Natural Products

Creatine

Creatine Monohydrate

Efficacy

• Indications with proven efficacy:
  None
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Enhancement of athletic performances
• Also used for these other indications, but with no proof of efficacy:
  Increase strength in muscle diseases (congestive heart failure, muscular dystrophy, gyrate atrophy of the choroid and retina)

Security

• Risk of Drug Interactions: Low
• Adverse Effects: Rare

What is it?

This product is considered a dietary supplement. Creatine is an amino acid, a constituent of proteins. It is mainly stored in muscles as creatine phosphate, where it can participate in the transport of phosphate, improving the conversion of ADP into ATP. ATP is the muscle's energy source.

Some believe that an increase in muscle concentrations of creatine phosphate improves the level of energy during brief, high-intensity activities.

Creatine is found in red meat, milk and fish. Each day, we ingest about 1 to 2 grams. It can be synthesized in the body from arginine, glycine and methionine.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

What is it used for?

Creatine is a source of energy readily available for muscle contraction. In addition, it improves the formation of muscle fibre. It is used to enhance athletic performances, mainly in brief, high-intensity activities, such as sprint, weight lifting or hockey. Body-builders use creatine to increase muscle mass.

Some think that creatine may be useful to improve post-operative recuperation.

Does it work?

Creatine is an energy source readily available for muscle contraction. The individuals most likely to benefit from the use of this product are those with a low dietary intake of creatine, such as vegetarians, and athletes that have not yet reached a high level of training. It is ineffective when used for increasing endurance or for improving performance in highly trained athletes.

• Enhancement of athletic performances:
  Creatine is mostly useful for brief, high-intensity activities, such as sprint, weight lifting or hockey. After taking a loading dose of 20 to 30 grams daily (in divided doses) over a period of 3 or more days (max. 7 days), a maintenance dose of 2 to 3 grams is taken each day. If the loading dose is omitted, the beneficial effects will appear less rapidly.

Is it safe?

• Creatine is well-tolerated and does not appear to be associated with any serious toxicity when used in appropriate doses in healthy adults. There have been reports of diarrhea, nausea, dehydration and muscular cramps associated with its use. People who use creatine should drink liberally (at least 1,8 liter daily). Long-term effects of creatine use are still undetermined.
• Creatine should be avoided by people with pre-existing renal disease or diabetes. There was one report of acute renal toxicity in an individual who had taken 20 grams of creatine daily for 4 weeks.
• No interaction with drugs are known to occur with this product. However we suggest to be careful with renal toxic drugs.
• Since there are no safety data available concerning its use during pregnancy and breast-feeding, pregnant and lactating women should not take creatine.

Clinical Notes

• Creatine is metabolized to creatinine, a substance used as a marker of the renal function. People who use creatine could have higher blood creatinine levels which could be falsely interpreted as renal impairment. Creatine use should always be disclosed to health-care professionals.
• It is not known whether taking creatine can interfere with the body's natural ability to synthesize it.

References

1. Pharmacist's Letter, CE Booklet: Nonherbal Dietary Supplement, 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Lininger S. et Al. The Natural Pharmacy, Prima Health, 1998
4. Passeportsanté.net. Créatine. http://www.passeportsante.net
5. Herbal Companion to AHFS DI, American Society of Health-System Pharmacists, 2001
6. Barnes CL et Kushner JM. Use of Creatine and Androstenedione to Enhance Athletic Performance. US Pharmacist, August 2003