Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?

Jose Antonio, Darren G Candow, Scott C Forbes, Bruno Gualano, Andrew R Jagim, Richard B Kreider, Eric S Rawson, Abbie E Smith-Ryan, Trisha A VanDusseldorp, Darryn S Willoughby, Tim N Ziegenfuss, Jose Antonio, Darren G Candow, Scott C Forbes, Bruno Gualano, Andrew R Jagim, Richard B Kreider, Eric S Rawson, Abbie E Smith-Ryan, Trisha A VanDusseldorp, Darryn S Willoughby, Tim N Ziegenfuss

Abstract

Supplementing with creatine is very popular amongst athletes and exercising individuals for improving muscle mass, performance and recovery. Accumulating evidence also suggests that creatine supplementation produces a variety of beneficial effects in older and patient populations. Furthermore, evidence-based research shows that creatine supplementation is relatively well tolerated, especially at recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day). Although there are over 500 peer-refereed publications involving creatine supplementation, it is somewhat surprising that questions regarding the efficacy and safety of creatine still remain. These include, but are not limited to: 1. Does creatine lead to water retention? 2. Is creatine an anabolic steroid? 3. Does creatine cause kidney damage/renal dysfunction? 4. Does creatine cause hair loss / baldness? 5. Does creatine lead to dehydration and muscle cramping? 6. Is creatine harmful for children and adolescents? 7. Does creatine increase fat mass? 8. Is a creatine 'loading-phase' required? 9. Is creatine beneficial for older adults? 10. Is creatine only useful for resistance / power type activities? 11. Is creatine only effective for males? 12. Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/beverages? To answer these questions, an internationally renowned team of research experts was formed to perform an evidence-based scientific evaluation of the literature regarding creatine supplementation.

Keywords: Adverse Effects; Anecdotal; Research; Safety; Social Media.

Conflict of interest statement

JA is Chief Executive Officer of the ISSN, an academic non-profit that receives support and/or sponsorship from companies that manufacture and/or sell creatine or creatine-containing products.

DGC has received research grants and performed industry sponsored research involving creatine supplementation, received creatine donation for scientific studies and travel support for presentations involving creatine supplementation at scientific conferences. In addition, DGC serves on the Scientific Advisory Board for Alzchem (a company which manufactures creatine) and the editorial review board for the Journal of the International Society of Sports Nutrition and is a sports science advisor to the ISSN. Furthermore, DGC has previously served as the Chief Scientific Officer for a company that sells creatine products.

SCF has served as a scientific advisor for a company that sells creatine products.

BG has received research grants, creatine donation for scientific studies, travel support for participation in scientific conferences (includes the ISSN) and honorarium for speaking at lectures from AlzChem (a company which manufactures creatine). In addition, BG serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine).

ARJ has consulted with and received external funding from companies that sell certain dietary ingredients and also writes for online and other media outlets on topics related to exercise and nutrition

RBK is co-founder and member of the board of directors for the ISSN. In addition, RBK has conducted industry sponsored research on creatine, received financial support for presenting on creatine at industry sponsored scientific conferences (includes the ISSN), and served as an expert witness on cases related to creatine. Additionally, he serves as Chair of the Scientific Advisory Board for Alzchem that manufactures creatine monohydrate.

ESR serves on the Scientific Advisory Board for Alzchem (a company which manufactures creatine). In addition, ESR received financial compensation to deliver the President’s Lecture on creatine supplementation at the 2019 ISSN annual conference.

AESR has received research funding from industry sponsors related to sports nutrition products and ingredients. In addition, AESR serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine).

TAV has received funding to study creatine and is an advisor for supplement companies who sell creatine. In addition, TAV is the current president of the ISSN.

DSW serves as a scientific advisor to the ISSN and on the editorial review board for the Journal of the International Society of Sports Nutrition. In addition, DSW is Past President of the ISSN and has received financial compensation from the ISSN to speak about creatine supplementation.

TNZ has conducted industry sponsored research involving creatine supplementation and has received research funding from industry sponsors related to sports nutrition products and ingredients. In addition, TNZ serves on the editorial review board for the Journal of the International Society of Sports Nutrition and is Past President of the ISSN.

Figures

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Fig. 1
Creatine supplementation strategies.

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