Talk to a healthcare provider before you take creatine. They’ll likely conduct a physical examination and ask questions, including: Stout JR, Sue Graves B, Cramer JT, Goldstein ER, Costa PB, Smith AE, Walter AA. Effects of creatine supplementation on the onset of neuromuscular fatigue threshold and muscle strength in elderly men and women (64 - 86 years). J. Nutr. Health Aging. 2007;11:459–64.

RBK is co-founder and member of the board of directors for the ISSN. In addition, RBK has conducted industry sponsored research on creatine, received financial support for presenting on creatine at industry sponsored scientific conferences (includes the ISSN), and served as an expert witness on cases related to creatine. Additionally, he serves as Chair of the Scientific Advisor Creatine monohydrate crystallizes from water as monoclinic prisms that hold one molecule of water of crystallization per molecule of creatine [ 187]. Subsequent drying of creatine monohydrate at about 100°C removes the water of crystallization yielding anhydrous creatine (100% creatine) [ 187]. Creatine is considered a weak base (pKb 11.02 at 25°C) that can only form salts with strong acids (i.e., pKa < 3.98). Creatine can also serve as a complexing agent with other compounds via ionic binding. Creatine monohydrate powder contains the highest percentage of creatine (87.9%) other than creatine anhydrous [ 187]. Creatine monohydrate manufactured in Germany involves adding acetic acid to sodium sarconsinate, heating, adding cyanamide, cooling to promote crystallization, separation and filtration, and drying has been reported to produce 99.9% pure creatine monohydrate with no contaminants. Meanwhile, other sources of creatine monohydrate that have different starting materials (e.g., sarcosinates and O-alkylisourea, sarcosinates and S-alkylisothiourea) and methods of creatine synthesis, particularly from sources produced in China, have been found to contain up to 5.4% dicyandiamide, 0.09% dihydrotriazine, 1.3% creatinine, dimethyl sulphate, thiourea, and/or higher concentrations of heavy metals like mercury and lead due to use of different chemical precursors, poorly controlled synthesis processes, and/or inadequate filtration methods that more readily produce these contaminants [ 197]. While the effects of ingesting these compounds on health are unknown, contamination with dihydrotriazine has been suggested to be of greatest concern since it is structurally related to carcinogenic compounds [ 197]. For this reason, German sourced creatine monohydrate has been primarily used in research to establish safety and efficacy and is therefore the recommended source of creatine monohydrate to use in dietary supplements [ 2, 187]. de Souza E Silva A; Pertille, A.; Reis Barbosa, C. G.; Aparecida de Oliveira Silva, J; de Jesus, D. V.; Ribeiro, A G S V; Baganha, R. J.; de Oliveira, J. J. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J. Ren. Nutr. 2019, 29, 480-489.Pischel, I.; Weiss, S. New creatine pyruvate derivatives from crystallization in polar solvents; Germany, 1996; , pp 1. Creatine is an osmotically active substance. Thus, an increase in the body's creatine content could theoretically result in increased water retention. Creatine is taken up into muscle from circulation by a sodium-dependent creatine transporter [ 1]. Since the transport involves sodium, water will also be taken up into muscle to help maintain intracellular osmolality. However, considering the activity of the sodium-potassium pumps, it is not likely that intracellular sodium concentration is dramatically affected by creatine supplementation [ 39]. Child, R.; Tallon, M. J. In In Creatine ethyl ester rapidly degrades to creatinine in stomach acid; International Society of Sports Nutrition 4th Annual Meeting; Las Vegas, NV, 2007; . Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis. Sports Med. 2017;47:163–73. Pritchard NR, Kalra PA. Renal dysfunction accompanying oral creatine supplements. Lancet. 1998;351:1252–3.

Kuehner C. Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr. Scand. 2003;108:163–74. Farshidfar F, Pinder MA, Myrie SB. Creatine Supplementation and Skeletal Muscle Metabolism for Building Muscle Mass- Review of the Potential Mechanisms of Action. Curr. Protein Pept. Sci. 2017;18:1273–87. The vast majority of speculation regarding the relationship between creatine supplementation and hair loss/baldness stems from a single study by van der Merwe et al. [ 61] where college-aged male rugby players who supplemented with creatine (25 g/day for 7 days, followed by 5 g/day thereafter for an additional 14 days) experienced an increase in serum dihydrotestosterone (DHT) concentrations over time. Specifically, DHT increased by 56% after the seven-day loading period, and remained 40% above baseline values after the 14-day maintenance period. These results were statistically significant compared to when the subjects consumed a placebo (50 g of glucose per day for 7 days, followed by 30 g/day for 14 days thereafter). Given that changes in these hormones, particularly DHT, have been linked to some (but not all) occurrences of hair loss/baldness [ 62], the theory that creatine supplementation leads to hair loss / baldness gained some momentum and this potential link continues to be a common question / myth today. It is important to note that the results of van der Merwe et al. [ 61] have not been replicated, and that intense resistance exercise itself can cause increases in these androgenic hormones. Concerns regarding the safety of creatine supplementation in children and adolescents (< 19 yrs) continues to be highly prevalent. The overwhelming majority of evidence in adult populations indicates that creatine supplementation, both short- and longer-term, is safe and generally well tolerated [ 2]. However, the question of whether or not this holds true for children and adolescents is relatively unclear. The physiological rationale supporting the potential ergogenic benefits of creatine supplementation in children and adolescents was first postulated by Unnithan and colleagues in 2001 [ 80]; which established a strong basis for future applications of creatine for younger athletes. More recently, in a comprehensive review examining the safety of creatine supplementation in adolescents, Jagim et al. [ 16] summarized several studies that examined the efficacy of creatine supplementation among various adolescent athlete populations and found no evidence of adverse effects. However, it is important to note that none of the performance-focused studies included in the Jagim et al. [ 16] review provided data examining specific markers of clinical health and whether or not they were impacted by the supplementation protocols.

Rewards For Life

Deldicque L, Decombaz J, Zbinden Foncea H, Vuichoud J, Poortmans JR, Francaux M. Kinetics of creatine ingested as a food ingredient. Eur. J. Appl. Physiol. 2008;102:133–43. In 1998, a case study of a young male with focal segmental glomerulosclerosis and relapsing nephrotic syndrome was reported [ 51]. The young male, who had kidney disease for 8 years and was treated with cyclosporine (i.e., immunosuppressant) for 5 years, had recently begun ingesting creatine supplementation (15 g/day for 7 days; followed by 2 g/day for 7 weeks). Based on increased blood levels of creatinine and subsequent estimate of calculated creatinine clearance, his kidney health was presumed to be deteriorating, although he was otherwise in good health. The patient was encouraged to discontinue creatine supplementation. At this time, it was already known that blood and urine creatinine levels can increase following ingestion of creatine containing food products, including creatine supplements [ 35]. This was ignored by the authors of this case study, as was the inclusion of two investigations which demonstrated that creatine supplementation did not negatively impact renal function [ 52, 53]. The dosage of creatine during the maintenance phase, which was also ignored, was only slightly higher than the daily creatine intake of a typical omnivore’s dietary intake, or in terms of food, a large hamburger or steak per day (meat contains about 0.7 g of creatine / 6 oz. serving; see [ 54]). In response to this case study, two separate teams of experts in creatine metabolism wrote letters to the editor of Lancet [ 53, 55]. However, the notion that creatine supplementation leads to kidney damage and/or renal dysfunction gained traction and momentum. Greenwood M, Farris J, Kreider R, Greenwood L, Byars A. Creatine supplementation patterns and perceived effects in select division I collegiate athletes. Clin. J. Sport Med. 2000;10:191–4.