If you are planning to take creatine to increase muscle mass and body building, consult your physician if you have medical problems or taking medicines, and please read the information below.
   A cautious approach to creatine would be to limit intake to 3 to 5 grams almost every day for three weeks followed by 3 grams two to four times a week. It would be wise to take a week or so off each month. It would also be wise to take a full month or so off every 3 to 4 months. Of course these creatine guidelines will vary between individuals. The amount and frequency of creatine use depends on how much muscle gain a person wants to maintain. Athletes and large individuals would require higher amounts of creatine, while non-athletes and small individuals would require less. There are a number of other factors that influence the amount of creatine intake including diet, sex, age, concurrent use of other supplement or medicines, medical condition, genetics, etc.
   After creatine is completely stopped, there is often a gradual decrease in muscle mass over time (days and weeks) probably to the level that it was before creatine intake. The rate of this decrease varies among individuals and also depends on dietary intake of creatine, protein and workout regimen. Taking creatine again generally restores muscle mass rather quickly.
   Creatine use results in increased body weight and total body water content (see study at bottom of page).

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What is Creatine?
Creatine is not an herb, mineral, vitamin, hormone, or steroid. Creatine is a natural nutrient found in our bodies and the bodies of most animals. Approximately 95% of the body's creatine supply is found in the skeletal muscles. The remaining 5% of creatine is scattered throughout the rest of the body, with the highest concentrations in the heart, brain and testes.
   The human body gets most of the creatine it needs from food or dietary supplements. Creatine is easily absorbed from the intestinal tract into the bloodstream. When dietary consumption of creatine is inadequate to meet the body's needs, a limited supply can be synthesized from the amino acids arginine, glycine and methionine. This creatine production occurs in the liver, pancreas and kidneys.

Who Can Benefit From Creatine?
So far it appears that the greatest benefits of creatine occur in those who wish to put on muscle mass and increase strength.
   Athletes in bodybuilding, powerlifting, martial arts, and track and field events such as shot-put may benefit from the use of creatine due to greater strength. So could wrestlers and football players and perhaps baseball players with a more powerful swing or pitch. Body builders and anyone who wishes to have more muscle build will find creatine extremely helpful. Creatine may even be helpful in soccer players or sprinters (see study at bottom of page).
   It is still unclear whether athletes involved in endurance activities such as marathon running or long-distance bicycling will benefit from creatine supplementation. There have been anecdotal reports that people in these sports may benefit, although most studies show that creatine either does not help or may actually hurt. The difficulty in these situations appears to center on the increased muscle mass which creatine provides. While that's great if you're a bodybuilder or wrestler, it can be a detriment if you have to carry all that weight around during a marathon or triathlon. It becomes a tradeoff between the increased strength you get from creatine and the increased muscle mass. Further research will provide us with more definitive answers as to what role creatine supplementation plays in endurance-type sports.        

Additional benefits of Creatine
Creatine may be helpful in certain muscular dystrophies (facioscapulohumeral dystrophy, Becker dystrophy, Duchenne dystrophy, sarcoglycan-deficient limb girdle muscular dystrophy). A placebo-controlled trial did not find evidence of a beneficial effect of creatine monohydrate on survival or disease progression in patients with ALS. Creatine has not found to be helpful in those with Myotonic Dystrophy Type 1
  Creatine has been found to increase strength and muscle mass in older adults who took 5 grams of creatine daily for 3 months. Creatine helps older individuals in their daily activities such as getting out of a chair.
   We are frequently asked if creatine enhances or decreases sex drive. We do not believe it has much of an influence either way.

Vegans and Creatine
Vegetarians, particularly those who are on a strict lacto-ovo-vegetarian (LOV) diet do not ingest much creatine since creatine is mostly found in meats, fish, and chicken. Creatine helps muscles stay bulky and strong.
   In a study published in the Journal of Sports Nutrition and Exercise Metabolism, thirty-two healthy men, who regularly consumed an omnivorous diet, were split into two groups. One group consumed a LOV diet while the other group had an omnivorous diet (they ate everything). The study lasted 26 days. In addition to their diet, on day 22 of the study, subjects were assigned in a double-blind manner to receive either creatine monohydrate 0.3 g per kilogram of body weight per day or an equivalent dose of placebo for 5 days. The results demonstrated that consuming a LOV diet for 21 days decreased muscle creatine concentration in individuals who normally consume meat and fish. However, the creatine content of muscle in the LOV group returned back to normal after a period of only 5 days.
   Creatine, 5 g a day for six weeks, has been shown to improve brain performance (memory and intelligence) in adults who are vegetarian.

Creatine Side Effects and Cautions
Nausea, stomach upset, dizziness or weakness, loose stools, diarrhea, and weight gain are the most common, and generally occur with creatine dosages greater than 5 grams a day.  Muscle cramping is also reported. Strains and sprains can occur (perhaps even muscle tears?) when individuals over enthusiastically and rapidly increase their workout regimen before their tendons and ligaments have adapted to the increase in muscle size and power. 
   Long-term consequences of daily creatine ingestion, especially in high dosages, are currently not known.  There is a possibility that excess creatine can put stress on the kidneys and liver.  Creatine converts into creatinine which, in high dosages, could act as a toxin. Whether there is a potential for increasing the risk of cancer with regular high dose use is currently not known. I discourage the regular, high dose use of creatine.  Individuals with kidney disease should not use creatine.
   One study shows long term creatine use for 21 months did not influence blood studies (metabolic markers, muscle and liver enzymes, electrolytes, lipid profiles, hematological markers, and lymphocytes). Kreider RB, et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes.   Mol Cell Biochem. 2003 Feb;244(1-2):95-104.
   We have also come across a few anecdotes about high dose creatine causing anxiety or depression. Time will tell whether creatine is responsible for these cognitive changes.
   There are no reports to date that creatine influences the size of genital organs or has a significant effect, positive or negative, on sex drive. Creatine doesn't seem to have a direct effect on libido, although feeling good about one's toned body could influence self-image and how others react to us and make us feel more attractive and sexual. The influence of creatine on sperm count or motility, if any, is not known at this time.
   Short term creatine supplementation does not seem to affect blood pressure, heart rate, or kidney function. A small to modest amount of alcohol intake should not interfere with low dose creatine use. We don't advise taking creatine while pregnant. There are no reports of creatine having an influence on hair loss.

Is Creatine better utilized if taken with other nutrients?
One study shows co-ingestion of alpha-lipoic acid with creatine and a small amount of sucrose can enhance muscle total creatine content as compared to the ingestion of creatine and sucrose or creatine alone.

Forms of creatine
There are various forms of creatine and since little or no research is currently available on Creatine Decanoate, Creatine Gluconate, Dicreatine Oronate, Disodium Creatine Phosphate, we prefer just using creatine monohydrate for the time being.

Creatine Emails - Creatine Supplement side effect
I am 25, and I have a concern. I recently started taking creatine. Its been over a week. After seven days of taking the recommended amount in the box, and by my trainer, I felt really sick after one of my wourkouts. I came home, and felt weak, dizzy, nauses, cold, and was about to pass-out. My trainer said that creatine doesn't cause that. I stopped for two days and now i'm back on it, because I want to get results. My question is. The package says
two scoops per serving, that is 13g of creatine. My trainer also suggested the same thing. After reading a website, and other sources I am starting to believe that that is not the recommended amount. The way I felt that day, was it because I was taking more than the amount I should take? Am I going to get the same results with the 4-5g a day?
   A. You may wish to read the side effects of creatine on Dr. Sahelian's web site, and also that he believes that lower amounts do work also with much fewer problems.

Q. I believe my 14 year old son had an adverse effect the other night a little while after taking a creatine / taurine drink. He went to get up to go to a friends house when he became unsteady. I asked him what was the matter with him and he said he did not know. As he was telling me this his speech was becoming slurred and his strength was diminishing. He went to lie down and started becoming lethargic and then started vomiting, I called an ambulance and they checked all vitals and everything seemed fine but they still took him to the hospital. I was asked if he had been drinking since the symptoms were similar although they couldn't smell any alcohol on him. I assured them that that was not possible since he had been working with his father the whole day and that we don't keep any alcohol at home. At the hospital his blood alcohol content was three times the legal adult limit. I thought they must have mixed up his blood work with someone else. In less than two hours of the onset of symptoms he was fine. If someone had that blood alcohol they would not be fine in less than two hours. While doing some online research I came across a letter to the FDA from 2004 stating that creatine ethyl ester would soon be offered as a "new more available source of creatine for dietary supplementation of creatine. It went on to say that "when associated with ethanol the two molecules are in the coupled form (ester) or dissociated form - carboxylic acid (ie. creatine) and alcohol (i.e. ethanol)." Is this possibly where my son got a blood alcohol content reading? I thought a "scoop" was a 5 gram serving so I had him take about 1/3rd of this. Only after this episode did I really read the label to find that a "scoop" was 43 grams. So in reality he was well over the 3 grams that we figured was safe. Needless to say, I have dumped out the creatine and told him no more supplements even with the doctors approval (which we had for the 3 gram level).
   A. This is an interesting report. We are not familiar with creatine ethyl ester and don't have any experience regarding blood alcohol level and the use of creatine ethyl ester.

Q. i have been taking creatine for about a month. i am tall and thin. its been a couple of days, over a month since i have been on it, and i have only gained about 5 pounds, but i play tennis so all the weight i put on i probably most likely burn off. as to muscle size, i try to workout really hard at the gym, im always trying to press more weight, i think the creatine gives me that extra bit of energy when i workout i can always push myself to lift that last couple of pounds.
i drink a lot of water when i am at the gym and i eat healthy and drink protein shakes. what i am trying to get at here, is should i be seeing really big muscle mass or does the creatine take a lot of time for the muscle mass to get bigger. i can tell my muscle mass has grown slightly but thats because i am always pushing myself.
   A. Each person responds differently to creatine supplementation and some people have a quick muscle mass increase while for others the muscle mass increase is slower. The fact that you already have some muscle mass increase should be encouraging.

Q. I am very sensitive to natural supplements. I experienced a creatine side effect. I took Creatine for the first time today (I took it about 6:00 a.m. and it's 10:00 a.m. now)...I wanted to try it because I have trouble exercising much
nowadays (I can't jostle my head much), so I was hoping that Creatine would help me to to gain a little strength, because I feel pretty weak. I took less than 1/2 of a teaspoon...and I am experiencing light-headeness and dizziness right now...enough to where I feel the need to sit down (don't feel confident walking). I will be allright...I am just mentioning this as more "evidence" as to how sensitive my body / brain is nowadays to most everything I try. It is just added "data" for when you read any of my e-mails. I guess I will be trying a "1/2 of a 1/2" of a teaspoon next time!

Q. Have you ever heard of or recommend Creatine Supplementation for alzheimers patients, suppose to help them gain back weight, and help with brain activity.
   A. We have not seen any studies regarding the use of creatine supplementation and its clinical effect on patients with Alzheimer's disease.

Q.  I found your website while looking for info on glyconutrients, but decided to see what else you have information on. I noticed in your information on creatine that you do not include anything on a recent development, kre-alkalyn. It is a form of creatine monohydrate that they claim is pH-correct. I was wondering what your take is on Kre-Alcalyn, if it is clever marketing or if it is a real alternative to the industry standard creatine monohydrate. If anything it would add some new information to your article on creatine.
   A. We have not seen any research with Kre-Alcalyn form of creatine.

Q. My kidney scores prevent me from continuing to take powdered creatine and ibuprofen (advil, etc), i.e. I repeated have above normal creatinine scores, 1.6, 1.4. I have heard of a product called Purple-K that is supposed to send all of the creatine in a capsule directly to your muscles. They claim it is not toxic to vital organs at all due to a new delivery system. From a scientific standpoint, do you think that is possible or how I can verify that claim? I couldn't find the product on the FDA website. I've pasted in the product info. Since I've stopped taking creatine, I've lost considerable muscle mass. Although I'm still pretty strong, I'm starting to look skinny. Would Whey Protein help or provide similar results in strength and mass as creatine if I can no longer take creatine? I want to be strong and/or have more mass but not at the ultimate expense of my health. I hope my questions are of are a nature that you can reply. I guess you don't sell the product Purple K, but do you have something similar or can you still reply to my questions? I really appreciate Dr. Ray Sahelian's question and answer segment. It was where I first learned that the creatine powder could be the culprit, which I acknowledge was made worse by ibuprofen. I used to take it like candy everytime I had an ache or pain. I had no idea it would eventually harm my kidneys.
   "PURPLE-K & creatinine? Creatinine is a toxic waste that is produced when regular creatine hits liquid. Creatinine is so toxic that your kidneys work overtime to protect you from damage. This stress is why people get gut-rot, diarrhea, nausea and bloating. PURPLE-K prevents this by giving you a 100% stable creatine source. If you've taken regular or "cheaper" creatine and experienced these side effects, now you know why. More importantly, now you know how to prevent these side effects from happening again! You need to use PURPLE-K creatine from now on... How does PURPLE-K stop the toxic conversion from creatine to creatinine? PURPLE-K is buffered creatine. The pH level of PURPLE-K is between 12-14 and this prevents it from breaking down in any liquids - even stomach acids. The exclusive Kre-Alkalyn pH Controlled Delivery System makes this possible. The patented formula covers all pH levels between 7-14. This forces the pH of all other creatine products to be 6.9 or less; which means they will convert to toxic creatinine."
   A. We have not seen any long term human studies with PURPLE-K to determine if the claims are true.

Q. I am just starting the loading phase using creatine. I had surgery a while back and really cannot start lifting or exercising for one more week. Can I start the loading phase before I start working out again? Or should I wait until I start exercising?
   A. We prefer using a gradual approach to creatine supplementation at about 2, 3, or 4 grams a day which can minimize the side effects that occur frequently with creatine loading. Therefore, the creatine low dosage approach can be started a few days before working out although creatine is more effective when combined with lifting weights. Creatine side effects with loading include nausea, stomach cramps, and diarrhea which occurs at a dosage about  grams.

Q. A new book on "Creatine and Creatine Kinase in Health and Disease" is now available from the Springer publishing company. A short summary of the book is provided below. We hope that this book will find your interest!. "Although creatine was discovered already in the 1830s, it is only in recent years that its crucial role for human health and general well-being has been increasingly realized and appreciated. A number of beneficial health effects have been ascribed to oral creatine supplementation, such as neuroprotective, ergogenic, anti-diabetic, anti-inflammatory, antiviral, or antitumor effects. Creatine may even improve memory and intelligence. In the present book, emphasis is placed on the intricate interplay between creatine and creatine kinase function on one hand, and proper brain function, neurodegenerative disease and/or neuroprotection on the other hand. The creatine book also elaborates on the recently identified inborn errors of creatine biosynthesis and transport, the so-called cerebral creatine deficiency syndromes. The clinical hallmarks of these disorders are mental retardation, epilepsy, autistic-like behaviour, and speech and language delay. In addition, the muscle growth- and strength-promoting effects, the pharmacokinetics and the safety of oral creatine supplementation are discussed. Finally, the creatine book outlines the emerging "systems biology" approaches for understanding the pleiotropic effects of creatine and creatine kinase, and hypothesizes on the most promising and influential future avenues of research towards creatine-based nutritional strategies for the prevention of neurological disease, and for improving the quality of life in general. Markus Wyss ,
DSM Corporate Human Resources, The Netherlands.

Q. I recently came across some ads for a "new type of creatine" Kre-Alkalyn, which is patented and supposedly buffered to a high pH so it doesn't turn into creatinine and cause "creatine side-effects". Have you heard or read any of this "science" and what's your take on it? I didn't see any reference to this form of creatine on your lists.
   Description: Creatine Monohydrate has been proven through decades of research to enhance strength, endurance, and athletic performance. However some athletes have noted side effects including nausea, stomach cramps, bloating, and a host of other unwanted reactions. What wasn't realized until recently is that these side effects are actually caused by creatinine, and not Creatine. Kre-Alkalyn is Creatine which is 100% stable and will not break down into Creatinine. This allows the Creatine to be absorbed more efficiently into the bloodstream. Kre-Alkalyn allows athletes to use smaller serving sizes while experiencing even more explosive results. Kre-Alkalyn has been referred to as a new form of Creatine. However, it is actually the best form of Creatine (Creatine Monohydrate) that has been fully stabilized. It is a new technology altogether: 100% stable Creatine. Kre-Alkalyn is processed at a higher pH level than regular Creatine Monohydrate."
   A. We have not seen any human studies comparing creatine monohydrate supplements to Kre-Alkalyn to determine which form is better. Creatine monohydrate works great with no side effects when 3 grams a day are used a few times a week. Until human research studies are published that clearly indicate Kre-Alcalyn is much superior to creatine monohydrate supplements, we don't see any reasons to switch.

Q. Recently I started taking creatine powder for help build muscle strength. I do find the creatine powder is helping somewhat. I take the recommended dosage one teaspoon. However, I heard creatine powder can affect one's liver?
Do you know of this to be true. Just thought creatine powder would help me build strength and size.
   A. We have not encountered any liver problems when creatine powder is used at about 3 grams a day for 5 days a week and a full week off a month.



 

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