Creatine supplements are touted as helping with everything from increased athletic prowess, stronger bones, preventing stroke, improving memory and helping to manage Parkinson's disease and more.
Not surprisingly, it's now one of the most popular dietary supplements on the market.
But does the evidence behind the hype stack up?
Creatine is a naturally occurring compound made from amino acids found in protein, and plays an important role in energy production within our cells. It's stored mostly in muscles and also in the brain – places where lots of energy is needed.
Our body produces some creatine, mainly in the liver, and it also comes from meat and fish in your diet. But increasingly it's being taken as a supplement in the form of creatine monohydrate, especially by athletes and bodybuilders – sales in the US alone are estimated at 2500-4000 tonnes per year.
Its usefulness in certain sports is well-documented, and creatine supplements have been used this way for several decades. But because of its role in various aspects of human physiology, creatine has been or is currently being investigated for various other uses, most excitingly in areas that could lead to a much improved quality of life for people with certain medical conditions and age-related changes.
No matter what the usage or condition, not everyone benefits to the same degree and some may not benefit at all. It's not clear why this is, but a creatine supplement seems to be most useful when existing creatine levels are low, which may occur in vegetarians, vegans, and people who don't eat much meat. The body can only use so much, so if you've got enough, having more won't help – any extra is excreted in urine. However, there have been cases where excessive amounts have been linked with more serious health effects, particularly kidney problems.
There's good evidence creatine is effective for:
- improving some aspects of sports performance
- improving weightlifting performance
- improving muscle strength and performance for people with muscular dystrophy
- maintaining or building muscle in older adults.
There's preliminary evidence, but more research is needed for:
- building or maintaining bone (in older adults)
- improving cognitive performance (memory, reasoning).
Unlikely to be effective
Current evidence shows it's unlikely to be effective for:
- aerobic exercise
- slowing the progression of Parkinson's disease
- slowing the progression of Huntington's disease (especially for women).
More research is needed for:
- Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease
- stroke prevention.
Creatine appears to be safe when appropriate doses are taken, even over long periods of time. The most common side effect is weight gain, associated with increased water in muscles. In large doses, gastrointestinal effects such as nausea and diarrhoea have been reported, and sometimes more serious problems.
Experts recommend caution for people with kidney problems or who have potential for kidney problems, such as a family history of kidney disease or diabetics, and suggest discussing your need to take creatine with your doctor.
Caution is also recommended for pregnant and breastfeeding women, and children and adolescents under 18, due to a lack of information about side effects in these groups.
Creatine supplements are only loosely regulated in Australia, with no routine independent safety and quality testing. They sometimes contain other ingredients, which aren't always labelled, that can cause serious health problems in some people - for example stimulants.
Creatine monohydrate typically comes in a powder form in containers that last a month or more. Depending on the brand and dose, creatine supplements cost around 10–25 cents per day.
There's some good evidence that creatine can help athletes in certain types of sport, but make sure you use it as directed and don't expect miracles. As for other applications, especially for medical conditions where it's not yet proven safe or effective, it's best to talk to your doctor about whether it may be helpful.
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