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June 23, 2010, Updated October 4, 2011
By L. Carr, Contributing Columnist
If you've ever worked out in a gym, chances are that one of the people
sweating next to you has used creatine. According to the American
College of Sports Medicine, creatine is the most popular sports
nutritional supplement averaging yearly sales of over $400 million.
The use of creatine in supplements is a modern occurrence but the
substance itself has a long history. Creatine was first discovered in
1832. It is a nitrogenous organic acid, naturally present in humans,
that helps supply energy to muscle.
Today creatine is most popularly used as an athletic performance
enhancer or as an aid for increasing muscle mass. As a supplement,
creatine is available in powder form to be mixed into a drink or as a
capsule. According to the American College of Sports Medicine, creatine
is the most popular sports nutritional supplement averaging yearly
sales of over $400 million. Experts, including those at the University of
Maryland Medical Center, recommend a start (or load) level of 5g of
creatine, four times a day, for one week. A maintenance dose of
creatine would ideally be between 2g and 5g a day. The body absorbs
creatine more effectively when it is taken with carbohydrates.
Purported Benefits of Creatine-Does Creatine Work?
Creatine is widely used by athletes and body builders as well as gym
fanatics who want to get a better result from their workout. Creatine’s
attraction is its purported ability to increase lean muscle mass and
enhance high-intensity performance.
Creatine is also said to have a beneficial effect on the strength of
people with neuromuscular disorders such as Parkinson’s and
Huntington’s disease. A 2001 study by Andreassen OA, Dedeoglu A,
Ferrante RJ, et al published in Neurobiology of Disease found that
creatine lessened brain atrophy in mice affected by Huntington’s
There's more. Creatine is also reported to help lower the levels of
triglycerides, ‘bad’ cholesterol, in the blood. A 1996 study by Earnest,
C., Almada, A., & Mitchell, T, published in Clinical Science, found several
months of creatine supplements for men and women with borderline
high cholesterol lowered ‘bad’ cholesterol by almost one third. Creatine
may help people with heart problems get the exercise they need by
increasing the amount of time they can work out without feeling tired.
Side Effects of Creatine – What Are the Facts?
With its purported benefits and wide popularity, is creatine a true
wonder-supplement? Side effects have been reported in connection
with creatine. What are the facts? Are you risking your health by taking
this performance-enhancing substance? Drawn from reserach, here is a
list of the side effects of creatine:
1. Creatine Causes Bloating, Water Retention and Dehydration
Creatine causes muscle to retain more water by pulling liquid into the
muscle and increasing protein synthesis. This may make the creatine
user look and feel bloated, particularly in the early stage of creatine
use. The initial muscle gain is mainly water. If you don’t exercise or lift
weights in order to grow muscle fibers, any weight gain will remain just
water weight. In some people this can result in a bulge around the
waist. Because more water is drawn to the muscles, dehydration can be
a problem when taking creatine. Users are advised to watch their fluid
intake and increase it when undertaking strenuous workouts.
2. Creatine Causes Kidney Problems
Lack of fluid in the body can cause kidney stones. Therefore, if
dehydration is a problem when taking creatine you are at higher risk of
developing kidney stones, right? Particularly as kidney stones have also
been linked to a high protein diet, common for body builders and
If you increase the amount of creatine in the muscles you will need to
get rid of the extra in urine. Passing an increased amount of urine could
put strain on the kidneys. What’s the evidence? There is significant
anecdotal evidence that creatine causes problems with the kidneys but
hard scientific evidence is lacking.
Two case studies have been reported, one in the Lancet (1998,
Prichard NR, Kaltra PA: “Renal dysfunction accompanying oral creatine
supplements”) and one in a 1999 letter to the New England Journal of
Medicine (Koshy KM, Griswold E, Scheenberger EE: “Interstitial
nephritis in a patient taking creatine”). “Creatine: a review of efficacy
and safety” (Graham AS, Hatton RC, 1999) states that creatine
supplementation results in urinary concentrations 90 times greater than
normal, creating the possibility of kidney damage.
However, a 2000 study found a different result. That study, in the
British Journal of Sports Medicine entitled "Dietary creatine
supplementation does not affect some haematological indices, or
indices of muscle damage and hepatic and renal function” found no
discernible negative effect on renal function after studying 48 healthy
patients. Moreover, a 2002 study from the Truman State University
studied 23 members of an NCAA Division II American football team,
half of which took creatine supplements. The researchers found no
detrimental effect on either kidney or liver function.
3. Creatine Exacerbates Existing Kidney Problems
There's evidence that creatine makes kidney problems worse. A 2001
study from the Department of Nutrition and Food Sciences and the
Center for Research on Women's Health, Texas Woman's University,
Denton, found creatine accelerated the growth of cysts in rats with
Polycystic Kidney Disease. The researchers urged people with renal
dysfunction to be cautious when taking creatine. As evidence is lacking,
people with kidney or liver disease should use creatine with caution.
4. Creatine Causes Muscle Cramps
There are other side effects of creatine linked to dehydration, one of
which is an increase in painful muscle cramps, spasms and pulled
muscles. However, a 2003 study published in the journal Medicine and
Science in Sports and Exercise (“Creatine supplementation and health
variables: a retrospective study”) found no difference in the reported
incidence of muscle cramp in a group of 26 athletes using creatine for
up to four years.
Studies of less than 30 people may not be enough to draw full
conclusions about muscle cramp side effects, and there is certainly
much anecdotal evidence linking creatine to cramps. Extra water
remains vital when taking creatine in order to limit any possible side
effects caused by dehydration.
Be careful when taking caffeine alongside creatine as the combination
can increase the risk.
5. Creatine Makes Asthma Symptoms Worse?
According to some reports, which have been disputed by others,
creatine may make your asthma symtoms worse. It has been reported
that creatine can exacerbate the symptoms of asthma by causing
inflammation of the airways. A 2007 study from the School of Medicine
at the University of São Paulo, Brazil, found that creatine exacerbated
the lung allergic response in mice modeled to suffer from chronic
allergic lung inflammation.
The Mayo Clinic warns against using creatine if you have known
allergies but evidence as to whether the supplement can significantly
affect the airways is inconclusive. Many athletes suffer from asthma and
they also take creatine; whether creatine or exercise is responsible for
asthma attacks is unclear.
A new comprehensive review of the issue of whether creatine causes
asthma has concluded that you are unlikely to make asthma worse, so
long as you do aerobic endurance exercise when you take creatine.
6. Creatine May be Dangerous for Diabetics
If you're diabetic, be careful about using creatine. Creatine may alter
the activity of insulin in the body, potentially causing harm to diabetes
sufferers. One 2002 study from the Department of Biochemistry,
University of Sydney, looked at the way creatine affects insulin
secretion and glucose tolerance. The researchers fed rats a diet
supplemented with creatine and monitored their glucose activity. The
study found that prolonged creatine supplementation produced
changes in insulin secretion and abnormalities in glucose levels.
7. Creatine Can Be Dangerous in Pregnancy
Pregnant women should not use creatine. It is not recommended to
take creatine when pregnant or breast feeding because the effects of
the supplement have not been sufficiently studied. Scientific
information regarding creatine use in pregnancy is not conclusive and
therefore experts advise caution.
8. Creatine Use By Teenagers May Be Dangerous
A 2001 New York study “Creatine Use Among Young Athletes” found
5.6 percent of the 10 to 18 year olds studied took creatine. The study
found 44 percent of Grade 12 athletes took creatine and usage was
more common among boys than girls. The most popular reason given
for taking creatine was to enhance performance, followed by desire for
an improved appearance.
As creatine hasn’t been studied to determine its full effect on
teenagers, such widespread use is a cause of concern, particularly if
teenage athletes are exceeding the recommended dosage. The body
may stop producing its own creatine if supplementation continues for
many years, which could have a pronounced effect on growing bodies.
The American College of Sports Medicine has discouraged creatine use
in people less than 18 years of age because of the unknown potential
adverse health effects.
Concern also exists over the danger of creatine creating the unrealistic
expectation that physical fitness and improved appearance can be
achieved with little effort.
9. Creatine Can Be Dangerous When Combined With Medication
As creatine is not regulated, anybody can buy it without an overall
health assessment or consideration of the potential interaction with any
other drugs they may be taking. Creatine may be harmful when taken
with certain pain relieving non-steroidal anti-inflammatory drugs
(NSAIDs), Cimetidine (Tagamet) and Probenicid. (Read more about
medications not to mix with creatine.)
10. Creatine Causes Diarrhea and Nausea
One of the most common side effects of creatine, particularly when
taken long term, is stomach upset, diarrhea and nausea. If you
experience any form of side effect when taking creatine you should
discontinue use or seek further medical advice.
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