Is creatine safe for women, children, the pregnant or the elderly?

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Is creatine safe for women, children, the pregnant or the elderly?

Following the example set by the sports medicine and exercise physiology fields, the creatine field has principally concentrated on male subjects between the ages of 18 and 35 years. Scientific studies conducted on this age group have typically demonstrated enhancements in physical performance during repeated bouts of maximal effort, particularly during later repetitions when the accumulation of lactic acid becomes appreciable, contributing significantly to the onset of muscle fatigue. Therefore, since one of the major ergogenic contributions of creatine is to lessen the buildup of lactic acid, exercise capacity increases as a result of creatine supplementation. Other contributions of creatine to the total ergogenic package have been discussed previously and have to do with increases in anaerobic energy reserves (ATP and Phosphocreatine; muscle cell proliferation and increases in the production of contractile and metabolic (energy-producing) proteins.

Although, the effects of creatine in children, the elderly and women has been studied much less, there is no a priori reason to think that creatine’s basic mechanism of action should differ with age or gender. However, subtle differences may exist in how creatine supplementation effects these distinct categories of individuals and special considerations may thus apply; some aspects of creatine supplementation in these populations may be detrimental and be a valid basis for concern, whereas others aspects of creatine supplementation may render a clear benefit to the individual supplementing. These considerations will be discussed below.

Children: Whether creatine is safe for children is our second most commonly asked question. And expectedly, the nature of creatine's side effects is our most frequent inquiry. Most creatine experts are of the opinion that it is best to postpone creatine supplementation until after puberty, particularly since the long-term consequences of creatine supplementation are still largely unknown. In other words, if adverse consequences to creatine supplementation do exist, then the younger an athlete starts the practice, the more likely potential side effects are to manifest within their lifetime.

A more pertinent question might be, however: “Should children push themselves beyond the normal limits of play?” Remember, creatine supplementation primarily enhances an athlete's ability to generate near maximal force during repetitive bouts of intense exercise. Given that some experts have warned that excessive mechanical stress might have deleterious consequences on a skeletal frame that is rapidly growing, I would advise against creatine supplementation before reaching puberty. This is just my personal opinion, the opinion of other experts may differ.

Adolescents: Creatine studies conducted on adolescents have given both positive and null results creating a bit of confusion in the field. The simple truth is, however, that too few studies exist to objectively state just how great an effective creatine supplementation has in the adolescent population. Nonresponders are observed even in the most heavily studied age group (18-35 years of age) and hence, the statistical uncertainty may merely reflect the fewer number of studies conducted on adolescents.

Elderly: Our muscular phosphocreatine levels decline as we age beyond our fifth decade. Such a decline in muscle creatine content may partially explain the decrease in strength and predisposition to fatigue that is observed in the elderly. Creatine supplementation might therefore prove especially worthwhile in the individuals over 50. In support of this notion several recent studies have demonstrated accentuated performance enhancement in healthy individuals in their 50s, 60s and early 70s. That is, creatine supplementation produces relatively greater gains in middle-aged subjects than in younger subjects.

By stark contrast, an effect of creatine supplementation (over physical performance) in individuals in their late 70s and 80s has been somewhat harder to resolve. Age-related decreases in activity-level, anabolic hormones, or type II fast muscle mass may underlie the reduced responsiveness of the elderly to creatine supplementation. Recall that type II muscle is the class of muscle fiber that is most responsive to the effects of creatine supplementation and principally mediate explosive bursts of power. This is not to say, however, that creatine supplementation is a pointless endeavor in later life. Quite the contrary. Many aspects of creatine supplementation may prove particularly beneficial for older athletes. For instance, creatine supplementation may reduce the chances of developing coronary heart disease as well as several neurological disorders that plague us in later life.

The elderly, however, are not without recourse in combating this age-related decline in creatine responsiveness over physical performance. Adopting a more healthful lifestyle, including regular exercise and eating a balanced diet (see next paragraph), can help maintain youthful anabolic hormone levels for longer in life and, hence, preserve one's sensitivity to creatine as well as improve one's overall quality of life. Maintaining an active lifestyle also helps prevent against the loss of existing muscle tissue, which should also translate into greater responses to creatine supplementation. Therefore, exercise and good nutrition should prolong your sensitivity to creatine for longer in life, which should, in turn, slow the normal aging process.

Methylation status is an important contributing factor to the natural decline in strength and mental capacity associated with advanced age. It is now widely accepted that many of the devastating loses in mental and physical capacity that were once thought to be unavoidably linked to the normal aging process are, in fact, now known to be the result of an aged-related decline in methylation capacity.

If you should opt to supplement with creatine, make sure to use only the highest grade creatine products, an important measure since many of the less expensive brands of creatine contain significant quantities of potentially harmful contaminants.

Women: Several recent studies have examined the effects of creatine supplementation in women of diverse fitness levels. And, although creatine clearly enhanced exercise performance in women, the documented effects were less pronounced than those observed in males of the same study. Specifically, gender differences were observed at the level of muscle protein turnover; creatine supplementation appears to have a greater anti-catabolic action in males. Differences in the anabolic-androgenic sex hormone, namely the predominance of testosterone in males, may underlie this distinct response to creatine in females.

Pregnancy: It is not known whether the levels of creatine in breast milk increase during supplementation. Until this information becomes available, women nursing infants are advised to abstain from using creatine. The point of this recommendation is to avoid inadvertently exposing the infant to abnormally elevated levels of creatine that might alter key metabolic processes during child development.

A similar concern arose from the finding that the expression level of the creatine transporter changes dramatically during the first few weeks of life in certain animal species. For instance, in rabbit pups the level of creatine transporter expressed on neurons within the brain drops by 60% between the first 5 to 15 days of life. That is, after birth. Given the fact that serum creatine levels have been shown to influence the expression of the creatine transporter, the possibility thus exists that exogenous creatine supplementation may upset an inherent developmental program based on natural changes in serum creatine levels. Again, this phenomenon remains to be demonstrated in humans.

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