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Review
. 2017 Jun 13:14:18.
doi: 10.1186/s12970-017-0173-z. eCollection 2017.

International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine

Richard B Kreider  1 , Douglas S Kalman  2 , Jose Antonio  3 , Tim N Ziegenfuss  4 , Robert Wildman  5 , Rick Collins  6 , Darren G Candow  7 , Susan M Kleiner  8 , Anthony L Almada  9 , Hector L Lopez  4   10
Affiliations
Review

International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine

Richard B Kreider et al. J Int Soc Sports Nutr. .

Abstract

Creatine is one of the most popular nutritional ergogenic aids for athletes. Studies have consistently shown that creatine supplementation increases intramuscular creatine concentrations which may help explain the observed improvements in high intensity exercise performance leading to greater training adaptations. In addition to athletic and exercise improvement, research has shown that creatine supplementation may enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and concussion and/or spinal cord neuroprotection. Additionally, a number of clinical applications of creatine supplementation have been studied involving neurodegenerative diseases (e.g., muscular dystrophy, Parkinson's, Huntington's disease), diabetes, osteoarthritis, fibromyalgia, aging, brain and heart ischemia, adolescent depression, and pregnancy. These studies provide a large body of evidence that creatine can not only improve exercise performance, but can play a role in preventing and/or reducing the severity of injury, enhancing rehabilitation from injuries, and helping athletes tolerate heavy training loads. Additionally, researchers have identified a number of potentially beneficial clinical uses of creatine supplementation. These studies show that short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly. Moreover, significant health benefits may be provided by ensuring habitual low dietary creatine ingestion (e.g., 3 g/day) throughout the lifespan. The purpose of this review is to provide an update to the current literature regarding the role and safety of creatine supplementation in exercise, sport, and medicine and to update the position stand of International Society of Sports Nutrition (ISSN).

Keywords: Adolescents; Athletes; Children; Clinical applications; Ergogenic aids; Muscle power; Muscular strength; Performance enhancement; Safety; Sport nutrition.

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Figures

Fig. 1
Fig. 1
Chemical structure and biochemical pathway for creatine synthesis. From Kreider and Jung [6]
Fig. 2
Fig. 2
Proposed creatine kinase/phosphocreatine (CK/PCr) energy shuttle. CRT = creatine transporter; ANT = adenine nucleotide translocator; ATP = adenine triphosphate; ADP = adenine diphosphate; OP = oxidative phosphorylation; mtCK = mitochondrial creatine kinase; G = glycolysis; CK-g = creatine kinase associated with glycolytic enzymes; CK-c = cytosolic creatine kinase; CK-a = creatine kinase associated with subcellular sites of ATP utilization; 1 – 4 sites of CK/ATP interaction. From Kreider and Jung [6]
Fig. 3
Fig. 3
Role of mitochondrial creatine kinase (mtCK) in high energy metabolite transport and cellular respiration. VDAC = voltage-dependent anion channel; ROS = reactive oxygen species; RNS = reactive nitrogen species; ANT = adenine nucleotide translocator; ATP = adenine triphosphate; ADP = adenine diphosphate; Cr = creatine; and, PCr = phosphocreatine. From Kreider and Jung [6]
Fig. 4
Fig. 4
Approximate muscle total creatine levels in mmol/kg dry weight muscle reported in the literature for vegetarians, individuals following a normal diet, and in response to creatine loading with or without carbohydrate (CHO) or CHO and protein (PRO). From Kreider and Jung [6]
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