Creatine continues to make waves in sporting circles, and not only in the wake of the recent record-breaking performances of swimmer Penny Heyns.
Heyns takes it in food supplement form (creatine monohydrate). Springbok rugby players have been on it for years. High school athletes are increasingly following suit, as are other sports people, all hoping for that magical, legal (and hopefully safe) extra edge over their opponents.
Creatine is a protein that occurs naturally in the muscles of all mammals in the form of creatine phosphate. It is the energy source for "explosive" activities such as sprinting. Dietary sources include meat and chicken.
Because the body's supplies of creatine are limited, it was thought that creatine monohydrate supplements could fill the gaps, and boost performance in explosive sports.
There is currently a vastly contradictory body of scientific evidence around this theory, which is why the myths continue to grow.
So too does concern about health risks, especially kidney problems, and side effects including muscle cramps, tiredness and water retention. Cape Town scientists recently voiced concerns that creatine supplementation could cause raised blood pressure levels.
Creatine has been called "a gift from God", a "wonder drug" and a "natural alternative to steroids".
But Bloemfontein medical practitioner Dr Carel de Ridder calls it "a useless gimmick".
De Ridder, who is medical director of SA cycling, and actively involved in fighting drug use in sport, believes the health risks of creatine supplementation are real, especially with long-term use.
"You can't saturate the body with creatine monohydrate and not expect its finely tuned metabolic processes to be affected adversely," he says.
De Ridder dismisses creatine as a performance booster and bulk enhancer. If it can boost performance at all, he says, it will do so only in people with the right genes.
Any weight gain is related to a waste product from the oversupply of creatine in the muscle intracellular water (water captured in muscle cells). This is not sustainable muscle bulk, he says.
Everyone is suddenly trying to be "very clever" with creatine, he says, especially parents who want to turn their children into sporting superheroes. "They will burn themselves," he says.
Ongoing controversy around creatine would be academic, he says, if we all strived for optimum performance "with what we have been born with", and if we put the emphasis back where it belongs - on natural ways of competing.
Biokinetician and Springbok rugby squad fitness trainer Kevin Stevenson gives creatine monohydrate routinely to most of the players at different cycles of their yearly training programmes. Percy Montgomery and Stephan Terblanche are among those who take it "religiously", he says.
Stevenson says his research shows that creatine supplementation is helpful to increase muscle size and strength. It may not make an athlete run faster, he says, but it could maintain optimum speed performance.
Cape Town sports scientist Professor Tim Noakes says the health risks have been grossly overplayed. It is "silly" to say that creatine is dangerous, he says, when available evidence suggests that it is perfectly safe, except for people suffering from kidney failure.
After all, athletes have been "creatine-loading" for centuries, he says. The Greek Olympic athletes regularly ate high-protein diets from animal sources to improve performance. (Biltong is an excellent source of creatine, he adds.)
Creatine's relative safety should not be confused with efficacy. Noakes says creatine supplementation is "a waste of time" for everyone except the elite athlete, who is brilliantly coached, training optimally, has the right genes, and needs a little extra bulk. Rugby players fall squarely into this category.
There is no documented evidence to suggest it can improve the performance of swimmers, says Noakes. However, he would not discourage competitive swimmers from taking creatine, as science cannot prove that it cannot give a competitive edge of 0,1 of a second needed to break a record.
Noakes says the real risk of creatine is to the financial health of many of those taking it in this country. (Creatine can cost between R300 and R400 a month.) And its real value as a performance enhancer is in its proven ability to boost the sales of companies manufacturing and selling creatine products.
It is no coincidence, says Noakes, that a leading American creatine producer recently won a business award for the company with the largest growth in the United States, after being in existence for little more than two years.
Not surprisingly, companies already making "a whack of money" remain keen to perpetuate "the myth" that creatine works, he says.
He is disturbed at the inordinate amount of money spent on creatine in South Africa. Sales from just one chain of well-known health clubs are already into millions of rands.
"It's all about choices," says Noakes. People who take the product should be informed about it, and aware that they could be looking for something which the product "cannot possibly produce".
They should also think about whether their money could not be better spent elsewhere, he says.