ESSNA – Position statement on creatine safety and toxicity

Creatine is one of the most important nutrients for the sports nutrition market and is a key ingredient in sports performance, muscle building and recovery products. It is typically supplemented in 5g daily doses, but to quickly attain maximal tissue creatine levels it can also be ‘loaded’ by supplementing 20g of creatine per day for 5 days.

In 2001 the Scientific Committee on Food (SCF) provided the European Commission with a report on ‘Composition and specification of food intended to meet the expenditure of intense muscular effort, especially for sportsmen’. This report claimed that data were lacking regarding the safety of creatine and that ingestion of more than 2-3g of creatine daily for prolonged periods may not be safe. In 2004 a report complied by the French food safety agency (Agence Française de Sécurité Sanitaire des Aliments, or AFSSA) questioned the safety of creatine loading and long-term creatine supplementation. As a consequence the European Commission released directive (SANCO D4/HL/mm/D440182) limiting the recommended conditions of use for creatine in supplements to 3g per day. This would have been potentially catastrophic for the sports nutrition industry and consumers. Although this low dose supplementation can produce some health benefits, higher doses are needed to produce the performance effects claimed on most products. Therefore, limiting creatine supplementation to 3 g would make most products too deficient in creatine to produce the claimed effects, indirectly removing legitimate creatine ‘health claims’ from the European market.

As experts in both creatine metabolism and regulatory issues relating to dietary supplements, Maximuscle Ltd. approached Alimentarius to write their position statement on creatine safety and toxicity. We prepared this document using peer reviewed scientific data and addressed all the safety concerns expressed by the SCF and AFSSA. Our report demonstrated that creatine monohydrate supplementation at 5 g per day is safe for periods of 5 to10 years. The position statement also showed that in contrast to the unsubstantiated claims in the 2004 AFSSA report, creatine loading was both justified and safe.

This creatine opinion was subsequently adopted by the European Specialist Sports Nutrition Alliance (ESSNA) and was used to overturn the EU directive. This has allowed sports and muscle building products to provide conditions of use that are appropriate to produce the claimed performance effects. The ESSNA position statement is still the most comprehensive document on creatine safety and toxicity available. As such it is widely referenced to support the safety of creatine products by companies such as Lucozade. It  also formed part of the evidence reviewed by the European Food Safety Authority (EFSA) when providing their positive article 13.1 opinions on creatine and performance. A summary of the ESSNA position statement on creatine safety and toxicity can be obtained here and a full copy of the report here.