What is it:
Creatine is a naturally occurring molecule in muscle cells that is made from amino acids, the building blocks of protein. It is also one of the most popular ergogenic aids among athletes. According to the National Academy of Sports Medicine, it facilitates ATP regeneration to improve training capacity, strength, power, and muscle mass. Besides high-intensity and short-duration or repeated bouts of exercise with short rest periods, creatine can be helpful in endurance-based sports by improving oxygen consumption. Having extra stores of creatine in your skeletal muscles means you can train more intensely and enjoy greater strength, power, and speed gains from your workouts. Recent evidence shows that creatine could also be beneficial to brain health as well as fighting sarcopenia, a loss of muscle mass that is typical as we age. Creatine monohydrate is considered to be the most effective form of creatine supplement.
Purported claims of creatine supplementation:
Enhanced body composition and lean mass
Increased strength and power
Enhanced glycogen synthesis
Improved exercise tolerance in a hot climate
Possible improvement of aerobic capacity via greater shuttling of ATP from mitochondria
Enhanced recovery and injury prevention
May Improve cognitive processing ability
What the science says:
Body composition, strength, and sports performance:
There is a multitude of evidence showing that CS can have a positive impact on body composition and sports performance in all age groups. Creatine supplementation (CS) can increase intercellular creatine concentration which may improve high-intensity exercise performance leading to greater training adaptations. Studies show that after creatine loading, the performance of high-intensity performance and repetitive exercise such as team sports with varying lengths of recovery between exercise bouts generally increases by 10-20%.
It is generally known that CS in conjunction with resistance training is more effective in both increasing muscle strength and anaerobic power than resistance training alone. A study published in the Journal of Strength and Conditioning Research showed that a 5-day loading regimen of 4 doses of 5g of CS per day coupled with resistance training resulted in significant improvements in both average anaerobic power, measured by the 30-second Wingate test and back squat strength compared with just training alone. However, a 2-day supplementation did not provide similar performance gains. Rawson and Volek measured the average increase in weightlifting performance (maximal repetitions at a given percent of maximal strength) following CS plus resistance training as 14% greater than the average increase in weightlifting performance following placebo ingestion during resistance training.
Endurance performance:
Glycogen replenishment is important in endurance sports for optimal recovery and performance. Creatine supplementation with carbohydrate loading has been shown to enhance recovery by increasing carbohydrate and creatine storage in muscles. Nelson and colleagues showed that creatine and glycogen loading together prior to an exhausting exercise bout was better at restoring glycogen stores than carbohydrate loading alone. Research also indicates that CS can decrease inflammation and cell damage after intense exercise.
Recovery and injury prevention:
Creatine supplementation has been shown in studies either to have no effect or to decrease the incidence of musculoskeletal injuries, dehydration, and/or muscle cramping during training or racing. A study with NCAA Division IA football players reported that players who used creatine experienced significantly less incidence of muscle cramping, heat illness/dehydration, muscle tightness, muscle strains, and total injuries compared to athletes who did not supplement with creatine.
Performing in a hot climate:
If you’re training or preparing to race in hot weather, creatine could augment heat tolerance at peak performance. Creatine intake usually leads to some level of fluid retention, and because of this hyperhydration, it can lead to more efficient thermoregulation. A study where participants supplemented 20g of creatine/day for seven days found that CS increased the time to exhaustion when exercising in the heat (~86 F) and reduced cardiovascular responses to heat such as heart rate, rectal temperature, and sweat rate.
Muscle atrophy and sarcopenia:
Because of creatine’s ability to promote muscle mass and strength gains, it has also been studied during long immobilization and rehabilitation to see if it can decrease muscle atrophy. A study published in the Journal of Exercise Physiology found that participants who supplemented with creatine experienced greater changes in the cross-sectional area of muscle fiber (+10%) and peak strength (+25%) during the rehabilitation period. The participants had their right leg in a cast, and performed three knee extension rehabilitation sessions per week for 10 weeks. Other studies have found similar positive effects of creatine use suggesting that CS can lessen the amount of muscle atrophy and the detrimental effects on muscle associated with immobilization while promoting strength gains when recovering from injuries.
Sarcopenia is a loss of muscle mass that accelerates in mid-life and decreases the quality of life. The role of creatine supplementation in decreasing the loss of muscle is gaining interest as a topic of research. A recent study among older adults demonstrated that there is little benefit of creatine supplementation alone on muscle function or mass but that creatine may be an effective dietary strategy to combat age-related sarcopenia when used in conjunction with exercise.
Cognitive function:
Many sports require motor control, decision-making, coordination, reaction time, and other cognitive tasks as key aspects of performance. Creatine may have a positive impact on mental fatigue. Although the research on creatine and its benefits for cognitive function and brain health is relatively new, there is a potential for CS to improve cognitive processing, especially in conditions induced by acute stressors such as traumatic brain injury, sleep deprivation, and during more complex and demanding cognitive tasks.
Our take:
Creatine might be the most important supplement you’re not taking. If you’d like to improve your body composition, strength, and performance, creatine is a very effective and safe choice to make. Its efficacy is widely recorded and it has been deemed safe even in long-term use. The quickest method of increasing muscle creatine stores may be to consume ~0.3 g/kg/day of creatine monohydrate for 5–7 days followed by 3–5 g/day thereafter to maintain elevated stores.
Will this benefit you?
Besides the well-documented benefits for sports performance, there might be general health benefits of supplementing with creatine. A number of recent studies have looked into creatine supplementation and its benefits for various conditions from Parkinson’s disease to ischemic heart disease as well as cognitive function. A growing body of evidence shows that creatine supplementation might improve health status when people age by minimizing bone loss, reducing fat accumulation in the liver, and slowing tumor growth in some cancer, among other things. However, research into creatine’s health benefits outside sports performance are still limited and the optimal dosing strategy to induce positive response is unknown.
If you still want to try it, here’s what to keep an eye on:
The only downside of creatine use is that it can create gastrointestinal issues and weight gain due to water retention, especially in rapid loading protocols where people are taking large quantities of creatine to quickly saturate the muscles. When supplementing with lower doses e.g. ~5g/day, GI issues and bloating usually don’t occur. If you have questions or concerns about creatine supplements, please talk to your Dietitian or Doctor.
One emerging area of creatine supplementation lies in improved symptoms of post-COVID fatigue syndrome. Creatine may aid in the recovery of both acute and chronic health issues.
References and further reading:
Creatine, body composition and performance: https://pubmed.ncbi.nlm.nih.gov/12945830/
5-day and 2-day CS for anaerobic power and strength: https://www.researchgate.net/publication/24350709_Effects_of_Two_and_Five_Days_of_Creatine_Loading_on_Muscular_Strength_and_Anaerobic_Power_in_Trained_Athletes
Muscle strength and weightlifting performance after CS: https://pubmed.ncbi.nlm.nih.gov/14636102/
Glycogen and creatine loading for recovery: https://pubmed.ncbi.nlm.nih.gov/11445755/
CS, inflammatory markers, and muscle soreness: https://pubmed.ncbi.nlm.nih.gov/15306159/
Cramping and injury incidence in college football players: https://pubmed.ncbi.nlm.nih.gov/14608430/
Creatine and exercising in the heat: https://pubmed.ncbi.nlm.nih.gov/15467102/
CS in rehab and muscle atrophy: https://physoc.onlinelibrary.wiley.com/doi/10.1111/j.1469-7793.2001.0625c.xd
CS and sarcopenia in older adults: https://pubmed.ncbi.nlm.nih.gov/31652853/
Cognitive function and creatine with MTBers: https://www.researchgate.net/publication/344333473_Supplemental_creatine_monohydrate_loading_improves_cognitive_function_in_experienced_mountain_bikers
Creatine and brain health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916590/
Post-COVID fatigue syndrome
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