Is creatine safe?
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Safety of Creatine Supplementation: A Comprehensive Review
Introduction to Creatine Safety
Creatine is a widely used dietary supplement, particularly popular among athletes for its potential to enhance performance in high-intensity, short-duration exercises. Despite its popularity, questions about its safety persist, especially concerning long-term use and its effects on various populations.
Short-Term Safety of Creatine
Multiple studies have consistently shown that short-term creatine supplementation is generally safe for healthy individuals. Research indicates that short-term use does not result in significant adverse effects, with most users experiencing no detrimental changes in blood, urine, or organ function markers1 4 10. For instance, a double-blind placebo-controlled study found no adverse events in resistance training practitioners supplemented with creatine monohydrate, confirming its safety over a 30-day period4.
Long-Term Safety and Tolerability
Long-term studies on creatine supplementation are less abundant, but existing research suggests that it is well-tolerated over extended periods. The International Society of Sports Nutrition (ISSN) reports that long-term supplementation, even up to 30 grams per day for five years, is safe for healthy individuals and various patient populations3. This is supported by other reviews that highlight the absence of significant adverse effects in long-term users10.
Potential Adverse Effects
While creatine is generally safe, some users may experience mild side effects such as weight gain, cramping, dehydration, diarrhea, and dizziness2. There are also isolated reports of renal dysfunction, although these are rare and not conclusively linked to creatine use2. A study on youth elite soccer players suggested potential adverse effects on lung function, particularly in those with allergic sensitization, indicating the need for further research in specific populations6.
Safety in Special Populations
Children and Adolescents
The safety of creatine in children and adolescents remains under-researched. Despite recommendations against its use in individuals under 18, anecdotal evidence suggests widespread use among young athletes8. Given the lack of comprehensive safety data for this age group, caution is advised, and the use of creatine should be discouraged until more research is available8.
Clinical Populations
Creatine has shown promise in various clinical settings, including neurodegenerative diseases, diabetes, and muscular dystrophies. Studies indicate that creatine supplementation can be beneficial and safe for patients with these conditions, provided it is administered under medical supervision3 5. However, individuals with pre-existing kidney conditions should exercise caution, as creatine may pose risks to renal function5.
Quality Control and Regulatory Concerns
One of the concerns with creatine supplements is the variability in product quality. Commercially marketed creatine products may not always meet the stringent quality control standards of pharmaceuticals, leading to potential impurities or incorrect dosages2 9. Consumers should seek products from reputable manufacturers to mitigate these risks.
Conclusion
Overall, creatine supplementation is considered safe for healthy individuals when used appropriately. Short-term use is well-tolerated, and long-term use appears to be safe based on current evidence. However, caution is advised for children, adolescents, and individuals with pre-existing kidney conditions. As with any supplement, it is crucial to use high-quality products and consult healthcare professionals before starting creatine supplementation. Further research is needed to fully understand the long-term safety and effects in various populations.
Sources and full results
Most relevant research papers on this topic
Creatine Use in Sports
Creatine supplementation is safe and effective for short-duration, maximal-intensity resistance training, but its long-term safety and impact on sports performance remain unclear.
Systematic Review
Rigorous JournalCreatine: a review of efficacy and safety.
Creatine may enhance short-duration, high-intensity exercise performance, but is not useful for endurance sports, and its use should be balanced with potential risks, including renal dysfunction.
Systematic ReviewInternational Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine
Creatine supplementation improves exercise performance, enhances recovery, and is safe and well-tolerated for use in healthy individuals and various patient populations.
Literature Review
Very Rigorous Journal
Highly CitedCreatine supplementation improves performance, but is it safe? Double-blind placebo-controlled study.
Creatine monohydrate supplementation is safe for health and does not cause adverse events, despite an expected weight increase in resistance training practitioners.
RCTBeyond sports: Efficacy and safety of creatine supplementation in pathological or paraphysiological conditions of brain and muscle
Creatine supplementation improves muscular strength and well-being in muscular dystrophies, prevents statin myopathy, and treats treatment-resistant depression in women, with safety up to 20 g/d.
Systematic ReviewEffect of Creatine Supplementation on the Airways of Youth Elite Soccer Players
Creatine supplementation may have adverse effects on the airways of elite athletes, particularly in those with allergic sensitization.
RCTVery Rigorous JournalCreatine supplementation with specific view to exercise/sports performance: an update
Creatine supplementation increases strength, fat-free mass, and muscle morphology when combined with heavy resistance training, but its effects diminish as exercise duration increases.
Very Rigorous JournalHighly CitedCreatine use among young athletes.
Creatine use is widespread among middle and high school athletes, with boys and certain sports showing higher usage, despite current recommendations against its use in adolescents under 18.
Observational StudyHighly CitedBioavailability, Efficacy, Safety, and Regulatory Status of Creatine and Related Compounds: A Critical Review
Creatine monohydrate (CrM) remains the only source of creatine with substantial evidence supporting bioavailability, efficacy, and safety, and is approved for use in global markets as a dietary ingredient or food additive.
Literature ReviewVery Rigorous Journal