[FF30X FAQ] Is Creatine Safe?

Question: I see that you recommend Creatine on the FF30X plan. Is it safe? My doctor is concerned.

Answer from the desk of:
Dr. Anthony Balduzzi, Founder, The Fit Father Project

The first thing I want to say (for all FF30X Program members) is that it's always best to listen to your doctor. They know your lab work. They are managing your care, and together, you two can make the best-informed health decisions for you.

Second, I also want to emphasize that everything we include in the program is thoroughly researched to be safe (our #1 priority) as well as effective. We share recommendations based on the best research available. 

Creatine's safety is no exception to that.

Here is a short list of scientific studies (both experimental and review) showing creatine's long-term safety in all sorts of people - ranging from athletes to elderly individuals with Parkinson's Disease:

1. Groeneveld GJ, et al. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. (2005)
http://www.ncbi.nlm.nih.gov/pubmed/15795816

2. Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem. (2003)
https://www.ncbi.nlm.nih.gov/pubmed/12701814

3. Lopez RM, et al. Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses. J Athl Train. (2009)
https://www.ncbi.nlm.nih.gov/pubmed/19295968

4. Greenwood M, et al. Cramping and Injury Incidence in Collegiate Football Players Are Reduced by Creatine Supplementation. J Athl Train. (2003)
https://www.ncbi.nlm.nih.gov/pubmed/14608430

5. Shao A, Hathcock JN. Risk assessment for creatine monohydrate. Regul Toxicol Pharmacol. (2006)
https://www.ncbi.nlm.nih.gov/pubmed/16814437

6. Bender A, et al. Long-term creatine supplementation is safe in aged patients with Parkinson disease. Nutr Res. (2008)
https://www.ncbi.nlm.nih.gov/pubmed/19083405

There are some isolated case-studies showing that some people have adverse reactions to creatine ( like this one here) of an 18-year old male who took 20g creatine/day for 5-days and had a very adverse reaction (acute renal failure). This is a very unfortunate incident, and case studies like these need to be looked at, but they do not carry a fraction of the weight of true scientific experiments and meta-reviews (with large subject numbers actual experimental variables).

People have crazy adverse reactions to all sorts of things in individualized circumstances - even Vitamin C. To emphasize this point, here's a similar example of a published case study showing a young child forming sever kidney stones with Vitamin C supplementation. https://www.ncbi.nlm.nih.gov/pubmed/25260453 Thankfully, Vitamin C doesn't cause these problems in 99.99% of the population. 

*In summary:* Creatine, really is a wildly effective and safe supplement. Although case study research is worth looking at, it carries a fraction of the weight of actual scientific studies. 

That said, this is not medical advice - just a summary of your research. You can definitely show your doctor these studies for further discussion if you'd like.

Here are some other FAQ documents about creatine:

I hope these documents help clear things up.

-Dr. Anthony Balduzzi

P.S. Although Creatine supplementation is safe, it can change some numbers on your blood work that doctors normally look at to evaluate your kidney function. 

Creatine supplementation sometimes elevates levels of CREATinine on your blood work. I intentionally used the caps to differentiate CREATinine this from CREATine, because the words are *very similar*.

In fact, the two compounds are related.

CREATinine is the metabolic by-product of CREATine metabolism. Docs use CREATinine as a measure of kidney function (if you look at your blood work, you will see a creatinine measure along with things like your Glomerular Filtration Rate (GFR) and Blood Urea Nitrogen (BUN).

When we take Creatine, naturally we have more of its byproduct CREAT-inine, which makes those levels look elevated on blood work. This *does not* mean you have kidney impairment - as long as your other markers (GFR/BUN/etc) are healthy. 

This study here showed these exact finding:

Bender A, et al. Long-term creatine supplementation is safe in aged patients with Parkinson disease. Nutr Res. (2008) https://www.ncbi.nlm.nih.gov/pubmed/19083405

Key quote from the study: " Although serum creatinine levels increased in Cr patients because of the degradation of Cr, all other markers of tubular or glomerular renal function, especially cystatin C, remained normal, indicating unaltered kidney function. The data in this trial provide a thorough analysis and give a detailed overview about the safety profile of Cr in older age patients."

Final punch line: Creatine supplementation is safe... AND... does often lead to increased Creatinine levels on blood work.