Tag Archives: JISSN

An Ode to Nutrient Timing


By Jose Antonio PhD FISSN FNSCA CSCS.  A few weeks back, one of my students asked me about a recent meta-analysis published in the Journal of the International Society of Sports Nutrition.  It was a well-written piece authored primarily by Brad Schoenfeld who is perhaps better known for his Lookgreatnaked.com website.  I mean who wouldn’t want to look frickin’ great naked, right?  Like the old Seinfeld comedy TV show demonstrated so poignantly, there’s ‘good naked’ and ‘bad naked.’  I’m a big fan of ‘good naked.’  Anyhow, the student posited the following:  “I read that nutrient timing doesn’t work according to that study published in the JISSN.”  JISSN is aka the Journal of the International Society of Sports Nutrition.  It’s an awesome scientific journal.  Besides, I’m the Editor in Chief.  And that’s reason enough to read it. :-)  Anyhow, getting back to my student’s query.  So much to learn, so little time.  Without delving into the minutae of different types of studies, I replied “that was a meta-analysis, not an original investigation.”  Mainstream journalists don’t realize that a meta-analysis does not provide new data.  It is merely a statistical analysis of existing data.  This is a huge difference.  The gold standard of scientific inquriy is the randomized controlled trial.   Either way.  This Millennial generation seems to believe everything they read; until of course they read something contrary.  No wonder they can’t make up their minds.

Bruce Lee says, "Timing is everything.  Especially when kicking someone's ass."

Bruce Lee says, “Timing is everything. Especially when kicking someone’s ass.”

So what gives?  What’s the devil in the details?  First, to summarize that meta-analysis, it stated in essence: “These results refute the commonly held belief that the timing of protein intake in and around a training session is critical to muscular adaptations and indicate that consuming adequate protein in combination with resistance exercise is the key factor for maximizing muscle protein accretion.[1]  In English, that means that protein timing is of no benefit and that the key factor is total protein intake.  Interestingly, in their Discussion, it is also stated that they “must acknowledge the possibility that protein timing was in fact responsible for producing a positive effect and that the associated increase in protein intake is merely coincidental.”  It makes sense that both timing and total protein intake are important.

Take the hypothetical scenario of a 180 pound man who consumes 180 grams of protein daily (to meet his athletic needs etc).  Would consuming all 180 grams at breakfast be as effective as spreading it out over 6 meals (30 grams every 3 hours)?  Uh hell no. What fool would eat like that? So when you eat (i.e. timing) is a critical factor.

Please note the distinction between protein timing with the sole purpose of promoting skeletal muscle hypertrophy and nutrient timing, which encompasses a variety of strategies that are related to performance and recovery.  I’ll get to what constitutes nutrient timing later.  But first let me shed some light on the issue of protein timing specifically.nutrient timing photo

In reality, there are only two studies, using resistance-trained subjects, whose protein intake was sufficiently high (1.8-1.9 g per kg per day) and matched, that employed a ‘protein timing’ strategy.  Please note however that most studies, for reasons that are too detailed to be covered here, typically compared protein to carbohydrate.  Those studies are quite important for historical reasons.  One day I’ll explain why over some beer and sushi.

Nevertheless, these two ‘protein timing’ studies were done by Paul Cribb PhD FISSN and Jay Hoffman PhD FISSN, respectively.  These were ‘apples to apples’ comparisons.  Not aardvark to orangutan comparisons (which in reality is most of what is called ‘protein timing’).  The Cribb study did indeed show a significant effect of immediate PRE and POST training supplementation working quite well (i.e. increased lean body mass and type IIA and IIX muscle fiber cross-sectional areas) in comparison to a Morning and Evening consumption strategy.  So in this case, timing matters.  Dr. Cribb concluded that “supplement timing represents a simple but effective strategy that enhances the adaptations desired from RE-training.[2]”  On the other hand, Dr. Hoffman basically replicated this study design and found that the “time of protein-supplement ingestion in resistance-trained athletes during a 10-wk training program does not provide any added benefit to strength, power, or body-composition changes.[3]”  So it either helps or has no effect, right? If you answered yes, you get 5 extra credit points on your final exam.

A simple maxim that I teach my students to follow vis a vis sports nutrition strategies is as follows:  “If it helps or has a neutral effect, try it.” Or better yet, do it.  So if you go beyond the mere dotting of i’s and crossing of t’s, you’d ask yourself the following questions.  1)  Is there any advantage to NOT utilizing a protein timing strategy?  Answer: No.  2) Is there a potential benefit to using a protein timing strategy? If you answered ‘yes,’ then go to the head of the class.  There is no downside to protein timing as a strategy.  In fact, take the common scenario of eating every three hours.  Let’s say meal 1, 2, and 3 are at 6am, 9am and 12noon.  Then you train at 3pm-4pm.  Wouldn’t it make sense to consume a protein-containing meal immediately after training?  That would make your fourth meal of the day consumed at 4pm.  Not quite every three hours.  However imagine waiting four hours post-training?  Why on Earth would anyone do that?  Hence, follow my advice and consume your meal immediately post-training at 4pm.  Then eat your regular dinner (i.e. meal #5) around 6-7pm.  Then around 9-10pm, have another small casein-based protein meal.

To give the ‘advice’ that it is useless or ineffective is a bit of an untruth (that’s Washington DC political-speak if you get my drift).  Even if something is marginally helpful, it is still helpful.  If one’s goal is to promote muscle hypertrophy, why wouldn’t you employ every possible tactic to get to your goal?  From a purely pragmatic standpoint, you should employ protein timing.

Now getting back to ‘nutrient timing.’   Folks have summarily dismissed nutrient timing because of their confusion with protein timing as it relates to skeletal muscle hypertrophy.  Nutrient timing is a very effective strategy.  To wit:

Consuming caffeine (in the form of a chewing gum) enhances cycling performance when administered immediately prior to, but not 1 or 2 hours before cycling.[4]

A 20 gram bolus of whey protein consumed every three hours is superior to other temporal patterns of feeding for the purpose of stimulating muscle protein synthesis and thus “has the potential to maximize outcomes of resistance training for attaining peak muscle mass.[5]”whey-protein-drinks-06

Consuming a sports drink 30 minutes before exercise improved performance better than consuming it 120 minutes prior. “This study provides new evidence to suggest that timing of carbohydrate intake is important in short duration high-intensity exercise tasks, but a concentration effect requires further exploration.[6]”  Certainly, it is well known that consuming a sports drink during exercise is better than drinking water. Thus, a “carbohydrate-electrolyte drink can increase endurance performance as well as enhance lactate removal and thereby delaying the onset of fatigue.[7]”

Another study showed that casein “protein ingested immediately before sleep is effectively digested and absorbed, thereby stimulating muscle protein synthesis and improving whole-body protein balance during postexercise overnight recovery.[8]”

In overweight individuals, shifting more of your calories towards breakfast versus later in the day is better for weight loss.[9]

Heck, common sense tells you that drinking water during a half-marathon run in the heat is better for performance than drinking after the run.  That’s a simple example of nutrient timing.

Thus, it is virtually impossible to escape the fact that nutrient timing plays an important role in many circumstances vis a vis the acute and chronic response to exercise.

I’d posit that not eating is the worst thing you can do.  Let’s face, there is nothing anabolic about not eating for 4 hours after training.  When in doubt, consume a protein-containing meal.  A meal doesn’t have to be a Thanksgiving-size portion.  A protein shake of 200 kcals or so constitutes a meal.  In essence, nutrient timing incorporates the use of methodical planning and eating of whole foods, beverages and supplements with the express purpose of enhancing recovery, performance, or body composition.[10]

One last note.  Science often reminds me of the tale of the six blind men and the elephant.  The tale goes like this.  One blind man feels the trunk and says it’s a snake.  Another touches the tail and says it’s a rope.  Another touches the legs and says it’s a tree. Another touches the ear and says it’s a fan.  Another touches the side of the animal and says it’s a wall.  While another grabs the tusks and says it’s a spear.  All of them are right…and wrong.  Don’t lose sight of the forest for the trees.

Our field is ultimately one governed by pragmatism.  Having done quite a bit of basic science (animal work particularly) research in my day, I can attest to its importance in understanding the underlying mechanisms that govern why things work the way they do.  However, our field is, when you get down to the nuts and bolts of it, an advice-driven one.  As scientists, we can argue over crossing t’s and dotting i’s, but in the end, we have to give the best advice we know based on the current data of the time.

If it helps or has a neutral effect, do it.


1.           Schoenfeld BJ, Aragon AA, Krieger JW: The effect of protein timing on muscle strength and hypertrophy: a meta-analysis. J Int Soc Sports Nutr 2013, 10:53.

2.           Cribb PJ, Hayes A: Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc 2006, 38:1918-1925.

3.           Hoffman JR, Ratamess NA, Tranchina CP, Rashti SL, Kang J, Faigenbaum AD: Effect of protein-supplement timing on strength, power, and body-composition changes in resistance-trained men. Int J Sport Nutr Exerc Metab 2009, 19:172-185.

4.           Ryan EJ, Kim CH, Fickes EJ, Williamson M, Muller MD, Barkley JE, Gunstad J, Glickman EL: Caffeine gum and cycling performance: a timing study. J Strength Cond Res 2013, 27:259-264.

5.           Areta JL, Burke LM, Ross ML, Camera DM, West DW, Broad EM, Jeacocke NA, Moore DR, Stellingwerff T, Phillips SM, et al: Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. J Physiol 2013, 591:2319-2331.

6.           Galloway SD, Lott MJ, Toulouse LC: Pre-Exercise Carbohydrate Feeding and High-Intensity Exercise Capacity: Effects of Timing of Intake and Carbohydrate Concentration. Int J Sport Nutr Exerc Metab 2013.

7.           Khanna GL, Manna I: Supplementary effect of carbohydrate-electrolyte drink on sports performance, lactate removal & cardiovascular response of athletes. Indian J Med Res 2005, 121:665-669.

8.           Res PT, Groen B, Pennings B, Beelen M, Wallis GA, Gijsen AP, Senden JM, LJ VANL: Protein ingestion before sleep improves postexercise overnight recovery. Med Sci Sports Exerc 2012, 44:1560-1569.

9.           Jakubowicz D, Barnea M, Wainstein J, Froy O: High Caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring) 2013, 21:2504-2512.

10.         Kerksick C, Harvey T, Stout J, Campbell B, Wilborn C, Kreider R, Kalman D, Ziegenfuss T, Lopez H, Landis J, et al: International Society of Sports Nutrition position stand: nutrient timing. J Int Soc Sports Nutr 2008, 5:17.

About the Author – Jose Antonio is the CEO and Co-founder of the International Society of Sports Nutrition and the Editor-in-Chief of the JISSN (www.jissn.com).  Check out the latest ISSN Conferences at www.theissn.org. If you’re ever in South Florida, he’d be happy to take you outrigger paddling.




Energy Drink Dumba$$es

By Jose Antonio PhD FISSN, FNSCA, CSCS.  There are some things that are just annoying.  Stepping on chewing gum.   Emails from Nigeria asking for $1,000 so they can transfer a $1,000,000 to your bank (Really?  What dope falls for this?).  Hitting every red light as you make your way home.  Celebrity confessions.  Having to actually watch a TV show with the commercials (thank god for TiVo!).  And reading the numbskull articles written by the mainstream press on pretty much all things related to sports nutrition.  Runner’s World, a magazine that I actually enjoy reading (yeah, don’t tell anyone), posted on their website an article entitled “Sports Nutrition Group Doubts Claims of Energy Drink Makers.” http://www.runnersworld.com/drinks-hydration/sport-nutrition-group-doubts-claims-energy-drink-makers  I’m thinking; hey, I wonder who that group is.  Inquiring minds need to know.  And guess what, it’s the International Society of Sports Nutrition!  The ISSN is the leading academic society that studies sports nutrition and supplements and I’m the head honcho.  I’ll at least give Runner’s World credit for citing the Position Paper that we recently published.  But that’s pretty much where the credit ends.

The Runner’s World interpretation of our article is so wrong.  Why?  Because my colleagues and I wrote the dang thing.  I think we’d know BETTER than anyone what the correct interpretation is!  To wit:  Here’s the headline – “Sports Nutrition Group Doubts the Claims of Energy Drink Makers.”  Uh no.  In fact, if you read #3 of the Position Paper’s abstract it says the following:  “Consuming ED 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance.”  That my friends is THE most important point.  The drinks work!  We can argue over the why and whether it’s the ingredients or combination thereof, but the bottom line is that as an ergogenic aid, the stuff will help you perform better.

And then we have the Dawn Report which states that the number of emergency room visits involving energy drinks has increased.  The implication is that energy drinks must be hurting thousands of people, right?  Well as they say in Alabama, shitfire Bubba, that ain’t no proof!

http://www.samhsa.gov/data/2k13/DAWN126/sr126-energy-drinks-use.htm Since when did emergency room visits become a substitute for scientific studies?  Did I miss something in my years of studying the frickin’ scientific method?  To fall for the moronic trap that sensational headlines are a substitute for honest-to-goodness critical thinking would be like judging a fish by its ability to climb trees.  As I tell my super-smart students at Nova Southeastern University in beautiful South Florida, read the data.  Read the science.  Whenever you see headlines such as this, instead of believing it hook, line and sinker, instead immerse yourself in the actual studies and decide for yourself.  Because one day you’ll write a scientific paper and then some journalist with about as much science training as your pet Beagle will tell you how it should be interpreted.  Ok enough of this.  Time to consume copious quantities of caffeine-filled java.

Reference: The 2013 International Society of Sports Nutrition position stand: energy drinks http://www.jissn.com/content/10/1/1



Idiots in the Mist – The Lowdown on Creatine

by Jose Antonio PhD.  For those of you who know me, you’re well aware that I’m pretty lazy when it comes to bs’ing you.  It takes too much work and frankly, it’s just a waste of time.  If you want a straight answer, I’ll give it.  If you want a sugar-coated answer that’ll make you feel better, go ask your Mommy.  So what’s with the sardonic prelude?  is-creatine-safe-how-the-king-of-supps-affects-your-organs-1

First a little edification.  I teach at Nova Southeastern University in Davie FL.  I try like a madman to instill lessons in critical thinking.  Any monkey can memorize and regurgitate information.  But true learning occurs when you can think critically and independently.  Sometimes the mark of a good thinker is when you realize the more you learn, the more questions you have.  Often, those who are uneducated don’t know enough to know what they don’t know.  Hence, they succumb to ‘bro-science.’

I implore students to think for themselves, look up the data, and not just believe what your buddy at the gym says.  When I read just plain stupid sh#* like “creatine supplementation is bad for your kidneys,” it would be like a rocket scientist at NASA reading “the Earth really is flat.”  Ask yourself, “is there data to support the statement?”  Certainly, if you are looking for 100% agreement on anything scientific, then you my friend are in the wrong field.  The only guarantees are death and taxes.  So how does one come to a reasonable and smart conclusion about sports nutrition? 

As they say on one of my favorite TV Shows “CSI,”  ‘just follow the data; the data will tell you the answer.’  So in essence you’re a sleuth looking at the evidence, the clues, and the data.  With regards to creatine, the data are so voluminous, so robust, so convincing that it would be idiotic to believe otherwise.  Unless of course you’re so skeptical that you think apples might rise tomorrow.

So here’s the lowdown on creatine. 

To wit:  I gave my two-cents worth of supplement advice vis a vis “The Creatine Report” by Nick Tumminello and Lou Schuler.  It is a nice, informative, and consumer-friendly piece on the most widely researched sports supplement in the history of mankind.  For a copy of the report, go to http://www.freecreatinereport.com/.  Nick and Lou did an excellent job outlining the facts and dispelling the myths associated with creatine.  One would think that with the HUNDREDS of randomized clinical trials on creatine the myths promulgated by the educated and uneducated would cease.  But alas, I am mistaken.

Apparently, one must never underestimate the stupidity of the general public (or the learned medical professional).  Nick was kind enough to share with me some of the questions/comments that he received regarding creatine.  To say some were just god-awful idiotic would be an insult to idiots.  Moreover, the gross ignorance demonstrated by so-called experts (i.e. the Mayo Clinic) is just plain embarrassing.  Below are some of the questions he received.  For me to answer each of them in detail would be like asking a physicist to explain why apples fall from a tree rather than rise.  Yep, we still have flat-earthers out there.  My response is easy to see.  It’s after my initials.

Questions from readers who slept through Biology 101.

– Is there any quality research showing Creatine doesn’t work? If so, should these results affect our decision to take creatine?

JA:  Of course there is good research out there that shows creatine does not have an ergogenic effect.  If you’re looking for 100% agreement in science, then you’re a fool.  Imagine giving aspirin to 100 individuals with a headache.  Ninety of them respond favorably and 10 do not.  And let’s say that’s the general pattern throughout the scientific literature.  So does that mean aspirin works (for treating headaches)?  Or not?  Scientific conclusions are based on the PREPONDERANCE of the evidence.  And it is clear that the preponderance of the evidence points to a robust ergogenic response from creatine supplementation.  Sure, it doesn’t work for everyone.  But then again what does?  For a scientific summary of creatine, please read the ISSN’s Position paper on creatine.[1http://www.jissn.com/content/4/1/6  

– Some people say creatine made them bloated. Is there any scientific evidence behind these claims? What do you say to people when they make (or repeat) this type of claim?

JA:  The problem with the word ‘bloated’ is that it has no scientific meaning.  How do you measure bloatedness?  If someone says they are bloated, how can you even argue against it?  If someone says they weigh more, that’s easy to measure.  If you ‘feel’ bloated (whatever that means to you) and that feeling bothers you, then by all means quit taking creatine. 

– There are also claims from people that creatine made them poop more often.  Any scientific validation to this claim? What do you say to folks who make (or repeat) this kind of claim?

JA:  What?  You gotta be kidding me.  Inasmuch as there hasn’t been a single study measuring ‘poop frequency’ and creatine use, it’s impossible to give a remotely scientific answer.  However, if you like pooping more, then by all means keep taking it (if that’s what creatine does to you).  If you don’t like it, then for chrissakes quit taking it.

Here are quotes verbatim from the Mayo Clinic: http://www.mayoclinic.com/health/creatine/NS_patient-creatine/METHOD=print; Sigh…

Mayo Clinic: Creatine has been associated with asthmatic symptoms. People should avoid creatine if they have known allergies to this supplement. Signs of allergy may include rash, itching, or shortness of breath.

JA:  There is animal data which suggests this.[2, 3]  However, with the hundreds of clinical trials in humans, there’s no evidence that creatine causes an allergic reaction in us bipeds. Hence, if you have a pet rodent, by all means don’t give it creatine.

Mayo Clinic:  There is limited systematic study of the safety, pharmacology, or toxicology of creatine. Individuals using creatine, including athletes, should be monitored by a healthcare professional. Users are advised to inform their physicians or other qualified healthcare professionals.

JA:  This is a bit of a straw man argument.  First of all, the data is ALWAYS LIMITED (i.e. ‘limited systematic study…’).  But my question is this.  How much data is sufficient to satisfy the naysayers?  If you do a NIH database search of ‘Creatine and Exercise,’ it turns up 597 peer-reviewed scientific publications.  If you search ‘Creatine and Health,’ it turns up 107 publications.  According to the hundreds of RCTs (randomized clinical trials), there is no evidence of harmful side effects vis a vis creatine supplementation.  And please, do not cite anecdotes or case studies as evidence to the contrary.  Physicians love using case studies.  But with hundreds of RCTs, it would be perverse to ignore the plethora of evidence supporting the safety and efficacy of creatine supplementation.  Again, read these papers for a good review of the literature.[1, 4http://www.ncbi.nlm.nih.gov/pubmed/21424716 and http://www.jissn.com/content/4/1/6  .

Mayo Clinic: Some individuals may experience gastrointestinal symptoms, including loss of appetite, stomach discomfort, diarrhea, or nausea.

JA:  Really?  And the double-blind, placebo-controlled trials that show this are published where exactly?  Now it is entirely possible that there are those who have idiosyncratic responses to creatine ingestion.  Is it within the realm of possibilities that some may experience GI distress?  Of course.  But then again, folks get that eating nachos and cheese, hot dogs, or white bread too. 

Mayo Clinic: Creatine may cause muscle cramps or muscle breakdown, leading to muscle tears or discomfort.

JA: This is one is just sheer fabrication.  Wouldn’t the hundreds of peer-reviewed studies that examined the effects of creatine supplementation on exercise performance have already shown this?  According to a study published in the British Journal of Sports Medicine, “Recent reports now suggest that creatine may enhance performance in hot and/or humid conditions by maintaining haematocrit, aiding thermoregulation and reducing exercising heart rate and sweat rate. Creatine may also positively influence plasma volume during the onset of dehydration. Considering these new published findings, little evidence exists that creatine supplementation in the heat presents additional risk, and this should be taken into consideration as position statements and other related documents are published.”[5] Another study found that “the incidence of cramping or injury in Division IA football players was significantly lower or proportional for creatine users compared with nonusers.”[6]  For the Mayo Clinic to post this on their website is at best irresponsible and at worst, just plain moronic.

Mayo Clinic: Strains and sprains have been reported due to enthusiastic increases in workout regimens once starting creatine. Weight gain and increased body mass may occur. Heat intolerance, fever, dehydration, reduced blood volume, or electrolyte imbalances (and resulting seizures) may occur.

JA: What?  Really?  Did the author of this Mayo Clinic piece fall asleep during ‘Science 101?’ Again as stated in the previous answer: “Recent reports now suggest that creatine may enhance performance in hot and/or humid conditions by maintaining haematocrit, aiding thermoregulation and reducing exercising heart rate and sweat rate. Creatine may also positively influence plasma volume during the onset of dehydration. Considering these new published findings, little evidence exists that creatine supplementation in the heat presents additional risk, and this should be taken into consideration as position statements and other related documents are published.”[5] Another study found that “the incidence of cramping or injury in Division IA football players was significantly lower or proportional for creatine users compared with nonusers.”[6]  I feel like a broken record at times (yes, that dates me huh?). 

Here’s another excerpt from a study:  “The incidence of cramping (37/96, 39%), heat/dehydration (8/28, 36%), muscle tightness (18/42, 43%), muscle pulls/strains (25/51, 49%), non-contact joint injuries (44/132, 33%), contact injuries (39/104, 44%), illness (12/27, 44%), number of missed practices due to injury (19/41, 46%), players lost for the season (3/8, 38%), and total injuries/missed practices (205/529, 39%) were generally lower or proportional to the creatine use rate among players. Creatine supplementation does not appear to increase the incidence of injury or cramping in Division IA college football players.”[7]  Hey Mayo Clinic, did you bother to read any of this? 

Mayo Clinic: Long-term administration of large quantities of creatine is reported to increase the production of formaldehyde, which may potentially cause serious unwanted side effects.

JA: One study from Medicine and Science in Sports and Exercise states: Low-dose creatine combined with protein supplementation increases lean tissue mass and… reduces muscle protein degradation and bone resorption without increasing formaldehyde production.[8]  A publication in the journal ‘Amino Acids’ states: “Even if there is a slight increase (within the normal range) of urinary methylamine and formaldehyde excretion after a heavy load of creatine (20 g/day) this is without effect on kidney function. The search for the excretion of heterocyclic amines remains a future task to definitively exclude the unproved allegation made by some national agencies. We advise that high-dose (>3-5 g/day) creatine supplementation should not be used by individuals with pre-existing renal disease or those with a potential risk for renal dysfunction (diabetes, hypertension, reduced glomerular filtration rate). A pre-supplementation investigation of kidney function might be considered for reasons of safety, but in normal healthy subjects appears unnecessary.”  Thus, if you are a normal healthy exercising individual (and that pretty much describes the demo of those who consume creatine), then you are perfectly okay taking it.

Mayo Clinic: Creatine may increase the risk of compartment syndrome of the lower leg, a condition characterized by pain in the lower leg associated with inflammation and ischemia (diminished blood flow), which is a potential surgical emergency.

JA: “A 7-day loading dose of CrM increased anterior compartment pressures after dehydration and immediately after the heat tolerance tests, but the changes did not induce symptoms and the pressure changes were transient.”[9]  Is it possible that in rare instances, creatine supplementation might increase the risk of compartment syndrome?  Well, in the realm of possibilities, anything is possible.  And you might get struck by lightning and bitten by a shark too.

Mayo Clinic: Reports of other side effects include thirst, mild headache, anxiety, irritability, aggression, nervousness, sleepiness, depression, abnormal heart rhythm, fainting or dizziness, blood clots in the legs (called deep vein thrombosis), seizure, or swollen limbs.

JA:  Depression?  With the millions of creatine users in North America alone, one would think you’d have the offices of clinical psychologists lined up with depressed patients.  Again, this is entirely taken out of context.  Here is an excerpt from the report in which this ‘depression’ is based:  “Eight unipolar and two bipolar patients with treatment-resistant depression were treated for four weeks with 3-5 g/day of creatine monohydrate in an open add-on design. Outcome measures were the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and Clinical Global Impression scores, recorded at baseline and at weeks 1, 2, 3 and 4. One patient improved considerably after one week and withdrew. Both bipolar patients developed hypomania/mania. For the remaining seven patients, all scale scores significantly improved. Adverse reactions were mild and transitory.  This small, preliminary, open study of creatine monohydrate suggests a beneficial effect of creatine augmentation in unipolar depression, but possible precipitation of a manic switch in bipolar depression.”  Did you read that?  They gave creatine to unipolar and bipolar patients!  Not exactly the demographic that walks into Vitamin Shoppe and buys creatine is it?   And this passes for ‘evidence’ that it may cause depression.  Now all the other nonsense listed by the Mayo Clinic is just that, nonsense.  Again, sounding like a broken record; please read these papers which give you a broad overview of the creatine literature.[1, 4

The Moral of the Story

Be smart; don’t be lazy; look up the data.  And please don’t believe all the silly comments you hear from your friends or read on the internet.  If you have questions about any sports nutrition topic, then for chrissakes, go to the original source.  Read the science!

Remember, if you eat a lot of fish, you are eating a fair amount of creatine.  Last time I checked, fish was one of the healthiest foods to consume on the planet.  So for the naysayers, if you’re going to condemn creatine, you might as well put fish (and other meats) in that category. 

Nonetheless, the data supporting creatine’s safety and efficacy is as clear as the Montana sky.  Do yourself a favor.  Read the peer-reviewed science on creatine.  Don’t succumb to the Google-induced idiocy when you do searches like “creatine and poop frequency,” or “creatine and repetitive TiVo watching of The View.”  Yep, you can pretty much find anything on the web.  If you’re convinced creatine supplementation causes a third eye to pop out in the middle of your forehead, then there’s no hope for you.

I’ll end this story with a quote by Dalbo et al:  “Creatine is one of the most popular athletic supplements with sales surpassing 400 million dollars in 2004. Due to the popularity and efficacy of creatine supplementation over 200 studies have examined the effects of creatine on athletic performance. Despite the abundance of research suggesting the effectiveness and safety of creatine, a fallacy appears to exist among the general public, driven by media claims and anecdotal reports, that creatine supplementation can result in muscle cramps and dehydration. Although a number of published studies have refuted these claims, a recent position statement by the American College of Sports Medicine (ACSM) in 2000 advised individuals who are managing their weight and exercising intensely or in hot environments to avoid creatine supplementation. Recent reports now suggest that creatine may enhance performance in hot and/or humid conditions by maintaining haematocrit, aiding thermoregulation and reducing exercising heart rate and sweat rate. Creatine may also positively influence plasma volume during the onset of dehydration. Considering these new published findings, little evidence exists that creatine supplementation in the heat presents additional risk, and this should be taken into consideration as position statements and other related documents are published.[5]”


1.            Buford TW, Kreider RB, Stout JR, Greenwood M, Campbell B, Spano M, Ziegenfuss T, Lopez H, Landis J, Antonio J: International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr 2007, 4:6.

2.            Ferreira SC, Toledo AC, Hage M, Santos AB, Medeiros MC, Martins MA, Carvalho CR, Dolhnikoff M, Vieira RP: Creatine activates airway epithelium in asthma. Int J Sports Med 2010, 31:906-912.

3.            Vieira RP, Duarte AC, Claudino RC, Perini A, Santos AB, Moriya HT, Arantes-Costa FM, Martins MA, Carvalho CR, Dolhnikoff M: Creatine supplementation exacerbates allergic lung inflammation and airway remodeling in mice. Am J Respir Cell Mol Biol 2007, 37:660-667.

4.            Jager R, Purpura M, Shao A, Inoue T, Kreider RB: Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids 2011, 40:1369-1383.

5.            Dalbo VJ, Roberts MD, Stout JR, Kerksick CM: Putting to rest the myth of creatine supplementation leading to muscle cramps and dehydration. Br J Sports Med 2008, 42:567-573.

6.            Greenwood M, Kreider RB, Greenwood L, Byars A: Cramping and Injury Incidence in Collegiate Football Players Are Reduced by Creatine Supplementation. J Athl Train 2003, 38:216-219.

7.            Greenwood M, Kreider RB, Melton C, Rasmussen C, Lancaster S, Cantler E, Milnor P, Almada A: Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem 2003, 244:83-88.

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