Creatine supplementation provided to active subjects over 70 years of age, and subjects 59-72 years of age, have
resulted in significant gains in several indices of muscle performance including increased maximal dynamic and
isometric strength, lower body mean power, lower extremity functional capacity, increased fat-free mass, increased
lean mass and endurance power. These studies suggest that Creatine supplementation may help to forestall or
reverse muscular atrophy and progressive weakness that occurs during aging, and that Creatine may be useful as
an intervention to improve the ability of certain elderly individuals to perform functional living tasks, decreasing
dependency and, enhancing their quality of life.19,20
Other studies have noted that younger individuals respond to Creatine supplementation more ef iciently than do
older subjects in that muscular phosphocreatine stores were shown to increase on average by 35% in young
subjects (~24 years of age) and 7% in older subjects (~70 years of age) after five days of Creatine supplementation
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(20 gms per day). As such, it may take a longer period to maximize Creatine stores in older subjects with Creatine
supplentation.21
Absorption and Utilization
Creatine absorption from the intestinal tract is very ef icient. Studies show that a 6-8 gm oral load of Creatine results in
approximately 50% of the ingested Creatine being excreted in the urine. Thus, researchers are still working to identify
the ideal single, daily and cumulative doses of Creatine for various applications.26 Other studies demonstrate that a 5
gm oral load of Creatine, followed by 93 gm oral load of simple carbohydrate in solution ( water ) at 30 minutes post-
Creatine intake (4-times per day), resulted in a 60% increase in total muscle Creatine compared to subjects ingesting
the same amount of Creatine in the absence of a simple carbohydrate drink. Subjects ingesting Creatine and the
simple carbohydrate drink had higher insulin levels and significantly less Creatine lost in their urine, indicating that
higher insulin levels are likely a key to greater muscle uptake and utilization of Creatine, and a reduction in urinary
loss. Thus, it is accepted that Creatine utilization is enhanced by concurrent ingestion of a simple carbohydrate drink
(e.g. fruit juice).25
Additionally, concurrent administration of Creatine and glycogen reveal that Creatine supplementation enhances
muscle levels of glycogen (glycogen supercompensation) beyond that attainable from glycogen loading alone. As
supercompensation of muscle glycogen is also an ergogenic factor in exercise performance, the combination of
Creatine and carbohydrate loading appear to improve performance by increasing muscle Creatine and muscle
glycogen.27
Dosage and Standardized Grade (2:1 powdered extract)
1. Athletic Performance (strength, sprint and repeated sprint power, lean mass etc.) - The usual protocol is 5 gm, 4-5-
times per day for five consecutive days during the loading phase, followed by 5 gm, twice daily as the maintenance
dose. Many athletes cycle one month on, one month of to prevent any possibility of toxicity and to prevent the
body from compensating by reducing its own endogenous synthesis of Creatine in the liver.28,22,23,26,27
2. Neuromuscular Diseases / Amyotrophic Lateral sclerosis - One study used 20 gm per day in 5 gm divided doses for
7 days, followed by 3 gm per day for 3-6 months.14 This dose may be appropriate for all neuromuscular diseases
mentioned above in regards to adult supplementation, 34 although one patient with myasthenia gravis demonstrated
significant improvement with 5 gm of Creatine per day combined with resistance training, 3 times per week.16 In
McArdles disease, a daily dose of Creatine of approximately 10 gm per day, followed by a maintenance dose of
approximately 4 gm per day has been used successfully to increase muscular strength. 35
Other researchers have shown that a daily adult dose of 10 gm of Creatine per day, and a daily dose of 5 gm of
Creatine for children, have been beneficial for individuals with various muscular dystrophies.39,40
3. Heart Failure - A daily dose of 20 gm of Creatine per day, in 5 gm divided doses, has shown good results over the
5-10 day test period. Participants showed improvement in strength, endurance and improved skeletal function
upon exertion.17,36,37
4. Musculoskeletal Rehabilitation During and After Immobilization - Same dose as for athletic performance.18
5. Anti-aging in Older Patients - Same dose as for athletic performance.19,20
Adverse Side Effects, Toxicity and Contraindications
As for the safety of Creatine supplementation, a 1997 study showed that short-term Creatine use (20 grams per day
for 5 days) did not increase markers of kidney stress in five healthy men.13 A study comparing Creatine users, for up to
five years duration, to control subjects has shown that Creatine users have no remarkable differences in their Creatine,
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urea, and plasma albumin clearances compared to controls. The researchers conclude that neither short-term,
medium-term, nor long-term oral Creatine supplements induce detrimental ef ects in the kidney of healthy
individuals.29,30,31 To date no liver abnormalities have been evident in short-term Creatine challenge studies.30
However, individuals with pre-existing kidney disease should be cautious as evidenced by the development of kidney
dysfunction in a 25 year old soccer player taking Creatine who previously had been treated for focal segmental
glomerulosclerosis of the kidney. His kidney function returned to normal after discontinuing Creatine
supplementation.28
Some experts suggest that compulsory regular kidney and liver monitoring should accompany the use of Creatine due
to the increased burden placed upon the liver and kidneys.30 As pointed out by other experts, Creatine is normally
found in cardiac muscle, brain, and testes, as well as skeletal muscle, and these former tissues have been largely
unstudied with respect to the ef ects of Creatine supplementation.32 The Food and Drug Administration (FDA) has
advised athletes to consult a physician or a health care professional before embarking on any scheme of Creatine
loading or supplementaion.28 Nevertheless, few reported adverse side ef ects from Creatine use have been reported
despite its widespread use among young athletes, with Creatine sales reaching $200 million in the U.S. in 1998.1
Other infrequently reported side ef ects include gastrointestinal disturbances and muscle cramps.30
In regards to children and younger athletes, the safety of Creatine supplementation has not yet been investigated in
these individuals. Until all safety issues have been evaluated, experts strongly recommend against use of Creatine
among children and adolescent athletes.33
Overall, Creatine supplementation appears to be safe for healthy adults. It's a low molecular weight compound that is
excreted in the kidneys by simple diffusion. In the maintenance phase, athletes consume only slightly more Creatine
(3-5 gm per day) than is generally found in the diet, which is usually about 2 gm per day.10,11
Drug-Nutrient Interactions
There are no well-known drug-nutrient interactions for Creatine at this time.38
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Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insuf icient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the at ending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
43. Kreider RB. Creatine, the next ergogenic supplement? Sportscience Trainng and Technology. Internet Society for Sports Science.
Available at: http://www.sportsci.org/traintech/cretine/rbk.html. Accessed May 5, 1998
44. Kreider RB. Creatine supplement: analysis of ergogenic value, medical safety, and concerns. Journal of Exercise Physiology Online
1998; 1(1). Available at: httyp://www.css.edu/users/tboone2/asep/jan3.html. Accessed May 5, 1998
45. Bramberger M. The magic potion. Sports Illus 1998;88(16):58-65
46. Bessman SP, Savabi F. The role of the phosphocreatine energy shuttle in exercise and muscle hypertrophy, in: Taylor AW, Gollnick
PD, Green HJ (eds.), International Series on Sport Sciences: Biochemistry of Exercise VII. Champaign, IL Human Kinetics
1988;19:167-78
47. Ingwall JS. Creatine and the control of muscle-specific protein synthesis in cardiac and skeletal muscle. Circ. Res 1976;38(5 suppl
1):1115-23
48. Sipila I, Rapola J, Simell O et al. Supplementary creatine as a treatment for gyrate atrophy of the choroids and retina. N Engl J Med
1981;304(5):867-70
49. Almada a, Kreider R, Ferreira M et al. Effects of calcium-HMB supplementation with or without creatine during training on strength
and sprint capacity, abstract. FASEB J 1997;11:A374
50. Earnest CP, Snell PG, Rodriguez R et al. The effect of creatine monohydrate ingestion on anaerobic power indices, muscular
strength and body composition. Acta Physiol Scand 1995;153(2):207-9
51. Burke LM, Pyne DB, Telford RD. Effect of oral creatine supplementation on single-effort sprint performance in elite swimmers. Int J
Sports Nutr 1996;6(3):222-3
52. Dawson B, Cutler M, Moody A et al. Effects of oral creatine loading on single and repeated maximal short sprints. Aust J Sci Med
Sports 1995;27(3):56-61
53. Redondo DR, Dowling EA, Graham BL et al. The effect of oral creatine monohydrate supplementaiton on running velocity. Int J
Sports Nutr 1996;6(3):213-21
54. Kreider RB, Ferreira M, Wilson M et al. Effects of creatine supplementation on body composition, strength, and sprint performance.
Med Sci Sports Exerc 1998;30(1):73-82
55. Poortmans JR, Auquier H, Renaut V et al. Effect of short-term creatine supplementation on renal responses in men. Eur J appl
Phsiol 1997;76(6):566-7
56. Mazzini L, Balzarini C, Colombo R, Mora G, Pastore I, De Ambrogio R et al. Effects of creatine supplementation on exercise
performance and muscular strength in amyotrophic lateral sclerosis: preliminary results. J Neurol Sci 2001 Oct 15;191(1-2):139-44
57. Persky AM, Brazeau GA. Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacol Rev 2001
Jun;53(2):161-76
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58. Stout JR, Eckerson JM, May E, Coulter C, Bradley-Popovich GE. Effects of resistance exercise and creatine supplementation on
myasthenia gravis: a case study. Med Sci Sports Exerc 2001 Jun;33(6):869-72
59. Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol 2001 Jun1;37(7):1765-74
60. A leg to stand on. Better Nutrition May 2002;64(5):p20
61. Chrusch MJ, Chilibeck PD, Chad KE, Davison KS, Burke DG. Creatine supplementation combined with resistance training in older
men. Med Sci Sports Exerc 2001 Dec;33(12):2111-7
62. Gotshalk LA, Volek JS, Staron RS, Denegar CR, Hagerman FC, Kraemer WJ. Creatine supplmentation improves muscular
performance in older men. Med Sci Sports Exerc 2002 Mar;34(3):537-43
63. Rawson ES, Clarkson PM, Price TB, Miles MP Differential response of muscle phosphocreatine to creatine supplementation in
young and old subjects. Acta Physiol Scand, 2002 Jan;174(1):57-65
64. Ezquierdo M, Ibañez J, González-Badillo JJ, Gorostiaga EM Effects of creatine supplementation on muscle power, endurance, and
sprint performance. Med Sci Sports Exerc, 2002 Feb;34(2):332-43
65. Cottrell G.T, Coast JR, Herb RA Effect of recovery interval on multiple-bout sprint cycling performance after acute creatine
supplementation. J Strength Cond Res, 2002 Feb;16(1):109-16
66. Lawler JM, Barnes, WS, Wu G, Song W, Demaree S. Direct antioxidant properties of creatine. Biochem Biophys Res Commun, 2002
Jan 11;290(1):47-52
67. Green AL, Hultman, E, Macdonald IA, Sewell DA, Greenhaf PL. Carbohydrate ingestion augments skeletal muscle creatine
accumulation during creatine supplementation in humans. Am J Physiol, 1996 Nov;271(5 Pt 1):821-6
68. Burke DG, Smith-Palmer T Holt LE, Head B, Chilibeck PD The effect of 7 days of creatine suppelmentation on 24-hour urinary
creatine excretion. J Strength Cond Res, 2001 Feb;15(1):59-62
69. Nelson AG, Arnall DA, Kokkonen J, Day R, Evans J. Muscle glycogen supercompensation in enhanced by prior creatine
supplementation. Med Sci Sports Exerc, 2001 Jul;33(7):1096-100
70. Culpepper R Michael. Creatine supplementation: Safe as steak? Southern Medical Journal, Sep98;91(9):890-3
71. Poortmans, JR, Francaux, M. Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci
Sports Exerc, 1999 Aug;31(8):1108-10
72. Poortmans, JR, Francaux, M. Adverse effects of creatine supplementation: fact or fiction? Sports Med, 2000 Sep;30(3):155-70
73. Schilling, B.K., Stone M.H., Utter, A., Kearney, J.T., Johnson, M., Coglianese, R., Smith, L., O’Bryant, H.S., Fry, A.C., Starks, M.,
Keith, R., Stone, M.E. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc, 2001
Feb;33(2):183-8
74. Juhn MS, Tarnopolsky M. Potential side effects of oral creatine supplementation: a critical review. Clin J Sport Med, 1998
Oct;8(4):298-304
75. Dietary Supplement Information Bureau.www.intramedicine.com
76. Tarnopolsky M, Martin J. Creatine monohydrate increases strength in patients with neuromuscular disease. Neurology. Mar
1999;52(4):854-7
77. Vorgerd, M., Grehl, T., Jager, M., et al. Creatine therapy in myophosphorylase deficiency (McArdle disease): a placebo-controlled
crossover trial. Arch Neurol. Jul 2000;57(7):956-63
78. Gordon A, Hultman E, Kaijeser L et al. Creatine supplementation in chronic heart failure increases skeletal muscle creatine
phosphate and muscle performance. Crdiovasc Res. Sep1995;30(3):413-8
79. Andrews R, Greenhaff P, Curtis S et al. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive
heart failure. Eur Heart J. Apr1998;19(4):617-22
80. Healthnotes, Inc 2001. www.healthnotes.com
81. Walter MC, Lochmuller H, Reilich P et al. Creatine monohydrate in muscular dystrophies: A double-blind.placebo-controlled clinical
study. Neurology 2000;54:1848-50
82. Felber S, Skladal D, Wyss M et al. Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31P magnetic
resonance spectroscopy study. Neurol Res 2000;22:145-50
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Dehydroepiandrosterone (DHEA)
General Features
DHEA is an intermediate steroid hormone produced mostly by the adrenal glands. All steroid hormones are derived
from cholesterol. In the synthesis of adrenal androgen hormones cholesterol is converted to pregnenolone and then to
DHEA. From DHEA the adrenal glands can synthesize androstenedione, which is further converted to testosterone.
In fat tissue androstenedione can be converted to estrone hormone by the aromatase enzyme, which is also known as
estrogen synthase enzyme. Thus, DHEA supplementation can af ect the increased production of androstenedione as
well as testosterone and estrogen.
DHEA is the most abundant hormone made by the adrenal glands. Some DHEA is secreted by the adrenal glands
and circulates in the bloodstream, where it is picked up by other tissues (i.e. adipose, testis, ovaries) and further
converted into other androgens or estrogens.
The serum concentration of DHEA (really DHEA - sulfate), is used as a measure of adrenal androgen production,
when monitoring various conditions.1
DHEA supplements can be made in the laboratory from diosgenin a steroid compound found in wild yams. However,
the body is unable to convert diosgenin into DHEA or any other hormone. Thus, supplementing with wild yam as a
means to af ect hormone levels is unsubstantiated.2
In humans, DHEA blood levels peak in early adulthood and then starts a lifelong descent. By the age of 70 DHEA
levels have declined by up to 75 percent compared with young adult levels. By age 90, we make 90 percent less
DHEA than a young adult.3,4
These findings have led some researchers to investigate whether returning DHEA levels to those of a young adult
(through supplementation) can serve as an anti-aging, and degenerative disease prevention strategy. Preliminary
reports in this regard are conflicting. Some evidence suggests that DHEA supplementation (25-200 mg per day) can
reverse some parameters of aging and improve wellbeing. Other reports correlate higher blood DHEA levels (and
supplementation in some cases) with increased risk of prostate cancer, postmenopausal breast cancer, and ovarian
cancer.5-13
As a result many health authorities are cautious about recommending DHEA supplementation as an anti-aging
intervention. Individuals with a history or family history of breast, ovarian or prostate cancer should not supplement
with DHEA indiscriminately until further studies are completed.14
The average male produces 31 mg of DHEA per day, while women make about 19 mg.15
Supplementation Studies and Clinical Applications
1. Systemic Lupus Erythematesus (SLE)
In a Stanford Medical Center study, DHEA supplementation (200 mg per day) decreased the SLE Disease Activity
Index by nearly two points, while the placebo group increased by almost a full point. DHEA patients had
significantly fewer flare ups and their required dosage of corticosteroid drug used to control symptoms decreased
by 35 percent, whereas the placebo group increased their dose of corticosteroids by forty percent. This was a
three-month study only. Long-term benefits are yet unknown and the major side ef ects in this study was mild to
severe acne in women in the DHEA group.16,17
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2. Dementia (Age-Related)
DHEA is found in high concentrations in the brain and declining levels with aging may af ect memory and cognitive
functions. DHEA supplementation shows promise in enhancing memory and improving cognitive function (men 25-
50 mg per day; women 15-25 mg per day).18,19