Creatine Supplementation Shows Promise

Creatine plays a pivotal role in making the “energy currency” referred to as ATP that fuels your brain and muscle tissues. Athletes use this over-the-counter nutritional supplement as a performance enhancer, and creatine can be purchased inexpensively in a flavored powder to make a sports drink. Studies show that supplementing 5 grams per day of creatine can improve cognitive function and build muscle strength, yet it’s relatively free of side effects (unlike most prescription medications).^1,2

While creatine sounds like a useful supplement, is there any evidence pointing to its potential to reduce fibromyalgia symptoms? Yes. More than one study has documented low ATP and creatine levels in the muscles of fibromyalgia patients.^3,4 In addition, reduced blood flow and impaired energy metabolism in the brain have also been reported.^5,6 The muscle findings correlated with pain, fatigue and reduced endurance, while the reports in the brain correlated with pain and overall function of patients with fibromyalgia.

Using the above reasons as a basis for why creatine might relieve the symptoms of fibromyalgia, a research team headed up by Howard Amital, M.D., of Israel, tested the nutritive supplement in 30 patients.⁷ The design of the study was uncontrolled (i.e., there was no placebo group for comparison) and the creatine was taken three times a day as an “add on” to the subjects’ current therapies which were not changed. Patients were evaluated at the beginning of the trial, after four weeks, after eight weeks (at the end of the creatine supplementation), and then at 12 weeks (4 weeks after discontinuing the supplement). Various pain, sleep and function-related questionnaires were used to assess fibromyalgia symptoms.

Only 16 of the 30 patients completed the eight-week trial, beginning with 1 gram tablets of creatine taken three times a day. After the third week, subjects increased their dose to 5 grams per day. Many subjects dropped out early in the study due to difficulties in swallowing the tablets, inability to adhere to the new treatment regimen (remembering to take 3 to 5 tablets per day), or fears that the new therapy would produce side effects.

Measures of pain, sleep, and physical function all improved significantly from the beginning of the study to the eighth week, based on subjective patient reports. After discontinuing the creatine, symptom deterioration was apparent. All findings were averaged for the group and turned out significant, with no side effects reported.

“In our study,” writes Amital, “there was a notable range in responses to creatine among subjects, as opposed to a uniform influence, suggesting the existence of creatine responders and nonresponders.” Due to the small number of patients studied, differences between the two groups, particularly characteristics of those who really improved on the supplement, could not be identified. Amital states that in the future, larger studies may reveal the differences between responder and nonresponders.

Another point made by Amital was that many of the study patients were trying creatine because all other therapies had failed to work (i.e., they were at the severe end of the fibromyalgia spectrum and may have been less likely to respond). He suggests that creatine might have a more pronounced effect when used in patients with less severe disease.

Creatine is most commonly purchased as a flavored powder (some taste better than others). It costs roughly $10 per month if you consume a total of 5 grams per day of the supplement (taken in three divided servings throughout the day). Drink with lots of water or fluids because it makes you thirsty, and the fluid helps ensure that the energy-making molecule is distributed to every cell. You can put the powder into orange juice or other carbohydrate-only flavored drinks, but avoid taking it with caffeine or protein because they will inhibit its absorption into the bloodstream. If you encounter bloating, water retention, or the thirst cravings are too intense, try dropping down to 3 grams per day (it’s possible to achieve the same desired effects at this lower dose).⁸ Consult your doctor before starting and be aware that creatine may not be advised for people with a history of kidney disease because its elimination from the body places an added load on your kidneys.

1. Rae C, et al. Proc R Soc Lond B 270:2147-50, 2003.
2. Cooke MB, et al. J Int Soc Sports Nutri 6:13-23, 2009.
3. Park JH, et al. Arthritis Rheum 31:406-13, 1998.
4. Lund E, et al. Scand J Rheumatol 32:138-45, 2003.
5. Mountz JM, et al. Arthritis Rheum 38:926-38, 1995.
6. Wood PB, et al. J Pain 10:47-52, 2009.
7. Leader A, et al. Ann NY Acad Sci 1173:829-36, 2009.
8. Terjung RL, et al. Med Sci Sports Exerc 32:706-17, 2003.