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Allah Yar R, Akbar A, Iqbal F. Creatine monohydrate supplementation for 10 weeks mediates neuroprotection and improves learning/memory following neonatal hypoxia ischemia encephalopathy in female albino mice. Brain Res. 2015;1595:92–100. Kersey RD, Elliot DL, Goldberg L, Kanayama G, Leone JE, Pavlovich M, Pope HG. National Athletic Trainers' Association National Athletic Trainers' Association position statement: anabolic-androgenic steroids. J. Athl Train. 2012;47:567–88. Creatine monohydrate crystallizes from water as monoclinic prisms that hold one molecule of water of crystallization per molecule of creatine [ 187]. Subsequent drying of creatine monohydrate at about 100°C removes the water of crystallization yielding anhydrous creatine (100% creatine) [ 187]. Creatine is considered a weak base (pKb 11.02 at 25°C) that can only form salts with strong acids (i.e., pKa < 3.98). Creatine can also serve as a complexing agent with other compounds via ionic binding. Creatine monohydrate powder contains the highest percentage of creatine (87.9%) other than creatine anhydrous [ 187]. Creatine monohydrate manufactured in Germany involves adding acetic acid to sodium sarconsinate, heating, adding cyanamide, cooling to promote crystallization, separation and filtration, and drying has been reported to produce 99.9% pure creatine monohydrate with no contaminants. Meanwhile, other sources of creatine monohydrate that have different starting materials (e.g., sarcosinates and O-alkylisourea, sarcosinates and S-alkylisothiourea) and methods of creatine synthesis, particularly from sources produced in China, have been found to contain up to 5.4% dicyandiamide, 0.09% dihydrotriazine, 1.3% creatinine, dimethyl sulphate, thiourea, and/or higher concentrations of heavy metals like mercury and lead due to use of different chemical precursors, poorly controlled synthesis processes, and/or inadequate filtration methods that more readily produce these contaminants [ 197]. While the effects of ingesting these compounds on health are unknown, contamination with dihydrotriazine has been suggested to be of greatest concern since it is structurally related to carcinogenic compounds [ 197]. For this reason, German sourced creatine monohydrate has been primarily used in research to establish safety and efficacy and is therefore the recommended source of creatine monohydrate to use in dietary supplements [ 2, 187].
Ustuner ET. Cause of androgenic alopecia: crux of the matter. Plast. Reconstr. Surg. Glob Open. 2013;1:e64.Studies show that it’s safe for many people to take creatine supplements. However, there isn’t enough evidence to know if it’s safe if you: Spillane M, Schoch R, Cooke M, Harvey T, Greenwood M, Kreider R, Willoughby DS. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. J. Int. Soc. Sports Nutr. 2009;6:6–6. In 1998, a case study of a young male with focal segmental glomerulosclerosis and relapsing nephrotic syndrome was reported [ 51]. The young male, who had kidney disease for 8 years and was treated with cyclosporine (i.e., immunosuppressant) for 5 years, had recently begun ingesting creatine supplementation (15 g/day for 7 days; followed by 2 g/day for 7 weeks). Based on increased blood levels of creatinine and subsequent estimate of calculated creatinine clearance, his kidney health was presumed to be deteriorating, although he was otherwise in good health. The patient was encouraged to discontinue creatine supplementation. At this time, it was already known that blood and urine creatinine levels can increase following ingestion of creatine containing food products, including creatine supplements [ 35]. This was ignored by the authors of this case study, as was the inclusion of two investigations which demonstrated that creatine supplementation did not negatively impact renal function [ 52, 53]. The dosage of creatine during the maintenance phase, which was also ignored, was only slightly higher than the daily creatine intake of a typical omnivore’s dietary intake, or in terms of food, a large hamburger or steak per day (meat contains about 0.7 g of creatine / 6 oz. serving; see [ 54]). In response to this case study, two separate teams of experts in creatine metabolism wrote letters to the editor of Lancet [ 53, 55]. However, the notion that creatine supplementation leads to kidney damage and/or renal dysfunction gained traction and momentum. Riehemann S, Volz HP, Wenda B, Hubner G, Rossger G, Rzanny R, Sauer H. Frontal lobe in vivo (31)P-MRS reveals gender differences in healthy controls, not in schizophrenics. NMR Biomed. 1999;12:483–9. Applied Physiology & Nutrition Research Group; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, Brazil
Zhu S, Li M, Figueroa BE, Liu A, Stavrovskaya IG, Pasinelli P, Beal MF, Brown RH, Kristal BS, Ferrante RJ, Friedlander RM. Prophylactic creatine administration mediates neuroprotection in cerebral ischemia in mice. J. Neurosci. 2004;24:5909–12. Abraham, S.; Jiang, S. Process for preparing a creatine heterocyclic acid salt and method of use; United States, 2005; , pp 1. Cannon JG, Orencole SF, Fielding RA, Meydani M, Meydani SN, Fiatarone MA, Blumberg JB, Evans WJ. Acute phase response in exercise: interaction of age and vitamin E on neutrophils and muscle enzyme release. Am. J. Physiol. 1990;259:1214. Gualano B, Macedo AR, Alves CR, Roschel H, Benatti FB, Takayama L, de Sa Pinto AL, Lima FR, Pereira RM. Creatine supplementation and resistance training in vulnerable older women: a randomized double-blind placebo-controlled clinical trial. Exp. Gerontol. 2014;53:7–15.
Creatine
Wright GA, Grandjean PW, Pascoe DD. The effects of creatine loading on thermoregulation and intermittent sprint exercise performance in a hot humid environment. J. Strength Cond Res. 2007;21:655–60. Greenhaff PL, Bodin K, Soderlund K, Hultman E. Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. Am. J. Physiol. 1994;266:725.
Freire Royes LF, Cassol G. The Effects of Creatine Supplementation and Physical Exercise on Traumatic Brain Injury. Mini Rev. Med. Chem. 2016;16:29–39. When assessing costs, take into account how many servings you will get, rather than just going by the cost per tub. The recommended dose is 3-5g (up to one teaspoon) of creatine after training, so 1kg will last many months. Creatine supplementation and resistance training produces the vast majority of musculoskeletal and performance benefits in older adults. Creatine supplementation alone can provide some muscle and performance benefits for older adults.
Smash your way through the toughest workouts – here’s all you need to know about creatine and choosing your ideal supplement
Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults-a meta-analysis. Med. Sci. Sports Exerc. 2014;46:1194–203. Diehl K, Thiel A, Zipfel S, Mayer J, Schnell A, Schneider S. Elite adolescent athletes' use of dietary supplements: characteristics, opinions, and sources of supply and information. Int. J. Sport Nutr. Exerc. Metab. 2012;22:165–74. Deminice R, de Castro GS, Brosnan ME, Brosnan JT. Creatine supplementation as a possible new therapeutic approach for fatty liver disease: early findings. Amino Acids. 2016;48:1983–91. Kreider RB, Melton C, Rasmussen CJ, Greenwood M, Lancaster S, Cantler EC, Milnor P, Almada AL. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol. Cell. Biochem. 2003;244:95–104.
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