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Although the athletes tested reported no stomach or digestive distress or muscular cramping, and all blood variables remained within normal limits, little was learned regarding the medical safety of short-term or long-term creatine supplementation. Three indicators reveal that further study is necessary before any conclusions can be reached regarding the safety of long-term creatine supplementation. First, researchers noticed a small but significant increase in fasting serum creatinine levels, which is used as an indirect marker of renal stress. This increase, however, may have been caused by the intense training rather than the creatine supplementation, so further research is necessary before a conclusion should be drawn. Second, there appeared to be a moderate increase in muscle and liver enzyme efflux, another indicator of intense training/exercise. Finally, high-density lipoprotein concentrations increased significantly, decreasing total cholesterol and triglycerides. Kreider and his seven fellow researchers agree that creatine supplements do enhance performance with regard to lifting volume and sprint performance in well-trained athletes and that no side effects were observed. However, they caution that additional research should investigate the medical safety of long-term supplementation and the effects of creatine on performance at lower levels of effort. Sports nutrition enthusiasts are strongly cautioned to check with a medical professional before self-prescribing creatine or other similar strength-builder.
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