Freire Royes LF, Cassol G. The Effects of Creatine Supplementation and Physical Exercise on Traumatic Brain Injury. Mini Rev. Med. Chem. 2016;16:29–39. Forbes S, Candow D, Krentz J, Roberts M, Young K. Body fat changes following creatine supplementation and resistance training in adults > 50 years of age: A meta-analysis. Journal of Functional Morphology and Kinesiology. 2019;4:62. In summary, creatine supplementation does not increase fat mass across a variety of populations. Is a creatine ‘loading-phase’ required? Manufacturers also make creatine supplements. Some people take creatine supplements because they work out a lot or don’t get enough creatine in their diet. Creatine supplements exist as:

Hayashi AP, Solis MY, Sapienza MT, Otaduy MC, de Sa Pinto AL, Silva CA, Sallum AM, Pereira RM, Gualano B. Efficacy and safety of creatine supplementation in childhood-onset systemic lupus erythematosus: a randomized, double-blind, placebo-controlled, crossover trial. Lupus. 2014;23:1500–11.

Balestrino M, Sarocchi M, Adriano E, Spallarossa P. Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease. Amino Acids. 1955-1967;2016:48. Myers V. C.; Fine, M. S. The creatine content of muscle under normal conditions. Its relation to the urinary creatinine. J Biol Chem. 1913;14:9–26. Increase anabolic hormones. Anabolic hormones contribute to growth and tissue repair. They include insulin, human growth hormone (hGH), estrogen and testosterone.

Kuehner C. Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr. Scand. 2003;108:163–74. Smaller, daily dosages of creatine supplementation (3-5 g or 0.1 g/kg of body mass) are effective. Therefore, a creatine ‘loading’ phase is not required. One might suggest that eight weeks or less of creatine supplementation is insufficient to arrive at a definitive conclusion regarding creatine’s effect on fat mass. Nonetheless, there are several investigations that have used much longer treatment periods. For example, healthy resistance-trained males were randomly assigned in a double-blind fashion to supplement with creatine (i.e., 20 g/day for 1 week followed by 5 g/day for 11 weeks) or placebo [ 93]. Lean body mass and muscle fiber size increased; percent body fat and fat mass were unaffected over the 12-week training period [ 93]. In older males (~70 yrs), 12 weeks of creatine supplementation during resistance training had no effect (compared to placebo) on fat mass [ 94]. Furthermore, Gualano et al. assessed the effects of creatine supplementation (24 weeks), with and without resistance training, in older females. Results showed no effect from creatine on fat mass [ 95]. Candow et al. [ 96] examined the effects of creatine supplementation in older adults (50-71 years) over a 32-week treatment period. Study participants were randomized to supplement with creatine or placebo before or after resistance training (3 days per week). There was an increase over time for lean tissue and strength with a decrease in fat mass. From a clinical perspective, children with acute lymphoblastic leukemia who supplemented with creatine (0.1 g/kg/day) for two sequential periods of 16 weeks experienced a significant reduction in fat mass. In contrast, the children who did not consume creatine gained fat mass [ 97]. In two studies involving postmenopausal women, Lobo et al. [ 98] found no change in absolute or relative body fat from one-year of low-dose creatine supplementation. Furthermore, two years of creatine supplementation also had no effect on fat mass [ 99]. Rawson ES, Clarkson PM, Tarnopolsky MA. Perspectives on Exertional Rhabdomyolysis. Sports Med. 2017;47:33–49.Deldicque L, Decombaz J, Zbinden Foncea H, Vuichoud J, Poortmans JR, Francaux M. Kinetics of creatine ingested as a food ingredient. Eur. J. Appl. Physiol. 2008;102:133–43. Talk to a healthcare provider before you take creatine. They’ll likely conduct a physical examination and ask questions, including:

Hausmann ON, Fouad K, Wallimann T, Schwab ME. Protective effects of oral creatine supplementation on spinal cord injury in rats. Spinal Cord. 2002;40:449–56. Child, R.; Tallon, M. J. In In Creatine ethyl ester rapidly degrades to creatinine in stomach acid; International Society of Sports Nutrition 4th Annual Meeting; Las Vegas, NV, 2007; .Kreider RB, Melton C, Rasmussen CJ, Greenwood M, Lancaster S, Cantler EC, Milnor P, Almada AL. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol. Cell. Biochem. 2003;244:95–104. Robinson SM, Reginster JY, Rizzoli R, Shaw SC, Kanis JA, Bautmans I, Bischoff-Ferrari H, Bruyere O, Cesari M, Dawson-Hughes B, Fielding RA, Kaufman JM, Landi F, Malafarina V, Rolland Y, van Loon LJ, Vellas B, Visser M, Cooper C. ESCEO working group Does nutrition play a role in the prevention and management of sarcopenia? Clin. Nutr. 2018;37:1121–32.