On Your Mark Nutrition


What You Oughta Know About Creatine

Photo by MRBIG_PHOTOGRAPHY/iStock / Getty Images
Photo by MRBIG_PHOTOGRAPHY/iStock / Getty Images


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.


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Katie Mark