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Health & Exercise Forum

Creatine in Strength Training

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Mar 8, 2010

Dr. Mackarey's Health & Exercise ForumThank you for reading “Health & Exercise Forum!” Special thanks to those corresponding with constructive comments and sage questions. The column should reflect your interests. This column is in response to an inquiry of one such reader on the training supplement, creatine. A few weeks ago, I received a request from a concerned mother of a local high school football player. Her son is spending the winter and spring weight training for next football season. He has been using protein shakes and wants to use creatine supplements to improve his size and strength. His mother is concerned and asked if I would address the use of creatine in strength training and make recommendations based on the literature.

Creatine History

As long as I can remember, young athletes would take or do anything that they believed would improve their speed, strength, agility and athletic edge in order to succeed in sports. Running with weights wrapped around the ankles, drinking raw eggs and whole milk, and consuming copious amounts of beef, pork, and chicken were not unusual. Today, it may not be much different. However, the products do not come from our kitchen cabinet and tremendous misinformation is associated with it. Creatine is one example that was purported to enhance performance as early as the 1970’s but only gained popularity in the 1990’s. 40% of all college athletes and 50% of professional athletes admit to using creatine at some point, despite a lack of scientific evidence to support its effectiveness or safety.

What is Creatine?

Creatine is a natural substance that turns into creatine phosphate in the body. Creatine phosphate helps produce adenosine triphosphate (ATP), which provides energy for muscles to contract. While the body produces some creatine, it can also be found in foods rich in protein such as meat and fish. Manufacturers claim that creatine use will improve strength, increase lean muscle mass and aide in the recovery from exercise induced fatigue.

Creatine Research

While creatine is popular among young people due in part to its availability, very little research has been done in people under 18 years of age.  Even in the few studies conducted on adults, the results regarding efficacy are mixed. Some studies show that creatine may improve strength performance due to the recovery cycle of ATP. In theory, the use of creatine is purported to allow one to recover more quickly from exercise. For example, shortly after lifting heavy weights to failure, a quick recovery might allow the weight lifter to lift an additional set of repetitions to increase the duration of intensive training. Therefore, based on this theory, one must work out to complete failure during training to benefit from creatine. However, it is important to remember, there is no evidence that this purported benefit is realized in performance improvement. Furthermore, no studies support the notion that it improves performance in endurance sports. Also, research does show that not all users are affected by creatine the same way. Most users fail to find any benefit at all. More concerning to this author is the fact that there are no guidelines for safety or disclosure of side-effects from long term use. Make no mistake, based on the research and current wisdom, CREATINE IS AN UNPROVEN TREATMENT SUPPLEMENT!

Manufacturers Recommended Usage

If one decides that creatine is a product they would like to use, despite the lack of evidence for its effectiveness, there are recommendations that one should follow for proper use. But, there is no established dose.

Remember, an average adult in the United States receives 1 to 2 grams of creatine each day from a normal, well-balanced diet. Creatine is naturally found in meat, poultry and fish. Manufacturers recommend 10 to 30 grams per day with a maintenance dose of 2 to 5 grams per day for athletic performance. Creatine is available in many forms; tablets, capsules and powder. It should be kept in a cool, dry place out of direct sunlight.

Creatine Side Effects

There are many reported side effects associated with creatine use such as; water retention, nausea, diarrhea, cramping, muscle pain and high blood pressure. It is recommended that one use large quantities of water when taking creatine to prevent dehydration. It may be very dangerous to use creatine when dehydration or weight loss is associated with an activity such as wrestling or summer sessions during football.  Furthermore, some studies show that large amounts of carbohydrates may increase the effects of creatine and caffeine may decrease the effects. Users are warned that using creatine with stimulants such as caffeine and guarana (a Brazilian plant extract similar to caffeine found in energy drinks) can lead to serious cardiac problems. The effects of creatine supplements on the many organ systems of the body are unknown. Furthermore, it is also not known how it may interact with other supplements, over-the-counter medications and prescription drugs.

Creatine Conclusion

I had the opportunity to interview Coach Jack Henzes, legendary coach of the very successful Dunmore High School football program. It is obvious why he has enjoyed many winning seasons. He insists that his players avoid supplements and practice good nutrition with intensive strength training. He has signs posted in the gym that clearly state, “Creatine is NOT Permitted!” To insure that his players are not influenced by poor practices and supplements available in gyms, he requires all players to exercise under the supervision of the coaching staff. His son, local orthopedic surgeon, Jack Henzes, MD has counseled his father on this and other matters related to dietary supplements and has served as a medical reviewer for this column.

In conclusion, creatine is a popular, easily available supplement purported to improve strength, endurance and performance in athletes. However, the research and current wisdom clearly fails to support these claims. CREATINE IS AN UNPROVEN TREATMENT SUPPLEMENT!

Sources: University of New England; Medicine & Science in Sports & Exercise; Jack Henzes, Sr., Football Coach, Dunmore High School

Medical Reviewer: Jack Henzes, MD, orthopedic surgeon, Scranton Orthopaedic Specialists

Visit your doctor regularly and listen to your body.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.