In 1992, Harris and colleagues demonstrated that oral creatine supplementation can enhance muscle creatine stores. Since then, creatine has become an important and popular ergogenic aid for improving athletic performance with reports of up to 74% of athletes supplementing with creatine. Although many recent studies have addressed the safety concerns of creatine supplementation on hydration status in hot and humid environments, anecdotal reports still exist linking creatine usage to heat-related problems. These concerns are based on the premise that creatine is an osmotically active substance resulting in an alteration in fluid balance by increasing intracellular fluid volume and preventing fluid from entering the extracellular environment to aid in thermoregulation. However, a number studies have demonstrated that when recommended amounts of creatine are consumed, creatine does not appear to increase the risk of heat-related problems during exercise and may actually have a positive influence on core temperature and heart rate responses.
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