Congestive heart failure (chronic)
Cardiac creatine levels are reported as depressed in chronic heart failure. Several studies report that creatine supplementation is associated with improved heart muscle strength, body weight and endurance in patients with heart failure. However, it is not clear what dose may be safe or effective. Supplementation is also reported to increase creatine in skeletal muscle in these patients, helping to increase strength and endurance. Well-designed studies comparing creatine with drugs used to treat heart failure are needed before a firm recommendation can be made. Heart failure should be treated by a qualified healthcare professional.
Enhanced athletic performance and endurance
It has been suggested that creatine may help improve athletic performance or endurance by increasing time to fatigue (possibly by shortening muscle recovery periods). However, the results of research evaluating this claim are mixed. Findings from different studies disagree with each other, and most studies do not support the use of creatine to enhance sustained aerobic activities. C
Enhanced muscle mass / strength
Multiple studies suggest that creatine may improve muscle mass and strength in men and women, particularly when accompanied by increased physical activity. However, studies of creatine in athletes have disagreed with each other. Although many experts believe that creatine may be useful for high-intensity, short-duration exercise, it has not been demonstrated effective in endurance sports. Benefit may be greatest when levels of creatine prior to supplementation are low, and in specific sub-populations such as older men.
GAMT deficiency
Some individuals are born with a genetic disorder in which there is a deficiency of the enzyme guanidinoacetate methyltransferase (GAMT). A lack of this enzyme causes severe developmental delays and abnormal movement disorders. The condition is diagnosed by a lack of creatine in the brain. Although there is only limited research in this area.
Heart muscle protection during heart surgery
There is early evidence that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatinine is administered during the operation. Further study is needed before a recommendation can be made.
High cholesterol
There is limited research in this area, and results from different studies disagree with each other (with some trials noting reductions in total cholesterol and triglyceride levels). It remains unclear what effect creatine has on lipids. Additional studies are needed before a clear conclusion can be drawn.
Huntington's disease
There is preliminary evidence that creatine may be well-tolerated and safe in Huntington's disease patients. Further research is needed before a recommendation can be made.
Hyperornithinemia (high levels of ornithine in the blood)
Ornithine is a byproduct formed in the liver. Some individuals are born with a genetic disorder that prevents them from appropriately breaking down ornithine, and blood levels of ornithine become too high. High amounts of ornithine can lead to blindness, muscle weakness and reduced storage of creatine in muscles and the brain. Although there is only limited research in this area, early evidence suggests that long-term, daily creatine supplements may help replace missing creatine and slow vision loss.
McArdle's disease
In McArdle's disease, there is a deficiency of energy compounds stored in muscle. This leads to muscle fatigue, exercise intolerance, and pain when exercising. Creatine has been proposed as a possible therapy for this condition. However, research is limited, and the results of existing studies disagree with each other. Therefore, it remains unclear if creatine offers any benefits to patients with McArdle's disease.
Muscular dystrophy
Creatine loss is suspected to cause muscle weakness and breakdown in Duchenne muscular dystrophy. Further research of creatine supplementation for muscular dystrophy is needed before a recommendation can be made. C
Myocardial infarction (heart attack)
There is early evidence that intravenous creatine following a heart attack may be beneficial to heart muscle function, and may prevent ventricular arrhythmias. Further study is needed before a recommendation can be made in this area.It has been reported that use of creatine phosphate may have a favorable effect on mental deterioration in "cardio-cerebral syndrome" following heart attacks in the elderly.
Neuromuscular disorders
Numerous studies suggest that creatine may be helpful in the treatment of various neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS) and myasthenia gravis, and may delay onset of symptoms when used as an adjunct to conventional treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis and supplementation does not seem to help people with tetraplegia.Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
AGAT deficiency, Alzheimer's disease, anti-arrhythmic, anti-convulsant, anti-inflammatory, antioxidant, breast cancer, cervical cancer, circadian clock acceleration, colon cancer, diabetes, diabetic complications, disuse muscle atrophy, fibromyalgia, growth, herpes, hyper cysteinemia, mitochondrial diseases, neuroprotection, Parkinson's disease, rheumatoid arthritis, hypoxic seizures, wasting of brain regions.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older):
A wide range of dosing has been used or studied by mouth. 400 milligrams per kilogram of body weight or up to 25 grams per day has been studied for multiple conditions.
Numerous dosing regimens for intravenous or intramuscular administration have been used in studies in humans. Intravenous dosing should be conducted only under strict medical supervision.
Children (younger than 18 years):
Dosing in children should be under medical supervision because of potential adverse effects.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Creatine has been associated with asthmatic symptoms. People should avoid creatine if they have a known allergy to this supplement.
Side Effects and Warnings
There is limited systematic study of the safety, pharmacology, or toxicology of creatine. Individuals using creatine, including athletes, should be monitored by a healthcare professional. Users are advised to inform their physician or other qualified healthcare professional.
Some individuals may experience gastrointestinal symptoms, including loss of appe e, stomach discomfort, diarrhea, or nausea.
Creatine may cause muscle cramps or muscle breakdown, leading to muscle tears or discomfort. Weight gain and increased body mass may occur. Heat intolerance, fever, dehydration, reduced blood volume, or electrolyte imbalances (and resulting seizures) may occur.
There is less concern today than there used to be about possible kidney damage from creatine, although there are reports of kidney damage, such as inters ial nephritis. Patients with kidney disease should avoid use of this supplement. Similarly, liver function may be altered, and caution is advised in those with underlying liver disease.
In theory, creatine may alter the activities of insulin. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.
Chronic administration of a large quan y of creatine is reported to increase the production of formaldehyde, which may potentially cause serious unwanted side effects.
Creatine may increase the risk of compartment syndrome of the lower leg, a condition characterized by pain in the lower leg associated with inflammation and ischemia (diminished blood flow), which is a potential surgical emergency.
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