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In their quest to run further, jump higher, and outlast the competition, many athletes have turned to a variety of performance-enhancing drugs and supplements. Creatine is the most popular of these substances, believed by some to enhance muscle mass and help athletes achieve bursts of strength.

Part of the reason for creatine's popularity might be its accessibility. Creatine powder, tablets, energy bars, and drink mixes are available without a doctor's prescription at pharmacies, supermarkets, health and nutrition shops and over the internet.

The European health regulator EFSA has approved a health claim for creatine that it increases physical performance in successive bursts of short-term, high-intensity exercise.

However, this claim is only approved for food that provides a daily intake of 3g of creatine, and which targets adults performing high-intensity exercise

What is creatine?

Creatine is a natural substance that turns into creatine phosphate in the body. Creatine phosphate helps make a substance called adenosine triphosphate (ATP). ATP provides the energy for muscle contractions.

The body produces some of the creatine it uses. It also comes from protein-rich foods such as meat or fish.

How is creatine used?

In the 1970s, scientists looked at taking creatine in supplement form to enhance physical performance. In the 1990s, athletes started to catch on, and creatine became a popular sports supplement.

Creatine was thought by some to improve strength, increase lean muscle mass, and help the muscles recover more quickly during exercise. This muscular boost may help athletes achieve bursts of speed and energy, especially during short bouts of high-intensity activities such as weight lifting or sprinting.

Despite the popularity of creatine among young people, there has been very little research conducted in children under the age of 18. Of those studies, a few have suggested a positive effect but the overall evidence is inconclusive.

Researchers are studying whether creatine might also be useful for treating certain health conditions caused by weakened muscles, including:

Creatine is also being studied as a way to lower cholesterol in people with abnormally high levels. Although early research has been promising, it's too early to say for sure whether creatine is effective for any of these conditions and more research is needed.

How safe is creatine?

Just because creatine is natural, doesn't necessarily mean that it is safe. Supplements aren't held to the same standards as other medication, which means you can't always know exactly what's in your supplement, or in what amounts.

Researchers still don't know the long-term effects of taking creatine supplements, especially in young people. Adolescents who take creatine often do so without their doctor's advice, which can cause them to take more than the recommended dose.

The EFSA says provided high purity creatine monohydrate is used in foods for particular nutritional uses, consumption of doses of up to 3g/day of creatine supplements is unlikely to pose any risk.

Although most healthy people can take it without any problems, creatine can, in rare cases, have adverse effects, particularly when used in excess. Side effects can include:

Certain drugs, including cimetidine, non-steroidal anti-inflammatories ( NSAIDs), and diuretics, can have potentially dangerous interactions with creatine.

Taking the stimulants caffeine and ephedra with creatine can increase the risk of side effects.

Creatine isn't recommended for people with kidney or liver disease, or diabetes. Others who should avoid taking it are children under the age of 18 and women who are pregnant or breastfeeding. Also don't use creatine if you are taking any medication or supplement that could affect your blood sugar, because creatine may also affect blood sugar levels.

If you do take creatine, drink enough water to prevent dehydration.

No matter what your personal health circumstances are, let your doctor know before you take creatine or any other supplement.

WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on September 19, 2017

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