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Creatine monohydrate is possibly the most popular and researched backed ergogenic aid available. For this reason, there have been many attempts to develop new forms of creatine that offer greater effects than creatine monohydrate. However, to date, such attempts have proved relatively unsuccessful. As such creatine monohydrate remains the preferred form of creatine for supplementation to boost high-intensity performance capacity.

Creatine Basics

Creatine Intake & Synthesis

Meat eaters get roughly 1g per day of creatine from their diet, which is about the same amount that is synthesised in the body by the kidneys and liver1. It follows that vegetarians tend to have lower resting muscle creatine levels with the bulk of dietary creatine coming from meat consumption2.

Creatine Distribution

When it comes to the distribution within the human body, most creatine (i.e. ~95%) is found in skeletal muscle, with the remaining 5% distributed between the brain, liver, kidney and testes1.

Creatine Metabolism

In the body, creatine exists either in the free or phosphorylated form3. Together these pools typically comprise between 120g-140g of total creatine in an average 70kg young male3. The variation in total creatine levels occurs as a result of individual differences in muscle fibre type distribution and total muscle mass. Individuals with a higher proportion of type II fibres tend to harbour higher muscle pools of creatine3.

How Creatine Works

Creatine supplementation serves to increase the body’s pools of creatine and creatine phosphate, which in turn helps the individual to better replenish ATP levels during high-intensity exercise. This allows the individual to sustain a higher intensity of exercise for longer, which in turn provides a greater training stimulus. Recent research has also suggested that creatine monohydrate supplementation may help increase muscle mass and strength via other independent molecular means, which are beyond the scope of this article. For more information on how to get the most out of creatine supplementation, read our article, Creatine Facts.

Creatine Dose

The typical creatine supplement protocol consists of a loading phase of 20 to 25 g per day split into 4 or 5 daily intakes of 5 g each3. While this is considered the traditional protocol, some researchers have suggested a protocol that allowed for more regular, smaller dosing (i.e. 20 intake of 1 g every 30 min) may be more effective in saturating intramuscular creatine stores3. Whatever the case, each loading phase must be followed by a maintenance phase of 3-5 g per day to ensure muscles stay saturated3.

Creatine Uptake in Muscle

Even though creatine monohydrate is one of the most research-backed supplements, studies have identified a minor trend for some individuals to respond only very moderately to supplementation4. This is thought to be due to individual differences in the regulation of the body’s creatine transporter, which is the key factor governing uptake of creatine into muscle5.

Alternative Forms of Creatine

This has lead to the development of different forms of creatine aimed at improving creatine transporter function and/or capacity or totally bypassing it altogether. However, despite the theoretical promise of some of these forms, such as creatine ethyl ester, scientific evidence proving their efficacy has lagged considerably5. The only major studies to date, which have shown improvements in creatine uptake, are those involving co ingestion of creatine and protein/carbohydrate. Protein such as whey protein and carbohydrate both stimulate insulin release, which has been shown to improve creatine retention in muscle3. For more information on the different forms of creatine, please read our article, 'Best Creatine'.

Creatine Monohydrate Supplements

While there is no shortage of creatine supplements to choose from, it is possible to save a bit of money on your creatine supplement without compromising on efficacy. As highlighted above, the three crucial elements to an effective creatine supplement is creatine, carbs and protein (or insulin-inducing amino acids such as leucine). There are supplements which combine these key ingredients together, but for the most basic approach, one can simply buy plain creatine monohydrate and provide their own carbohydrates in the form of a banana or juice etc. A couple of nutrients worth mentioning are chromium picolinate and alpha-lipoic acid. Each of these has been shown to boost insulin function and therefore are good inclusion in a creatine supplement.

Summary

To sum up, there are a plethora of studies from all over the world conducted by independent researchers, which support the use of creatine monohydrate supplementation to boost intramuscular creatine pools and with that enhance anaerobic exercise capacity, and increase strength, power and muscle mass7. Because of the popularity and efficacy of creatine monohydrate, several novel forms of creatine have been developed in an attempt to improve of mimic’s the effects of creatine monohydrate. However, such forms have proved largely unsuccessful when compared with creatine monohydrate in formal studies. An individual’s response to creatine monohydrate supplementation will depend on their diet, muscle fibre type, total muscle mass and exercise regime. Creatine monohydrate supplementation is most beneficial for individuals engaged in weight/strength training and power sports as well as those involving episodic sprinting or high-intensity bursts3.

1. Persky A & Brazeau G. Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacol Rev. 2001;53:161–176.
2. Burke DG, et al. Effect of creatine supplementation and resistance-exercise training on muscle insulin-like growth factor in young adults. Int J SportNutr Exerc Metab. 2008;18:389–398.
3. Cooper R, et al. Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition. 2012;9:33.
4. Greenhaff P. The nutritional biochemistry of creatine. J Nutr Biochem. 1997;8:610-618.
5. Spillane M, et al. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. Journal of the International Society of Sports Nutrition. 2009;6:6.
6. Snow RJ & Murphy RM. Creatine and the creatine transporter. Mol Cell Biochem. 2001;224(1-2):169-181.
7. Jager R, et al. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011;40:1369–1383.

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