Creatine has been used in clinical trials for several classes of neuromuscular disorder. Although not a cure per se, creatine supplementation may improve the quality of life of those inflicted with these disorders. In fact, preliminary studies have demonstrated that creatine supplementation improves strength in patients with several classes of neuromuscular disorder.

Creatine has also been used postoperatively on patients recovering from orthopedic surgery.

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Creatine Guidelines-- updated Oct 2002 by Ray Sahelian, MD If you are planning to take creatine to increase muscle mass and strength, consult your physician if you have medical problems or taking medicines, and please read the paragraphs below. A cautious approach would be to limit intake to 3 grams almost every day for three weeks followed by 3 grams two or three times a week. It would be wise to take a week off per month. ("wash-out-period") It would also be wise to take a full month or more off every 3 to 4 months. Of course these are rough guidelines. The amount and frequency of creatine use depends on how much muscle gain a person wants to maintain. Athletes may require higher dosages, small individuals would require less and larger individuals may require more. There are a number of other factors that influence the amount of creatine intake including sex, age, concurrent use of other supplement or medicines, medical condition, genetics, etc.

I do not recommend any specific brand or product and I cannot give advice whether you should or should not take creatine. I also have not seen any studies comparing regular creatine monohydrate versus serum or patch, micronized, or any other type, and hence do not have an opinion on the different types of creatine. Regular creatine monohydrate powder seems to work quite well by itself. As to the timing of creatine intake--whether before a workout, or after a workout--I have not seen any specific studies addressing this question. Creatine seems to work well for most people no matter when they take it, but it would seem logical that taking it right before, during, or after a workout may be a better option than taking it at a sedentary time. A recent study showed taking a protein supplement right after a workout helps increase muscle size to a greater extent than taking the protein two hours after a workout. Creatine supplements may work well combined with a protein powder supplement, either from soy or casein. Creatine can be taken with practically any fluid, and my preference is fruit or vegetable juices since they contain many vitamins and phytonutrients. One can add protein powder, and other health/vitamin/green powders. Creatine taken with a small amount of food reduces the nausea that sometimes happens when taken on an empty stomach. Drinking additional water may be helpful. It has been reported that simultaneous ingestion of creatine with caffeine reduces its effectiveness. Creatine will increase the size of muscles even without working out, but the gains are minimal compared to creatine supplements along with a workout. Muscle size will likely decrease a few days or weeks after stopping creatine use, particularly if one stops working out.

Additional benefits: Creatine may be helpful for certain muscular dystrophies (facioscapulohumeral dystrophy, Becker dystrophy, Duchenne dystrophy, sarcoglycan-deficient limb girdle muscular dystrophy). Creatine has been found to increase strength by about 10 percent in older men who took the supplement for one week. Creatine helped these older men in their daily activities such as getting out of a chair.

Side Effects and Cautions:  Nausea, stomach upset, dizziness or weakness, loose stools, diarrhea, and weight gain are the most common, and generally occur with dosages greater than 5 grams a day. Muscle cramping is also reported. Strains and sprains can occur (perhaps even muscle tears?) when individuals over enthusiastically and rapidly increase their workout regimen before their tendons and ligaments have adapted to the increase in muscle size and power. Long-term consequences of daily creatine ingestion, especially in high dosages, are currently not known. There is a possibility that excess creatine can put stress on the kidneys and liver. Creatine converts into creatinine which, in high dosages, could act as a toxin. Whether there is a potential for increasing the risk of cancer with regular high dose use is currently not known. I discourage the regular, high dose use of creatine. Individuals with kidney disease should not use creatine. I have also come across a few anecdotes about high dose creatine causing anxiety or depression. Time will tell whether creatine is responsible for these cognitive changes. There are no reports to date that creatine influences the size of genital organs or has a significant effect, positive or negative, on sex drive. Creatine doesn't seem to have a direct effect on libido, although feeling good about one's toned body could influence self-image and how others react to us and make us feel more attractive and sexual. The influence of creatine on sperm count or motility, if any, is not known at this time. Short term creatine supplementation does not seem to affect blood pressure, heart rate, or kidney function. A small to modest amount of alcohol intake should not interfere with low dose creatine use. I don't advise taking creatine while pregnant. There are no reports of creatine having an influence on hair loss.