DEAR DR. DONOHUE: I read your article on performance-enhancing supplements. You indicated that you would address creatine later. I’m interested because my grandson, 17 years old, takes it. — J.M.

DEAR DR. DONOHUE: You had a column on stuff that enhances performance. You mentioned creatine. How about doing that now? — K.S.

ANSWER: Creatine is a subject that brings letters both praising it and condemning it. I’m a believer in its efficacy — to a point. I’m speaking of creatine monohydrate, the most popular version of creatine.

In the liver, our bodies cycle three amino acids, the building blocks of protein, into creatine. Those amino acids are arginine, glycine and methionine. Ninety-five percent of the body’s creatine stores are in muscle. The biggest food sources of it are red meat and fish.

Creatine is involved in energy production and metabolism. It’s been shown to improve performance and to condition the body to respond more quickly and more effectively to training. Protein synthesis is another creatine-influenced body process. Muscles are protein. Protein synthesis enhances muscle growth. Another benefit of creatine is energy production, specifically the molecule ATP, adenosine triphosphate. It provides energy for the performance of rapid movement and power in hefting heavy weights.

Speed runners, but not so much distance runners, improve with creatine supplements. Weightlifters on creatine lift heavier weights and lift them more times than they could without it.

After five years of careful observation, no health damage has been shown due to creatine. However, some users develop nausea and have to give it up. The question of creatine-related muscle cramping always comes up. It doesn’t cause cramps. It’s also been accused of leading to kidney damage. It does not do so. However, people with poor kidney function should not use it. Your 17-year-old grandson can take it safely.

Creatine gives an edge to professional athletes and to those competing at high levels. It’s not something intended for ordinary athletes, although it is something they can try.

DEAR DR. DONOHUE: Neither my husband nor I know where our teenage daughter came from. She loves to run. Her goal is a marathon. My husband and I don’t run.

We’re quite proud of her. She has a tendency to occasionally develop a pain in her side when she runs. What can she do to prevent this? — G.F.

ANSWER: You’re talking about side stitches, a common running problem. The pain can be felt either on the right or left side beneath the ribs. No one is positive what it is. Some feel it’s a cramp in the diaphragm muscle, the large breathing muscle that separates the chest cavity from the abdominal cavity.

Your daughter shouldn’t eat a large meal within three to four hours of running.

She should be sure she’s well-hydrated by drinking an 8-ounce glass of water one hour and a half-hour before she takes off. It might be a good idea if she wore a belt that holds a canteen of water so she can continue to drink during her run. Many who have side stitches predict pretty accurately when they’re going to develop them. If your daughter is one of them, she should alter her breathing when she feels one coming on. She should exhale through lips drawn together as they would be to whistle.

DEAR DR. DONOHUE: I watched my grandsons play. Play, for them, means ceaseless running. They’re only two years apart, 9 and 11. The older one is thin. When I was watching, he wore a tight T-shirt. I could see his heart beating. The younger one is beefier, and I didn’t see his heart beating. Is this an indication that the older is exercising too hard? — V.D.

ANSWER: No. Watch all runners, including Olympic athletes. You can see the hearts of many of them pounding against their chest. It’s quite normal.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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