Creatine: a simple guide

Creatine is one of the most popular supplements used in the sports industry.

Table of contents

• What is creatine?
• Why supplement?
• Potential benefits from supplementation
• Who should use it?
• How to take it?
• Possible side effects
• What are the best forms of creatine?
• Take aways

What is creatine?

Creatine is an amino acid mainly found in muscle cells that generates energy (ATP) quickly for short maximal outputs of exercise, like sprints and heavy lifts. Within the three energy systems, creatine plays a role within the phosphocreatine energy system.

When phosphocreatine is broken down into a phosphate group and creatine, ATP is generated. Creatine stores are therefore necessary to combine with the phosphate group to regenerate phosphocreatine for further ATP production.  

Creatine is synthesised by the body in small amounts and also found within the diet mainly in sources such as red meat and seafood. 

Since ATP can’t be easily stored, replenishing adequate muscle stores of creatine that can be utilised to generate phosphocreatine are important to maintain ATP availability. As creatine stores break down during exercise and eventually run out, creatine supplementation can increase muscle stores by 20-40% greater and subsequent phosphocreatine stores (1).

Why supplement?

In a diet where you are including food sources rich in creatine, muscle creatine stores are about 60-80% saturated. Therefore for anyone who trains harder, who may be larger in size and/or vegetarian/vegan (1), creatine supplementation can help the muscle reach a level where it is saturated with creatine and therefore beneficial for training results.

Creatine supplementation is associated with a variety of beneficial training adaptations and shown to enhance performance and recovery.  For anyone lifting heavy, creatine supplementation may be particularly beneficial (1).

Research also indicates that creatine may improve certain health conditions – from diabetes, to heart health, osteoarthrisis, depression and neurodegeneration (1). Creatine may be able improve aging, bone health and reduce muscle loss (sarcopenia) (2,3).

Potential benefits from creatine supplementation

Increased maximal power and strength: creatine may improve work performed during max effort muscle contractions (e.g. bench press, squats etc), (4) and maintain muscular performance during high-volume resistance training (5).

Improved sprint performance: single effort sprint performance and repetitive sprint performance improve from supplementation with creatine (4).

Improved strength and power: supplementation with creatine increases muscular strength, without fat gain (8).

Greater energy production: supplementation with creatine for 3-4 days results in greater anaerobic energy production (6).

Enhanced post-exercise muscle protein synthesis: combined with resistance training, creatine supplementation may enhance the muscle protein synthesis signalling process (9).

Muscle mass gains: supplementing with creatine may result in greater gains in strength and muscle mass (7).

Enhanced muscle glycogen supercompensation: co-ingesting creatine with a workout meal enhances glycogen (carb stores) restoration (10,11) and enhances glycogen supercompensation (25). Glycogen replenishment is key for recovery and maintaining intense/longer training periods (12) and glycogen supercompensation may enhance moderate intensities of exercise.

Reduced muscle damage: creatine supplementation may improve the rate of muscle recovery after injury (13). This may be due to its inhibitory effects on inflammatory markers (14). Supplementation may reduce muscle soreness and levels of inflammatory biomarkers (15).   

Reduce pains and injuries: athletes using creatine experience less muscle cramping, dehydration, muscle tightness, muscle strains, non-contact injuries and total injuries than athletes who do take creatine (16,17).

Enhance rehab from injury: creatine may reduce muscle breakdown rates (18) and result in greater strength gains during rehab (19,20)

Limit damage from concussion: creatine supplementation may limit damage from concussion (21,22).

Who should use it?

It is mainly known for benefiting  gym goers and weight training, but it has been shown to be beneficial for many different training modalities and sports – from running, cycling and swimming, to football, basketball, rugby and wrestling.

However, as you’ve seen from above, it might additionally be useful for anyone who wants to prevent injury, going through rehab and who is at risk from concussion.

Additionally, because creatine is only found in animal foods, vegetarians and vegans have lower intramuscular creatine stores (26) and therefore may be especially beneficial for them.

How to take it?

The most effective way to increase muscle creatine stores and subsequent phosphocreatine levels starts with a loading phase whereby 5g of creatine monohydrate (or approx. 0.3 g/kg bodyweight) is taken four times daily for 5-7 days (1).

Once this loading phase has taken place and muscle creatine stores are fully saturated, creatine stores can usually be maintained by ingesting 3-5g/day – although larger athletes may require more (approx. 5-10g/day) to maintain stores (1).

An alternative method is to gradually increase muscle levels of creatine over a 28 day period, ingesting 3 g/day daily – this may have less of an impact on training/performance since the muscles will not be saturated with creatine.

By consistently taking your creatine with a meal (protein and carbs), you can promote greater creatine retention.

Possible side effects:

A consistent reported side effect from creatine is weight gain – an approx. 1-2kg increase in lean body mass during the loading phase. This may be mainly due to an increase in extracellular water (as creatine pulls water into the cell), as well as the potential for new muscle tissue (1). Unless of course you are consuming extra calories, and then of course there is the potential for fat gain regardless of creatine.

Although there have been various anecdotal claims that creatine supplementation increases incidence of musculoskeletal injuries, dehydration, muscle cramping, GI upset and renal dysfunction, these claims appear to be unsubstantiated and are not supported by the literature. If you do not have existing issues with your liver and kidneys, there is not evidence to support creatine having detrimental effects. In fact, the consumption of 3g of creatine throughout life has been recommended to promote general health (28).

The International Society of Sports Nutrition (ISSN) concluded that there is no compelling evidence that the short-or-long-term use of creatine monohydrate (up to 30g/day for 5 years) has any detrimental effects on otherwise healthy individuals or among clinical populations who may benefit from creatine supplementation.

Can it cause baldness?

One study found an increase of approx 50% dihydrotestosterone (DHT) levels when loading creatine (28). Whilst DHT is a normal hormone that is involved in sexual health and muscle mass – it has also been associated with baldness in males. 

Whilst the study did not include any date on hair loss, it is fair to say that creatine supplementation over a period of time make increase levels of DHT. 

What are the best forms of creatine?

Go for creatine monohydrate

Take aways:

Creatine monohydrate supplementation may benefit: performance and recovery in a variety of sports/trainings, as well as helping you with mass gains.

Creatine monohydrate supplementation may benefit: athletes who are vegetarian or vegan.

If supplement, expect a 1-2 kg increase in weight: during the loading phase.

Creatine supplementation isn’t a must: so consider it based on your unique situation and goals and whether it makes sense as part of your personalised nutrition plan.

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What are your thoughts? Do you take creatine? What are your experiences? Would love to hear in the comments below!

References:

1. Kreider et al. (2017). International society of sports nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport and medicine.
2. Candow (2011). Sarcopenia: current theories and the potential beneficial effect of creatine application strategies.
3. Candow et al. (2010). Potential of creatine supplementation for improving aging bone health.
4. Kreider (2003). Effect of creatine supplementation on performance and training adaptations.
5. Volek et al. (2004). The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching.
6. Wallimann et al. (1984). Function of M-line-bound creatine kinase as intramyofibrillar ATP regenerator at the receiving end of the phosphorylcreatine shuttle in muscle.
7. Kreider et al. (1999) Effects of nutritional supplementation during off-season college football training on body composition and strength
8. Earnest et al. (1995) The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition
9. Olsen et al. (2006). Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training.
10. Greene et al (1996). Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans
11. Steenge et al (1985). Protein and carbohydrate induced augmentation of whole body creatine retention in humans.
12.  Kreider et al (2010). ISSN exercise and sport nutrition review: research & recommendations
13. Cooke et al. (2009). Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals.
14. Deminice et al. (2013). Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans.
15. Santos et al. (2004). The effect of creatine supplementation upon inflammatory and muscle soreness markers after a 30 km race.
16. Greenwood et al. (2003). Creatine supplementation during college football training does not increase the incidence of cramping or injury
17. Greenwood et al. (2003). Cramping and injury incidence in collegiate football players are reduced by creatine supplementation.
18. Hespel et al. (2001). Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the experession of muscle myogenic factors in humans
19. Hespel et al. (2007). Ergogenic effects of creatine in sports and rehabilitation.
20. Op’t et al. (2001). Effect of oral creatine supplementation on human muscle GLUT4 protein content after immobilisation
21. Balestrino et al. (2016). Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease.
22. Royes et al. (2016). The effects of creatine supplementation and physical exercise on traumatic brain injury.
23. Buford et al. (2007). International society of sports nutrition position stand: creatine supplementation and exercise
24. Dalbo et al. (2008). Putting to rest the myth of creatine supplementation leading to muscle cramps and dehydration
25. Nelson et al. (2001). Muscle glycogen supercompensation is enhanced by prior creatine supplementation.
26. Benton et al. (2010). The influence of creatine supplementation on the cognitive functioning.
27. Wallimann et al. (2011). The creatine kinase system and pleiotropic effects of creatine.
28. Van der Merwe et al. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratios in college-aged rugby players.