From the Guidelines
Creatine monohydrate supplementation is generally safe and offers significant benefits for muscle strength and exercise performance, but individuals with pre-existing kidney conditions should exercise caution due to potential kidney stress. When considering the use of creatine supplements, it is essential to weigh the benefits against the potential risks. The benefits of creatine supplementation include increased muscle strength, improved high-intensity exercise performance, and faster muscle recovery 1.
Key Benefits and Risks
- Increased muscle strength and exercise performance
- Faster muscle recovery
- Potential cognitive benefits
- Minimal risks for most healthy adults, with common side effects including water retention and mild digestive discomfort
- Potential kidney stress in those with pre-existing kidney conditions, as certain dietary supplements, including creatine monohydrate, have been associated with nephrotoxicity, such as rhabdomyolysis 1
Important Considerations
It is crucial for individuals with kidney disorders, pregnant or breastfeeding women, and those under 18 to consult healthcare providers before using creatine supplements. Staying well-hydrated while supplementing is also important to minimize any potential side effects.
Dosage and Form
The recommended dosage is typically 3-5 grams daily, which can be taken at any time of day with or without food. Creatine monohydrate is the most researched and cost-effective form of creatine supplementation.
Mechanism of Action
Creatine monohydrate works by increasing phosphocreatine stores in muscles, which helps regenerate ATP (the body's energy currency) during high-intensity exercise, allowing for greater work capacity during short bursts of intense activity. In a unique situation of using creatine supplementation in a patient with a solitary kidney, the use of creatinine did not alter kidney function; however, creatinine clearance measurements were incorrect, leading to a misclassification of acute kidney injury due to influences of creatine supplementation on creatinine clearance measurements 1.
From the Research
Risks of Creatine Supplementation
- There is no definitive evidence that creatine supplementation causes gastrointestinal, renal, and/or muscle cramping complications 2
- High-dose creatine supplementation may stimulate the production of methylamine and formaldehyde (as potential cytotoxic metabolites of creatine) in the urine of healthy humans, but there is currently no definite clinical evidence about their adverse effects on kidney function 3
- Creatine supplementation appears to have no detrimental effects on kidney function in individuals without underlying kidney diseases, but it is advisable not to use creatine supplementation in sportsmen or women with pre-existing kidney disease or those with a potential risk for kidney dysfunction 3, 4
- Liver and kidney functionality show no change in healthy subjects supplemented with creatine, even during several months, in both young and older populations 4
Benefits of Creatine Supplementation
- Creatine supplementation can increase muscle phosphocreatine content, leading to improvements in high-intensity, intermittent high-intensity, and even endurance exercise 2, 5
- Creatine supplementation can enhance muscular strength and general well-being in muscular dystrophies, and may have a disease-modifying capacity in hereditary diseases where creatine synthesis is impaired 6
- Creatine supplementation can improve muscular and neuropsychological performance in vegetarians or vegans, and may be beneficial for athletes, heavy-duty laborers, or individuals who undergo intense mental effort 6
- Creatine supplementation may be effective in treating secondary prevention of statin myopathy, treatment-resistant depression in women, muscular atrophy, and sarcopenia in the elderly, as well as brain energy shortage (mental fatigue, sleep deprivation, environmental hypoxia) 6