olympic Games in Barcelona. Linford Christie, who won the Gold medal in the 100m event, admitted to victorious creatine monohydrate supplements during his training syllabus. The International Olympic Committee does not consider creatine an illegal substance so athletes are forgive to take it. 30% of high school athletes admitted to using it with the figure for two professional and college athlete s is higher still. In terms of nutritional appurtenance give the sack annual sales of creatine are nearly 500 million dollars in the USA alone (Metzl et al, 2001) fashioning it the most popular ergogenic aid used legally. In 2004, a new form of creatine accessory was introduced to the market called creatine ethyl radical ester. This is now a very commonly used form of the supplement. It is said to be beneficial receivable to increase absorption rates compared with standard creatine monohydrate. only, studies adopt also shown that there is no advantage to be gained from taking creatine ethyl ester (Figure 2) compared with stiff creatine monohydrate supplements (Spillane et al,2009). The understand focussed on claims that using the revolutionary creatine ethyl ester increases the bio-availability of creatine allowing for greater gains in performace. Subjects were randomly assigned in a double blind fashion to either a creatine ethyl ester separate, a creatine monohydrate a ssort or a maltodextrose placebo group. During the probe both the creatine monohydrate subjects and the creatine ethyl ester subjects observed improvements in both muscle strength and muscle power but there was detailed dissimilarity recorded amid the two creatine based groups. The authors were able to close down that despite claims, creatine ethyl ester provides no benefits, as a sports supplement, compared with creatine monohydrate (Spillane et al,2009)Figure 2 Creatine ethyl esterAs can clearly be seen from the diagram the chemical structure of creatine ethyl ester is slightly antithetic to that of creatine. The molecular formula is C6H13N3O2.How to take creatine?Creatine monohydrate is widely available and is usually found in powder or capsule form. Unlike many protein supplements creatine is not usually flavoured and is retributive mixed with water. When starting to take creatine as a supplement the athlete must first undergo the loading phase which usually lasts no mor e than a hebdomad. This is necessary to elevate intramuscular levels of creatine phosphate and involves taking 5 grams of creatine 4 clock times a day. Taking 20g a day elevates both free creatine and creatine phosphate levels by mingled with 10 and 30% (McArdle,2009). The short term the great unwashed gains experienced by users of creatine are likely to be primarily caused by water retention. Users of creatine should limit their caffeine use of goods and services because it is now good known that caffeine counteracts the ergogenic benefits that the substance provides. In 1996 a Belgian accept cerebrate caffeine has the ability to completely ward off the ergogenic benefit of creatine subjunction (Vandenberghe et al, 1996). thence it is vital that athletes who use creatine limit their caffeine intake to a minimum if not dispose caffeine containing drinks from their diet all together to prevent the impact of the supplement being inhibited. It has also been proven that caff eine intake pro coarses muscle residue time, therefore opposing the action of the creatine which is able to shorten muscular relaxation time (Hespel,2002).Does creatine possess opposite benefits?As tumefy as the much documented use of creatine as a sports supplement, the compound is the basis of intense, scientific research with regards to its come-at-able benefits in other areas. Among these is the potential use of creatine to protect against both neurological and atherosclerotic disease. It is fancy that creatine political science may be beneficial in treating chronic obstructive pulmonary disease by change magnitude muscle mass (Fuld et al, 2005). Creatine supplementation displayed neuroprotective moments in various savage models of both Huntingtons and Parkinsons disease (Wyss and Schulze, 2002) as well as in McArdles disease (Vorgerd et al,2000). Also in this theme, the authors looked into atherosclerotic protection which may be provided by creatine by freeze offing the concentration, in the blood, of the amino acid homocysteine. Homocysteine has antecedently been identified as an atherosclerotic risk factor. A 2002 call for focused primarily on the effects creatine had on transgenic animal models of Huntingtons disease. Again, this study found creatine to be beneficial in that pick rates increased and delayed the development of motor symptoms associated with the condition (Andreassen et al, 2001). Much research has focused on the possibility of creatine supplementation increasing strength and power in neuromuscular disease perseverings who often suffer with muscular dystrophy (Tarnospolsky and Martin,1999) . Handgrip and body weight, as well as other flyers, were taken and showed significant improvement after the course of supplementation. As well as the potential neuroprotective benefits of creatine, research has also taken place to settle other advantages of the creatine compound. Sullivan et al, for example found that creatine can help provide protection against traumatic brain injury (Sullivan et al, 2001). However, this evidence was only gathered using transgenic mice models so further and more extensive studies need to be conducted. Animal models were used during the study and post chronic administration of creatine cortical damage to the mice was reduced by as much as 50%.The potential use of creatine as a form of treatment in Huntingdons disease is revolutionary and vitally important. This is because there is no current effective treatment for the condition so all forms of potential therapy must be explored. A study in 2000 looked into whether, by increasing phosphocreatine levels, creatine could be administered to Hutingdons disease sufferers.Although there has been particular research into the matter, there is a possibility that creatine supplementation can influence bone biology (Candow and Chilibeck,2010). Resistance training alone has antecedently shown to be beneficial, especially to the elderly to he lp reduce bone dismission which in turn decreases the likelihood of bone fractures. Long term creatine supplementation, possibly coupled with resistance training may be a future method in helping to brinytain bone structure and reduce the risk of falls and injuries (Candow and Chilbeck,2010).As well as this the agedness process is also amenable for sarcopenia which is essentially a reduction in muscle mass resulting in decreased muscle function and muscle weakness (Evans,1995) (Tarnopolsky and Safdar,2008). Creatine supplementation, combined with resistance training may be able to reduce muscle wastage and increase muscular hypertrophy (Dalbo et al,2009). This is believed to be due to the activation of satellite cells. These were first discovered in 1961 during microscopical studies of muscle fibre tissue (Mauro,1961). Since then much information has been obtained as to their function. Satellite cells are believed to function as progenitor cells to the myofibre nuclei which are convoluted in muscle cell set outth (Campion,1984). Muscle fibres are not able to divide, so new muscle fibres are formed through the division of satellite cells. This contributes to the ability of skeletal muscle tissue to regenerate itself by-line an injury (Martini,2006).Are there any risks to taking creatine in the long term?Despite the various benefits I arouse draw creatine does remove its critics. Numerous studies get down focused on the worrying link between its use and renal dysfunction or even complete renal failure. In particular a study by Pritchard and Kalra reason out that creatine had been the underlying factor which led to renal dysfunction in their subject (Pritchard and Kalra,1998) . This was thought to be due by and large to the fact that creatine is degraded to creatinine prior to excretion in the urine. This led to further studies on the issue but there is still no definitive answer as to whether the use of creatine as a supplement contributes to renal d ysfunction. Another study by Thorsteinsdottir et al in 2006 focused on the alarming case of a healthy 24 year old who was diagnosed with acute renal failure while taking several dietary supplements, including creatine monohydrate. For example, a topic by Poortmans and Francaux (1998) looked into the findings from the Pritchard paper by supplementing subjects for as long as 5 years. They found no link whatsoever between the use of creatine and impaired renal function. The same paper also found there to be no impact on blood pressure either. Despite this it is generally evaluate that those suffering with renal disorders should refrain from the use of the supplement. eon use of creatine as a supplement for a period up to 8 weeks has shown no detrimental health effects, further work must be done to investigate any long term health implications which may arise. Studies focusing on creatine supplementation in endurance athletes have aroundtimes found that taking the substance could ac tually inhibit performance. This is thought to be due to the weight gain sometimes attributed to the use of creatine (Balsom et al,1994). There have also been numerous links between creatine supplementation and increases in acne, especially among adolescent athletes which could be another factor in a performer choosing to avoid supplementation. Creatine use has been conjugated with outbreaks of acne especially among adolescents. A study by Kaymak in 2008 concluded that between 15-20% of subjects treated had high blood plasma levels of creatine phosphokinase. A clinical report by Landau et al in 2001 also produced similar results with up to 51% of patients being treated with isotretinoin having elevated blood creatine kinase levels.As creatine use became more prominent links began to be beat that the person taking the supplement could be more prone to muscular cramping and spasms, particularly during exercise (Poortmans,2000).However, there is also evidence to the contrary. In 2001 a study was carried out using 26 athletes from various sports (Schilling et al, 2001) . Although the authors focused on the long term clinical markers of creatine use they were able to conclude that there was no increased risk of muscular cramping through use of the supplement. These findings were backed up in 2003 when a paper was published pursuance a 3 year study using elite college athletes (Greenwood et al, 2003). The entropy was collected between 1998 and 2000 and the authors looked into whether creatine use had any affect over the rate of muscular cramping and injury. Their results showed no significant difference between the placebo group and the creatine taking group allowing them to conclude that creatine had no effect over cramping rate. Similiar conclusions were made in a study by Dalbo et al(2008).Although the legal age of evidence gathered suggests that using creatine monohydrate as a nutritional supplement does lead to performance improvements in high intensity, s hort duration exercise there is some evidence to the contrary. A 1995 study concluded that there is no benefit to using creatine during short term, high intensity cps riding (Cooke et al,1995). There was no difference between the power output of the harbor group compared with the group who had taken the supplement. These findings are interesting due to the large amount of research which concluded that creatine supplementation was advantageous during this manner of exercise.Creatine and endurance eventsMost of the evidence gathered has suggested that creatine is only beneficial in short, power based activities and has no knownadvantages with regards to endurance events. This is partly thought to be due to the weight gain attributed to creatine supplementation due to water retention. However in 2004 a novel experiment was conducted which investigated the potential use of creatine to reduce inflammatory and muscle philia markers during a 30km bicycle scarper (Santos et al,2004) . T he markers the scientists measured were creatine kinase (CK), lacate dehydrogenase (LDH), prostaglandin E2 (PGE2) and tumor necrosis factor alpha. The subjects used were all experienced road runners whose personal best times for a battle of Marathon distance ranged from 2.5 to 3 hours. The subjects undertook the standard creatine loading phase, as well as a petite dose of maltodextrin, in the fortnight leading(p) up to the race. Maltodextrin is a commonly used food additive that is used in both the creatine subjects and the placebo subjects so there is no difference in the flavour of the compounds taken. Santos et al found that, in their subjects, the markers of muscle soreness were significantly higher in the control group (who took maltodextrine but not creatine) than in those who had taken creatine. This implies that although creatine has not even to prove any performance benefits during endurance events it may be beneficial in decrease soreness and improving recovery post ex ercise by decrease cell damage (Santos, R et al, 2004).In this project I go away look into the array of benefits creatine can provide as well as investigating its negative aspects. I then hope to conclude in what situations the benefits outweigh the potential risks as well as where the risk factor may be too high to warrant using the substance.Creatine as a sports supplementAs I have already mentioned, it is now known that creatine monohydrate supplements work by increasing the total amount of phosphocreatine available to resting muscle cells. During intense exercise this is broken down to its constituent elements (Phosphate and creatine) and the energy released is used to drive the re-synthesis of ATP, the worldwide energy currency (Kreider, RB, 1998). As only a very small amount (approximately 2g per day) is synthesised naturally by the liver, pancreas and kidneys extra phosphocreatine in the muscle cells serves to reduce fatigue during high intensity, short duration activities like sprinting.A study by Kerksick et al in 2007 investigated the impact of various different protein sources and creatine on the human body spare-time activity a 12 weeks high intensity resistance program. 49 subjects were used who regularly tended to(p) the gym to carry out weight lifting exercises. Some subjects were administered with a colostrum protein blend, which is formed from the mild delivered by cows in the days following giving birth. Other subjects were given colostrums combined with creatine administration. A protein control group was put in place and Kerksick et al predicted that the inclusion of creatine with the colostrums blend would bring about greater improvements in both body composition and power than those taking colostrum alone. The resistance training program led to mass gains for all subjects but the greatest lean mass gains were achieved by those taking a blend of creatine and colostrums protein. However, there was no significant improvement in subject s one repetition maximum on the bench press between the protein control group, the c colostrum group or the colostrums/creatine group. ascribable to the increased availability of phosphocreatine it would have been predicted that the colostrum/creatine group would have achieved the greatest improvements in this exercise over the 12 week study.In some cases as superficial as one week of supplementation can be decent to produce performance improvements (Volek et al,1997). Volek used 14 active, male subjects in a double blind fashion where 7 where unknowingly the placebo group and 7 were administered with oral creatine monohydrate supplement. Bench press and squat jumps were the chosen exercises to measure the effect of creatine on performance. As well as increases in the weight subjects could bench press, and increases in power output for the squat jumps there was also a noticeable increase in lean body mass among the subjects of up to 2.7 kg, possibly due to the water retention att ributed to creatine use.Despite all the evidence which has been gathered implying that creatine does play a role in helping enhance ATP resynthesis during short term, high intensity exercises there is some evidence to the contrary. In particular a paper by Cooke et al in 1995 concluded that their subjects had experienced no benefit whatsoever to using the supplement for their high intensity, intermittent bicycle sprints. The authors focused primarily on the power output the subjects were able to asseverate as well as fatigue levels experienced. 12 healthy yet untrained male subjects were used for the study, 6 of which were the placebo group with the other 6 making up the supplemented group. The supplemented subjects used the loading phase technique to increase the levels of phosphocreatine in resting muscle cells faster, but the phase only lasted for 5 days. This may have been too short a period of time to load them as most manufacturers suggest a 2 week loading phase. However, as I have mentioned Volek et al, 1997 found performance improvements could choke in as little as a week. Cooke et al found there to be no significant difference between the power output between the two groups, prior to or after the supplementation period. This led the authors to conclude that use of creatine as an ergogenic aid has no positivistic effect over a persons ability to exert more power in muscular contraction, which opposes much of the evidence gathered in other studies.Creatine and its neuroprotective effectsIn some studies creatine has demonstrate neuroprotective effects. In some animal models creatine has provided neurological protection against the onset of symptoms in both Parkinsons and Huntingtons disease (Wyss and Schulze,2002). There are three main steps involved in creatine metabolism with one being creatine transporter. The others are, firstly, AGAT which is L-arginine glycine amidinotransferase. This forms precursors to the creatine molecule itself. Also, GAMT is involved in the biosynthesis of creatine molecules. Deficiency of either AGAT or GAMT leads to a deficiency in both creatine and phosphocreatine in the brain, which can lead to stern mental retardation (Schutz and Stockler, 2007). In the studies carried out by Wyss and Schulze there was a noticeable improvement in clinical symptoms of both AGAT and GAMT deficiencies but there was no change with the creatine transporter disorders. Dechent et al, 1999 also found that oral creatine monohydrate supplementation also increased creatine levels in the brain.Furthermore, in transgenic mouse models of Huntingtons disease, creatine administration has shown to improve survival rates, as well as prevent the inevitable onset of symptoms. (Andreassen et al,2001). This was concluded to be via a similar method to how creatine operates as an ergogenic aid, but by increasing phosphocreatine levels in the brain, rather than in muscle cells. A negligible dietary administration, of full 2% creati ne was enough to provide positive results in the study and provide neurological protection. Huntingtons disease is often associated with bolshy in weight and the creatine presence also helped to minimise weight loss in the animal subjects.In 2002 a revolutionary study was carried out by Jacobs et al into the possibility of using oral creatine monohydrate to assist the recovery of patients with spinal cord injuries at the cervical vertebrae level. sixteen subjects were used for the study who had suffered injuries between the C5 and C7 vertebrae. Results showed that VO2 max, VCO2 max, and time to fatigue were all greater in the supplemented group compared with the placebo group and Jacobs concluded that there is definite benefit in using creatine to assist with training in the replacement of such severe spinal injuries. This again demonstrates the potential uses that creatine supplementation has in providing neurological protection and rehabilitation.Creatine supplementation may als o be beneficial in patients suffering with amyotrophic lateral sclerosis (Rosenfeld, 2008). This is a neurodegenerative progressive disorder which is characterised by muscular dystrophy and can be fatal. An advantage of this trial was the large sample size, which was over 100 subjects. While creatine did not significantly improve motor or respiratory capacity there was a definitive trend toward increased survival rates among the creatine supplemented subject group. Rosenfeld called for further research to be considered into the increases survival rates that were linked to the use of creatine.Creatine and renal failureIt has been predicted that a long term nitrogen rich diet lends itself to cause both structural and functional deformities of the kidney and may eventually cause renal hyperfiltration (Poortmans and Francaux,1999). Due to the high nitrogen content of creatine much research has been done into whether there is a long term danger to using the supplement.In 1998 a rather co ntroversial paper was published by Pritchard and Kalra which researched into the possible links between use of creatine as a sports supplement, following the death of 3 American college wrestlers who were taking the substance. The article was published in the Lancet and became the topic of much debate in years to come. Pritchard and Kalra concluded that there was strong circumstantial evidence to suggest that creatine was responsible for the deterioration in renal function (Pritchard and Kalra,1998). The subject suffered with focal segmental glomerulosclerosis but despite this all markers of renal function were normal, such as creatinine clearance values. However, when the 25 year old subject was studied 8 years later creatinine clearance had decreased considerably. The male admitted to using creatine based supplements during a pre season football training program which Pritchard and Kalra matte up was an underlying factor in the deterioration in the mans renal functioning. This p aper was a topic for much debate, due largely to the fact that the patient investigated by Pritchard and Kalra had underlying renal issues prior to the study, which the authors seem to ignore in their conclusions. The size of the study is also questionable due to the fact that there was only a sole participant therefore no a repeat or variety in results taken. There were also just 4 references noted at the end of the article suggesting that Pritchard and Kalra may not have taken into full account all other evidence that had been obtained by other studies.Due to the ever increasing popularity of creatine supplementation, on with its continued link with renal failure there have been a vast number of studies in this area. A study by Edmunds et al in 2000 focused on the advancement of renal disease in HanSprague-Dawley (SPRD) rat models with cystic kidney disease. The rats undertook the loading phase of supplementation which I described in the introduction. This is the same technique used in humans to increase the amount of free phosphocreatine. Obviously, the intake of creatine was reduced, in comparison with humans, to 2g/kg of diet for the one week loading phase, followed by a 5 week period where the dosage administered was 0.4g/kg of diet to compare. The authors measured the advancement of renal disease my taking kidney size records as well as determining cyst scores. The cysts often develop in chronic cases where the cysts grow and inhibit the blood filtering capabilities of the organ (Parker,2007).Edmunds hypothesis stated that due to the relatively short life span of the animals used, any impact that creatine supplementation has on renal function could be more readily detected. The findings support this hypothesis as the rats that had been administered with creatine suffered greater renal disease progression than the control group. The kidney sizes were as much as 10% larger, in some cases, than the control group which is an indicator of further progres sion of the condition. The creatine was administered in a creatine/glutamine mixture which supplement manufacturers often do as glutamine is believed to significantly improve absorption of creatine. As expected all other markers of renal function agreed with the hypothesis. Creatinine serum clearance was 23% lower in the supplemented group and cyst scored were 23% greater compared with the control group. At the time of Edmunds paper there had still not been a long term controlled study into the effect creatine supplementation may have on renal function. Although the findings seem conclusive I feel it is important to consider that animal models were used as oppose to humans, although this was partially due to the time restrictions. Also the sample sizes are adequate but by no means large with 14 males and just 12 females making up the creatine supplemented groups. As well as this the length of the study is quite short with the supplementing period lasting 6 weeks in total. Therefore it remains unclear as to the long term risks that can be associated with creatine and renal issues. In spite of this, the paper exacerbates the advice that athletes with any form of renal condition should avoid using creatine as an ergogenic aid.In contrast there numerous studies have taken place which have focused on the potential link between creatine and renal disorders and concluded that there is no health risk to taking the substance. In 1999, Poortmans and Francaux conducted a long term study on the issue. This was important because some of the investigations done around this time were short term and didnt account for the potential long term health risks, if creatine were to be taken over a substantial period of time. Poortmans and Francaux refer to the controversial Lancet payoff by Pritchard and Kalra in their introduction and used this to form their hypothesis that short and medium term creatine supplementation in men does not have any detrimental e