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Consumers should be mindful of the potential risks and hazards associated with creatine supplementation. It is recommended that creatine supplementation should be prescribed under a physician’s supervision to ensure that the quantity of creatine being administered is appropriate for a particular person’s daily requirements and the desired results. The amount of creatine used in clinical trials was much higher than the recommended optimal dosage ( 20 mg/kg/day) of creatine; suggesting that even lower dosage of creatine may have similar effects on muscle performance and strength. Consistent with this, a recent meta-analysis [84] suggested that creatine supplementation at even very low doses of 0.1 – 0.2 g/kg/day, had statistically significant but small positive effects on muscle strength, maximal aerobic capacity, and muscular power. In contrast, higher doses of creatine (0.3 – 0.5 g/kg/day) did not have any additional effects on these measures. There are also indications of potential adverse effects associated with high doses (0.6 g/kg/day) of creatine, which can include an increase in the urinary concentration of creatinine [84]. Specifically, a dose of 0.6 g/kg/day has been shown to increase the urinary excretion of creatinine by 25-85% in young adults [85]. Additionally, higher doses of creatine have been demonstrated to increase serum creatine kinase (CK) levels [84,85,86], which are surrogate markers of muscular damage and/or muscle breakdown. Interestingly, CK levels have been shown to negatively correlate with the size of force-generating muscle fibers, which is one known effect of creatine [87].
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