madman
Super Moderator
Abstract
Although creatine has been mostly studied as an ergogenic aid for exercise, training, and sport, several health and potential therapeutic benefits have been reported. This is because creatine plays a critical role in cellular metabolism, particularly during metabolically stressed states, and limitations in the ability to transport and/or store creatine can impair metabolism. Moreover, increasing the availability of creatine in tissue may enhance cellular metabolism and thereby lessen the severity of the injury and/or disease conditions, particularly when oxygen availability is compromised. This systematic review assesses the peer-reviewed scientific and medical evidence related to creatine’s role in promoting general health as we age and how creatine supplementation has been used as a nutritional strategy to help individuals recover from injury and/or manage chronic disease. Additionally, it provides reasonable conclusions about the role of creatine on health and disease based on current scientific evidence. Based on this analysis, it can be concluded that creatine supplementation has several health and therapeutic benefits throughout the lifespan.
1. Introduction
Creatine supplementation is one of the most studied and effective ergogenic aids for athletes [1]. The multifaceted mechanisms by which creatine exerts its beneficial effect include increasing anaerobic energy capacity, and decreasing protein breakdown, and leading to increased muscle mass and physical performance [1]. While these well-recognized creatine effects benefit the athlete, creatine may also serve as a potential clinical and therapeutic supplementary treatment to conventional medical interventions [2–10]. In this regard, over recent years, researchers have been investigating the potential therapeutic role of creatine supplementation on health-related conditions such as diabetes [11], sarcopenia [4,6,12,13], osteoporosis [2,14], cancer [10,15–18], rehabilitation [4,19–26], cognition [3,27–29], and cardiovascular health [5,6,8,30–32], among others. This work has increased interest in creatine use as a nutritional strategy to help maintain functional and mental capacity and, as we age, reduce the risk of chronic disease, and/or serve as an adjunctive intervention to help manage the disease and/or promote recovery. This special issue aims to provide comprehensive reviews of the role of creatine in health and clinical disease. To do so, we have invited a number of top creatine scholars to contribute comprehensive reviews as well as encouraged colleagues to submit meta-analyses and original research to this special issue.
As an introduction about creatine’s potential role in health and disease, the following provides a general overview of creatine’s metabolic role, purported benefits throughout the lifespan, and potential therapeutic applications. Additionally, we provide reasonable conclusions about the state of the science on creatine supplementation. This overview will be accompanied by separate, more comprehensive, literature reviews on the metabolic basis of creatine in health and disease as well as the potential role of creatine in pregnancy; children and adolescents; exercise and performance; physical therapy and rehabilitation; women’s health; aging, sarcopenia, and osteoporosis; brain neuroprotection and function; immunity, cancer protection, and management; heart and muscle health; and, chronic and post-viral fatigue. We hope that this review and the special issue will help readers and medical practitioners better understand the safety and efficacy of creatine supplementation in a variety of populations and provide recommendations about future research needs.
3. Metabolic Role
4. General Health Benefits
5. Role of Creatine in Aging Populations
5.1. Muscle Mass, Strength, Bone, and Body Composition
5.2. Cognitive Function
5.3. Glucose Management and Diabetes
5.4. Heart Disease
6. Potential Therapeutic Role of Creatine Supplementation
6.1. Creatine Synthesis Deficiencies
6.2. Neurodegenerative Diseases and Muscular Dystrophy
6.3. Brain and Spinal Cord Neuroprotection
6.4. Enhanced Rehabilitation Outcomes
6.5. Pregnancy
6.6. Immune Support
6.7. Anticancer Properties
6.8. Improve Functional Capacity in Patients with Chronic Fatigue?
6.9. Antidepressive Effects
6.10. Fertility
6.11. Skin Health
7. Conclusions
The benefits of creatine monohydrate supplementation go well beyond increasing muscle Cr and PCr levels and thereby enhancing high-intensity exercise and training adaptations. Research has clearly shown several health and/or potential therapeutic benefits as we age and in clinical populations that may benefit by enhancing Cr and PCr levels. Although additional research is needed to explore further the health and potential therapeutic benefits of creatine supplementation, many of these topics will be described in more detail in other papers within this special issue. Based on the available evidence, the following can be reasonably concluded based.
1. Creatine supplementation can increase cellular energy availability and support general health, fitness, and well-being throughout the lifespan
2. Creatine supplementation, particularly with resistance training, can promote gains in strength and help maintain or increase muscle mass in older individuals. Additionally, creatine supplementation during energy-restriction-induced weight loss may be an effective way to preserve muscle while dieting and thereby help manage adult-onset obesity
3. Creatine supplementation may support cognitive function, particularly as one age
4. Creatine supplementation may support healthy glucose management
5. Phosphocreatine administration and possibly creatine supplementation may support heart metabolism and health, particularly during ischemic challenges
6. Long-term, high-dose creatine supplementation in individuals with creatine synthesis deficiencies can increase brain creatine and PCr levels and may reduce the severity of deficits associated with these disorders
7. Although creatine supplementation has been shown to have neuroprotective properties and improve strength and endurance, the efficacy of long-term, high-dose creatine supplementation in individuals with neurodegenerative diseases is equivocal, while promising, in patients with muscular dystrophy
8. Creatine supplementation may increase brain creatine content, enhance energy availability during ischemic events, and provide neuroprotection from TBI and/or SCI
9. Creatine supplementation prior to and following injury may reduce immobilization-related atrophy and/or enhance rehabilitative outcomes in a number of populations
10. Creatine supplementation during pregnancy may help support the mother and child’s nutritional needs and health; however, due to the limited studies in pregnant humans, caution should be exercised when recommending use during human pregnancy
11. Creatine supplementation may have anti-inflammatory and immunomodulating effects
12. Creatine is an important energy source for immune cells, can help support a healthy immune system, and may have some anticancer properties.
13. Creatine and/or GAA may improve functional capacity in patients with chronic fatigue-related syndromes such as post-viral fatigue syndrome (PFS) and myalgic encephalomyelitis (ME)
14. Creatine may support mental health
15. Creatine may support reproductive health
16. Creatine may support skin health
Although creatine has been mostly studied as an ergogenic aid for exercise, training, and sport, several health and potential therapeutic benefits have been reported. This is because creatine plays a critical role in cellular metabolism, particularly during metabolically stressed states, and limitations in the ability to transport and/or store creatine can impair metabolism. Moreover, increasing the availability of creatine in tissue may enhance cellular metabolism and thereby lessen the severity of the injury and/or disease conditions, particularly when oxygen availability is compromised. This systematic review assesses the peer-reviewed scientific and medical evidence related to creatine’s role in promoting general health as we age and how creatine supplementation has been used as a nutritional strategy to help individuals recover from injury and/or manage chronic disease. Additionally, it provides reasonable conclusions about the role of creatine on health and disease based on current scientific evidence. Based on this analysis, it can be concluded that creatine supplementation has several health and therapeutic benefits throughout the lifespan.
1. Introduction
Creatine supplementation is one of the most studied and effective ergogenic aids for athletes [1]. The multifaceted mechanisms by which creatine exerts its beneficial effect include increasing anaerobic energy capacity, and decreasing protein breakdown, and leading to increased muscle mass and physical performance [1]. While these well-recognized creatine effects benefit the athlete, creatine may also serve as a potential clinical and therapeutic supplementary treatment to conventional medical interventions [2–10]. In this regard, over recent years, researchers have been investigating the potential therapeutic role of creatine supplementation on health-related conditions such as diabetes [11], sarcopenia [4,6,12,13], osteoporosis [2,14], cancer [10,15–18], rehabilitation [4,19–26], cognition [3,27–29], and cardiovascular health [5,6,8,30–32], among others. This work has increased interest in creatine use as a nutritional strategy to help maintain functional and mental capacity and, as we age, reduce the risk of chronic disease, and/or serve as an adjunctive intervention to help manage the disease and/or promote recovery. This special issue aims to provide comprehensive reviews of the role of creatine in health and clinical disease. To do so, we have invited a number of top creatine scholars to contribute comprehensive reviews as well as encouraged colleagues to submit meta-analyses and original research to this special issue.
As an introduction about creatine’s potential role in health and disease, the following provides a general overview of creatine’s metabolic role, purported benefits throughout the lifespan, and potential therapeutic applications. Additionally, we provide reasonable conclusions about the state of the science on creatine supplementation. This overview will be accompanied by separate, more comprehensive, literature reviews on the metabolic basis of creatine in health and disease as well as the potential role of creatine in pregnancy; children and adolescents; exercise and performance; physical therapy and rehabilitation; women’s health; aging, sarcopenia, and osteoporosis; brain neuroprotection and function; immunity, cancer protection, and management; heart and muscle health; and, chronic and post-viral fatigue. We hope that this review and the special issue will help readers and medical practitioners better understand the safety and efficacy of creatine supplementation in a variety of populations and provide recommendations about future research needs.
3. Metabolic Role
4. General Health Benefits
5. Role of Creatine in Aging Populations
5.1. Muscle Mass, Strength, Bone, and Body Composition
5.2. Cognitive Function
5.3. Glucose Management and Diabetes
5.4. Heart Disease
6. Potential Therapeutic Role of Creatine Supplementation
6.1. Creatine Synthesis Deficiencies
6.2. Neurodegenerative Diseases and Muscular Dystrophy
6.3. Brain and Spinal Cord Neuroprotection
6.4. Enhanced Rehabilitation Outcomes
6.5. Pregnancy
6.6. Immune Support
6.7. Anticancer Properties
6.8. Improve Functional Capacity in Patients with Chronic Fatigue?
6.9. Antidepressive Effects
6.10. Fertility
6.11. Skin Health
7. Conclusions
The benefits of creatine monohydrate supplementation go well beyond increasing muscle Cr and PCr levels and thereby enhancing high-intensity exercise and training adaptations. Research has clearly shown several health and/or potential therapeutic benefits as we age and in clinical populations that may benefit by enhancing Cr and PCr levels. Although additional research is needed to explore further the health and potential therapeutic benefits of creatine supplementation, many of these topics will be described in more detail in other papers within this special issue. Based on the available evidence, the following can be reasonably concluded based.
1. Creatine supplementation can increase cellular energy availability and support general health, fitness, and well-being throughout the lifespan
2. Creatine supplementation, particularly with resistance training, can promote gains in strength and help maintain or increase muscle mass in older individuals. Additionally, creatine supplementation during energy-restriction-induced weight loss may be an effective way to preserve muscle while dieting and thereby help manage adult-onset obesity
3. Creatine supplementation may support cognitive function, particularly as one age
4. Creatine supplementation may support healthy glucose management
5. Phosphocreatine administration and possibly creatine supplementation may support heart metabolism and health, particularly during ischemic challenges
6. Long-term, high-dose creatine supplementation in individuals with creatine synthesis deficiencies can increase brain creatine and PCr levels and may reduce the severity of deficits associated with these disorders
7. Although creatine supplementation has been shown to have neuroprotective properties and improve strength and endurance, the efficacy of long-term, high-dose creatine supplementation in individuals with neurodegenerative diseases is equivocal, while promising, in patients with muscular dystrophy
8. Creatine supplementation may increase brain creatine content, enhance energy availability during ischemic events, and provide neuroprotection from TBI and/or SCI
9. Creatine supplementation prior to and following injury may reduce immobilization-related atrophy and/or enhance rehabilitative outcomes in a number of populations
10. Creatine supplementation during pregnancy may help support the mother and child’s nutritional needs and health; however, due to the limited studies in pregnant humans, caution should be exercised when recommending use during human pregnancy
11. Creatine supplementation may have anti-inflammatory and immunomodulating effects
12. Creatine is an important energy source for immune cells, can help support a healthy immune system, and may have some anticancer properties.
13. Creatine and/or GAA may improve functional capacity in patients with chronic fatigue-related syndromes such as post-viral fatigue syndrome (PFS) and myalgic encephalomyelitis (ME)
14. Creatine may support mental health
15. Creatine may support reproductive health
16. Creatine may support skin health
