Should Youth Athletes Use Creatine?

17-year-old, Jenkins comes strutting out of the weight room after he just crushed a workout living his strongest, healthiest, and injury-free life. While walking out of the weight room Jenkins is using Nutrition with Wendi’s recommended “25-50-30 rule” and is downing a shaker bottle with chocolate milk and creatine paired with a banana. Jenkins is a smart kid and has focused on proper sleep, hydration, eating well, and managing his stress while training hard. But of course many make comments like, “You know that powder he is mixing in there is steroids right? One of my parent’s friends said his coach has been encouraging the use of anabolic steroids for years!” YIKES RIGHT??

Ever heard this crazy misinformation before? Yeah, me too. It has spread like wildfire.  It is even more gut-wrenching when it’s spread by doctors, trainers, health care professionals, influencers, or random people on the internet that know very little about science, sports performance, or even what creatine is. Insert facepalm. Good news! I am here to dispel those myths and provide the science to help combat the misinformation that is so toxic.

Creatine is one of the most effective ergogenic aids for adult athletes and is safe. Creatine effectively increases lean mass, strength, power, speed, and exercise capacity (1).  But what about youth athletes? I have had several high school coaches and concerned parents of youth athletes ask me questions like, “Is creatine safe for my kids? Should my female athletes be using creatine?” In almost every conversation, my first response is, “It depends.” Just like any other question I get, nutrition-, health-, fitness- or performance-related, it should be individualized. Creatine, however, is beneficial to all populations according to the science outlined in this article. As a registered dietitian, I strongly promote a “food first” and back-to-basics philosophy. For more information on healthy eating and performance nutrition, see a previous blog here. I empower anyone working with youth athletes to use the guidance in this article when considering “to supplement with creatine or not.”

Creatine Monohydrate 101:

  • 95% of creatine is found in skeletal muscle
  • The human body needs 1-3 g per day
  • Most creatine in the diet comes from animal products like meat, fish, & poultry
  • Enhances post-exercise recovery, injury prevention, and/or spinal cord neuroprotection and muscle growth

What is it?

Creatine is a naturally occurring compound formed by three amino acids, making it a tripeptide (tri- meaning three) of the amino acids L-glycine, L-arginine, and L-methionine. Creatine is assembled in a two-step process that occurs in the kidneys and liver. 

Creatine can be consumed via dietary sources, which include foods like eggs, milk, tuna, salmon, herring, cod, shrimp, beef, and pork. Consuming enough creatine from the diet is challenging given the total creatine pool available according to an article published in Frontiers in Nutrition Sport and Exercise Nutrition by Candow et al., 2019. This literature, along with the International Society of Sports Nutrition Position Stand on Creatine Supplementation and Exercise, suggests the body needs to replenish about 1–3 g of creatine per day to maintain normal (un-supplemented) creatine stores depending on muscle mass.  Creatine monohydrate is the most well-studied form of creatine in the literature. For a more detailed breakdown of other forms please check out Will Brink’s fantastic breakdown on Creatine HCL vs Monohydrate for a deep dive.

Creatine improves numerous factors including strength, power, sprint ability, muscular endurance, resistance to fatigue, muscle mass, recovery, cognition, and rate of muscle growth. Creatine is one of the most widely studied, proven performance enhancers available that also offers clinical benefits (4).

How does creatine work?

Creatine deposits high-energy phosphate groups in the form of phosphocreatine. This is given to adenosine diphosphate (ADP), regenerating it to adenosine triphosphate (ATP), the sole energy carrier in the human body, which can be called “energy currency” for cells to carry out their functions. For example, during conditions of short-term, high-energy demand activities (<30 seconds) with limited recovery time, ATP runs out quickly, which illustrates the importance of creatine stored in muscles in the form of creatine phosphate. This is explained here

Since creatine phosphate restores ATP, it gives muscle cells the ability to produce greater energy. The greater creatine stores you have, the greater energy your muscle cells can yield during high-intensity exercise, thus leading to increased exercise performance. Even though the most well-documented and primary benefit is higher energy production, this mechanism also supports muscle gain and strength increases, as explained here.

Despite creatine being widely tested since the early 1900s with significant data supporting its effectiveness, it is widely misunderstood by many trainers, coaches, athletes, and concerned parents of high school athletes. Yes, it is 2021 and people still think creatine monohydrate is a steroid due to misinformation generated across social media and the general population (4).

Disregard the false, outlandish, disproven claims. I am referencing the silly fallacies like, “creatine will make you fat,” “creatine will cause liver, kidney, or bone injury,” “creatine will dehydrate you,” or my personal favorite, “creatine is a steroid that will also lead to baldness.” I know. What a bunch of nonsense. I addressed these fallacies in a previous blog, Creatine Not Just for Men or Muscle. Please go check it out if you are a female because creatine can help you improve your lean mass and lose that fat.

Antonio et al. published a phenomenal paper outlining the common questions and misconceptions regarding creatine use available for open access here (1). I highly recommend you read it and share it with anyone who may have creatine confusion disorder. I made that up, but you get my point. Creatine monohydrate is beneficial for many things beyond performance, which is not my opinion but the science!

Potential ergogenic benefits of creatine supplementation in adults (4):

  • Greater training tolerance
  • Increased sprint performance
  • Increased work performed during sets of maximal effort
  • Increased lean mass & strength adaptations during physical training
  • Enhanced glycogen synthesis
  • Increased work capacity
  • Enhanced recovery
  • Increased anaerobic threshold

If you’re interested in my opinion as a dietitian and performance practitioner working with several athletes I highly recommend creatine. Creatine is like the Swiss Army knife of supplements! It can do so many things!

In November 2020 I had the fortunate opportunity to be a guest on Dr. Bradford Cooper’s podcast, Catalyst Coaching, where I discussed the role creatine plays according to science. Please check out the video or podcast here.

What about side effects?

There is robust evidence to support the effectiveness of creatine in the adult population. Among children and adolescents, there is mounting evidence to support the therapeutic benefits of creatine supplementation as well as clinical and exercise performance. Available studies in the adolescent population involving high-intensity exercise training indicate performance benefits as well as no reported side effects (1,2).

In relation to performance, the International Society of Sports Nutrition (ISSN) has concluded that creatine monohydrate is the most effective ergogenic supplement available to athletes in terms of increasing high-intensity exercise and supporting lean body mass during training. The ISSN has also concluded CM is safe.(4).

Does creatine work in young athletes?

Regardless of the limited data in this population, creatine is likely safe, beneficial, and well-tolerated among youth athletes as evidenced by the available data (2). 

  • Creatine supplementation improved time performance and strength in highly competitive swimmers (2,3).
  • Youth soccer players experienced improved sprinting, vertical jump, dribbling, and shooting (6).
  • Creatine can support brain health, offering neuroprotective effects following a concussive injury in athletes < 16 years old (4).

Check out a Creatine Supplementation in Children and Adolescents review carried out by Jagim and Kerksick, 2021, outlining the available studies involving youth athletes for more information.

Another podcast to check out is Gerry DeFilippo. Gerry kindly invited me on his podcast to discuss the different forms of creatine. To learn more download and listen to Episode #143 Everything You Need to Know About Creatine with Wendi Irlbeck.

Should my teen athletes be supplementing with creatine?

As always, food first, but creatine can be a safe and effective regimen for young athletes who meet the following criteria (1,5):

  • Consuming a well-balanced diet
  • Consuming a diet with a greater emphasis on plant proteins like soy and pea which do not provide creatine like animal proteins
  • Involved in high-intensity training, competitive sports which include:
    • Track
    • Swimming
    • Lacrosse
    • Ice Hockey
    • American Football
    • Volleyball
    • Field Hockey
    • Basketball
    • Soccer
    • Tennis
    • Olympic Weightlifting
    • Rugby
    • Combat Sports (MMA, wrestling, boxing, etc.)

It is always best practice that athletes of any age fully educate themselves by consulting with a registered dietitian nutritionist, certified sports nutritionist, exercise physiologist, or sports-focused physician before use of any supplement. Similarly, any products used should be NSF International Certified for Sport to reduce the risk of consuming any harmful or contaminated products. Supplements are regulated but not as heavily regulated as pharmaceuticals. Please see reasons to use NSF Certified for Sport products in a previous blog.

“The USADA recommends that athletes use only dietary supplements that have been certified by a third-party program that tests for substances prohibited in sport. The USADA is responsible for anti-doping education and testing for athletes in the U.S. Olympic and Paralympic Movements as well as the UFC.”

Therefore, all supplements used should be third-party tested for safety, purity, and compliance. For the sake of convenience and safety, you and your athlete can download the NSF Certified Sport app.

I preach food first, nutrient periodization, quality rest, good sleep hygiene, hydration, and appropriate training, all of which can be better enhanced using creatine monohydrate (CM). Based on the strongest science and studies, CM is the recommended form. CM is used in the studies. Therefore, it should be used in practice as well. I discussed the other forms in my guest appearance on Muscles and Management.

When to use creatine?

The science suggests creatine is most effective immediately post-workout when paired with protein and carbohydrate (7). Creatine consumed immediately post-resistance training is superior to pre-workout in terms of body composition and strength (7). The recommended dose is 3-5 g of creatine per day. Creatine can be used at any time of day. Creatine is safe and effective on rest days from exercise as well as training days.

While CM is best paired with a carbohydrate-rich source (like oatmeal, whole-grain bread, rice, fruit, smoothies, or yogurt) to draw it into muscle cells, it can also be added to water or other beverages. A saturated cell is a happy cell! This supports recovery and muscle repair following resistance training. 

Most creatine supplements are in powder form and must be used in warm water to support the dissolving process. CM will dissolve slowly in cold water and often ends up in the bottom of a shaker bottle, which won’t do any good if it doesn’t make it into your mouth! Creapure is a great brand to use and offers more explanation on dosing. Check it out here! No, I do not have a partnership or any affiliation with Creapure. I just want to share that they make a great product.

My female youth soccer players have integrated CM post-training with their tart cherry juice and chocolate milk. I have taken time to discuss the safety, use, and benefits with my youth athlete’s parents, coaches, and even their PE teachers. I have 50% of my youth athletes supplementing with CM. CM is always a conversation we have after we wrap up their 6-week Nutrition with Wendi Coaching Program.

Do I need to load?

No, you do not need to “creatine load”. In fact, many studies use a typical creatine dose of 5-10 g daily or smaller doses like the standard 2-3 g. However, if you desire to do a loading phase, it would look something like 20-25 g for 5-7 days followed by a maintenance phase of 5 g daily for 4 weeks, 2 weeks off, and then repeat. I do not have any of my athletes do this cycling as it is unnecessary. See the ISSN’s Position Stand for more on this (4).

Studies support the benefits of CM supplementation regardless of the dose. However, that does not mean more is better. If you are a vegetarian and new to using CM, you would benefit from saturating the muscles with CM, leading to an acute increase in strength and bodyweight via water retention. However, please refer to the experts and those I respect most in the field like Dr. Darren Candow, Dr. Tim N. Ziegenfuss, Dr. Scott Forbes, Dr. Jose Anotonio, Dr. Rich Krider, Dr. Eric Rawson, and others who can further provide the research they have been doing for the last few decades.

Please see another podcast in which I had the opportunity to speak about creatine in the youth population via the Big Time Strength podcast.

Closing thoughts

There is robust literature to support the beneficial effects creatine has on body composition, physical performance, injury prevention, recovery, brain health, and clinical use. Currently, there have not been any negative effects associated with the use of CM in both the adolescent and adult population. Adolescent athletes under the age of 18, and even children as young as infants, can safely consume CM. There is zero evidence to suggest CM supplementation would cause harm, dehydration, cramping, or any other outlandish claims that have been disproven by Antonio et al., 2021, and others. Not incorporating a CM supplement would be a disservice to your athletes or even yourself!

Key takeaways:

  • Anyone looking to improve their health of any age or activity level can safely consume 3-5 g of creatine monohydrate immediately post-workout paired with a carbohydrate. 
  • By supplementing with creatine monohydrate immediately following training, you’re able to support muscle growth and recovery, injury prevention, and overall health. 
  • Yes, creatine is safe to consume if you are a teen athlete. Yes, you should use creatine monohydrate.
  • No, creatine is not a steroid. No, creatine will not cause baldness. No, creatine will not dehydrate you. No, creatine will not cause cramps. No, creatine will not decrease your bone mineral density.
  • If you have a beating pulse, then creatine monohydrate is for you!

Sports physicians, athletic trainers, coaches, performance nutritionists, and others working with youth athletes should provide the best guidance to teen athletes based on the available science to support their principal interests. Kids are going to be using supplements like energy drinks and pre-workouts, which contain dangerous amounts of caffeine. I would rather we provide education behind the safety and use of creatine, which is not dangerous but beneficial. I would like to see more people using creatine given the ergogenic benefits and no reported adverse effects. Creatine monohydrate is a safe, effective, and inexpensive way to support health and physical performance! Please don’t let, “Joe Public” from accounting or “Susie Quinn,” on Instagram tell you any different. 

In good health and wellness,

Wendi Irlbeck, MS, RDN, CISSN

Wendi Irlbeck, MS, RDN, CISSN  is a registered dietitian nutritionist and performance coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. She partners with parents, sports performance staff, and special needs and recreational athletes to offer nutritional guidance and optimal athletic performance and lifestyle plans. Wendi provides virtual services including telehealth but is based in Grand Rapids, Michigan. Wendi works with clients of all levels and ages across the US as well as Canada and the UK. You can find more about Wendi and scheduling an appointment with her on her website.

What can hiring a sports nutritionist offer your program? Learn more here.  Interested in signing up for the NEW and upcoming NWW newsletter? Click here to sign up!

References

  1. Antonio, J., Candow, D.G., Forbes, S.C. et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition 18, 13 (2021). https://doi.org/10.1186/s12970-021-00412-w
  2. Grindstaff PD, Kreider R, Bishop R, Wilson M, Wood L, Alexander C, et al. Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers. Int J Sport Nutr. (1997) 7:330–46.
  3. Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103. doi: 10.1123/ijsnem.14.1.95. PMID: 15129933.
  4. Kreider, R.B., Kalman, D.S., Antonio, J. 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 14, 18 (2017). https://doi.org/10.1186/s12970-017-0173-z
  5. Jagim AR, Stecker RA, Harty PS, Erickson JL, Kerksick CM. Safety of creatine supplementation in active adolescents and youth: A Brief Review. Front Nutr. 2018;5:115. Published 2018 Nov 28. doi:10.3389/fnut.2018.00115
  6. Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103. doi: 10.1123/ijsnem.14.1.95. PMID: 15129933
  7. Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Int Soc Sports Nutr. 2013 Aug 6;10:36. doi: 10.1186/1550-2783-10-36. PMID: 23919405; PMCID: PMC3750511.