Is there any risk that creatine can induce cancer or BSE (bovine spongiform encephalopathy, common

Fråga: "Is there any risk that creatine can induce cancer or BSE (bovine spongiform encephalopathy, commonly known as "mad cow disease") in patients receiving 100-200 mg creatine/kg/day for the treatment of muscle diseases?"

Sammanfattning: There is no evidence that creatine can cause cancer. There are, however, no studies on adverse effects of creatine in high doses. The Scientific Committee of Food (European Commission) has evaluated the safety/risk of recommended supplemented regimens and concludes that consumption of doses up to 3 grams creatine per day are unlikely to pose any risk. Information concerning possible adverse effect with high doses is lacking. Creatine is produced in a synthetic process and there should be no risk for BSE-contamination.

Svar: The question about creatine and risk for cancer has risen since a French report recommended creatine not to be marketed because data on effects of high doses of creatine are lacking. The report discusses that creatine theoretically may be metabolised to products that could cause cancer (1). Despite a thorough literature search, neither studies on cancer or genotoxicity of creatine nor epidemiological studies or case reports on creatine and cancer could be found. According to the Swedish national food administration (2), the theories on carcinogenicity in the French report are focused mainly on the fact that creatine can act as a precursor to mutagenic substances formed during frying or grilling of meat or fish, and that creatine may be metabolised to acetaldehyde which has been shown to act as a mutagen in vitro.

The adverse effects of creatine have been discussed in previous Drugline documents (3, 4). The Scientific Committee of Food (European Commission) has evaluated the safety/risk of recommended supplemented regimen (5). They conclude that creatine appears to be well-tolerated in short term human trials. However, the objectives of the studies performed have been to assess the effect on exercise performance and not adverse effects. Although no important adverse effects have been reported in the efficacy trial, such evidence is insufficient to provide reassurance about the safety of creatine supplementation in high doses. The Committee considers, however, that consumption of doses up to 3 grams creatine per day is unlikely to pose any risk (5).

As a nutrition supplement, creatine is produced in a synthetic process and there should be no risk for BSE-contamination (6, 7). The manufacturing in Sweden follow directive from the European Community and a certificate according to the European Pharmacopea standards should always be enclosed together with the product in order to certify the manufacturing process.