Written by: ND. Juan Diego Quintero & Prof. Diego A. Bonilla, ISAK 3
Creatine is a nutrient widely recognized for its positive effects on physical performance and body composition. In addition, it is supported by evidence regarding its safety and potential applications in health and the treatment of various conditions throughout the lifespan (1).
Over the past decade, adolescents have emerged as one of the groups most interested in and likely to consume creatine monohydrate, with an estimated 16.7% using it—particularly those who are physically active and competitive athletes (2). The primary reason for its consumption is the improvement of athletic performance, although creatine has also been explored for its protective effects against traumatic brain injuries in contact sports (e.g., rugby, American football) and its potential to enhance cognitive functions such as memory, processing speed, and concentration (3–5).
Despite these benefits, some studies have linked dietary supplement use (including creatine) with eating disorders (EDs), which are multifactorial in origin and influenced by sociocultural, psychological, genetic, and environmental factors (6). However, many of these studies suffer from significant methodological limitations, such as reliance on unvalidated self-reported surveys and the misclassification of supplements alongside medications (e.g., laxatives) or illegal substances (e.g., steroids), which are indeed commonly used in certain ED cases (6). Furthermore, some research has suggested that weight-control supplements may be associated with a higher risk of EDs, though no causal relationship has been established (7–10).
When it comes to the question of whether creatine is associated with EDs in young people, the short answer is no. In fact, as one of the most studied and evidence-backed supplements, such claims are unfounded and may pose a barrier to advancements in public health (6,11). The safety of creatine monohydrate has been extensively evaluated over the past 30 years, with studies showing no significant risks even at high doses or with long-term use (up to five years) (12). Additionally, the FDA classifies high-quality creatine monohydrate as a Generally Recognized as Safe (GRAS) ingredient, and less than 0.1% of adverse events related to dietary supplements are associated with its use (13). Therefore, legislation restricting the sale of creatine-containing products to children and adolescents is not based on scientific evidence, which strongly supports the importance of creatine in the diet and its safety as a supplement (read the recent ISSN Press Release: “Creatine supplementation is safe, beneficial throughout the lifespan, and should not be restricted”).
It’s also worth noting that some EDs are characterized by restrictive eating patterns or behaviors that negatively impact musculoskeletal development and cognitive functions due to inadequate intake of essential nutrients (14–16). This can lead to specific deficiencies, including reduced availability of dietary creatine, which is primarily found in meat and fish (1,14). Consequently, individuals with EDs may experience creatine levels comparable to those seen in vegans, vegetarians, and older adults, who are common cases that benefit from creatine monohydrate supplementation (13).
In general, creatine monohydrate is a safe and effective supplement for improving physical performance and body composition. Its impact on brain function and the musculoskeletal system makes it a promising non-pharmacological tool for future research on neuropsychiatric disorders, including EDs (Figure 1). It is crucial to differentiate evidence-based supplements like creatine monohydrate from potentially harmful substances such as laxatives or steroids to avoid misconceptions that could negatively impact health and nutritional treatment across various populations.
Figure 1. Advantages (green) and open questions (orange) regarding creatine use in the general population (13).
Want to know more about this topic?
Watch this conference talk by Dr. Susan J. Hewlings, PhD, RD, Douglas Kalman, PhD, RD, and Rick Collins—Setting the Record Straight on Dietary Supplements, Eating Disorders, and Mental Wellness: https://www.youtube.com/watch?v=bFIZrRwO4XQ
References
1. Kreider, R. B., & Stout, J. R. (2021). Creatine in Health and Disease. Nutrients, 13(2), 447. https://doi.org/10.3390/nu13020447
2. Jagim, A. R., & Kerksick, C. M. (2021). Creatine Supplementation in Children and Adolescents. Nutrients, 13(2), 664. https://doi.org/10.3390/nu13020664
3. Dolan, E., Gualano, B., & Rawson, E. S. (2019). Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury. European journal of sport science, 19(1), 1–14. https://doi.org/10.1080/17461391.2018.1500644
4. Candow, D. G., Forbes, S. C., Ostojic, S. M., Prokopidis, K., Stock, M. S., Harmon, K. K., & Faulkner, P. (2023). “Heads Up” for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports medicine (Auckland, N.Z.), 53(Suppl 1), 49–65. https://doi.org/10.1007/s40279-023-01870-9
5. Roschel, H., Gualano, B., Ostojic, S. M., & Rawson, E. S. (2021). Creatine Supplementation and Brain Health. Nutrients, 13(2), 586. https://doi.org/10.3390/nu13020586
6. Hewlings, S. J. (2023). Eating Disorders and Dietary Supplements: A Review of the Science. Nutrients, 15(9), 2076. https://doi.org/10.3390/nu15092076
7. Hazzard, V. M., Simone, M., Austin, S. B., Larson, N., & Neumark-Sztainer, D. (2021). Diet pill and laxative use for weight control predicts first-time receipt of an eating disorder diagnosis within the next 5 years among female adolescents and young adults. The International journal of eating disorders, 54(7), 1289–1294. https://doi.org/10.1002/eat.23531
8. Blanck, H. M., Serdula, M. K., Gillespie, C., Galuska, D. A., Sharpe, P. A., Conway, J. M., Khan, L. K., & Ainsworth, B. E. (2007). Use of nonprescription dietary supplements for weight loss is common among Americans. Journal of the American Dietetic Association, 107(3), 441–447. https://doi.org/10.1016/j.jada.2006.12.009
9. Levinson, J. A., Sarda, V., Sonneville, K., Calzo, J. P., Ambwani, S., & Austin, S. B. (2020). Diet Pill and Laxative Use for Weight Control and Subsequent Incident Eating Disorder in US Young Women: 2001-2016. American journal of public health, 110(1), 109–111. https://doi.org/10.2105/AJPH.2019.305390
10. Svantorp-Tveiten, K. M. E., Friborg, O., Torstveit, M. K., Mathisen, T. F., Sundgot-Borgen, C., Rosenvinge, J. H., Bratland-Sanda, S., Pettersen, G., & Sundgot-Borgen, J. (2021). Protein, Creatine, and Dieting Supplements Among Adolescents: Use and Associations With Eating Disorder Risk Factors, Exercise-, and Sports Participation, and Immigrant Status. Frontiers in sports and active living, 3, 727372. https://doi.org/10.3389/fspor.2021.727372
11. Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18. https://doi.org/10.1186/s12970-017-0173-z
12. Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), 13. https://doi.org/10.1186/s12970-021-00412-w
13. Ostojic, S. M. (2021). Creatine as a food supplement for the general population. Journal of functional foods, 83, 104568. https://doi.org/10.1016/j.jff.2021.104568
14. Jenkins, P. E., Proctor, K., & Snuggs, S. (2024). Dietary intake of adults with eating disorders: A systematic review and meta-analysis. Journal of psychiatric research, 175, 393–404. https://doi.org/10.1016/j.jpsychires.2024.05.038
15. Balasundaram P, Santhanam P. Eating Disorders. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567717/
16. Iceta, S., Rodrigue, C., Legendre, M., Daoust, J., Flaudias, V., Michaud, A., & Bégin, C. (2021). Cognitive function in binge eating disorder and food addiction: A systematic review and three-level meta-analysis. Progress in neuro-psychopharmacology & biological psychiatry, 111, 110400. https://doi.org/10.1016/j.pnpbp.2021.110400
About the authors
Prof. Diego A. Bonilla, MSc
Senior Researcher (MinCiencias Colombia #957 SNCTI). CEO & Scientific Director at DBSS. Interested in understanding adaptation in complex systems under the allostasis-interoception paradigm. View the full author profile →