Creatine

• Overview
• Uses
• Side Effects
• Precautions
• Interactions
• Dosing

Creatine is a chemical that is found in the body. It is found mostly in muscles but also in the brain. It is also found in foods such as red meat and seafood. Creatine can also be made in the laboratory.

Creatine is most commonly used for improving exercise performance and increasing muscle mass in athletes and older adults. There is some science supporting the use of creatine in improving the athletic performance of young, healthy people during brief high-intensity activity such as sprinting. Because of this, creatine is often used as a dietary supplement to improve muscle strength and athletic performance. In the U.S., a majority of sports nutrition supplements, which total $2.7 billion in annual sales, contain creatine.

Creatine use is allowed by the International Olympic Committee, National Collegiate Athletic Association (NCAA), and professional sports.

In addition to improving athletic performance and muscle strength, creatine is taken by mouth for creatine deficiency syndromes that affect the brain, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), depression, diabetes, fibromyalgia, Huntington's disease, disease that cause inflammation in the muscles (idiopathic inflammatory myopathies), Parkinson's disease, diseases of the muscles and nerves, multiple sclerosis, muscle atrophy, muscle cramps, breathing problems in infants while sleeping, head trauma, Rett syndrome, an eye disease called gyrate atrophy, inherited disorders that affect the senses and movement, schizophrenia, muscle breakdown in the spine, and recovery from surgery. It is also taken by mouth to slow the worsening of amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease), osteoarthritis, rheumatoid arthritis, McArdle's disease, and for various muscular dystrophies.

People apply creatine to the skin for aging skin.

How does it work?

Creatine is involved in making the energy muscles need to work.

Vegetarians and other people who have lower total creatine levels when they start taking creatine supplements seem to get more benefit than people who start with a higher level of creatine. Skeletal muscle will only hold a certain amount of creatine; adding more won't raise levels any more. This "saturation point" is usually reached within the first few days of taking a "loading dose."

Possibly Effective for...

• Athletic performance. Creatine seems to help improve rowing performance, jumping height, and soccer performance in athletes. But the effect of creatine on sprinting, cycling, or swimming performance varies. The mixed results may relate to the small sizes of the studies, the differences in creatine doses, and differences in test used to measure performance. Creatine does not seem to improve serving ability in tennis players.
• Syndromes caused by problems metabolizing creatine. Some people have a disorder that prevents their body from making creatine. This can lead to low levels of creatine in the brain. Low levels of creatine in the brain can lead to decreased mental function, seizures, autism, and movement problems. Taking creating by mouth daily for up to 3 years can increase creatine levels in the brain in children and young adults with a disorder of creatine production called guanidinoacetate methyltransferase (GAMT) deficiency. This can help improve movement and reduce seizures. But it doesn't improve mental ability. Arginine-glycine amidinotransferase (AGAT) deficiency is another disorder that prevents the body from making creatine. In children with this condition, taking creatine for up to 8 years seems to improve attention, language, and mental performance. But taking creatine does not seem to improve brain creatine levels, movement, or mental function in children who have a disorder in which creatine isn't transported properly.
• Muscle strength. There is a lot of mixed research on creatine's ability to improve muscle strength. However, analyses of this research show that creatine seems to modestly improve upper body strength and lower body strength in both younger and older adults.

Possibly Ineffective for...

• Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). Taking creatine by mouth does not seem to slow disease progression or improve survival in people with ALS.

Insufficient Evidence to Rate Effectiveness for...

• Skin aging. Early research shows that applying cream containing creatine, guarana, and glycerol to the face daily for 6 weeks reduces wrinkles and skin sagging in men. Other research suggests that a cream containing creatine and folic acid reduces wrinkles and improves sun-damaged skin.
• Lung disease (Chronic obstructive pulmonary disease). Early research on the effects of creatine in people with chronic obstructive pulmonary disease (COPD) is inconsistent. Some research suggests that taking creating daily does not improve lung function. However, other research suggests that taking creatine may improve lung function or exercise capacity.
• Heart failure. Some early research shows that taking creatine daily for 5-10 days improves muscle strength and endurance but does not improve symptoms of heart failure. Taking lower doses of creatine daily for 6 months does not improve exercise capacity or heart failure symptoms in men.
• Depression. Early research suggests that taking creatine daily for 8 weeks enhances the effects of the antidepressant drug escitalopram in women with major depressive disorder.
• Diabetes. Early research shows that taking creatine by mouth for 5 days reduces blood sugar after eating in people with newly diagnosed diabetes. However, the effects of taking creatine for longer than 5 days in people with diabetes are not know.
• Fibromyalgia. Early research suggests that taking 5 grams of creatine four times daily for 5 days followed by 5 grams daily for 16 weeks improves strength in women with fibromyalgia. But creatine does not seem to improve aerobic exercise capacity, pain, sleep, quality of life, or mental function in people with fibromyalgia.
• Vision loss (gyrate atrophy of the choroid and retina). Early research shows that creatine deficiency, which has been associated with this form of vision loss, can be corrected with supplements. Taking creatine daily for one year seems to slow eye damage and vision loss.
• Inherited nerve damage (hereditary motor and sensory neuropathy). Early research in people with inherited nerve damage diseases such as Charcot-Marie-Tooth Disease, suggest that taking creatine by mouth daily for between one and 12 weeks has no effect on muscle strength or endurance.
• Inherited disease called Huntington's disease. Early research suggests that taking creatine by mouth daily for one year does not improve muscle strength, coordination, or symptoms in people with Huntington's disease.
• Muscle diseases such as polymyositis and dermatomyositis. Early studies suggest taking creatine might produce small improvements in muscle strength in people with these conditions.
• Muscle disorder called McArdle disease. Some early research suggests that taking creatine by mouth daily improves muscle function in some people with McArdle disease. However, taking higher doses of creatine seem to make muscle pain worse.
• Muscular and neurological diseases called mitochondrial myopathies. Early research suggests that taking creatine by mouth does not improve muscle function or quality of life in people with mitochondrial myopathies. However, creatine might improve some measures of muscle strength.
• Multiple sclerosis. Early research suggests that taking creatine by mouth daily for 5 days does not improve exercise ability in people with multiple sclerosis.
• Loss of muscle tissue. Taking creatine by mouth daily does not seem to increase muscle mass or strength in men with muscle loss due to HIV. However, taking creatine seems to help maintain muscle mass and reduce the loss of muscle strength that is associated with having to wear a cast.
• Muscle cramps. Early research shows that taking creatine by mouth before hemodialysis treatments seems to reduce muscle cramps.
• Muscular dystrophy. Early research on the use of creatine by mouth in people with muscular dystrophy is not clear. Some evidence shows that muscle strength and fatigue seem to improve after taking creatine daily for 8-16 weeks. However, other research suggests that creatine provides no benefit for people with muscular dystrophy.
• Breathing problems while sleeping in newborns. Early research shows that giving creatine to premature infants does not improve breathing problems while sleeping.
• Brain injury. Early research shows that taking creatine by mouth daily for 7 days increases the ability to exercise by increasing lung function in people with a spinal cord injury. However, other research shows that creatine does not improve wrist muscle or hand function. Early research also shows that taking creatine by mouth daily for 6 months reduces amnesia following a traumatic brain injury in children.
• Osteoarthritis. Early research suggests that taking creating by mouth daily in combination with strengthening exercises improves physical functioning in postmenopausal women with knee osteoarthritis.
• Parkinson's disease. Early research suggests that taking creatine twice daily for 12-18 months slows the progression of Parkinson's disease in people who have not yet started conventional medicines.
• Nervous system disorder called Rett syndrome. Early research suggests that taking creating daily for 6 months can slightly improve symptoms in females with Rett syndrome.
• Rheumatoid arthritis. Early research shows that taking creatine by mouth daily increases muscle strength, but does not improve physical functioning in adults with rheumatoid arthritis. In children, taking a specific supplement (Kre-Celazine) containing creatine and fatty acids twice daily for 30 days might reduce pain and swelling. But the effects of creatine alone are not clear.
• Schizophrenia. Early research shows that taking creatine by mouth daily for two months does not improve symptoms or mental function in people with schizophrenia.
• Muscle loss in the spine. Early research suggests that children with muscle loss in the spine do not benefit from taking creatine by mouth.
• Recovery from surgery. Early research shows that taking creatine daily does not speed up recovery of muscle strength after surgery.
• Bipolar disorder.
• Other conditions.

More evidence is needed to rate the effectiveness of creatine for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Creatine is LIKELY SAFE when taken by mouth at doses up to 25 grams daily for up to 14 days. Lower doses up to 4-5 grams taken daily for up to 18 months are also LIKELY SAFE. Some early research also suggests that creatine is POSSIBLY SAFE when taken in doses up to 10 grams daily for up to 5 years.

Creatine can cause stomach pain, nausea, diarrhea, and muscle cramping.

Creatine causes muscles to draw water from the rest of your body. Be sure to drink extra water to make up for this. Also, if you are taking creatine, don't exercise in the heat. It might cause you to become dehydrated.

Many people who use creatine gain weight. This is because creatine causes the muscles to hold water, not because it actually builds muscle.

There is concern that creatine might cause irregular heartbeat in some people. But more information is needed to know if creatine can cause this problem.

Pregnancy and breast-feeding: There is not enough reliable information about the safety of taking creatine if you are pregnant or breast feeding. Stay on the safe side and avoid use.

Children: Creatine is POSSIBLY SAFE in children when taken by mouth appropriately. Creatine 3-5 grams daily for 2-6 months has been taken safely in children 5-18 years of age. Creatine 2 grams daily for 6 months has been taken safely in children 2-5 years of age. Additionally, creatine 0.1-0.4 grams/kg daily for up to 6 months has been taken safely in both infants and children.

Bipolar disorder: There have been cases of manic episodes in people with bipolar disorder who took creatine daily for 4 weeks. Creatine might make mania worse in people with bipolar disorder.

Kidney disease or diabetes: Do not use creatine if you have kidney disease or a disease such as diabetes that increases your chance of developing kidney disease. There is some concern that creatine might make kidney disease worse.

---

Medications that can harm the kidneys (Nephrotoxic Drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

While most evidence shows that creatine does not harm the kidneys, in rare cases creatine has been reported to cause damage to the kidneys. Some medications can also harm the kidneys. Taking creatine with other medications that can harm the kidneys might increase the chance of kidney damage.

Some of these medications that can harm the kidneys include cyclosporine (Neoral, Sandimmune); aminoglycosides including amikacin (Amikin), gentamicin (Garamycin, Gentak, others), and tobramycin (Nebcin, others); nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene); and numerous others.

The following doses have been studied in scientific research:

ADULT

BY MOUTH:

• For athletic performance: Many different dosing regimens have been used; however, most use a short-term "loading dose" followed by a long-term maintenance dose. Loading doses are typically 20 grams daily for 4-7 days. Maintenance doses are typically 2-10 grams daily.
• For muscle strength: Many different dosing regimens have been used; however, most use a short-term "loading dose" followed by a long-term maintenance dose. The most common loading doses are typically around 20 grams daily for 5-7 days. Maintenance doses ranging from 1 to 27 grams daily have also been used.

CHILDREN

BY MOUTH:

• For syndromes caused by problems making or transporting creatine: Doses of 400-800 mg of creatine per kg of body weight have been taken daily for up to 8 years. Also, 4-8 grams of creatine has been taken daily for up to 25 months.