Marie Spano

Is Creatine Safe?

It's a proven muscle builder and performance enhancer, but how safe is it? You may be surprised to find out!

By Marie Spano, MS, RD

Stop me if you've heard this story (or something similar): With the sun baking every football player on his team in their second practice of the day, the head coach looked up to the bright blue sky hoping for a shower to cool off the athletes and soften a field that felt like concrete after months of below average rainfall.

Just 15 minutes until a water break, he watched his starting linebacker—a talented young man who had been playing poorly all week and complaining of muscle cramps. Pale and sweating profusely on this dry, arid day, the linebacker suddenly collapsed in the middle of a play. Shaken and confused, the other players just starred at him as the coaches and trainers sprinted onto the playing field to assist the athlete.

Disoriented and weak, the teenager was rushed to the local emergency room where they diagnosed him with heat exhaustion. After questioning him on his supplement use and food and fluid intake, the nurse proudly exclaimed that she had stumbled onto the sole cause of his bouts of cramps and heat exhaustion: creatine.

Despite the warnings of well-meaning coaches, should athletes really avoid creatine?

The coaches immediately informed the rest of the team and told them that no player would be allowed to take creatine. Their season ended at 2-7 as they were outrun and outplayed by their opponents.

Sounds familiar, doesn't it?

But was creatine really to blame in this situation, or have the supplement and steroid use scandals in sports made all other supplements guilty by association?

A Valid Theory?

Even some researchers have theorized that creatine supplementation could shift our body's fluid balance such that our cells fill with water and the environment outside of our cells, the extracellular compartment, more closely resembles a lake in Southern California—short on fluid. This situation, fluid-filled cells sitting in an environment with little fluid could theoretically lead to cramping, dehydration, and wacked-out electrolytes.

This theory and the athletes clutching their calves and blaming creatine as they wince in cramp-induced pain, have led to a plethora of safety studies on creatine. Luckily, the scientists at the University of Oklahoma reviewed these studies for us in an effort to quiet the misinformed locker room chatter about creatine. Once and for all. Here's what they found:

"Studies analyzing fluid volume indicate that creatine does, in fact, increase total body water..."

Creatine Is Hydrating

Yes, it turns out to be the opposite of the theory. Studies analyzing fluid volume indicate that creatine does, in fact, increase total body water and intracellular water but has no effect on extracellular water (the water in that Southern CA lake). And, much to the surprise of out of shape, overweight athletes who need to point their fingers at anything other than themselves, creatine might actually enhance performance in hot and/or humid conditions. That's right, not only is creatine not to blame when it comes to cramps and heat illnesses, but, it seems creatine helps us regulate our body temperature, reduce sweat rate and exercising heart rate (so our hearts aren't working so hard in the heat), and maintain our red blood cells per volume of blood (i.e., hematocrit).

So what about the studies showing that athletes who were taking creatine reported cramping, GI distress, diarrhea, and upset stomach? Two large studies consisting of 219 collegiate athletes and 1,349 high school football players, respectively, did not control for other supplements used. In addition, in both studies the athletes were participating in hot environments. At Baylor University, researchers examined 72 NCAA Division 1 football players who chose to consume or not consume creatine. This particular study found that the creatine group experienced significantly less muscle cramping, muscle tightness, muscle strains, heat illness, dehydration, and total injuries than the group not taking creatine.

Creatine and Kidney Damage

Alas, what about our kidneys? Doesn't creatine damage them over time?

Scientists took healthy sedentary males aged 18-35 years and examined the effect, if any, that creatine would have on renal functioning. In a randomized, placebo-controlled, double-blind fashion, subjects were given either 10 grams of creatine or a placebo (sugar) for three months during which they exercised aerobically three times a week for 40 minutes per session. Measures of kidney functioning, including serum creatinine, serum and urinary sodium, and potassium were determined at baseline and at the end of the study. Cystatin C was also assessed pre and post as well as four weeks into the trial. Of the parameters examined, cystatin C decreased over time (which signifies an increase in the glomerular filtration rate; cystatin C actually will increase with impaired kidney functioning) and serum creatinine decreased in the placebo group.

"In fact, creatine supplements, like 3-XL, may decrease one's risk of dehydration during exercise by increasing total body water."

No other parameters changed, indicating that three months of 10 g/day creatine supplementation does not impair kidney functioning in healthy males.

Conclusion

Previous reviews of creatine published in Real Solutions have established the benefits of creatine supplementation for strength gains and performance in short, intense bouts of exercise. Together, this review study and randomized clinical trial indicate that creatine is also a safe supplement for healthy individuals.

In fact, creatine supplements, like 3-XL, may decrease one's risk of dehydration during exercise by increasing total body water. The recommended dose of creatine is two to three grams per day for women and five grams per day for men during periods of intense training. Sorry, ingesting it while you are on your two-week honeymoon in Hawaii probably won't make you build pecs overnight to impress your new bride. But it won't harm you or your honeymoon either!

References

Dalbo VJ, Roberts M, Kerksick C, Stout J. Putting the myth of creatine supplementation leading to muscle cramps and dehydration to rest. Br J Sports Med. 2008 Jan 9; [Epub ahead of print].

Gualano B, Ugrinowitsch C, Novaes RB et al. Effects of creatine supplementation on renal function: a randomized, double-blind, placebo-controlled clinical trial. Eur J Appl Physiol. 2008 Jan 11 [Epub ahead of print]

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