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Vial fell or was shaken accidentally If a reconstituted vial was shaken vigorously (dropped, thrown in a bag, held by a toddler), some peptide degradation may have occurred

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However, a study published in the Journal of the International Society of Sports Nutrition concluded that you do not have to load creatine

8-OHdG: 8-hydroxy-2-deoxyguanosine AD: Alzheimers disease Akt: protein kinase B APP: amyloid precursor protein ATF6: activating transcription factor 6 ATP: adenosine triphosphate CBS: cystathionine -synthase CCR2: C-C chemokine receptor type 2 CHOP: CCAAT/enhancer-binding protein homologous protein co-IP: co-immunoprecipitation ER: endoplasmic reticulum ETC C1: electron transport chain complex 1 ETC: electron transport chain GLUT4: glucose transporter type 4 GlyNAC: glycine and N -acetylcysteine GRP78: glucose-regulated protein 78 GSH: glutathione HbA1c: hemoglobin A1c HI: human insulin HOMA-IR: homeostatic model assessment of insulin resistance IL-6: interleukin-6 IR: insulin receptor IRE1: inositol-requiring enzyme 1 IRS-1: insulin receptor substrate-1 IV: intravenous JNK: c-Jun N-terminal kinase LC-MS/MS: liquid chromatography-tandem mass spectrometry LC-MS: liquid chromatography-mass spectrometry LPS: lipopolysaccharide MDA: malondialdehyde MeSH: Medical Subject Headings MSM: methylsulfonylmethane NAC: N -acetylcysteine Ndufs3: NADH dehydrogenase (ubiquinone) Fe-S protein 3 NF-B: nuclear factor kappa-light-chain-enhancer of activated B cells NMR: nuclear magnetic resonance Nox: NADPH oxidase p22: p22phox (a subunit of NADPH oxidase) PBMCs: peripheral blood mononuclear cells PDI: protein disulfide isomerase PDIA4: protein disulfide isomerase family A, member 4 PERK: protein kinase R-like endoplasmic reticulum kinase PI3K: phosphoinositide 3-kinase PS1: presenilin 1 RBC: red blood cell ROS: reactive oxygen species SANRA: Scale for the Assessment of Narrative Review Articles SOCS: suppressor of cytokine signaling T2DM: type 2 diabetes mellitus TLR4: toll-like receptor 4 TNF-: tumor necrosis factor-alpha UPR: unfolded protein response XBP-1: X-box binding protein 1 YAP: Yes-associated protein During the preparation of this work, the author(s) used ChatGPT (OpenAI) and Midjourney for figure design and language editing