nutrition

The Super Supplement: Creatine Explained

Creatine is a supplement that has fascinated me since I first heard of it a couple of years back. It is possibly the most widely researched supplement in regard to fitness and strength training, but its many benefits go much further than just the fitness industry.

What is Creatine?

When I first came across creatine, it was one of the most researched supplements I had never heard of. I’d heard of many other nutritional supplements, but for some reason creatine had eluded my knowledge. The other day I posted a couple of polls on my Instagram story asking if people had heard of creatine, and if they had did they actually know what it was. 70% of people who answered the poll had heard of creatine but only 54% said they knew anything about it.

I still believe that when it comes to the fitness industry, it’s not as widely talked about as other supplements like proteins and the amino acids, despite possibly having a larger backing of research.

So, what actually is creatine?

Creatine is a naturally occurring substance found in the human body and in animal tissue. When we perform exercise, our bodies use up energy, and one of those sources of energy is something called adenosine triphosphate (ATP).  In fact, it is the body’s main immediate source of energy. Every time you perform a strength exercise, to every time your heart beats, to every time a brain cell is used, your body uses ATP.

ATP is composed of an adenosine molecule and three phosphate molecules. Energy is released when ATP drops one of its phosphate bonds to become adenosine diphosphate (ADP). Like a pop when you burst a balloon, or a snap when you break a stick in half, the energy is instant and short lived.

ATP can be produced in many ways, such as though glycolysis where glucose is broken down, but for the purposes of this blog post, we will be considering the synthesis of ATP through the phosphocreatine system (don’t worry, I’m explaining this next).

We store creatine in our muscles. When we absorb creatine into our cells, it is paired with phosphate to become phosphocreatine. In times of high energy demand, phosphocreatine gives its phosphate group to resynthesise the ADP into ATP, allowing us to be ready to go again in a short period of time.

Compared to resting state, the demand for ATP during exercise can result in a 1000-fold increase[1]. In order to maintain the intensity, ATP in the muscles needs to be replenished at a very high rate.

It is understood that consuming creatine as a supplement has the ability to increase muscle stores of phosphocreatine, thus potentially increasing the speed and ability to resynthesise ADP to ATP. However, only a certain amount of creatine can be stored in our muscles at any one time, and once the muscles have reached saturation, creatine will no longer be absorbed into the cells.

The below research uses primarily a type of creatine supplementation called creatine monohydrate. It is the standard form of the supplement and it is the most affordable. It is also the most studied form of creatine. There are many variations of creatine however for the purposes of this article, the creatine referred to is creatine monohydrate.

Creatine for Strength

Creatine is most widely known for its effects on strength performance. The effect creatine has on strength, increasing power output, strength and muscle mass, and a reduction in muscle damage[2][3][4][5] is very well documented.

Perhaps the most commonly used test of maximal strength out there is the one repetition maximum test (1RM) where lifters test how much weight they can lift in one attempt. Consumption of creatine over a period of time can help to significantly increase the weight lifted and the power output of a 1RM[6][7][8][9][10].

Two meta-analyses* conducted by the same authors in 2015 and 2017 explored the impact of creatine on strength in the lower limbs and in the upper limbs [11][12]. The studies nicely demonstrated creatine to be effective for improving strength performance in both upper and lower limbs. For upper limb performance, the pectoral muscles (the muscles of your chest) saw the most improved performance with bench pressing increasing by approximately 5.3% with creatine supplementation. For lower limb performances, the quadriceps saw the largest improvement, which the maximal weight lifted during squats and leg press increasing by approximately 8% and 3% respectively. These studies also noted that the response to creatine supplementation did not differ between males and females, sedentary and physically active adults and was independent of age. There was a reported additional benefit of creatine for those without a history of weight-training. One thing to mention here is that the maintenance dose of creatine differed extensively among the included studies, from 1.25g/day up to 27g/day, and the studies using increased doses of creatine could have swayed the results to seem like there is a bigger effect than the standard recommended dose of 5g/day would give.

* Meta-analyses are studies where the authors take the results of many studies and combine them to essentially create one overall result.

Creatine for Plant-Based Diets

When we switch to plant-based diets, we are pretty much cutting out the entire of our exogenous creatine supply[13] and the amount of creatine stored in our muscle’s declines. This declination of creatine supply can be ameliorated by supplementation. For vegetarians, creatine supplementation increases muscular strength and endurance, power output, and brain function and memory. It’s also possible these effects are more pronounced in vegetarians than omnivores[14][15][16]. Factors that may influence the added benefits of creatine for plant-based diets may be the total amount of stored creatine in the body, how long the individual has been plant based for and how strict the plant-based diet is. As vegans may have the lowest creatine stores, they may see the most pronounced benefits of creatine.

Creatine for the Brain and Mental Health

Creatine isn’t just useful for our muscles; it is also an essential compound for brain function. A recent review in 2018 found that creatine supplementation possibly improves short term memory and intelligence in healthy individuals[17]. It’s a little less clear if it is beneficial for other facets of brain function however research is beginning to focus on its role in neurodegenerative diseases. Unfortunately there is very little/no promising evidence currently for this.

There is a fairly good amount of evidence as well for a role of creatine in mental health problems with lower creatine intake levels being associated with depression[18] in US adults. Animal studies have found creatine supplementation to have small antidepressant effects in mice and rats[19][20][21][22]. Studies in humans have also found creatine to have possible antidepressant effects. In one study, creatine supplementation used in conjunction with antidepressants (SSRIs or SNRIs) was found to be effective for women with SSRI- or SNRI-resistant depression[23] however this was a small open-label study, and these results will need to be replicated in much larger studies to confirm them. Similarly, creatine was used as an add-on treatment in a proof-of-concept study for bipolar depression[24]. The study found that creatine was superior to placebo in remission rates for the depression phase of bipolar disorder. These findings also need further study in larger scale randomised control trials.

Side Effects

According to a 2017 review of creatine, the only side effect consistently reported is weight gain and that studies both short and long term, with healthy and ‘diseased’ populations and of all ages have consistently shown creatine to have no adverse health risks[25]. The dosage noted here was 3-8g per day. The standpoint of the review is that “creatine supplementation is not only safe but has been reported to have a number of therapeutic benefits in healthy and diseased populations ranging from infants to the elderly. There is no compelling scientific evidence that the short- or long-term use of creatine monohydrate (up to 30 g/day for 5 years) has any detrimental effects on otherwise healthy individuals or among clinical populations who may benefit from creatine supplementation”.

Disclaimer

I am not a nutritionist and have no nutritional qualifications. I am not an expert and do not claim to be. I have written this article of my own interest and looked at the current body of research, admittedly a very small part of it due to the vast amount of research out there. If you are interested in creatine supplementation but are unsure, speak to a nutritionist, a dietitian or your GP.

Photo is not mine. It comes from the MyProtein Facebook Page.


[1] Julien S. Baker, Marie Clare McCormick, and Robert A. Robergs, ‘Interaction among Skeletal Muscle Metabolic Energy Systems during Intense Exercise’, Journal of Nutrition and Metabolism, 2010 (2010) <https://doi.org/10.1155/2010/905612&gt;.

[2] João Pedro Nunes and others, ‘Creatine Supplementation Elicits Greater Muscle Hypertrophy in Upper than Lower Limbs and Trunk in Resistance-Trained Men’, Nutrition and Health, 23.4 (2017), 223–29 <https://doi.org/10.1177/0260106017737013&gt;.

[3] João G. Claudino and others, ‘Creatine Monohydrate Supplementation on Lower-Limb Muscle Power in Brazilian Elite Soccer Players’, Journal of the International Society of Sports Nutrition, 11 (2014), 32 <https://doi.org/10.1186/1550-2783-11-32&gt;.

[4] Chia-Chi Wang and others, ‘Effects of 4-Week Creatine Supplementation Combined with Complex Training on Muscle Damage and Sport Performance’, Nutrients, 10.11 (2018) <https://doi.org/10.3390/nu10111640&gt;.

[5] Mojtaba Kaviani, Aboozar Abassi, and Philip D. Chilibeck, ‘Creatine Monohydrate Supplementation during Eight Weeks of Progressive Resistance Training Increases Strength in as Little as Two Weeks without Reducing Markers of Muscle Damage’, The Journal of Sports Medicine and Physical Fitness, 59.4 (2019), 608–12 <https://doi.org/10.23736/S0022-4707.18.08406-2&gt;.

[6] Scott B Johnson and others, ‘The Effects of Creatine Monohydrate on 1-RM Bench Press’, 7.

[7] Jorge M. Zuniga and others, ‘The Effects of Creatine Monohydrate Loading on Anaerobic Performance and One-Repetition Maximum Strength’, The Journal of Strength & Conditioning Research, 26.6 (2012), 1651–56 <https://doi.org/10.1519/JSC.0b013e318234eba1&gt;.

[8] Eric Rawson and Jeff Volek, ‘Effects of Creatine Supplementation and Resistance Training on Muscle Strength and Weightlifting Performance’, Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 17 (2003), 822–31 <https://doi.org/10.1519/1533-4287(2003)017<0822:EOCSAR>2.0.CO;2&gt;.

[9] Alanna K. Whinton and others, ‘Repeated Application of a Novel Creatine Cream Improves Muscular Peak and Average Power in Male Subjects’, The Journal of Strength & Conditioning Research, 34.9 (2020), 2482–91 <https://doi.org/10.1519/JSC.0000000000003730&gt;.

[10] Trent J. Herda and others, ‘Effects of Creatine Monohydrate and Polyethylene Glycosylated Creatine Supplementation on Muscular Strength, Endurance, and Power Output’, The Journal of Strength & Conditioning Research, 23.3 (2009), 818–26 <https://doi.org/10.1519/JSC.0b013e3181a2ed11&gt;.

[11] Charlotte Lanhers and others, ‘Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses’, Sports Medicine (Auckland, N.Z.), 45.9 (2015), 1285–94 <https://doi.org/10.1007/s40279-015-0337-4&gt;.

[12] Charlotte Lanhers and others, ‘Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis’, Sports Medicine (Auckland, N.Z.), 47.1 (2017), 163–73 <https://doi.org/10.1007/s40279-016-0571-4&gt;.

[13] Laura Blancquaert and others, ‘Changing to a Vegetarian Diet Reduces the Body Creatine Pool in Omnivorous Women, but Appears Not to Affect Carnitine and Carnosine Homeostasis: A Randomised Trial’, The British Journal of Nutrition, 119.7 (2018), 759–70 <https://doi.org/10.1017/S000711451800017X&gt;.

[14] Kaviani, Abassi, and Chilibeck.

[15] David Benton and Rachel Donohoe, ‘The Influence of Creatine Supplementation on the Cognitive Functioning of Vegetarians and Omnivores’, The British Journal of Nutrition, 105.7 (2011), 1100–1105 <https://doi.org/10.1017/S0007114510004733&gt;.

[16] Darren G. Burke and others, ‘Effect of Creatine and Weight Training on Muscle Creatine and Performance in Vegetarians’, Medicine and Science in Sports and Exercise, 35.11 (2003), 1946–55 <https://doi.org/10.1249/01.MSS.0000093614.17517.79&gt;.

[17] Konstantinos I. Avgerinos and others, ‘Effects of Creatine Supplementation on Cognitive Function of Healthy Individuals: A Systematic Review of Randomized Controlled Trials’, Experimental Gerontology, 108 (2018), 166–73 <https://doi.org/10.1016/j.exger.2018.04.013&gt;.

[18] Amanda V. Bakian and others, ‘Dietary Creatine Intake and Depression Risk among U.S. Adults’, Translational Psychiatry, 10.1 (2020), 52 <https://doi.org/10.1038/s41398-020-0741-x&gt;.

[19] Patricia J. Allen, Kristen E. D’Anci, and others, ‘Sex-Specific Antidepressant Effects of Dietary Creatine with and without Sub-Acute Fluoxetine in Rats’, Pharmacology, Biochemistry, and Behavior, 101.4 (2012), 588–601 <https://doi.org/10.1016/j.pbb.2012.03.005&gt;.

[20] Patricia J. Allen, Kristen E. D’Anci, and others, ‘Chronic Creatine Supplementation Alters Depression-like Behavior in Rodents in a Sex-Dependent Manner’, Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 35.2 (2010), 534–46 <https://doi.org/10.1038/npp.2009.160&gt;.

[21] Na-Ri Ahn and others, ‘Effects of Creatine Monohydrate Supplementation and Exercise on Depression-like Behaviors and Raphe 5-HT Neurons in Mice’, Journal of Exercise Nutrition & Biochemistry, 20.3 (2016), 24–31 <https://doi.org/10.20463/jenb.2016.09.20.3.4&gt;.

[22] Patricia J. Allen, Joseph F. DeBold, and others, ‘Chronic High-Dose Creatine Has Opposing Effects on Depression-Related Gene Expression and Behavior in Intact and Sex Hormone-Treated Gonadectomized Male and Female Rats’, Pharmacology, Biochemistry, and Behavior, 130 (2015), 22–33 <https://doi.org/10.1016/j.pbb.2014.12.014&gt;.

[23] Brent M. Kious and others, ‘An Open-Label Pilot Study of Combined Augmentation With Creatine Monohydrate and 5-Hydroxytryptophan for Selective Serotonin Reuptake Inhibitor- or Serotonin-Norepinephrine Reuptake Inhibitor-Resistant Depression in Adult Women’, Journal of Clinical Psychopharmacology, 37.5 (2017), 578–83 <https://doi.org/10.1097/JCP.0000000000000754&gt;.

[24] Ricardo Alexandre Toniolo and others, ‘A Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Trial of Creatine Monohydrate as Adjunctive Treatment for Bipolar Depression’, Journal of Neural Transmission (Vienna, Austria: 1996), 125.2 (2018), 247–57 <https://doi.org/10.1007/s00702-017-1817-5&gt;.

[25] Richard B. Kreider and others, ‘International Society of Sports Nutrition Position Stand: Safety and Efficacy of Creatine Supplementation in Exercise, Sport, and Medicine’, Journal of the International Society of Sports Nutrition, 14.1 (2017), 18 <https://doi.org/10.1186/s12970-017-0173-z&gt;.

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