Tuesday, May 13, 2014

Creatine: Why The Confusion?

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On just about a weekly basis I get questions about creatine, and it's usually along the lines of asking if it's safe to take or how they heard it's illegal, or if they take it won't they tear their muscles?

It's amazing this exists because creatine is arguably the most studied and well-researched supplement of all-time, and study after study shows how remarkably safe and effective creatine is.

It's dumbfounding, why to this day, it carries negative myths that just refuse to die. NO STUDY has shown any adverse side effects other than weight gain (hey that's why most people take it) and stomach cramping if taken in too large of doses.

It's often made out to be like some kind of steroid-like supplement only found on the black market. But creatine is actually a natural substance in the body and is very important in the creatine-phosphate (CP) energy system, which is our fast/short-term energy system that rapidly produces ATP.

Let's repeat that again, CREATINE IS A NATURAL SUBSTANCE in your body and it is VITAL for creating immediate energy.

But for those who still think it's bad, well you better not eat beef, or chicken, or eggs, or salmon because creatine is naturally in all those foods.

(Photo Credit - telegraph.co.uk)

It bears repeating that Creatine's main action in the body is storing high-energy phosphate groups to be used to create ATP - (ATP is the energy source used to fuel our body and without ATP we would cease to exist)

When you perform any kind of activity, but especially high intensity exercises like sprinting, lifting, jumping, your body produces ATP by transferring a phosphate, from creatine-phosphate, to ADP to create ATP. So the more creatine you have available, the more potential for creating energy you have in your tissues and the longer you can sustain intense activities.

Let's discuss some interesting tidbits that research has uncovered about creatine
  • 95 percent of creatine in the body is held in muscle. The heart, brain, and testes hold the remaining 5 percent (Terrilion, K. 1997) 
  • Improved muscular endurance (Willoughby, et al, 2001; Balsom P, et al, 1995; Englehart et ak, 1998; ) 
  • Increased anaerobic power and performance (Countless Studies) 
  • Increased hydration in hot conditions (Chwalbinska-Moneta J, 2003) 
  • May Be An Effective Anti-Inflammatory Following Exercise (Vandenberghe K, et al, 1997) 
  • May Improve Cognitive Function (Rae C, et al, 2003; Bentonand D, Donohoe R (2011) 
  • Improves Adolescent Athletic Performance (Murphy AJ, Watsford ML, Coutts AJ, Richards DA, 2005) 

Anaerobic Power and Performance

This is the main reason most people take creatine and for good reason. There is tons of research showing the benefits of creatine combined with strength, power, and speed type of training. Volek et al (1999) stated "Creatine supplementation enhanced fat-free mass, physical performance, and muscle morphology in response with resistance training."

This is just an example of how creatine may benefit anaerobic athletes and here are some other benefits shown by research
  • Improved Maximal Strength (Izquierdo et al, 2002; Pearson et al, 1999) 
  • Improved Power (Chwalbinska-Moneta et al, 2003; Balsom et al, 1993; Greenhaff et al, 1993; Pearson et al, 1999) 
  • Increase in Muscle Mass (Willoughby et al, 2001; Balsom et al, 1995; Vandenberghe et al, 1997; Sim et al, 1998; Volek et al, 1999) 
  • Increase in Repeat Sprint Ability ((Izquierdo et al, 2002; Dawson et al, 1995) 


Creatine isn't often thought of as a supplement for endurance athletes, but it does have some efficacy in improving these types of activities. In fact, Engelhardt et al 1998 conclude, "We conclude that creatine supplementation at doses of 6 g daily has positive effects on short-term exercise included into aerobic endurance exercise."  These researchers actually noted that the cardiovascular system, oxygen uptake, and blood lactate concentration were not affected by creatine, but interval power performance was significantly increased.

The mechanisms for improved endurance may be byproducts of the anaerobic improvements.  Despite most endurance events requiring very little anaerobic output, there are still benefits to be gained by improving anaerobic power as seen by the importance of intermediate and finishing spurts, which fall under anaerobic conditions.

Creatine can help endurance athletes with their intermittent aerobic power, strength, and economy which will all lead to improved endurance performance.  So while it may not directly improve aerobic markers, it affects total endurance through different mechanisms, mechanisms that many endurance athletes don't ever think about enhancing.   


One of the biggest concerns regarding creatine intake is muscle cramping and having to drink boat loads of water. Every time I recommend creatine, I usually get "Won't I have to drink a ton of water?" First off, drinking a lot of water isn't a bad thing so I don't see it as a negative; most people could stand to drink water. Secondly, no you really don't have to do anything special in terms of hydration, but it's always a good idea to drink plenty of fluids with or without creatine supplementation.

Check out this study by Mike Greenwood et al (2003). (Check out all of Greenwood's work, he's done a lot of great research on creatine)

“During one season of NCAA Division IA football training and competition, it was discovered that creatine users had significantly less cramping; heat illness or dehydration; muscle tightness; muscle strains; and total injuries than nonusers. Thus, even for athletes who are well-trained, it is clear that regular creatine consumption does not cause harm, and in fact may have a protective effect against certain exercise- related maladies.”

Look at the chart below. Creatine users had lower incident of injury, dehydration, illness, muscle strains, and missed practices.

Creatine increases intracellular hydration which is a positive outcome for protein synthesis and cellular integrity. Here's a quote from some people much smarter than me, Dr. Schliess and Dr. Häussinger, “Alterations in cellular hydration not only contribute to metabolic regulation, but also critically determine the cellular response to different kinds of stress. Whereas cell swelling triggers anabolic pathways and protects cells from heat and oxidative challenge, cellular dehydration contributes to insulin resistance and catabolism and increases the cellular susceptibility to stress induced damage.”


Creatine may have the ability to reduce inflammation after strenuous exercise. One study looked at inflammation markers and soreness after a 18.75 mile race (Life Science, 2004)

Specifically the researchers looked at the effect of creatine supplementation on inflammatory and muscle soreness markers such as...
  • Creatine Kinase (CK) 
  • Lactate Dehydrogenase (LDH) 
  • Prostaglandin E2 (PGE2) 
  • Tumor Necrosis Factor-Alpha (TNF-alpha) 
Runners were supplemented for 5 days prior to the race with 20g of creatine per day (loading). Pre-race blood samples were collected before running, immediately after the race, and 24 hours after the race.

The creatine group showed lower markers of cellular damage, soreness, and inflammation. In fact, they showed much lower levels of CK, PGE2, TNF-Alpha, and LDH, all of these are markers of inflammation and damage due to exercise.

Creatine Group                                                                                 Control Group
CK - 19% Increase                                                                              CK - Over 4-fold Increase
PGE2 - 70% Increase                                                                          PGE2 - Over 6-fold Increase
TNF-Alpha - 34% Increase                                                                 TNF-Alpha - 100% Increase
LDH - No difference                                                                           LDH - 43% Increase

The researchers concluded this, “These results indicate that creatine supplementation reduced cell damage and inflammation after an exhaustive intense race." This is reason for creatine supplementation for athletes under strenuous training conditions or in-season when the physical demands are high.

The other aspect of hydration that many talk about is it's effect on kidney function.  Many claim creatine supplementation puts added stress upon the kidneys, but this lacks any foundation.  There is no evidence that creatine in the short-term or long-term has detrimental effects on the kidney and this has been shown in studies lasting as long as 5-years.


I heard Brandon Marcello. Director of Sports Performance at Stanford, speak at a conference earlier this year and he spoke about training females.  He got into nutrition a little bit, and touched upon the benefits of creatine, not only for performance but for the brain.  He noted that one of the first things he started giving his young daughter was creatine, for the brain health benefits it provides.  I'd never heard of this, so I looked into it further and lone behold their are some strong benefits to this.

A study done way back in 2003 looked at the supplementation of creatine on brain performance (Rae, et al 2003).  What they found was that 6-weeks of 5g per day of creatine supplementation greatly improved brain function.  Here's a quote from the study,

"The results found agree with previous observations showing that brain creatine levels correlate with improved recognition memory and reduce mental fatigue.”

As Marcello pointed out in his presentation, research in creatine protecting and enhancing brain function is just as strong as the research on building muscle.  A growing number of studies have found that creatine can protect the brain from injury in many different ways but not limited to fighting Parkinson's, Huntington's, improving energy, protecting against and helping recover from strokes, and ALS.

Pretty amazing stuff going on in this research and be ready for more great work on the horizon.  Some other interesting studies to check out include...

The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores. David Benton and Rachel Donohoe. British Journal of Nutrition 2011; 105: 1100-1105

Creatine improves health and survival of mice.  Bender A et al. Neurobiol Aging 2008 Sep; 29(9):1404-1411


As Marcello touched upon, he gives his young daughter (<10 years old) creatine, and this guy has a PhD in Sports Nutrition and leads Stanford's Sport Performance...  I think it's safe to say creatine is perfectly fine for children.

In fact some of the first research on creatine was done to look at it's affects on infants and children that were weak or presented muscular dystrophy (Stockler et al, 1996; Tarnopolsky et al, 2004))

Not only are the brain benefits clear like we stated, but it also may enhance performance.  Studies have shown improvements in strength and performance in highly trained youth athletes (Juhasz et al, 2009).  Again there has been no literature showing any kind of side effects from chronic use and the benefits for the body and brain are very evident.

Photo Credit: IYCA.org

Final Word

I tell athletes and parents many these things, but many are still skeptical; old myths die hard I guess.  Many people smarter than myself have delved into this topic much deeper than I could ever imagine and the outcome is always the same... If you're trying to get stronger, bigger, faster, more powerful, then you should use creatine.  It can only help, it won't hurt; plus an added benefit is it's not-expensive! For about $10/month you can get a quality creatine, and you should be looking to take about 5g per day (honestly don't worry about a loading phase, just stick to 5g a day)

You don't have to take my word for it, but I'll leave you with a word from Jose Antonio, PhD and supplement specialist

“Creatine is perhaps the most studied ergogenic aid in history. Plus, the science clearly shows that there are no harmful side effects of creatine supplementation.  There is zero scientific evidence that creatine supplementation causes muscle cramps or tears, harms the kidneys, causes dehydration or a myriad of other silly myths promulgated by the mainstream press. If these side effects exist, show me the science!”

Go Get Em!

1 comment:

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