creatine

The Creatine Safety Myth

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Why Are Placebo Controls Important?

Author: Dr. Stephen Chaney 

The FDA considers creatine monohydrate as GRAS (Generally Recognized as Safe). The International Society For Sports Nutrition, the International Olympic Committee, the NCAA, and professional sports associations all consider creatine to be safe, effective, and legal.

So, why do you keep hearing things on social media like:

  • “Creatine stresses your kidneys. It can damage your kidneys.”
  • “Creatine causes muscle cramping. It can damage your muscles.”
  • “Creatine causes dehydration and heat intolerance. It can cause heat stroke and seizures.”
  • “Creatine causes bloating, nausea, stomachaches, and diarrhea. You will feel terrible.”
  • “Creatine causes you to gain weight. It will make you fat.”

So, the question becomes, are the government and sports authorities lying to us, or are the reports of creatine dangers simply food myths?”

To answer this question a group of sports nutrition experts recently conducted a comprehensive review of all previous placebo-controlled studies of creatine side effects (DE Gonzalez et al, Sports, 14, 137, 2026).

danger symbolIn the words of the authors, “Collectively, the available evidence does not support many of the negative claims commonly attributed to the use of creatine monohydrate; however, these myths and misconceptions continue to persist among the general public and have even influenced policy and legislative discussions…

…Accordingly, the purpose of the present analysis was to directly address these concerns by systematically evaluating whether total creatine monohydrate dose or duration predicts the likelihood of side effects, thereby providing a more granular and clinically relevant assessment of creatine monohydate safety.”

I was particularly interested in this study because, among other things, they looked at the dose dependence of creatine side effects – including doses as high as 38 g/day.

That was of interest to me because I had recently reviewed a study looking at the ability of creatine supplementation to clear up the brain fog associated with sleep deprivation.

That was information that might be useful for anyone who is suffering from sleep deprivation but can’t tolerate caffeine. However, the dose of creatine that was most effective at clearing up the brain fog associated with sleep deprivation was 20-30 grams depending on body weight. That’s much higher than the usual recommended dose of 5 g/day, and I wasn’t certain about the safety of such a high dose.

I was hoping that this study would answer that question for me. And it did.

How Was This Study Done?

clinical studyThe investigators used all available databases to search for creatine studies in humans that included a record of side effects and were placebo controlled. They excluded reviews and meta-analyses to avoid duplication.

They ended up with 684 randomized placebo-controlled clinical trials with 12,800 human subjects.

The dose of creatine monohydrate used in these studies ranged from 2 gm/day to 38 gm/day. And the duration of supplementation ranged from 3 days to 14 years. For both dose and duration, the studies were divided into thirds – a lower third, a middle third, and an upper third.

The investigators assessed the frequency of 35 possible side effects in each dose and duration category. Finally, the data were adjusted for biological sex, age, fitness level, and health status.

Does Creatine Cause Side Effects?

The results were as follows:

  • Reported side effects increased slightly with dose. When they looked at the percentage of side effects reported by participants in the upper third for dosage:
    • 16.4% of participants reported gastrointestinal issues (bloating, stomachache, or diarrhea).
    • 6.2% of participants reported musculoskeletal issues (mainly muscle cramps).
    • 4.9% of participants reported neurological issues (mainly headaches).
    • 4.0% of participants reported sleep, fatigue, or appetite issues.
    • All other side effects were reported by less than 1% of participants. Most notably, renal (kidney) and liver side effects were almost non-existent.
  • Reported side effects also increased slightly with duration. When they looked at the percentage of side effects reported by participants in the upper third for duration of supplementation:
    • 14.9% of participants reported gastrointestinal issues.
    • 5.6% of participants reported musculoskeletal issues.
    • 4.2% of participants reported neurological issues.
    • 2.8% of participants reported sleep, fatigue, or appetite issues.
    • All other side effects were reported by less than 1% of participants.

At first glance, you might look at these data and say, “Aha! There are side effects to creatine supplementation, especially when used at high doses or for a long time.”

But the authors of the study pointed out:

  • The reported side effects in these studies were mild and short-lived.
    • The side effects were reported by a small subset of individuals, and in these cases
    • The gastrointestinal issues can usually be avoided by dividing the creatine dosage into two or three smaller amounts spaced out throughout the day.
    • The musculoskeletal issues can usually be avoided by keeping adequately hydrated.
    • The sleep and fatigue issues can usually be avoided by taking the creatine earlier in the day.

placeboBut there was one other factor that negated any concern about creatine side effects. All these studies were placebo controlled, and side effects in the placebo group were the same or greater than in the creatine group!

The authors concluded, “These findings suggest that creatine supplementation is safe across a range of doses, durations, and populations according to human trials. While higher total doses and longer supplementation periods are associated with more side effects at the study level, the overall incidence remains low, with most effects being mild and nonspecific.

Furthermore, placebo groups often report similar or even higher rates of side effects. These results reinforce the consensus on creatine’s safety and add nuance by considering exposure levels and duration”

Why Are Placebo Controls Important?

Question MarkThis study illustrates the importance of placebo-controlled studies.

  • Some studies report amazing benefits associated with certain foods or supplements. But without placebo controls, they are worthless.
  • Other studies report terrifying side effects associated with certain foods or supplements. But without placebo controls, they are worthless.

You may be wondering why people taking a placebo would experience side effects. In the context of this study, the answer is obvious.

  • Most people experience some sort of gastrointestinal distress on an occasional basis.
  • Everyone who works out has days when they experience muscle cramps.
  • Most people experience nights when they have trouble falling asleep and/or wake up feeling fatigued.

And in clinical studies like the ones included in this review, they will be looking for those symptoms. That’s because medical ethics requires that study participants be informed of the purpose of the study and any side effects they might experience. Before being included in the study they will need to sign an “informed consent” form that lists possible side effects. And during the study, they may be given a form where they can check off any side effects they experience.

And if the informed consent and check off forms happen to miss any side effect, the participants need only to go to the internet to learn all the dreadful things that could happen to them if they were to take a creatine supplement.

The Creatine Safety Myth 

Myth BusterThe FDA and sports authorities were right all along. Creatine is safe and effective.

Yes, some individuals may experience mild side effects, but those can be avoided by dividing up the dose, staying adequately hydrated, and/or changing the timing of creatine supplementation.

In short, the reports of dreadful side effects from creatine are just another food myth.

You might ask, “Where do food myths like this come from?” I have written two books on food myths called “Slaying the Food Myths” and “Slaying the Supplement Myths”, so I am an expert on that topic.

The short answer is that it all starts when a misleading claim is posted online. It usually emphasizes miraculous cures or deadly dangers in a very compelling manner. It is often based on a personal testimony and often references poorly designed studies. For example, the study might report side effects of creatine supplementation without a placebo control to serve as a reference point.

Or the online post might be purposely misleading. As the authors of this study pointed out that, “Much of the misinformation about creatine comes from companies and influencers who are promoting different types of creatine as more effective than creatine monohydrate with fewer side effects.” They are purposely misleading you for financial gain.

The misleading information is repeated online by people who like conspiracy theories and don’t know how to distinguish between reliable and unreliable sources. Once it has been repeated often enough, it becomes generally recognized as true. It becomes a food myth.

And, unfortunately, AI, unless used carefully, answers your queries based on the number of times a statement occurs online rather than on the accuracy of the statement.

In the words of the authors of this study, “Based on the current evidence, creatine is one of the most well-studied and well-tolerated dietary supplements. No consistent or clinically meaningful dose-dependent increases in side-effect reporting were observed across models; even at higher doses and prolonged durations, reporting remained low and largely comparable to placebo at the study level.

This analysis affirms previous findings on the overall safety of creatine supplementation and suggests that high-dose or longer-duration supplementation is well-tolerated by both clinical and athletic users.”

The Bottom Line 

The FDA considers creatine monohydrate as GRAS (Generally Recognized as Safe). The International Society For Sports Nutrition, the International Olympic Committee, the NCAA, and professional sports associations all consider creatine to be safe, effective, and legal.

But online articles abound claiming that creatine supplementation has dangerous side effects. So, the question becomes, are the government and sports authorities lying to us, or are the reports of creatine dangers simply food myths?”

To answer this question a group of sports nutrition experts recently conducted a comprehensive review of all previous placebo-controlled studies of creatine side effects.

This review confirmed previous findings on the overall safety of creatine supplementation and found that even high-dose or longer-duration supplementation is well-tolerated by both clinical and athletic users.”

For more information on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 ___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Is Creatine Better Than Coffee For Sleep Deprivation?

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The Effect Of Creatine On The Sleep-Deprived Brain 

Author: Dr. Stephen Chaney 

The role of creatine for muscle metabolism is well established. It has been used by athletes for years to optimize their exercise. It is both safe and effective for this purpose.

However, it’s use for optimizing brain function is more controversial. Clinical studies on this topic are conflicting. The problem is 3-fold:

  • Creatine does not cross the blood-brain barrier easily. So, the brain takes up creatine less efficiently than muscle.
  • Some people don’t need extra brain creatine. They make all they need.
  • There appears to be significant individual differences in the uptake of creatine into the brain and/or the effectiveness of creatine at improving brain function.

The authors of the article I am going to review summed up the existing research on creatine and brain function by saying:

  • Most healthy adults do not need extra creatine for brain function. Studies on healthy, non-stressed adults have typically shown no benefit of creatine supplementation.
  • However, there are several conditions that decrease brain creatine levels and/or increase brain energy needs, which creates a need for higher brain creatine levels. These conditions are:
    • Concussions and other forms of traumatic brain injury.
    • Alzheimer’s and other neurodegenerative diseases.
    • Hypoxia (reduced oxygen flow to the brain) caused by atherosclerotic narrowing of the carotid arteries, asthma, and COPD.
    • Depression.
    • Sleep deprivation.
  • Under these conditions, uptake of creatine into the brain appears to be enhanced, and creatine supplementation appears to improve brain function.

The authors of this study focused on sleep deprivation. Sleep deprivation differs from the other conditions listed above in that it is episodic rather than chronic. So, rather than using smaller doses daily, they tested the effect of a single, high dose administered during the sleep deprivation.

In a previous study they had shown that a very high dose of creatine was effective at increasing brain creatine levels by 5% and reducing the symptoms of sleep deprivation by 10-25%.

For this study (A Gordji-Nejad et al, Nutrients, 18: 192, 2026) they repeated their experiments using a lower dosage to determine whether the brain benefits of creatine during sleep deprivation are dose dependent.

What Is Creatine And What Does It Do?

confusionI have discussed this topic at depth in an article from a previous issue of “Health Tips From the Professor”, so I will give the Cliff Notes version here.

Creatine is a storage form of cellular energy.

  • In muscle the best analogy would be a car battery. When we start the car, the battery provides the initial energy to get the engine going. Then, when we are cruising down the highway the kinetic energy generated by the turning of the driveshaft is stored in the battery, so it is fully charged the next time we need to start the car.
  • In our muscles, creatine is the “battery” that provides the initial energy to get our muscles going. And when we are at rest, we recharge our creatine “battery”, so we are ready the next time we need to spring into action.
  • In our brain, our creatine “battery” provides the extra energy our brain needs when it is under stress due to any of the conditions listed above – including sleep deprivation.

In our car, eventually the battery wears out and needs to be replaced. Here the analogy breaks down. Creatine is constantly being converted to creatinine and flushed out of the body, so we need a constant supply of new creatine to keep our cellular creatine “batteries” charged.

  • Our muscles can’t make creatine, so they rely on creatine made by other tissues in the body, diets high in animal protein, and/or creatine supplements. And because it is dependent on exogenous creatine sources, it is very efficient at taking up creatine from the bloodstream. That is why creatine supplements are so effective at improving muscle function.
  • Our brain normally makes all the creatine it needs, so it is inefficient at taking creatine from the bloodstream. However, when the brain is under stress due to traumatic brain injury, neurodegenerative diseases, hypoxia, and sleep deprivation, its need for creatine is increased, and the efficiency of creatine uptake appears to be enhanced. Under these conditions, creatine supplements do appear to improve brain function.

How Was This Study Done?

clinical studyThe authors recruited 29 healthy subjects age 20-40 (average = 29) for the study.

  • 17 were female, 12 were male.
  • None of them reported sleep disorders, psychiatric or neurological conditions, or alcohol or drug abuse.
  • None of them smoked or took medication.

Consumption of caffeine and alcohol were prohibited for 48 hours prior to the study.

They were all well rested prior to the study. They were required to sleep for at least 7 hours every night for the previous two weeks and to record all sleep and awake times. The night before the study they were asked to go to bed by 11 PM and wake up at 7 AM.

The sleep-deprivation occurred over the next 21 hours. During this period the subjects were continuously observed to make sure they didn’t fall asleep. No exercise or cognitively stressful activity was allowed. The subjects were only allowed to drink water and eat non-protein snacks during the deprivation study.

The study was a double-blind, randomized clinical trial with a crossover design. In a crossover study each subject serves as their own control. In the first phase of the study each patient was given 0.09 g of creatine per pound of body weight or a placebo in a double-blind manner (neither the patient nor the investigators knew who got the creatine and who got the placebo). After two weeks at least 7 hours of sleep a night, the deprivation portion of the study was repeated except that what the subjects took was reversed (those who received creatine the first time received the placebo the second time and vice versa).

The subjects were given a battery of tests four times during sleep deprivation. At each occurrence the subjects completed self-assessments for sleepiness and fatigue. They then were given tests to measure the speed and accuracy of seven different measures of mental acuity. The design of the sleep deprivation portion of the study was as follows:

  • Sleep deprivation started at 7 AM.
  • Baseline assessment occurred at 6:30 PM (11.5 hours without sleep).
  • The subjects were given creatine or a placebo at 9 PM (14 hours without sleep).
  • Testing was repeated at 12 PM, 2 AM, and 4 AM (17, 19, and 21 hours without sleep).

The Effect Of Creatine On The Sleep-Deprived Brain

Safe and effective creatine intake is proportional to our body weight. That’s why the authors of this study reported creation dose as grams of creatine per pound of body weight. However, you are not used to seeing it expressed that way, so let me give you a table to help you understand what these numbers mean.

Creatine g/lb to grams per serving
g/lb 120 lb 140 lb 200 lb Comments
0.045g/lb 5 gm 7 gm 9 gm This is the daily intake range you see recommended most often.
0.09 g/lb 10 gm 14 gm 18 gm The amount used in this study. It has been shown to be safe and effective for muscle gain.
0.16 g/lb 19 gm 25 gm 30 gm The amount used in their previous study. Some athletes use this much, but it is not widely studied.

With that in mind, here are the results of the study.

  • Creatine supplementation at this dose was well tolerated. There were no reports of gastrointestinal distress or other adverse physical effects.
  • Creatine supplementation had no significant effect on self-reported sleepiness or fatigue.
  • Creatine improved several measures of cognitive performance during sleep deprivation by 6-12%.
    • The cognitive benefits were most evident for logic, numerical ability, processing speed in language tasks, and psychomotor vigilance.
      • Psychomotor vigilance is how well an individual can maintain attention over time. It is assessed by measuring how long it takes subjects to respond to visual stimuli at random intervals. It is an important cognitive function for activities like driving a car.
  • Women and vegetarians benefitted more than men.

The authors concluded, “Our results show a dose of 0.09g/lb creatine is associated with reduced deterioration in cognitive performance during sleep deprivation. Although the effect is less pronounced than with a high dose of 0.16 g/lb, there is still an improvement of up to 12%…

The decrease in improvement compared to high dose shows that cerebral cellular creatine uptake and the improvement effect during sleep deprivation are dose-dependent.

As the administered dose of 0.09 g/lb is [known to be] safe, future studies could focus on adding additional components or making modifications to increase cellular uptake and enhance the effect. Furthermore, the findings of our study provide a basis for further research to determine the specific dosage for different population groups.”

Is Creatine Better Than Coffee For Sleep Deprivation?

Question MarkLet’s return to the question I posed at the beginning of this article. You didn’t sleep a wink last night. Your brain is fuzzy. Should you reach for a cup of coffee? Or is creatine better than coffee for sleep deprivation?

There are two answers to this question.

The first answer is, “We don’t know”. Coffee has been around forever. Everyone “knows” it helps when we are sleep deprived. But it has never gone through the kind of rigorous testing that creatine was given in this study. And it has never been compared in head-to-head testing with creatine.

The cognitive benefits from creatine were modest, so it is likely that coffee is more effective – but we don’t know for sure.

The second answer is, “It depends”. There are many people who can’t or prefer not to drink coffee.

  • For some people coffee causes jitters, anxiety, and heart palpitations.
  • For others it causes gastrointestinal disturbances.
  • Some people prefer to avoid stimulants of any kind.
  • For many people coffee causes insomnia. And if you have had a sleepless night, the thing you want the most is restful sleep, not more insomnia.

And, if we are sleep deprived, it’s usually not just one cup of coffee. It’s several cups of coffee or one of those “monster drinks” with tons of caffeine. And regular consumption of these high-caffeine drinks is linked to all the issues listed above plus:

  • High blood pressure, cardiac events, severe headaches, and even kidney issues.

If you are someone with any of these concerns, it is useful to know that there is a non-stimulant alternative that can help you think more clearly when you are sleep deprived.

What Does This Study Mean For You?

Simply put, this study suggests that creatine may be an alternative to coffee and other caffeinated beverages when you are sleep deprived.

This study shows that a single dose of 10-20 grams of creatine, depending on your body weight, can give you a modest increase in mental clarity if taken while you are severely sleep deprived. While somewhat higher than the dosages most supplement companies recommend, this is well within the dose range that has been shown to be safe and effective for enhancing muscle function.

The authors of the study said that “Future studies could focus on adding additional components or making modifications to increase cellular uptake and enhance the effectiveness of creatine.

For muscle cells, insulin enhances the uptake of creatine. So, if creatine is taken with a meal that is high in carbohydrate, uptake may be increased by up to 60%. We don’t know whether insulin also increases creatine uptake in the brain, but until further research comes along it is worth a try.

Note: Studies also show that combining creatine with a shake that is high in both carbohydrate and protein after a workout optimizes both creatine uptake and muscle repair. In today’s world of low-carbohydrate protein shakes that is a paradigm shift!

In a previous study, the same authors showed that a single dose of 20-30 grams of creatine, depending on body weight, was even more effective at enhancing mental clarity during severe sleep deprivation. That is a dosage that has not been extensively tested.

Many athletes consume creatine dosages in that range with no apparent ill effects. However, athletes aren’t always the best examples of safe supplement use.

Whichever dose of creatine you choose, there are some cautions you should be aware of.

  • Creatinine, the breakdown product of creatine metabolism, puts some stress on the kidneys.
    • While this is not a problem if your kidneys are healthy, you should consult with your health professional about taking creatine if you have any indications of impaired kidney function.
  • Adequate hydration (preferably with water) is important because creatine pulls water with it as it enters your muscle cells.
    • This plumps up your muscles, which is great if you are a body builder.
    • This dehydrates you, which can cause side effects like muscle cramps, headaches, nausea, stomach cramps, and diarrhea.
    • These side effects are usually transitory and can be avoided or reduced by adequate hydration. If symptoms continue despite adequate hydration, you should lower the dose or discontinue creatine supplementation.

The Bottom Line

A recent study looked at whether a creatine supplement could help prevent the loss of cognitive function associated with severe sleep deprivation. The study showed:

  • Creatine improved several measures of cognitive performance during sleep deprivation.
  • The cognitive benefits were most evident for logic, numerical ability, processing speed in language tasks, and psychomotor vigilance.
  • Women and vegetarians benefitted more than men.
  • The effect was dose dependent.

For more details about the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Is Creatine Good For The Brain?

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Creatine And Energy Metabolism

Author: Dr. Stephen Chaney

Creatine has developed a reputation as the “go to” supplement for athletes.

  • In a recent survey of NCAA Division I athletes, 48% of male athletes use creatine on a regular basis.
  • Over 80% of professional athletes in power sports like football use it.

But you may have seen recent reports that creatine is also good for the brain. You may be wondering:

  • Are those reports true?
  • If you are not an athlete, should you be taking creatine for a healthy brain?
  • If so, how much should you be taking?
  • Is regular creatine use safe?

I will review a couple of recent studies and answer these questions below. But first, it is time for my favorite topic: Metabolism 101. This week’s Metabolism 101 topic is, “Creatine And Energy Metabolism”.

Metabolism 101: Creatine And Energy Metabolism

Energy Metabolism: Before discussing the role of creatine in the body, I should start at the beginning by describing the basics of energy metabolism in our body. As you have probably heard, ATP is the energy currency of the cell.

Our cells generate energy in two ways:

  • Anaerobic (without oxygen) metabolism can generate ATP quickly but can only sustain high-intensity work for a few minutes.
  • Aerobic (with oxygen) metabolism requires oxygen and organelles called mitochondria to generate ATP. Aerobic metabolism can provide enough ATP to sustain moderate to low intensity work for hours.

Our cells don’t store ATP. They use it as fast as it is produced to:

  • Synthesize protein and many other components of the cell.
  • Synthesize DNA and fuel cell division.
  • Repair and regenerate cell membranes and cellular organelles.
  • Pump nutrients in and out of the cells and transport them to where they are needed within the cell.

And this is just the tip of the iceberg. Thousands of cellular reactions require ATP.

The Role Of Creatine In Cellular Energy Metabolism: Let’s start with the basics:

We can think of creatine as an energy bank.

  • When the cell has plenty of ATP, it makes a deposit into its energy bank by converting creatine into creatine-phosphate.
  • When the cell needs energy quickly it makes a withdrawal from its energy by converting creatine phosphate to creatine and generating ATP.

Creatine is found primarily in high energy tissues (muscle, brain, and testes) – No, I’m not going to talk about creatine and fertility today.

Every time the creatine-creatine-phosphate cycle occurs in high energy tissues, a small amount of creatine is converted to creatinine and filtered through the kidneys. There are two important consequences of this fact:

#1: The faster the phosphocreatine/creatine cycle turns, the more rapidly creatine will be converted to creatinine and drained from the body.

#2: Our body needs to constantly replenish its creatine stores. It does this in two ways:

  • Creatine is synthesized by the liver, kidneys, and pancreas. But it is not stored there. It is released into the bloodstream for use by high energy tissues. It is also synthesized by the brain. But creatine synthesized in the brain can only be used by the brain. It is not released into the bloodstream.
  • Creatine can come from muscle-containing foods – primarily red meat, chicken, and fish. Plant foods provide no creatine.
  • Creatine can also come from supplements – the topic of this article.
  • High-energy tissues have transporters that allow them to take up creatine from the bloodstream.

Creatine plays slightly different roles in muscle and brain.

Creatine Supplementation For Optimizing Muscle Function

Creatine in the muscle is primarily used for high-intensity short duration exercise. In muscle you can think of creatine as being used to “jump-start” high intensity exercise.

  • It takes a few seconds for anaerobic metabolism to go into overdrive. Creatine-phosphate stores fill that gap.
  • Muscle creatine-phosphate stores can fuel high-intensity exercise for 8-15 seconds (average = 10 seconds).

Creatine supplementation is well accepted for sports requiring short, intense bursts of power, speed, and strength, such as football, basketball, hockey, soccer, wrestling, bodybuilding, and sprinting. It is supported by dozens of published clinical studies.

The rationale is not hard to understand.

  • Muscle normally contains enough creatine-phosphate to support around 10 seconds of high-intensity exercise.
  • Creatine-phosphate supplementation increases muscle creatine stores by 20-40%. That supports another 2-4 seconds of exercise.
  • That may not sound like much. But anaerobic metabolism does not kick in until creatine-phosphate stores are exhausted, so the total amount of high-intensity power attained during each rep of a workout is increased by 2-4 seconds.
  • Over a period of weeks or months that extra 2-4 seconds of high intensity exercise during each rep of training translates into real gains in lean muscle mass, muscle strength, and exercise performance.
  • Of course, creatine supplementation provides little benefit for athletes involved in endurance sports.

Here are some other notable points about creatine supplementation for athletes:

  • Creatine supplementation benefits most athletes involved in high-intensity sports, but it appears to be particularly useful for vegans and vegetarians who may not be getting creatine from their diet.
  • Clinical studies and real-life experience have shown that creatine is safe when used properly. (I will discuss mild side effects and cautions below).
  • The doses used most frequently are:
    • Around 20 grams/day for quick results. For optimal absorption, it is best to divide it into 4 daily servings of 5 grams.
    • Around 5 grams/day for maintenance and for general use.
    • The eventual amount of muscle creatine is the same with 20- and 5-gram doses. The only difference is the speed at which optimal creatine levels are attained.
  • Creatine is best utilized when taken with food or smoothies containing both carbohydrate and protein.
  • Adequate hydration is important (more about that below).

Creatine Supplementation And Brain Health

Brain HealthBrain is different from muscle in that it depends on aerobic metabolism and is always using ATP at a high rate. Brain accounts for 20% of our body’s energy demand. In brain we can think of creatine as a buffer or reserve.

  • Brain creatine-phosphate stores are used in situations where the brain needs to increase its energy use over baseline (more about that below).

The initial excitement about creatine supplementation optimizing brain health came from mouse studies. However, we need to remember that mice aren’t humans. In this case the difference is clear.

  • Creatine supplementation increases brain creatine levels by 50% in mice, but only around 5-10% on average in humans.

So, it is not clear whether the results obtained with mice also apply to humans. The results of clinical trials with humans are mixed. They are promising, but not definitive.

Is Creatine Good For The Brain?

To answer that question I will share two recent reports with you as examples of where the creatine and brain health hypothesis stands at present.

Study #1: Creatine Supplementation And Alzheimer’s Disease.

Memory loss due to Dementia and Alzheimer’s disease with the medical icon of a tree in the shape of a human head and brain losing leaves.

This study (AN Smith et al, Alzheimer’s & Dementia, 11270101, 2025) was designed to test the hypothesis that creatine supplementation might be beneficial for Alzheimer’s patients. It was a pilot study – designed to determine whether there was enough evidence to justify a larger clinical trial.

How Was This Study Done? Twenty participants, 60-90 years old (average = 73), were enrolled in this study. They had been previously diagnosed with Alzheimer’s disease and had been taking Alzheimer’s medication for at least 30 days. Each participant had a partner (spouse, family member, or friend) to support them and aid in accurate participation and reporting.

  • Participants consumed 20 grams of creatine, split into two 10-gram doses for 8 weeks.
    • Participants and their partners were given compliance trackers with two boxes to be checked each day to measure adherence to the supplementation protocol. Adherence was 90%.
  • Blood creatine levels were measured at baseline, 4 weeks, and 8 weeks as another measure of adherence.
  • Two measures of cognitive health were administered at baseline and at 8 weeks.
    • MMSE (a 30-item cognitive test).
    • The NIH Toolbox Cognitive Battery, which measures attention, category switching, episodic memory, working memory, speed of processing, written language, and auditory language.
  • Brain creatine levels were measured using nuclear magnetic resonance (NMR) spectroscopic imaging.

What Did The Study Show?Question Mark

  • Participants and their partners reported 13 incidences of mild side effects, which included cramping/muscle pain, diarrhea, constipation, nausea, facial flushing, and sleep disturbances.
  • Blood creatine levels increased 23-fold in 4 weeks and remained elevated at 8 weeks.
  • Brain creatine levels increased by 11% at 8 weeks.
  • When assessed with the NIH Toolbox Cognitive Battery, creatine supplementation (20 grams/day) improved:
    • Total cognition by 4%.
    • Fluid cognition by 7%.
    • List sorting working memory by 11%.
    • Oral reading recognition by 5%.
    • Attention by 7%.
  • There were no significant changes in the 5 other cognition categories in the NIH Toolbox Cognitive Battery.

The authors concluded, “Our study provides the first evidence in humans that creatine supplementation is feasible and may increase brain creatine and offer cognitive benefits to patients with Alzheimer’s Disease.”

These results are preliminary and suggest that future efficacy trials comparing creatine to placebo are needed to generate evidence that can be compared to other Alzheimer’s Disease clinical trials.”

“Should creatine provide benefit, the public health implications may be substantial given Alzheimer’s Disease cases are anticipated to rise and creatine is cost-effective with a good safety profile.”

Why Did I Include This Study? You may be wondering why I included such a preliminary study in my review. The answer is simple: It provides a graphical view of individual variability.

Every study mentions individual variability, but because this study has only 20 participants, the authors were able to graphically show the response of every individual in the study. And the results were informative.

  • In terms of brain creatine levels:
    • Some individuals had increases in the 25-30% range.
    • Others had increases of around 2-5%.
  • Similar variability was seen with each individual measure of cognition.

However, the most interesting result was that several measures of cognition were highly correlated with the changes in brain creatine levels. This suggests that the limiting factor in the brain health benefits of creatine may be the ability of creatine supplementation to influence brain creatine levels.

Study #2: Creatine Supplementation And Brain Health.

This study (H Roschel et al, Nutrients, 13, 586, 2021) is a review of 16 studies looking at the effect of creatine supplementation on various aspects of brain health.

  • All the studies were small.
  • They used different measures of cognitive health.
  • Most of the studies were short (2-15 days).
  • They used different measures of brain creatine levels (Creatine levels vary according to the region of the brain that is scanned).

While emphasizing the weaknesses and inconsistencies of published studies, the authors said:

  • “Creatine supplementation may positively influence some aspects of cognition under stressful conditions such as:
    • Hypoxia (reduced oxygen flow to the brain caused by chronic conditions like atherosclerotic narrowing of the carotid arteries, asthma, and COPD.
    • Sleep deprivation, especially when combined with exercise.”
  • They also discussed the theory that creatine supplementation may be beneficial for conditions associated with reduced brain creatinine levels such as:
    • Alzheimer’s disease, cognitive decline in general, mild traumatic brain injury, and depression.

They put particular emphasis on the potential benefits of creatine supplementation for mild traumatic brain injury, saying:

“Collectively, despite limited data, creatine supplementation seems potentially beneficial in reducing severity of or enhancing recovery from mild traumatic brain injury (mTBI), warranting further studies on its role not only as a post-injury therapy but also as a neuroprotective agent in populations at high risk of mTBI”

“Encouraging supplementation to reduce damage from or enhance recovery from mTBI…would ordinarily be considered premature. However, in this instance, given the devastating effects of mTBI, combined with the large body of safety and efficacy creatine supplementation data, encouraging supplementation for populations who are at high risk for mTBI might be considered more prudent.”

Finally, the authors concluded,

“There is a potential for creatine supplementation to improve cognitive processing, especially in conditions characterized by brain creatine deficits, which could be induced by acute stressors (e.g., exercise, sleep deprivation) or chronic, pathologic conditions (e.g., mTBI, cognitive decline, Alzheimer’s disease, depression).”

What Does This Study Mean For You?

Questioning WomanIf you are interested in creatine to support any kind of high intensity, short duration activity, the data are clear. Creatine supplementation in the 5-20 gm/day range with adequate hydration is both safe and effective.

Creatine offers little benefit for endurance events. But if you engage in any kind of high intensity training to build muscle mass in preparation for endurance events, creatine is likely to be of benefit.

However, we are at the early stages of understanding the effects of creatine supplementation on brain health and cognitive function. Most of the results are promising, but preliminary.

Here is a brief summary:

  • The effectiveness of creatine supplementation at increasing brain creatine levels and improving brain function is highly variable.
    • For some individuals, creatine supplementation results in a 25-30% increase in brain creatine levels. Those individuals are likely to experience brain health benefits.
    • For other individuals, creatine supplementation results in 2-5% increase in brain creatine levels. These individuals may not experience noticeable brain health benefits.
  • These reason for this variability in the effect of creatine supplementation is unknown at present.

This reminds me of my last decade (2002-2012) of cancer research at the University of North Carolina. At the beginning of the decade, here were certain cancer drugs that were considered unproven because their effectiveness was variable. They appeared to help some cancer patients, but were ineffective for others.

The we started to look at the genetic mutations that caused individual cancers. By the end of the decade we had discovered those drugs were amazingly effective for cancers with certain genetic backgrounds. Those drugs went from being “duds” to being “stars”.

Creatine supplementation for brain health is where those cancer drugs were in 2002. Until we can predict which individuals will experience a significant increase in brain creatine levels with supplementation, clinical studies will continue to be inconsistent, and the scientific community will continue to consider creatine supplementation for brain health to be “unproven”.

  • But the good news is that, with adequate hydration, creatine supplementation is safe. So, you can take it for its muscle benefits. And, if you also experience brain health benefits, consider it an added benefit.

And there are certain situations where even the medical profession often recommends creatine supplementation for brain health. For example:

  • Studies suggest that creatine supplementation may improve brain function for people with sleep deprivation, mild traumatic brain injury, cognitive decline, conditions that restrict blood flow to the brain, Alzheimer’s disease, and depression.
    • For example, it is often recommended for mild traumatic brain injury because the health consequences of untreated traumatic brain injury are severe and the risks of creatine supplementation are low.

Finally, the optimal dosage and duration of creatine supplementation for brain health benefits is unknown.

  • Most studies use 20 grams/day divided into two or three smaller doses.
  • But the effect of body weight on dosage recommendations has not been studied. People in the sports medicine field tell me that female gymnasts use significantly less creatine than male football players. If your body weight is low, you might want to aim for 10-15 grams/day.

Creatine Supplementation Cautions 

While the safety of creatine supplementation is well established, there are some cautions you should be aware of:

  • Creatinine, the breakdown product of creatine metabolism, puts some stress on the kidneys.
    • While this is not a problem if your kidneys are healthy, you should consult with your health professional about taking creatine if you have any indications of impaired kidney function.
    • Even if your kidneys are perfectly healthy, creatine supplementation may increase blood creatinine levels. If your health professional is using creatinine levels to measure kidney health, you should let them know that you are supplementing with creatine.
  • Adequate hydration (preferably with water) is important because creatine pulls water with it as it enters your muscle cells.
    • This plumps up your muscles, which is great if you are a body builder.
    • This dehydrates you, which can cause side effects like muscle cramps, headaches, nausea, stomach cramps, and diarrhea.
    • These side effects are usually transitory and can be avoided or reduced by adequate hydration. If symptoms continue despite adequate hydration, you should lower the dose or discontinue creatine supplementation.

The Bottom Line 

If you are interested in creatine to support any kind of high intensity, short duration activity, the data are clear. Creatine supplementation in the 5-20 gm/day range with adequate hydration is both safe and effective.

However, we are at the early stages of understanding the effects of creatine supplementation on brain health and cognitive function. Most of the results are promising, but preliminary.

I discussed two studies on creatine supplementation and brain health in this article. Here is a brief summary of their findings:

  • Creatine supplementation may improve brain function for people with sleep deprivation, mild traumatic brain injury, cognitive decline, conditions that restrict blood flow to the brain, Alzheimer’s disease, and depression).
    • Although the effectiveness of creatine supplementation on brain function is uncertain at present, many experts recommend it if you fall into one of the categories listed above because creatine supplementation has been shown to be safe by decades of sports medicine studies.
  • The effectiveness of creatine supplementation at increasing brain creatine levels and improving brain function is highly variable.
    • For some individuals, creatine supplementation results in a 25-30% increase in brain creatine levels. Those individuals are likely to experience brain health benefits.
    • For other individuals, creatine supplementation results in 2-5% increase in brain creatine levels. These individuals may not experience noticeable brain health benefits.
  • But the good news is that, with adequate hydration, creatine supplementation is safe. So, you can take it for its muscle benefits. And, if you also experience brain health benefits, consider it an added benefit.

For more information on this study, what it means for you, and cautions about using creatine supplements, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance 

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About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading Biochemistry textbooks for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

Use of Sports Supplements By Young Athletes

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Are Sports Supplements Effective? Are They Safe?

Author: Dr. Pierre DuBois

plate-of-pills-200-300In recent years, the use of sports supplements by young athletes has increased dramatically. The most commonly used sports supplements among teenagers of all ages were vitamins and minerals, though “ergogenic aids” are used by some teen athletes specifically to enhance performance. Among these performance-enhancing supplements  are substances such as caffeine, creatine, ephedra and other stimulants, human growth hormone (HGH) and anabolic steroids.

Of the vitamin and mineral supplements, mutivitamins, vitamin C, calcium and iron were reported as being taken most often. While the risks of taking vitamin supplements is relatively low, there is some concern that young athletes may then progress to taking more dangerous substances under the impression that they are as harmless as vitamins and minerals. And while the risk of overdose with vitamins and minerals is low, it is not nonexistent, and some vitamins can be toxic when too much is taken (such as iron and vitamin A) or may interact with other vitamins or drugs.

Although many performance-enhancing supplements are advertised as being safe – especially those made from natural compounds –  a great number of them have not been tested by any regulatory agency, so their actual safety is not known. In addition, there are no formal guidelines for dosage in many cases, so there could be adverse side effects if too much is inadvertently taken.

The pressure to excel at sports is greater than ever, and there is increasing competition to get into elite sports programs where they have a better chance of being discovered by professional sports scouts looking for the next big star. The possibility of fame and fortune can be a strong enticement to young athletes to try performance-enhancing supplements to give them an edge over their competition. And often it is their coach that suggests or encourages this practice.

According to studies done on high school athletes, they report taking supplements to not only enhance performance, but also to encourage growth and muscle development, prevent illness and reduce fatigue. Supplement use was greatest among athletes who practiced two or more different sports and those who were required to “bulk up”, such as wrestlers and weight lifters.

While the opinions of friends, teammates and coaches were a big influence on the decision of young football players to take supplements (particularly creatine), it was their parents who had the greatest amount of influence on their decision. So it is incredibly important for parents to be educated as to the benefits and drawbacks of each of these supplements for young athletes.

The Bottom Line:

  • There is tremendous pressure on teenage athletes to qualify for elite programs that will increase their chances of being selected for the top college teams and eventually getting onto professional teams. Because of that, the use of sports supplements by teenage athletes is commonplace.
  • Vitamin and mineral supplements are generally harmless unless taken in excessive amounts.
  • Performance-enhancing sports supplements, on the other hand, are poorly regulated. Many are useless and others are potentially harmful. In next week’s “Health Tips From The Professor”, I’ll give you some examples of sports supplements you might want to avoid.
  • If you are the parent of a teen athlete, have a conversation with your child about supplements. Don’t lecture, but involve them in the process of doing research. You may be surprised what you both find.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor