Creatine

Dylan Bowe | Last Updated – 30/12/2023 | 4 Minute Read

What is creatine?

Creatine is one of the most popular nutritional ergogenic aids that athletes use to enhance their performance. Research has consistently shown that creatine supplementation increases intramuscular creatine concentration, can improve exercise performance and improve training adaptations. Along with this performance improvements, creatine may also enhance recovery, injury prevention and rehabilitation. Creatine itself is a naturally occurring non-protein amino acid compound mostly found in red meat and seafood (1), and within the body most of our creatine is found in skeletal muscle (95%) with small amounts found in the brain and testes (5%). About two thirds of intramuscular creatine is phosphocreatine (PCr) while the remainder is free creatine. The primary metabolic role of creatine is to combine with a phosphoryl group (Pi) to form PCr through the enzymatic reaction of creatine kinase (CK). As adenosine triphosphate (ATP), which is needed for energy in sprints and high intensity exercise, degrades to adenosine diphosphate and a phosphate group to provide energy for active – the energy from hydrolysis of PCr into creatine and Pi can be used as a buffer to resynthesise ATP. This helps maintain ATP availability during maximal exercise and the greater creatine stores in the body, the greater ATP production. These processes are extremely important as the most immediate energy system availability in the body is this ATP-PCr system, which provides instant energy and be delivered at a high rate. 

What are the benefits?

Creatine supplementation increases muscle availability of creatine and PCr which can enhance acute exercises capacity and training adaptations in adolescents (3), younger adults (4) and older individuals (2). These adaptations should may allow an athlete to do more work over a series of sprints or sets leading to greater gains in performance, strength and/or muscle mass due to improvements in training quality. Creatine supplementation is primarily recommended for power/strength athletes or athletes who need to sprint intermittently and recover during competition (basketball, soccer, MMA etc). However, it may be of benefit to endurance athletes who also strength train 1-3 times per week, as any adaptations to these strength sessions may be enhanced and thus could lead to greater overall performance.

The ergogenic benefits of creatine supplementation includes:

• Increased single and repetitive sprint performance 
• Increased work performed during sets of maximal effort muscle contractions
• Increased muscle mass and strength adaptations during training
• Increased anaerobic threshold
• Enhanced glycogen synthesis
• Possible enhancement of aerobic capacity via greater shuttling of ATP from mitochondria
• Increased work capacity
• Enhanced recovery
• Greater training tolerance

Although creatine has been researched far less for cognitive performance and mental health than physical performance, it may have some benefits. Creatine may reduce mental fatigue in some scenarios, particularly in highly stressful contexts involving sleep deprivation or exercise to exhaustion (10). Creatine may also improve some aspects of memory, particularly for people with below average creatine levels which include vegetarians or older adults, and also there is research that is looking into the relationship between creatine and reducing symptoms of depression. However, more research is needed in these areas on the cognitive benefits before creatine can be said to be an effective aid to cognitive performance or mental health. 

Supplementation protocol

In an diet that contains 1-2g/day of creatine, muscle creatine stores are about 60-80% saturated, therefore supplementing with creatine aims to increase muscle creatine and PCr by 20-40%. However, depending on someone’s diet, creatine consumption may be less if someone is vegan or vegetarian, and unless you are consuming a lot of red meat or salmon every day, you should consider creatine supplementation. The most effective way to increase creatine stores in our muscles is to ingest 5g of creatine monohydrate four times daily for 5-7 days which is known as the loading phase (8). This allows the muscles to be completely saturated in a timely manner and once this loading phase is over, creatine stores can generally be maintained by consuming 3-5g/day of creatine monohydrate, although some larger athletes with greater amounts of muscle mass may need 5-10g/day (5,7). An alternative supplementation protocol is to ingest 3g/day for 4 weeks however, this results in a gradual increase in muscle creatine content and may therefore have less effect on exercise performance until creatine stores are fully saturated.

Along with this supplementation guidance, it is important to note that ingesting creatine with carbohydrates (see Aiveen article on carbs here)  has been reported to more consistently promote greater creatine retention (9). Research shows that once creatine stores are elevated, it takes 4-6 weeks to return to baseline levels (6), therefore there isn’t need to worry if you miss a day of supplementation here or there.

It should be noted that creatine supplementation often causes water retention which can lead to an increase in body weight (usually no more than 1-2kg), which may be of concern to weight category sport athletes, however if supplementing long term this can be accounted for and shouldn’t be an issue given the benefits towards performance.

In conclusion, creatine can accelerate the recycling of ADP into ATP, thereby quickly replenishing cellular energy stores and improve athletic performance. Creatine monohydrate supplementation is not only safe, but has been reported to have a number of therapeutic benefits in healthy and diseased populations from infants to the elderly. There is no compelling evidence that short or long term use (up to 30g/day for 5 years) has any detrimental effects on healthy individuals. Therefore, if you are an athlete wanting to get an edge and improve your performance, creatine monohydrate may help. 

References 

1. Bertin, M., Pomponi, S.M., Kokuhuta, C., Iwasaki, N., Suzuki, T. and Ellington, W.R. (2007) Origin of the genes for the isoforms of creatine kinase. Gene, 392(1-2), pp.273-282
2. Buford, T.W., Kreider, R.B., Stout, J.R., Greenwood, M., Campbell, B., Spano, M., Ziegenfuss, T., Lopez, H., Landis, J. and Antonio, J. (2007) International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), pp.1-8.
3. Cornish, S. M., Chilibeck, P. D., & Burke, D. G. (2006). The effect of creatine monohydrate supplementation on sprint skating in ice-hockey players. The Journal of Sports Medicine and Physical Fitness, 46(1), pp. 90-98
4. Galvan, E., Walker, D.K., Simbo, S.Y., Dalton, R., Levers, K., O’Connor, A., Goodenough, C., Barringer, N.D., Greenwood, M., Rasmussen, C. and Smith, S.B. (2016) Acute and chronic safety and efficacy of dose dependent creatine nitrate supplementation and exercise performance. Journal of the International Society of Sports Nutrition, 13(1), p.12.
5. Green, A.L., Hultman, E., Macdonald, I.A., Sewell, D.A. and Greenhaff, P.L. (1996) Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. American Journal of Physiology-Endocrinology And Metabolism, 271(5), pp.E821-E826
6. Greenhaff, P.L., Casey, A., Short, A.H., Harris, R., Soderlund, K. and Hultman, E. (1993) Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clinical Science, 84(5), pp.565-571
7. Harris, R.C., Söderlund, K. and Hultman, E. (1992) Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical science, 83(3), pp.367-374
8. Hultman, E., Soderlund, K., Timmons, J.A., Cederblad, G. and Greenhaff, P.L. (1996) Muscle creatine loading in men. Journal of applied physiology, 81(1), pp.232-237.
9. Kreider, R.B., Melton, C., Rasmussen, C.J., Greenwood, M., Lancaster, S., Cantler, E.C., Milnor, P. and Almada, A.L. (2003) Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Molecular and cellular biochemistry, 244, pp.95-104
10. Roschel, H., Gualano, B., Ostojic, S.M. and Rawson, E.S. (2021) Creatine supplementation and brain health. Nutrients, 13(2), p.586