Creatine Monohydrate by Ray Sahelian, M.D. - Creatine monohydrate and safety with kidney health

See creatine for more up to date information. Subscribe to a FREE, monthly Supplement Research Update newsletter. We email a brief abstract of 4 to 6 studies on supplements and natural medicine topics, including creatine monohydrate safety, and their practical interpretation by Ray Sahelian, M.D.

Creatine and kidney health - Does creatine monohydrate harm kidney function or cause danger to the kidneys?
We get questions from parents concerned about the use of creatine monohydrate by their teenage sons and daughters. Here is a typical question followed by some studies regarding the role of creatine monohydrate and kidney safety or harm. The research with creatine monohydrate and renal damage is not clear, but to be on the safe side it is important not to take this supplement every day but rather 3 or 4 days a week with a full week off each month.

Q. My son is 16 years old and would like to take creatine monohydrate supplement as he is on a weight lifting program. I have heard some negative things such as it may affect your kidneys.
   A. If teenagers were to use creatine monohydrate supplement for weight lifting, the dosage should be limited to 3 grams a day with 2 days off each week and a full week off each month, and a full month off every 3 months. Your son's doctor should approve of this treatment. We have not had any reports of kidney harm when creatine monohydrate is limited to these dosages and when breaks are taken as we advise. However there have been reports in the medical literature of individuals having causing harm to the kidneys when using high dosages of creatine along with many other supplements.

Q. I manage a health food store and a customer, older gentleman, bought some creatine and wanted to know if it would affect his kidneys. His doctor told him he had some kidney problems but he didn't know what it was. I suggested that he take small amounts. Your input would be very helpful.
   A. Research with creatine monohydrate and renal damage is not clear, but to be on the safe side, particularly in someone who has kidney problems, it is important not to take this supplement every day but rather 3 or 4 days a week with a full week off each month. We also suggest the daily dosage not to exceed 1 or 2 grams. He should have approval by his doctor.   

Acute renal failure in a young weight lifter taking multiple food supplements, including creatine monohydrate.
 J Ren Nutr. 2006 Oct;16(4):341-5. Thorsteinsdottir B, Grande JP, Garovic VD. Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55902, USA.
We report a case of a healthy 24-year-old man who presented with acute renal failure and proteinuria while taking creatine monohydrate and multiple other supplements for bodybuilding purposes. A renal biopsy showed acute interstitial nephritis. The patient recovered completely after he stopped taking the supplements. Recently there have been case reports of renal dysfunction, including acute interstitial nephritis, associated with the use of creatine monohydrate.

Effect of oral creatine supplementation on urinary methylamine, formaldehyde, and formate.
Med Sci Sports Exerc. 2005 Oct;37(10):1717-20. Higher Institute of Physical Education and Physical Therapy, Free University of Brussels, Brussels, Belgium.
Twenty young healthy men ingested 21 g of creatine monohydrate daily for 14 consecutive days. Oral creatine monohydrate supplementation increased plasma creatine content 7fold and urine output 141 fold with no effect on creatinine levels. Twenty-four-hour urine excretion of methylamine and formaldehyde increased, respectively, 9-fold and 4.5-fold after creatine feeding, with no increase in urinary albumin output. Short-term, high-dose oral creatine supplementation enhances the excretion of potential cytotoxic compounds, but does not have any detrimental effects on kidney permeability. This provides indirect evidence of the absence of microangiopathy in renal glomeruli.

Few adverse effects of long-term creatine monohydrate supplementation in a placebo-controlled trial.
 Int J Sports Med. 2005 May;26(4):307-13. Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH.
Department of Neurology, University Medical Centre Utrecht, The Netherlands.
We performed a double-blind, placebo-controlled trial of creatine monohydrate in patients with the neurodegenerative disease amyotrophic lateral sclerosis, because of the neuroprotective effects it was shown to have in animal experiments. 175 subjects (age = 57 +/- 11 y) were randomly assigned to receive creatine monohydrate 10 g daily or placebo during an average period of 310 days. No significant differences in the occurrence at any time of adverse effects due to creatine supplementation were found. After two months of treatment, oedematous limbs were seen more often in subjects using creatine monhydrate, probably due to water retention. Severe diarrhoea and severe nausea caused 3 subjects in the creatine group to stop intake of creatine, after which these adverse effects subsided. Long-term supplementation of creatine monohydrate did not lead to an increase of plasma urea levels or to a higher prevalence of micro-albuminuria.

Creatine monohydrate for Parkinson's disease
Creatine monohydrate, a supplement sold to improve exercise performance, is being tested to see if helps those with Parkinson's disease. Early research suggests creatine monohydtate supplements might be able to help slow the progression of Parkinson's, an incurable brain disorder that can slowly but steadily paralyze patients. The National Institute of Neurological Disorders and Stroke, one of the U.S. National Institutes of Health, is launching the trial as the first in a series of government-sponsored studies of new Parkinson's treatments. The NINDS will recruit 1,720 people with early-stage Parkinson's disease across the United States and Canada. Patients and doctors alike will not know whether they are getting creatine monohydrate or a placebo. The study is due to last three to five years. Creatine monohydrate may affect the mitochondria -- structures that produce energy inside cells. In mice, creatine was shown to prevent the loss of dopamine-producing brain cells. Palo Alto, California-based Avicena Group, Inc. will provide the purified creatine monohydrate for the trial. The company has also been testing creatine monohydrate against the nerve disorders Huntington's disease and amyotrophic lateral sclerosis, also known as ALS.

Creatine monohydrate and adolescents or teenagers
Q. My son who is just 15 is using creatine against my advice. I would like to ask you about the product as he is developing headaches and my nutritionist has advised against the use of creatine monohydrate product until he is older.
   A. Creatine monohydrate is fine to use by adolescents at a dosage of 3 grams a day five days a week for a maximum of one month with a one or two month break before resuming.

Creatine monohydrate questions
My creatine monohydrate label recommends taking creatine monohydrate one hour before workout. Since this is the time a actually eat my pre workout meal, is it okay to take the creatine monoydrate with my small meal. I have been told to take it on an empty stomach, but I don't know whether thats necessary.
   A. We have found that cratine monohydrate seems to work well no matter when and how it is taken.

Q. I have recently seen ads for Creatine Alpha Keto Glutarate, Creatine Ethyl Ester HCl and Tricreatine Malate. What is the advantage of taking Creatine Alpha Keto Glutarate, Creatine Ethyl Ester HCl and Tricreatine Malate over creatine monohydrate?
   A. At this time hardly any research has been done with Creatine Alpha Keto Glutarate, Creatine Ethyl Ester HCl and Tricreatine Malate. Therefore, I prefer to stay with creatine monohydrate since it works very well.

Q. I am looking into using creatine monohydrate but am unsure as to if i would like to have to use it undefinitly. I want to gain mustle and maybe lose some body fat, but i just am unsure about it. Reading articles, i red that taking creatine monohydrate helps u perform better. Also incresing mustle mass due to more containing more water. And that if u
were to stop the use size would gradually decrease. Would using creatine monohydrate, then stoping the use be a faster and more effective way (whilst being on protein powder pemanitly) of increasing permanent mustle mass as opposed to working out just with protein powders? i ask this as i think if u can get more reps and power at the gym if you use creatine monhydrate, obviously the mustle groeth would be larger during this period, but then once finishing the use will it deflat to an amount where u could had just not bothered with the creatine monohydrate? Is creatine monohydrate worth it in the long run?
   A. We think creatine monohydrate improves muscle mass quicker than not using it, and when someone takes a break from using it, muscle tissue does reduce, but not less than it was before using the creatine monohydrate. When the creatine is restarted, muscle mass comes back very quickly. We think it is worth using it 2 or 3 weeks a month at a low dose of about 3 grams.

Q.  I have just started to supplement creatine monohydrate as an added boost to my workouts. I am curious to know if I can achieve the same results without 'loading;' I particularly am worried that this practice can cause damage to one's kidneys. Consuming 20-25g creatine monohydrate per day over a one week period and then cutting back to 10g per day for the remaining weeks seems to be overdoing it in my opinion. During the 'loading' phase it seems that only so much of the creatine monohydrate (depending on the intensity of the workout) would become saturated into the muscle tissue as creatine phosphate. I have read from other sources that one can see the same results over a longer period of time when they consume no more than 5g per day. I would just like to seek your professional opinion. Also, though cardiac muscle differs from that of skeletal or smooth muscle, have there been any noted cases of enlarged hearts (from water retention) due to creatine monohydrate intake?
   A. Using about 3 grams of creatine monohydrate a day works well too, with hardly any side effects. We have not come across studies of enlarged hearts from creatine monohydrate use, but researchers have not looked into this thoroughly yet.

Q. I bought some cell tech creatine monhydrate products, it said they expired 6 months ago, i was just wondering if it is safe to drink them, they seem fine, they dont look like they are rotten or something, they were sealed up unitl now that I opened them.
   A. We have no idea how Cell Tech manufactures their product or the shelf life. Some supplements can last longer than the date listed on the bottle, others don't, and we can't say about this particular creatine monohydrate product.

Q. I would like to start with appreciating my respects to Dr. Ray Sahelian. I am 24-years-old boy from Turkey. I have recently started to deal with bodybuilding sport. My advisor gave me a starter program and I worked out according to this program and did not take any supplementation. At the end of the month, my advisor change my program and bring me a box of whey protein and I continue my work-out program by administrating whey protein for three months and I am still taking. At this point, I have some doubts about supplements that I would like to use. As I said before I am now using whey protein. But I am chemist and now doing my master study in organic chemistry I am always long standing at the laboratory by carrying out my experiment all day. I would like to continue with creatine monohydrate instead of taking whey protein. Actually what I need is not taking the mass as weight and what I need is to get immediate energy while working. however I have some doubts about creatine monohydrate side effect. My advisor recommend me to take creatine monohydrate as long as I have to drink at least 4 liter water along with taking creatine (I think in order to protect kidney) I am really confused about taking this supplement. I have read many positive and negative things about creatine monohydrate on your site and from different sources. Please help to overcome my confusion is it right to take such kinds of creatine monohydrate supplement or do I make badness to my body ? Thank you very much to prepare such a useful site for people.
   A. Both whey protein and creatine monohydrate supplements are useful for muscle growth. Large doses are not needed, and if the creatine monohydrate dose is limited to 3 grams a day, a glass of extra water is all that is needed and there should not be any problems to the kidneys. It is a good idea to take one or two days off each week and one week off every two months.

Q. What is your opinion on glycocyamine, it is supposed to be a creatine monohydrate precursor and good for muscle growth?
   A. I don't have a strong opinion on this nutrient yet, I am awaiting more research.

Q. Which is better, creatine monohydrate or creatine ethyl ester?
   A. Almost all human studies have been done with creatine monohydrate. We are not aware of any significant research done in humans with creatine ethyl ester supplements. We are also not aware of any research comparing creatine monohydrate to creatine ethyl ester. Therefore, as of November 2007 we prefer to use creatine monohydrate since it works well, very well.

Q. I would like to ask that is there a way i can prevent loss in muscle mass after i stop taking creatine monohydrate? I just want to take it for a month and have never used any supplement before.
   A. One way is to continue working out with weights and to take protein supplements, such as whey or soy protein. Another option is to use creatine monohydrate supplement one week a month as a maintenance.

Q. I take creatine monohydrate 5 times a week with 2 day rest. My question is how often do I have to work out? Like every day when I take creatine monhydrate, or that's my question.
   A. There is no set number of times you have to work out when you take creatine monohydrate supplement. However, if you work out every other day or even 20 minutes every day it can help you gain muscle mass.