What You Oughta Know About Creatine
Creatine (Cr) is one of the most widely studied supplements for athletic performance, but it typically remains misunderstood. It allows for maximum effort for slightly longer exercise capacity:
Train harder
Sprint longer
Recover faster
This is an advantage for all athletes.
Quick Facts About Creatine Phosphate (phosphocreatine, PCr):
What: a molecule found in every cell of the body
Purpose: to increase the total amount of PCr in cells
Function: enter muscle and form creatine phosphate that can donate a phosphate group to ADP (Adenosine Di-Phosphate) to re-form ATP (Adenosine Tri-Phosphate) - the energy currency of the body
Body Source: made in the liver, kidney and pancreas from amino acids – arginine, glycine and methionine
Dietary Sources: animal proteins (beef, salmon, tuna, salmon)
Supplement Source: sold as a powder, capsule, tablet, drink mix. Creatine monohydrate is the most popular form.
Safety: no adverse health effects reported to date
PCr is important because it provides immediate energy to fuel muscle contraction, which is critical for anaerobic sport. When releasing energy, ATP loses a phosphate to form ADP.
When ATP levels decrease, an enzyme starts to break down another high-energy source in the muscle called creatine phosphate, which gives its phosphate to replenish ATP. This helps give fast energy for activities lasting ~20 seconds, like in sprinting and weight lifting.
ATP doesn’t need PCr; however, PCr can provide a quicker path to getting more ATP.
This allows for short bursts of energy.
Examples include:
Strength Athlete: perform another rep before failure
Sprinter: sustain high energy levels before performance drops
Ergogenic for Exercise Performance and Training Adaptations
Creatine has shown benefits in high intensity exercise like sprinting and weightlifting by increasing creatine phosphate stores, work capacity and max effort in power and strength.
A review investigated the ergogenic value of Cr supplementation for exercise performance and training adaptations. The results included:
Short-term Cr supplementation of 20 g/day for 5-7 days can increase:
Total Cr levels by 10-30%; and
PCr levels by 10-40%
70% of the 300 studies reported an ergogenic benefit with improvements including:
Maximum strength/power: 5-15%
Repeated sprint performance: 5-15%
Single sprint performance: 1-5%
No studies found negative effects
Essentially, an overwhelming amount of the research supports Cr supplementation as an ergogenic aid for many different sports.
Recovery: Optimize Glycogen and Alleviate Muscle Damage
Recovery is especially key for athletes under intense training and/or those wanting to enhance training adaptations. For those who deplete a lot of their glycogen during exercise, creatine is suggested to help optimize glycogen levels, which is critical for recovery during intense training cycles.
Studies looking at inflammatory markers and muscle soreness have found that creatine may also alleviate muscle damage from intense training and sustain muscular performance during periods of intense and high-volume resistance training (1-3). This is something to consider for those athletes who are overreaching.
Protect the Brain
The risk for concussions and spinal cord injury (SCI) for athletes in contact sports is a growing concern. This is where preventative nutrition can offer support. Creatine has shown to provide neuroprotective benefits (4-6), specifically related to short- and long-term neurodegeneration. And there’s evidence that creatine supplementation can alleviate the consequences from concussions, traumatic brain injury and SCI (7-8).
Should Young Athletes Take Creatine?
Supplement labels provide warnings that those under 18 years old should not take creatine because creatine supplementation is not safe for younger individuals. Yet, the International Society of Sports Nutrition has pointed out that this is more as a legal precaution as there is no scientific evidence that younger populations should not take creatine. In fact, creatine supplementation may help with training adaptations and lower the risk for injury. It is advised that creatine supplementation is appropriate for younger athletes who participate in serious supervised training; have a well-balanced diet; know about the appropriate use of creatine; and follow the recommended dosages.
With creatine’s potential role in neuroprotection, this is important as a preventative measure for young athletes participating in contact sports (e.g., prone to concussion).
Food-First Approach or Supplement?
When whole food sources are not enough to increase the amount of a particular nutrient then supplementation is necessary. Given that Cr supplementation is beneficial for athletes, it’s not feasible or healthful to only consume creatine from dietary (animal-based) sources to reach the dose needed for a performance benefit.
A normal diet can provide 1-2 g of creatine per day, which leads to muscle stores that are only about 60-80% filled.
For example, 16 oz of beef provides 5 g of creatine. An athlete would have to eat 64 oz of beef to get 20 g of creatine (the recommended dose for creatine supplementation during a loading phase).
Creatine supplementation can increase muscle creatine and PCr by another 20-40% (9-11).
This is why Cr supplementation is a powerful addition to a nutrient-dense diet.
Which Form of Creatine?
For Cr supplementation, the type of Cr does NOT matter, but creatine monohydrate is the most logical form for supplementation.
Creatine Monohydrate (CM) - a creatine molecule attached to water - is the most studied and popular form of creatine. It is 100% bioavailable. Given that Cr is the most studied supplement for athletic performance, CM is, therefore, the most studied form of creatine.
Cr can be combined with different organic aids to form Cr salts, which are suggested to help improve Cr uptake and storage in the muscle.
For example:
Creatine Ethyl Ester (CEE): Cr with an ester attached. Yet, CM has shown to increase muscle creatine levels more than CEE.
Creatine Hydrochloride (HCL): Cr with hydrochloric acid attached. It is more soluble than CM, but no studies have shown it increases Cr levels in the muscle more than CM.
Buffered Creatine: creatine with a pH of 12 that is claimed to have more bioavailability because it does not increase creatinine (i.e., the breakdown product of creatine) in the body. The claim that a buffered form of creatine is more efficacious and safer compared to CM was shown to be false.
Despite what some companies in the supplement industry might claim (e.g., faster muscle gain, enhanced absorption, no water retention), there are no advantages in terms of more Cr in the muscle when using other forms of Cr.
In comparison to other forms of creatine, CM gives you more bang for your buck.
Does Creatine Increase Water Retention?
As for CM supplementation and water retention, Cr hydrates the muscle, which increases volume.
Creatine can cause the weight scale to go up, but it is due to water getting pulled into the muscle.
Specifically, creatine increases water within the cell (intracellular) giving a “full” look compared to the water retention experienced from stress, which is water retained right under the skin (giving a “soft” look).
However, CEE (the other form of Cr) increases extracellular water (giving a “soft” look), whereas CM increases intracellular water (giving a “full” look).
Combining Creatine with Other Substances
CM is 100% bioavailable (12). Combining CM with an insulin stimulating carbohydrate can be helpful for promoting Cr uptake into the muscle (13). Yet, combining CM with a protein, especially whey protein, can also be helpful.
Combining CM with whey protein (14) or carbohydrate (glucose) (15-16), can help improve muscle growth and strength. This is because insulin stimulates the cell’s CM transporter.
Therefore, CM taken with protein and carbohydrate can help increase whole-body Cr stores, especially if taken before and after resistance exercise (17). Because of the variability between individuals regarding response to Cr supplementation, combining CM with other substances to increase CM uptake helps alleviate this concern.
Practical Advice
Choose creatine monohydrate (CM).
More Cr does not mean better.
Muscle can only store a certain amount of Cr so too much Cr is eliminated in the urine.
Cr supplementation typically starts with a loading phase of:
2-3 days
0.071 g/kg bodyweight split into 4 doses per day (~20g per day for a 70 kg person) (18)
Following the loading phase, Cr supplementation to maintain muscle Cr levels can be 0.029 g/kg body weight once per day.
Combine each dose of CM (5-10 g) with carbohydrate (20-50 g) and with or without whey protein.
Take CM with carbohydrate and protein close to exercise for increased:
Cr levels
Glycogen repletion
Training adaptations
For further information, check out the Position Stand on the Safety and Efficacy of Creatine Supplementation in Exercise, Sport and Medicine from the International Society of Sports Nutrition.
References
1. Santos RV, et al. The effect of creatine supplementation upon inflammatory and muscle soreness markers after a 30 km race. Life Sci. 2004;75(16): 1917–24.
2. Deminice R, et al. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013;29(9):1127–32.
3. Volek JS, et al. The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching. Eur J Appl Physiol. 2004;91(5–6):628–37.
4. Tarnopolsky MA, et al. Creatine transporter and mitochondrial creatine kinase protein content in myopathies. Muscle Nerve. 2001;24(5):682–8.
5. Tarnopolsky MA. Clinical use of creatine in neuromuscular and neurometabolic disorders. Subcell Biochem. 2007;46:183–204.
6. Tarnopolsky MA. Potential benefits of creatine monohydrate supplementation in the elderly. Curr Opin Clin Nutr Metab Care. 2000;3(6):497–502.
7. Balestrino M, et al. Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease. Amino Acids. 2016;48(8):1955–67.
8. Freire Royes LF, Cassol G. The effects of Creatine supplementation and physical exercise on traumatic brain injury. Mini Rev Med Chem. 2016;16(1):29–39.
9. Kreider RB. Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem. 2003;244(1–2):89–94.
10. . Casey A, et al. Creatine ingestion favorably affects performance and muscle metabolism during maximal exercise in humans. Am J Physiol. 1996;271(1 Pt 1):E31–7.
11. Greenhaff PL, et al. Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clin Sci (Lond). 1993;84(5):565–71.
12. Deldicque L, Decombaz J, Zbinden Foncea H, Vuichoud J, Poortmans JR, Francaux M. Kinetics of creatine ingested as a good ingredient. Eur J Appl Physiol. 2008;102(2):133-43.
13. Stout JEJ, Noonan D, Moore G, Cullen D. Effects of 8 weeks of creatine supplementation on exercise performance and fat-free weight in football players during training. Nutr Res. 1999;19(2):217-25.
14. Burke DG, Chilibeck PD, Davidson KS, Candow DG, Farthing J, Smith-Palmer T. The effect of whey protein supplementation with and without creatine monohydrate combined with resistancing training on lean tissue mass and muscle strength. Int J Sports Nutr Exerc Metab. 2001;11(3):349-64.
15. Kreider RB, Ferreira M, Wilson M, Grindstaff P, Plisk S, Reinardy J, et al. Effects of creatine supplementation on body composition, strength and sprint performance. Med Sci Sports Exerc. 1998;30(1):73-82.
16. Crubb PJ, Williams AD, Stathis CG, Carey MF, Hayes A. Effects of whey protein isolate, creatine, and resistance training on muscle hypertrophy. Med Sci Sports Exerc. 2007;39(2):298-307.
17. Cribb PJ, Hayes A. Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc. 2006;38(11):1918-25.
18. Persky AM, Brazeen GA, Hochhaus G. Pharmakokinetics of the dietary supplement creatine. Clin Pharmakokinet. 2003; 42: 557–574.