Introduction
With an ever-increasing array of supplements and supplement companies to choose from, it’s not surprising that many people find it difficult to know what supplements (if any) they should take, and if indeed they will provide the ergogenic effect the manufacturer’s claim. For those that are serious about their training, the use of certain supplements promising improvements in performance and/or recovery is undeniably enticing. After all, if you are someone who has been consistently training well and eating a healthy balanced diet for years, then the additional benefit supplements may offer is an appealing prospect. The reality however, is that when we look at most supplements that promote an ergogenic benefit, very often these claims are over-hyped at best and at worst, just don’t seem to do what they say on the tin!
One such supplement that has a long history of being the real deal is creatine. Creatine was discovered in 1832 by Michel Eugène Chevreul, but it wasn’t until the influential biopsy work by Harris et al. (1992) that research began to look at the relationship between oral creatine supplementation and exercise performance.
This article will take a deeper dive into creatine supplementation and answer the following questions:
- What is creatine and how does it work?
- What are its ergogenic effects and who would supplementation most benefit?
- What is the best type of creatine to take and how much should I take?
- Is creatine safe and are there any side effects?
What is creatine and how does it work?
Creatine is a naturally occurring compound, of which 95% is found in skeletal muscle. There is a maximum amount of creatine that can be stored in the muscle tissue before it reaches a point of saturation, and baseline levels can vary considerably from individual to individual depending upon the degree to which creatine is consumed within the diet as well as other factors such as age and activity levels. Foods naturally high in creatine include red meat, poultry, pork, fish/seafood, dairy and eggs. Due to the natural sources of creatine containing foods, it is important to acknowledge that vegans and vegetarians may have lower levels of creatine stored within the muscle tissue compared to those consuming an omnivorous diet. This does not necessarily mean that vegans and vegetarians are deficient in creatine but for reasons we will touch on later in this article, they are certainly a specific population that could be particularly responsive to creatine supplementation.
Creatine plays a fundamental role in muscle contraction. Creatine is mostly metabolised within the tissues to phosphocreatine (PC), where it plays a key role in the maintenance and recycling of Adenosine triphosphate (ATP), which is probably best defined as the energy currency of all our cells. Activities that depend on short explosive bursts of power (10-15 seconds) and/or high intensity of effort like weightlifting, sprinting, throwing, jumping are primarily reliant on the ATP-PC energy system for muscle contraction. Once you have depleted your stores of ATP the muscle becomes fatigued and power output starts to decline. Now you have a basic understanding of the importance of phosphocreatine in muscle contraction, it becomes easier to appreciate how and why creatine supplementation would and could be advantageous in certain circumstance. After all, the more phosphocreatine you can store within your muscles, the greater your ability to endure intense periods of muscle contraction. This has potential to influence performance via increased output and fatigue resistance. The next section will take a closer look at the specific ergogenic effects of creatine and explore the types of people most likely to benefit from creatine supplementation.
What are the ergogenic effects of creatine and who would supplementation most benefit?
With hundreds of published articles spanning well over 25 years, creatine is one of the most popular and researched supplements out there. Due to the large body of evidence surrounding creatine, it is also one of the few supplements where we can confidently say we know with a large degree of accuracy how it behaves and how people respond when taking it. We know repeated bouts of high-intensity exercise, typically lasting less than 30 seconds, are positively influenced with creatine supplementation (Branch, 2003). Furthermore, the beneficial effects of creatine supplementation would appear to diminish in exercise modalities spanning greater than 30 seconds and of lower intensity, raising the question as to whether individuals primarily engaged in aerobic exercise and sports would gain and additional advantage with creatine supplementation. In contrast, an excellent narrative review by Rawson and Volex, (2003) and meta-analysis by Lanher’s et al. (2017) repeatedly found that supplementation with creatine monohydrate when combined with resistance training consistently improved muscular strength, total lifting volume, muscular endurance via increased total number of reps at a given load, and increases in lean body mass. It could be hypothesised that improvements in these metrics may have a broader carry over into certain sports and their associated performance characteristics. For example, Suchomel et al. (2016) identified that greater muscular strength is strongly associated with improved force-time characteristics that contribute to an athlete’s overall performance. Potential mechanisms for improved exercise performance and exercise adaptation following creatine monohydrate supplementation and resistance training are many and include:
- Increased muscle creatine availability post exercise
- Increased phosphorylcreatine resynthesis during a workout
- Increased glycogen availability before training
- Increased glycogen resynthesis following training
- Increased growth factor and gene expression
- Increased satellite cell number and activity
- Decreased post exercise inflammation
- Decreased post exercise muscle damage
It is possible that these adaptations are in response to the increase in intracellular water following supplementation with creatine (Deminice et al. 2016).
Now that you are more familiar with the modes of exercise that would most benefit from creatine supplementation, and those that do not, as well as the specific adaptations and responses you should expect from long term supplementation, the next question is what type of creatine is the best and what is the optimal dose-response?
What is the best type of creatine to take and how much should I take?
With its effectiveness well established, creatine and its many derivatives are plentiful across all major supplement suppliers. The big question is, with so many different forms available, all promising the latest, most effective delivery system for maximum uptake and performance benefit, which one should you choose? The answer is much simpler than you may think. Currently there is no evidence to suggest any alternative form of creatine is any more effective than creatine monohydrate. Creatine monohydrate is the form that has been most studied, and as such we know it has an excellent efficacy and safety profile as well as being the cheapest (Fabio et al. 2021).
With regards to how best to take creatine monohydrate, the literature has proposed either a short-term or long-term protocol, both of which are effective in saturating muscle tissue creatine levels. The short-term protocol requires a high dose loading phase (20g/day for 5-7 days) followed by a maintenance dose of 3-5g/day. The long-term protocol involves a lower daily dose of 3-5g/day, whereby muscle saturation will take approximately 30 days. Snow and Murphy (2003) identified that creatine assimilation could be further enhanced by taking creatine with a carbohydrate source (preferably one with a high glycaemic index), a combination of carbohydrate and protein as well as taking creatine post exercise, due to creatine uptake being insulin-mediated. The research would also indicate that individuals with lower baseline levels of creatine see the greatest magnitude of increase following supplementation and potentially may experience bigger performance benefits when compared to individuals with higher baseline levels of creatine within the muscle tissue (Harris et al. 1992). This is why our diet and the foods we consume play an important role in determining the concentrations of creatine within the body. On average the body produces 1-2g of creatine a day and approximately the same amount is obtained via a typical omnivorous diet. As mentioned earlier in this article, individuals following a vegan or vegetarian diet may have significantly lower levels of creatine and therefore vegans and vegetarians (especially those engaged in regular resistance training) should consider creatine supplementation in order to enhance performance and recovery from training.
Is creatine safe and are there any side effects?
This last section will cover the safety and potential side effects of creatine. With over 25 years of research behind it, the safety of creatine has been extensively investigated and so long as dosages do not exceed those outlined in this article, creatine would appear to have an excellent safety profile. Side effects would also appear to be minimal, with some individuals occasionally reporting some gastrointestinal distress following high ingestion of supplemental creatine during a high dose loading phase protocol (as previously outlined earlier in the article).
Finally, whilst not perceived by most to be a negative side effect, some individuals may report an increase in body mass following creatine supplementation. This is an important consideration for individuals who participate in weight controlled sports, particularly if that individual is at the higher end of their weight category cut off point.
Practical applications:
- Creatine is an extensively studied dietary supplement that is not only cheap, but has an excellent efficacy and safety profile.
- Creatine has ergogenic effects once levels within the muscle tissue become saturated.
- The literature consistently finds performance-enhancing properties with regards to resistance training and intermittent high intensity activities.
- Optimal dosing strategies are: 20g/day for 5-7 days, followed by a maintenance dose of 3-5g/day, or a continuous 3-5g/day, whereby muscle saturation will take approximately 30 days.
- Creatine uptake can be further enhanced by consuming the dose either with carbohydrates, carbohydrates and protein and/or post-exercise.
- Creatine monohydrate would appear to be the most effective, safest and cost-effective form of creatine.
- Some individuals may experience increases in body mass and potentially gastrointestinal symptoms with higher dosages, so experimentation is advised in order to identify the best individual dose-response.
- Overall, creatine would seem to benefit athletes or recreationally trained individuals who seek to enhance performance and recovery, specifically muscular strength and size and explosive high intensity activities lasting less than 30 sessions.
References:
Branch, J.D. (2003). Effect of creatine supplementation on body composition and performance: ameta-analysis. Int. J. Sport Nutr. Exerc. Metab.13:198-226.
Deminice, R., F.T. Rosa, K. Pfrimer, E. Ferrioli, A.A. Jordao, and E. Freitas (2016). Creatine supplementation increases total body water in soccer players: a deuterium oxide dilution study. Int. J. Sports Med.37:149-153.
Fazio C, Elder CL, Harris MM. Efficacy of Alternative Forms of Creatine Supplementation on Improving Performance and Body Composition in Healthy Subjects: A Systematic Review. The Journal of Strength & Conditioning Research. 2021 Feb 11.
Harris, R.C., K. Söderlund, and E. Hultman (1992). Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin. Sci. 83:367-374.
Lanhers, C., B. Pereira, G. Naughton, M. Trousselard, F.X. Lesage, and F. Dutheil (2017). Creatine supplementation and upper limb strength performance: a systematic review and meta-analysis. Sports Med.47:163-173.
Rawson, E.S., and J.S. Volek (2003). Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J. Strength Cond. Res.17:822-831.
Snow, R.J., and R.M. Murphy (2003). Factors influencing creatine loading into human skeletal muscle. Exerc. Sport Sci. Rev.31:154-158.
Suchomel, T.J., S, Nimphius, and M.H., Stone (2016). The importance of muscular strength in athletic performance. J. Sports Med.46:1419–1449.