Creatine

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Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Enhanced muscle mass / strength
Several high-quality studies have shown an increase in muscle mass with the use of creatine. However, some weaker studies have reported mixed results. Overall, the available evidence suggests that creatine does increase lean body mass, strength, and total work. Future studies should take into account the effect of different individual fitness levels of study subjects. 		A
Congestive heart failure (chronic)
Patients with chronic heart failure have low levels of creatine in their hearts. Several studies report that creatine supplements may improve heart muscle strength, body weight, and endurance in patients with heart failure. 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. 		B
Adjunct in surgery (coronary heart disease)
Early studies suggest a potential benefit of creatine supplements in patients undergoing coronary artery surgery. Some evidence suggests that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatinine is used during the operation. Larger, well-designed studies are needed before a strong recommendation can be made. 		C
Apnea (of prematurity)
Early studies of creatine in animals and humans have found mixed results in patients with a breathing disorder in infants, called apnea of prematurity. Well-designed studies are needed to better understand this relationship. 		C
Bone density
Early studies examining the effect of creatine in aging suggest that creatine may increase bone density when combined with resistance training. Further studies in which creatine alone is compared with placebo are needed. 		C
Chronic obstructive pulmonary disease
It is unclear if creatine can help treat chronic obstructive pulmonary disease. Study results are mixed. More clinical trials are needed before a strong recommendation can be made. 		C
Depression
Early research suggests a potential beneficial of creatine supplements in depression. Creatine may have brought on a manic switch in patients with bipolar depression. Large, well-designed studies are needed. 		C
Dialysis
Early studies suggest that creatine does not lower homocysteine levels in chronic hemodialysis patients. However, these patients were also using vitamin B12 and folate. Muscle cramps are also common complications of hemodialysis. Creatine may offer some benefit for this side effect. However, studies in which creatine alone is compared with placebo are needed. 		C
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). It has been studied in cyclists, females, high-intensity endurance athletes, rowers, runners, sprinters (general), swimmers, and the elderly. However, the results of research evaluating this claim are mixed. 		C
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. However, there is limited evidence for the effect of creatine supplementation in this disorder. High-quality studies are needed. 		C
High cholesterol
Early studies did not find a benefit of creatine in the treatment of high cholesterol. More studies are needed before a clear conclusion can be drawn. 		C
Huntington's disease
There is not enough scientific information to make a firm recommendation about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship. 		C
Hyperornithinemia (high levels of ornithine in the blood)
Ornithine is normally formed in the liver. Some individuals are born with a genetic disorder that prevents them from appropriately breaking down ornithine, which causes blood levels to become too high. High amounts of ornithine may 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. 		C
Ischemic heart disease
Early high-quality studies suggest a potential benefit of creatine in people with ischemic heart disease. More clinical trials are needed before a firm recommendation can be made. 		C
McArdle's disease
In McArdle's disease, there is a deficiency of energy compounds stored in the muscles. 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 are mixed. Therefore, it remains unclear if creatine offers any benefits to patients with McArdle's disease. 		C
Memory
Early studies show that creatine may improve cognition in certain populations, such as vegetarians and the elderly. Further research is required before recommendations can be made. 		C
Multiple sclerosis
Early study suggests that creatine supplementation does not improve work production in people with multiple sclerosis. However, large, well designed studies are required before a strong recommendation can be made. 		C
Muscular dystrophy
Creatine loss is suspected to cause muscle weakness and breakdown in patients with Duchenne muscular dystrophy. Studies with creatine have found mixed results for this condition. Further research is needed before a strong recommendation can be made. 		C
Myocardial infarction (heart attack)
There is early evidence that intravenous creatine after a heart attack may be beneficial to heart muscle function and may prevent irregular heart rhythms. Further study is needed before a recommendation can be made in this area. It has been reported that the use of creatine phosphate may have a favorable effect on mental deterioration in "cardio-cerebral syndrome" following heart attacks in the elderly. More research is needed. 		C
Neuromuscular disorders (general, mitochondrial disorders)
Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard 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. 		C
Spinal cord injury
It is unclear if creatine is helpful in patients with spinal cord injuries. Results from early studies have been mixed. Further studies are required before a firm recommendation can be made. 		C
Amyotrophic lateral sclerosis (ALS)
Overall, the evidence suggests that creatine supplementation does not offer benefit to individuals with amyotrophic lateral sclerosis (ALS). 		D
Surgical recovery
Early studies suggest that creatine has no effect on strength or body composition in people undergoing soft tissue surgery. Creatine supplements are likely ineffective in this condition, and cannot be recommended without evidence from additional studies. 		D

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

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, anticonvulsant, anti-inflammatory, antioxidant, attention deficit hyperactivity disorder, bipolar disorder, brain damage, breast cancer, cervical cancer, circadian clock acceleration, colon cancer, diabetes, diabetic complications, disuse muscle atrophy, fibromyalgia, growth, herpes, hyperhomocysteinemia (an abnormally large level of homocysteine in the blood), mitochondrial diseases, mood disorder, neuroprotection, nutritional supplement, ophthalmologic disorders (gyrate atrophy), osteoarthritis, Parkinson's disease, rheumatoid arthritis, seizures (caused by lack of oxygen to the brain), sexual dysfunction, wasting of brain regions.

Dosing Related terms
NS_patient-creatine Portions of this document last updated: Sept. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

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