The use of creatine as a nutritional supplement is safe, effective, and ethical, according to the recent position published by the International Society of Sports Nutrition (ISSN) (1).
Despite lingering myths, creatine remains one of the most-researched sports supplements with hundreds of studies supporting its benefits in improving exercise capacity, strength, and muscle mass. Creatine has been around for more than 25 years and experts in the field have reported that creatine supplementation is not only beneficial for athletic performance, but is also clinically safe (2-4).
In its position, the ISSN reported that several hundred peer-reviewed research studies have been conducted to evaluate the efficacy of creatine supplementation in improving exercise performance. Nearly 70 percent of these studies have reported a significant improvement in exercise capacity (5).
Short-term supplementation has been reported to improve maximal power and strength (5 to 15 percent), work performed during sets of maximal effort muscle contractions (5 to 15 percent), sprint performance (1 to 5 percent), and work performed (5 to 15 percent) (5). Long-term supplementation appears to enhance the overall quality of training, leading to 5 to 15 percent greater gains in strength and performance.
Theoretically, creatine supplementation around training may lead to greater training adaptations due to an enhanced quality and volume of work performed. Approximately 95 percent of the body’s creatine is stored in muscle tissue (6). The total amount of creatine in muscle averages to about 120 grams for an average individual. However, the average human has the capacity to store up to 160 grams of creatine under certain conditions, including supplementation (6).
In muscle cells, the energy supplied for contractions is adenosine triphosphate (ATP) and during intense exercise, ATP needs to be replenished from creatine stores. As these creatine stores become depleted during exercise, energy availability diminishes due to the inability to resynthesize ATP for high-intensity effort. The ability to maintain maximal-effort exercise declines and the availability of creatine in the muscle may significantly increase the amount of energy for high-intensity exercise.
Dietary sources of creatine can be found in meats and fish. The supplementation of creatine provides an efficient way of receiving all the performance benefits without the excessive intake of fat and protein.
The ISSN Position Statement centers around nine key points (1):
- Creatine monohydrate is one of the most effective nutritional supplements.
- Creatine monohydrate supplementation is safe.
- There is no scientific evidence that the short- or long-term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals.
- If proper precautions and supervision are provided, supplementation in young athletes is acceptable.
- Creatine monohydrate is the most extensively studied and clinically effective form of creatine.
- The addition of carbohydrate or carbohydrate and protein to a creatine supplement appears to increase muscular retention of creatine.
- Creatine should be dosed at three to five grams per day.
- Creatine products are readily available as a dietary supplement and are regulated by the S. Food and Drug Administration (FDA).
- Creatine monohydrate has been reported to have a number of potentially beneficial uses in several clinical populations.
- Kreider RB, Kalman DS, Antonio J et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017 Jun 13;14:18.
- Greenwood M, Kreider RB, Melton C et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem. 2003 Feb;244(1-2):83-8.
- Kreider RB, Melton C, Rasmussen CJ et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem. 2003 Feb;244(1-2):95-104.
- Poortmans JR, Francaux M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci Sports Exerc. 1999 Aug;31(8):1108-10.
- Kreider RB. Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem. 2003 Feb;244(1-2):89-94.
- Balsom PD, Söderlund K, Ekblom B. Creatine in humans with special reference to creatine supplementation. Sports Med. 1994 Oct;18(4):268-80.