Kreider RB, et al. Effects of ingesting supplements designed to promote lean tissue accretion on body composition during resistance training. Int J Sport Nutr. 1996;6(3):234–46. Scofield DE, Unruh S. Dietary supplement use among adolescent athletes in central Nebraska and their sources of information. J Strength Cond Res. 2006;20(2):452–5. Polyviou TP, et al. Effects of glycerol and creatine hyperhydration on doping-relevant blood parameters. Nutrients. 2012;4(9):1171–86. Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health & Kinesiology, Texas A&M University, College Station, TX, 77843-4243, USA Like carbohydrate, creatine monohydrate has osmotic properties that help retain a small amount of water. For example, initial studies reported that creatine loading promoted a short-term fluid retention (e.g., about 0.5 – 1.0 L) that was generally proportional to the acute weight gain observed [ 22, 46]. For this reason, there was interest in determining if creatine supplementation may help hyper-hydrate an athlete and/or improve exercise tolerance when exercising in the heat [ 76, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126]. For example, Volek and colleagues [ 76] evaluated the effects of creatine supplementation (0.3 g/kg/day for 7 days) on acute cardiovascular, renal, temperature, and fluid-regulatory hormonal responses to exercise for 35 min in the heat. The researchers reported that creatine supplementation augmented repeated sprint cycle performance in the heat without altering thermoregulatory responses. Kilduff and associates [ 123] evaluated the effects of creatine supplementation (20 g/day for 7 days) prior to performing exercise to exhaustion at 63% of peak oxygen uptake in the heat (30.3 °C). The researchers reported that creatine supplementation increased intracellular water and reduced thermoregulatory and cardiovascular responses to prolonged exercise (e.g., heart rate, rectal temperature, sweat rate) thereby promoting hyper-hydration and a more efficient thermoregulatory response during prolonged exercise in the heat. Watson and colleagues [ 117] reported that short-term creatine supplementation (21.6 g/day for 7 days) did not increase the incidence of symptoms or compromise hydration status or thermoregulation in dehydrated (−2%), trained men exercising in the heat. Similar findings were observed by several other groups [ 118, 119, 127, 128] leading researchers to add creatine to glycerol as a highly effective hyper-hydrating strategy to help athletes better tolerate exercise in the heat [ 116, 120, 121, 122, 125, 126]. These findings provide strong evidence that creatine supplementation (with or without glycerol) may serve as an effective nutritional hyper-hydration strategy for athletes engaged in intense exercise in hot and humid environments thereby reducing risk to heat related-illness [ 5, 129]. Enhanced rehabilitation from injury

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Label advisories on creatine products that caution against usage by those under 18 years old, while perhaps intended to insulate their manufacturers from legal liability, are likely unnecessary given the science supporting creatine’s safety, including in children and adolescents. Sharov VG, et al. Protection of ischemic myocardium by exogenous phosphocreatine (neoton): pharmacokinetics of phosphocreatine, reduction of infarct size, stabilization of sarcolemma of ischemic cardiomyocytes, and antithrombotic action. Biochem Med Metab Biol. 1986;35(1):101–14. Ogborn DI, et al. Effects of creatine and exercise on skeletal muscle of FRG1-transgenic mice. Can J Neurol Sci. 2012;39(2):225–31. Poortmans JR, Francaux M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci Sports Exerc. 1999;31(8):1108–10. Benzi G. Is there a rationale for the use of creatine either as nutritional supplementation or drug administration in humans participating in a sport? Pharmacol Res. 2000;41(3):255–64.Spillane M, et al. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. J Int Soc Sports Nutr. 2009;6:6. Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair. 2007;21(2):107–15. Ostojic SM. Guanidinoacetic acid as a performance-enhancing agent. Amino Acids. 2016;48(8):1867–75. McMorris T, et al. Creatine supplementation, sleep deprivation, cortisol, melatonin and behavior. Physiol Behav. 2007;90(1):21–8. Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes with the intent of increasing high-intensity exercise capacity and lean body mass during training.

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Alves CR, et al. Creatine supplementation in fibromyalgia: a randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken). 2013;65(9):1449–59. Komura K, et al. Effectiveness of creatine monohydrate in mitochondrial encephalomyopathies. Pediatr Neurol. 2003;28(1):53–8. Polyviou TP, et al. Thermoregulatory and cardiovascular responses to creatine, glycerol and alpha lipoic acid in trained cyclists. J Int Soc Sports Nutr. 2012;9(1):29. Hanna-El-Daher L, Braissant O. Creatine synthesis and exchanges between brain cells: what can be learned from human creatine deficiencies and various experimental models? Amino Acids. 2016;48(8):1877–95. Gualano B, et al. Creatine in type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Med Sci Sports Exerc. 2011;43(5):770–8.

Ingredients

Gualano B, et al. Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain. Amino Acids. 2016;48(8):1793–805.

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Balestrino M, et al. Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease. Amino Acids. 2016;48(8):1955–67. Ayoama R, Hiruma E, Sasaki H. Effects of creatine loading on muscular strength and endurance of female softball players. J Sports Med Phys Fitness. 2003;43(4):481–7.Tyler TF, et al. The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial. Am J Sports Med. 2004;32(2):383–8.

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Cooke MB, et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. 2009;6:13. Mazzini L, et al. Effects of creatine supplementation on exercise performance and muscular strength in amyotrophic lateral sclerosis: preliminary results. J Neurol Sci. 2001;191(1–2):139–44. Creatine Monohydrate, Flavouring, Acid (Citric Acid), Sweetener (Sucralose), Spirulina Extract. Apple & Lime Flavour

Nutrition

Earnest CP, et al. The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition. Acta Physiol Scand. 1995;153(2):207–9. Polyviou TP, et al. The effects of hyperhydrating supplements containing creatine and glucose on plasma lipids and insulin sensitivity in endurance-trained athletes. J Amino Acids. 2015;2015:352458.