Is creatine (a dietary supplement) safe for teenagers?

Creatine Supplementation Safety in Teenagers

Creatine supplementation appears to be safe for teenagers when used appropriately, though long-term studies specifically in adolescent populations remain limited.

Safety Profile

• Creatine has been extensively researched and is well-supported as one of the most effective dietary supplements available with a strong safety profile in adults 1.
• Limited but growing evidence suggests creatine supplementation in adolescents is generally safe when used appropriately, with no adverse events reported in existing studies 2.
• The UEFA Expert Group Statement on Nutrition in Elite Football acknowledges creatine as a performance supplement with established protocols, indicating its acceptance in sports nutrition 3.

Benefits and Mechanisms

• Creatine increases muscle creatine stores, enhancing the resynthesis of phosphocreatine, which is important for rapid energy production in high-intensity exercise 4.
• It may improve high-intensity repeated sprint performance and enhance training capacity 3.
• Creatine supplementation in conjunction with resistance exercise may increase muscle mass over time 4.

Usage Patterns

• Despite recommendations against use in those under 18 years old, studies show widespread use among adolescent athletes, with usage rates approaching collegiate levels in grades 11 and 12 5.
• Usage is significantly more common among male athletes (8.8%) compared to female athletes (1.8%), with highest rates in football players, wrestlers, hockey players, gymnasts, and lacrosse players 5.

Recommended Protocol (if used)

• Loading phase: ~20 g/day (divided into four equal daily doses) for 5-7 days 3.
• Maintenance phase: 3-5 g/day (single dose) for the duration of supplementation 3.
• Lower dose approaches (2-5 g/day for 28 days) may avoid the associated increase in body mass 3.

Potential Concerns

• Short-term creatine supplementation appears to increase body mass, though initial increases are likely water retention associated with the osmotic effect of increased intramuscular creatine 4.
• Creatine may act as a false indicator of renal dysfunction by increasing creatinine levels 6.
• Limited research exists on long-term use of creatine supplementation in doses exceeding 10 g/day, particularly in adolescent populations 6.

Precautions

• Individuals with pre-existing kidney disease or those taking nephrotoxic medications should avoid creatine supplementation due to potential increased risk of renal dysfunction 6.
• One case report documented acute renal failure in a 20-year-old man taking 20 g/day of creatine for four weeks, though this appears to be an isolated incident 6.
• Creatine should be discontinued if there is evidence of renal dysfunction, as noted in the Lancet Neurology guidelines for Duchenne muscular dystrophy management 3.

Monitoring Recommendations

• If used, teenagers taking creatine should be monitored for potential side effects, particularly those affecting renal function 6.
• Renal function markers beyond serum creatinine and creatinine clearance should be considered when monitoring adolescents using creatine supplements 6.

Conclusion

While creatine appears to be relatively safe for teenage athletes when used appropriately, parents and healthcare providers should weigh the limited but growing evidence base against potential concerns, particularly regarding long-term effects that remain understudied in adolescent populations 2.