madman
Super Moderator
Abstract
Supplementing with creatine is very popular amongst athletes and exercising individuals for improving muscle mass, performance, and recovery. Accumulating evidence also suggests that creatine supplementation produces a variety of beneficial effects in older and patient populations. Furthermore, evidence-based research shows that creatine supplementation is relatively well tolerated, especially at recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day). Although there are over 500 peer-refereed publications involving creatine supplementation, it is somewhat surprising that questions regarding the efficacy and safety of creatine still remain. These include, but are not limited to 1. Does creatine lead to water retention? 2. Is creatine an anabolic steroid? 3. Does creatine cause kidney damage/renal dysfunction? 4. Does creatine cause hair loss/baldness? 5. Does creatine lead to dehydration and muscle cramping? 6. Is creatine harmful to children and adolescents? 7. Does creatine increase fat mass? 8. Is a creatine loading phase required? 9. Is creatine beneficial for older adults? 10. Is creatine only useful for resistance/power type activities? 11. Is creatine only effective for males? 12. Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/beverages? To answer these questions, an internationally renowned team of research experts was formed to perform an evidence-based scientific evaluation of the literature regarding creatine supplementation.
Introduction
Creatine (methyl guanidine-acetic acid) is endogenously formed from reactions involving the amino acids arginine, glycine, and methionine in the kidneys and liver [1]. Exogenously, creatine is primarily consumed from meat and/or as a dietary supplement. According to PubMed (archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health’s National Library of Medicine), there are over 500 peer-refereed publications involving various aspects of creatine supplementation. Based on the enormous popularity of creatine supplementation, the International Society of Sports Nutrition (ISSN) published an updated position stand in 2017 on the safety and efficacy of creatine supplementation in exercise, sport, and medicine [2]. This comprehensive paper provided an evidence-based review of the literature examining the effects of creatine supplementation on performance, recovery, injury prevention, exercise tolerance and rehabilitation, neuroprotection, aging, clinical and disease state populations, and pregnancy. Importantly, the safety profile of creatine was also reviewed. As of September 1, 2020, the paper has been viewed 179,000 times and cited 100 times (according to Web of Science). Furthermore, Altmetric data indicates that the paper has been mentioned in 19 news outlets, 4 blogs, 492 tweets, 54 Facebook pages, and been uploaded 69 times in video posts. Instagram stories and posts are not included as Altmetric data.
Despite the widespread outreach of the 2017 ISSN position stand paper [2], along with other evidence-based review/meta-analysis papers involving various aspects of creatine supplementation published after the 2015 Creatine in Health, Sport and Medicine Conference in Germany [3–34], questions and misconceptions involving creatine supplementation still remain. These include, but are not limited to 1. Does creatine supplementation lead to water retention? 2. Is creatine is an anabolic steroid? 3. Does creatine supplementation cause kidney damage / renal dysfunction? 4. Does creatine supplementation cause hair loss/baldness? 5. Does creatine supplementation lead to dehydration and muscle cramping? 6. Is creatine supplementation harmful to children and adolescents? 7. Does creatine supplementation increase body fat? 8. Is a creatine supplementation ‘loading phase required? 9. Is creatine supplementation beneficial for older adults? 10. Is creatine supplementation only useful for resistance/power type activities? 11. Is creatine supplementation only effective for males? 12. Are other forms of creatine similar or superior to monohydrate? Is creatine stable in solutions/beverages? To address these questions, an internationally renowned team of research experts, who have collectively published over 200 peer-refereed articles involving creatine supplementation, was formed to perform an evidence-based scientific evaluation of the literature. Each question was answered by one researcher, chosen according to her/his expertise on the topic. Then, the final version of this manuscript was reviewed and approved by all authors, therefore reflecting the group opinion.
Does creatine lead to water retention?
*In summary, while there is some evidence to suggest that creatine supplementation increases water retention, primarily attributed to increases in intracellular volume, over the short term, there are several other studies suggesting it does not alter total body water (intra or extracellular) relative to muscle mass over longer periods of time. As a result, creatine supplementation may not lead to water retention.
Is creatine an anabolic steroid?
*In summary, because creatine has a completely different chemical structure, it is not an anabolic steroid.
Does creatine cause kidney damage/renal dysfunction?
*In summary, experimental and controlled research indicates that creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals.
Does creatine cause hair loss/baldness?
*In summary, the current body of evidence does not indicate that creatine supplementation increases total testosterone, free testosterone, DHT, or causes hair loss/baldness.
Does creatine lead to dehydration and muscle cramping?
*In summary, experimental and clinical research does not validate the notion that creatine supplementation causes dehydration and muscle cramping.
Is creatine harmful to children and adolescents?
*In summary, based on the limited evidence, creatine supplementation appears safe and potentially beneficial for children and adolescents.
Does creatine increase fat mass?
*In summary, creatine supplementation does not increase fat mass across a variety of populations.
Is a creatine ‘loading phase required?
*In summary, accumulating evidence indicates that you do not have to ‘load’ creatine. Lower, daily dosages of creatine supplementation (i.e. 3-5 g/day) are effective for increasing intramuscular creatine stores, muscle accretion, and muscle performance/recovery.
Is creatine beneficial for older adults?
*In summary, there is a growing body of evidence showing that creatine supplementation, particularly when combined with exercise, provides musculoskeletal and performance benefits in older adults.
Is creatine only useful for resistance/power type activities?
*In summary, there is a variety of athletic events, not just resistance/power activities, which may benefit from creatine supplementation.
Is creatine only effective for males?
*In summary, there is accumulating evidence that creatine supplementation has the potential to be a multifactorial therapeutic intervention across the lifespan in females, with little to no side effects.
Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/ beverages?
*In summary, while some forms of creatine may be more soluble than creatine monohydrate when mixed in fluid, evidence-based research clearly shows creatine monohydrate to be the optimal choice.
Conclusions
Based on our evidence-based scientific evaluation of the literature, we conclude that:
(1). Creatine supplementation does not always lead to water retention.
(2). Creatine is not an anabolic steroid.
(3). Creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals.
(4). The majority of available evidence does not support a link between creatine supplementation and hair loss/baldness.
(5). Creatine supplementation does not cause dehydration or muscle cramping.
(6). Creatine supplementation appears to be generally safe and potentially beneficial for children and adolescents.
(7). Creatine supplementation does not increase fat mass.
(8). Smaller, daily dosages of creatine supplementation (3-5 g or 0.1 g/kg of body mass) are effective. Therefore, a creatine ‘loading’ phase is not required.
(9). Creatine supplementation and resistance training produce the vast majority of musculoskeletal and performance benefits in older adults. Creatine supplementation alone can provide some muscle and performance benefits for older adults.
(10). Creatine supplementation can be beneficial for a variety of athletic and sporting activities.
(11). Creatine supplementation provides a variety of benefits for females across their lifespan.
(12). Other forms of creatine are not superior to creatine monohydrate.
Supplementing with creatine is very popular amongst athletes and exercising individuals for improving muscle mass, performance, and recovery. Accumulating evidence also suggests that creatine supplementation produces a variety of beneficial effects in older and patient populations. Furthermore, evidence-based research shows that creatine supplementation is relatively well tolerated, especially at recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day). Although there are over 500 peer-refereed publications involving creatine supplementation, it is somewhat surprising that questions regarding the efficacy and safety of creatine still remain. These include, but are not limited to 1. Does creatine lead to water retention? 2. Is creatine an anabolic steroid? 3. Does creatine cause kidney damage/renal dysfunction? 4. Does creatine cause hair loss/baldness? 5. Does creatine lead to dehydration and muscle cramping? 6. Is creatine harmful to children and adolescents? 7. Does creatine increase fat mass? 8. Is a creatine loading phase required? 9. Is creatine beneficial for older adults? 10. Is creatine only useful for resistance/power type activities? 11. Is creatine only effective for males? 12. Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/beverages? To answer these questions, an internationally renowned team of research experts was formed to perform an evidence-based scientific evaluation of the literature regarding creatine supplementation.
Introduction
Creatine (methyl guanidine-acetic acid) is endogenously formed from reactions involving the amino acids arginine, glycine, and methionine in the kidneys and liver [1]. Exogenously, creatine is primarily consumed from meat and/or as a dietary supplement. According to PubMed (archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health’s National Library of Medicine), there are over 500 peer-refereed publications involving various aspects of creatine supplementation. Based on the enormous popularity of creatine supplementation, the International Society of Sports Nutrition (ISSN) published an updated position stand in 2017 on the safety and efficacy of creatine supplementation in exercise, sport, and medicine [2]. This comprehensive paper provided an evidence-based review of the literature examining the effects of creatine supplementation on performance, recovery, injury prevention, exercise tolerance and rehabilitation, neuroprotection, aging, clinical and disease state populations, and pregnancy. Importantly, the safety profile of creatine was also reviewed. As of September 1, 2020, the paper has been viewed 179,000 times and cited 100 times (according to Web of Science). Furthermore, Altmetric data indicates that the paper has been mentioned in 19 news outlets, 4 blogs, 492 tweets, 54 Facebook pages, and been uploaded 69 times in video posts. Instagram stories and posts are not included as Altmetric data.
Despite the widespread outreach of the 2017 ISSN position stand paper [2], along with other evidence-based review/meta-analysis papers involving various aspects of creatine supplementation published after the 2015 Creatine in Health, Sport and Medicine Conference in Germany [3–34], questions and misconceptions involving creatine supplementation still remain. These include, but are not limited to 1. Does creatine supplementation lead to water retention? 2. Is creatine is an anabolic steroid? 3. Does creatine supplementation cause kidney damage / renal dysfunction? 4. Does creatine supplementation cause hair loss/baldness? 5. Does creatine supplementation lead to dehydration and muscle cramping? 6. Is creatine supplementation harmful to children and adolescents? 7. Does creatine supplementation increase body fat? 8. Is a creatine supplementation ‘loading phase required? 9. Is creatine supplementation beneficial for older adults? 10. Is creatine supplementation only useful for resistance/power type activities? 11. Is creatine supplementation only effective for males? 12. Are other forms of creatine similar or superior to monohydrate? Is creatine stable in solutions/beverages? To address these questions, an internationally renowned team of research experts, who have collectively published over 200 peer-refereed articles involving creatine supplementation, was formed to perform an evidence-based scientific evaluation of the literature. Each question was answered by one researcher, chosen according to her/his expertise on the topic. Then, the final version of this manuscript was reviewed and approved by all authors, therefore reflecting the group opinion.
Does creatine lead to water retention?
*In summary, while there is some evidence to suggest that creatine supplementation increases water retention, primarily attributed to increases in intracellular volume, over the short term, there are several other studies suggesting it does not alter total body water (intra or extracellular) relative to muscle mass over longer periods of time. As a result, creatine supplementation may not lead to water retention.
Is creatine an anabolic steroid?
*In summary, because creatine has a completely different chemical structure, it is not an anabolic steroid.
Does creatine cause kidney damage/renal dysfunction?
*In summary, experimental and controlled research indicates that creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals.
Does creatine cause hair loss/baldness?
*In summary, the current body of evidence does not indicate that creatine supplementation increases total testosterone, free testosterone, DHT, or causes hair loss/baldness.
Does creatine lead to dehydration and muscle cramping?
*In summary, experimental and clinical research does not validate the notion that creatine supplementation causes dehydration and muscle cramping.
Is creatine harmful to children and adolescents?
*In summary, based on the limited evidence, creatine supplementation appears safe and potentially beneficial for children and adolescents.
Does creatine increase fat mass?
*In summary, creatine supplementation does not increase fat mass across a variety of populations.
Is a creatine ‘loading phase required?
*In summary, accumulating evidence indicates that you do not have to ‘load’ creatine. Lower, daily dosages of creatine supplementation (i.e. 3-5 g/day) are effective for increasing intramuscular creatine stores, muscle accretion, and muscle performance/recovery.
Is creatine beneficial for older adults?
*In summary, there is a growing body of evidence showing that creatine supplementation, particularly when combined with exercise, provides musculoskeletal and performance benefits in older adults.
Is creatine only useful for resistance/power type activities?
*In summary, there is a variety of athletic events, not just resistance/power activities, which may benefit from creatine supplementation.
Is creatine only effective for males?
*In summary, there is accumulating evidence that creatine supplementation has the potential to be a multifactorial therapeutic intervention across the lifespan in females, with little to no side effects.
Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/ beverages?
*In summary, while some forms of creatine may be more soluble than creatine monohydrate when mixed in fluid, evidence-based research clearly shows creatine monohydrate to be the optimal choice.
Conclusions
Based on our evidence-based scientific evaluation of the literature, we conclude that:
(1). Creatine supplementation does not always lead to water retention.
(2). Creatine is not an anabolic steroid.
(3). Creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals.
(4). The majority of available evidence does not support a link between creatine supplementation and hair loss/baldness.
(5). Creatine supplementation does not cause dehydration or muscle cramping.
(6). Creatine supplementation appears to be generally safe and potentially beneficial for children and adolescents.
(7). Creatine supplementation does not increase fat mass.
(8). Smaller, daily dosages of creatine supplementation (3-5 g or 0.1 g/kg of body mass) are effective. Therefore, a creatine ‘loading’ phase is not required.
(9). Creatine supplementation and resistance training produce the vast majority of musculoskeletal and performance benefits in older adults. Creatine supplementation alone can provide some muscle and performance benefits for older adults.
(10). Creatine supplementation can be beneficial for a variety of athletic and sporting activities.
(11). Creatine supplementation provides a variety of benefits for females across their lifespan.
(12). Other forms of creatine are not superior to creatine monohydrate.
