Is creatine supplementation safe for high school athletes?

February 11, 2019

Richard B. Kreider, PhD, FACSM, FISSN, FACN, FNAK

I get this question a lot. Last year we updated our ISSN position stand on creatine supplementation in collaboration with the Council for Responsible Nutrition in part because of efforts by lawmakers in several states to limit sales of creatine to minors despite overwhelming evidence of potential benefits cited in the literature. In this regard, the ISSN position stand concluded that creatine monohydrate supplementation is not only safe, but has been reported to have a number of therapeutic benefits in healthy and diseased populations ranging from infants to the elderly. There is no compelling scientific evidence that the short- or long-term use of creatine monohydrate (up to 30 g/day for 5 years) has any detrimental effects on otherwise healthy individuals or among clinical populations who may benefit from creatine supplementation. 

Additionally, if proper precautions and supervision are provided, creatine monohydrate supplementation in children and adolescent athletes is acceptable and may provide a nutritional alternative with a favorable safety profile to potentially dangerous anabolic androgenic drugs. However, the ISSN recommends that creatine supplementation only be considered for use by younger athletes who: a.) are involved in serious/competitive supervised training; b.) are consuming a well-balanced and performance enhancing diet; c.) are knowledgeable about appropriate use of creatine; and d.) do not exceed recommended dosages.

The truth is that creatine monohydrate remains one of the few nutritional supplements for which research has consistently shown has ergogenic benefits. Additionally, a number of potential health benefits have been reported from creatine supplementation. Comments and public policy related to creatine supplementation should be based on careful assessment of the scientific evidence from well-controlled clinical trials; not unsubstantiated anecdotal reports, misinformation published on the Internet, and/or poorly designed surveys that only perpetuate myths about creatine supplementation. Given all the known benefits and favorable safety profile of creatine supplementation reported in the scientific and medical literature, it is the view of ISSN that government legislatures and sport organizations who restrict and/or discourage use of creatine may be placing athletes at greater risk—particularly in contact sports that have risk of head trauma and/or neurological injury thereby opening themselves up to legal liability. This includes children and adolescent athletes engaged in sport events that place them at risk for head and/or spinal cord injury.

To learn what the science says about creatine supplementation, click on the ISSN position stand image.