Finally, Volek and colleagues [ 77 ] evaluated the effects of creatine supplementation 0. The researchers found that creatine supplementation was effective in maintaining muscular performance during the initial phase of high-volume resistance training overreaching that otherwise results in small performance decrements.

These findings suggest that creatine supplementation can help athletes tolerate heavy increases in training volume. Similar findings were reported by Greenwood and coworkers [ ] who examined injury rates during a 4 months American collegiate football season among creatine users 0.

Finally, Schroder et al. The researchers found that long-term low-dose creatine monohydrate supplementation did not promote clinically significant changes in health markers or side effects. Thus, contrary to unsubstantiated reports, the peer-reviewed literature demonstrates that there is no evidence that: 1 creatine supplementation increases the anecdotally reported incidence of musculoskeletal injuries, dehydration, muscle cramping, gastrointestinal upset, renal dysfunction, etc.

If anything, evidence reveals that athletes who take creatine during training and competition experience a lower incidence of injuries compared to athletes who do not supplement their diet with creatine. Like carbohydrate, creatine monohydrate has osmotic properties that help retain a small amount of water.

For example, initial studies reported that creatine loading promoted a short-term fluid retention e. For example, Volek and colleagues [ 76 ] evaluated the effects of creatine supplementation 0.

The researchers reported that creatine supplementation augmented repeated sprint cycle performance in the heat without altering thermoregulatory responses. The researchers reported that creatine supplementation increased intracellular water and reduced thermoregulatory and cardiovascular responses to prolonged exercise e.

Watson and colleagues [ ] reported that short-term creatine supplementation Similar findings were observed by several other groups [ , , , ] leading researchers to add creatine to glycerol as a highly effective hyper-hydrating strategy to help athletes better tolerate exercise in the heat [ , , , , , ].

These findings provide strong evidence that creatine supplementation with or without glycerol may serve as an effective nutritional hyper-hydration strategy for athletes engaged in intense exercise in hot and humid environments thereby reducing risk to heat related-illness [ 5 , ].

During the 10 week rehabilitation phase, participants performed three sessions a week of knee extension rehabilitation. These changes were associated with greater changes in myogenic regulating factor 4 MRF4 and myogenic protein expression. Collectively, these findings suggest that creatine supplementation lessened the amount of muscle atrophy and detrimental effects on muscle associated with immobilization while promoting greater gains in strength during rehabilitation.

Results revealed that peak oxygen uptake and ventilatory anaerobic threshold were increased following creatine supplementation. Conversely, Tyler et al. While not all studies show benefit, there is evidence that creatine supplementation may help lessen muscle atrophy following immobilization and promote recovery during exercise-related rehabilitation in some populations.

Thus, creatine supplementation may help athletes and individuals with clinical conditions recover from injuries. It has been known for a long time that creatine supplementation possesses neuroprotective benefits [ 29 , 38 , 40 , ]. For this reason, a number of studies have examined the effects of creatine supplementation on traumatic brain injury TBI , cerebral ischemia, and SCI.

For example, Sullivan et al. The protection appeared to be related to creatine-induced maintenance of neuronal mitochondrial bioenergetics. Therefore, the researchers concluded that creatine supplementation may be useful as a neuroprotective agent against acute and chronic neurodegenerative processes.

The researchers reported that creatine ingestion improved locomotor function tests and reduced the size of scar tissue after the SCI. The authors suggested that pretreatment of patients with creatine may provide neuroprotection in patients undergoing spinal surgery who are at risk to SCI.

Adcock et al. The authors concluded that creatine supplementation appears to improve brain bioenergetics thereby helping minimize the impact of brain ischemia. Similarly, Zhu and colleagues [ ] reported that oral creatine administration resulted in a marked reduction in ischemic brain infarction size, neuronal cell death, and provided neuroprotection after cerebral ischemia in mice.

The authors suggested that given the safety record of creatine, creatine might be considered as a novel therapeutic agent for inhibition of ischemic brain injury in humans. Allah et al. The authors concluded that creatine supplementation has the potential to improve the neuro-function following neonatal brain damage.

Finally, Rabchevsky and associates [ ] examined the efficacy of creatine-supplemented diets on hind limb functional recovery and tissue sparing in adult rats. Results revealed that creatine feeding significantly reduced loss of gray matter after SCI.

Given the role of creatine in metabolism, performance, and training adaptations; a number of researchers have been investigating the potential therapeutic benefits of creatine supplementation in various clinical populations.

The following highlights some of these applications. Creatine deficiency syndromes are a group of inborn errors e. Individuals with creatine synthesis deficiencies have low levels of creatine and PCr in the muscle and the brain.

For this reason, a number of studies have investigated the use of relatively high doses of creatine monohydrate supplementation e. These studies generally show some improvement in clinical outcomes particularly for AGAT and GAMT with less consistent effects on CRTR deficiencies [ ].

For example, Battini et al. Stockler-Ipsiroglu and coworkers [ ] evaluated the effects of creatine monohydrate supplementation 0. The median age at treatment was The researchers found that creatine supplementation increased brain creatine levels and improved or stabilized clinical symptoms.

Moreover, four patients treated younger than 9 months had normal or almost normal developmental outcomes. Long-term creatine supplementation has also been used to treat patients with creatine deficiency-related gyrate atrophy [ , , , , ].

These findings and others provide promise that high-dose creatine monohydrate supplementation may be an effective adjunctive therapy for children and adults with creatine synthesis deficiencies [ 18 , , , , ]. Additionally, these reports provide strong evidence regarding the long-term safety and tolerability of high-dose creatine supplementation in pediatric populations with creatine synthesis deficiencies, including infants less than 1 year of age [ ].

A total of 1, patients took an average of 9. Results revealed no clinical benefit on patient outcomes in patients with PD or ALS. However, there was some evidence that creatine supplementation slowed down progression of brain atrophy in patients with HD although clinical markers were unaffected.

Creatine and phosphocreatine play an important role in maintaining myocardial bioenergetics during ischemic events [ 33 ]. In a recent review, Balestrino and colleagues [ 33 ] concluded that phosphocreatine administration, primarily as an addition to cardioplegic solutions, has been used to treat myocardial ischemia and prevent ischemia-induced arrhythmia and improve cardiac function with some success.

They suggested that creatine supplementation may protect the heart during an ischemic event. A growing collection of evidence supports that creatine supplementation may improve health status as individuals age [ 41 , 43 , 44 , 45 , ]. Creatine supplementation significantly decreased HbA1c and glycemic response to standardized meal as well as increased GLUT-4 translocation.

These findings suggest that creatine supplementation combined with an exercise program improves glycemic control and glucose disposal in type 2 diabetic patients. Candow and others [ ] reported that low-dose creatine 0. Similarly, Chilibeck et al.

A recent meta-analysis [ 80 ] of elderly individuals 64 years participating in an average of These findings were corroborated in a meta-analysis of elderly participants 64 years who experienced greater gains in muscle mass and upper body strength with creatine supplementation during resistance-training compared to training alone [ 37 ].

These findings suggest that creatine supplementation can help prevent sarcopenia and bone loss in older individuals. For example, Watanabe et al. Since creatine uptake by the brain is slow and limited, current research is investigating whether dietary supplementation of creatine precursors like GAA may promote greater increases in brain creatine [ , ].

Since creatine supplementation has been shown to improve brain and heart bioenergetics during ischemic conditions and possess neuroprotective properties, there has been recent interest in use of creatine during pregnancy to promote neural development and reduce complications resulting from birth asphyxia [ , , , , , , , , , ].

The rationale for creatine supplementation during pregnancy is that the fetus relies upon placental transfer of maternal creatine until late in pregnancy and significant changes in creatine synthesis and excretion occur as pregnancy progresses [ , ].

Consequently, there is an increased demand for and utilization of creatine during pregnancy. Maternal creatine supplementation has been reported to improve neonatal survival and organ function following birth asphyxia in animals [ , , , , , , ]. Human studies show changes in the maternal urine and plasma creatine levels across pregnancy and association to maternal diet [ , ].

Consequently, it has been postulated that there may be benefit to creatine supplementation during pregnancy on fetal growth, development, and health [ , ].

This area of research may have broad implications for fetal and child development and health. Since creatine monohydrate became a popular dietary supplement in the early s, over 1, studies have been conducted and billions of servings of creatine have been ingested.

The only consistently reported side effect from creatine supplementation that has been described in the literature has been weight gain [ 5 , 22 , 46 , 78 , 91 , 92 , ].

Available short and long-term studies in healthy and diseased populations, from infants to the elderly, at dosages ranging from 0. Additionally, assessments of adverse event reports related to dietary supplementation, including in pediatric populations, have revealed that creatine was rarely mentioned and was not associated with any significant number or any consistent pattern of adverse events [ , , ].

Unsubstantiated anecdotal claims described in the popular media as well as rare case reports described in the literature without rigorous, systematic causality assessments have been refuted in numerous well-controlled clinical studies showing that creatine supplementation does not increase the incidence of musculoskeletal injuries [ 22 , , , ], dehydration [ , , , , , , , ], muscle cramping [ 76 , , , , ], or gastrointestinal upset [ 22 , , , ].

Nor has the literature provided any support that creatine promotes renal dysfunction [ 22 , 51 , 85 , , , , , , , , , ] or has long-term detrimental effects [ 22 , 23 , 53 , , ]. Rather, as noted above, creatine monohydrate supplementation has been found to reduce the incidence of many of these anecdotally reported side effects.

These reports prompted some concern that creatine supplementation may impair renal function [ , , , ] and prompted a number of researchers to examine the impact of creatine supplementation on renal function [ 22 , 51 , 85 , , , , , , , , , , , , ]. Likewise, Baracho and colleagues [ ] reported that Wistar rats fed 0, 0.

Kreider et al. Gualono and associates [ ] reported that 12 weeks of creatine supplementation had no effects on kidney function in type 2 diabetic patients.

While some have suggested that individuals with pre-existing renal disease consult with their physician prior to creatine supplementation in an abundance of caution, these studies and others have led researchers to conclude that there is no compelling evidence that creatine supplementation negatively affects renal function in healthy or clinical populations [ 5 , 6 , 22 , 53 , , , ].

Performance-related studies in adolescents, younger individuals, and older populations have consistently reported ergogenic benefits with no clinically significant side effects [ 5 , 6 , 22 , 23 , 53 , , , , , ]. The breadth and repetition of these findings provide compelling evidence that creatine monohydrate is well-tolerated and is safe to consume in healthy untrained and trained individuals regardless of age.

Some critics of creatine supplementation have pointed to warnings listed on some product labels that individuals younger than 18 years of age should not take creatine as evidence that creatine supplementation is unsafe in younger populations.

These studies provide no evidence that use of creatine at recommended doses pose a health risk to individuals less than 18 years of age. For this reason, it is our view that creatine supplementation is an acceptable nutritional strategy for younger athletes who: a.

are consuming a well-balanced and performance enhancing diet; c. are knowledgeable about appropriate use of creatine; and d.

do not exceed recommended dosages. After reviewing the scientific and medical literature in this area, the International Society of Sports Nutrition concludes the following in terms of creatine supplementation as the official Position of the Society:.

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.

Creatine monohydrate supplementation is not only safe, but has been reported to have a number of therapeutic benefits in healthy and diseased populations ranging from infants to the elderly.

If proper precautions and supervision are provided, creatine monohydrate supplementation in children and adolescent athletes is acceptable and may provide a nutritional alternative with a favorable safety profile to potentially dangerous anabolic androgenic drugs.

However, we recommend that creatine supplementation only be considered for use by younger athletes who: a. At present, creatine monohydrate is the most extensively studied and clinically effective form of creatine for use in nutritional supplements in terms of muscle uptake and ability to increase high-intensity exercise capacity.

The addition of carbohydrate or carbohydrate and protein to a creatine supplement appears to increase muscular uptake of creatine, although the effect on performance measures may not be greater than using creatine monohydrate alone. The quickest method of increasing muscle creatine stores may be to consume ~0.

Initially, ingesting smaller amounts of creatine monohydrate e. Clinical populations have been supplemented with high levels of creatine monohydrate 0. Further research is warranted to examine the potential medical benefits of creatine monohydrate and precursors like guanidinoacetic acid on sport, health and medicine.

Creatine monohydrate remains one of the few nutritional supplements for which research has consistently shown has ergogenic benefits. Additionally, a number of potential health benefits have been reported from creatine supplementation.

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Exp Gerontol. Ramirez-Campillo R, et al. Effects of plyometric training and creatine supplementation on maximal-intensity exercise and endurance in female soccer players. Creatine has many benefits for health and performance.

It can help you gain muscle, increase strength, and improve brain function, to name a few. There are many myths regarding the safety and side effects of creatine. The truth is that creatine is actually very safe. Creatine is a well-studied supplement with proven benefits for high intensity exercise.

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Nutrition Evidence Based Everything You Need to Know About Creatine. Medically reviewed by Amy Richter, RD , Nutrition — By Rudy Mawer, MSc, CISSN — Updated on November 2, Basics How it works Muscle gain Exercise Brain health Other benefits Types Dosage Side effects FAQs Bottom line Creatine helps your muscles produce energy during heavy lifting or high intensity exercise.

What is creatine? How does creatine work? How does creatine affect muscle growth? Effects on strength and exercise performance. Creatine effects on the brain. Other health benefits.

Different types of supplements. Dosage instructions. Safety and side effects. Frequently asked questions. The bottom line. How we reviewed this article: Sources.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Nov 2, Written By Rudy Mawer. Oct 11, Medically Reviewed By Amy Richter, MS, RD. Share this article. Read this next. Creatine Side Effects: Is It Safe? FAQs You Should Know.

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Creatine supplementation in fibromyalgia: a randomized, double-blind, placebo-controlled trial. Arthritis Care Res Hoboken. Roitman S, et al. Creatine monohydrate in resistant depression: a preliminary study. Bipolar Disord. A potential role for creatine in drug abuse? Mol Neurobiol. Toniolo RA, et al.

Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial. J Affect Disord. Dechent P, et al.

Increase of total creatine in human brain after oral supplementation of creatine-monohydrate. Lyoo IK, et al. Multinuclear magnetic resonance spectroscopy of high-energy phosphate metabolites in human brain following oral supplementation of creatine-monohydrate. Psychiatry Res.

Pan JW, Takahashi K. Cerebral energetic effects of creatine supplementation in humans. Am J Physiol Regul Integr Comp Physiol. Watanabe A, Kato N, Kato T.

Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res. Rae C, et al. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. Creatine supplementation, sleep deprivation, cortisol, melatonin and behavior.

Physiol Behav. Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol. Psychopharmacology Berl.

Ling J, Kritikos M, Tiplady B. Cognitive effects of creatine ethyl ester supplementation. Behav Pharmacol. Ostojic SM. Guanidinoacetic acid as a performance-enhancing agent. Ostojic SM, et al. Guanidinoacetic acid versus creatine for improved brain and muscle creatine levels: a superiority pilot trial in healthy men.

Ellery SJ, et al. Renal dysfunction in early adulthood following birth asphyxia in male spiny mice, and its amelioration by maternal creatine supplementation during pregnancy. Pediatr Res. LaRosa DA, et al. Maternal creatine supplementation during pregnancy prevents acute and long-term deficits in skeletal muscle after birth asphyxia: a study of structure and function of hind limb muscle in the spiny mouse.

Ellery SJ, Walker DW, Dickinson H. Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Dietary creatine supplementation during pregnancy: a study on the effects of creatine supplementation on creatine homeostasis and renal excretory function in spiny mice.

Dickinson H, et al. Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy.

BMC Pregnancy Childbirth. Bortoluzzi VT, et al. Co-administration of creatine plus pyruvate prevents the effects of phenylalanine administration to female rats during pregnancy and lactation on enzymes activity of energy metabolism in cerebral cortex and hippocampus of the offspring.

Neurochem Res. Vallet JL, Miles JR, Rempel LA. Effect of creatine supplementation during the last week of gestation on birth intervals, stillbirth, and preweaning mortality in pigs. J Anim Sci. Creatine pretreatment prevents birth asphyxia-induced injury of the newborn spiny mouse kidney.

Maternal dietary creatine supplementation does not alter the capacity for creatine synthesis in the newborn spiny mouse. Reprod Sci. Ireland Z, et al. A maternal diet supplemented with creatine from mid-pregnancy protects the newborn spiny mouse brain from birth hypoxia.

Geller AI, et al. Emergency department visits for adverse events related to dietary supplements. Zorzela L, et al. Serious adverse events associated with pediatric complementary and alternative medicine.

Eur J Integr Med. CFSAN Adverse Event Reporting System CAERS. Accessed 18 Apr Creatine supplementation patterns and perceived effects in select division I collegiate athletes.

Hile AM, et al. Creatine supplementation and anterior compartment pressure during exercise in the heat in dehydrated men. Poortmans JR, et al. Effect of short-term creatine supplementation on renal responses in men. Eur J Appl Physiol Occup Physiol. Robinson TM, et al. Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function.

Groeneveld GJ, et al. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Effects of creatine supplementation on renal function: a randomized, double-blind, placebo-controlled clinical trial.

Lugaresi R, et al. Does long-term creatine supplementation impair kidney function in resistance-trained individuals consuming a high-protein diet? Farquhar WB, Zambraski EJ. Curr Sports Med Rep. Thorsteinsdottir B, Grande JP, Garovic VD.

Acute renal failure in a young weight lifter taking multiple food supplements, including creatine monohydrate. J Ren Nutr. Kuehl K, Goldberg L, Elliot D, Renal insufficiency after creatine supplementation in a college football athlete Abstract.

Pritchard NR, Kalra PA. Renal dysfunction accompanying oral creatine supplements. Barisic N, et al. Effects of oral creatine supplementation in a patient with MELAS phenotype and associated nephropathy.

Juhn MS, Tarnopolsky M. Potential side effects of oral creatine supplementation: a critical review. Juhn MS. Oral creatine supplementation: separating fact from hype.

Phys Sportsmed. Benzi G. Is there a rationale for the use of creatine either as nutritional supplementation or drug administration in humans participating in a sport?

Pharmacol Res. Benzi G, Ceci A. Creatine as nutritional supplementation and medicinal product. Poortmans JR, Francaux M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Francaux M, et al.

Effect of exogenous creatine supplementation on muscle PCr metabolism. Adverse effects of creatine supplementation: fact or fiction? Ferreira LG, et al. Effects of creatine supplementation on body composition and renal function in rats. Baracho NC, et al. Study of renal and hepatic toxicity in rats supplemented with creatine.

Acta Cir Bras. Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. Taes YE, et al. Creatine supplementation does not decrease total plasma homocysteine in chronic hemodialysis patients.

Kidney Int. Shelmadine BD, et al. The effects of supplementation of creatine on total homocysteine. J Ren Nurs.

Effects of thirty days of creatine supplementation on total homocysteine in a pilot study of end-stage renal disease patients. Pline KA, Smith CL. The effect of creatine intake on renal function. Ann Pharmacother. Persky AM, Rawson ES.

Safety of creatine supplementation. In sickness and in health: the widespread application of creatine supplementation. Williams MH. Facts and fallacies of purported ergogenic amino acid supplements. Clin Sports Med. Download references. We would like to thank all of the participants and researchers who contributed to the research studies and reviews described in this position stand.

Your dedication to conducing groundbreaking research has improved the health and well-being of countless athletes and patients. Prepared as a Position Stand on behalf of the International Society of Sport Nutrition with approval of Editors-In-Chief, Founders, and Research Committee Members.

RBK prepared the manuscript. Remaining coauthors reviewed, edited, and approved the final manuscript. The manuscript was then approved by the Research Committee and Editors-In Chief to represent the official position of the International Society of Sports Nutrition.

RBK is a co-founder of the International Society of Sports Nutrition ISSN and has received externally-funded grants from industry to conduct research on creatine, serves as a scientific and legal consultant, and is a university approved scientific advisor for Nutrabolt.

He prepared this position stand update at the request of the Council for Responsible Nutrition and ISSN. DSK is a co-founder of the ISSN who works for a contract research organization QPS.

QPS has received research grants from companies who sell creatine. DSK sits in an advisory board Post Holdings to Dymatize that sells creatine. DSK declares no other conflicts of interest.

JA is the CEO and co-founder of the ISSN; has consulted in the past for various sports nutrition brands. TNZ has received grants and contracts to conduct research on dietary supplements; has served as a paid consultant for industry; has received honoraria for speaking at conferences and writing lay articles about sports nutrition ingredients; receives royalties from the sale of several sports nutrition products; and has served as an expert witness on behalf of the plaintiff and defense in cases involving dietary supplements.

TNZ is also co-inventor on multiple patent applications within the field of dietary supplements, applied nutrition and bioactive compounds.

RW is the Chief Science Officer for Post Active Nutrition. ALA is CEO of Vitargo Global Sciences, Inc. HLL has received research grants from companies who sell creatine and do business in the dietary supplement, natural products and medical foods industry. HLL is co-founder of Supplement Safety Solutions, LLC, serving as an independent consultant for regulatory compliance, safety surveillance and Nutravigilance to companies who sell creatine.

Lopez is also co-inventor on multiple patent applications within the field of dietary supplements, applied nutrition and bioactive compounds. Remaining investigators have no competing interests to declare.

This paper was reviewed by the International Society of Sports Nutrition Research Committee and represents the official position of the Society. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Nutrition Research Unit, QPS, Sunset Drive Suite , Miami, FL, , USA. Department of Health and Human Performance, Nova Southeastern University, Davie, FL, , USA. The Center for Applied Health Sciences, Allen Road, STE , Stow, OH, , USA.

Post Active Nutrition, Leslie St, Dallas, TX, , USA. Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, S4S 0A2, Canada. High Performance Nutrition, LLC, Mercer Island, WA, , USA. Vitargo Global Sciences, Inc. Supplement Safety Solutions, LLC, Bedford, MA, , USA. You can also search for this author in PubMed Google Scholar.

Correspondence to Richard B. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Kreider, R. et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine.

J Int Soc Sports Nutr 14 , 18 Download citation. Received : 27 April Accepted : 30 May Published : 13 June Anyone you share the following link with will be able to read this content:.

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Kreider 1 , Douglas S. Kalman 2 , Jose Antonio 3 , Tim N. Ziegenfuss 4 , Robert Wildman 5 , Rick Collins 6 , Darren G. Candow 7 , Susan M. Kleiner 8 , Anthony L. Lopez 4 , 10 Show authors Journal of the International Society of Sports Nutrition volume 14 , Article number: 18 Cite this article k Accesses Citations Altmetric Metrics details.

Abstract Creatine is one of the most popular nutritional ergogenic aids for athletes. Background Creatine is one of the most popular nutritional ergogenic aids for athletes. Metabolic role Creatine, a member of the guanidine phosphagen family, is a naturally occurring non-protein amino acid compound found primarily in red meat and seafood [ 1 , 2 , 3 , 4 ].

Full size image. Bioavailability The most commonly studied form of creatine in the literature is creatine monohydrate [ 53 ].

Ergogenic value Table 1 presents the reported ergogenic benefits of creatine supplementation. Table 1 Potential ergogenic benefits of creatine supplementation Full size table. Table 2 Examples of sport events that may be enhanced by creatine supplementation Full size table.

Prevalence of use in sport Creatine is found in high amounts in the food supply and therefore its use is not banned by any sport organization although some organizations prohibit provision of some types of dietary supplements to athletes by their teams [ 5 , 53 , 78 , 91 , 92 ].

Other applications in sport and training Recent research demonstrates a number of other applications of creatine supplementation that may benefit athletes involved in intense training and individuals who want to enhance training adaptations.

Enhanced recovery Creatine supplementation can help athletes recover from intense training. Enhanced tolerance to exercise in the heat Like carbohydrate, creatine monohydrate has osmotic properties that help retain a small amount of water.

Potential medical uses of creatine Given the role of creatine in metabolism, performance, and training adaptations; a number of researchers have been investigating the potential therapeutic benefits of creatine supplementation in various clinical populations.

Creatine synthesis deficiencies Creatine deficiency syndromes are a group of inborn errors e. Ischemic heart disease Creatine and phosphocreatine play an important role in maintaining myocardial bioenergetics during ischemic events [ 33 ].

Aging A growing collection of evidence supports that creatine supplementation may improve health status as individuals age [ 41 , 43 , 44 , 45 , ]. Pregnancy Since creatine supplementation has been shown to improve brain and heart bioenergetics during ischemic conditions and possess neuroprotective properties, there has been recent interest in use of creatine during pregnancy to promote neural development and reduce complications resulting from birth asphyxia [ , , , , , , , , , ].

Safety Since creatine monohydrate became a popular dietary supplement in the early s, over 1, studies have been conducted and billions of servings of creatine have been ingested.

Position of the international society of sports nutrition ISSN After reviewing the scientific and medical literature in this area, the International Society of Sports Nutrition concludes the following in terms of creatine supplementation as the official Position of the Society: 1. Conclusion Creatine monohydrate remains one of the few nutritional supplements for which research has consistently shown has ergogenic benefits.

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Cooke MB, et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. Hespel P, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans.

J Physiol. Effect of oral creatine supplementation on human muscle GLUT4 protein content after immobilization. Gualano, B. Roschel, A. Lancha-Jr, C. Brightbill, and E. Rawson In sickness and in health: the widespread application of creatine supplementation. Amino Acids. Persky, A. Safety of creatine supplementation.

Rawson, E. Clarkson, and M. Tarnopolsky Perspectives on exertional rhabdomyolysis. Sports Med. Lopez, R. Casa, B. McDermott, M. Ganio, L. Armstrong, and C. Maresh Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses. Gualano B, Rawson ES, Candow DG, Chilibeck PD.

Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain. Branch JD Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab 13 2 — Rawson ES, Volek JS Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance.

J Strength Cond Res 17 4 — pii:R Bemben MG, Lamont HS Creatine supplementation and exercise performance: recent findings.

Sports Med 35 2 — pii Hespel P, Derave W Ergogenic effects of creatine in sports and rehabilitation. Subcell Biochem — Engelhardt, M. Neumann, A.

Berbalk, and I. Reuter There is also no evidence that creatine harms the liver and kidneys in healthy people who take standard doses. That said, people with preexisting liver or kidney concerns should consult a doctor before supplementing.

Studies suggest it can reduce cramps and dehydration during endurance exercise in high heat. One study linked creatine supplements with an increase in a hormone called DHT, which can contribute to hair loss.

But most available research does not support this link. Creatine exhibits no harmful side effects. Creatine is a leading supplement used for improving athletic performance. It may help boost muscle mass, strength, and exercise efficiency. It may also reduce blood sugar and improve brain function, but more research is needed in these areas to verify these benefits.

Research from has found that creatine supplementation may be beneficial for women across many life stages by helping support both the muscles and the brain. When combined with resistance training, creatine may help improve body composition and bone density in post-menopausal women.

Earlier research suggested that creatine may not be as effective in women compared to men due to physiological and hormonal differences.

But newer research seems to suggest there are still plenty of benefits for women. More research is needed on larger doses. The effects of creatine are noticeable in as little as 2 weeks. Without a loading phase, it may take you up to 4 weeks to observe the effects.

A study noted that taking up to 30 g per day well above the standard dosage of creatine did not have adverse effects on the kidneys of healthy people. Still, the researchers cautioned that it might be safest for people with pre-existing kidney disease to not use creatine because taking it could metabolize into methylamine and formaldehyde, which could be toxic to the kidneys with pre-existing conditions.

It supports quality of life in older adults, brain health, and exercise performance. Vegetarians — who may not obtain enough creatine from their diet — and older adults may find supplementing particularly useful. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

VIEW ALL HISTORY. Creatine has many benefits for health and performance. It can help you gain muscle, increase strength, and improve brain function, to name a few.

There are many myths regarding the safety and side effects of creatine. The truth is that creatine is actually very safe. Creatine is a well-studied supplement with proven benefits for high intensity exercise.

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Nutrition Evidence Based Everything You Need to Know About Creatine. Medically reviewed by Amy Richter, RD , Nutrition — By Rudy Mawer, MSc, CISSN — Updated on November 2, Basics How it works Muscle gain Exercise Brain health Other benefits Types Dosage Side effects FAQs Bottom line Creatine helps your muscles produce energy during heavy lifting or high intensity exercise.