Cut the Crap: Using Creatine is Wrong!
“The intentional use of performance enhancement is unfair, and therefore morally and ethically indefensible.” – American Academy of Pediatrics
Although nutritional substances are designed to chemically improve the athlete’s physical performance, many athletes, coaches, trainers, sports nutritionists, exercise physiologists, and others do not think of these substances as providing an unfair advantage to competitors. Creatine is one of many such nutritional substances. Almost everyone believes it increases physical performance. But, no one seems to believe that the “increase” in performance is unfair or illegal. Such substances are marketed as a legal alternative to banned ergogenic supplements. This thinking is ill-founded and troubling.
The idea that it is legal and ethical to use creatine makes no sense at all. Just because it is said to be a naturally occurring substance found in low doses in foods does not excuse the use of it by athletes to enhance performance. Relying on supplements to build muscle tissue, strength, and power may not presently be illegal, but it certainly is unethical. Yet, throughout the Internet, at workshops, conferences, in health food stores, and in sports nutrition classes, creatine is reported to enhance the athlete’s physical performance. This has gotten beyond making any sense, but no one talks about the ethics of creatine use by athletes. Perhaps, even worse, no one seems concerned about the ethics of creatine use by children or adolescents.
Metzl and colleagues [1] reported in 2001 in Pediatrics that the creatine use rate in 12th grade student athletes was 44%. Indeed, it is the most popular nutritional supplement used by high school athletes. It is also a disturbing trend among middle school and high school athletes [2]. There must be thousands of websites devoted to creatine. The yearly sales of millions and millions of dollars [3] are huge. The industry is benefiting tremendously as do the sports nutrition consultants who are among the first to say that creatine is safe and natural. They don’t separate the young athletes from the collegiate athletes or the professional athlete from the Olympic athlete. Everybody is a target for taking creatine. It is clear that the industry wants every kid and health club member using creatine. And, if they cannot convince them of enhancing performance, then it is all about improving appearance [4].
Where does one draw the line? When is the winning at all costs mentality beyond good common sense? When does one say enough to the use of potentially harmful substances to improve performance? How do exercise physiologists get out of this mess? How do they get pass providing evidence for supplements, magic pills, shots, and ointments? Who’s kidding whom? Just take a glance at the performance-enhancing substances? Something isn’t right? Frankly, in the opinion of this writer, exercise physiologists who parade supplement research before their colleagues without considering the ethical implications are part of the problem. Rather than emphasis on values of fairness and wholesomeness, it is unfortunate that grown men and women are encouraging young athletes to use performance-enhancing substances. At least the American Academy of Pediatrics got it right by strongly discouraging the use of performance-enhancing substances for athletics or other purpose [5]. The Academy has 11 recommendations that every exercise physiologist should read and consider adopting.
How many times have I heard, “No one is doing anything illegal by taking creatine.” Sure, it may not be cheating when defined against a legal measure, but it is nonetheless cheating when a substance provides a benefit to an athlete. When a person has to explain this point, it is already beyond common sense. The lack of a history of ethical reflection in exercise physiology is part of the problem. Admittedly, this is an unpleasant but necessary task to write about. Of course an absence of discussion of ethical concerns relative to the use of supplements is not evidence of appropriateness. The fact that few exercise physiologists have expressed concerns in this area does not mean that none exist. The bottom line is that creatine is a questionable supplement [6]. Why do you think the National Collegiate Athletic Association prohibits member schools from giving creatine to athletes? Also, why did the French Agency of Medical Security for Food conclude that the use of creatine is against the spirit of sportsmanship and fair competition [7]?
Interestingly, note the response of one sports nutritionist [8] in regards to whether creatine is safe: “There’s been about 900 studies right now on creatine supplementation and every study indicates that it appears to be safe.” First, there is the emphasis placed on the number of studies, which is impressive if it is true. Second, the use of the words “every study” is similar to the essence of a final hit on a nail to support the intent of the sentence. Then, out of the blue, Kreider uses the words: “appears to be safe.” It’s a funny thing when researchers use words, yet readers frequently fail to read between the lines. The intent of the statement is to argue the safety of creatine while inserting a solution to making a huge mistake when it is determined to be unsafe. This method of writing proves to market products while leaving the back door open to the author(s).
Above all, none of this is actually new thinking. What is new however is taking pride in one’s work to do no harm to others. There is no point to disagreeing with me. I’m concerned with my own thoughts. Nobody is perfect and, of course, many people (including college teachers) have preconceived ideas about sports supplements. This does not mean that the ideas are automatically right or even ethical. This is why athletes and parents should be alert to the propensity of leaders who are pursuing their own interests and the interests of their “extended” employers. This is also why the time has come to reject the idea that research gives others the right to do as they please. Athletics should be about athletes rather than supplements.
These are not trivial points by any means. The choice is clear. Do exercise physiologists cut the crap and make tough decisions to think as healthcare professionals? Or, do they continue their work in controversial social, professional, and ethical questions? Some enlightened leaders are challenging themselves to engage the spirit of fair play and common sense. This “self-exploration” comes at any moment we individually and/or collectively stop the rhetoric, cut the crap, and restore the original spirit and authenticity of exercise physiology.
References
1. Metzl, J.D., Small, E., Levine, S.R., and Gershel, J.C. (2001). Creatine Use Among Young Athletes. Pediatrics. 108:2:421-425.
2. Buckley, W., Yesalis, C., and Freidl, K. (1988). Estimated Prevalence of Anabolic Steroid Use Among High School Seniors. Journal of American Medical Association. 260:3441-3445 [Abstract].
3. Kramer, W. (1999). Proceedings of the American College of Sports Medicine Advanced Team Physician Course. Orlando, FL: American College of Sports Medicine.
4. Robertson, J. (2002). Doping Scandals: Winning at Whatever the Price. Northwest Runner. [Online]. http://www.nwrunner.com/features/04-02Dr_Rob.html
5. American Academy of Pediatrics. (2004). Section on Sports Medicine and Fitness. Sports Shorts: Performance-Enhancing Substances. [Online]. http://www.aap.org/family/sportsshorts12.pdf.
6. MayoClinic.com. (2005). Performance-Enhancing Drugs: Dangerous, Damaging and Potentially Deadly. [Online]. http://www.mayoclinic.com
7. A.D.A.M., Inc. (2004). Creatine. [Online]. http://www.umm.edu/altmed/ConsSupplements/Print/Creatinecs.html
8. Kreider, R. (2004). Creatine Supplement Is Putting Muscle Into The Cosmetics Industry. WorldNow and KTRE. [Online]. http://www.ktre.com/global/story.asp?s=2296267&ClientType=Printable