The Truth about Creatine: Not a Panacea, but Close

A Panacea, according to the first semi-reputable website in Google (which happens to be Wikipedia) is a term used “to represent any solution to solve all problems related to a particular issue”. In medicinal terms, it’s used to refer to a medicine that does everything and does everything well with no side effects.

There are no Panaceas in existence. It’s a literary term to explain ideal situations and concepts. Panaceas tend to be incompatible with reality.

Creatine (usually sold as Creatine Monohydrate) tends to come close though. It beneficially influences a wide variety of conditions and goals, but not all. It’s healthy and free from serious side effects. The ‘lack of harm’ is not due to it being understudied either, entering ‘Creatine Supplementation’ into Pubmed (largest online database of primary and secondary scientific evidence) yields over 1400 hits, and throwing ‘Blind’ into the search to get mostly double blind placebo controlled studies gets about 350.

Despite the above, it still seems to be restricted to weightlifters and athletes for its power enhancing properties. In part because the adage “If it’s too good to be true, it usually is”, which applies to almost everything, doesn’t apply to creatine. It is to be expected that people try to find the ‘fatal flaw’ with creatine to knock it off its pedestal, because almost all other supplements have some sort of flaw which brings them down from godly to normal. Sadly, it appears that people have resorted to making stuff up about creatine.

I’ll try to make this article quick and concise. My goals here are to fully show why creatine is not harmful in any way (a bold claim), note all possible side-effects of creatine, and then cite instances where creatine exerts benefit that go beyond the standard ‘build muscle and strength’ aspects that are marketed.

First, we Examine Creatine

A side project I am working on is Examine.com, a website that is aiming to be a database of supplemental science. It is basically a mixture of Wikipedia and TvTropes for supplements, and aims to be a living, breathing review article about everything. I defer to Examine’s Creatine page for most of the following, as I cannot write an article without citing what I say yet the thought of replicated 300+ citations gnaws at my sanity. If the page is too complex, just zip to the ‘Human Trials Clinical Rubric’ to get a general overview of human intervention studies on the compound.

Side-effects of Creatine

• If you don’t drink enough water with creatine, you will get a stomach ache
• If you take too much creatine at once, you could have loose stools
• Some people view the gains in water weight as a ‘side-effect’

That is about it.

The idea that creatine harms the kidneys is mostly due to confusion. There is a compound called creatinine (note the extra ‘in’) that is a metabolite of creatine. Creatine is made in the body naturally, and you always have a certain circulating level of creatinine. It is filtered out at a constant rate by the kidneys, and when the kidneys fail their job gets backlogged a bit. Higher than normal blood levels of creatinine are due to either kidney failure or creatine supplementation, but this is a ‘X and Y both cause Z, despite X and Y not being related’ issue. I could find 10 studies that investigated creatine supplementation and kidney function, and all of them (including the one on the guy with one sub-optimal kidney fed 20g daily) came back negative.

Creatine does not hurt kidney function.

The notion of creatine harming the liver is similar to the above. Some studies take sedentary people and divide them into two groups, one which supplements creatine, and assess some blood markers. These studies tend to note an increase in liver enzymes (ALT, AST, GST) which are usually indicative of liver damage. The problem here is that it is no different than placebo, because the increase seen is due to starting an exercise regimen.

Beyond the above possible explanation, there are no other links between creatine supplementation and the liver.

As for the heart, some people note an elevated heart rate with creatine supplementation. This can be a big concern, as creatine is not a stimulant and doesn’t influence adrenaline in the body. However, I should note that out of all the literature I have read that measures side-effects and cardiac function in response to creatine supplementation, not once has creatine ever differed from placebo.

What can increase heart rate though? Hypochondrias and the Nocebo effect; Nocebo is just the Placebo effect when only looking at adverse effects.

In explaining the actual three side-effects noted above, they are all related to the creatine molecule really liking water (a property called ‘Hygroscopic’, which is just a fun word to know). When it is in your muscle tissue, it draws water in and you gain water weight. When not given enough water in the stomach, it tries to draw water from around it and sometimes precipitates, which can lead to cramping. If too much is in the colon, it draws water into the colon and that causes the loose stools; this usually occurs only during creatine ‘loads’ of 20-25g a day. Not severe problems by any means, but still seen as ‘side-effects’ by many. Cramping isn’t fun.

Beyond Power; benefits of Creatine

Creatine, for all intents and purposes, is pretty much a vitamin. It lacks the classification as such since we can restrict our diet from all creatine (found in meats, eggs, and dairy) and not die since our liver creates creatine from amino acids. Similar to vitamins, there appears to be something similar to a deficiency state for creatine. Subclinical ones are just associated with impaired function, and severe ones (genetic problems with getting creatine into a cell) cause mental retardation and related cognitive disorders. [x]

The ‘subclinical deficiency’ tends to occur with restriction of dietary creatine, or impaired creatine synthesis; vegetarianism and old age, respectively. Studies on creatine and improving cognition fall on their face when studying young omnivores (normal creatine status) but show cognitive improvement on multiple parameters vegetarians [x] [x] and the elderly.[x]

Building off the elderly population being deficient, it is being explored for various disease states associated with age. Not a huge body of evidence on any single one, but it is showing promise in Osteoarthritic Symptoms,[x] Sarcopenia,[x] and resistant depression;[x] not so promising on Parkinson’s [x] and Huntingtons Disease.[x] Of course, through bone and muscle health it does seem to improve general functionality in the elderly [x] which can lead to less falls (although many of us younger folks may not fully grasp it, falling when your bones are brittle can be fatal; usually you get sent to the hospital due to a cracked bone and your vitality plummets when you catch an infection. Falls are serious business). At least one study noted improvements in bone mineral density, but it’s far from conclusive. [x]

I am not saying that Creatine supplementation can cure the above, but I am at least suggesting that it may help. The promising preliminary evidence above coupled with the apparent lack of harm from taking low dose creatine with some liquids suggests that there really isn’t any reason to not supplement creatine. Granted there are some ‘non-responders’ to creatine (some problems with getting excess creatine into cells) that don’t even gain water weight for some currently unknown reason, but creatine supplementation is safe and at least worth a try if you fall into one of the above populations. Worth a try even if you don’t, as it reliably increases power in omnivores as well.

Silver Hydra is an Online Nutritional Consultant and Supplement Researcher

Follow him on Twitter @Silverhydra or visit his blog at Silverhydra.com