or for how long it should be provided. Indeed, animal studies suggest that long-term feeding of creatine may reduce its ability to protect against the consequences of brain injury (Prass et al., 2007). These challenges to the feasibility of prospective studies will be common to any nutrient or food component of interest. To overcome these challenges, the committee recommends in Chapter 5 that a study be conducted on preinjury and postinjury dietary intake status (e.g., dietary supplement use) in individuals with TBI in order to determine any relationship to TBI outcome, including an analysis of the possible synergistic effects between nutrients, food components, and dietary supplements. Creatine should be included as part of that study.

With respect to treatment, preliminary studies by Sakellaris and colleagues (2006, 2008) provide evidence of the potentially positive therapeutic effects of creatine on brain function and behavior after brain injury. These positive effects should be confirmed in the adult population.

RECOMMENDATION 10-1. Based on the evidence supporting the effects of creatine on brain function and behavior after brain injury in children and adolescents, DoD should initiate studies in adults to assess the value of creatine for treating TBI patients.

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