Chances are you’ve already heard something about creatine. Perhaps you’ve seen it displayed on a vitamin shelf, advertised in a magazine or featured on a TV show like 20/20. But what exactly is creatine and where does it come from? Is it safe?

And if it is some kind of natural steroid used by elite athletes like baseball hero Mark McGwire, then why are physicians prescribing it for fibromyalgia, chronic fatigue syndrome, ischemic heart disease, inflammation, muscular dystrophy, amyotrophic lateral sclerosis (ALS), multiple sclerosis and Parkinson’s disease? Why is creatine used to reduce muscle wasting in aids & cancer , applied during orthopedic rehabilitation and recommended for post-surgery convalescence?

Truth is creatine is a naturally occurring substance that’s been part of our food chain for tens of thousands of years. It’s inside everyone (regardless of what you eat) hiding in every active cell waiting to explode. That’s right, every man, woman and child — even an unborn fetus. Creatine is a product of protein metabolism and is synthesized in the liver, pancreas and spleen from special protein building blocks called amino acids. In nature, it’s found only in animal protein, and once consumed as food or as a dietary supplement (creatine monohydrate) it moves from your intestines in blood towards your muscles, glands and vital organs.

Most of the creatine you make or consume ends up in muscle (95%) with the support of insulin and several enzymes. That’s why creatine is usually mixed with additional phosphates and an insulin-releasing carbohydrate like maltodextrin. When combined with nutrients like HMB, alpha-lipoic acid and grape seed extract, it gets even better. Insulin metabolism tends to improve and many essential mechanisms required to sustain and preserve cell function are reinforced, especially under stressful conditions.

Once inside the cell, creatine combines with phosphorous to form a high-energy compound called creatine phosphate (CP). Creatine phosphate functions as an energy reservoir for the production of ATP, the body’s principle energy currency. ATP (adenosine triphosphate) keeps your motor running, but it’s stored in small amounts and requires continuous replenishment.

During low-intensity activity, such as walking or grocery shopping, ATP levels are maintained primarily from fats and carbohydrates (aerobic metabolism). But if we need to pick up the pace and move quickly, like when running after a bus or away from danger (flight or fight response), well…that’s when you can really appreciate and feel the power of creatine (anaerobic metabolism). Of course the millions of athletes worldwide who have used creatine monohydrate as a supplement for over twelve years without any adverse effects, already know how it improves motivation and exercise performance. But they’re not the only ones who desire more strength and stamina…are they?

The neat thing about the supplement is that you can control the dosage and get more of it inside a weak or tired muscle cell. More creatine leads to a greater influx of water, and this "cell volumizing" effect creates an environment which optimizes tissue repair and growth. Creatine monohydrate is engineered pharmaceutically — it is not derived from animals and contains no animal by-products. The best single time to take creatine is after physical activity, and for best results combine creatine with a high-glycemic fruit (like papaya or mango) and mix in a blender with whey protein isolate, L-glutamine, an omega-3 rich blended oil and filtered water.

If you’re a grandparent (like me), creatine can help muster up what it takes to get more active and play with your grandchildren. And what about Mum and Dad? How are they able to manage the kids, work full-time, take care of the house, educate themselves and get to the gym? ENERGY. That’s how. That’s what good health and performance is all about.

So that’s why I use creatine and fed it to my children in the appropriate and logical dose as they grew up into adults and now my grandchildren. When used correctly, it’s as safe as vitamin C, and just like vitamin C, the amount and form you take is based on bodyweight (lean mass), age, gender, activity level and individual preference. And one more thing...don't believe anyone who says that creatine is harmful. They literally don't know what they're talking about.

Scientific Reports

1) Long-term oral creatine supplementation does not impair renal function in healthy athletes

Creatine supplements are presently used worldwide by healthy individuals and athletes to increase their maximal performance and to gain better adaptation during intense training sessions. Critics, physicians, conservative non-users and bias media reports have suggested that due to creatine’s high nitrogen content (32%) some strain could be placed on the kidney’s if taken in large excess for a long period of time.

This report demonstrates that neither short-term, medium-term, nor long-term (10 months to 5 years) use of oral creatine supplements induce detrimental effects on the kidney of healthy individuals. There were no statistical differences between the control group and the creatine consumer group for plasma contents and urine excretion rates for creatinine, urea, and albumin. Clearance of these compounds did not differ between the two groups.

Thus, glomerular filtration rate (creatinine clearance), tubular reabsorption (urea clearance) and glomerular membrane permeability (albumin clearance) were normal in both groups, rejecting any detrimental effect of creatine supplementation on these renal parameters. No sign of hyperfiltration was observed.

Medicine & Science in Sports & Exercise, Volume 31, Number 8, August 1999 (pg 1108)
[Jacques R. Poortmans and Marc Francaux, Chimie Physiologique, Institut Superieur d’Education Physique et de Kinesitherapie, Univerite Libre de Bruxelles, Brussels, Belgium]

2) Creatine supplementation: performance, clinical chemistry and muscle volume

This placebo controlled, double-blind cross-over study was designed to study the effects and side effects of creatine supplementation on high-intensity, short-term muscle work, on biochemical parameters related to creatine metabolism in blood and urine, and on muscle volume of the lower limb muscles.

The results proved that creatine supplementation is effective in improving short-term performance, and the methods used showed no detrimental side effects. Blood lactate values were lower in the creatine group and the athletes were less fatigued than the placebo group. There were no significant changes in liver enzymes, plasma urea or hematocrit. Creatinine clearance and CK remained within the normal range in all trials.

Medicine & Science in Sports & Exercise, Volume 31, Number 12, December 1999 (pg 1763)
[Matthias Kamber, Markus Koster, Roland Kreis, Gianni Walker, Chris Boesch and Hans Hoppeler, Institute of Sport Sciences, Swiss Sports School, Magglingen, Switzerland; and Departments of Clinical Research, Nephrology, and Anatomy, University of Bern, Bern Switzerland]

3) Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma Creatinine, or CK activity in men and women

The purpose of this study was to examine the effect of acute creatine supplementation upon total and lean mass and to determine potential side affects in both men and women. CrM did not affect blood pressure, plasma creatinine, estimated creatinine clearance, plasma CK activity, renal function, or plasma CK activity, or handgrip strength. In contrast, CrM significantly increased fat-free mass and total body mass as compared with placebo, with no changes in body fat.

Medicine & Science in Sports & Exercise, Volume 32, Number 2, February 2000 (pg 291)
[Sasa Mihic, Jay R. MacDonald, Scott McKenzie and Mark A. Tarnopolsky, Departments of Kinesiology and Medicine, McMaster University, Hamilton, Ontario, Canada]

4) Media Reports are NOT Reliable

The consumption of oral creatine monohydrate has become increasingly common among professional and amateur athletes. Despite numerous publications on the ergogenic effects of this naturally occurring substance, there is little information on the possible adverse effects of this supplement. The objectives of this review are to identify the scientific facts and contrast them with reports in the news media, which have repeatedly emphasized the health risks of creatine supplementation and do not hesitate to draw broad conclusions from individual case reports.

Exogenous creatine supplements are often consumed by athletes in amounts of up to 20 g/day for a few days, followed by 1 to 10 g/day for weeks, months and even years. Usually, consumers do not report any adverse effects, but body mass increases. There are few reports that creatine supplementation has protective effects in heart, muscle and neurological diseases. Gastrointestinal disturbances and muscle cramps have been reported occasionally in healthy individuals, but the effects are anecdotal. Liver and kidney dysfunction have also been suggested on the basis of small changes in markers of organ function and of occasional case reports, but well controlled studies on the adverse effects of exogenous creatine supplementation are almost nonexistent.

We have investigated liver changes during medium term (4 weeks) creatine supplementation in young athletes. None showed any evidence of dysfunction on the basis of serum enzymes and urea production. Short term (5 days), medium term (9 weeks) and long term (up to 5 years) oral creatine supplementation has been studied in small cohorts of athletes whose kidney function was monitored by clearance methods and urine protein excretion rate. We did not find any adverse effects on renal function.

The present review is not intended to reach conclusions on the effect of creatine supplementation on sport performance, but we believe that there is no evidence for deleterious effects in healthy individuals. Nevertheless, idiosyncratic effects may occur when large amounts of an exogenous substance containing an amino group are consumed, with the consequent increased load on the liver and kidneys. Regular monitoring is compulsory to avoid any abnormal reactions during oral creatine supplementation.

Sports Medicine: 30 (3) SEP pg 155-170.
[Poortmans, JR; Francaux, M., (2000) Adverse effects of creatine supplementation - Fact or fiction?]

5) Creatine is Safe, Safe, Safe!

Dr. Paul Greenhalf Ph.D., professor and researcher at the School of Biomedical Sciences at Nottingham University, is a true authority on the subject of creatine supplementation. Presented in the August 2000 issue of British Journal of Sports Medicine, a study overseen by Dr. Greenhalf and colleagues examined the effects of nine weeks of creatine supplementation on 48 healthy subjects split into three experimental protocols. For the first five days subjects ingested 20 grams of creatine per day, followed by a "maintenance' serving of three grams per day for the remainder of the investigation. Blood samples were collected before and after periods of creatine supplementation and were analyzed for signs of adverse changes in liver, muscular and kidney function.

According to Dr. Greenhalf, all measured indices were well within their respective normal ranges at all times, showing no indication of impairment to the liver or kidneys, nor were there any signs of muscle damage. The researchers concluded, "These data provide evidence that there are no obvious adverse effects of acute or more chronic creatine supplementation on hepatic (liver), muscle, and renal (kidney) function. Therefore, there is no apparent health risk associated with creatine supplementation to healthy people when it is ingested in quantities that have been scientifically proven to increase creatine stores".

British Journal Sports Medicine 34 (4) pp 284-288
[Robbinson, T.M. et al., (2000) Dietary Creatine Supplementation Does Not Affect Some Haematological Indices, or Indices of muscle damage and Hepatic and Renal Function]

6) Effects of Long-term Creatine Supplementation

The purpose of this study was to determine the effect of long-term Cr supplementation on blood parameters reflecting liver and kidney function. 23 members of an NCAA Division II American football team (ages = 19-24 yr) with at least 2 years of strength training experience were divided into a Cr monohydrate group in which they voluntarily and spontaneously ingested creatine, and a control in which they took no supplements. Individuals in the CrM group averaged regular daily consumption of 5 to 20 g for 0.25 to 5.6 years.

Venous blood analysis for serum albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, urea, and creatine produced no significant differences between groups. Creatinine clearance was estimated from serum creatinine and was not significantly different between groups. Within the CrM group, correlations between all blood parameters and either daily dosage or duration of supplementation were nonsignificant. Therefore, it appears that oral supplementation with CrM has no long-term detrimental effects on kidney or liver functions in highly trained college athlete in the absence of other nutritional supplements.

International Journal of Sport Nutrition and Exercise Metabolism, Volume 12, Number 4, December 2002
[Mayhew, D.L., Mayhew, J.L., Ware, J.S., Trueman State University, Athletic Department, Kirksville, MO]

Photo by Nicole De Khors from Burst

As always, stay well and live free!

Dr.C