As a mom of two teenagers participating in sports, a sports dietitian, and a woman who optimizes my own workouts and cognition, I can understand the confusion regarding supplements and the concern of parents when their teen comes home with supplements or asks to get them. You may have heard the pros, the cons and still aren’t sure about the safety.
Here is the information you need to know to make an informed choice.
Lately, creatine has made its way through many sports, especially soccer due to fairly recent research in elite soccer athletes. Ask almost any high school athlete if they have heard of creatine and likely they have. It isn’t uncommon for coaches to suggest the supplement. My son came home from lacrosse practice with “Hey, Mom. Coach said we need to take creatine.” It’s important to know the details of what kind, how much, how often, how to purchase it safely, and any potential side effects. I will say…
Creatine is one of the most well-researched supplements and is associated with several benefits, including:
- Potential protection and recovery from concussions
- Improvements in high-intensity exercise performance
- Improved training adaptations
- Enhanced recovery post-exercise
- Injury prevention and/or reduction of injury severity
- Thermoregulation
WHAT IS CREATINE?
The first two terms that you will find when you Google creatine are “amino acid” and “muscles”. The second thing you might read about is “building muscle” and “enhancing performance”.
Let’s start with or review the basics.
Creatine is a small molecule that helps supply energy to your muscles. We can get half of our needs from our diet (foods such as dairy, red meat, poultry, legumes and seafood), and the other half of our needs, our body can produce. Creatine is synthesized in the kidney, liver and pancreas from the amino acids L-arginine, glycine and L-methionine. Once creatine is synthesized, it is stored as phosphocreatine in the skeletal muscle, heart, brain, and other tissues. The human body can make 1g of creatine per day. Intramuscular creatine stores in vegetarians are typically lower, as they do not obtain creatine through their diet, and they may experience a greater response to supplementation.
Amino acids are the building blocks in the human body. Creatine is a derivative of amino acids. We need them for critical roles like regulating our immune function and building muscle. Twenty amino acids are needed, but only nine are classified as essential – our body cannot make them, we must get them from our diet.
“Supplemental creatine is not a band-aid solution. Strategic
Nicole Roesch, RDN, LDN, CPT
nutrition, training, and sleep practices are essential for each
of these performance-related outcomes.
You cannot “out-supplement” the foundational level actions.”
Creatine: The Supplement
Creatine is a dietary supplement that can be found in most health food stores and online. More and more influencers and wellness industry professionals are promoting it. Creatine is relatively safe for healthy people. However, people with chronic renal disease or using potentially nephrotoxic medications should not use creatine.
Creatine increases the intramuscular creatine stores and can improve exercise capacity and training adaptations – meaning better training, and better performance by delivering improvements in strength and power output.
Recently, creatine has also been established as a legitimate supplement related to rehabilitation and neuromuscular disorders with growing evidence for some therapeutic efficacy in thermoregulation, concussions, head trauma, autism, and neuroprotection.
The most commonly used form of creatine is creatine monohydrate. This form of creatine is the cheapest, most effective, and dissolves most easily in water.
HOW IS IT TAKEN – ADULTS:
The typical recommended dose on the label is 5 grams. Creatine supplementation can involve an optional loading phase of 20 grams per day (divided into four doses) for 5-7 days. This method can lead to digestive issues in some individuals and doesn’t necessarily provide any unique benefits that an individual wouldn’t get by taking the maintenance dose of 3-5 grams per day. Larger athletes may need to ingest 5-10 grams daily to maintain muscle creatine saturation.
Creatine loading can help saturate the muscle at a slightly quicker rate and can help increase lean mass and water content faster. Additionally, some brain health and cognitive benefits have been seen with creatine loading doses up to 20 g/day for 7 days. Clients who are working towards a very specific timeline for a weight gain goal or who want to supplement with creatine for brain and cognitive benefits should work on a plan with their sports dietitian to figure out if creatine loading is appropriate for their goals.
Should women take creatine?
For women, creatine can be particularly helpful. That’s because women naturally have lower creatine stores than men, so supplementation may offer even greater benefits. In pre-menopausal women, creatine has been shown to improve strength and power when taken in both loading and maintenance doses. And despite common myths, creatine does not cause unwanted weight gain or increase fat mass — especially when taken without added sugars or carbs.
In post-menopausal women, the research is promising too. When combined with resistance training, creatine can help preserve lean muscle mass and strength. It may even help reduce the breakdown of muscle and bone — which is key since women face a higher risk of osteoporosis with age.
Are there side effects?
Stomach cramps can occur with inadequate hydration. If diarrhea and/or nausea occurs, the dose can be spread out throughout the day. Taking it with meals may also help.
How and when should it be taken?
There is no scientific consensus on the optimal time to take creatine (pre-, during, or post-exercise) for greater performance benefits. Creatine’s effects are enhanced by exercise due to increased muscle blood flow, so taking creatine at any of these times (pre-, during, or post-exercise) may be ideal. Ultimately, the best timing is when consistency can be maintained. Consider also that supplementation not only involves this daily use but also accounting for it in your budget. Your dietitian can work with you on taking breaks from supplementation when performance and body composition are less critical for specific sports or activities, which can be a useful cost-saving strategy.
Common Myth: Creatine is not a steroid
Creatine is not a steroid nor does it act like one, as it has a completely different molecular structure and physiological mechanism of action. I have heard parents and their concerns that it is similar to a steroid but rest assured, it is not.
If your teen has their sight on college athletics, know that creatine is not banned by any major athletic governing body or organization. However, you should always ensure that the brand of supplements is Certified for Sport®. Products that carry the NSF label certify that “what is on the label is in the bottle and that the product does not contain unsafe levels of contaminants, prohibited substances or masking agents.”
Common Myth: Creatine will make me gain weight
A common concern with creatine supplementation is water retention, or what many will call weight gain. It must be clear that an increase in water weight is not the same as an increase in fat mass. Since creatine is osmotically active, it naturally pulls water into muscle cells, increasing intracellular water retention, meaning it pulls water into muscle cells.
During the initial loading phase—when a higher dose is taken for 5-7 days to quickly saturate muscles—this effect can lead to temporary water retention and slight weight gain (the number on the scale). However, this water weight typically stabilizes within a few weeks as the body adjusts.
While the initial fluid retention may cause a gain in water weight, it also enhances muscle hydration, which can improve performance during intense workouts. Staying well-hydrated and following proper dosing guidelines can help minimize any temporary effects.
RECOMMENDATIONS FOR TEENS
Research in the adolescent population is limited to only a few controlled investigations examining the ability of creatine supplementation to impact measures of exercise performance. “All available studies to date have been completed in only two types of athletes: swimming (n = 5) and soccer (n = 4).” (Jagim AR, Kerksick CM. 2021).
The International Society of Sports Nutrition position stand on creatine states that:
“If proper precautions and supervision are provided, creatine monohydrate supplementation in children and adolescent athletes is acceptable and may provide a nutritional alternative with a favorable safety profile to potentially dangerous anabolic androgenic drugs.
However, we recommend that creatine supplementation only be considered for use by younger athletes who:
(a) are involved in serious/competitive supervised training;
(b) are consuming a well-balanced and performance-enhancing diet;
(c) are knowledgeable about the appropriate use of creatine; and
(d) do not exceed recommended dosages.”
Supplements in adolescents should be supervised and considered in the entire training picture and remember:
- A supplement is not a magic pill and will not give the desired effect without other factors such as diet, training, and sleep.
- Supplements aren’t intended to replace wholesome food. They cannot replicate the complex nature of a wide variety of nutrients found in foods.
Advice from a Registered Dietitian
My professional opinion and my “mom opinion” say, “don’t go down the supplement road so quickly.” Consider your teens’ age, commitment to the sport, and maturity level. Identify the reasons why they are so interested and have a conversation. Supplements are just that – a supplement to a healthy dietary pattern so get the basics right first. There is little point in taking a supplement to imprive performance when eating fast food and not getting adequate sleep.
If your teen is in a competitive sport and heading for NCAA sports, it may be something to discuss for a competitive advantage. If your teen wants to use it recreationally, I would think twice. Until the age of 21, children are still growing physically and mentally. There is ALWAYS room to clean up your diet first and to focus on training. Nothing beats a solid foundation.
Key Take-a-Ways:
- Creatine is extensively researched and is well-supported as one of the most effective dietary supplements available. However, “while the authors of this article agree, and would like to publicly state that an absence of self-reported adverse events by study subjects is not a confirmation of safety, it does support the hypothesis that creatine is likely safe for this population (adolescents).”
- Nonetheless, safety studies in youth and adolescent populations using randomized controlled trial designs are desperately needed to help continue building the safety profile for creatine supplementation among these younger age groups.” (Jagim & Kerksick, 2021)
- As the name suggests, supplements are designed to “supplement” one’s diet. They’re not meant to replace an athlete’s food intake or become the primary source of nutrients. Make sure your child first gets the majority of their energy and nutrient needs through food. There are NO QUICK FIXES.
- Always ask a trusted source FIRST before trying supplements.
SOURCES
Jagim AR, Kerksick CM. Creatine Supplementation in Children and Adolescents. Nutrients. 2021 Feb 18;13(2):664. doi: 10.3390/nu13020664. PMID: 33670822; PMCID: PMC7922146.
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