In competitive athletics, techniques for performance enhancement are continuously being assessed and reassessed in search of the optimal training regimen. With increased education surrounding banned substances such as steroids, athletes are turning more and more to dietary supplementation for optimal performance.

Creatine monohydrate is one such dietary supplement that the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports continues to monitor for potential sport performance enhancement and potential injury.

Creatine monohydrate appears to be the supplement of choice. Approximately 28 to 41 percent of all student-athletes at NCAA institutions uses creatine monohydrate, with the majority (45 to 74 percent) participating in what are classified as power sports (powerlifters, boxers, weightlifters, and track and field athletes). Current research is mixed about who will benefit from using creatine monohydrate.

Even with mixed results, there has been no slowing of the dietary-supplement industry in marketing creatine monohydrate as a performance enhancer.

The primary function of creatine is to act as a buffer against rapid increase in energy requirements. Phosphocreatine helps replenish adenosine triphosphate (ATP) during short bursts of high-intensity exercise. Depletion of phosphocreatine is related to the onset of fatigue during heavy exercise. Thus, it is theorized that increased creatine in muscle via supplementation may have a positive effect on high-intensity exercise performance by prolonging the availability of the very powerful (ATP-CP and anaerobic glycolysis), but low-capacity energy system.

When high doses of creatine are ingested over a period of four to six days, the muscle creatine content will remain elevated for several weeks. While the performance results vary in research studies, the one area that has produced consistent results is an increase in body weight. However, results are inconclusive as to whether or not increases in lean muscle mass can be attributed to creatine monohydrate.

To date there is no direct cause-and-effect relationship between creatine ingestion and negative side effects in scientific literature. All articles relating to the ingestion of creatine monohydrate agreed that further research is needed in the area of long-term use.

There is one area that should be cause for concern when considering the use of creatine monohydrate.

The International Olympic Committee funded an international study of non-hormonal nutritional supplements for anabolic-androgenic steroids. Approximately 600 non-hormonal, over-the-counter nutritional supplements were purchased via the internet, phone order and in shops and pharmacies. These over-the-counter nutritional supplements were chemically analyzed with gas chromatography and mass spectrometry. Approximately 15 percent of all samples were found to contain non-labeled ingredients that could provide a positive doping test. Shortly after the findings were published, the IOC Medical Commission recommended to athletes and their entourage not to use such products.

Every NCAA institution has an obligation to educate student-athletes on banned substances. Additionally, the drug-education package discourages student-athletes from taking any dietary supplements, especially dietary supplements touted as ergogenic aids. While creatine monohydrate and other nutritional supplements are not banned, some over-the-counter supplements may be tainted and largely responsible for the growing number of athletes testing positive for banned substances.

Robin Meiggs is assistant director of the Human Performance Laboratory at Humboldt State University and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.

Current NCAA position

The NCAA provides its membership guidance on the use of nutritional supplements by college student-athletes in the NCAA Sports Medicine Handbook, Guideline j, Nutritional Ergogenic Aids. The guideline notes the following:

A high carbohydrate diet is associated with improved performance and enhanced ability to train.

Supplements should be used only if student-athletes have problems consuming the needed amount of carbohydrate in their diet because of the large volume of food they may need.

Some laboratory studies have found that creatine use enhances short-term, high-intensity exercise capability; other studies have contradicted these claims.

The safety of creatine supplements has not been verified.

The handbook also directs the membership to the Resource Exchange Center (REC), sponsored by the National Center for Drug Free Sport and subscribed to by the NCAA. The REC provides the membership an accurate authoritative resource for questions about banned substances, nutritional/dietary supplements and medications. The REC can be accessed toll free at 877/202-0769 or online at www.drugfreesport.com/rec. NCAA members should contact Drug Free Sport at info@drugfreesport.com if they are unaware of their password.

In addition, the NCAA Drug-Testing Program book posts the following statement:

"Many nutritional/dietary supplements contain NCAA banned substances. In addition, the U.S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore purity and safety of nutritional/dietary supplements cannot be guaranteed. Impure supplements may lead to a positive NCAA drug test. The use of supplements is at the student-athlete's own risk. Student-athletes should contact their institution's team physician or athletic trainer for further information."