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Kenneth H. Cooper MD, MPH


Creatine Supplements: Friend or Foe for Exercise Performance?

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Wednesday, Mar 14, 2018

Nutritional ergogenic aids are defined as substances found in food or dietary supplements that improve, or are thought to improve athletic performance. This may come as a surprise to you, but dietary supplements do not have to be proven safe or effective before reaching the public, and are not regulated to any significant degree by the Food and Drug Administration (FDA). The FDA is far too busy regulating food and drugs, and simply does not have the means to regulate the thousands of dietary supplements that are available. As a result of Congress passing the Dietary Supplement Health and Education Act (DSHEA) in 1994, supplement manufacturers can make pretty much whatever claims they want. The only statement that is off-limits is to claim that the product can prevent, cure, or treat disease unless there is overwhelming scientific evidence to support such a claim. Needless to say, these lax restrictions open the door to misrepresentation and outright fraud in some cases.

This is not to say that dietary supplements have no impact on athletic performance. There are a few supplements that have undergone rigorous scientific scrutiny and have actually been found to improve performance. One example of such a supplement is creatine. Over the past quarter-century, hundreds of well-controlled creatine studies have been published in the scientific literature. Recently, the International Society of Sports Nutrition (ISSN) issued a position stand on the safety and efficacy of creatine in exercise, sport, and medicine.

Before we discuss the ISSN position stand and put to rest some long-standing myths, a little background information is in order. Creatine is present in red meat and seafood, and is also manufactured by the liver. It is present in muscle tissue as a substance called phosphocreatine (PC). During very short-duration high-intensity exercise (also known as anaerobic exercise), PC helps to replenish the muscle’s energy supply.

The vast majority of training studies show that creatine supplementation helps to increase the amount of PC that is stored in the muscles. This is especially true if creatine is taken with carbohydrate and protein. This in turn helps to delay fatigue during highly anaerobic activities. Creatine supplementation is of no value for aerobic (endurance) activities, however. It is important to note that the majority of creatine studies were performed on people who were training vigorously. Sedentary individuals are thus very unlikely to obtain any benefit whatsoever from creatine supplementation.

At this point, it is important to mention that there a few different forms of creatine supplements. Creatine monohydrate has been shown to be the most effective form of creatine supplementation. It’s also important to mention that creatine monohydrate supplementation is safe in the adult population when used as directed. Despite what you might read on the internet or hear in the gym, no clinically significant or serious adverse event related to creatine supplementation has ever been reported in the scientific literature. In fact, the ISSN recently stated among other things, that ‘creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes with the intent of increasing high-intensity exercise capacity and lean body mass during training.’ 

So to summarize:
  • Creatine is found in the diet, is produced by the liver, and is used by muscle tissue to replenish energy supplies during very short-duration high-intensity (anaerobic) exercise. 
  • Creatine supplementation increases muscle stores of phosphocreatine (PC).
  • In adults who are training vigorously, creatine supplementation has been shown to help delay fatigue during anaerobic types of exercise.
  • Creatine monohydrate is the most effective form of creatine supplementation.
  • Creatine supplementation will not improve performance in endurance events.
  • There is no scientific evidence that creatine supplementation at recommended dosages causes adverse events such as liver or kidney problems.  
It is important to note that relatively few studies have examined the safety and efficacy of creatine supplementation for athletic performance in children and adolescents. Therefore, it seems prudent to error on the side of caution for these populations until more data is gathered. 

Kreider, R. B. International Society of Sports Nutrition position stand: safety and efficacy of creatine in exercise, sport, and medicine. (2017). Journal of International Society of Sports Nutrition.

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