Background. Competitive athletes, including adolescents, seek ways to gain advantage over competitors. One ergogenic aid is creatine, a naturally occurring nitrogen compound found primarily in skeletal muscle. Increasing creatine levels may prolong skeletal muscle activity, anchancing work output.
Methods. A questionnaire assessing awareness and use of creatine supplementation was completed by 674 athletes from 11 high schools. Data were statistically analyzed to determine variation among groups.
Results. Of those surveyed, 75% had knowledge of creatine supplements, and 16% used creatine to enhance athletic performance. Percentage of use increased with age and grade level. Awareness and use were greater among boys than girls. Adverse effects were reported by 26%. Most athletes consumed creatine using a method inconsistent with scientific recommendations.
Conclusions. Use of creatine by adolescent athletes is significant and inconsistent with optimal dosing. Physicians, athletic trainers, and coaches should disseminate proper information and advise these adolescent athletes.
IN SKELETAL MUSCLE, creatine is primarily stored as free creatine and phosphocreatine (PCr) and is found naturally in foods such as meat and fish. Phosphocreatine is the first primary fuel reserve for the resynthesis of adenosine triphosphate during anaerobic exercise. [1,2] Therefore, rapid depletion of muscle PCr is believed to be a limiting factor during maximal anaerobic work. Increasing creatine levels may prolong skeletal muscle activity, thus enhancing work output.
Creatine supplementation can increase total creatine content in muscle by more than 20%.  The maximum level is achieved most quickly by consuming large daily doses (20 to 30 g) for 3 to 5 days, followed by a daily maintenance dose of 2 to 3 g. [4-7] The same creatine levels can be achieved more slowly by taking a 3 g maintenance dose for 28 days. 
The effectiveness of increased PCr stores in the body is debated. Creatine supplementation has been shown to improve exercise performance in repeated bouts of stationary cycling ranging from 5 to 60 seconds. [9-12] Specific increases have been documented in peak power, total work, and decreased lactate production. [5,13,14] While significant enhancements have been reported in high-intensity, short-duration exercise, it does not appear to be beneficial in endurance sports. [15-17]
No randomized trials have evaluated shortor long-term adverse effects of creatine, though there are anecdotal reports of dehydration, musculotendinous strains, renal dysfunction, rhabdomyolysis, gastrointestinal disturbances, and increased levels of creatine in the brain. [18-20]
Competitive athletes at all levels are searching for an advantage over their competitors.
Often, ergogenic aids are sought to gain that advantage. Ethical issues are raised by this behavior and are compounded further when the substances being used do not live up to claims or, more importantly, threaten the health of users. The adolescent population, because they are still developing physically and emotionally, have the most to lose. The purpose of our survey was to determine the use of oral creatine as an ergogenic aid among the adolescent athlete population.
MATERIALS AND METHODS
A survey instrument (Appendix) containing 18 questions on oral creatine supplementation was developed and distributed to 11 local public...