Endogenous creatine is created in a stable, slightly alkaline, environment. It is reasonably efficacious in delivering ATP to its target in the body. Manufactured creatine is introduced orally into an acidic environment. A percentage is degraded in the stomach, or as a result of acidophilic bacterial exposure. In either case, a certain amount of orally ingested creatine never becomes available for ATP transport. Creatine supplementation, in and of itself, has been shown to influence endothelial permeability and cell surface reactivity to a modest degree, potentially interfering/blocking an inflammatory stimulus. In vitro endothelial cell adhesion experiments demonstrate that, as creatine concentrations increase, endothelial cell surface adhesion and permeability were both modified.Creatine does not cross the plasma membrane very well. Roughly 95% of creatine is released in close proximity to the muscle tissue and transported into the cell via a limited capacity creatine-transporter system. Recent reports have shown that an artificially created alkaline environment can influence cell membrane permeability and cell behavior. The alkalinity of soda has shown anti-proliferative effects on tumor cell lines. The ability of alkaline buffered creatine to produce micro-environmental remodeling, influence cell membrane behavior and impact cisplatin-mediated toxicity, are also examined in this paper.