WOODLAND PARK, Colo.—The International Society of Sports Nutrition (ISSN) issued a statement regarding the safety of creatine monohydrate after media reports questioned whether it caused dehydration or muscle breakdown in Oregon high school athletes. In this case, several athletes from McMinnville High School were hospitalized for rhabdomyolysis (i.e., a rapid breakdown of skeletal muscle due to injury that typically presents with marked elevations in the enzyme creatine kinase [CK] in the blood) and/or anterior compartment syndrome (ACS). Excessive exercise in hot and humid environments can promote dehydration, muscle breakdown, and result in marked elevations in muscle CK levels. ISSN noted in severe instances, this may lead to exertional rhabdomyolysis, particularly in athletes who have been engaged in intense exercise in hot and humid environments for several days and who become chronically dehydrated.

According to press reports, the athletes in this case were engaged in a several day "immersion" camp.  The athletes began to complain about swelling in their arms after performing a series of push-up and chair dip exercises in a 30-second alternating bouts of repetitions for over 20 minutes until exhaustion in a hot and humid wrestling room.  Temperatures in the room were reported as high as 115-120?F.  None of the athletes indicated they took creatine—or any other supplement or drug. Nevertheless, media reports indicated officials are investigating whether creatine may have been linked to this incident.

ISSN stated “suggestions that creatine caused this incident is inconsistent with the scientific literature and implausible." It quoted Richard Kreider, Ph.D., FACSM, FISSN, a sports nutrition researcher out of Texas A & M University, as stating: “Many studies have been done since the early 1990s that show creatine does not cause dehydration, muscle damage, or increase susceptibility to heat-related illness in athletes involved in intense training in hot and humid environments.  If anything, research shows that creatine promotes hyperhydration (i.e., whole body fluid retention) leading to less thermoregulatory stress during intense exercise in the heat.  It is unfortunate that individuals unfamiliar with the creatine literature are speculating that creatine caused this problem when the athletes indicated they did not take creatine and they ignore the obvious precursors: excessive and inappropriate training in a hot and humid environment."

ISSN’s research committee in 2007 developed a position statement on the topic of creatine supplementation and exercise. It stated, in part:

1. Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training.
2. Creatine monohydrate supplementation is not only safe, but possibly beneficial in regard to preventing injury and/or management of select medical conditions when taken within recommended guidelines.
3. There is no scientific evidence that the short- or long-term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals.
4. If proper precautions and supervision are provided, supplementation in young athletes is acceptable and may provide a nutritional alternative to potentially dangerous anabolic drugs.
5. At present, creatine monohydrate is the most extensively studied and clinically effective form of creatine for use in nutritional supplements in terms of muscle uptake and ability to increase high-intensity exercise capacity.
6. Creatine monohydrate has been reported to have a number of potentially beneficial uses in several clinical populations, and further research is warranted in these areas.