Scientific Advisory Board – Creatine for Health
IN THIS ARTICLE
1. Introduction
2. The case and its fatal flaws
3. Why do papers like this get published?
4. What does the actual evidence say about creatine and safety?
5. Our conclusion and your takeaway
At Creatine for Health, our mission is to empower you with accurate, evidence-based information about creatine supplementation. This often means promoting the robust science behind its benefits for muscle, brain, and metabolic health.
But sometimes, it also means we must address poor-quality science that circulates fear and misinformation. A recent “case report” published in Cureus, titled “Creatine Use and Thromboembolism Risk in Athletes: A Case Report,” [1] is a good example of the latter.
As members of the Scientific Advisory Board (SAB) of Creatine for Health read this paper, a clear consensus emerged: this case report lacks scientific soundness and draws dangerously speculative conclusions. We believe it’s crucial to explain why this is the case, so the public can become more informed consumers of scientific news.
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The case and its fatal flaws
The article describes a physically active man in his 20s who developed a deep vein thrombosis (DVT). The authors then question whether his creatine supplementation could be the cause. A closer look at the details reveals why this conclusion is scientifically untenable.
- Ignoring established, major risk factors: The patient had two of the most well-known, potent risk factors for venous thromboembolism and DVT [2-4]: prolonged sitting (a recent four-hour flight) and a current smoking habit. Later testing also revealed a genetic predisposition (heterozygous Factor V Leiden) [5, 6]. To blame creatine while downplaying these definitive risks is poor editorial judgment and an oversight of key clinical data.
- The nature of a “case report”: It’s vital to understand what a case report is and isn’t. It is a description of a single, unique event. It cannot prove that one thing caused another. It can only suggest a hypothesis for future research. Concluding a “potential thrombotic risk” from a single case with confounding factors is a gross overreach.
- Missing critical information: The report fails to provide basic data needed for any assessment: the dose of creatine, the duration of use, the patient’s hydration status, or what other supplements or substances were consumed. By this flawed logic, one could just as irresponsibly blame “the cup of coffee he drank or an energy drink.”
Why do papers like this get published?
This is a frustrating reality in science publishing. Case reports of alleged harm from popular supplements often gain traction despite weak evidence. They feed a pre-existing negative bias against nutritional supplements. These ludicrous papers just pollute the literature, and sadly, people only remember the negative.
The media often amplifies these stories without critical analysis, leading to long-lasting myths. For example, this reminds us of the 1990s myth that creatine caused fatal dehydration in wrestlers, a myth that still surfaces today despite being thoroughly debunked.
In this particular case, the authors of the case report did not report according to the CARE guidelines, which were developed to increase the accuracy, transparency, and usefulness of case reports. Unfortunately, the reviewers, the editor, and the journal did not request this either.
What does the actual evidence say about creatine and safety?
As SAB members of Creatine for Health, who have collectively studied creatine in thousands of patients and athletes for decades, we emphasize the real-world evidence from high-quality clinical research. The opinions about creatine safety should be based on evidence, not on case reports riddled with obvious confounding variables. It’s not only bad science, it’s bad medicine. Here are the facts:
- Largest safety analysis: The most comprehensive safety review to date analyzed data from 685 human clinical trials, including 12,839 participants supplemented with creatine and 13,452 taking a placebo. The prevalence of reported side effects was virtually identical between the groups (Creatine: 13.7%, Placebo: 13.2%, p=0.776). There was no significant difference in the total frequency of side effects among participants, and critically, no increase in markers of renal or other organ damage [7].
- Adverse event reports: An analysis of 28.4 million global adverse event reports revealed that mentions of creatine were extremely rare (0.00072%). In nearly half of these cases, creatine was not even listed in the product ingredients, and most others involved creatine co-ingested with other compounds [7].
- Thromboembolism risk? No evidence: As Dr. Tarnopolsky notes from his decades of clinical practice, following hundreds of patients (including smokers and those with vascular conditions) on creatine for up to 20 years, “we have never seen an enrichment of DVT in those on versus not on creatine.”
- Large-scale data is key: When a nutrient is as common as creatine, it will inevitably coincide with various health events purely by chance. Only properly designed large cohort studies or randomized controlled trials (RCTs) can determine if a real risk exists. Decades of such research have NOT linked creatine supplementation to increased risk of thrombosis.
- Renal safety reaffirmed: The paper resurrects outdated concerns. However, two meta-analyses [8, 9], a mendelian randomization analysis [10], and other critical review articles and RCTs [11-13] have conclusively shown that creatine supplementation does not harm kidney function.
Our conclusion and your takeaway
The recent case report is an example of pseudo-scientific “clickbait”. It uses a temporal association to vilify a supplement while ignoring glaringly obvious alternative causes.
Here is your checklist for evaluating scary supplement headlines:
- Is it a single case report? If yes, be highly skeptical of causal claims.
- Are stronger, established risk factors being ignored? (e.g., blaming a supplement when a patient smokes, had recent air travel and has a genetic condition).
- Does it contradict the weight of higher-quality evidence? (e.g., decades of RCTs and meta-analyses).
Creatine monohydrate remains one of the most extensively researched supplements in the world with an exceptional safety profile. We encourage you to view dramatic, singular case reports with a critical eye and trust in the collective body of rigorous science.
References
1. Abdalla, O.S., et al., Creatine Use and Thromboembolism Risk in Athletes: A Case Report. Cureus, 2025.
2. Kunutsor, S.K. and J.A. Laukkanen, Physical Activity, Sedentary Behaviors, and Venous Thromboembolism: A Narrative Review of the Current Evidence. Heart and Mind, 2024. 8(3): p. 137-145.
3. Dicks, A.B., et al., A Comprehensive Review of Risk Factors and Thrombophilia Evaluation in Venous Thromboembolism. Journal of Clinical Medicine, 2024. 13(2).
4. Li, Y., et al., Comprehensive Mendelian Randomization Analysis of Smoking and Its Effects on Venous Thromboembolism. Semin Thromb Hemost, 2025. 51(3): p. 279-289.
5. Aznar, J., et al., Risk of venous thrombosis in carriers of the prothrombin G20210A variant and factor V Leiden and their interaction with oral contraceptives. Haematologica, 2000. 85(12): p. 1271-6.
6. Hirmerova, J., J. Seidlerova, and I. Subrt, The association of factor V Leiden with various clinical patterns of venous thromboembolism-the factor V Leiden paradox. QJM, 2014. 107(9): p. 715-20.
7. Kreider, R.B., et al., Safety of creatine supplementation: analysis of the prevalence of reported side effects in clinical trials and adverse event reports. J Int Soc Sports Nutr, 2025. 22(sup1): p. 2488937.
8. de Souza, E.S.A., et al., Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr, 2019. 29(6): p. 480-489.
9. Naeini, E.K., et al., Effect of creatine supplementation on kidney function: a systematic review and meta-analysis. BMC Nephrol, 2025. 26(1): p. 622.
10. Zhou, B., et al., Exploring the relationship between creatine supplementation and renal function: insights from Mendelian randomization analysis. Ren Fail, 2024. 46(2): p. 2364762.
11. Longobardi, I., et al., Is It Time for a Requiem for Creatine Supplementation-Induced Kidney Failure? A Narrative Review. Nutrients, 2023. 15(6).
12. Domingues, W.J.R., et al., Does Creatine Supplementation Affect Renal Function in Patients with Peripheral Artery Disease? A Randomized, Double Blind, Placebo-controlled, Clinical Trial. Ann Vasc Surg, 2020. 63: p. 45-52.
13. Bernales-Delmon, W., et al., Oral creatine in hemodialysis patients increases physical functional capacity and muscle mass, an open label study. PLoS One, 2025. 20(7): p. e0328757.