Learn what two supplements may enhance strength and add muscle

In a landmark study printed in the Journal of Applied Physiology, researchers set out to determine which nutritional supplements actually promoted measurable lean mass and strength gains, and which could be safely cast aside as pretenders.

41 In this meta-analysis—where numerous studies are examined and analyzed, held up or dressed down, lauded or laughed at—only two supplements emerged unscathed. Just two supplements—in an evaluative process that encompassed a time period stretching from 1967 to 2001—could be recommended for adding muscle and strength.

And the winners are …

The two? Creatine and beta-hydroxy-beta-methyl butyrate, better known as HMB. Now, many supplements could not be included in the study simply because they did not meet a predetermined set of experimental criteria. More than likely, there are other supplements that are helpful in promoting lean mass and strength gains, but it’s not likely that any are of the caliber of creatine and HMB. Meanwhile, in the stark reality known as the “other end of the spectrum,” some supplements can now safely be described as hot air in a capsule.

And so it really boils down to two. With creatine, as the researchers discovered, you can expect net lean mass gains of 0.36 percent per week. For someone with 150 pounds of lean mass, that’s a musculature gain of one half pound a week. Two pounds a month. Six pounds in three months. And that’s with creatine alone, not factoring in a solid nutritional and training regimen. With HMB, the gains are a nearly identical 0.28 percent per week.

The expected strength gains obtained from these two supplements are even more impressive. Creatine delivers a 1.09 percent weekly boost in strength, with HMB superior at 1.40 percent per week.

To put this in perspective, if your maximum bench press is 250 pounds, a compounded 1 percent weekly gain would push your max to 260 pounds in just one month. Again, that’s factoring in just one supplement, irrespective of diet and advanced training techniques, and assuming only a 1 percent weekly increase. Use both supplements, train hard and eat right, and you might surpass that figure significantly.

Perhaps it’s not surprising that these two supplements are superior to all others. Creatine, especially, has experienced an unprecedented amount of fanfare, from hard-core bodybuilders to casual gym-goers, underground publications to mass media outlets. Its worth and value is unquestioned, and the latest research only adds to its legacy. It would be unfair to say that HMB is just as popular, but this paramount study certainly establishes that it, too, belongs.

Accordingly, this chapter will focus predominately on these two supplements. It will outline their history, their composition and their efficacy. You will learn why they work, how they work and how to make them work. The chapter will also examine other supplements, but without solid research it must be stated that none will ever reside in the same category as creatine and HMB. Some have promise, yes, but only time will bear out their fate. Quite naturally, however, the chapter will begin with the most successful sports supplement in history—creatine.

Creatine

One of the greatest discoveries in the history of sports supplementation was the revelation that muscle creatine stores could be elevated by oral ingestion of the dietary supplement creatine.24 From there, the innumerable studies that would follow touched off a firestorm of interest in the supplement, and since then, no supplement has even remotely established the same scientific support as has creatine. Why has creatine become such a driving force in the sports supplement arena since it was first brought to the market in the early 1990s? Simple. It works!

Creatine supplementation can build muscle, improve strength and power, and may also help you improve aerobic performance, although researchers aren’t entirely certain how this occurs. While the distinct methods by which creatine exerts its impressive effects still require further examination, it is a virtual certainty that creatine is highly effective for numerous athletic pursuits, making it one of the most popular supplements ever produced.

A brief history of creatine

Contrary to what you might read in popular bodybuilding and fitness magazines, the discovery of creatine was not made in the United States. While its use in this country was certainly popularized by the flood of studies performed by U.S. scientists, the scientific discovery of creatine itself was actually made in the 1800s. Some of the earliest research on creatine as an ergogenic aid was performed in the former Soviet Republic. In fact, it was research that was far superior to anything taking place in the United States at the time.31

The Russians essentially pioneered the use of creatine as a sports supplement. Evidence suggests that it was being used successfully by Russian athletes as early as the 1970s and 1980s, well before it gained overwhelming popularity here in the early 1990s.

With the Russians’ early discovery of creatine’s effectiveness, combined with their superior training methods, they were placed in rarefied athletic company for much of the Cold War, when information was not shared freely with their Western counterparts.31

The Soviets attained a dominant athletic position in the Olympic Games shortly after World War II and much of their success could be attributed to their incredibly advanced research testing in exercise and muscle biochemistry. Of course, their secretive nature about such testing became a Russian trademark, and it wasn’t the least bit surprising that they neglected to share any of their findings with the West, particularly the United States.

The Russians first established that oral creatine supplements could improve athletic performance in short, intense activities such as sprints and weight lifting. By comparison, this identical discovery wasn’t made in the West until the 1990s. In addition, the Russians discovered that creatine is found in higher concentrations within fast-twitch muscle fibers (as opposed to slow-twitch), and that chronic exercise increases levels of creatine within these fibers.

They figured that higher levels of creatine would likely improve performance, and soon, they were confident that they could turn out superior athletes by boosting creatine stores within muscle. In developing what was likely the first oral creatine supplement ever produced, they did exactly that.31

Given the initial progress made by the Russians, it’s evident that creatine isn’t a new supplement. In fact, many of the critical questions surrounding creatine—proper dosing, the upper limit of stored creatine in the human body, time period of discontinuance necessary to restore baseline levels, and agents that improve creatine absorption—were addressed long before creatine was ever brought to the forefront of sports supplementation.

In roughly 1833, a French scientist named Chevreul first identified creatine, although it wasn’t until approximately 1847 that a Dr. Liebig provided evidence linking creatine to muscle tissue. In 1922, human studies were reviewed dating back to 1910, in which subjects ingested 1 to 20 grams of creatine per day for six days.28

Case study reports in 1926 also detail human subjects consuming 2.5 grams of creatine, four times per day for 10 days12. In the 1970s, researchers concluded that the increase in total creatine content in muscle may somehow be mediated by insulin.14It would take another 17 years before the Harris (1992) study ignited the creatine explosion and 21 years before scientists (again) shed light on the theory that uptake of creatine into muscle was mediated by insulin.20,24

How creatine works

Approximately 95 percent of all the creatine stored in the human body is found in skeletal muscle. Creatine is naturally produced in the body from the amino acids methionine, arginine and glycine47and is available through the diet from foods like fish and beef.74

However, the powdered form is not only more convenient, it’s also much more practical. For instance, you would have to ingest roughly 2 ½ pounds of raw meat to equal one 5-gram serving of supplemental creatine.

Your body utilizes a few different methods for producing energy within the body, but the ultimate source of that energy is always a chemical known as adenosine triphosphate, or ATP. For you to run, walk, lift weights and even breathe, your body must either derive energy from its immediate ATP stores or it must create it using stored glucose or fats.

The problem is, your body only has enough immediate ATP to last for about three to five seconds of intense activity, which is typical of a weight-training set or an all-out sprint. This is one of the reasons why you can only sprint at full speed for a short time or why you fatigue quickly during your five-rep max on the bench press—your ATP is depleted rapidly, and it takes a few minutes to regenerate.

That leaves us with glucose and fats. Either one can be used to create ATP, but it takes time. You can’t go all-out on a lift or a sprint and expect a meaningful contribution from carbs or fats—they simply can’t produce ATP quickly enough. These systems are very valuable, however, for providing sustained energy during longer term exercise bouts. These just aren’t the kind of activities that are going to pack on mass. No one got big running marathons.

The key, then, is to enhance short-term exercise performance by increasing your immediate ATP stores. Knowing this, researchers, for years, focused on how to do just that, but it was futile since you couldn’t really increase ATP beyond existing levels. In fact, taking ATP itself made no difference. Why? Simple. The limiting factor in this case was not ATP, but rather a chemical known as phosphocreatine (PCr).

Chemically speaking, once you utilize an ATP molecule for energy, it’s reduced to ADP, or adenosine diphosphate. ADP, lacking one phosphate, is basically useless unless a companion chemical can donate the additional phosphate, allowing ADP to once again become an energy providing ATP molecule. That companion chemical is, of course, phosphocreatine.

Therefore, by increasing the levels of PCr within muscle, you could regenerate ATP like never before. You would be stronger. You would perform, say, eight reps with a weight that was previously a five-rep max. Your three-rep max would be your six-rep max. You could work out with greater poundages for longer periods of time. Run faster, jump higher, recover quicker. Grow bigger.

This is exactly what the ingestion of a creatine supplements allows. With the absorption of creatine into muscle, you’ve provided a greater pool of phosphocreatine, allowing faster and more prolific regeneration of ATP, the ultimate source of energy.

This is why creatine has attracted the attention of the weight-training community, the athletic community, the scientific community, and even the medical community. The research emphatically supports its use, and its mechanisms for enhancing strength and lean body mass are practical and purposeful, as outlined by the following:



Increased ability to train at higher intensities and workloads, thus providing greater stimulus for training adaptations.10
Increased protein synthesis secondary to increased muscle cell hydrations.6, 25
An increase in myosin heavy-chain mRNA and protein expression, which basically stimulates the building of new muscle.75, 76
Increase in satellite cell activity.15 Satellite cells are cells that are attached to the muscle cell membrane. When activated, they are involved in repairing damaged muscle and aid in increasing muscle size and/or increasing muscle fiber number.


Creatine enhances strength

After numerous research studies validated the success of oral creatine in elevating the body’s phosphocreatine stores, over 20 studies have reported that creatine supplementation enhances muscle strength and lean body mass responses to resistance training.70,53 With a firm understanding of the mechanisms responsible for these enhancements, the following is a brief rundown of the most comprehensive studies and their results.

Dr. Earnest and colleagues were the first to investigate chronic creatine use on strength and power, and instead of using a traditional set of untrained individuals, they examined creatine’s effects on resistance-trained men. 16 The subjects—men with 10 years of weight training experience—received a 28-day supply of creatine, and after just 14 days of supplementation, they demonstrated significantly greater sprint capacity.

After receiving the full 28-day complement of creatine, both muscular strength and total lifting volume improved. Several other studies also showed creatine’s positive effect on strength and power.37,62,63

Longer studies on creatine have also demonstrated similar positive results. One in particular involved untrained, sedentary women who supplemented four daily servings of creatine (5-gram doses), for four days, followed by a 70-day maintenance period of 2.5-gram, twice-daily servings.67 During this latter “maintenance” period, the women underwent a resistance-training program. After five and 10 weeks of creatine supplementation, strength was significantly greater in the creatine group versus a group that trained without creatine.

Furthermore, after stopping the resistance-training program, a smaller group continued to take 5 grams of creatine daily for an additional 10 weeks. The researchers discovered that, despite the fact that the women were no longer working out, the continued use of creatine delayed decreases in strength that occurred in subjects that ceased both training and creatine use. In other words, creatine maintained some of their strength gains even when they quit training!

Creatine builds muscle

During the initial explosion of interest surrounding creatine, the question of whether creatine was effective at building muscle mass was largely up for debate. Many of the studies focused on strength and athletic performance enhancement, and it was thought that much of the body weight gains could be attributed to excess water retention.

However, researchers soon discovered that, in addition to the improvement of strength, creatine supplementation has a significant effect on body composition. In fact, there are now a multitude of studies that have demonstrated creatine’s prowess in spurring lean body mass gains.

One of the better studies to date studied the effects of creatine supplementation on experienced weight-trained men. 69 The investigators began the subjects with 25 grams per day for seven days, followed by a maintenance dose of 5 grams per day for 77 days.

Their training targeted all of the major muscle groups and spanned three or four days per week. After the 12-week training and supplementation period, the creatine-supplemented group gained an average of 9.5 pounds of lean body mass compared to only 4.6 pounds in placebo group. That represents a whopping 107 percent difference.

Figure 2 is an average of several studies that examined the effects of creatine supplementation on lean body mass. It is apparent that there is a wide range of responses—gains encompassed anywhere from 0 to 10 pounds—with the average gain being approximately 5 pounds.

Factors such as training status, duration of the study, gender, dosage, training program and others affect your response to creatine supplementation. However, the fact remains, in every properly-designed training study reviewed, creatine supplementation enhanced the effect of training on lean body mass gains greater than training alone.

Figure 2. Average lean body mass change after creatine supplementation. Blue represents placebo group and purple is creatine group. Data averaged from various studies. 5,16,32,33,37,45,47,48,54,67,69

Nutrients that enhance the effects of creatine

Creatine plus beta-hydroxy-beta-methlybutyrate (HMB)

HMB is a metabolite of the amino acid leucine a compound found in all dietary protein and an essential building block of protein in all tissues.44As outlined at the outset of this chapter, studies have shown that HMB supplementation alone may increase strength and lean body mass in exercising individuals.

Other studies have also suggested that HMB may have protein-sparing or anti-catabolic action (more on HMB later). Thus, combining HMB and creatine may have a synergistic effect for strength athletes or anyone looking to pack on lean muscle mass.

A recent study, published in the journal Nutrition, may have proved that the combination of HMB and creatine is the most naturally potent method for gaining strength and lean mass.30After three weeks of training, the researchers found that that the creatine plus HMB supplement group experienced a 28 percent greater strength increase over the HMB-only group and held a 25 percent advantage over the creatine-only group, thus validating the advantage of using both creatine and HMB.

Creatine plus carbohydrates

When it comes to nutrients that enhance the effect of creatine, some of the most solid research has been performed using the powerful combination of carbohydrates plus creatine.

The main benefit of adding carbohydrates to your creatine is that it increases creatine uptake within the body. Obviously, the more creatine you can absorb, the greater the corresponding effect. Carbohydrates, especially if they’re the “fast-acting” kind—such as glucose—can indirectly aid creatine absorption by stimulating the release of insulin from the pancreas.

Insulin is a powerful hormone that effectively “shuttles” protein, carbohydrates and, in this case, creatine, into muscle cells. Therefore, if you can enhance the release of insulin when taking creatine, you can send more of it to muscle cells, which may augment its already positive effects. Again, it’s the presence of carbohydrates in the blood stream that allow this to happen.

So what does the research have to say? One study reported that ingesting 5 grams of creatine 30 minutes after consuming 93 grams of simple sugars resulted in a 60 percent increase in total muscle creatine concentration when compared to a group that consumed creatine alone. 20

That’s quite an improvement, and it stands to reason that an enhancement such as this should also lead to elevated improvements in performance and physique-related measures. Countless other studies have supported the addition of carbohydrates to creatine for physique- and performance-enhancement, 37 and some studies show this is possible by adding fewer carbohydrates.56,58,62

Creatine plus phosphates

Phosphates are one of the most abundant minerals in the body, and are extremely important in human metabolism. Approximately 80 percent to 90 percent of the phosphates in the body combine to form calcium phosphate, which is used for the development of bones and teeth. Other phosphate salts, such as sodium phosphate, are involved in acid-base balance. The remainder of the body’s phosphates is found in a variety of organic forms, including phospholipids, which help cell membranes and DNA. Furthermore, phosphates are essential to the normal function of most of the B vitamins involved in the energy processes within the cell.

To put it simply, phosphates may help exercise performance through their ability to buffer lactic acid, improve the body’s ability to deliver oxygen to contracting muscles, and enhance the cardiovascular system’s ability to deliver more nutrients to the muscle, which is important for muscle growth.7

Now, what about the theory of synergy between phosphates and creatine? First, you must understand that when creatine is ingested, it enters the blood stream as free creatine. It can only exert its powerful effects when it’s “phosphorylated“ within the muscle cell, which is a fancy way of saying that a phosphate is attached to it (the same goes for glucose to make glycogen).

Here’s the key: the amount of creatine that is phosphorylated, and thus the amount that is effective may be dependent on how much phosphate is available, and the human body can only supply a limited amount. Thus, if you have inadequate phosphates available, lower muscle creatine levels may result, despite the fact that you may be supplementing with creatine.

Why is this important? Obviously, if more creatine is phosphorylated, then more of it is effective, and you will likely experience greater gains. We know that the regeneration of ATP (needed for muscle contraction) is crucial for allowing repeated reps and sets in the gym, and this process relies heavily on creatine phosphate and glycolysis.

So, taking phosphates with creatine may be a one-two punch at improving performance by increasing creatine phosphate levels (more energy for training) in the muscle, which also delays fatigue by increasing oxygen to working muscles and buffering lactic acid.

The research proves it. In one study, researchers investigated the effect of supplemental creatine alone versus creatine plus phosphates on muscle power.73 Male and female subjects were given either 5 grams of creatine four times daily, or 5 grams of creatine plus 1 gram of sodium phosphate four times per day, for five days. The results showed that the combination of creatine plus phosphate resulted in a significantly higher muscle power output.

A more recent study examined the effects of creatine versus creatine plus phosphate on anaerobic working capacity. 18At the end of the experiment, the subjects who took creatine plus phospate scored 104 percent greater than the placebo group, and 67 percent better than the creatine group. Pretty impressive, and precisely why many creatine products now also contain phosphates.

Creatine plus protein

We know that carbohydrates can enhance the positive performance effects of creatine, but what about protein? If it does, in fact, work synergistically with creatine, it would likely be accomplished through different mechanisms, since carbohydrates are primarily a fuel source, while much of protein’s contribution to exercise includes repair of damaged muscle fibers through the provision of amino acids needed for muscle protein gain (i.e., hypertrophy).

Like weight training itself, creatine has been shown to enhance muscle protein synthesis. Therefore, it would seem to make sense that combining protein with creatine would be a powerful combo for gaining strength and lean body mass. In a study examining the effects of resistance training and whey protein supplementation—with and without creatine—on lean body mass and muscle strength, 36 men supplemented with either whey protein, whey protein and creatine or a placebo over the course of a six-week resistance-training program.

The results? Significantly greater strength and lean body mass for the group taking the combination of whey protein and creatine. And, quite naturally, this supports the theory that protein enhances the already potent effects of creatine.9

Creatine plus glutamine

For starters, we know that the building blocks of proteins are amino acids, and that the best sources of proteins contain the highest percentage of essential amino acids. Essential amino acids, of course, are those that you must obtain from your diet. In the case of glutamine, however, it’s considered a "conditionally essential amino acid."

Interestingly, glutamine (not carbohydrates or fat) is the preferred fuel source for rapidly dividing cells such as intestinal cells and your immune system cells. Glutamine also has a role in acid-base balance, as a nitrogen carrier and as a precursor for important macromolecules (i.e., proteins, nucleic acids). Furthermore, under certain stressful catabolic conditions, glutamine may be needed as part of your diet; hence the term "conditionally essential." Can you think of activities that foster a stressful catabolic condition? That’s right, exercise, and more specifically, weight training. Since weight training is catabolic (rest and recovery is anabolic), pumping iron puts a strain on glutamine reserves.

And because glutamine makes up roughly 61 percent of the amino acid pool in skeletal muscle, the loss of muscle glutamine may be a signal of muscle breakdown. So, it now becomes “essential” that intramuscular glutamine stores are maintained, 1and quite conceivable that adding glutamine to your creatine supplementation program may be a good idea.

In a recent study, 29 male and female college track athletes were randomly divided into three groups: a creatine-only group, a creatine plus glutamine group and a placebo group. 38 During the seven weeks of supplementation, all treatment groups went through an identical resistance- training program, but the creatine-only and the creatine plus glutamine groups were the only ones that demonstrated significant increases in lean body mass.

But was the creatine plus glutamine group any better? Actually, not statistically. What should be pointed out is that the creatine plus glutamine group did show 26 percent greater lean body mass gains than the creatine-only group, only this was not deemed significant enough, as permitted by the study design. Therefore, future investigations should repeat this study with more subjects and for a longer period of time. We’ll just have to wait.

On the forefront: Creatine plus beta-alanine

Beta-alanine is an amino acid produced naturally in the body and found in foods such as chicken. In and of itself, it is a fairly innocuous amino acid. But once it’s plugged into the metabolic pathway in your body it produces another biochemical called carnosine, which is a powerful buffering agent. It has the ability to neutralize lactic acid buildup in your muscles, and it accounts for up to 60 percent of your body’s natural lactic acid buffering action.

The build-up of lactic acid in muscles is one of the main limiting factors in muscular performance. Therefore, the more carnosine your muscles hold, the longer you’ll be able to delay the accumulation of lactic acid in your muscles during intense exercise, and the longer you’ll be able to exercise at peak levels.

One recent study demonstrated this effect when scientists correlated the bicycle sprint performance of subjects with their naturally-occurring muscle carnosine levels. They found that there is a very strong relationship between the amount of carnosine in the muscle and the ability to perform at peak levels throughout the sprint. Those with high levels of carnosine significantly outpaced their lower-carnosine counterparts in the sprint—especially in the last 10 seconds of a 30-second sprint. This type of reserve power when you really need it is what every athlete looks for.

And it doesn’t take much of beta-alanine to substantially raise your carnosine levels. Research shows that just 3.2 grams of beta-alanine taken over a four-week period can increase muscle carnosine content by up to 42 percent. And that’s enough to make a noticeable difference in the gym.

What’s really interesting is that beta-alanine may actually help creatine work better in your body—not by getting more creatine into your muscle cells, but using the creatine that’s there and making it act more effectively on your muscles.

Creatine only works within a very limited pH range. In other words, if your muscles become too acidic due to lactic acid buildup, creatine simply won’t work like it’s supposed to. So by effectively buffering lactic acid, carnosine (secondary to beta-alanine supplementation) supports optimal creatine effectiveness.

The creatine controversy—how safe is it?

Creatine safety—people under 18

Currently, there is no published scientific evidence which suggests that regular creatine supplementation causes harm to people under 18. Despite any unfounded claims made to the contrary, this statement is fact. Perhaps any negativity addressed at creatine could be countered by the following—an intriguing series of studies involving the role of creatine in guanidinoacetate methyltransferase deficiency, a novel inborn error of metabolism.59

In this and other investigations, creatine supplementation has been used as replacement therapy to treat infants with congenital defects in which they fail to produce normal amounts of bodily creatine. 60 Interestingly, they have found long-term (22 months) oral administration of creatine monohydrate (4 to 8 grams per day) normalizes brain and total body levels of creatine and also improves motor function, and this occurred with absolutely no harmful effects. Furthermore, the dose given would be the equivalent of approximately 100 grams daily (for an average size individual) for nearly two years. As a comparison, the current recommended daily dose is 3 to 5 grams, an intake that is 20-fold less.

Creatine safey—healthy adults

Creatine has reportedly been linked to a myriad of health problems, ranging from the mild (e.g., muscle cramps) to the critical (e.g., renal failure). It should be clear that in normal healthy individuals, these purported ill effects have no factual basis. The published scientific evidence clearly shows that creatine supplementation in normal healthy adults poses little to no risk. To make things a bit more concise and thorough, we’ve included the following table, which lists the anecdotal side effects and safety concerns and allays them with what has actually been found in controlled studies.

Table 1. Anecdotal reports versus actual data

In a retrospective study on the safety and side effects of creatine, investigators concluded “there were no differences in the reported incidence of muscle injury, cramps or other side effects” as compared to control groups not receiving creatine. 57 Another study also reported on the safety of creatine and concluded “there is no evidence for deleterious effects in healthy individuals.” 50

Recently, another study concluded that long-term (21 months) creatine supplementation while training does not significantly affect clinical markers of health in athletes. 34 Again, this basically supports what others have concluded—that creatine is not harmful to the body. An additional study concluded that creatine supplementation while training does not increase the incidence of cramping or injury and, perhaps surprisingly, they also reported that creatine supplementation may actually reduce the incidence of dehydration, cramping and/or injury during intense training. 22,23

This suggests that the anecdotal claims of cramping and muscle strains supposedly caused by creatine are likely related to poor hydration habits or over-exertion during exercise, rather than by some physiological effect of creatine.

And what of the ongoing claims that creatine poses a negative stress on renal and kidney function, as raised in both the general population and scientific communities? Well, to date, no study has shown a link between creatine use and renal failure, aside from creatine use in subjects with existing renal dysfunction.17 Neither short-, medium- or long-term creatine use has been shown to negatively impact kidney function.49,51,55

One potential side effect, if you can consider it one, is that the use of creatine has consistently resulted in weight gain. Of course, this depends upon whom you ask, as weight gain may be a welcome offshoot for some. If you’re a competitive jockey or swimmer, then weight gain is probably unwanted, but an offensive lineman in football or competitive bodybuilder likely wouldn’t mind it.

GI (gastrointestinal) distress is one undesirable effect that has also been noted in the literature, but it’s only been found to occur when creatine is consumed just prior to or during exercise.68The high amount of simple sugars that often accompanies carbohydrate intake may also be, in part, to blame for stomach upset since sugar slows gastric emptying in the gut.

Thus, a reasonable interpretation of the scientific literature would lead a reasonable person to the following conclusion: regular creatine supplementation in normal healthy adult individuals “does not cause serious adverse health effects, including kidney damage.”

Creatine case study

When a nutritional supplement advances beyond the confines of barbells and sporting arenas and into the forefront of medicine, you’ve found a product that can profoundly affect a person’s entire way of life. The latest advancements concerning the medicinal effects of creatine, albeit elementary, suggest that it is in fact one of those supplements, and likely the only one, that can make significant improvements in the lives of the physically challenged.

Take, for example, a case study published in Medicine and Science in Sports and Exercise involving the use of creatine in the treatment of neurologic disorders. 61 It tracks the difficult life of an individual we’ll call E.M., a 27-year old medical student who suffers from myasthenia gravis, a neurological condition that results in muscle wasting, fatigue and weakness.

E.M. was an avid weight lifter that, three months prior to his diagnosis of myasthenia gravis in 1995, had noticed sharp drops in his strength and visible muscle atrophy. At one point, E.M. had bench pressed 300 pounds, but at the time of his diagnosis he could no longer perform even a single push-up. And, despite use of medications and surgery on his thymus, none of his previous strength or musculature had even remotely returned.

In 1999, he had an exacerbation of his disease and underwent a repeat thymectomy as treatment in April. Following his sternotomy and thymic tissue removal, and three months of restricted exercise, he started a training program that included the use of supplemental creatine.

Since the use of creatine was part of an organized research study, his body mass index (BMI) was calculated, and body part measurements were taken in order to record baseline diameter values. He kept a detailed workout log from the beginning of July until early December 1999. Again, previous to his trial of creatine supplementation, he was unable to gain appreciable muscle mass or make even minimal gains in strength, no matter how diligently he trained. His weight had dropped to 170 pounds, roughly a 15- to 20-pound decline from his normal weight.

However, as a result of his 15-week trial with creatine, he was able to gain approximately 11 pounds of muscle mass while maintaining the same body fat percentage, and his strength also returned. Prior to the study, he could only bench press 30-pound dumbbells for three sets of 10. After training and using supplemental creatine, he was soon able to press 60- to 65-pound dumbbells for three sets of 10, an astounding increase in strength for any individual, let alone one suffering from a neurologic disorder.

The potential medicinal uses of creatine

As a result of case studies and the mechanisms by which it can improve strength and prevent muscle losses, creatine has launched itself into a new category of sport supplement—an ergogenic aid that can positively influence the realm of medicine and disease.

Creatine may play a vital role in the treatment of many common diseases and rehabilitation. In 1928, Dr. Hunter first stated that patients with muscular diseases retained less creatine than healthy subjects.29 Creatine has since been discovered to play a role in such diseases as gyrate atrophy (muscular atrophy of the retina), muscular dystrophy, rheumatoid arthritis, firbromyalgia, congestive heart failure, neuromuscular disease, stroke/neurodegenerative disese and postoperative surgical recovery.4,64 Whether or not creatine supplementation can effectively treat these diseases is yet inconclusive, but recent work is very promising.

The future of creatine

While creatine has definitely left its mark on the athletic and fitness worlds, the coming years may find creatine launching itself into arenas far more important than those that reward strength and speed. Whether it’s the training table or hospital bed, creatine is rapidly becoming a safe, effective supplement for an incredible array of applications. Without question, athletes will continue to use creatine to improve advanced function.

However, it is now possible to visualize creatine as instrumental in simply promoting function in people with delicate health. Weakness and poor endurance are hallmarks of many disease processes, and to date few medicinal choices exist for improving these conditions. Since creatine has already proven itself superior in these areas athletically, it will only be fitting to find it as a preeminent topic of future medical research.

Creatine: Recommendations for use

Whether your goal is to gain muscle, become stronger or improve athletic performance, the manner in which you use creatine is virtually the same. The only real decision you have to make is whether to “load” or not. The loading phase, as its termed, refers to the first five to seven days of dosing, in which roughly 20 to 30 grams are ingested daily (in divided 5-gram doses) to fully saturate the muscles with creatine.

Research has confirmed that this method is, in fact, effective at substantially increasing creatine levels.21It’s also important to mention that once you’ve achieved this level of saturation, you only need to maintain it with a once-daily 5-gram dose. Excess intakes will not increase muscle creatine levels further.

The loading method is also effective at achieving a rapid weight gain, most of which is likely water weight, and which may or may not be a desirable effect. If, for instance, you want to avoid a rapid weight gain, research has demonstrated that you don’t have to load.

One study confirmed that you could achieve the same level of muscle creatine saturation by using just 3 grams per day, although it would take a month to attain it, whereas you could do it in six days of daily 20- to 30-gram doses. 27 It all depends on how fast you want to get there, and if you’re trying to avoid a rapid water weight gain (in which case you would not load).

But how much should you take? Does everybody need the same dose? Simply put, the answer lies in your body weight. Specifically, the more you weigh, the more you need. A proper loading dose is usually an amount equal to your body weight multiplied by 0.1364 grams of creatine daily. For a 200-pound person, that’s roughly 27 grams of creatine daily, split into dosages of 4 to 5 grams each.

And for the maintenance phase, interestingly enough, the researchers discovered that you could maintain your elevated levels of muscle creatine by taking just 2 grams per day. However, they discovered that this amount was not sufficient to maintain levels of performance. So, a 5-gram maintenance dose appears to be ideal.69

As for improving its effectiveness, creatine should be ingested with at least 30 grams of a fast-acting carbohydrate, such as glucose, to improve absorption. This was discussed in previous sections, as was the effectiveness of adding compounds such as phosphates. And when it comes to timing, post-workout is an ideal time to take your 5-gram maintenance dose, since your muscle creatine levels drop somewhat following intense exercise.

HMB (beta-Hydroxy-beta-Methylbutyrate)

As we discussed at the outset of the chapter, only two supplements can justifiably and consistently claim that they are powerful enough to improve lean body mass and strength. In creatine, we’ve covered one, with its relatively simple mechanisms and volumes of successful research. In HMB, we have a supplement with similarly compelling research, but nevertheless it remains research that is, at times, quite complex. HMB’s mechanisms for action, to put it simply, are involved.

HMB is a metabolite of the amino acid leucine, an essential building block of protein in all tissues that is found in all dietary protein. 43 Among the amino acids, leucine holds a special place. In addition to being an essential amino acid, it’s also one of the three branched chain amino acids (the other two are isoleucine and valine), a trio of compounds that together possess unique performance-enhancing effects. But what ultimately separates leucine from the other two, and from all other amino acids for that matter, is its role in regulating protein synthesis and protein breakdown.

Before we delve into the connection between HMB and leucine, we must first set the stage with a little history of leucine and its first metabolite, a compound called ketoisocaproate, better known as KIC. Early research on KIC demonstrated that it could duplicate most, if not all, of the effects of leucine in tissues. These effects included decreased protein breakdown and increased protein synthesis, two prerequisites for recovery and lean muscle gain. 13,40 Additional studies also supported these effects.8,11,39

Here’s where it gets interesting. Scientists speculated that there was a “mystery” compound behind all these protein-sparing effects. The data with KIC indicated that the leucine effect was, in fact, not due to leucine but instead due to a downstream product. Thus, the same question remained: Was the effect due to KIC itself or some further breakdown product in the pathway (of which, by the way, there are about eight additional biochemicals)? In the early 1980s, scientists suggested an alternative metabolic pathway of leucine metabolism, one which indicated that KIC’s effects were being executed by an enzyme distinct to, you guessed it, HMB.

Scientists at Iowa State University were the first to test the hypothesis that this HMB metabolite was responsible for the potent effects of leucine and KIC on protein metabolism. This led them first to a series of successful animal experiments and, in research spanning the last 10 years, to humans. These extensive studies suggest that HMB may be the bioactive component of leucine metabolism that plays a regulator role in protein metabolism.43,44 In other words, it was the key that unlocked the complex door of protein synthesis and anti-catabolism (prevents protein breakdown).

Research in animals suggests HMB plays some role in protein metabolism, especially in stressful situations. Although no one is certain of the mechanism(s) behind HMB, scientists have been working on two hypotheses: 43

Hypothesis 1: HMB may regulate enzymes responsible for muscle tissue breakdown. This theory is supported by the evidence found in several studies where biochemical indicators of muscle damage (CPK and 3-MH) decreased in the blood.

Hypothesis 2.: HMB may be an essential component of the cell membrane. Scientists propose that under stressful situations, the body may not make enough HMB to satisfy the increased needs of tissues. It could also be that stress may alter enzymes or concentration of certain biochemicals that decrease normal HMB production. Either scenario requires dietary supplementation of HMB for skeletal muscle system to function maximally.

Evidence that HMB enhances strength and lean body mass

The first human study with HMB showed that after just one week of training and supplementation, muscle protein breakdown in a group given 3 grams of HMB decreased 44 percent (compared with the placebo group). 43 Also, muscle breakdown muscle damage continued to be lower in the HMB group for the entire three-week study.

OK, so there were some encouraging results in the level of biochemical indicators of muscle damage, but what about real-life, tangible progress? Well, the research also focused on that, and found that strength increased in both of the HMB-supplemented groups: 23 percent for a group taking 1.5 grams per day, and 29 percent for the 3-gram group.

So, we have an initial study on HMB indicating that it may reduce the damaging effects of resistance exercise on muscle, with the pleasant consequence of increasing maximal strength in response to exercise. Several other studies have shown positive gains in strength in both men and women from supplementing with 3 grams of HMB a day and engaging in a weight-training program.19,42,46,72

The effects of HMB on lean body mass are also promising, even if the research may not be as comprehensive as the literature on strength augmentation. Like studies on creatine, most investigations will emphasize its strength- and performance-enhancing effects while viewing the influence on lean body mass as secondary. That’s just reality within the research community, since gaining strength or improving performance is simply deemed more important than packing on muscle.

Nevertheless, one study recently reported that HMB supplementation tended to increase lean body mass in 70-year-old adults participating in a strength-training program.71 And, in an extensive study more specific to the traditional weight-training demographic, (Panton et al, 2000) the HMB group had greater gains in strength and lean body mass and, according to the investigators, “This study showed, regardless of gender or training status, HMB may increase upper body strength and minimize muscle damage when combined with an exercise program.”

HMB—Recommendations for use

As complex as HMB’s mechanisms are, it has been shown to uncrease muscle strength and enhance recovery and muscle breakdown. Take 1 gram, three times a day with meals.

Miscellaneous mass- and strength-enhancing nutrients

Essential amino acids

Amino acids are the building blocks of protein in the body, and are essential for making structural proteins, enzymes and certain hormones and neurotransmitters. Amino acids are also involved in the metabolic pathways that affect exercise metabolism.36 Further, it’s been suggested that additional protein (amino acids) may enhance muscle tissue growth and even serve as a potential energy source during exercise.35

All amino acids are termed either essential or non-essential, with essential amino acids (EAA) being those that are not made by the body and must be obtained through the diet. EAA include the following: isoleucine, leucine, valine, lysine, methionine, phenylalanine, threonine and tryptophan. High amounts of EAAs can be found in animal-based protein (e.g., beef, pork, chicken, milk proteins such as whey and casein and eggs) and most nutrition shakes.

So, if you ingested additional EAAs, could it lead to strength and mass gains? Well, scientists recently demonstrated that the consumption of EAA can, in fact, augment muscle protein synthesis in healthy human subjects.52,65 For example, one study examined the effects of EAA in six healthy adults (three men, three women).

The study was simple—the researchers placed the subjects on a resistance-training program and followed it with the consumption of either 40 grams of EAA or a placebo. Investigators found that EAA was very effective at stimulating muscle growth. This was followed up with the same protocol (but with only 6 grams of EAA and 36 grams of sugar), which showed a significantly greater muscle growth with the EAA supplement (when given after resistance exercise versus the placebo supplement).

More recently, a study researched whether the timing of EAA supplementation had an effect on muscle protein metabolism. Specifically, the study examined whether taking 6 grams of EAA plus 35 grams of sucrose immediately before training or immediately after training, had a different impact on muscle protein metabolism.66 Interestingly, they discovered that if you consumed this mixture immediately before weight training, net muscle protein accretion or gain was more than double than if you consumed it immediately after weight training. An examination of the data shows that EAA consumed with sugar before exercise produces a 158 percent greater anabolic effect than consuming after training.

The available evidence from short-term studies using 6 grams to 40 grams of EAA suggests that it may enhance the anabolic stimulus of weight training. However, more evidence is needed to determine the long-term benefits of EAA supplementation on strength and lean body mass.

Vitamin C

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin found in many fruits and vegetables, and is one of the more important antioxidants present in the human body. But the body can’t make it by itself, so you must obtain it through the diet. Vitamin C has many functions in the body, many of which are vital to the athlete or active person. Its primary role is the synthesis of collagen, which is important for the strengthening of cartilage, tendons and bones. It also plays a critical role in the formation of neurotransmitters and hormones, both of which are released during exercise for the purpose of stimulating muscle growth and breaking down carbohydrates and fat for energy.

In addition, vitamin C is involved in the synthesis of red blood cells, which are vital to delivering oxygen to the muscle, and, as stated, it’s a powerful antioxidant that prevents the buildup of free radicals in the body. Free radicals, we know, can lead to muscle and tendon damage, as well as a host of other unwanted effects.

Past studies show that supplementing vitamin C at doses between 500 milligrams and 3,000 milligrams per day may improve strength, power and endurance.3,26 More recently, scientists examined the effects of vitamin C on the development of strength during eight weeks of weight training, and sure enough, vitamin C supplementation provides an advantage and results in a measurable strength improvement in conjunction with weight training.2

As usual, more research is always needed, but so far, it would appear that 500 milligrams to 1,000 milligrams per day of vitamin C would benefit the strength athlete. Naturally, it would behoove all athletes (and non-athletes as well) to consume a plethora of fruits and vegetables to get adequate vitamin C. However, it may be necessary to take supplemental vitamin C to reach the desired daily allotment of 500 milligrams to 1,000 milligrams.

Past, present and future

The past has taught us the importance of an increased protein intake for recovery and lean mass/strength gains, it has taught us of the remarkable influence of supplements such as creatine and HMB, and it has taught us the relative differences and benefits, of the varied types of carbohydrates, protein and fat.

From high- and low-glycemic carbohydrates, to whey and casein protein, to omega-3 and omega-6 fatty acids, the past and current sports nutrition climate has signaled the next advancement in a strikingly rapid evolution—nutrient timing (more on this in Chapter 10). Among the more promising areas is most certainly the influence of nutrients on the neural systems of recovery, as preliminary research on the subject can attest. Continued advancements in nutrient combinations and their timings is also an exciting development.

The future, or evolution, of sports nutrition is a continual process, building upon past and current research to navigate the delicate maze that leads to performance and physique enhancement. With remarkable strides made in the last decade, we should expect the next 10 years to be marked by similar progress. Regardless of what the next great frontier may be its impact will most certainly be felt in athletic arenas, gyms and physiques across the globe.

A nutritional supplement plan for gaining lean mass and strength:

7 a.m. Breakfast*
Nutritional supplements: 1 gram HMB (EAS’ HMB)
Antioxidant/multivitamin blend
1 teaspoon flax seed oil

10 a.m. Mid-morning snack*

12 p.m. Lunch*
Nutritional supplements: 1 gram HMB (EAS’ HMB)
6 grams EAAs**
1 teaspoon flax seed oil

1 p.m. Strength-training workout

2 p.m. Post-workout meal*
Nutritional supplements: 5 grams mixed creatine blend*** (EAS’ Phosphagen HP)
1 gram HMB (EAS’ HMB)
3 grams EAAs**
1 teaspoon flax seed oil

5 p.m. Dinner*

8 p.m. Pre-bed snack*



**Most nutrition shakes contain the amount of essential amino acids (EAAs) that you need. You can also find EAA supplements at any specialty nutrition store or health food store.
***If you choose to “load” your creatine, take 20 to 30 grams of creatine in divided doses of 5 grams for five to seven days before maintaining with 5 grams a day, taken after workouts.