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Medscape
4 days ago
- Health
- Medscape
Creatine: Is the Supplement Ready for Clinical Use?
Popular among bodybuilders, creatine supplementation is gaining traction for its potential use beyond athletic performance. Researchers are exploring its clinical role in managing muscular and neurologic disorders, as well as its application in geriatric care. But what evidence supports these broader uses? When is creatine appropriate to recommend, at what doses, and are there contraindications? Medscape's Portuguese edition spoke with several experts to examine how creatine supplementation may benefit patients in clinical practice. Like endogenous creatine, supplemental creatine is converted into phosphocreatine and stored in skeletal muscle, where it plays a critical role in rapid adenosine triphosphate (ATP) replenishment. 'Supplementation helps accelerate muscle recovery by providing an available energy reserve,' explained Beatriz Leite, clinical nutritionist with a PhD in health sciences from the Federal University of São Paulo and a member of the Multiprofessional Committee of the Brazilian Society of Rheumatology, São Paulo, Brazil. The body naturally synthesizes around 1-2 g of creatine daily, and the compound is also present in animal-derived foods. About 1 kg of red meat contains roughly 5 g of creatine — so a 200-g serving provides about 1 g. The typical supplementation dose, ranging from 3 to 5 g/d, is designed to complement both endogenous production and dietary intake to support intramuscular creatine accumulation. Safety Profile A recent meta-analysis of 685 clinical trials concluded that creatine supplementation is not linked to clinically significant adverse effects and is generally well tolerated — particularly at recommended doses of 3-5 g/d or 0.1 g/kg/d. 'Creatine monohydrate is essentially identical to what the body produces. It's metabolized the same way, and I see no meaningful risk of side effects. It's a very safe supplement,' said Andréa Fioretti, head of the Department of Sports and Exercise Endocrinology at the Brazilian Society of Endocrinology and Metabolism. Concerns have lingered about creatine's potential to elevate serum creatinine levels and place strain on liver or kidney function. However, a meta-analysis indicates that creatine does not significantly alter serum creatinine. 'Creatine is excreted by the kidneys as creatinine. So when a patient supplements with creatine, the apparent rise in serum creatinine is usually a false signal — not an indicator of renal damage,' Fioretti explained. Supporting this, a study from the University of São Paulo found that creatine supplementation actually reduced levels of cystatin C, further reinforcing the absence of renal harm. Nonetheless, Leite advised individualized assessment. 'In patients with renal or hepatic conditions, more careful evaluation is essential. Supplementation should only be considered if there's a clear therapeutic benefit,' she noted. Gustavo Starling Torres, MD, sports medicine physician and director at the Brazilian Society of Exercise and Sports Medicine, agreed: 'The supplementation protocol should always be individualized, taking into account therapeutic goals, patient tolerance, and overall clinical condition.' In such cases, renal function testing may be advisable. 'If there's concern about kidney function, a creatinine test can help guide decisions,' said Fioretti. 'This ensures the supplement is used in patients who genuinely need it — those with muscle mass deficiencies.' Michele Trindade, PhD, adjunct professor in the Department of Physical Education at the State University of Maringá in Maringá, Brazil, and vice president of the Brazilian Association of Sports Nutrition, also advised caution when considering creatine supplementation in pregnant or breastfeeding women and in children. 'They're not currently included in official recommendations because there's insufficient safety and efficacy data for pregnant individuals and fetuses. We also don't yet know how much transfers into breast milk,' she explained. Regarding children, Trindade added that creatine is not recommended — even in cases of malnutrition. 'When treating a malnourished child, the priority is nutritional rehabilitation. Malnutrition involves more than loss of muscle mass; it includes deficiencies in total caloric intake and essential micronutrients like vitamins and minerals that regulate metabolic function.' Uncertain Benefits in Neurologic and Muscle Disorders Like skeletal muscle, the brain depends on the rapid ATP regeneration provided by the creatine-phosphocreatine system, raising interest in its possible neurologic benefits. A systematic review in healthy older adults suggested that 'oral creatine administration may improve short-term memory and intelligence/reasoning of healthy individuals, but its effect on other cognitive domains remains unclear, leaving questions around ideal dosing and the mechanisms underlying potential cognitive enhancement.' Another review exploring creatine's potential in neurologic conditions noted that while early human studies — particularly in neurodegenerative diseases — are promising, more robust evidence is needed. Well-designed, long-term randomized controlled trials are essential to establish efficacy, cost-effectiveness, and safety in these populations. Creatine has also been studied as an adjunctive therapy for conditions such as Duchenne muscular dystrophy, amyotrophic lateral sclerosis (ALS), and certain metabolic myopathies. However, the available data remain inconclusive. In the context of muscle disorders, a systematic review observed that creatine monohydrate may help reduce intracellular calcium accumulation and provide energy for muscle contraction, though the optimal dosing and magnitude of effect are still unclear. In a study involving 107 patients with probable or confirmed ALS, daily creatine monohydrate was well tolerated and associated with a trend toward increased survival — mirroring findings from an earlier trial. However, the authors concluded that supplementation at 5 g/d did not significantly improve markers of disease progression or reduce fatigue during isometric contraction, despite anecdotal reports from participants. Geriatric Use Findings on creatine supplementation in older adults remain mixed. 'Evidence is very limited in this population. Few studies have demonstrated improvements in physical performance or muscle strength,' said Ivan Aprahamian, MD, PhD, internal medicine and geriatrics specialist and a member of the Brazilian Society of Geriatrics and Gerontology. Aprahamian noted that creatine may serve as a helpful adjunct in managing sarcopenia. 'In older adults with reduced muscle mass or strength who are engaged in resistance training, creatine may support improvements in muscle health,' he explained. The recommended dosage remains 3-5 g/d, taken consistently. In such cases, Fioretti recommended first screening for sarcopenia using the SARC-F questionnaire — which assesses autonomy and independence — alongside grip strength testing. 'If reduced strength is confirmed, further evaluation of muscle mass using bioimpedance or DEXA, followed by a physical performance assessment, is warranted,' she said. On the basis of results, a resistance training program can be initiated in combination with creatine supplementation and appropriate carbohydrate and protein intake. 'Older adults often consume excessive carbohydrates and insufficient protein. After approximately 6 months, it's advisable to repeat assessments to monitor improvements in muscle mass and physical function,' Fioretti added. Leite agreed: 'Creatine is not a miracle solution. It must be combined with a well-structured dietary plan.' Even in sedentary seniors, she noted, supplementation may still offer benefits. 'While it may not significantly increase muscle mass, it can help reduce the rate of muscle loss,' she explained. For physically inactive older adults, the standard dose of 3-5 g/d is still recommended. 'This may support musculoskeletal health, though the effect on strength is modest,' said Trindade, who also cautioned that responses may vary by sex. Limited data suggest that women — who typically have higher baseline intramuscular creatine levels — may be less responsive to supplementation. 'We don't fully understand why, but it's likely related to hormonal differences.' Established Benefits Despite a growing number of hypotheses, robust evidence currently supports creatine supplementation primarily in the context of sports medicine. Misconceptions persist — particularly the belief that creatine directly causes muscle hypertrophy. 'In high-intensity, short-duration resistance training, where energy reserves are quickly depleted, creatine helps by rapidly replenishing ATP. This indirectly supports muscle hypertrophy,' explained Leite. In athletic settings, creatine can be taken either before or after exercise, with comparable benefits. 'Scientific literature shows that timing matters less than consistency. Regular use is key to saturating muscle creatine stores,' said Torres. Creatine's effect is cumulative. 'What matters is the total amount stored in muscle,' noted Trindade. 'After ingesting monohydrate, blood levels peak at around an hour, and the creatine is distributed to muscles that haven't yet reached storage capacity. Once saturated, muscles rely on these reserves.' For fitness professionals, the benefits are often seen in practice. 'Among clients who take creatine after workouts, I've observed better lean mass gains — which is often their primary goal,' said Celina Moreno, a trainer since the 1970s who witnessed the early rise of powdered supplements in gyms. Alexandre Pereira da Costa Filho, who works at a chain of fitness centers, takes 9 g of creatine before bed — about 0.1 g/kg/d for his 86 kg body weight. He cautioned that loading protocols involving high initial doses followed by lower maintenance levels should be guided by a professional. 'Only do this under the supervision of a nutritionist. Always consult a qualified professional before making decisions,' he advised. For those seeking faster performance gains, Trindade recommended a loading phase: 20 g/d, divided into four doses, for 5 days, followed by a maintenance dose of 3-5 g/d. However, this protocol may cause fluid retention and modest weight gain. 'Most people don't notice it, but it depends on whether they're exercising enough to compensate,' added Fioretti. Quality Control In April, Brazil's national health regulatory agency, Anvisa, published an analysis of 41 creatine supplements from 29 manufacturers. Only one product had an incorrect concentration, but 40 showed labeling discrepancies. 'Some products may contain less creatine than declared — or even contaminants, especially when unregulated,' warned Torres. He advised choosing certified products to minimize risk.
The Independent
09-07-2025
- Science
- The Independent
The simple verbal cues that can make you run faster without training
A study from the University of Essex involving 20 Tottenham Hotspur academy players, aged 14-15, showed that specific verbal cues can instantly enhance athletic performance and improve sprint times. Moran and researchers found that young soccer players run faster when focusing on their environment, rather than their body. While simple analogies worked to speed up sprints by 3 percent over 65 feet. Focusing on external cues, such as 'push the ground away' or 'sprint as if you are a jet taking off', led to better results than internal cues. The method sped up sprints by 3 per cent over a distance of 65 feet, an improvement typically requiring weeks of targeted training. Researchers suggest that using simple, evocative analogies can help coaches and parents maximise performance in young athletes across various sports.
Yahoo
25-06-2025
- Health
- Yahoo
Don't Freak Out If This Happens When You First Start Taking Creatine
"Hearst Magazines and Yahoo may earn commission or revenue on some items through these links." CREATINE IS MORE popular than ever, and many guys credit the supplement for helping them build stronger muscles, boost their athletic performance and improve brain function. But taking creatine sometimes also brings an unwanted side effect: weight gain. Creatine is a naturally occurring compound that helps supply energy to your muscles. Your body makes about half of what it needs in the liver, kidneys, and pancreas. The rest typically comes from your diet—mainly red meat, seafood, dairy, and other high-protein animal products, according to the Cleveland Clinic. Lately, more people are turning to creatine supplements to help support their muscle energy levels. But like any supplement, they can come with side effects. Weight gain is a well-known one, says Kristyen Tomcik, Ph.D., an assistant professor of nutrition at the Case Western Reserve University School of Medicine in Cleveland, Ohio. He says he experienced it personally during the first couple of weeks of going back on creatine after stopping the supplement for a while. 'But I think the thing that people should know when it comes to creatine is that it's not weight gain in the sense of you are gaining fat mass,' Tomcik explains. THE NUMBER ON the scale may tick up after you start taking creatine because the supplement can increase 'total body water,' says Aubrey Grant, M.D., director of sports and performance cardiology at MedStar Health in Washington, D.C. 'This happens because creatine is stored in skeletal muscle, where it pulls water into the muscle cells through osmotic effects,' he explains. This often results in about a 1- to 3-pound weight gain in the first week or two of supplementation. 'It is a predictable physiological response, and for most users, it is not harmful,' Dr. Grant says. And, it's not fat gain, he emphasizes. The water weight gain from creatine is like what happens when you start a low-carb diet — just in reverse, Tomcik says. With creatine, your muscles hold more water. With low-carb diets, you often lose water weight at first because your body is depleting its stored carbohydrates, or glycogen, which hold water. Water retention is more common during the early stages of taking creatine, Dr. Grant says. After a few weeks, the water weight gain usually plateaus, Tomcik explains. 'However, some degree of increased intracellular water in the muscles will persist as long as creatine supplementation is continued,' Dr. Grant adds. ONE OF THE most studied benefits of creatine supplements is its role in increasing lean muscle mass and strength, Dr. Grant says. Creatine improves energy stores in the muscles, allowing for greater energy availability during short bursts of high-intensity activity, such as weightlifting or sprinting. Research suggests that supplementing creatine could increase muscle mass and lean body mass when combined with strength training. Tomcik says creatine typically gives you extra energy to 'do a little more volume in the gym,' which over time usually translates to gaining muscle mass. This might also increase the number you see on the scale. 'If someone is training hard, creatine can contribute to actual increases in muscle mass, not just water weight,' Dr. Grant says. 'That form of 'weight gain' is generally desirable.' MOST CREATINE WATER weight is minimal and will level out over a few weeks, Tomcik says. 'It's not really anything to worry about.' Also, if you experience lean muscle gain, 'that's likely beneficial, especially for performance and metabolic health,' Dr. Grant says. But if you're pairing your creatine supplements with a poor diet or not strength training, you may gain weight that's not favorable, Dr. Grant adds. When using creatine, he recommends having a structured resistance training routine, maintaining a balanced diet with adequate protein, and staying hydrated, as creatine increases muscle water content, so you need to hydrate more. If you're going full on with a 20-gram-a-day loading dose of creatine and not feeling great or your weight is increasing, Tomcik suggests cutting back to 3 to 5 grams a day and possibly increasing it slowly. CREATINE SUPPLEMENTS ARE safe for most men, especially when you take 3 to 5 grams a day, Dr. Grant says. However, talk to your doctor before starting the supplement if you have kidney disease or a risk for kidney disease. Also, see your doctor if, after taking creatine, you experience bloating, GI distress, blood pressure increases, or significant weight gain without strength improvements. 'In general, for healthy men using creatine responsibly and paired with a solid training program, small increases in weight should not be a source of concern — they are often a marker of increased lean body mass and performance adaptation,' Dr. Grant says.$43.00 at Thorne$100.00 at You Might Also Like The Best Hair Growth Shampoos for Men to Buy Now 25 Vegetables That Are Surprising Sources of Protein
Medscape
20-06-2025
- Health
- Medscape
Can Type 1 Diabetics Master Ultra-Trail Running?
Elite athletic performance is possible in individuals with insulin-dependent diabetes. In addition to managing blood glucose levels, sports can help build essential psychosocial skills. This is the message from Jean-Charles Vauthier, MD, PhD, a sports medicine physician and researcher at the PRISME/InterPsy (EA 4432) laboratory at the University of Lorraine in Nancy, France. He explored this through interviews with ultra-trail runners living with type 1 diabetes (T1D) and presented his findings at the 2025 French-speaking Diabetes Society Congress, held April 1-4 at the Palais des Congrès in Paris, France. An ultra-trail is a long-distance trail running competition, usually held in natural settings such as forests, plains, or mountains, and typically covers more than 80 km. It is a physically and mentally demanding event, particularly for athletes with insulin-dependent diabetes who must also regulate their blood glucose levels. Vauthier initially focused on physiological changes and their effects on performance and alertness. As the director of the Trail Scientifique de Clécy in Normandy, France, he and his team monitored 55 non-diabetic athletes using masked continuous glucose monitors (CGMs) over the course of a 156-km ultra-trail (six laps of 26 km, with +6000 m elevation gain). The athletes wore CGMs starting the day before the race and continued wearing them for 10 days thereafter. Building on his earlier physiological research, Vauthier shifted his focus to the subjective experiences of insulin-dependent athletes. In collaboration with the InterPsy Laboratory at the University of Lorraine, he conducted remote interviews with 13 ultra-trail runners to better understand the challenges they face and the psychosocial skills they develop through long-distance competitions. 'As a diabetic myself and an ultra-trail runner, I am considered a peer and have access to social networks dedicated to this practice,' he explained in the preamble. 'This allowed me to approach the runners more easily on the theme: 'Tell me about your last race.'' Each interview lasted an hour and focused on the paradox of living with a chronic illness while pursuing extreme athletic goals. Qualitative analysis identified recurring themes, including their stories, and revealed several key themes, including how the experience shaped their self-understanding, helped them manage their diabetes, boosted their motivation, built their expertise, and increased their sense of independence. Digital Communities 'We are seeing communities being created where everyone contributes pieces — like a puzzle — which creates a kind of nebula of collective intelligence. No two do the same thing, but no one copies each other; therefore, everyone benefits. Of course, by 2025, these are essentially digital communities,' said Vauthier. 'It is really a form of peer support,' he explained. 'It is a bit like the model used in addiction recovery, such as Alcoholics Anonymous — except in this case, the groups are not created for therapeutic purposes, but they end up serving that role. They are not activist groups and have no specific agenda, yet they are still incredibly powerful.' He continued. 'What is also quite striking is the almost familial relationships that individuals with T1D have with each other. With the sensors, pumps, and omnipods, they easily recognise each other on the beach, and it is pretty much the only case where athletes accept their role as role models and will say to a child with a sensor, look at me too, I have one, and you see, anything is possible. I participate in marathons with T1D. I do a lot of ultra trails. These communities also offer practical solutions to a wide range of challenges, particularly technical challenges. For example, how to display blood sugar readings on a watch while running, how to interpret an error message on a pump, or how to keep a sensor in place during hot weather or rain.' 'You post a question and get 40 replies in 10 minutes. Patients with T1D are highly responsive. It is truly the art of resourcefulness, elite version,' Vauthier noted. Building Flexibility The study also explored psychosocial skills, which play a key role in many educational programs. Researchers have found that trail running has a notably positive impact on individuals with T1D, helping them manage stress, give and receive social support, and improve their problem-solving abilities. 'When you are able to manage when your pump breaks down in the middle of a run in the mountains, if there is no more food at the refreshment point because you had to stop unexpectedly, then you are able to manage your daily worries thanks to a strong approach to empowerment and a great ability to be flexible — a useful quality in everyday life.' Finally, being able to run an ultra-trail when you are diabetic requires you to know your illness perfectly and tame it completely. 'And we feel that it is not the same thing to know your illness to avoid theoretical complications at 20 years old than to prepare for a race that you dream of. The motivations are not the same. Ultimately, they become hyper-experts without any desire — as we might have thought beforehand — to put themselves in danger. This study shows that the patient's experience is extremely important and that it is always interesting to listen to them talk about their illness,' Vauthier said. The Clinician's Role Vauthier raised important questions about how healthcare professionals should engage with these highly skilled patient communities: should they act as mentors and join GroupSat at the risk of affecting their spontaneity? 'Are we ready to prescribe WhatsApp groups, especially when there is so much talk about social prescribing these days?' he asked. He also emphasised that the athletes interviewed were not representative of the general diabetic population. They all came from higher socio-professional backgrounds, with strong technical abilities and high health literacy levels. 'To me, they are a bit like the 'Formula 1' of diabetes,' he said. Continuing this metaphor, Vauthier questioned whether the lessons learned from these athletes could be applied to the general population. 'Is this a kind of laboratory — or a sign of growing health inequalities between those who have access to strong networks and advanced technologies and those who do not?' The athletes voiced concerns about this gap and admitted that researchers did not yet have a clear answer.
Medscape
18-06-2025
- Health
- Medscape
Are Sports Drink Just Colorful Delusions?
Every gym in America is awash in neon. The rainbow array of sports drinks promises to transform weekend warriors into athletic dynamos. For decades, these beverages have occupied a curious space in American consumer culture, somewhere between medicine and marketing, between science and snake oil. Now comes a study showing sports drinks might improve athletic performance. Sort of. Researchers from Peking University in Beijing, China, recently presented a poster at the American Society for Nutrition (ASN) 2025 Annual Meeting in Orlando, Florida, from what appears to be a rigorous experiment: 23 trained adults who consumed a multi-ingredient sports drink performed 15% better during high-intensity exercise than when they drank a placebo beverage. The drink contained a blend of macronutrients and micronutrients: Sugar for immediate energy, taurine and lysine as amino acids, inositol for cellular function, caffeine as a stimulant, and niacin and vitamins B6 and B12 to help metabolize food into energy. The patients experienced less fatigue, maintained higher energy levels, and showed improved metabolic markers that suggested their bodies were preserving muscle protein during exercise, according to the researchers. 'I wouldn't say the findings are shocking or excitingly novel,' said Andrew Jagim, PhD, director of Sports Medicine Research at Mayo Clinic Health System, in La Crosse, Wisconsin. The participants were already trained athletes performing structured, 100-minute exercise sessions, a far cry from the typical American's relationship with physical activity. According to the US Department of Health and Human Services, adults should spend at least 150 min/wk doing aerobic exercise, but only two thirds of Americans meet this guideline. This disconnect between laboratory conditions and real life gets to the heart of what Stella Volpe, PhD, MS, head of the Department of Human Nutrition, Foods, and Exercise at Virginia Tech University in Blacksburg, Virginia, calls the fundamental question: 'For the average person who might be exercising 30 minutes a day, likely they don't need something like this. Likely they are fine with just water.' Jose Antonio, PhD, MS, the CEO of the International Society of Sports Nutrition and professor of health and human performance at Nova Southeastern University in Fort Lauderdale, Florida, concurs. 'Traditionally, sports drinks have been shown for decades to improve performance, reduce fatigue, etc.,' Antonio said. 'It often depends on what the ingredients are. We already know caffeine is effective. The most important components of this sports drink are, of course, the fluid itself, but [also] the sugar and caffeine. The rest of it has a minor effect.' Sports drinks can be dense in calories. A 16-oz bottle of AMP Energy, for example, is 220 calories per serving compared with 155 for a 12-oz serving of Coca-Cola. For Jagim, the question becomes one of benefits and costs: 'Are those extra calories in that drink really worth what they're chasing in terms of just burning more calories during the workout?' 'When I train or race, I focus on two things [in a sports drink]: Sugar and caffeine,' he added. 'The rest is ok, but for most, it doesn't matter. Don't trip over dollars to pick up pennies.' But a psychological dimension complicates the purely nutritional calculus. Volpe, a professional athlete on the USA Masters field hockey team, said she will 'hydrate better if I drink more.' Consuming a beverage that tastes better than water can improve overall fluid intake. If a sports drink gets someone to stay properly hydrated during exercise, as long as they do not have diabetes or are trying to lose weight, the modest caloric cost might be worth paying. 'I'd say go for it,' she said. Jagim and Antonio agree valuable future research would be testing different treatment groups using different versions of the same drink. 'Then you'd be able to answer that question of which ingredient is the more important one here,' Jagim said. 'Is it the carbohydrate or the caffeine? Or is it truly, when we combine them, we get that synergistic benefit, where they collectively help each other make you feel better and perform better?' Antonio, Jagim, and Volpe reported having no relevant financial conflicts of interest.
