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Are there any concerns or considerations?

There is no evidence of systematic serious adverse effects related to creatine monohydrate supplementation. Speculation and anecdotes about muscle, renal, and thermoregulatory dysfunction are not supported with research or post-marketing surveillance.1, 13 However, there are some implications of creatine supplementation that warrant discussion, including acute weight gain and gastrointestinal tract distress.

Rapid weight gain

  • As carbohydrate ingestion and increased muscle glycogen is associated with an acute increase in body mass secondary to increased body water, increased creatine ingestion and muscle creatine is also associated with weight gain/increased body water. However, with creatine supplements, this increase in body mass is maintained as long as muscle creatine remains elevated. Following cessation of creatine supplementation, muscle creatine levels, and subsequently body mass, decrease slowly to normal over 4 to 6 weeks’ time. Although this may only be a maximum of 1 or 2 kg, this could be problematic for athletes attempting to “make weight”.
  • Creatine supplementation offers a metabolic advantage but could present a biomechanical disadvantage for some athletes. In theory, body weight supported sports (e.g. running) could be negatively impacted by creatine supplementation. It appears these concerns are unfounded, as studies have showed improved running and swimming performance, but weight gain in some sports such as pole vaulting, in theory, could present a challenge.

Gastrointestinal tract distress

  • Some people may experience mild, temporary gastrointestinal (GI) upset during supplementation, although this is anecdotal, and not widely reported in the literature.
  • Avoiding the loading phase in favour of the lower-dose, longer-duration supplementation protocol, ingesting creatine with meals, not ingesting creatine at the same time as high-fibre foods or supplements that are known to increase GI disturbances (e.g. sodium bicarbonate) are all sensible decisions to help avoid GI upset.
  • As with any dietary supplement, experimentation should be conducted in the off-season.

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