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Creatine and Acne

Creatine is an energy supplement for increasing muscle mass. Does it cause acne? Research findings suggest so.
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What is Creatine?

Creatine is a protein-like compound found mostly in the cells of the skeletal muscles. It increases energy production in cells by increasing the production of adenosine triphosphate or ATP which is the chief energy molecule in the body.

The most accurate description of creatine is that it is a nitrogenous organic acid. It is produced from 3 amino acids (glycine, L-methionine and L-lysine) in the liver and kidneys.

Creatine is interconverted to creatinine (a compound whose serum levels are used to access renal function and for diagnostic purposes) in the body.

Creatine can also be obtained from meat. Therefore, vegetarians need to take creatine supplements to get appreciable amounts of creatine.

This energy supplement also improves cognition and memory. In a study involving vegetarians, creatine supplements were found to provide these benefits by increasing body’s store of the compound. However, since vegetarians usually have lower levels of creatine, it is still unknown whether creatine supplements can also improve cognitive performance and memory functions in non-vegetarians.

Creatine supplements are commonly ingested by athletes especially bodybuilders and wrestlers who want to quickly build up their muscle mass. Different studies have identified a number of mechanisms by which creatine contributes to muscle development.

The most common conclusions are that creatine

  • increases water retention in muscle cells
  • stimulates the activity of satellite cells which causes muscle hypertrophy
  • repairs damaged muscle fibers by contributing to their growth

Creatine is extensively used in sports. It can provide the burst of energy needed to improve power and performance especially for anaerobic high-intensity exercises.  The effect of creatine is lesser and short-lived for aerobic exercises.

Even though creatine is an energy compound, its use is not discouraged in athletics and the compound is not included in any list of banned substances provided by anti-doping agencies.

Creatine Supplements

The most popular creatine supplements are creatine monohydrate and creatine ethyl ester.

These are supplied as caplets, capsules or powders to be reconstituted as drink. The anabolic effects of creatine are enhanced when taken along with high glycemic carbohydrates.

Of the two creatine supplements, creatine monohydrate has a better therapeutic profile. Contrary to popular belief, the ethyl ester salt of creatine is easily affected by stomach acid. In this supplement, the creatine is unstable in acidic environment.

A new creatine supplement, creatine hydrochloride, has an even better therapeutic profile than creatine monohydrate. Creatine hydrochloride is 59 times more soluble than the monohydrate. Therefore, it is more extensively absorbed and given in lower doses.

Creatine is extensively absorbed and highly bioavailable when supplied by these supplements. However, it is also quickly used up by the body. Therefore, constant supplementation with 2 -5 g is required to maintain a high level of creatine in the body.

Short-term creatine supplementation is generally considered safe. Even long-term use of 3 g per day of creatine is also regarded as safe.

The use of creatine is not recommended for those with impaired liver and kidney functions, asthmatics, pregnant and breastfeeding women. However, there is no convincing scientific proof that creatine causes liver or kidney damage.

Other side effects that are reported but not proven include dehydration, muscle cramp, electrolyte imbalances and reduced blood volume.

Does Creatine Cause Acne?

Although most creatine users and manufacturers argue that creatine does not cause acne, there is now overwhelming evidence that it most likely does. At best, creatine worsens acne.

Creatine supporters are eager to conclude when acne breaks out during creatine supplementation, it is usually the high glycemic diet taken alongside and/or the dehydration following strenuous exercise that should be blamed.

The rationalization is that sugar and dehydration cause hormonal imbalance and thus acne.

However, when the results of different studies examining the effects of creatine on the endocrine system are critically analyzed, it becomes clear that creatine can directly cause or at least contribute to acne development.

The Endocrine Effects of Creatine

Besides the anabolic effects that creatine produces in the body, it also affects the endocrine system.

Different studies have shown that creatine supplementation increases the levels of testosterone, dihydrotestosterone (DHT) and insulin-like growth factor I (IGF-I).

In a 2006 study published in International Journal of Sport Nutrition and Exercise Metabolism, 39 college football players were given either creatine or placebo over a period of 10 weeks while partaking in resistance training. The results showed that resting testosterone levels were increased by an average of 22%.

A 2008 study published in the same journal examined the levels of insulin-growth factor 1 (IGF-1) in young adults following creatinine supplementation and regular resistance exercise during an 8-week period.

The study result showed that regardless of diet, the IGF-1 levels in the study participants increased by 24%.

A 2009 study published in Clinical Journal of Sport Medicine examined hormonal production in 20 male South African rugby players after 3 weeks of supplementation with creatine monohydrate. A 6-week washout period was allowed following this double-blind, placebo-controlled, crossover study.

The result of the study showed that the conversion of testosterone to DHT was increased during the period of the supplementation.

DHT levels were increased by 56% during the first week of loading up on creatine and maintained at 40% above normal levels during the 2-week period when maintenance dose was taken.

What the Results Mean

The studies summarized above establish that creatine increases the levels of the very hormones that have been shown to cause acne. Testosterone, DHT and IGF-1 are all directly linked to acne.

Male sex hormones such as testosterone are produced in increasing amounts during puberty and they are the chief cause of acne in teenagers.

Testosterone is not the only androgen that is known to cause acne: DHT produces an even greater effect.

Androgens cause the enlargement of the sebaceous glands which leads to increased production of sebum. With excess sebum reaching the skin, an ideal environment for bacterial colonization is created. Therefore, acne-causing bacteria such as Propionibacterium acnes thrive on the skin.

Furthermore, increased sebum production means that there will be increased clogging of the skin pores by a mixture of dead skin cells, bacteria and sebum.

This causes the formation of acne lesions and a cycle of inflammation that produces all the symptoms of acne such as seborrhea, comedones, papules, pimples, nodules, cysts and acne scars.

Besides the androgens, the other hormone implicated in acne development is insulin-like growth factor 1.

Conclusion

Since creatine directly increases the levels of these hormones, it can clearly cause and/or worsen acne.

It may well be that low doses of creatine can be well tolerated in some individuals.

In addition, the role of creatine in acne development might be cumulative and, therefore, short-term use of the supplement may not cause acne in some people. However, there have been reports of acne breakouts even with low doses and a few days after the start of creatine supplementation.

Clearly, more studies are needed to conclusively explore the likelihood of creatine causing acne but the results from available studies all point to the fact that creatine supplementation creates the very hormonal imbalance that triggers acne.

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