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Creatine is generally considered to be one of the oldest, best studied, and most effective bodybuilding supplements on the market. However, when it comes to sports supplements, there is a lot of choice out there, and it is difficult to know what will benefit your style of training and nutrition.

Creatine is a nitrogenous substance naturally found in the body, made up of amino acids. It is stored, mainly in the skeletal muscles, in a form known as phosphocreatine.

Creatine is used by athletes to increase power during short term, high energy activities like sprints or lifts, and to increase muscle mass.

Creatine Studies

Creatine has been known and studied since the early 1900s, but only shot to prominence as a sports supplement after the 1992 Olympic Games, after it was revealed that many successful competitors were using creatine to enhance their performance. A great deal of research has been conducted into creatine, the mode of action is well known, and there is a solid base of evidence showing its effectiveness.

Creatine has been deemed the most effective ergogenic supplement for the improvement of high impact exercise capacity and lean body mass by the International Society of Sports Nutrition (1).

There are a huge number of studies showing how creatine can improve athletic performance. Research has shown that creatine is well absorbed into the muscles, via the digestive system, where it increases the reservoir of phosphate ions, which are then used to replenish the energy molecule, ATP. This means that the cells have more energy, and can regenrate more quickly after high intensity exercise.

By this mechanism of action, creatine has been scientifically proven to increase maximum power and strength in the majority of people (2,3).

Creatine has been studied, albeit less rigorously, for other mechanisms of action and effects. It can promote muscle hypertrophy by stimulating cells called satellite cells to repair muscle fibres (4,5)

It can cause water retention in the muscles, which give the appearance of greater muscle size. The swelling of the cells can stimulate muscle cell growth via the stress response (6). This mechanism also results in enhanced glycogen storage (7). There is research showing that creatine is able to decrease catabolic (or muscle wasting) substances in the body (8), and that supplementation increases the levels of anabolic hormones, including testosterone and IGF-1, in the body (9,10). Creatine has also been shown to enhance cognitive function (11), particularly in vegetarians and people who would not otherwise be consuming creatine in their diet (12)

In addition to a role as a performance enhancing, muscle building, and nootropic sports supplement, creatine is also being researched for a potential role in treating conditions like muscular dystrophy, traumatic brain injury, metabolic disorders, age related muscle degeneration, and some conditions with a neurological basis.

Is Creatine Safe?

Much of the extensive amount of research that has performed on creatine has been devoted to establishing its safety. A large meta analysis of available research on the subject concluded that creatine supplementation had no detrimental effects on the kidneys, liver, heart or muscles (13). A second meta-analysis made the finding that daily doses of 5-20g of creatine can be taken in the long term without significant adverse effects (14), and the European Food Safety Authority have declared doses of up to 3g per day to be risk free (15).

It is however recommended that people with underlying liver or kidney disease consult a medical practitioner before embarking on a supplementation regime, and to be aware that some people may experience an allergic reaction to creatine. The most common side effect of creatine supplementation is an upset stomach, which can be avoided by consuming sufficient water with the dose (16).

Creatine for Persons under 18

There have been no studies into creatine use for sports performance in under 18s. It is not generally recommended that children use sports supplements, but given its safety, there is no reason somebody under the age of 18 could not use creatine under parental supervision.

Creatine vs Whey

Creatine and whey are probably the two most popular supplements out there. While creatine enhances power during high intensity exercise, creating the conditions to build lean body mass, whey is the supplement that provides the protein building blocks to physically build muscle. Creatine and whey are a great combination because they work in different ways. Creatine supplementation is much more effective when muscle building proteins are in abundance, and many people using whey to bulk up see better results when they add creatine to their regime.

Creatine vs Pre Workouts

Pre workouts are dessigned to provide the body with nutrients that are best used during training. Creatine falls into this category, and many pre-workouts contain creatine along with other supplements.

The convenience of getting your daily dose of creatine along with other ingredients that will push you through your workout is a big pro of pre workouts over pure creatine, however there are a few important cons. Creatine may be underdosed in pre-workouts, requiring additional supplementation anyway. The stimulants that are contained in many pre-workouts can interfere with creatine absorption, and many people prefer their creatine after a workout. Ultimately, pre-workouts and creatine are different, and many people choose to use both instead of choosing one or the other.

Creatine vs Glutamine

Creatine and Glutamine are both very important in the body, and very effective at building muscle, but they work in different ways. Whilst creatine is engaged in supplying energy to the muscles during exertion, glutamine moves nitrogen around the body. Glutamine is depleted in large amounts during exercise, and if not replenished, this loss will result in muscle breakdown to maintain sufficient levels for necessary tasks. Having less creatine in the muscles means that ATP, the cell's energy source, is regenerated more slowly, which means less power. These two molecules have different modes of action, and both are very effective in maximising muscle gains, so many athletes choose to supplement with both.

Creatine vs BCAA

BCAAs are essential amino acids. They are necessary to build protein, including muscle, and they have a role in stimulating the body to lay down lean mass. Creatine increases muscle mass by increasing power and exercise volume. BCAAs and creatine are a great combination, because they work to build muscle in different ways. Similarly to whey, BCAAs provide the physical building blocks to lay down new muscle fibres in response to the ergogenic effects of creatine. Supplementing with both BCAAs and creatine is common, and they often sit side by side in pre-workout formulations.

(1) Buford TW, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr. (2007)
(2) Hespel P, Derave W. Ergogenic effects of creatine in sports and rehabilitation. Subcell Biochem. 2007;46:245-59.
(3) Bird, Stephen. "CREATINE SUPPLEMENTATION AND EXERCISE PERFORMANCE: A BRIEF REVIEW". www.jssm.org.
(4) Hespel, P; Eijnde, BO; Derave, W; Richter, EA (2001). "Creatine supplementation: Exploring the role of the creatine kinase/phosphocreatine system in human muscle". Canadian journal of applied physiology = Revue canadienne de physiologie appliquee. 26 Suppl: S79–102
(5) Olsen, S.; Aagaard, P; Kadi, F; Tufekovic, G; Verney, J; Olesen, JL; Suetta, C; Kjaer, M (2006)."Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training". The Journal of Physiology 573 (2): 525–34.
(6) Niisato N, et al. Cell swelling activates stress-activated protein kinases, p38 MAP kinase and JNK, in renal epithelial A6 cells. Biochem Biophys Res Commun. (1999)
(7)S Y Low, M J Rennie, P M Taylor. Modulation of glycogen synthesis in rat skeletal muscle by changes in cell volume. J Physiol. 1996 September 1; 495(Pt 2): 299–303.
(8)Saremi, A.; Gharakhanloo, R.; Sharghi, S.; Gharaati, M.R.; Larijani, B.; Omidfar, K. (2010). "Effects of oral creatine and resistance training on serum myostatin and GASP-1". Molecular and Cellular Endocrinology317 (1–2): 25–30.
(9) Burke, DG; Candow, DG; Chilibeck, PD; MacNeil, LG; Roy, BD; Tarnopolsky, MA; Ziegenfuss, T (2008). "Effect of creatine supplementation and resistance-exercise training on muscle insulin-like growth factor in young adults". International journal of sport nutrition and exercise metabolism 18 (4): 389–98.
(10) Hoffman J, Ratamess N, Kang J, Mangine G, Faigenbaum A, Stout J. Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes. Int J Sport Nutr Exerc Metab. 2006
(11) Rae, C.; Digney, A. L.; McEwan, S. R.; Bates, T. C. (2003). "Oral creatine monohydrate supplementation improves brain performance: A double-blind, placebo-controlled, cross-over trial". Proceedings of the Royal Society B: Biological Sciences 270 (1529): 2147–50.
(12)Benton, D.; Donohoe, R. (2011). "The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores.". Br J Nutr. 105: 1100–1105.
(13) Persky, A. M.; Rawson, E. S. (2007). "Safety of creatine supplementation". Sub-cellular biochemistry. Subcellular Biochemistry 46: 275–289.
(14)Bizzarini E, De Angelis L (December 2004). "Is the use of oral creatine supplementation safe?". The Journal of Sports Medicine and Physical Fitness 44 (4): 411–6
(15) Opinion of the Scientific Panel on food additives, flavourings, processing aids and materials in contact with food (AFC) on a request from the Commission related to creatine monohydrate for use in foods for particular nutritional uses. EFSA 26th April 2004. http://www.efsa.europa.eu/de/efsajournal/pub/36.htm Accessed 7-1-2014
(16) "Creatine: Safety". MayoClinic.com. Accessed 7-1-2014

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