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Creatine Prescription

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By: 
Dr. Dan Reardon
M.B.Ch.B, B.Sc(Hons)

Creatine is a bodybuilder’s weapon for muscle mass, power and performance—but could it also help improve your health?

Creatine appeared in health-food stores in North America in 1995 when Bill Phillips, Anthony Almada, and Ed Byrd brought it to market. We’re around 20 years into the commercial use of creatine, so why is creatine’s safety questioned even now? The fact is, in 20 years, there haven’t been any reported adverse effects when creatine has been used as recommended. Thankfully, many researchers have wondered whether creatine could in fact have medical uses, so the question “Is creatine safe?” has become “Can creatine supplementation be therapeutic?” Creatine supplementation is good for muscles, so what conditions would likely benefit from creatine supplementation? Let’s consider muscle disorders.

HOW MUCH CREATINE?

So-called experts will talk about a range of dosages, but my angle is therapeutics. In my opinion, even with conditions such as diabetes, the safe use of creatine is acceptable. I wouldn’t exceed more than 2 to 3 grams per day, which is in keeping with research, even for people with pre-existing renal problems.1

CREATINE REDUCES REACTIVE OXIDATIVE SPECIES

It would be very easy to get sucked into journal after journal and some very deep-seated science about the effects that creatine has on skeletal muscle, but there are only really two important things to note. The first is that creatine supplementation has been shown to reduce the production of reactive oxidative species (ROS). This is important because ROS can lead to changes in the electron transfer chain (energy production), increased protein degradation and an increase in intracellular calcium.2 This can lead to problems ranging from muscle cell inflammation to death, particularly in people with muscle disorders or myopathies. So if a product can reduce muscle catabolism and is safe, why wouldn’t the medical world want to use it? The evidence suggests that creatine supplementation can do this, even when Duchenne muscular dystrophy models are tested.3,4

MUSCLE DISEASES

Dermatomyositis is a condition which leads to inflammation in the muscles and skin. The fact is, creatine is used for many muscular diseases and has been shown to be effective in people with idiopathic inflammatory myopathies, as shown in a Cochrane systematic review (the best type of review) published in February 2011.5 In researching whether dermatomyositis could fit into that criteria, I found a study that showed that oral creatine supplements combined with home exercise improved functional performance without significant adverse effects in patients with polymyositis or dermatomyositis. They appear safe, effective, and inexpensive.6

CREATINE AND OSTEOARTHRITIS

In the right context, muscle atrophy could be considered a muscle disease. One of the most common conditions that leads to muscle atrophy (other than old age, immobility, etc) is osteoarthritis. Can creatine supplementation help people suffering with osteoarthritis? Some of the key researched benefits of creatine include improved strength, power, and muscle mass. Exercise can improve the symptoms of pain in osteoarthritic joints and can also help reduce weight, which is another factor that can reduce the morbid symptoms of osteoarthritis. Given the benefits of creatine, it’s possible that increasing muscle mass and strength may reduce the symptoms of osteoarthritis in the relevant joint as well.

CREATINE MAY IMPROVE KNEE OSTEOARTHRITIS

In a randomized, double-blind, placebo-controlled trial, postmenopausal women with knee osteoarthritis supplementing with creatine were put through a strength-training program over 12 weeks.7 The women using creatine had a significant improvement in physical function, stiffness, and lower-limb lean muscle mass improvement. Despite these findings, it remains highly unlikely that doctors would recommend a strength-training program followed by a dose of creatine as a treatment for people with arthritic joint conditions. As a doctor, you prescribe pain killers, advise on weight loss, and maybe refer to a rheumatologist or orthopedic surgeon for joint replacement consideration; you probably wouldn’t be insured to tell people to use creatine.

FRACTURE HEALING

We can even consider bone density when talking about muscle disease. The best way to improve bone density is to promote bone activity at the site of muscle insertions. So as muscles get bigger and stronger, they exert a stronger pull on bones. Given the evidence that shows creatine can increase lean muscle mass, this will likely lead to a greater tension through bone as a result of muscle pull, and therefore lead to an increase in bone density.8 There is increasing evidence that creatine, in the absence of resistance training, influences bone biology.9,10 This also has massive potential benefits in the medical world, and whenever I think about this concept, I always wonder if creatine could in fact improve or speed up fracture healing.

FINAL THOUGHTS

One of the major issues I have is that as a practicing doctor, I can’t recommend the use of products such as creatine. Wearing my hat as an exercise professional, I can, but that’s an entirely different arena. I’ve touched upon muscular disease and mentioned osteoarthritis, and the current research is also finding evidence for the use of creatine for such illnesses as neurodegenerative disease. Until medical establishments recognize such supplements as being “safe,” we simply wouldn’t be insured as medical professionals to recommend their use to patients, even with the evidence that exists – that creatine is one of the most researched supplements with the best body of evidence.

Medical References

1. Kim HJ, Kim CK, Carpentier A, Poortmans JR. Studies on the safety of creatine supplementation. Amino Acids. 2011 May;40(5):1409-18.
2. Tarnopolsky MA. Clinical use of creatine in neuromuscular and
neurometabolic disorders. Subcell Biochem. 2007;46:183-204.
3. Menezes LG, Sobreira C, Neder L, Rodrigues-Júnior AL, Martinez JA. Creatine supplementation attenuates corticosteroid-induced muscle wasting and impairment of exercise performance in rats. J Appl Physiol. 2007 Feb;102(2):698-703.
4. Passaquin AC, Renard M, Kay L, et al. Creatine supplementation reduces skeletal muscle degeneration and enhances mitochondrial function in mdx mice. Neuromuscul Disord. 2002 Feb;12(2):174-82.
5. Kley RA, Tarnopolsky MA, Vorgerd M. Creatine for treating muscle disorders. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD004760. Review.
6. Chung YL, Alexanderson H, Pipitone N, et al. Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment: Six-month, double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007 May 15;57(4):694-702.
7. Neves M Jr, Gualano B, Roschel H, Fuller R, Benatti FB, Pinto AL, Lima FR, Pereira RM, Lancha AH Jr, Bonfá E. Beneficial effect of creatine supplementation in knee osteoarthritis. Med Sci Sports Exerc. 2011 Aug;43(8):1538-43.
8. Chilibeck PD, Chrusch MJ, Chad KE, Shawn Davison K, Burke DG. Creatine monohydrate and resistance training increase bone mineral content and density in older men. J Nutr Health Aging. 2005 Sep-Oct;9(5):352-3.
9. Candow DG, Chilibeck PD. Potential of creatine supplementation for improving aging bone health. J Nutr Health Aging. 2010 Feb;14(2):149-53.
10. Antolic A, Roy BD, Tarnopolsky MA, et al. Creatine monohydrate
increases bone mineral density in young Sprague-Dawley rats. Med Sci Sports Exerc. 2007 May;39(5):816-20.

About Dr. Dan Reardon M.B.Ch.B., B.Sc.(Hons)
Dr. Dan Reardon is an experienced doctor from the UK specializing in emergency medicine, but his entrepreneurial flair and love of fitness, nutrition, and supplements make him a regular fixture in the fitness world. Dr. Dan is featured in a mass of magazine copy throughout the globe; owns a successful social media consultancy business; is the CEO of fitnessinventor.com, the inaugural fitness, nutrition and supplements, questions and answers website, with MUSCLE INSIDER writer Mark Gilbert; and will release his first co-authored book in January 2013. Dr. Dan plugs that gap between the medical and fitness world.

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