Although the overwhelming majority of evidence in adult populations indicates that creatine supplementation is safe and well tolerated [1], the question of whether or not this holds true for children and adolescents is relatively unclear.
The physiological rationale supporting the potential ergogenic benefits of creatine supplementation in children and adolescents was introduced in 2001 and established a strong basis for future applications of creatine for younger athletes.
A recent comprehensive review examining the safety of creatine supplementation in adolescent athlete populations found no evidence of adverse effects [2].
Research continues to accumulate that highlights the fact that high school aged individuals and younger are supplementing with creatine. Creatine use in this population can operate in an ergogenic fashion as shown in the multitude of studies in the table below [1].
Table: Efficacy of creatine use in adolescents [3-8]
Finally, one should not dismiss the now 25+ years of research that continues to highlight that creatine use in a multitude of populations is safe and effective means to improve both clinical and ergogenic outcomes [9].
Clinically speaking, creatine has been found to potentially offer health benefits with minimal adverse effects in younger populations.
There were no adverse changes in laboratory parameters of hematology, kidney function, liver function or inflammatory markers after 12 weeks of creatine supplementation in pediatric patients with systemic lupus erythematosus [10].
Pediatric patients with Duchenne muscular dystrophy showed significant improvements in fat-free mass and hand grip strength following 4 months of creatine supplementation [11].
In addition, significant improvements were reported in traumatic brain injury-related outcomes in children and adolescents who received oral creatine supplementation (0.4g/kg/day) for 6 months [12].
These neurological benefits may have potential applications for young athletes participating in collision sports, which pose underlying risks of concussions or sub-concussive impacts.
In addition, several of these clinical trials implemented strict clinical surveillance measures, including continual monitoring of laboratory markers of kidney health, inflammation, and liver function, none of which were negatively impacted by the respective creatine supplementation interventions.
These findings support the hypothesis of creatine supplementation likely being safe for children and adolescents.
However, perhaps the strongest supporting evidence for the safety of creatine is the recent classification of creatine as generally recognized as safe (GRAS) by the United States Food and Drug Administration (FDA) in late 2020.
Ultimately, this classification indicates that the currently available scientific data pertaining to the safety of creatine, is sufficient and has been agreed upon by a consensus of qualified experts, thereby determining creatine to be safe under the conditions of its intended use [13].
The bulk of dietary supplement survey data indicates that a relatively high percentage of youth and adolescent athletes are currently or have previously supplemented with creatine.
This increase trend in use warrants additional research to determine with greater certainly whether both acute and longer term creatine supplementation is safe for children and adolescents.
In summary, based on the limited evidence, creatine supplementation appears safe and potentially beneficial for children and adolescents.
References:
1. Kreider, R.B., et al., International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr, 2017. 14: p. 18.
2. Jagim, A.R., et al., Safety of Creatine Supplementation in Active Adolescents and Youth: A Brief Review. Front Nutr, 2018. 5: p. 115.
3. Juhasz, I., et al., Creatine supplementation improves the anaerobic performance of elite junior fin swimmers. Acta Physiol Hung, 2009. 96(3): p. 325-36.
4. Claudino, J.G., et al., Creatine monohydrate supplementation on lower-limb muscle power in Brazilian elite soccer players. J Int Soc Sports Nutr, 2014. 11: p. 32.
5. Dawson, B., T. Vladich, and B.A. Blanksby, Effects of 4 weeks of creatine supplementation in junior swimmers on freestyle sprint and swim bench performance. J Strength Cond Res, 2002. 16(4): p. 485-90.
6. Grindstaff, P.D., et al., Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers. Int J Sport Nutr, 1997. 7(4): p. 330-46.
7. Ostojic, S.M., Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab, 2004. 14(1): p. 95-103.
8. Theodorou, A.S., et al., The effect of longer-term creatine supplementation on elite swimming performance after an acute creatine loading. J Sports Sci, 1999. 17(11): p. 853-9.
9. Kerksick, C.M., et al., ISSN exercise & sports nutrition review update: research & recommendations. J Int Soc Sports Nutr, 2018. 15(1): p. 38.
10. Hayashi, A.P., et al., Efficacy and safety of creatine supplementation in childhood-onset systemic lupus erythematosus: a randomized, double-blind, placebo-controlled, crossover trial. Lupus, 2014. 23(14): p. 1500-11.
11. Tarnopolsky, M.A., et al., Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology, 2004. 62(10): p. 1771-7.
12. Sakellaris, G., et al., 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): p. 322-9.
13. Antonio, J., et al., Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr, 2021. 18(1): p. 13.
