Skip to main content
NCBI home page
EFSA Journal logoLink to EFSA Journal
. 2016 Feb 23;14(2):4400. doi: 10.2903/j.efsa.2016.4400

Creatine in combination with resistance training and improvement in muscle strength: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA)
PMCID: PMC13093162  PMID: 42016888

Abstract

Following an application from AlzChem AG, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Austria, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to creatine in combination with resistance training and improvement in muscle strength. The Panel considers that the food constituent, creatine, which is the subject of the health claim, is sufficiently characterised. The Panel considers that improvement in muscle strength is a beneficial physiological effect. A total of 21 human intervention studies and two meta‐analyses were provided by the applicant as being pertinent to the claim. The Panel considers that no conclusions can be drawn from 11 studies and the meta‐analyses cannot be used for the scientific substantiation of the claim. In weighing the evidence the Panel took into account that, overall, the human intervention studies submitted provide evidence for an effect of creatine, consumed at doses of at least 3 g/day in combination with regular resistance training (three times per week for several weeks) of moderate intensity, on muscle strength in adults over the age of 55, while no such effect was observed when similar doses of creatine on a weekly basis were given on training days only (three times per week). The Panel also took into account the plausible mechanism by which daily consumption of creatine in combination with resistance training could improve muscle strength. On the basis of the data presented, the Panel concludes that a cause and effect relationship has been established between the consumption of creatine in combination with resistance training and improvement in muscle strength in adults over the age of 55.

Keywords: creatine, muscle strength, resistance training, health claims

Suggested citation: EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) , 2016. Scientific opinion on creatine in combination with resistance training and improvement in muscle strength: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006. EFSA Journal 2016;14(2):4400, 17 pp. doi: 10.2903/j.efsa.2016.4400

Panel members: Jean Louis Bresson, Barbara Burlingame, Tara Dean, Susan Fairweather‐Tait, Marina Heinonen, Karen Ildico Hirsch‐Ernst, Inge Mangelsdorf, Harry McArdle, Androniki Naska, Monika Neuhäuser‐Berthold, Grażyna Nowicka, Kristina Pentieva, Yolanda Sanz, Alfonso Siani, Anders Sjödin, Martin Stern, Daniel Tomé, Dominique Turck, Hendrik Van Loveren, Marco Vinceti and Peter Willatts

Correspondence: nda@efsa.europa.eu

Acknowledgement: The Panel wishes to thank the members of the Working Group on Claims: Jean‐Louis Bresson, Susan Fairweather‐Tait, Marina Heinonen, Ambroise Martin, Harry McArdle, Yolanda Sanz, Alfonso Siani, Anders Sjödin, Sean (J.J.) Strain, Hendrik Van Loveren and Peter Willatts for the preparatory work on this scientific output.

Adoption date: 2 February 2016

Published date: 23 February 2016

Question number: EFSA‐Q‐2015‐00437

On request from: Competent Authority of Austria following an application by AlzChem AG

References

  1. ACSM (American College of Sports Medicine) , online. Resistance training and the older adult. Available online: https://www.acsm.org/docs/current‐comments/resistancetrainingandtheoa.pdf [Accessed: 20 January 2016]
  2. Aguiar AF, Januario RS, Junior RP, Gerage AM, Pina FL, do Nascimento MA, Padovani CR and Cyrino ES, 2013. Long‐term creatine supplementation improves muscular performance during resistance training in older women. European Journal of Applied Physiology, 113, 987–996. [DOI] [PubMed] [Google Scholar]
  3. Bemben MG, Witten MS, Carter JM, Eliot KA, Knehans AW and Bemben DA, 2010. The effects of supplementation with creatine and protein on muscle strength following a traditional resistance training program in middle‐aged and older men. Journal of Nutrition, Health and Aging, 14, 155–159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bermon S, Venembre P, Sachet C, Valour S and Dolisi C, 1998. Effects of creatine monohydrate ingestion in sedentary and weight‐trained older adults. Acta Physiologica Scandinavica, 164, 147–155. [DOI] [PubMed] [Google Scholar]
  5. Berneis K, Ninnis R, Häaussinger D and Keller U, 1999. Effects of hyper‐ and hypoosmolality on whole body protein and glucose kinetics in humans. American Journal of Physiology, 276, E188–E195. [DOI] [PubMed] [Google Scholar]
  6. Brose A, Parise G and Tarnopolsky MA, 2003. Creatine supplementation enhances isometric strength and body composition improvements following strength exercise training in older adults. Journals of Gerontology, Series A, Biological Sciences and Medical Sciences, 58, 11–19. [DOI] [PubMed] [Google Scholar]
  7. Buford TW, Kreider RB, Stout JR, Greenwood M, Campbell B, Spano M, Ziegenfuss T, Lopez H, Landis J and Antonio J, 2007. International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4, 6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Campbell WW, Barton ML Jr, Cyr‐Campbell D, Davey SL, Beard JL, Parise G and Evans WJ, 1999. Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance‐training‐induced changes in body composition and skeletal muscle in older men. American Journal of Clinical Nutrition, 70, 1032–1039. [DOI] [PubMed] [Google Scholar]
  9. Candow DG, Little JP, Chilibeck PD, Abeysekara S, Zello GA, Kazachkov M, Cornish SM and Yu PH, 2008. Low‐dose creatine combined with protein during resistance training in older men. Medicine and Science in Sports and Exercise, 40, 1645–1652. [DOI] [PubMed] [Google Scholar]
  10. Candow DG, Forbes SC, Little JP, Cornish SM, Pinkoski C and Chilibeck PD, 2012. Effect of nutritional interventions and resistance exercise on aging muscle mass and strength. Biogerontology, 13, 345–358. [DOI] [PubMed] [Google Scholar]
  11. Candow DG, Chilibeck PD and Forbes SC, 2014a. Creatine supplementation and aging musculoskeletal health. Endocrine, 45, 354–361. [DOI] [PubMed] [Google Scholar]
  12. Candow DG, Zello GA, Ling B, Farthing JP, Chilibeck PD, McLeod K, Harris J and Johnson S, 2014b. Comparison of creatine supplementation before versus after supervised resistance training in healthy older adults. Research in Sports Medicine, 22, 61–74. [DOI] [PubMed] [Google Scholar]
  13. Canete S, San Juan AF, Perez M, Gomez‐Gallego F, Lopez‐Mojares LM, Earnest CP, Fleck SJ and Lucia A, 2006. Does creatine supplementation improve functional capacity in elderly women? Journal of Strength and Conditioning Research, 20, 22–28. [DOI] [PubMed] [Google Scholar]
  14. Carter JM, Bemben DA, Knehans AW, Bemben MG and Witten MS, 2005. Does nutritional supplementation influence adaptability of muscle to resistance training in men aged 48 to 72 years. Journal of Geriatric Physical Therapy, 28, 40–47. [DOI] [PubMed] [Google Scholar]
  15. Cherniack EP, 2012. Ergogenic dietary aids for the elderly. Nutrition, 28, 225–229. [DOI] [PubMed] [Google Scholar]
  16. Chrusch MJ, Chilibeck PD, Chad KE, Davison KS and Burke DG, 2001. Creatine supplementation combined with resistance training in older men. Medicine and Science in Sports and Exercise, 33, 2111–2117. [DOI] [PubMed] [Google Scholar]
  17. Coggan AR, Spina RJ, Rogers MA, King DS, Brown M, Nemeth PM and Holloszy JO, 1990. Histochemical and enzymatic characteristics of skeletal muscle in master athletes. Journal of Applied Physiology, 68, 1896–1901. [DOI] [PubMed] [Google Scholar]
  18. Cooke MB, Brabham B, Buford TW, Shelmadine BD, McPheeters M, Hudson GM, Stathis C, Greenwood M, Kreider R and Willoughby DS, 2014. Creatine supplementation post‐exercise does not enhance training‐induced adaptations in middle to older aged males. European Journal of Applied Physiology, 114, 1321–1332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Dalbo VJ, Roberts MD, Lockwood CM, Tucker PS, Kreider RB and Kerksick CM, 2009. The effects of age on skeletal muscle and the phosphocreatine energy system: can creatine supplementation help older adults. Dynamic Medicine, 8, 6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Dangott B, Schultz E and Mozdziak PE, 2000. Dietary creatine monohydrate supplementation increases satellite cell mitotic activity during compensatory hypertrophy. International Journal of Sports Medicine, 21, 13–16. [DOI] [PubMed] [Google Scholar]
  21. Deminice R and Jordao AA, 2012. Creatine supplementation reduces oxidative stress biomarkers after acute exercise in rats. Amino Acids, 43, 709–715. [DOI] [PubMed] [Google Scholar]
  22. Devries MC and Phillips SM, 2014. Creatine supplementation during resistance training in older adults‐a meta‐analysis. Medicine and Science in Sports and Exercise, 46, 1194–1203. [DOI] [PubMed] [Google Scholar]
  23. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) , 2011. Scientific Opinion on the substantiation of health claims related to creatine and increase in physical performance during short‐term, high intensity, repeated exercise bouts (ID 739, 1520, 1521, 1522, 1523, 1525, 1526, 1531, 1532, 1533, 1534, 1922, 1923, 1924), increase in endurance capacity (ID 1527, 1535), and increase in endurance performance (ID 1521, 1963) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2011;9(7): 2303, 24 pp. doi:10.2903/j.efsa.2011.2303 [Google Scholar]
  24. Eijnde BO, Van Leemputte M, Goris M, Labarque V, Taes Y, Verbessem P, Vanhees L, Ramaekers M, Vanden Eynde B, Van Schuylenbergh R, Dom R, Richter EA and Hespel P, 2003. Effects of creatine supplementation and exercise training on fitness in men 55–75 yr old. Journal of Applied Physiology, 95, 818–828. [DOI] [PubMed] [Google Scholar]
  25. Eliot KA, Knehans AW, Bemben DA, Witten MS, Carter J and Bemben MG, 2008. The effects of creatine and whey protein supplementation on body composition in men aged 48 to 72 years during resistance training. Journal of Nutrition, Health and Aging, 12, 208–212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Faulkner JA, Larkin LM, Claflin DR and Brooks SV, 2007. Age‐related changes in the structure and function of skeletal muscles. Clinical and Experimental Pharmacology and Physiology, 34, 1091–1096. [DOI] [PubMed] [Google Scholar]
  27. Fimognari C, Sestili P, Lenzi M, Cantelli‐Forti G and Hrelia P, 2009. Protective effect of creatine against RNA damage. Mutation Research, 670, 59–67. [DOI] [PubMed] [Google Scholar]
  28. Gotshalk LA, Volek JS, Staron RS, Denegar CR, Hagerman FC and Kraemer WJ, 2002. Creatine supplementation improves muscular performance in older men. Medicine and Science in Sports and Exercise, 34, 537–543. [DOI] [PubMed] [Google Scholar]
  29. Gotshalk LA, Kraemer WJ, Mendonca MA, Vingren JL, Kenny AM, Spiering BA, Hatfield DL, Fragala MS and Volek JS, 2008. Creatine supplementation improves muscular performance in older women. European Journal of Applied Physiology, 102, 223–231. [DOI] [PubMed] [Google Scholar]
  30. Greenhaff PL, Bodin K, Soderlund K and Hultman E, 1994. Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. American Journal of Physiology, 266, E725–E730. [DOI] [PubMed] [Google Scholar]
  31. Gualano B, Macedo AR, Alves CR, Roschel H, Benatti FB, Takayama L, de Sa Pinto AL, Lima FR and Pereira RM, 2014. Creatine supplementation and resistance training in vulnerable older women: a randomized double‐blind placebo‐controlled clinical trial. Experimental Gerontology, 53, 7–15. [DOI] [PubMed] [Google Scholar]
  32. Hass CJ, Collins MA and Juncos JL, 2007. Resistance training with creatine monohydrate improves upper‐body strength in patients with Parkinson disease: a randomized trial. Neurorehabilitation and Neural Repair, 21, 107–115. [DOI] [PubMed] [Google Scholar]
  33. Hespel P, Op't Eijnde B, Van Leemputte M, Urso B, Greenhaff PL, Labarque V, Dymarkowski S, Van Hecke P and Richter EA, 2001. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. Journal of Physiology, 536, 625–633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ingwall JS, 1976. Creatine and the control of muscle‐specific protein synthesis in cardiac and skeletal muscle. Circulation Research, 38, I115–I123. [PubMed] [Google Scholar]
  35. Jakobi JM, Rice CL, Curtin SV and Marsh GD, 2001. Neuromuscular properties and fatigue in older men following acute creatine supplementation. European Journal of Applied Physiology, 84, 321–328. [DOI] [PubMed] [Google Scholar]
  36. Larsen RG, Callahan DM, Foulis SA and Kent‐Braun JA, 2012. Age‐related changes in oxidative capacity differ between locomotory muscles and are associated with physical activity behavior. Applied Physiology, Nutrition, and Metabolism, 37, 88–99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. McCully KK, Fielding RA, Evans WJ, Leigh JS Jr and Posner JD, 1993. Relationships between in vivo and in vitro measurements of metabolism in young and old human calf muscles. Journal of Applied Physiology, 75, 813–819. [DOI] [PubMed] [Google Scholar]
  38. Möller P, Bergstrom J, Furst P and Hellstrom K, 1980. Effect of aging on energy‐rich phosphagens in human skeletal muscles. Clinical Science, 58, 553–555. [DOI] [PubMed] [Google Scholar]
  39. Neves M Jr, Gualano B, Roschel H, Fuller R, Benatti FB, Pinto AL, Lima FR, Pereira RM, Lancha AH Jr and Bonfa E, 2011. Beneficial effect of creatine supplementation in knee osteoarthritis. Medicine and Science in Sports and Exercise, 43, 1538–1543. [DOI] [PubMed] [Google Scholar]
  40. O'Connor RS, Steeds CM, Wiseman RW and Pavlath GK, 2008. Phosphocreatine as an energy source for actin cytoskeletal rearrangements during myoblast fusion. Journal of Physiology, 586, 2841–2853. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Olsen S, Aagaard P, Kadi F, Tufekovic G, Verney J, Olesen JL, Suetta C and Kjaer M, 2006. Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. Journal of Physiology, 573, 525–534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Parise G, Mihic S, MacLennan D, Yarasheski KE and Tarnopolsky MA, 2001. Effects of acute creatine monohydrate supplementation on leucine kinetics and mixed‐muscle protein synthesis. Journal of Applied Physiology, 91, 1041–1047. [DOI] [PubMed] [Google Scholar]
  43. Rawson ES, Wehnert ML and Clarkson PM, 1999. Effects of 30 days of creatine ingestion in older men. European Journal of Applied Physiology and Occupational Physiology, 80, 139–144. [DOI] [PubMed] [Google Scholar]
  44. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I and Mitnitski A, 2005. A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association journal, 173, 489–495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Rogers ME, Bohlken RM, Beets MW, Hammer SB, Ziegenfuss TN and Sarabon N, 2006. Effects of creatine, ginseng, and astragalus supplementation on strength, body composition, mood, and blood lipids during strength‐training in older adults. Journal of Sports Science & Medicine, 5, 60–69. [PMC free article] [PubMed] [Google Scholar]
  46. Sahlin K, 1978. Intracellular pH and energy metabolism in skeletal muscle of man. With special reference to exercise. Acta Physiologica Scandinavica, Supplementum, 455, 1–56. [PubMed] [Google Scholar]
  47. SCF (Scientific Committee on Food) , 2001. Report on Scientific Committee on Food on composition and specification of food intended to meet the expenditure of intense muscular effort, especially for sports men SCF/CS/NUT/SPORT/5 Final (corrected).
  48. Sestili P, Martinelli C, Colombo E, Barbieri E, Potenza L, Sartini S and Fimognari C, 2011. Creatine as an antioxidant. Amino Acids, 40, 1385–1396. [DOI] [PubMed] [Google Scholar]
  49. Sipila I, Rapola J, Simell O and Vannas A, 1981. Supplementary creatine as a treatment for gyrate atrophy of the choroid and retina. New England Journal of Medicine, 304, 867–870. [DOI] [PubMed] [Google Scholar]
  50. Smith SA, Montain SJ, Matott RP, Zientara GP, Jolesz FA and Fielding RA, 1998. Creatine supplementation and age influence muscle metabolism during exercise. Journal of Applied Physiology, 85, 1349–1356. [DOI] [PubMed] [Google Scholar]
  51. Stout JR, Sue Graves B, Cramer JT, Goldstein ER, Costa PB, Smith AE and Walter AA, 2007. Effects of creatine supplementation on the onset of neuromuscular fatigue threshold and muscle strength in elderly men and women (64–86 years). Journal of Nutrition, Health and Aging, 11, 459–464. [PubMed] [Google Scholar]
  52. Tarnopolsky M, Zimmer A, Paikin J, Safdar A, Aboud A, Pearce E, Roy B and Doherty T, 2007. Creatine monohydrate and conjugated linoleic acid improve strength and body composition following resistance exercise in older adults. PLoS ONE, 2, e991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Terjung RL, Clarkson P, Eichner ER, Greenhaff PL, Hespel PJ, Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA, Wagenmakers AJ and Williams MH, 2000. American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Medicine and Science in Sports and Exercise, 32, 706–717. [DOI] [PubMed] [Google Scholar]
  54. Tokarska‐Schlattner M, Epand RF, Meiler F, Zandomeneghi G, Neumann D, Widmer HR, Meier BH, Epand RM, Saks V, Wallimann T and Schlattner U, 2012. Phosphocreatine interacts with phospholipids, affects membrane properties and exerts membrane‐protective effects. PLoS ONE, 7, e43178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Willoughby DS and Rosene J, 2001. Effects of oral creatine and resistance training on myosin heavy chain expression. Medicine and Science in Sports and Exercise, 33, 1674–1681. [DOI] [PubMed] [Google Scholar]
  56. Willoughby DS and Rosene JM, 2003. Effects of oral creatine and resistance training on myogenic regulatory factor expression. Medicine and Science in Sports and Exercise, 35, 923–929. [DOI] [PubMed] [Google Scholar]
  57. Wyss M and Kaddurah‐Daouk R, 2000. Creatine and creatinine metabolism. Physiological Reviews, 80, 1107–1213. [DOI] [PubMed] [Google Scholar]
  58. Young RB and Denome RM, 1984. Effect of creatine on contents of myosin heavy chain and myosin‐heavy‐chain mRNA in steady‐state chicken muscle‐cell cultures. Biochemical Journal, 218, 871–876. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from EFSA Journal are provided here courtesy of Wiley

RESOURCES