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Nine untrained male subjects participated in a placebo (Pl)/creatine (Cr), single-blind study conducted over a 5-wk period. Placebo and Cr treatments were presented in a sequential manner because muscle Cr washout time after supplementation is unknown. The mean ( +/- SE) age, height, and initial body mass for the subjects was 25.7+/- 1.2 yr, 177 +/- 2 cm, and 78.5 +/- 3.8 kg, respectively. Each subject performed five 15-s bouts of maximal cycling (1-min rest periods) after 7 d of Pl (6 g glucose X 5 doses daily) and again after ingesting Cr for 7 d (5 g creatine plus 1 g glucose X 5 doses) with a 2-wk intervention period. Only 6 of 9 subjects were able to complete five 1-min bouts of maximal cycling (5-min rest periods) after an additional 2 d of Pl and Cr treatment. Cr ingestion resulted in a significant increase in the work performed during each 15-s bout of maximal cycling compared to Pl trials. Moreover, the total work completed during five 15-s bouts of cycling increased significantly from 47.5 +/- 2.3 kJ with Pl treatment to 50.6 +/- 2.3 kJ after Cr supplementation (P < 0.05). Peak blood lactate concentrations determined 4 min after the fifth 15-s work bout were 14.4 +/- 0.5 mmol.L-1 and 14.3 +/- mmol.L-1 for Pl and Cr trials, respectively (P < 0.05). Total work completed during five 1-min bouts of maximal cycling was not significantly increased after Cr supplementation (P > 0.05). Additionally, Cr supplementation did not slow the rate of decline in the work accomplished during repeated bouts of maximal cycling. These findings suggest that Cr ingestion may augment the rate of ATP resynthesis from phosphocreatine during exercise in untrained subjects.

To determine the impact of creatine supplementation on high-intensity, intermittent work, 18 participants each performed 2 sets of 4 different work bouts to exhaustion. For 5 days prior to the first set of work bouts, all participants received a placebo (5 g of calcium chloride daily). For the second set of work bouts, 9 participants again received the placebo, while the other 9 received creatine supplementation (18.75 g creatine monohydrate daily for 5 days prior to and 2.25 g creatine daily during testing). The four work bouts in each set consisted of cycling to exhaustion at 150% peak oxygen uptake (VO2peak) either nonstop (A), intermittently for either 60-s work/120-s rest periods (B), 20-s work/40-s rest (C), or 10-s work/20-s rest (D). Creatine supplementation significantly increased (p < .01) the total work time of all bouts. Protocol D showed the greatest increase (> 100%); C increased 61.9%; B increased 61.0%; and A increased 23.5%. These results demonstrate that creatine supplementation significantly extends one's capacity to maintain a specific level of high-intensity, intermittent exercise.

Guanidinoacetate methyltransferase deficiency is a recently described inborn error of creatine biosynthesis that responds to treatment with oral creatine supplementation. The previously reported clinical features consist of developmental arrest and an extrapyramidal movement disorder. We describe a patient who presented with epilepsy, global developmental delay, and a persistently low plasma creatinine level. The diagnosis was established by measuring urinary guanidinoacetate and by demonstrating absence of the creatine/phosphocreatine peak in the patient's basal ganglia in 1H magnetic resonance spectroscopy. The clinical and biochemical abnormalities responded to creatine replacement.

Mitochondrial inclusion bodies are often described in skeletal muscle of patients suffering diseases termed mitochondrial myopathies. A major component of these structures was discovered as being mitochondrial creatine kinase. Similar creatine kinase enriched inclusion bodies in the mitochondria of creatine depleted adult rat cardiomyocytes have been demonstrated. Structurally similar inclusion bodies are observed in mitochondria of ischemic and creatine depleted rat skeletal muscle. This paper describes the various methods for inducing mitochondrial inclusion bodies in rodent skeletal muscle, and compares their effects on muscle metabolism to the metabolic defects of mitochondrial myopathy muscle. We fed rats with a creatine analogue guanidino propionic acid and checked their solei for mitochondrial inclusion bodies, with the electron microscope. The activity of creatine kinase was analysed by measuring creatine stimulated oxidative phosphorylation in soleus skinned fibres using an oxygen electrode. The guanidino propionic acid-rat soleus mitochondria displayed no creatine stimulation, whereas control soleus did, even though the GPA solei had a five fold increase in creatine kinase protein per mitochondrial protein. The significance of these results in light of their relevance to human mitochondrial myopathies and the importance of altered cell energetics and metabolism in the formation of these crystalline structures are discussed.

Objective: This study was undertaken to investigate the influence of oral supplementation with creatine monohydrate on muscular performance during repeated sets of high-intensity resistance exercise., Subjects/design: Fourteen active men were randomly assigned in a double-blind fashion to either a creatine group (n = 7) or a placebo group (n = 7). Both groups performed a bench press exercise protocol (5 sets to failure using each subject's predetermined 10-repetition maximum) and a jump squat exercise protocol (5 sets of 10 repetitions using 30% of each subject's 1-repetition maximum squat) on three different occasions (T1, T2, and T3) separated by 6 days., Intervention: Before T1, both groups received no supplementation. From T1 to T2, both groups ingested placebo capsules. From T2 to T3, the creatine group ingested 25 g creatine monohydrate per day, and the placebo group ingested an equivalent amount of placebo., Main Outcome Measures: Total repetitions for each set of bench presses and peak power output for each set of jump squats were determined. Other measures included assessment of diet, body mass, skinfold thickness, and preexercise and 5-minute postexercise lactate concentrations., Results: Lifting performance was not altered for either exercise protocol after ingestion of the placebos. Creatine supplementation resulted in a significant improvement in peak power output during all 5 sets of jump squats and a significant improvement in repetitions during all 5 sets of bench presses. After creatine supplementation, postexercise lactate concentrations were significantly higher after the bench press but not the jump squat. A significant increase in body mass of 1.4 kg (range = 0.0 to 2.7 kg) was observed after creatine ingestion., Conclusion: One week of creatine supplementation (25 g/day) enhances muscular performance during repeated sets of bench press and jump squat exercise.

The study was designed to investigate the effect of creatine monohydrate ingestion (20 g daily for 5 days) on performance in 45 s maximal continuous jumping and in all-out treadmill running at 20 km x h(-1), (inclination 5 degrees, duration approximately 60s). The participants were qualified sprinters and jumpers. The effect of creatine was compared with placebo in a double-blind design. Creatine (Cr) supplementation led to a significant enhancement of performance capacity in the jumping test by 7% during the first 15 s and by 12% during the second 15 s of the exercise. The positive effect of Cr supplementation was not observed in the last third of the continuous jumping exercise, when the contribution of anaerobic metabolism was decreasing. The time of intensive running up to exhaustion improved by 13%. The results show that Cr supplementation helps to prolong the time during which the maximal rate of power output could be maintained.

Mitochondrial and cytosolic creatine kinase (CK) isozymes are active in cells with high and variable ATP metabolic rates. beta-Guanidinopropionic acid (GPA), a competitive inhibitor of creatine transport, was used to study the hypothesis that the creatine-CK-phosphocreatine (PCr) system is important in regulating brain ATP metabolism. The CK-catalyzed reaction rate and reactant concentrations were measured in vivo with 31P nuclear magnetic resonance spectroscopy during energy deficit (hypoxia) or high-energy turnover (seizures) states in urethane-anesthetized mice fed GPA, creatine, or standard chow (controls). Brain phosphagen (i.e., cellular energy reserves) or PCr plus phosphorylated GPA (GPAP) concentrations were equal. The phosphagen-to-NTP ratio was lower than in controls. In vivo CK reaction rate decreased fourfold, whereas ex vivo CK activity that was biochemically measured was doubled. During seizures, CK-catalyzed fluxes increased only in GPA-fed mice. Phosphagen increased in GPA-fed mice, whereas PCr decreased in controls. Survival was higher and brain phosphagen and ATP losses were less for hypoxic GPA-fed mice than for controls. In contrast to mice fed GPA, hypoxic survival and CK reactant concentrations during hypoxia and seizures were the same in creatine-fed mice and controls. Thus GPA, GPAP, or adaptive changes in ATP metabolism stabilize brain ATP and enhance survival during hypoxia in mice.

In an infant with progressive, severe extrapyramidal movement disorder and extremely. low urinary creatinine excretion, in vivo proton magnetic resonance spectroscopy of the brain showed a depletion of creatine and an accumulation of guanidinoacetate, the immediate precursor of creatine. The suggested defect in creatine biosynthesis at the level of guanidinoacetate methyltransferase was confirmed by the demonstration of defective activity of this enzyme in liver tissue and by identification of the underlying genetic defect. Creatine substitution by means of oral creatine monohydrate at high dosage (4-8 g per day) resulted in a striking improvement of the extrapyramidal movement disorder, normalisation of abnormal slow background activity in the EEG, and disappearance of bilateral abnormal signal intensities in the globus pallidus. The low urinary creatine excretion normalized and brain creatine and creatine phosphate, as measured by in vivo magnetic resonance spectroscopy, increased significantly. Guanidinoacetate methyltransferase deficiency is a new, treatable inborn error of metabolism. Screening methods and non-invasive diagnosis of the enzyme defect are needed for the early detection and treatment of patients with this effect.

1H-MR spectra of human skeletal muscle feature peak splittings due to dipolar coupling. Quantitative difference spectroscopy in a double-blind cross-over trial testing oral creatine supplementation revealed that most of the resonances affected by dipolar coupling can be assigned to creatine and/or phosphocreatine. The assignment was performed in two different skeletal muscles and confirmed by measurements at the magic angle where dipolar splittings vanish. Numerical spectral simulations revealed that the observed spectra are consistent with partly-averaged dipolar coupling among methylene and methyl protons of (phospho)creatine. The possible nature of the molecular dynamics leading to incomplete dipolar averaging is discussed.

Our purpose was to determine the effect of creatine supplementation on power output during a 30-s maximal cycling (Wingate) test. Nine males underwent 3 randomly ordered tests following ingestion of a creatine supplementation (CRE), placebo (PLA), and control (CON) CRE was ingested as creatine monohydrate (CrH2O) dissolved in a flavored drink (20g.d-1 for 3 d), while PLA consisted of the drink only. Tests were performed 14 d apart on a Monarch ergometer modified for immediate resistance loading. Needle biopsies were taken from the vastus lateralis at the end of each treatment period and before the exercise test. No difference was found between conditions for peak, mean 10-s, and mean 30-s power output, percent fatigue, or post-exercise blood lactate concentration. Similarly, no difference between conditions was observed for ATP, phosphocreatine (PCr), or total creatine (TCr); however, the TCr/ATP was higher in the CRE condition (P < 0.05) than in the CON and PLA conditions. Findings suggest that 3 d of oral Cr supplementation does not increase resting muscle PCr concentration and has no effect on performance during a single short-term maximal cycling task.

This study investigated the effect of carbohydrate (CHO) ingestion on skeletal muscle creatine (Cr) accumulation during Cr supplementation in humans. Muscle biopsy, urine, and plasma samples were obtained from 24 males before and after ingesting 5 g Cr in solution (group A) or 5 g Cr followed, 30 min later, by 93 g simple CHO in solution (group B) four times each day for 5 days. Supplementation resulted in an increase in muscle phosphocreatine (PCr), Cr, and total creatine (TCr; sum of PCr and Cr) concentration in groups A and B, but the increase in TCr in group B was 60% greater than in group A (P < 0.01). There was also a corresponding decrease in urinary Cr excretion in group B (P < 0.001). Creatine supplementation had no effect on serum insulin concentration, but Cr and CHO ingestion dramatically elevated insulin concentration (P < 0.001). These findings demonstrate that CHO ingestion substantially augments muscle Cr accumulation during Cr feeding in humans, which appears to be insulin mediated.

Background: The creatine/creatine-phosphate system is essential for the storage and transmission of phosphate-bound energy in muscle and brain. In infants, inefficiency or failure of this metabolic pathway can impair the development of motor control and mentation., Methods: We studied and treated an infant with extrapyramidal signs who was shown--by assay for urinary creatinine and by analysis of brain metabolites with use of nuclear magnetic resonance spectra--to have depletion of body and brain creatine, due to inborn deficiency of guanidinoacetate methyltransferase (GAMT)., Findings: Long-term oral administration of creatine-monohydrate (4-8 g per day) to this index patient resulted in substantial clinical improvement, disappearance of magnetic resonance (MRI) signal abnormalities in the globus pallidus, and normalisation of slow background activity on the electroencephalogram (EEG). During the 25-month treatment period, both brain and total body creatine concentrations became normal., Interpretation: Oral creatine replacement has proved to be effective in one child with an inborn error of GAMT. It may well be effective in the treatment of other disorders of creatine synthesis.

Creatine supplementation has been shown to augment muscle PCr content and increase the rate of ATP resynthesis. Thus, we hypothesized that creatine supplementation might enhance sprinting performance. Eighteen subjects completed both of two testing sessions (control and postsupplement) 1 week apart, wherein they sprinted three 60-m distance trials that were recorded with videotape. Following the control session, for 7 days, subjects in the treatment group ingested a creatine-glucose mixture, while the placebo group consumed a glucose powder, followed by the postsupplementation session. Velocities of the subjects through three testing zones within the 60-m sprint were calculated from the videotape. Resultant velocities were analyzed using a MANOVA with a 2 x 2 x 3 x 3 (Group x Session x Trial x Zone) design. Results indicated that there were no statistically significant main or interaction effects on velocity between groups for session, trial, or zone. These data do not support the hypothesis that supplementary creatine ingestion will enhance velocity during the early or latter segments of a 60-m sprint.

Oral supplementation with creatine monohydrate (Cr.H2O) has been reported to increase muscle creatine phosphate levels. The aim of the present study was to determine the effect of such supplementation on performance of a single-effort sprint by elite swimmers. Thirty-two elite swimmers (M = 18, F = 14; age = 17-25 years) from the Australian Institute of Sport were tested on two occasions, 1 week apart. Tests performed were 25-m, 50-m, and 100-m maximal effort sprints (electronically timed with dive start, swimmers performing their best stroke), each with approximately 10 min active recovery. A 10-s maximal leg ergometry test was also undertaken. Swimmers were divided into two groups matched for sex, stroke/event, and sprint time over 50 m, and groups were randomly assigned to 5 days of Cr.H2O supplementation (4 . day-1 x 5 g Cr.H2O + 2 g sucrose, n = 16) or placebo (4 . day-1 x 5 g Polycose + 2 g sucrose, n = 16) prior to the second trial. Results revealed no significant differences between the group means for sprint times or between 10-s maximal leg ergometry power and work. This study does not support the hypothesis that creatine supplementation enhances single-effort sprint ability of elite swimmers.

Objective: To examine the effect of a relatively low dose of creatine on skeletal muscle metabolism and oxygen supply in a group of training athletes., Methods: 31P magnetic resonance and near-infrared spectroscopy were used to study calf muscle metabolism in a group of 10 female members of a university swimming team. Studies were performed before and after a six week period of training during which they took either 2 g creatine daily or placebo. Calf muscle metabolism and creatine/choline ratios were studied in resting muscle, during plantar flexion exercise (10-15 min), and during recovery from exercise., Results: There was no effect of creatine on metabolite ratios at rest or on metabolism during exercise and recovery from exercise. Muscle oxygen supply and exercise performance were not improved by creatine if compared to placebo treated subjects., Conclusions: Oral creatine supplementation at 2 g daily has no effect on muscle creatine concentration, muscle oxygen supply or muscle aerobic or anaerobic metabolism during endurance exercise.

Several nutritional modifications have been used by athletes to improve performance. Recent attention has focused on high fat diets, branched-chain amino acids, creatine, carnitine, bicarbonate and phosphate loading, and caffeine. Of these, only caffeine, which is present in food but has no known nutritional value, appears on the list of substances banned by the International Olympic Committee (IOC). While there is a theoretical basis for each of these diet manipulations to enhance performance, there are insufficient data to state unequivocally that high fat diets, branched-chain amino acids, carnitine or phosphate loading are effective. Caffeine has been found to enhance endurance performance, while creatine and bicarbonate loading were generally found to benefit short term strenuous exercise. Acute ingestion of these diet manipulations appears safe, although some, like caffeine and bicarbonate, can cause gastrointestinal disturbances or other problems in certain individuals. Long term use of high fat diets may have negative consequences on health. The safety of long term use of these diet manipulations has not been established.

The aim of the present study was to assess the effect of creatinine administration on urea metabolism in sedentary and exercised Wistar rats and also on the rate of glycogen resynthesis in the liver and skeletal muscle of endurance-trained animals after exhausting exercise. Creatine treatment for 7 days significantly increased the concentration of urea in blood plasma of sedentary as well as exercised rats and this effect was also maintained in trained animals 24 h after exhausting swimming. The rate of glycogen resynthesis in the liver and skeletal muscle after glycogen-depleting exercise was not modified by creatine administration.

This investigation determined whether oral creatine (Cr) loading could enhance single and repeated short sprint performance. A 1 x 10 s cycle sprint (Study One) and 6 x 6 s (departing every 30 s) repeated cycle sprints (Study two) were the performance tests used. Separate groups of subjects, randomly assigned to either a Cr or placebo (P) group, were used in each study in a double blind design. After performing a familiarization and two baseline tests subjects loaded with 5g of Cr or P four times per day for five days before repeating the tests one and three days post-loading. In Study One (n = 9 in each group), work completed (kJ) at 2, 4, 6, 8 and 10 s and peak power (W) were greater than baseline values in each of the post-loading trials in both the Cr and P groups. There were no between group performance differences. In Study Two (n = 11 in each group) after loading, the Cr group recorded significantly greater scores than the P group in total work (kJ) completed over the 6 sprints, work completed in sprint 1, and peak power (W). Post-exercise blood lactate and pH responses were not different between the Cr and P groups after loading in either study. Although Study One results are equivocal, Study Two results suggest that Cr supplementation can enhance both single (if sprint 1 results are considered in isolation) and repeated short sprint performance.

Background: Cardiac creatine levels are depressed in chronic heart failure. Oral supplementation of creatine to healthy volunteers has been shown to increase physical performance., Aim: To evaluate the effects of creatine supplementation on ejection fraction, symptom-limited physical endurance and skeletal muscle strength in patients with chronic heart failure., Methods: With a double-blind, placebo-controlled design 17 patients (age 43-70 years, ejection fraction < 40) were supplemented with creatine 20 g daily for 10 days. Before and on the last day of supplementation ejection fraction was determined by radionuclide angiography as was symptom-limited 1-legged knee extensor and 2-legged exercise performance on the cycle ergometer. Muscle strength as unilateral concentric knee extensor performance (peak torque, Nm at 180 degrees/s) was also evaluated. Skeletal muscle biopsies were taken for the determination of energy-rich phosphagens., Results: Ejection fraction at rest and at work did not change. Performance before creatine supplementation did not differ between placebo and creatine groups. While no change was seen in the placebo group compared to baseline, creatine supplementation increased skeletal muscle total creatine and creatine phosphate by 17 +/- 4% (P < 0.05) and 12 +/- 4% (P < 0.05), respectively. Increments were seen only in patients with < 140 mmol total creatine/kg d.w. (P < 0.05). One-legged performance (21%, P < 0.05), 2-legged performance (10%, P < 0.05), and peak torque, Nm (5%, P < 0.05) increased. Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine (P < 0.05). The increments in 1-legged, 2-legged and peak torque were significant compared to the placebo group, (P < 0.05)., Conclusions: One week of creatine supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance. This new therapeutic approach merits further attention.

Phosphocreatine (PCr) availability is likely to limit performance in brief, high-power exercise because the depletion of PCr results in an inability to maintain adenosine triphosphate (ATP) resynthesis at the rate required. It is now known that the daily ingestion of four 5-g doses of creatine for 5 days will significantly increase intramuscular creatine and PCr concentrations prior to exercise and will facilitate PCr resynthesis during recovery from exercise, particularly in those individuals with relatively low creatine concentrations prior to feeding. As a consequence of creatine ingestion, work output during repeated bouts of high-power exercise has been increased under a variety of experimental conditions. The reduced accumulation of ammonia and hypoxanthine in plasma and the attenuation of muscle ATP degradation after creatine feeding suggest that the ergogenic effect of creatine is achieved by better maintaining ATP turnover during contraction.

Creatine phosphate allows high rates of adenosine triphosphate resynthesis to occur in muscle and therefore plays a vital role in the performance of high-intensity exercise. Recent studies have shown that feeding large amounts of creatine (typically 20 g per day for 5 days) increases muscle total creatine (and phosphocreatine) content. The extent of the increase that is normally observed is inversely related to the presupplementation level. Vegetarians, who have a very low dietary creatine intake, generally show the largest increases. Creatine supplementation has been shown to increase performance in situations where the availability of creatine phosphate is important; thus, performance is improved in very high-intensity exercise and especially where repeated sprints are performed with short recovery periods. Creatine supplementation is widely practiced by athletes in many sports and does not contravene current doping regulations. There are no reports of harmful side effects at the recommended dosage.

1. Oral creatine supplementation has been shown to increase muscle creatine and phosphocreatine concentrations with consequent benefits on performance during short-term maximal exercise. However, recently there have been anecdotal reports that creatine supplementation can also influence the pattern of substrate utilization and improve performance during more prolonged, submaximal exercise, which, based on recent experimental evidence, may have some scientific justification. 2. Eight men performed a continuous incremental exercise test running at 10 km/h on a motorized treadmill at predetermined workloads from 50% to 90% of maximal oxygen uptake, before and after 5 days of creatine supplementation (4 x 5 g daily). Exercise was performed for 6 min at each workload to achieve a steady state, and respiratory gas exchange and blood lactate concentrations were measured during the last 30 s at each workload. Measurements were also made at 5-min intervals for the first 15 min of recovery. 3. The results showed no measurable effect of creatine supplementation on respiratory gas exchange and blood lactate concentrations during either incremental submaximal exercise or recovery. This suggests that creatine supplementation does not influence substrate utilization during and after this type of exercise.

Transport of creatine in the mouse liver has been investigated in vivo and in the perfused organ. Experiments were carried out with transgenic mice expressing creatine kinase in the liver (brain isoenzyme CKBB; EC 7.2.3.2.) [Koretsky, Brosnan, Chen, Chen and Van Dyke (1990) Proc. Natl. Acad. Sci. U.S.A. 87, 3112-3116] and in the corresponding control mice. The animals were fed a regular chow with or without the addition of 10% creatine (w/w) for 5 days. The kinetics of creatine uptake was measured in the perfused liver by 31P-n.m.r. spectroscopy and biochemical analysis following infusion of creatine at concentrations ranging over 0-15 mM and at an extracellular pH of either 7.40 or 6.40. The results suggest that creatine is actively transported by a pH-dependent mechanism obeying a saturable Michaelis-Menten type of kinetics (Km = 0.80 +/- 0.18 and 5.12 +/- 2.40 mM; Vmax. = 0.57 +/- 0.04 and 1.72 +/- 0.32 mumol.g of liver-1.min-1 at pH 7.40 and 6.40 respectively). Creatine export was evaluated in the perfused liver preloaded with creatine and the results show that less than 2.5 and 5% of the total creatine pool is exported to the perfusate during 80 min of perfusion at pH 7.40 and 6.40 respectively. Taken together, these results seem to explain the observation that creatine accumulates in the mouse liver only when blood creatine is raised by creatine feeding.

Since the discovery of creatine in 1832, it has fascinated scientists with its central role in skeletal muscle metabolism. In humans, over 95% of the total creatine (Crtot) content is located in skeletal muscle, of which approximately a third is in its free (Crf) form. The remainder is present in a phosphorylated (Crphos) form. Crf and Crphos levels in skeletal muscle are subject to individual variations and are influenced by factors such as muscle fibre type, age and disease, but not apparently by training or gender. Daily turnover of creatine to creatinine for a 70kg male has been estimated to be around 2g. Part of this turnover can be replaced through exogenous sources of creatine in foods, especially meat and fish. The remainder is derived via endogenous synthesis from the precursors arginine, glycine and methionine. A century ago, studies with creatine feeding concluded that some of the ingested creatine was retained in the body. Subsequent studies have shown that both Crf and Crphos levels in skeletal muscle can be increased, and performance of high intensity intermittent exercise enhanced, following a period of creatine supplementation. However, neither endurance exercise performance nor maximal oxygen uptake appears to be enhanced. No adverse effects have been identified with short term creatine feeding. Creatine supplementation has been used in the treatment of diseases where creatine synthesis is inhibited.

Biopsy samples were obtained from the vastus lateralis muscle of eight subjects after 0, 20, 60, and 120 s of recovery from intense electrically evoked isometric contraction. Later (10 days), the same procedures were performed using the other leg, but subjects ingested 20 g creatine (Cr)/day for the preceding 5 days. Muscle ATP, phosphocreatine (PCr), free Cr, and lactate concentrations were measured, and total Cr was calculated as the sum of PCr and free Cr concentrations. In five of the eight subjects, Cr ingestion substantially increased muscle total Cr concentration (mean 29 +/- 3 mmol/kg dry matter, 25 +/- 3%; range 19-35 mmol/kg dry matter, 15-32%) and PCr resynthesis during recovery (mean 19 +/- 4 mmol/kg dry matter, 35 +/- 6%; range 11-28 mmol/kg dry matter, 23-53%). In the remaining three subjects, Cr ingestion had little effect on muscle total Cr concentration, producing increases of 8-9 mmol/kg dry matter (5-7%), and did not increase PCr resynthesis. The data suggest that a dietary-induced increase in muscle total Cr concentration can increase PCr resynthesis during the 2nd min of recovery from intense contraction.

The effect of dietary creatine (Cr) supplementation on performance during 3, 30 s bouts maximal isokinetic cycling and on plasma ammonia and blood lactate accumulation during exercise was investigated. Placebo (P) ingestion had no effect on peak power output (PPO), mean power output (MPO) and total work output during each bout of exercise. Cr ingestion (4 x 5 g.day-1 for 5 days) significantly increased PPO in exercise bout 1 (p < 0.05) and MPO and total work output in exercise bouts 1 (p < 0.05, p < 0.05, respectively) and 2 (p < 0.05, p < 0.05, respectively). Cr ingestion had no effect on any of the measures of performance during exercise bout 3. No difference was observed in peak plasma ammonia accumulation before (146 + 30 mumol.l-1) and after (122 +/- 17 mumol.l-1) P ingestion, however the corresponding concentration was lower following Cr ingestion (129 +/- 22 mumol.l-1) compared with before Cr ingestion (160 +/- 18 mumol.l-1, p < 0.05), despite subjects performing more work. No difference in peak blood lactate accumulation was observed before and after P or Cr ingestion. The results demonstrate that Cr ingestion can increase whole body exercise performance during the initial two, but not a third, successive bout of maximal exercise lasting 30 s. The lower accumulation of plasma ammonia under these conditions suggests this response is achieved by an effect on muscle ATP turnover.

The present study was performed to determine whether 31P NMR relaxation times (T1) of adenosine triphosphate (ATP) might be used to monitor the resultant altered myocardial physiology produced by ischemia and possibly to explain mechanisms of altered physiology. To this end, pre- and postischemic T1s were determined in hearts perfused in the Langendorff mode, using 31P NMR inversion recovery methods. In hearts without any pretreatment (CON), post-ischemic ATP T1 values were significantly decreased compared with pre-ischemic values (P < 0.05); Pre-isch: gamma = 0.58 +/- 0.08; alpha = 0.62 +/- 0.06; beta = 0.38 +/- 0.08; Post-isch: gamma = 0.33 +/- 0.05; alpha = 0.43 +/- 0.03; beta = 0.23 +/- 0.05. In groups pretreated with creatine (CR), cyclocreatine (CY), or superoxide dismutase plus catalase (SOD-CAT) before ischemia, the post-ischemic ATP T1 values were similar and were not significantly changed from pre-ischemic values. These combined data suggest that T1s of ATP might be used to monitor altered myocardial physiology and could provide insight into mechanisms of alteration.

1. The present experiment was undertaken to investigate the influence of oral creatine supplementation, shown previously to increase the total creatine content of human skeletal muscle (Harris RC, Soderlund K, Hultman E. Clin Sci 1992; 83: 367-74), on skeletal muscle isokinetic torque and the accumulation of plasma ammonia and blood lactate during five bouts of maximal exercise. 2. Twelve subjects undertook five bouts of 30 maximal voluntary isokinetic contractions, interspersed with 1 min recovery periods, before and after 5 days of placebo (4 x 6 g of glucose/day, n = 6) or creatine (4 x 5 g of creatine plus 1 g of glucose/day, n = 6) oral supplementation. Muscle torque production and plasma ammonia and blood lactate accumulation were measured during and after exercise on each treatment. 3. No difference was seen when comparing muscle peak torque production during exercise before and after placebo ingestion. After creatine ingestion, muscle peak torque production was greater in all subjects during the final 10 contractions of exercise bout 1 (P < 0.05), throughout the whole of exercise bouts 2 (P < 0.01), 3 (P < 0.05) and 4 (P = 0.057) and during contractions 11-20 of the final exercise bout (P < 0.05), when compared with the corresponding measurements made before creatine ingestion. Plasma ammonia accumulation was lower during and after exercise after creatine ingestion. No differences were found when comparing blood lactate levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth rate inhibition of subcutaneously implanted tumors results from feeding rats and athymic nude mice diets containing 1% cyclocreatine or 1%, 2%, 5%, or 10% creatine. The tumors studied included rat mammary tumors (Ac33tc in Lewis female rats and 13762A in Fischer 344 female rats), rat sarcoma MCI in Lewis male rats, and tumors resulting from the injection of two human neuroblastoma cell lines, IMR-5 and CHP-134, in athymic nude mice. Inhibition was observed regardless of the time experimental diets were administered, either at the time of tumor implantation or after the appearance of palpable tumors. For mammary tumor Ac33tc, the growth inhibition during 24 days after the implantation was approximately 50% for both 1% cyclocreatine and 1% creatine, and inhibition increased as creatine was increased from 2% to 10% of the diet. For the other rat mammary tumor (13762A), there was approximately 35% inhibition by both 1% cyclocreatine and 2% creatine. In the case of the MCI sarcoma, the inhibitory effect appeared more pronounced at earlier periods of growth, ranging from 26% to 41% for 1% cyclocreatine and from 30% to 53% for 1% creatine; there was no significant difference in growth rate between the tumors in the rats fed 1% and 5% creatine. The growth rate of tumors in athymic nude mice, produced by implantation of the human neuroblastoma IMR-5 cell line, appeared somewhat more effectively inhibited by 1% cyclocreatine than by 1% creatine, and 5% creatine feeding was most effective. For the CHP-134 cell line, 33% inhibition was observed for the 1% cyclocreatine diet and 71% for the 5% creatine diet. In several experiments, a delay in appearance of tumors was observed in animals on the experimental diets. In occasional experiments, neither additive inhibited tumor growth rate for the rat tumors or the athymic mouse tumors.

1. The present study was undertaken to test whether creatine given as a supplement to normal subjects was absorbed, and if continued resulted in an increase in the total creatine pool in muscle. An additional effect of exercise upon uptake into muscle was also investigated. 2. Low doses (1g of creatine monohydrate or less in water) produced only a modest rise in the plasma creatine concentration, whereas 5g resulted in a mean peak after 1h of 795 (SD 104) mumol/l in three subjects weighing 76-87 kg. Repeated dosing with 5g every 2h sustained the plasma concentration at around 1000 mumol/l. A single 5g dose corresponds to the creatine content of 1.1 kg of fresh, uncooked steak. 3. Supplementation with 5g of creatine monohydrate, four or six times a day for 2 or more days resulted in a significant increase in the total creatine content of the quadriceps femoris muscle measured in 17 subjects. This was greatest in subjects with a low initial total creatine content and the effect was to raise the content in these subjects closer to the upper limit of the normal range. In some the increase was as much as 50%. 4. Uptake into muscle was greatest during the first 2 days of supplementation accounting for 32% of the dose administered in three subjects receiving 6 x 5g of creatine monohydrate/day. In these subjects renal excretion was 40, 61 and 68% of the creatine dose over the first 3 days. Approximately 20% or more of the creatine taken up was measured as phosphocreatine. No changes were apparent in the muscle ATP content.(ABSTRACT TRUNCATED AT 250 WORDS)

N-Methyl-N-(beta-hydroxyethyl)guanidine O-phosphate (creatinol O-phosphate, COP) has proved to possess anti-ischemic and anti-arrhythmic activities associated with improved ionic balance and heart performance. These activities, which have also been shown in clinical studies, are more evident in pharmacological and clinical conditions involving a hypoxic damage of the heart muscle. Pharmacokinetic studies have shown that absorption of COP administered i.m. is complete. COP is distributed in all organs, and in particular, in the kidney, liver and myocardium. After being dephosphorylated, this drug is eliminated with urine. Dephosphorylation of COP occurs in the kidney and liver. COP crosses the membrane of the myocardial cell, concentrating in the cytosoluble fraction. The results of the toxicological studies confirm that COP has no side effects, is excellently tolerated and has a favourable therapeutic index.

Acute clinical tolerance to N-methyl-N-(beta-hydroxyethyl) guanidine O-phosphate (creatinol O-phosphate, COP) was investigated in volunteer human subjects without heart or renal disease and without other serious illness. COP was administered i.v. at three different dosages, 1020 mg (group A), 2040 mg (group B) and 3060 mg (group C), in comparison with a placebo (group D). Arterial pressure, heart rate, ECG pattern and a complete blood analysis showed no change at any COP dosage, with the exception of blood phosphate, which increased in groups B and C. Cumulative urinary excretion of phosphate and creatinine and diuresis increased, whereas other urine parameters did not change. The phosphate and creatinine increases derived from the COP molecule and the increase in diuresis from a simple osmotic process required to dilute the phosphate in the tubular fluid. All these alterations were statistically significant and dose-related with COP and had been expected. COP proved to be a very well tolerated drug without any evident side effect.

Creatine and creatinine intake can cause increased urinary creatinine excretion. To estimate the contribution of diet to creatinine excretion in infants, creatine and creatinine were determined in human milk, pasteurized cow's milk and formulas for preterm and term infants. Soy-based formulas did not contain creatine and creatinine. Average concentrations in human milk (creatine 77 [60-100] mumol/l, creatinine 52 [41-65] mumol/l) were markedly lower than in pasteurized cow's milk which contained 598 (476-640) mumol/l creatine and 105 (79-122) mumol/l creatinine. Creatine and creatinine concentrations differed widely in formulas for both preterm and term infants, from 155-559 and 33-174 mumol/l, respectively. The influence of ingested creatine on creatinine excretion should theoretically be negligible. On the other hand, based on known absorption data, creatinine from the diet should increase creatinine excretion in a 3-month-old infant up to an amount in the range of 5.3-28.4% of the endogenous production. Therefore creatinine ingestion should be taken into account when interpreting creatinine excretion in infants.

The transfer of 14C-creatine to the rat fetus was studied following continuous i.v. infusion into the mother. In the presence of a relatively constant maternal plasma 14C-creatine concentration, creatine was accumulated by the chorioallantoic placenta and visceral yolk sac to concentrations higher than that found in maternal or fetal plasma. The ability of the extraembryonic membranes to accumulate creatine changed during gestation; nevertheless, these membranes concentrated creatine against a gradient throughout the period studied (14-22 days of gestation). Neither 14C-creatine nor 14C-urea were concentrated in the placentae or fetal plasma when compared to maternal plasma. Simultaneous infusion of beta-guanidinopropionic acid with 14C-creatine reduced both movement and accumulation of creatine into the fetoplacental unit. It is concluded that the accumulation of creatine by the chorioallantoic placenta and by the visceral yolk sac is an active process with creatine diffusing down its concentration gradient into the fetal circulation.