ISSN position stands: protein and exercise; diets and body composition; safety and efficacy of creatine supplementation in exercise, sport, and medicine

Going quietly under the radar, the ISSN — International Society of Sports Nutrition — has just recently released 3 position stands this past June 2017. They’re well sourced research articles that give scientific based prescriptions.

  • Protein and exercise
  • Diets and body composition
  • Safety and efficacy of creatine supplementation in exercise, sport, and medicine

I’ll post the basic summaries with a bit of commentary, but they pretty much stand for themselves if you want to read them.

Protein and exercise

The International Society of Sports Nutrition (ISSN) provides an objective and critical review related to the intake of protein for healthy, exercising individuals. Based on the current available literature, the position of the Society is as follows:

  1. An acute exercise stimulus, particularly resistance exercise, and protein ingestion both stimulate muscle protein synthesis (MPS) and are synergistic when protein consumption occurs before or after resistance exercise.
  2. For building muscle mass and for maintaining muscle mass through a positive muscle protein balance, an overall daily protein intake in the range of 1.4–2.0 g protein/kg body weight/day (g/kg/d) is sufficient for most exercising individuals, a value that falls in line within the Acceptable Macronutrient Distribution Range published by the Institute of Medicine for protein.
  3. Higher protein intakes (2.3–3.1 g/kg/d) may be needed to maximize the retention of lean body mass in resistance-trained subjects during hypocaloric periods.
  4. There is novel evidence that suggests higher protein intakes (>3.0 g/kg/d) may have positive effects on body composition in resistance-trained individuals (i.e., promote loss of fat mass).
  5. Recommendations regarding the optimal protein intake per serving for athletes to maximize MPS are mixed and are dependent upon age and recent resistance exercise stimuli. General recommendations are 0.25 g of a high-quality protein per kg of body weight, or an absolute dose of 20–40 g.
  6. Acute protein doses should strive to contain 700–3000 mg of leucine and/or a higher relative leucine content, in addition to a balanced array of the essential amino acids (EAAs).
  7. These protein doses should ideally be evenly distributed, every 3–4 h, across the day.
  8. The optimal time period during which to ingest protein is likely a matter of individual tolerance, since benefits are derived from pre- or post-workout ingestion; however, the anabolic effect of exercise is long-lasting (at least 24 h), but likely diminishes with increasing time post-exercise.
  9. While it is possible for physically active individuals to obtain their daily protein requirements through the consumption of whole foods, supplementation is a practical way of ensuring intake of adequate protein quality and quantity, while minimizing caloric intake, particularly for athletes who typically complete high volumes of training.
  10. Rapidly digested proteins that contain high proportions of essential amino acids (EAAs) and adequate leucine, are most effective in stimulating MPS.
  11. Different types and quality of protein can affect amino acid bioavailability following protein supplementation.
  12. Athletes should consider focusing on whole food sources of protein that contain all of the EAAs (i.e., it is the EAAs that are required to stimulate MPS).
  13. Endurance athletes should focus on achieving adequate carbohydrate intake to promote optimal performance; the addition of protein may help to offset muscle damage and promote recovery.
  14. Pre-sleep casein protein intake (30–40 g) provides increases in overnight MPS and metabolic rate without influencing lipolysis.

Note since there is some misunderstanding: The protein recommendations are in g/kg which means that you need to divide by 2.2 to get g/lbs. This means that the recommendations above are generally within the more commonly known .7-1 g/lbs for athletic populations and 1-1.5+ g/lbs for resistance trained athletes who are cutting.

Diets and body composition

The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of diet types (macronutrient composition; eating styles) and their influence on body composition. The ISSN has concluded the following.

  1. There is a multitude of diet types and eating styles, whereby numerous subtypes fall under each major dietary archetype.
  2. All body composition assessment methods have strengths and limitations.
  3. Diets primarily focused on fat loss are driven by a sustained caloric deficit. The higher the baseline body fat level, the more aggressively the caloric deficit may be imposed. Slower rates of weight loss can better preserve lean mass (LM) in leaner subjects.
  4. Diets focused primarily on accruing LM are driven by a sustained caloric surplus to facilitate anabolic processes and support increasing resistance-training demands. The composition and magnitude of the surplus, as well as training status of the subjects can influence the nature of the gains.
  5. A wide range of dietary approaches (low-fat to low-carbohydrate/ketogenic, and all points between) can be similarly effective for improving body composition.
  6. Increasing dietary protein to levels significantly beyond current recommendations for athletic populations may result in improved body composition. Higher protein intakes (2.3–3.1 g/kg FFM) may be required to maximize muscle retention in lean, resistance-trained subjects under hypocaloric conditions. Emerging research on very high protein intakes (>3 g/kg) has demonstrated that the known thermic, satiating, and LM-preserving effects of dietary protein might be amplified in resistance-training subjects.
  7. The collective body of intermittent caloric restriction research demonstrates no significant advantage over daily caloric restriction for improving body composition.
  8. The long-term success of a diet depends upon compliance and suppression or circumvention of mitigating factors such as adaptive thermogenesis.
  9. There is a paucity of research on women and older populations, as well as a wide range of untapped permutations of feeding frequency and macronutrient distribution at various energetic balances combined with training. Behavioral and lifestyle modification strategies are still poorly researched areas of weight management.

Note since there is some misunderstanding: The protein recommendations are in g/kg which means that you need to divide by 2.2 to get g/lbs. This means that the recommendations above are generally within the more commonly known .7-1 g/lbs for athletic populations and 1-1.5+ g/lbs for resistance trained athletes who are cutting.

Safety and efficacy of creatine supplementation in exercise, sport, and medicine

Creatine is one of the most popular nutritional ergogenic aids for athletes. Studies have consistently shown that creatine supplementation increases intramuscular creatine concentrations which may help explain the observed improvements in high intensity exercise performance leading to greater training adaptations. In addition to athletic and exercise improvement, research has shown that creatine supplementation may enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and concussion and/or spinal cord neuroprotection. Additionally, a number of clinical applications of creatine supplementation have been studied involving neurodegenerative diseases (e.g., muscular dystrophy, Parkinson’s, Huntington’s disease), diabetes, osteoarthritis, fibromyalgia, aging, brain and heart ischemia, adolescent depression, and pregnancy. These studies provide a large body of evidence that creatine can not only improve exercise performance, but can play a role in preventing and/or reducing the severity of injury, enhancing rehabilitation from injuries, and helping athletes tolerate heavy training loads. Additionally, researchers have identified a number of potentially beneficial clinical uses of creatine supplementation. These studies show that short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly. Moreover, significant health benefits may be provided by ensuring habitual low dietary creatine ingestion (e.g., 3 g/day) throughout the lifespan. The purpose of this review is to provide an update to the current literature regarding the role and safety of creatine supplementation in exercise, sport, and medicine and to update the position stand of International Society of Sports Nutrition (ISSN).

After reviewing the scientific and medical literature in this area, the International Society of Sports Nutrition concludes the following in terms of creatine supplementation as the official Position of the Society:

  1. Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes with the intent of increasing high-intensity exercise capacity and lean body mass during training.
  2. Creatine monohydrate supplementation is not only safe, but has been reported to have a number of therapeutic benefits in healthy and diseased populations ranging from infants to the elderly. There is no compelling scientific evidence that the short- or long-term use of creatine monohydrate (up to 30 g/day for 5 years) has any detrimental effects on otherwise healthy individuals or among clinical populations who may benefit from creatine supplementation.
  3. If proper precautions and supervision are provided, creatine monohydrate supplementation in children and adolescent athletes is acceptable and may provide a nutritional alternative with a favorable safety profile to potentially dangerous anabolic androgenic drugs. However, we recommend that creatine supplementation only be considered for use by younger athletes who: a.) are involved in serious/competitive supervised training; b.) are consuming a well-balanced and performance enhancing diet; c.) are knowledgeable about appropriate use of creatine; and d.) do not exceed recommended dosages.
  4. Label advisories on creatine products that caution against usage by those under 18 years old, while perhaps intended to insulate their manufacturers from legal liability, are likely unnecessary given the science supporting creatine’s safety, including in children and adolescents.
  5. At present, creatine monohydrate is the most extensively studied and clinically effective form of creatine for use in nutritional supplements in terms of muscle uptake and ability to increase high-intensity exercise capacity.
  6. The addition of carbohydrate or carbohydrate and protein to a creatine supplement appears to increase muscular uptake of creatine, although the effect on performance measures may not be greater than using creatine monohydrate alone.
  7. The quickest method of increasing muscle creatine stores may be to consume ~0.3 g/kg/day of creatine monohydrate for 5–7-days followed by 3–5 g/day thereafter to maintain elevated stores. Initially, ingesting smaller amounts of creatine monohydrate (e.g., 3–5 g/day) will increase muscle creatine stores over a 3–4 week period, however, the initial performance effects of this method of supplementation are less supported.
  8. Clinical populations have been supplemented with high levels of creatine monohydrate (0.3 – 0.8 g/kg/day equivalent to 21–56 g/day for a 70 kg individual) for years with no clinically significant or serious adverse events.
  9. Further research is warranted to examine the potential medical benefits of creatine monohydrate and precursors like guanidinoacetic acid on sport, health and medicine.


Some of the conclusions are more well known than others. For example, there’s a lot of basic conclusions that you need increased caloric intake to gain muscle, and that you need less calories to gain muscle. Some are less well known such as the fact that higher protein intakes (2.3-3.1 g/kg or about 1.1-1.5 g/lbs) can be useful for maintaining lean mass in resistance trained subjects under hypocaloric situations. Also the part about the satiety effects of protein for thermic and satiety effects in resistance trained subjects. Some like creatine’s usefulness in injury prevention, thermoregulation, rehabilitation, and use in concussion and spinal cord neuroprotection you just wouldn’t know unless you’re a well informed medical professional. Still others take a stand on some of the conflicting literature like protein intake and mass gains. For example, the distribution of protein over the course of time versus daily intake.

Overall, I was personally surprised at all of the ways creatine can be used. Ergogenically, injury prevention, exercise heat tolerance, enhanced rehabilitation, brain and spinal neuroprotection, creatine deficiency diseases, neurodegenerative diseases, ischemic heart disease, aging, pregnancy. I’ve personally heard of most of these before, but exercise heat tolerance, heart disease, and pregnancy were pretty new to me. However, those definitely make sense once you think about it.

Most of the other knowledge on diets I was privy to. The specific leucine recommendations and pre-sleep casein are good to know specifically for those looking to optimize muscle mass gains. Hopefully, this should finally put some of the low-fat and low-carb controversy to rest along with the intermittent fasting debates. What really matters is caloric intake, protein, and adherence to diet. Obviously, nutritional value of foods can and should be taken into consideration, especially for those aiming to be healthy. But that can easily be met by fruits and vegetables with good amounts of other whole foods while keeping calories low.

I’m pretty happy with the range of subjects they covered and the depth that their research goes into.

Feel free to read each of them as they’re all very long and detailed if you want to know more about these subjects.

Discussion on bodyweight fitness.

Photo is the logo of ISSN —

Author: Steven Low

Steven Low, author of Overcoming Gravity: A Systematic Approach to Gymnastics and Bodyweight Strength (Second Edition), is a former gymnast who has performed with and coached the exhibitional gymnastics troupe, Gymkana. Steven has a Bachelor of Science in Biochemistry from the University of Maryland College Park, and his Doctorate of Physical Therapy from the University of Maryland Baltimore. Steven is a Senior trainer for Dragon Door’s Progressive Calisthenics Certification (PCC). He has also spent thousands of hours independently researching the scientific foundations of health, fitness and nutrition and is able to provide many insights into practical care for injuries. His training is varied and intense with a focus on gymnastics, parkour, rock climbing, and sprinting.