FACT SHEETS

Grading Criteria
Strong scientific evidence it works
The A ranking is achieved when there are at least two double blind
placebo controlled studies with similar methodology, or numerous

A studies of this quality that may have related but not similar
methodology (most likely in the form of a meta-analysis). Studies
conducted in animals and reviews that do not provide new evidence do
not count, and for epidemiological evidence to receive an A ranking the
effect must remain consistent across no less than 3 studies.

Good scientific evidence it works

The B ranking is achieved when the body of evidence suggests benefit
and is relatively cohesive but the parameters of A have not been met.

B
This tends to be when multiple studies have been conducted but
their methods varying widely (despite studying the same parameter)
or when animal and in vitro evidence is convincing but human
interventions are minimal yet present. The B ranking is also given to
convincing epidemiological evidence that does not have accompanying
interventions proving the mechanism of action.

Neutral scientific evidence; unknown if it works

The C ranking is given to supplements that either show benefit from

C a single human study (of lacklustre design), exclusively from animal

studies, or when numerous trials conducted on the topic show no
cohesiveness as to demonstrate whether the supplement succeeds or
fails.

Some scientific evidence it does not work

The D ranking is given to supplements that have either one well

D
controlled study (double blind placebo controlled trial) or numerous
human studies of lesser quality that demonstrate a failure of the
supplement to have an effect while simultaneously having either no
human evidence to suggest benefit or evidence to suggest benefit of a
much lesser quality.

Strong scientific evidence it does not work

F
The F ranking is given to supplements that have numerous, well
controlled, studies to suggest that the supplement fails to affect the
target parameter while also having proven rationale as to why the
supplement fails to affect the target parameter.
 CREATINE
How it became
Evidence a Supplement
Muscle Growth (with Exercise) Creatine was known by biologists
Creatine is most well known as the ‘king’ of exercise supplements, for a long time before it was used
and this is partially due to robust evidence that shows people as a dietary supplement as an extra

A who supplement creatine and exercise grow muscle tissue at a

faster rate than people who do similar exercises without creatine
supplementation. The general benefit of creatine increasing the rate
reserve for energy in a cell where it
helps replenish the main cellular
energy currency, ATP, in situations
of muscular growth is beyond a shadow of a doubt, but the degree it where the cell undergoes stress.
benefits does seem to differ based on the individual using creatine. Due to the presence of creatine in
high levels in meat products and
Improving Strength (Athletes) meat’s historical association with
In concert with the increased muscular growth is increased strength in exercise and strength, as well as
the general curiosity of seeing what

A
power-based activities. While a large part of this is due to the increased
muscularity, creatine also appears to increase strength in these happens when you consume a
activities before any additional muscle is even built. The temporary compound that is so vital in the cell,
strength increase creatine confers leaves when supplementation is research started in rodents and it
stopped, but the strength gained from the new muscle tissue remains. was very quickly apparent that not
only could it get to the cell but it
could increase muscular strength.
Power-based Sports Performance
While creatine has mixed benefits in sports performance overall, sports Ever since then creatine has seen

A
that have power-based segments such as basketball (jumping) or consistent sales and usage due to
hockey (sprinting) see localized benefits on these parts due to creatine its efficacy and overall benefits,
supplementation. Sports based almost exclusively on power such although it is at times somewhat
as sprinting and powerlifting see unanimous benefits from creatine unreliable when it comes to how
supplementation. much people respond beneficially
to it. For those lucky few who can
Reducing Depression get all the benefits of creatine
Creatine seems to be effective in fighting depression, with all evidence it stands as a testament that

B showing mild benefits in women only. There is a lack of evidence overall sometimes, things that are too
on creatine and depression in men, but the limited evidence available good to be true may exist.
suggests that this is either a gender-exclusive effect or is simply much
more likely to benefit women with depression than men.

Cognition
While the topic of cognitive capacities with creatine is not overly

C researched, there are a few trials assessing a variety of parameters

with generally mild benefits when the subject is in a fatigued state, is
vegetarian, or is elderly. Most trials on this general topic are standalones
without replication.
 CREATINE
Improving Strength (Elderly)
While creatine may be beneficial to the elderly who are also
participating in exercise protocols, for the purpose of reducing falls,

C it is fully reliant on there actually being some manner of exercise.

Furthermore, the degree of benefit seems to be lesser than youth
supplementing creatine. Creatine also does not appear to help
sarcopenia (age-related muscle loss) when supplemented reactively,
with lifetime creatine usage on the risk of sarcopenia not assessed.

Endurance-based Sports Performance

Despite the apparent benefits of creatine in sports and exercise based
in powerful movements, sports and activities that involve repetitive
actions for a prolonged period of time either see minimal benefit or

C none at all. The benefits of creatine are related to how long one can
keep the activity up, with almost unanimous benefits in powerlifting,
mixed and moderate benefits in rowing tests, and no apparent benefit
(or downside) to marathons and endurance sports. Sports such as
hockey and soccer only see benefits to the intermittent bursts of power
in these sports, with little to no effect on endurance.
 CREATINE
What’s next?
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For example, you can see above that curcmin is great for
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Pain

Pain is the adverse sensation associated with injury, arthritis, and various forms of nerve injury that
impairs well being and day-to-day living. Supplements may either universally reduce pain, or may
alleviate the pain associated with a disease state.

LEVEL OF MAGNITUDE OF SCIENTIFIC

EVIDENCE SUPPLEMENT CHANGE EFFECT CHANGE STUDIES COMMENTS

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B Curcumin 4 studies
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B Horse Chestnut 1 study
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Minor
4 studies
There appears to be a reduction in pain
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B Type II Collagen 5 studies

 CREATINE
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 CREATINE
Bassit RA, et al Effect of short-term creatine supplementation on markers of skeletal muscle damage after strenuous contractile activity . Eur J Appl Physiol. (2010)

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Lopez RM, et al Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses . J Athl Train. (2009)

Sakkas GK, et al Creatine fails to augment the benefits from resistance training in patients with HIV infection: a randomized, double-blind, placebo-controlled
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Little JP, et al Creatine, arginine alpha-ketoglutarate, amino acids, and medium-chain triglycerides and endurance and performance . Int J Sport Nutr Exerc Metab.
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Gualano B, et al Does creatine supplementation improve the plasma lipid profile in healthy male subjects undergoing aerobic training . J Int Soc Sports Nutr.
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Hadjicharalambous M, Kilduff LP, Pitsiladis YP Brain serotonin and dopamine modulators, perceptual responses and endurance performance during exercise in
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Cancela P, et al Creatine supplementation does not affect clinical health markers in football players . Br J Sports Med. (2008)

Burke DG, et al Effect of creatine supplementation and resistance-exercise training on muscle insulin-like growth factor in young adults . Int J Sport Nutr Exerc
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Candow DG, et al Low-dose creatine combined with protein during resistance training in older men . Med Sci Sports Exerc. (2008)

Rawson ES, et al Creatine supplementation does not improve cognitive function in young adults . Physiol Behav. (2008)

Koenig CA, et al Comparison of creatine monohydrate and carbohydrate supplementation on repeated jump height performance . J Strength Cond Res. (2008)

Walter AA, et al Effects of creatine loading on electromyographic fatigue threshold in cycle ergometry in college-age men . Int J Sport Nutr Exerc Metab. (2008)

Eliot KA, et al The effects of creatine and whey protein supplementation on body composition in men aged 48 to 72 years during resistance training . J Nutr Health
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Deacon SJ, et al Randomized controlled trial of dietary creatine as an adjunct therapy to physical training in chronic obstructive pulmonary disease . Am J Respir
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 CREATINE
Eckerson JM, Bull AA, Moore GA Effect of thirty days of creatine supplementation with phosphate salts on anaerobic working capacity and body weight in men . J
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Jäger R, et al The effects of creatine pyruvate and creatine citrate on performance during high intensity exercise . J Int Soc Sports Nutr. (2008)

Gualano B, et al Effects of creatine supplementation on renal function: a randomized, double-blind, placebo-controlled clinical trial . Eur J Appl Physiol. (2008)

Brault JJ, et al Parallel increases in phosphocreatine and total creatine in human vastus lateralis muscle during creatine supplementation . Int J Sport Nutr Exerc
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Rawson ES, Conti MP, Miles MP Creatine supplementation does not reduce muscle damage or enhance recovery from resistance exercise . J Strength Cond Res.
(2007)

Chilibeck PD, Magnus C, Anderson M Effect of in-season creatine supplementation on body composition and performance in rugby union football players . Appl
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Faager G, et al Creatine supplementation and physical training in patients with COPD: a double blind, placebo-controlled study . Int J Chron Obstruct Pulmon Dis.
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Smith AE, et al Effects of creatine loading on electromyographic fatigue threshold during cycle ergometry in college-aged women . J Int Soc Sports Nutr. (2007)

Roitman S, et al Creatine monohydrate in resistant depression: a preliminary study . Bipolar Disord. (2007)

Cribb PJ, Williams AD, Hayes A A creatine-protein-carbohydrate supplement enhances responses to resistance training . Med Sci Sports Exerc. (2007)

Stout JR, et al Effects of creatine supplementation on the onset of neuromuscular fatigue threshold and muscle strength in elderly men and women (64 - 86
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Gotshalk LA, et al Creatine supplementation improves muscular performance in older women . Eur J Appl Physiol. (2008)

McMorris T, et al Creatine supplementation and cognitive performance in elderly individuals . Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. (2007)

Cancela P, et al Creatine supplementation does not affect clinical health markers in soccer players . Br J Sports Med. (2007)

Wright GA, Grandjean PW, Pascoe DD The effects of creatine loading on thermoregulation and intermittent sprint exercise performance in a hot humid
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Cramer JT, et al Effects of creatine supplementation and three days of resistance training on muscle strength, power output, and neuromuscular function . J
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Kaptsan A, et al Lack of efficacy of 5 grams daily of creatine in schizophrenia: a randomized, double-blind, placebo-controlled trial . J Clin Psychiatry. (2007)

Kilduff LP, et al Reliability and detecting change following short-term creatine supplementation: comparison of two-component body composition methods . J
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Armentano MJ, et al The effect and safety of short-term creatine supplementation on performance of push-ups . Mil Med. (2007)

Gualano B, et al Effects of creatine supplementation on glucose tolerance and insulin sensitivity in sedentary healthy males undergoing aerobic training . Amino
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Silva AJ, et al Effect of creatine on swimming velocity, body composition and hydrodynamic variables . J Sports Med Phys Fitness. (2007)

Beck TW, et al Effects of a drink containing creatine, amino acids, and protein combined with ten weeks of resistance training on body composition, strength, and
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Branch JD, Schwarz WD, Van Lunen B Effect of creatine supplementation on cycle ergometer exercise in a hyperthermic environment . J Strength Cond Res. (2007)

Hass CJ, Collins MA, Juncos JL Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized
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Cribb PJ, et al Effects of whey isolate, creatine, and resistance training on muscle hypertrophy . Med Sci Sports Exerc. (2007)

Stout JR, et al Effects of twenty-eight days of beta-alanine and creatine monohydrate supplementation on the physical working capacity at neuromuscular
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 CREATINE
Ferguson TB, Syrotuik DG Effects of creatine monohydrate supplementation on body composition and strength indices in experienced resistance trained women .
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Pan JW, Takahashi K Cerebral energetic effects of creatine supplementation in humans . Am J Physiol Regul Integr Comp Physiol. (2007)

Hoffman J, et al Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes . Int J Sport Nutr Exerc
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Weiss BA, Powers ME Creatine supplementation does not impair the thermoregulatory response during a bout of exercise in the heat . J Sports Med Phys Fitness.
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Cribb PJ, Hayes A Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy . Med Sci Sports Exerc. (2006)

McMorris T, et al Creatine supplementation, sleep deprivation, cortisol, melatonin and behavior . Physiol Behav. (2007)

Bender A, et al Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial . Neurology. (2006)

Zoeller RF, et al Effects of 28 days of beta-alanine and creatine monohydrate supplementation on aerobic power, ventilatory and lactate thresholds, and time to
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Reardon TF, et al Creatine supplementation does not enhance submaximal aerobic training adaptations in healthy young men and women . Eur J Appl Physiol.
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Pluim BM, et al The effects of creatine supplementation on selected factors of tennis specific training . Br J Sports Med. (2006)

Norman K, et al Effects of creatine supplementation on nutritional status, muscle function and quality of life in patients with colorectal cancer--a double blind
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Glaister M, et al Creatine supplementation and multiple sprint running performance . J Strength Cond Res. (2006)

Watson G, et al Creatine use and exercise heat tolerance in dehydrated men . J Athl Train. (2006)

Netreba I, et al Creatine as a metabolic controller of skeletal muscles structure and function in strength exercises in humans . Ross Fiziol Zh Im I M Sechenova.
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Kuethe F, et al Creatine supplementation improves muscle strength in patients with congestive heart failure . Pharmazie. (2006)

Cornish SM, Chilibeck PD, Burke DG The effect of creatine monohydrate supplementation on sprint skating in ice-hockey players . J Sports Med Phys Fitness. (2006)

Olsen S, et al Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training . J
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Cañete S, et al Does creatine supplementation improve functional capacity in elderly women . J Strength Cond Res. (2006)

Shi D Oligosaccharide and creatine supplementation on glucose and urea nitrogen in blood and serum creatine kinase in basketball athletes . J Huazhong Univ
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Okudan N, Gokbel H The effects of creatine supplementation on performance during the repeated bouts of supramaximal exercise . J Sports Med Phys Fitness.
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McConell GK, et al Creatine supplementation reduces muscle inosine monophosphate during endurance exercise in humans . Med Sci Sports Exerc. (2005)

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Poortmans JR, et al Effect of oral creatine supplementation on urinary methylamine, formaldehyde, and formate . Med Sci Sports Exerc. (2005)

Murphy AJ, et al Effects of creatine supplementation on aerobic power and cardiovascular structure and function . J Sci Med Sport. (2005)

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 CREATINE
Chilibeck PD, et al Creatine monohydrate and resistance training increase bone mineral content and density in older men . J Nutr Health Aging. (2005)

Perret C, Mueller G, Knecht H Influence of creatine supplementation on 800 m wheelchair performance: a pilot study . Spinal Cord. (2006)

Anomasiri W, Sanguanrungsirikul S, Saichandee P Low dose creatine supplementation enhances sprint phase of 400 meters swimming performance . J Med Assoc
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Roy BD, et al Creatine monohydrate supplementation does not improve functional recovery after total knee arthroplasty . Arch Phys Med Rehabil. (2005)

Fuld JP, et al Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease . Thorax. (2005)

Javierre C, et al Creatine supplementation and performance in 6 consecutive 60 meter sprints . J Physiol Biochem. (2004)

Theodorou AS, et al Effects of acute creatine loading with or without carbohydrate on repeated bouts of maximal swimming in high-performance swimmers . J
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Hoffman JR, et al Effect of low-dose, short-duration creatine supplementation on anaerobic exercise performance . J Strength Cond Res. (2005)

Deldicque L, et al Increased IGF mRNA in human skeletal muscle after creatine supplementation . Med Sci Sports Exerc. (2005)

Ahmun RP, Tong RJ, Grimshaw PN The effects of acute creatine supplementation on multiple sprint cycling and running performance in rugby players . J Strength
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Watt KK, Garnham AP, Snow RJ Skeletal muscle total creatine content and creatine transporter gene expression in vegetarians prior to and following creatine
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Bender A, et al Creatine supplementation lowers brain glutamate levels in Huntington’s disease . J Neurol. (2005)

Chilibeck PD, et al Effect of creatine ingestion after exercise on muscle thickness in males and females . Med Sci Sports Exerc. (2004)

Taes YE, et al Creatine supplementation does not decrease total plasma homocysteine in chronic hemodialysis patients . Kidney Int. (2004)

Shefner JM, et al A clinical trial of creatine in ALS . Neurology. (2004)

Kilduff LP, et al The effects of creatine supplementation on cardiovascular, metabolic, and thermoregulatory responses during exercise in the heat in endurance-
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Braegger CP, et al Effects of creatine supplementation in cystic fibrosis: results of a pilot study . J Cyst Fibros. (2003)

Mendes RR, et al Effects of creatine supplementation on the performance and body composition of competitive swimmers . J Nutr Biochem. (2004)

Santos RV, et al The effect of creatine supplementation upon inflammatory and muscle soreness markers after a 30km race . Life Sci. (2004)

Korzun WJ Oral creatine supplements lower plasma homocysteine concentrations in humans . Clin Lab Sci. (2004)

Tarnopolsky MA, et al Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy . Neurology. (2004)

Selsby JT, DiSilvestro RA, Devor ST Mg2+-creatine chelate and a low-dose creatine supplementation regimen improve exercise performance . J Strength Cond Res.
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Mero AA, et al Combined creatine and sodium bicarbonate supplementation enhances interval swimming . J Strength Cond Res. (2004)

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Kilduff LP, et al Effects of creatine on body composition and strength gains after 4 weeks of resistance training in previously nonresistance-trained humans . Int J
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Koçak S, Karli U Effects of high dose oral creatine supplementation on anaerobic capacity of elite wrestlers . J Sports Med Phys Fitness. (2003)

Ayoama R, Hiruma E, Sasaki H Effects of creatine loading on muscular strength and endurance of female softball players . J Sports Med Phys Fitness. (2003)

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 CREATINE
Kutz MR, Gunter MJ Creatine monohydrate supplementation on body weight and percent body fat . J Strength Cond Res. (2003)

Rawson ES, Volek JS Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance . J Strength Cond Res. (2003)

Havenetidis K, Bourdas D Creatine supplementation: effects on urinary excretion and anaerobic performance . J Sports Med Phys Fitness. (2003)

Burke DG, et al Effect of creatine and weight training on muscle creatine and performance in vegetarians . Med Sci Sports Exerc. (2003)

Kinugasa R, et al Short-term creatine supplementation does not improve muscle activation or sprint performance in humans . Eur J Appl Physiol. (2004)

van Loon LJ, et al Creatine supplementation increases glycogen storage but not GLUT-4 expression in human skeletal muscle . Clin Sci (Lond). (2004)

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Brilla LR, et al Magnesium-creatine supplementation effects on body water . Metabolism. (2003)

Lyoo IK, et al A Randomized, Double-Blind Placebo-Controlled Trial of Oral Creatine Monohydrate Augmentation for Enhanced Response to a Selective Serotonin
Reuptake Inhibitor in Women With Major Depressive Disorder . Am J Psychiatry. (2012)

Sakellaris G, et al Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study . Acta Paediatr. (2008)

Dabidi Roshan V, et al The effect of creatine supplementation on muscle fatigue and physiological indices following intermittent swimming bouts . J Sports Med
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