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Quick Creatine Summary Points

  • Creatine is a naturally occuring compound in the body, but is also one of the best, most validated supplements on the market
  • Creatine supplementation helps to boost energy, lean muscle mass and exercise performance
  • Creatine can also help benefit other health conditions such as muscle disorders and bone disorders to name a few
  • Many types of creatine supplements exist, but the most validated is creatine monohydrate
  • Creatine is better absorbed with carbohydrates and it should be taken away from caffeine
  • There is no need to cycle creatine and it can be taken long term with few negative side effects

Creatine - The Basics

If you’ve been working out for awhile or have been in the sporting industry for a long time, you would’ve most likely heard of creatine. Many of you would have probably also heard that it’s one of the best supplements around to be taking. But do you know why exactly it’s so good? Well, if you didn’t or you’re just hearing about creatine for the first time, then read on and find out why it’s a must have supplement if you’re going to take your training and health seriously.

What Is Creatine?

Creatine is a naturally occurring chemical compound in our body made up of three amino acids; L-arginine, glycine and L-methionine. It is normally found in skeletal muscle and acts as a substrate or fuel to provide a quick source of energy in the form of phosphocreatine.

More Creatine = More Energy

Ingesting more creatine through diet or through supplementation can potentially improve the ability of your body to produce energy by increasing phosphocreatine stores in the body. It is understood that an initial loading phase of 20g/day of creatine can lead to approximately a 20% increase in muscular concentrations of creatine with around 20% of that being in the form of phosphocreatine.1 However, there is a genetically defined upper limit to which our body and muscles can store creatine with the rest being excreted as waste. While everyone’s upper limits vary, the figure generally lies at around 1.5-1.7g/kg2 of bodyweight for body storage of creatine and 150-160mmol/kg dry mass1 for muscle storage of creatine. Therefore, after the initial loading phase, it isn’t strictly necessary to continue supplementing at high doses. In fact, after 1-2 weeks of Creatine Monohydrate loading, a small serving of 2-5g/day of creatine is enough to sustain the high levels in the blood.

Finding Creatine

A good proportion of our body’s creatine is made using the three amino acids mentioned previously in our liver, kidney and pancreas. The rest of our creatine comes from food sources. As creatine is mainly found in the muscle, it makes sense then that the majority of dietary creatine would come from meat sources, especially game meats such as venison, kangaroo or rabbit. It is also found in high concentrations in fish such as herring, salmon and tuna. As a result, vegetarians and vegans are often lacking in creatine levels, however this can easily be rectified through supplementation. This is also why vegetarians stand much more to gain from creatine supplementation, as they can raise their levels more significantly and therefore stand to see more noticeable changes than a person who consumes meat regularly.

Types of Creatine

Creatine supplements have been around for awhile now and over the years have evolved to take on several different formulations, each purporting to be better absorbed than their predecessor. Detailed below is a short summary of the main types of creatine available today11,12,13,14:

  • Creatine Monohydrate (CM) – By far the most common and well known type of protein on the market today. Creatine monohydrate is basically creatine attached to water. CM is generally 88% creatine with 12% water. That is, for every gram of creatine monohydrate powder taken, 880 mg is creatine. The majority of the studies showing the ergogenic benefits of creatine have used creatine monohydrate as the source.
  • Creatine Phosphate (CPh) – In order to use creatine as a fast form of energy, it needs to be bound onto phosphate, hence the appeal of selling creatine in phosphate form. However, no current studies have shown it to be superior to the monohydrate form. Creatine phosphate consists of 62.3% creatine and 37.7% phosphate.
  • Creatine Pyruvate (CPy) – Creatine pyruvate consists of 60% creatine and 40% pyruvate. This form of creatine was created as pyruvate has been shown help benefit fatigue. There has been at least one study showing increase bioavailability of creatine pyruvate, however, more studies are required before any further recommendations can be made.
  • Creatine Citrate (CC) – Creatine citrate was initially made popular due to its superior dissolvability and its ability to positively counter fatigue. Creatine citrate has been said to contain anywhere between 40-65% creatine. Again, no studies have shown it to be more effective than creatine monohydrate.
  • Creatine Esters (CE) – Creatine esters are creatine supplements in which the creatine has been attached to either a methanol or ethanol. Pharmaceutical companies often attach certain drugs to alcohols in order to increase bioavailability, especially for hydrophilic (water loving) substances such as creatine. A recent study compared creatine monohydrate to creatine ethyl ester and found that both resulted in similar improvements. Creatine ethyl ester is 82.4% creatine, while creatine methyl esters are usually 72.2%
  • Creatine Hydrochloride (HCl) – Creatine hydrochloride was recently created in 2009 and has been shown in an industry funded study to be more up to 59 times more soluble in water that creatine monohydrate.

Other types of creatine are available and continue to become available, however, these are the main ones.

Forms of Creatine

By far the most common form of creatine is in micronized form. The process of micronization reduces the compounds size, which helps to influence solubility or dissolvability. Creatine can also be sold as creatine candy bars, gum, as liquid form or as effervescent creatine. It may also be injected, however this form of creatine is much more expensive, not to mention invasive procedure and is usually not duplicated outside of clinical purposes. There is currently no evidence suggesting novel forms of creatine are better than the usual micronized powdered form.

What Can Creatine Do For You?

Creatine is perhaps seen by the sports science community as being one of the most effective ergogenic supplements due to years of research showing beneficial and reproducible effects. In terms of exercise performance, creatine supplementation and a general increase in creatine levels in the body can help by3:

1. Increasing pre-exercise phosphocreatine levels.
2. Promoting glycogen storage.
3. Increased resynthesis of phosphocreatine from creatine stores
4. Increased expression of anabolic growth factors
5. Improved buffering capacity due to the use of hydrogen ions in the phosphagen system.
6. Improved training volume as a result

In the simplest of terms increased creatine means more energy at a sustained rate with the ability to promote lean muscle mass and training gains and reduction of fatigue. In terms of resistance training4, studies have shown that creatine has been shown to improve strength and endurance and as such has been able to affect training volumes to an extent to induce positive muscular adaptations. Furthermore, creatine supplementation along with resistance training has also been shown to increase muscle fibre size moreso than resistance training alone.

Creatine & Sports

The use of creatine can also benefit those in sports4. For example, in cycling, creatine supplementation has been shown to be beneficial with multiple sprint performances of under 30 seconds in duration. Similarly running sprints performance has also been benefitted with creatine supplementation. While runners tended to gain mass with creatine, they were also able to make improvements in stride frequency and running speed. Results with swimming also coincide with that of cycling and running with improvements in sprints lasting under 30s. Still other swimming studies have been able to show a 1.8s decrease in two successive 100m sprints. While the positive results for creatine supplementation on sprint performance aren’t at high magnitudes, remember that the difference between first and second and even tenth only differ by mere millisecond to seconds.

Unfortunately, there hasn’t been too many studies looking at sports which involve a variety of movements and factors rather than a straight sprint action. While some studies have shown improvements in soccer dribbling test times, tests looking at tennis stroke, forehand or backhand velocity were deemed inconclusive. It is perceived by both coaches, athletes and experts that perhaps the use of creatine benefits best by supporting the athletes resistance training programs, and gains coming from that are used to support sports specific performance.

Creatine & Health

Aside from sports and exercise, creatine has also been used to benefit people living with a variety of health issues4 including muscle disorders, bone and cartilage disorders, brain disorders and even in the diabetic management or COPD.

Needless to say, a whole other article could be written examining the clinical applications of creatine supplementation on a variety of disease and disorders.

Creatine, Carbohydrates & Caffeine

When supplementing with creatine, consuming carbohydrates5 can improve the absorption of creatine into the muscle through the action of insulin. However, long term consumption of large quantities of quick absorbing carbohydrates can be detrimental to long term health, especially in terms of development of insulin resistance. Instead, current recommendations are to consume creatine with a mixture of carbohydrates and protein, as both macronutrients are able to exert an insulin response and may actually exert a greater response than carbohydrates alone6, while being less taxing due to the lower glucose load.

Taking creatine and caffeine has also been a contentious topic due to an earlier study showing that daily consumption of both creatine and caffeine actually resulted in no change in muscular strength7. Later studies have revealed that this is because chronic caffeine consumption actually decreases overall levels of creatine in the muscle8. However, one study was able to show that having one large dose of caffeine prior to exercise along with chronic creatine supplementation has been shown to improve performance, but only if one doesn’t consume caffeine on a regular basis9.

Cycling Creatine

While cycling some supplements such as those containing stimulants is necessary to ensure long term effectiveness of the supplement, cycling creatine isn’t considered a necessary practice, but may be an economically viable practice. As excess creatine is simply excreted out, there is no danger of toxicity. As mentioned previously, we do have an upper limit of creatine storage capacity so continual daily consumption of large amounts of creatine may not be offering additional benefits after 4-5 weeks.

Creatine Side Effects

There have been concerns raised in the past about the dangers of excessive creatine intake on the kidneys. However, research has since shown that unless pre-existing kidney issues exist, long term consumption of creatine is deemed safe. However, researchers recommend that frequent doses (4 x 5g) are perhaps better than one large dose (1 x 20g) in providing sustained high serum concentrations and a reduction in the chance of producing cytotoxic agents which may harm the kidneys over an extended period of time.10 Overall though, creatine is an extremely safe supplement to consume and studies of up to 6 months have shown no significant side effects. However, due to its strong water loving nature, some people may find that increased creatine doses may result in water retention resulting in other side effects such as bloating, muscle cramps, diarrhoea and high blood pressure. People with kidney or liver disease should also avoid supplementing with creatine as these are the major clearance pathways.

Creatine Dosing Recommendations

For best results, build up you initial creatine levels by consuming 20g/d for 5-10 days, before consuming a smaller dose of 2-5g to maintain these high  levels. The form and type of creatine you choose is entirely subjective and one should always pick supplements that provide the best results. However, it is important to understand that dosing recommendations and positive efficacy studies are based on creatine monohydrate. If you are choosing another form of creatine, always keep in mind that not all creatine are created equal.

Creatine - A Foundation Supplement

The sports supplement universe is continually evolving and at an extremely fast pace, faster than the studies showing its effectiveness. However, in this same universe, there are a range of supplements that have stood the test of time and are now considered foundation supplements for anyone new to supplementing. Creatine is one of those supplements. So if you are looking to gain an edge in the gym or on the sporting arena, the addition of creatine to your supplementation regime is by far one of the superior options and one of the smartest choices you can make if you’re interested in seeing results.

1 Greenhalff P (1995) ‘Creatine and its application as an ergogenic aid.’ Int J Sport Nutr 5:S100–S110
2  Williams MH, Branch JD (1998) Creatine supplementation and exercise performance: An update. J Am Coll Nutr 17:216-234.
3  Rawson E, Persky A (2007) Mechanisms of muscular adaptations to creatine. Int Sport Med J 8:43–53
4 Gualano B, Roschel H, Lancha-Jr AH, Brightbill CE, Rawson ES. ‘In sickness and in health: the widespread application of creatine supplementation.’ Amino Acids. 2011 Nov 19. [Epub ahead of print]
5 Green AL, Hultman E, Macdonald IA, Sewell DA, Greenhaff PL. ‘Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans.’ Am J Physiol. 1996 Nov;271(5 Pt 1):E821-6.
6 Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P. ‘Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load.’ Diabetes Care. 1984 Sep-Oct;7(5):465-70.
7 Vandenberghe K, Gillis N, Van Leemputte M, Van Hecke P, Vanstapel F, Hespel P. ‘Caffeine counteracts the ergogenic action of muscle creatine loading.’ J Appl Physiol. 1996 Feb;80(2):452-7.
8 Egawa T, Hamada T, Kameda N, Karaike K, Ma X, Masuda S, Iwanaka N, Hayashi T. ‘Caffeine acutely activates 5'adenosine monophosphate-activated protein kinase and increases insulin-independent glucose transport in rat skeletal muscles.’ Metabolism. 2009 Nov;58(11):1609-17. Epub 2009 Jul 15.
9 Doherty M, Smith PM, Davison RC, Hughes MG. ‘Caffeine is ergogenic after supplementation of oral creatine monohydrate.’ Med Sci Sports Exerc. 2002 Nov;34(11):1785-92.
10 Kim JH, Kim CK, Carpentier A, Poortmans JR (2011) Studies on the safety of creatine supplementation. Amino Acids 40:1409–1418
11 Jäger R, Harris RC, Purpura M, Francaux M. ‘Comparison of new forms of creatine in raising plasma creatine levels.’ J Int Soc Sports Nutr. 2007 Nov 12;4:17.
12 Spillane M, Schoch R, Cooke M, Harvey T, Greenwood M, Kreider R, Willoughby DS. ‘The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels.’ J Int Soc Sports Nutr. 2009 Feb 19;6:6.
13 Jäger R, Metzger J, Lautmann K, Shushakov V, Purpura M, Geiss KR, Maassen N. ‘The effects of creatine pyruvate and creatine citrate on performance during high intensity exercise.’ J Int Soc Sports Nutr. 2008 Feb 13;5:4.
14 Jäger R, Purpura M, Shao A, Inoue T, Kreider RB. ‘Analysis of the efficacy, safety, and regulatory status of novel forms of creatine.’ Amino Acids. 2011 May;40(5):1369-83. Epub 2011 Mar 22.

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