Rethinking creatine fortification: Addressing nutritional gaps through food enrichment

Creatine, a conditionally essential nutrient, plays a vital role in cellular energy metabolism, particularly during periods of high metabolic demand. Given that dietary creatine is primarily sourced from animal-based foods, individuals following vegetarian or vegan diets, as well as those with increased nutritional needs, may be at risk of inadequate creatine intake. Population-based studies indicate that up to 65.2 % of individuals consume creatine at suboptimal levels, which has been linked to adverse health outcomes, including increased risk of depression, a higher incidence of certain cancers, and greater likelihood of liver disease. This report examines the potential for creatine fortification within the framework of established nutrient fortification guidelines. Key principles of effective fortification—such as the selection of widely consumed food vehicles, maintenance of nutrient balance, stability, bioavailability, and safety—support creatine's viability as a fortificant. Dairy products, consumed by approximately 80 % of young children and 60 % of older adults, along with cereals, found in 70 % of American households, emerge as promising candidates for fortification. Additionally, creatine's chemical stability allows it to retain up to 100 % of its original concentration for 12 months, ensuring its integrity in fortified foods. Its nearly 100 % bioavailability further supports efficient absorption and utilization. Furthermore, creatine's strong safety profile, with tolerable intake levels of up to 5 g/day and no reported toxicity even at doses of 30 g/day over several years, reinforces its inclusion in public health strategies. While additional research is needed to refine optimal fortification levels and assess long-term safety, creatine fortification presents a promising intervention for addressing dietary deficiencies and improving population health outcomes.