Contraindications for creatine supplementation
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Creatine Supplementation Contraindications: Renal Disease, Kidney Function, and At-Risk Populations
Research consistently shows that creatine supplementation is generally safe for healthy individuals when taken at recommended doses. However, there are important contraindications and precautions for certain groups. Individuals with pre-existing renal disease or those at risk for kidney dysfunction—such as people with diabetes, hypertension, or reduced glomerular filtration rate—should avoid high-dose creatine supplementation (greater than 3–5 g/day) or use it only under medical supervision. For these individuals, a pre-supplementation assessment of kidney function is advised to ensure safety, though this is not necessary for healthy people without risk factors 123.
Safety in Healthy Adults and Females: No Major Adverse Effects
Large-scale analyses of clinical trials and systematic reviews have found no significant increase in adverse events, including kidney or liver dysfunction, in healthy adults or females taking creatine at standard doses. There is no evidence of increased mortality, serious adverse outcomes, or significant changes in renal or hepatic function in these populations. The risk of total adverse outcomes, weight gain, or organ complications does not appear to be higher in females using creatine compared to those not using it 235.
Minor Side Effects: Gastrointestinal Issues and Muscle Cramping
Some users may experience minor side effects such as gastrointestinal discomfort or muscle cramping, but these are infrequent and occur at similar rates in people taking placebos. The overall prevalence of these side effects is low and not clinically significant. There is no evidence that creatine increases the risk of dehydration, muscle cramping, or other commonly cited side effects in healthy individuals 123.
Special Populations: Children, Adolescents, and Pregnancy
While creatine is generally well tolerated, caution is advised for children, adolescents, and pregnant women due to limited long-term safety data in these groups. Although no major adverse effects have been reported, more research is needed to confirm safety in these populations, and supplementation should only be considered under medical guidance 24.
Conclusion
Creatine supplementation is safe for most healthy adults when used at recommended doses. The main contraindication is for individuals with existing or potential kidney problems, who should avoid high doses or consult a healthcare provider before use. Minor side effects are rare and not clinically significant. For children, adolescents, and pregnant women, creatine should be used cautiously and only with medical supervision.
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