Ephedrine

GSSI SPORTS SCIENCE NEWS

Although banned by the NFL, NCAA, and International Olympic Committee, dietary supplements containing ephedrine are still consumed by athletes and the general public, often in hopes that it will aid weight loss or provide a stimulant-induced performance edge. Recent events have demonstrated that the stimulant effects of the drug are not without potential risk. Although it is too soon to draw definitive conclusions, it appears as though ephedrine may have played a role in the heatstroke death of Baltimore Orioles pitcher Steve Bechler in February 2003. Unfortunately, many athletes continue to use ephedrine. To find out the latest on this common dietary supplement, we asked Ellen Coleman, RD., MA, M.P.H., a nutrition consultant for the Los Angeles Lakers and Anaheim Angels, to research the most current findings regarding this drug.

We hope you find this information useful.

Bob Murray, Ph.D., FACSM
Director, Gatorade Sports Science Institute

EPHEDRINE-CONTAINING SUPPLEMENTS
-Ellen Coleman, R.D., M.A., M.P.H.

In many competitions, the difference between winning and losing can occur in one play or the divisions of seconds. So it is not surprising that athletes may utilize ephedrine-containing supplements to improve their performance, have more energy or decrease their body fat. Unfortunately, athletes who use ephedrine risk getting more than they bargained for from the drug. While it may help them run farther and faster, it can also make them prey to the myriad of negative-even life-threatening-side effects. The fact is ephedrine use, at this stage of the game, is controversial at best. Especially when you consider that the NFL, NCAA, and International Olympic Committee have all taken steps to keep it off the playing fields. And now, the FDA is getting into the discussion.

WHAT IS EPHEDERINE?
So what exactly is ephedrine? Classified as a sympathomimetic drug (a beta-1 and beta-2 adrenergic receptor agonist), it's a central nervous system stimulant that increases serum levels of norepinephrine. The herbs ma huang, ephedra sinica and Sida cordifolia all contain ephedrine, which structurally is similar to amphetamines (1).

Ephedrine is an effective bronchodilator due to its stimulation of beta-2 receptors in the lungs. However, it also stimulates beta-1 receptors in the heart and causes dose-dependent increases in heart rate and blood pressure. Drugs that are more selective beta-2 agonists are generally preferred for treatment of asthma (1).

EPHEDRINE'S ROLE IN ATHLETIC PERFORMANCE AND WEIGHT LOSS Ephedrine's appeal to users rests in the fact that it may do one or all of the following three things, depending on the individual:

. Improve athletic performance by stimulating the central nervous system and by increasing heart rate and contraction force via activation of the beta-1 receptors.

Suppress appetite by increasing norepinephrine release through stimulation of adrenergic pathways in the hypothalamus (1).

Promote weight loss by increasing thermogenesis and resting energy expenditure via stimulation of the muscle beta-2 receptors to increase substrate metabolism.

Users often combine the drug with caffeine and aspirin (called the "ECA stack") to enhance its effectiveness as a weight loss agent. In this context, ephedrine stimulates the release of norepinephrine, which stimulates the release of adenosine and the synthesis of prostaglandins by the activated tissue. Adenosine and prostaglandins both inhibit the effect of norepinephrine. Caffeine opposes the effect of adenosine and so increases norepinephrine release. Aspirin inhibits the synthesis of prostaglandins and so enhances the effect of norepinephrine (1).

SIDE EFFECTS
What users may not understand or take seriously when they seek the performance-enhancing benefits of the supplement are the adverse effects it can produce. Ephedrine raises heat production and body temperature and increases the athlete's risk of developing a heat injury during exercise in warm weather. In addition to increased heat production, other symptoms include dizziness, headache, gastrointestinal distress, irregular heartbeat, and heart palpitations to heart attack, stroke, seizures, psychosis and even death.

These side effects can vary among individuals and occasions and don't always depend on how much is consumed. Also, combining caffeine (from coffee, Guarana, mate, or Kola nut) with ephedrine containing products (such as those mentioned earlier) greatly increases the risk.

If the knowledge of these adverse effects isn't enough to deter users, the International Olympic Committee, the National Collegiate Athletic Association (NCAA) and the National Football League (NFL) are hoping some of their recent policies banning the drug-and suspending players for doping-will be. At the very least, many in their ranks view the use of ephedrine-containing supplements to enhance performance as cheating.

RESEARCH FINDINGS
Still, are these organizations' concerns about ephedrine really valid? In December of 2000, a prestigious medical journal set out to answer that question by examining the adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids.

The study, which was commissioned by the Food and Drug Administration (FDA), reviewed the records from 140 ephedrine users who experienced complications (heart attack, stroke, seizure and death) between 1997 and 1999. These users were young and healthy-and some had only been taking ephedrine for a few days. (2)

The researchers found that:

One-third of the patients' complications were definitely or probably caused by ephedrine use.
Another third of the problems were possibly caused by ephedrine.
In one-fifth of the cases there was not enough information to determine the cause.

While these results illustrate the risks associated with ephedrine, the results of research illustrate its effectiveness. According to research:

. A combination of ephedrine and caffeine (0.8 to 1.0 mg of ephedrine per kg and 4 to 5 mg of caffeine per kg consumed 11/2 hours before exercise) may improve both anaerobic and high-intensity aerobic performance C4, 5).

Combining ephedrine and caffeine (20 mg ephedrine and 200 mg caffeine, consumed three times per day) with a low-calorie diet (1,000 calories) may also help to promote weight loss in obese individuals (§, 1).

The unreliable potency of ephedrine-containing supplements is also disturbing. A recent study analyzed the amount of ephedra alkaloids in 20 products and found that they contained zero to over 150 percent of the amount of ephedrine listed on the label. Half of the products tested varied more than 20 percent from their product label. There was also substantial lot to lot variation from the same manufacturers, indicating poor quality control cm.

FEDERAL FINDINGS
Despite its effectiveness, in June of 2002, Health and Human Services Secretary Tommy Thompson called for an extensive scientific review of ephedrine to address health concerns associated with its use. The Rand Corporation is conducting this comprehensive review of the existing science on ephedrine and the National Institutes of Health will use this information to evaluate the safety of the product (9).

Just two months later in August, the FDA asked the US Department of Justice to pursue a criminal investigation of Metabolife, a leading producer of ephedrine-containing supplements. The agency wanted to know if they made false statements to the FDA regarding the existence of adverse event reports. Metabolife stated that 400,000 people called between 1997 and 2001 and reported 13,000 incidents of health-related issues. (9)

The FDA has tried to get these adverse event reports since 1997, even resorting to litigation, but has been unsuccessful.

"Metabolife has refused and resisted us every step of the way," says FDA Deputy Commissioner Lester Crawford, adding that the FDA is so concerned about the volume of reports that it's set up a special task force to review the records. (9)"Given their long history of being uncooperative, we view their offer to make these reports available now to be disingenuous."

In October of 2002, Secretary Thompson urged the FDA to recommend strong mandatory warning labels for ephedrine-containing products. The FDA is working on proposed regulations regarding Good Manufacturing Practices for dietary supplements. These measures do not preclude further actions as a result of the Rand Corporation's review of ephedrine. In addition, the FDA announced a new program to analyze all herbal ephedrine products to ensure that they contain natural (not synthetic) ingredients as required by law. It is illegal for companies to market non-herbal synthetic ephedrine products as dietary supplements (lQ).

Conclusion
Although ephedrine may improve athletic performance, the risks associated with this supplement far outweigh the benefits. Supplements containing ephedrine (see "Products Containing Ephedrine" below) will not enable athletes to reach their goals. Sound nutrition, hydration and training programs will.

Ellen Coleman works with athletes at The SP.OR. T. Clinic in Riverside, Calif., and she is a nutrition consultant for the Los Angeles Lakers and Anaheim Angels

References

1. Rawson ES, Clarkson PA. Ephedrine as an ergogenic aid. Performance-enhancing Substances in Sport and Exercise. Ed Bahrke MS, Yesalis CEo Human Kinetics. 2002.

2. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. NEJM. 343:1833-8, 2000.

3. Public Citizen Health Research Group. Petition to the Food and Drug Administration (FDA) requesting the ban of production and sale of dietary supplements containing ephedrine alkaloids. (HRG Publication #1590). ,Y\!"'\'M;Im;§D_QrgfmJblicatiQD_!.r§!§i3;,(J,cfml 10=7053

4. Bell DG, McLellan TM, Sabiston CM. Effect of ingesting caffeine and ephedrine on 10-km run performance. Med Sci Sports Exerc. 34:344-9, 2002.

5. Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc. 33:1399-403, 2001.

6. Astrup A, Breum L, Toubro S, Hein P, Quaade F. The effect and safety of an ephedrine/caffeine compound compared to ephedrine,caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int JObes Relat Metab Disord. 16 (4):269-77, 1992.

7. Astrup A, Buemann B, Christensen NJ, Toubro S, Thorbek G, Victor OJ, Quaade F. The effect of ephedrine/caffeine mixture on energy expenditure and body composition in obese women. Metabolism. 41:686-8,1992.

8. Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm. 57:963-9, 2000.

9. Food and Drug Administration. FDA News: Statement from FDA Deputy Commissioner Crawford regarding Metabolife. August 15, 2002.

10. Food and Drug Administration. FDA News: Secretary Thompson urges strong warning labels for ephedra. October 8, 2002.

GSSI Sports Science News is designed to provide up-to-date information on current topics in sports nutrition and exercise science. For further information on this or other topics, please visit the Gatorade Sports Science Institute Web site at www.gssiweb.com or The Gatorade Company at WWW-,-gatorade.com. We also encourage you to register for your free online membership with GSSI to receive the latest research on sports science topics.

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Androstenedione

Wellness Update 1998, #7

Androstenedione, (andro-steen-die-own), or "andro" for short, has become a very popular word lately.  Androstenedione is a nutritional supplement which can be purchased over-the-counter by anyone, of any age.  It has been available for over 60 years, but has become popular recently because of new marketing strategies and several high profile athletes, most notably Mark McGwire, have admitted using it.

Synthetically produced androstenedione is classified as a steroid, although it has no muscle building effects on its own.

Synthetically produced androstenedione is classified as a steroid, although it has no muscle building effects on its own.  When converted into testosterone by the liver, it purportedly raises the body's testosterone levels allowing athletes to train harder and recover from exercise more quickly.  A great deal of controversy exists concerning whether it raises the body's testosterone levels enough to make any appreciable difference in size, strength or speed.

Use of androstenedione is banned by the NCAA, National Football League, and International Olympic Committee.

There are other controversies surrounding androstenedione, which are complicated and confusing.  First, it is an over-the-counter nutritional supplement that can be purchased by people of any age at most stores selling supplements.  (General Nutrition Centers recently took androstenedione off the shelves due to the possible negative effects to young users.)  Yet, its use is banned by the NCAA, National Football League and International Olympic Committee due to concern it could cause the same long-term damage associated with anabolic steroids. 

Second, it reportedly raises testosterone levels "naturally" to levels similar to those achieved when one uses testosterone-related drugs, or steroids.  Yet, natural testosterone production is not controlled by how much androstenedione one takes, but by the level of other hormones in the body.  Also, any increase in testosterone through the use of androstenedione is very transient.  Androstenedione only increases the amount of testosterone one produces for a period of time lasting about 2-3 hours.  There is great debate over whether that is enough time to allow one to build significantly more muscle mass than would occur without the use of androstenedione.  Even companies selling androstenedione disagree over its effectiveness as a muscle enhancer.

"Despite how manufacturers try to position androstenedione as a natural substance, it is still an anabolic steroid."

Androstenedione is reported by the manufacturers to be safe, with no side effects.  Yet, on labels, statements are made urging women and anyone under 18 years of age not to use it.  The Association of Professional Team Physicians, an organization of team physicians from professional sport teams, has stated, "Despite how manufacturers try to position androstenedione as a natural substance, it is still an anabolic steroid.  Simply put, its chemical structure is that of a steroid."  This is a concern because anabolic steroids have side effects such as acne, breast enlargement in males, personality changes such as increased aggression, sterility, and damage to the liver and heart.

Dr. Chuck Yesalis, Ph.D., a world renowned expert in performance-enhancing drugs from Penn State University, believes if steroids are a banned substance androstenedione must also be banned.  According to Yesalis, androstenedione has chemical properties similar to steroids and we should expect the two will have similar effects.

While androstenedione is usually taken as a pill or capsule there are other ways it can be used.  A nasal spray was used by East German athletes in the 1970's and, most recently, injectable forms are being developed.  The major concerns of the nasal spray are severe sinus headaches, irritability, and the possibility of damage to the sinuses.  Injectable forms pose a serious risk of infection from HIV, or other blood borne pathogens, in those users who share needles.

BUYER BEWARE: Androstenedione is an unregulated nutritional supplement.

Androstenedione, like most other food supplements, is an unregulated nutritional supplement.  It has not been evaluated for safety by the Food and Drug Administration (FDA).  Nutritional supplements are sold in a "buyer beware market."  When reading the claims made about androstenedione, or any nutritional supplement, remember, the following four tips:

1) Supplement manufacturers do not have to prove their products work,
2) Supplement manufacturers do not have to prove that their products are safe,
3) Supplement manufacturers can put health claims on their product labels, and,
4) Supplements do not have to be manufactured according to any quality standards.

Consumers have to be sure they have accurate information about supplements before purchasing them.

"School personnel and coaches should not dispense any drug, medication or food supplement except with extreme caution and in accordance with policies developed in consultation with parents, health-care professionals and senior administrative personnel of the school or school district."

The following position statement was issued recently by the National Federation of State High School Associations, "School personnel and coaches should not dispense any drug, medication or food supplement except with extreme caution and in accordance with policies developed in consultation with parents, health-care professionals and senior administrative personnel of the school or school district.  Use of any drug, medication or food supplement in a way not prescribed by the manufacturer should not be authorized or encouraged by school personnel and coaches.  Even natural substances in unnatural amounts may have short-term or long-term negative health effects.  In order to minimize health and safety risks to student-athletes, maintain ethical standards and reduce liability risks, school personnel and coaches should never supply, recommend or permit the use of any drug, medication or food supplement solely for performance-enhancing purposes."

"In order to minimize health and safety risks to student-athletes, maintain ethical standards and reduce liability risks, school personnel and coaches should never supply, recommend or permit the use of any drug, medication or food supplement solely for performance-enhancing purposes."

As with creatine, there is simply not enough scientific evidence regarding androstenedione's safety to warrant its use by high school student-athletes.  The Iowa High School Athletic Association highly discourages coaches from promoting or providing nutritional supplements to their student-athletes.

Sources:  Bartoll, Joachim. Androstenedione, <www.bahnhof.se/~jbartoll/androstenedione. Html>; Colgan, Michael, Ph.D. Natural Muscular Development, "Androstenedione and Tales of Testosterone,"  <www.musculardevelopment.com/oct/andro1.html>; Mihoces, Gary.  USA TODAY, "Debate of 'Andro' Builds", August 25, 1998; National Federation of State High School Associations, "NFHS Takes Position on Androstenedione," News Release, August 27, 1998; Peak Nutrition, "Androstenedione,"  <www.peaknutrition.com/aapi/anin.html>; Reed, Kristin. Yourhealthdaily, "McGwire's Muscle-building Supplement Raises No Red Flag at FDA," 1998 Bloomberg News.

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Creatine

Few topics have been as hotly debated in recent years as the use of creatine by high performance athletes to boost performance. Its advocates claim measurable improvements in performance. Its detractors raise doubts about effectiveness and safety.

To provide Canadian athletes with a scientific assessment of the pros and cons of creatine, the Sport Medicine and Science Council of Canada commissioned nutrition expert Marilyn Booth to produce an overview based on the best available research.  Following is a summary of Marilyn's review. You can find the full article on the SMSCC web site at http://www.smscc.ca/archives/creatine.htm. To review summaries of other articles on creatine you can subscribe to the new SMCC/SIRC Sport Info Alert by sending an email to: smscci@smscc.ca

What is Creatine?
Creatine is made in the liver, kidney and pancreas from amino acids arginine, glycine and methionine. Humans require about two grams per day. It is estimated that humans produce about one gram creatine per day and obtain one gram from food. Creatine is found in raw meat and fish (about five grams per kg), but much of the creatine is destroyed in cooking. An abnormally high intake of creatine can be attained by ingesting commercially available creatine supplements such as creatine mono-hydrate.

How does creatine work in the body?
Most of the creatine in the body is in skeletal muscle. Creatine exists as free creatine (Cr) or in combination with phosphate as phosphocreatine (PCr).  Phosphocreatine (PCr) acts as an energstorage unit and is used to regenerate adenosine triphosphate (ATP), the fuel needed to supply energy for muscular contraction.

Phosphocreatine is most important during high intensity, short-term anaerobic exercise or when all-out efforts must be repeated. Theoretically, if a person does not have peak phosphocreatine levels, the ability to restore ATP during high intensity activity could be reduced.

In theory, phosphocreatine supplementation could be beneficial for athletes who most repeat all-out exercise routines over time. At this time, research outside laboratory situations has not clearly substantiated the theory.

Will taking a creatine supplement improve performance?
Research results are not consistent regarding improved performance as a result of creatin supplementation. A number of factors may explain these discrepancies.

Following supplementation, usually with creatine monohydrate, performance may improve during the later repetitions when brief, high intensity activities are performed repeatedly (e.g., six-second sprints on bicycle ergometer).

Most studies show little or no improvement in performance of a single effort, and no increase in the maximum speed that can be reached by an athlete during a sprint.

The response to creatine supplementation varies from one person to another. In controlled laboratory tests, when initial muscle creatine levels were low, there was greater improvement. There was little or no improvement if muscle creatine levels were high or near normal.

Because creatine supplementation is associated with weight gain, its use may impede rather than improve performance in cases where weight has a detrimental effect on performance.

Creatine increase does not benefit endurance activities as a different energy system is used. In addition, the weight gain from creatine supplementation is likely to be an impediment during endurance activities.

Are there side effects?
The side effects most frequently reported in the experimental literature is rapid weight gain (up to three kilograms) in the first day or two of creatine supplementation. This suggests the weight is a result of fluid retention, rather than lean muscle tissue.

In one survey, 14 of 17 participants reported "tightness in muscles" for several days following the loading phase.

Other side effects are based on anecdotal reports of athletes experiencing stomach and muscle cramping, diarrhea and skin irritation.

What about long-term consequences?
There are no long-term studies at present. Most research has been conducted using low doses for a short period of time (20 to 30 grams for five days followed by two grams per day). All research has been conducted on adults and safety for young people is unknown.

Is there a simple test to determine if muscle creatine level is below average?
No. Experimental studies to determine actual muscle creatine content use a muscle biopsy where a hollow needle is inserted into the muscle to withdraw a muscle tissue sample for analysis.

Is creatine the first step toward a "doping outlook"?
Creatine is not on the list of banned substances but some suggest that reaching for any chemical interferes with the intrinsic value of sport. An athlete may start by looking for a chemical edge and proceed to reaching for a banned substance. Studies indicate an attitude toward doping begins with a relatively innocuous substance which the athlete hopes will provide a shortcut to success.

Courtesy:  Sport Medicine & Science Council of Canada

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Published by the Iowa High School Athletic Association

WHAT IS CREATINE?

Creatine is a natural substance produced by the liver, kidneys, and pancreas. Creatine can also be obtained by eating meat and fish. Creatine is essential to short-term, high intensity (anaerobic) exercise and is stored primarily in the muscles. Creatine enables the muscles to sustain maximal contractions for 3-10 seconds.  When creatine supplies in the muscles are depleted, the body relies on carbohydrates for energy during anaerobic exercise. The use of carbohydrates results in the formation of lactic acid causing muscle fatigue and delayed onset of muscle soreness (muscle soreness the day following a workout). Creatine supplementation is promoted as a method of increasing the amount of creatine available to the muscles, thus decreasing utilization of carbohydrate. This decreases lactic acid build-up, resulting in less muscle fatigue and less delayed onset muscle soreness. This is advantageous to athletes, allowing them to recover from workouts more quickly.

WHAT ARE THE BENEFITS OF CREATINE SUPPLEMENTATION?

Studies have shown creatine can be beneficial for well hydrated athletes performing high intensity, short duration tasks, such as strength training. Some athletes involved in intensive strength training, and using creatine supplements, report an increase in body weight, muscle size, and/or muscle strength. Approximately one-third of the athletes using creatine supplements show no increase in muscle creatine levels and report no increase in weight, size, or strength. It is believed those not reporting any benefits from creatine supplements have naturally high levels of creatine that negate any benefits supplementation might provide.

A recent study has shown that wrestlers using creatine, who lost 3-4 percent of their body weight in a five-day period, were not able to maintain power at maximal efforts and had decreased muscular endurance! On an average the wrestlers using creatine increased their body weight by 2 percent in five days! Based on the few studies conducted using athletes trying to control their weight, creatine is not recommended as a way to lose weight or maintain performance while losing or maintaining weight!

Two other recent studies showed no improvement in athletes running or swimming sprints as a result of creatine supplementation. Student-athletes must realize that creatine supplementation is no assurance of improved athletic performance!

Creatine supplementation typically involves taking 20 grams of creatine per day for five days, then using a maintenance dose of two grams per day during the remainder of the training period. Does greater than this have not shown increased benefits.  Unfortunately, many athletes believe the old adage, "if a little is good, more must be better." Taking large doses of creatine does not seem to have added benefits, but may very well increase possible risks.

WHAT ARE THE RISKS OF CREATINE SUPPLEMENTATION?

The greatest risk of creatine supplementation may be that no one knows what the long-term risks are! The major concerns regarding the short-term use of creatine supplements are dehydration and muscle dysfunction. Scientists believe creatine draws fluid into the muscles, taking it away from the vital organs of the body. Because fluid is shunted away from the vital organs, athletes using creatine may dehydrate much more quickly than other athletes and need to be monitored very carefully to avoid serious heat illness.

If creatine use is in any way related to dehydration, and it seems there is a connection, there are two areas of serious concern. Those areas are the use of creatine by athletes who are, or will be, competing in the "dog days of summer" and the use of creatine by wrestlers who are trying to lose weight.  The combination of creatine supplementation, high heat, and high humidity could be deadly!   Conditions creating high heat and humidity can be found naturally in the environment or created through the use of artificial weight loss methods such as rubber or plastic suits, saunas, or superheated wrestling rooms. Regardless of how the conditions are created, there is great concern for athletes who use creatine and work out in high heat and high humidity.

Most of the studies regarding creatine use have been conducted over the course of a few weeks to a couple of months at regulated doses. The long-term negative effects of creatine supplementation have not been studied nor have the effects of high doses.  One possible concern of long-term, high dose use is kidney damage. Only a certain amount of creatine can be stored in the muscles and the excess is excreted through the kidneys. As the kidneys excrete creatine a by-product called creatinine produced.  Elevated creatine levels are one measure of possible kidney damage and potential failure. Users of creatine supplements have higher than normal creatinine levels and the long-term effect of these high levels is unknown.

There have been anecdotal reports that athletes using large doses of creatine, estimated at 20 grams per day, or more, seem to suffer from muscle cramps, muscle pulls, and muscle tears much more frequently than those not using creatine. This muscle dysfunction may be due to changes in the muscle tissue caused by a high level of water retention within the muscle cells. Other short-term consequences some athletes report while using large doses of creatine include mild diarrhea and nausea.

HOW SAFE ARE CREATINE SUPPLEMENTS?

Many promoters of creatine believe there is no need to study the possible negative effects because creatine is a substance found naturally in the body. The problem is supplementation increases creatine levels within the muscles to unnaturally high amounts. Even some vitamins, which are natural substances, can be potentially dangerous when taken in excess!

Creatine supplements, like most other food supplements, are unregulated nutritional supplements. They have not been evaluated for safety by the Food and Drug Administration (FDA). Nutritional supplements are sold in a "buyer beware market."  When reading the claims made about creatine, or any nutritional supplement, remember, the following four tips:

1) Supplement manufacturers do not have to prove their products work!
2) Supplement manufacturers do not have to prove that their products are safe!
3) Supplement manufacturers can put health claims on their product labels, and
4) Supplements do not have to be manufactured according to any quality standards.

Consumers have to be sure they have accurate information about supplements before purchasing them.

WHAT DO SOME OF THE EXPERTS THINK?

Dr. Joseph Buckwalter, the University of Iowa's Football Team Physician, has been monitoring and studying the use of creatine by University of Iowa athletes for the past two years. An analysis of creatine's effectiveness in building muscle and improving recovery time has not been too encouraging. According to Dr. Buckwalter, "We have found some positive impact, but not a lot."

The NCAA Committee on competitive Safeguards and Medical Aspects of Sports believes more research must be done to determine what negative effects, if any, might result from long-term creatine supplementation. Until that research is completed, the committee discourages its use. The Committee does not believe athletics department staff should endorse any nutritional product purporting to improve student-athletes' athletic performance.

The Association of Professional Team Physicians is comprised of team physicians who provide service to professional sports teams. In a recent survey, 85 percent of professional team physicians indicated they believe professional athletes should not be using creatine until more research has been conducted regarding its safety.

It seems clear that while creatine supplementation may cause increases in body weight, as well as muscle size and strength, there is simply not enough scientific evidence regarding creatine's safety to warrant its use by high school student-athletes. High school coaches are discouraged from supplying creatine, or any nutritional supplement, to their student-athletes as supplying suchproducts could create serious ethical and legal concerns.