By Jose Antonio, Ph.D. – Random Note: A question came up regarding the effects of creatine supplementation on blood pressure. For the life of me I could not figure out why anyone would think creatine would adversely affect blood pressure. Nevertheless, here is a reference that I’d suggest you read (Med Sci Sports Exerc. 2000. Mihic et al.)
But enough of that. Here’s my question. If creatine is safe for kids who might be ill or sick, then why on Earth would it be harmful to a healthy adult? To wit: Walk around any mall in the heartland of America and you’ll find this common site. Kids sitting at a brightly colored table in a Food Court peppered with all sorts of different fast foods. Parents are more than willing to buy their kids French fries, donuts, fried chicken, cheeseburgers and other assorted not-so-good for you foods. Let’s face it; it’s tough to get kids to eat salmon and broccoli right? Nonetheless, it is socially acceptable to eat like sh#$ and therefore look like sh$%. Though looking like sh$% seems to be less tolerated despite the fact that the two often go hand in hand. However, the mere mention that kids should be consuming dietary supplements, in this case creatine, brings gasps of horror! Creatine! What about the kids? Will it harm them? Will their kidneys peeter out and die? Egads!
Never has a supplement been studied so much yet misunderstood entirely by the general public. Folks are often surprised to hear that creatine is naturally found in meats, especially fish. So if you’re afraid of creatine, I’d suggest you avoid the sushi bar like a sailor avoids the confessional. In a nutshell, creatine is probably the most studied dietary supplement in the history of mankind. Out of the hundreds of studies performed on creatine, there is no evidence to show that it causes any harm. In fact, there are studies in kids (even infants) showing no side effects. So what are folks so scared? Two reasons: they’re either idiots or they’re uninformed. We fear what we don’t understand, right?
Background on Creatine – Creatine plays an important role in energy metabolism and is synthesized or made in the liver, kidney and pancreas. It is stored mainly in skeletal muscles, heart and brain. There is scientific evidence which show a short and long-term therapeutic benefit of creatine supplementation in children and adults with gyrate atrophy (a result of the inborn error of metabolism with ornithine delta- aminotransferase activity), muscular dystrophy (facioscapulohumeral dystrophy, Becker dystrophy, Duchenne dystrophy and sarcoglycan deficient limb girdle muscular dystrophy), McArdle’s disease, Huntington’s disease and mitochondria-related diseases. Hypoxia and energy related brain pathologies (brain trauma, cerebral ischemia, prematurity) might benefit from creatine supplementation.
Studies of Creatine in Kids
Creatine and Kids with Cancer – Nine children with ALL (acute lymphoblastic leukemia, a type of cancer) in the maintenance phase of treatment on the Dana-Farber Cancer Institute (DFCI) protocol 2000-2001 were treated with creatine monohydrate (CrM) (0.1 g/kg/day; equal to 6.8 grams for a 150 lb person) for two sequential periods of 16 weeks (16 weeks treat > 6 weeks wash-out > 16 weeks treat). A cohort of 50 children who were receiving the same chemotherapy at the same time served as controls. Despite the long course of corticosteroid treatment for ALL, children showed significant increases in height, bone mineral density, and fat free mass (i.e. muscle) over approximately 38 weeks during the study. There was an increase in body mass index over time, but children taking CrM had a reduction, while the control group showed an increase in % body fat. Thus, children with ALL treated with corticosteroids as part of a maintenance protocol of chemotherapy showed an increase in % body fat; however, those consuming CrM demonstrated lesser body fat accumulation. No side effects were reported.
Creatine and Kids with Muscular Dystrophy – In another study, 30 boys with Duchenne’s Muscular Dystropy (DD) (50% were taking corticosteroids) completed a double-blind, randomized, cross-over trial with 4 months of CrM (about 0.10 g/kg/day), 6-week wash-out, and 4 months of placebo. Four months of CrM supplementation led to increases in fat free mass and handgrip strength in the dominant hand and a reduction in a marker of bone breakdown; furthermore, the supplement was well tolerated in children with this muscle disease.
Creatine and Kids with Traumatic Brain Injury – In perhaps one of the more intriguing studies, creatine was given to kids with traumatic brain injury or TBI. The effect of creatine was determined on 39 children and adolescents, aged between 1 to 18 years old, with TBI. The creatine was administered for 6 months, at a dose of 0.4 g/kg in an oral suspension form every day. That’s a huge dose which is equal to 27 grams for a 150 lb person. The administration of creatine to children with TBI improved results in several parameters, including duration of post-traumatic amnesia (PTA), duration of intubation, intensive care unit (ICU) stay, disability, good recovery, self care, communication, locomotion, sociability, personality/behavior and neurophysical, and cognitive function. Significant improvement was recorded in the categories of Cognitive, personality/behavior, Self Care, and communication aspects in all patients. No side effects were seen because of creatine administration. Thus, there is evidence that creatine supplementation is beneficial to pediatric patients with traumatic brain injury.
Creatine and Exercising Kids – Sixteen male fin swimmers (age:15.9 years) were randomly and evenly assigned to either a creatine (CR, 4×5 g/day creatine monohydrate for 5 days) or placebo group (P, same dose of a dextrose-ascorbic acid placebo) in a double-blind research. Before and after creatine supplementation, the average power output was determined by a Bosco-test and the swimming time was measured in two maximal 100 m fin swims. After five days of supplementation the average power of one minute continuous rebound jumps increased by 20.2%. The swimming time was significantly reduced in both first and second sessions of swimming in the CR group, but remained almost unchanged in the P group. Thus, creatine supplementation enhances the dynamic strength and may increase anaerobic metabolism in the lower extremity muscles, and improves performance in consecutive maximal swims in highly trained adolescent fin swimmers. In another study, four weeks of creatine supplementation enhanced swim bench test performance.
Creatine and Infants – According to researchers, hypoxic ventilatory depression in mice and muscle fatigue in adult humans are improved by creatine supplementation (CS). However, a study in human infants found that creatine supplementation did not improve symptoms of apnea of prematurity in infants. Interestingly though, no side effects were seen with creatine supplementation (equal to a 13.6 gram daily dose in a 150 lb person).  In an interesting case report, scientists studied and treated an infant with an inborn deficiency of guanidinoacetate methyltransferase (GAMT). Long-term oral administration of creatine-monohydrate (4-8 g per day) to this patient resulted in substantial clinical improvement, disappearance of magnetic resonance (MRI) signal abnormalities in the globus pallidus, and normalisation of slow background activity on the electroencephalogram (EEG). During the 25-month treatment period, both brain and total body creatine concentrations became normal. Accordingly, oral creatine replacement has proved to be effective in one child with an inborn error of GAMT. It may well be effective in the treatment of other disorders of creatine synthesis. It is interesting that a dose of 4-8 grams per day in an infant would be equal to over 100 grams daily in an adult.
Conclusion – Supplementation of kids of varying ages with creatine has been shown to improve exercise performance, promote recovery post traumatic brain injury, help infants with inborn errors of metabolism, and ameliorate body fat gain secondary to corticosteroid treatment. No side effects are reported in these investigations. Thus, the preponderance of the evidence clearly shows that creatine supplementation may indeed be beneficial for kids with no side effects.
BIO – Jose Antonio Ph.D. is the CEO of the ISSN (www.theissn.org)
 Evangeliou A, Vasilaki K, Karagianni P, Nikolaidis N. Clinical applications of creatine supplementation on paediatrics. Curr Pharm Biotechnol 2009;10 (7):683-90.
 Bourgeois JM, Nagel K, Pearce E, Wright M, Barr RD, Tarnopolsky MA. Creatine monohydrate attenuates body fat accumulation in children with acute lymphoblastic leukemia during maintenance chemotherapy. Pediatr Blood Cancer 2008;51 (2):183-7.
 Tarnopolsky MA, Mahoney DJ, Vajsar J, Rodriguez C, Doherty TJ, Roy BD, Biggar D. Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology 2004;62 (10):1771-7.
 Sakellaris G, Kotsiou M, Tamiolaki M, Kalostos G, Tsapaki E, Spanaki M, Spilioti M, Charissis G, Evangeliou A. Prevention of complications related to traumatic brain injury in children and adolescents with creatine administration: an open label randomized pilot study. J Trauma 2006;61 (2):322-9.
 Sakellaris G, Nasis G, Kotsiou M, Tamiolaki M, Charissis G, Evangeliou A. Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study. Acta Paediatr 2008;97 (1):31-4.
 Juhasz I, Gyore I, Csende Z, Racz L, Tihanyi J. Creatine supplementation improves the anaerobic performance of elite junior fin swimmers. Acta Physiol Hung 2009;96 (3):325-36.
 Dawson B, Vladich T, Blanksby BA. Effects of 4 weeks of creatine supplementation in junior swimmers on freestyle sprint and swim bench performance. J Strength Cond Res 2002;16 (4):485-90.
 Bohnhorst B, Geuting T, Peter CS, Dordelmann M, Wilken B, Poets CF. Randomized, controlled trial of oral creatine supplementation (not effective) for apnea of prematurity. Pediatrics 2004;113 (4):e303-7.
 Stockler S, Hanefeld F, Frahm J. Creatine replacement therapy in guanidinoacetate methyltransferase deficiency, a novel inborn error of metabolism. Lancet 1996;348 (9030):789-90.