The Benefits of Creatine Supplementation

What is Creatine?

Creatine is a non-protein amino acid found in abundance in animal foods such as red meat and fish. A pound of either contains roughly 1 to 2 g of creatine. About 95% of bodily creatine is stored in skeletal muscle, roughly two-thirds of which is phosphocreatine and one-third of which is free creatine. Other creatine storage depots include energy-hungry organs such as the brain and testes.

Perhaps 1 to 2% of intramuscular creatine is degraded into creatinine each day, which is excreted in urine. Therefore, approximately 1 to 3 g of creatine needs replenishing daily to maintain basal levels. Some of this replacement is fulfilled by the liver and kidneys, which can use the amino acids arginine and glycine to synthesize creatine. A tiny minority of people has gene mutations that result in impaired creatine synthesis or transport. These unfortunate people experience severe neurodevelopmental problems beginning early in life and benefit from consuming more creatine in their diets.

Before supplementation, our intramuscular pools of creatine and phosphocreatine are usually at about 70% of their full capacities. The levels of these pools can be raised by increasing dietary creatine. As vegans and vegetarians omit many creatine-rich foods, they tend to have lower creatine pools than omnivores and hence tend to benefit more from creatine supplementation. At the other end of the spectrum, creatine ingestion doesn’t increase creatine stores in a small proportion of people. It follows that these individuals don’t seem to experience the benefits of creatine supplementation.

Creatine and Energy

To generate free energy to fuel metabolic reactions, our bodies mainly break down adenosine triphosphate (ATP) into adenosine diphosphate (ADP) and inorganic phosphate. This depletes cellular energy (ATP) stores.

Now, creatine combines with inorganic phosphate to form phosphocreatine in a reaction accelerated by an enzyme named creatine kinase. Most of us increase our phosphocreatine stores when we consume creatine. In turn, our fortified phosphocreatine stores can donate additional high-energy phosphate groups during very energy-demanding activities, more efficiently recycling ATP from ADP. This is the main way creatine supplementation improves high-intensity exercise performance.

In addition to directly supporting energy production, the creatine kinase/phosphocreatine system is also integral to shuttling energy between mitochondria and other sites in cells in need of energy. In this way creatine also helps protect against excessive oxidative stress within mitochondria. (Check out this episode of humanOS Radio for more on why this is important!)

Now that you know some of the primary roles of creatine in cells, what are some benefits of creatine supplementation?

Benefits of Creatine Supplementation: Acute Exercise Performance

Perhaps the clearest of all the benefits of creatine supplementation is improved performance during strength and power exercises requiring repeated efforts. (Think multiple sets of heavy squats or repeated 30-second cycling sprints.) The magnitude of these improvements can be as large as 10 to 20% and generally tracks changes in intramuscular creatine stores after supplementation – greater increases in muscle creatine associate with larger performance gains.

I don’t know about you, but I find that very impressive.

Benefits of Creatine Supplementation: Post-Exercise Recovery and Injury Prevention

Creatine also speeds recovery from exercise, enhancing adaptations such as strength and skeletal muscle hypertrophy. This has repeatedly been shown in teenagers, young adults, and the elderly alike. Accelerated recovery not only results from enhanced ATP restoration, for creatine also bolsters repletion of muscle carbohydrate stores, which may be related to protection against exercise-induced muscle damage. Such effects are especially germane to people undergoing short-term periods in which exercise training loads are substantially increased (“overreaching”).

We don’t know as much about the long-term consequences of creatine supplementation. However, creatine use has been associated with reduced risk of injuries like muscle strains. Interestingly, there is also some weak evidence that creatine may protect against dehydration, muscle cramps, and thermoregulatory issues. It’s plausible that this is because creatine affects osmosis, drawing water into muscle tissue. This might be one way by which creatine boosts endurance exercise performance in the heat.

Benefits of Creatine Supplementation: Clinical Uses

I’m not going to focus on why many people with clinical conditions also experience benefits of creatine supplementation. However, I’ll briefly touch on some pathologies to point those of you who are interested in this to other resources on these topics. For brevity, I’ll only focus on studies of humans.

An obvious use case is injury rehabilitation. Creatine has sometimes (not always) been shown to improve responses to rehabilitation protocols. Related to this, a very rigorous review of all studies that explored effects of creatine in treating skeletal muscle disorders unambiguously showed that creatine improves muscle strength and quality of life in muscular dystrophy patients.

If you reflect on the effects of creatine supplementation within cells, you can probably come up with numerous conditions in which creatine may help people prevent or overcome morbidity. Sometimes, for example, energy supply to tissues is temporarily compromised, as in the case of impaired blood flow to the brain (cerebrovascular disease) or heart (myocardial ischemia). Sure enough, there’s preliminary evidence that creatine may help in these pathologies.

Aging (senescence, specifically) is characterized by deterioration in many biological processes, including energy supply and regulation of oxidative stress. Therefore, there are good reasons to believe that creatine may improve numerous variables that often worsen with age, including physical function and quality of life in people with osteoarthritis, blood lipids, blood sugar regulation in type 2 diabetes, and cognition. Speaking of which…

Benefits of Creatine Supplementation: Cognition

I’ve previously written about Bacopa Monnieri and cocoa, two nootropics with strong studies showing their benefits in humans. Well, creatine is up there too. (In case you’re interested in specifics, on days each week when I need to be especially sharp I consume 350 mg Bacopa Monnieri, 75 g cocoa, and 5 g creatine monohydrate. It’s my favorite combination to date.)

Some people might not think of creatine as a nootropic, but it certainly is one. Creatine supplementation increases energy stores in the brain, typically raising brain creatine content by 5 to 15%. This may be one way by which creatine delays mental fatigue and enhances working memory (that limited, short-term capacity that you use to memorize things like new numerical sequences). Creatine has even been shown to boost a measure of overall intelligence. One study that I find particularly interesting reported that creatine supplementation offsets the adverse effects of sleep deprivation on balance, mood, and reaction time.

One point to note here is that it takes a while for creatine to accumulate in the brain. Interestingly, it appears that creatine precursors like guanidinoacetic acid may help expedite increases in brain creatine stores.

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Side-Effects and Safety of Creatine Supplementation

The most common side-effect of creatine supplementation is a small increase in lean body mass. Needless to say, this is almost always a good thing!

As I discussed in a previous article, a recent preclinical study highlighted that creatine may influence sleep homeostasis, suggesting there may be something to the common anecdote that creatine disturbs sleep. I too believe that creatine disrupts my sleep. But I don’t think this results in any adverse consequences.

In general, chronic creatine supplementation seems to be safe, although I think people with renal dysfunction should err on the side of caution and not take it.

To my knowledge, there’s no evidence that supplementing creatine suppresses creatine stores once people stop taking it. This implies that very-long-term creatine supplementation should be safe. However, I’d rather be safe than sorry and personally use creatine intermittently, typically only during particularly strenuous exercise training cycles.

Recommendations

Creatine Source and Dose

Use regular creatine monohydrate. Go for batch-tested stuff with the label Creapure®. This brand is a good option. Don’t bother with other forms like citrate, ethyl ester, or nitrate. And avoid prepared drinks with creatine as an ingredient: When creatine remains in solution it soon degrades to creatinine, especially at higher temperatures and lower pH values.

For recreationally active people, 3 g of creatine monohydrate per day is about right. Hard-training and larger athletes may benefit from doses as high as 10 g each day, and higher doses might also be necessary to saturate brain creatine stores.

Some people recommend first “loading” creatine (typically consuming 5 g 4 times a day for 5 to 7 days). This isn’t necessary though, for muscle stores will be saturated regardless after a few weeks. Remember that you can also use creatine as an alternative to things like caffeine to acutely to ward off some of the negative consequences of sleep loss.

Last, the optimal daily creatine dose in some clinical populations may be as high as 30 g.

When and With What to Take Creatine

One study reported that taking creatine post-exercise may improve strength and body composition adaptations to resistance training, but this finding needs replicating. Just make sure you take it consistently – don’t sweat the small stuff!

Consuming carbohydrate and/or protein at the same time will increase creatine uptake. Creatine isn’t very soluble but mixing it with a warm drink will improve dissolution. Alternatively, do what I do and simply swallow the powder, chasing it with water.

Once filled, creatine stores will remain elevated for 4 to 6 weeks after discontinuing supplementation.

Conclusions

Creatine rocks. It’s that simple.

Seriously, if you’re after a low-cost, high-value way to improve your health and performance, supplementing with creatine is a smart start. There could be a lot to gain, and there’s surely very little to lose.

Predictably, more studies have been done on creatine use among men than women, but both sexes seem to respond well to supplementation. One reason that I mention this is that a much smaller proportion of females use it than males. Ladies, don’t miss out!

Also, there’s no strong rationale to be wary about young people using creatine: Multiple studies have shown that kids benefit from creatine supplementation too.

Finally, even though it’s been around for a long time, we have much to learn about creatine. I suspect we’ll continue to identify more uses for this supplement, both in humans and in agriculture. (Might creatine be an advantageous addition to animal feed, for example?)

Key Takeaways

We all consume creatine in many foods. Supplementing with it is perfectly safe.

Creatine supplementation generally raises cellular energy status.

Creatine supplementation consistently improves physical performance and body composition adaptations to exercise in people of all ages.

Creatine supplementation seems to benefit cognition. Creatine may also have therapeutic value in numerous clinical conditions.

Supplementing with 3 g of creatine monohydrate with food each day is an effective strategy for most people.

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