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Creatine


What is it?

Creatine is a chemical that is normally found in the body, mostly in muscles. It is made by the body and can also be obtained from certain foods. Fish and meats are good sources of creatine. 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. But older adults don’t seem to benefit. Creatine doesn’t seem to improve strength or body composition in people over 60.

Creatine use is widespread among professional and amateur athletes and has been acknowledged by well-known athletes such as Mark McGuire, Sammy Sosa, and John Elway. Following the finding that carbohydrate solution further increases muscle creatine levels more than creatine alone, creatine sports drinks have become popular.

Creatine is allowed by the International Olympic Committee, National Collegiate Athletic Association (NCAA), and professional sports. However, the NCAA no longer allows colleges and universities to supply creatine to their students with school funds. Students are permitted to buy creatine on their own and the NCAA has no plans to ban creatine unless medical evidence indicates that it is harmful. With current testing methods, detection of supplemental creatine use would not be possible.

In addition to improving athletic performance, creatine is used for congestive heart failure (CHF), depression, bipolar disorder, Parkinson’s disease, diseases of the muscles and nerves, an eye disease called gyrate atrophy, and high cholesterol. It is also used to slow the worsening of amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease), rheumatoid arthritis, McArdle’s disease, and for various muscular dystrophies.

Americans use more than 4 million kilograms of creatine each year.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CREATINE are as follows:

Possibly effective for...

  • Athletic performance. Many factors seem to influence the effectiveness of creatine, including the fitness level and age of the person using it, the type of sport, and the dose. Creatine does not seem to improve performance in aerobic exercises, or benefit older people. Also, creatine does not seem to increase endurance or improve performance in highly trained athletes. There is some evidence that creatine “loading,” using 20 grams daily for 5 days, may be more effective than continuous use. However, there is still some uncertainty about exactly who can benefit from creatine and at what dose. Studies to date have included small numbers of people (all have involved fewer than 72 participants), and it is not possible to draw firm conclusions from such small numbers.
  • Parkinson’s disease. Creatine might slow the worsening of some symptoms in people with early Parkinson’s disease.
  • Syndromes caused by problems metabolizing creatine. Problems metabolizing creatine cause low levels of creatine in the brain, which results in mental retardation, seizures, autism, and movement disorders. Taking creating by mouth daily for up to 3 years increases creatine levels in the brain and improves movement disorders and seizures, but has little effect on mental ability in children and young adults with the creatine deficiency syndrome called gaunidinoacetate methyltransferase (GAMT) deficiency. However, taking creatine for up to 8 years seems to improve attention, language, and academic performance in children with the creatine deficiency syndrome called arginine-glycine amidinotrasferase (AGAT) deficiency. Taking creatine does not seem to improve brain creatine levels, movement disorders, or mental abilities in children with creatine transporter defect.

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). 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. Taking creatine by mouth daily for 5-10 days seems to improve muscle strength and endurance but not symptoms of heart failure.
  • 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.
  • 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 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 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.
  • 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 daily reduces how quickly Parkinson’s disease progresses. However, in people who already have advanced Parkinson’s disease, taking creatine does not provide this benefit.
  • 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 people with rheumatoid arthritis.
  • Schizophrenia. Early research shows that taking creatine by mouth daily for two months does not improve symptoms or mental function in people with schizophrenia.
  • Spinal cord 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.
  • 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.
  • Trauma. Early research suggests that taking creatine by mouth daily reduces amnesia, headache, dizziness, and fatigue in children after a traumatic brain injury.
  • High cholesterol.
  • Bipolar disorder.
  • Other conditions.
More evidence is needed to rate the effectiveness of creatine for these uses.

How does it work?

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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.”

Are there safety concerns?

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Creatine is LIKELY SAFE when taken by mouth appropriately for up to 5 years.

When taken by mouth in high doses, creatine is POSSIBLY UNSAFE. There is some concern that it could harm the kidney, liver, or heart function. However, a connection between high doses and these negative effects has not been proven. Creatine can also 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 some concern that combining creatine with caffeine and the herb ephedra (also called Ma Huang) might increase the chance of having serious side effects such as stroke.

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.

There is concern that creatine might cause a skin condition called pigmented purpuric dermatosis in some people. But more information is needed to know if creatine can cause this problem.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of creatine during pregnancy and breast-feeding. Stay on the safe side and avoid use.

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.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Medications that can harm the kidneys (Nephrotoxic Drugs)
Taking high doses of creatine might harm 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.

Are there interactions with herbs and supplements?

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Caffeine
There is some concern that combining caffeine, ephedra, and creatine might increase the risk of serious adverse effects. There is a report of stroke in an athlete who consumed creatine monohydrate 6 grams, caffeine 400-600 mg, ephedra 40-60 mg, and a variety of other supplements daily for 6 weeks. Caffeine might also decrease creatine's beneficial effects on athletic performance.

Ephedra
There is some concern that combining ephedra, caffeine, and creatine might increase the risk of serious adverse effects. There is a report of stroke in an athlete who consumed creatine monohydrate 6 grams, caffeine 400-600 mg, ephedra 40-60 mg, and a variety of other supplements daily for 6 weeks.

Are there interactions with foods?

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Carbohydrates
Combining carbohydrates with creatine can increase muscle creatine levels more than creatine alone. Supplementing 5 grams of creatine with 93 grams of simple carbohydrates 4 times daily for 5 days can increase muscle creatine levels as much as 60% more than creatine alone.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:
  • For improving physical performance, several dosing regimens have been tried:
    • Creatine is typically loaded with 20 grams per day (or 0.3 grams per kg) for 5 days followed by a maintenance dose of 2 or more grams (0.03 grams per kg) daily, Although 5 day loading is typical, 2 days of loading has also been used.
    • A loading dose of 9 grams per day for 6 days has also been used. Some sources suggest that, instead of acutely loading, similar results can be obtained with 3 grams per day for 28 days.
During creatine supplementation, the water intake should be 64 ounces per day.
  • For heart failure: 20 grams per day for 5-10 days.
  • For Parkinson's disease:
    • 10 grams/day.
    • A loading dose of creatine 20 grams/day for 6 days followed by 2 grams/day for 6 months, and then 4 grams daily for 18 months has also been used.
  • For improving resistance training in people with Parkinson's disease: a loading dose of 20 grams/day for 5 days, followed by 5 grams/day.
  • For gyrate atrophy: 1.5 grams per day.
  • For muscular dystrophies: 10 grams per day has been used by adults and 5 grams per day has been used by children.
  • For McArdle’s disease: 150 mg / kg daily for 5 days and then continue with 60 mg / kg / day.

Other names

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Cr, Creatina, Créatine, Créatine Anhydre, Creatine Anhydrous, Creatine Citrate, Créatine Citrate, Creatine Ethyl Ester, Créatine Ethyl Ester, Creatine Ethyl Ester HCl, Créatine Ethyl Ester HCl, Créatine Kré Alkaline, Creatine Malate, Créatine Malate, Creatine Monohydrate, Créatine Monohydrate, Créatine Monohydratée, Creatine Pyroglutamate, Créatine Pyroglutamate, Creatine Pyruvate, Créatine Pyruvate, Dicreatine Malate, Dicréatine Malate, Di-Creatine Malate, Éthyle Ester de Créatine, Glycine, N-(aminoiminométhyl)-N-Méthyl, Kre-Alkalyn Pyruvate, Malate de Tricréatine, N-amidinosarcosine, N-(aminoiminomethyl)-N Methyl Glycine, Phosphocreatine, Phosphocréatine, Tricreatine HCA, Tricréatine HCA, Tricreatine Malate, Tricréatine Malate.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Creatine page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html.

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Page last updated: 10 December 2014