Creatine is a naturally occurring compound found in all living organisms. It is used as an energy source for muscles, which are essential for locomotion and strength. Creatine helps increase oxygen carrying capacity (V̇o 2 max) and increases the rate at which ATP molecules are produced from glucose. Creatine supplementation may improve physical performance and athletic ability. However, there have been no long term studies on its effects on tendon health.
The main side effect of creatine supplementation is gastrointestinal upset, including nausea, diarrhea, cramps and vomiting. These symptoms usually disappear within 24 hours after discontinuation of creatine use. Some users experience other adverse reactions such as headache, fatigue and depression.
There are two types of creatine: phosphocreatine and hydroxycreatine. Both forms have similar properties but different mechanisms of action. They both work by increasing the amount of water in cells. Water is necessary for cell function and it is known that increased water content improves tissue elasticity.
Phosphocreatine works by increasing the amount of phosphate ions in cells. Phosphate ions are negatively charged atoms with one proton attached to them. When they come into contact with each other, they create a net charge of -1. This creates a positive ionic potential between adjacent phosphate ions which causes them to attract each other and stick together forming larger molecules called cross-links.
These cross-links play a large role in the structure of biological molecules including DNA. They are responsible for connecting the long chains of repetitive Adenine, Cytosine, Guanine and Thymine or Alanine, Austine, Guanine and Tymine. These long chains that make up your genetic code can then fold up into certain structures that dictate what type of proteins they create. These proteins are used in everything your body does, from building muscle to sending messages along your nerves. If there are more cross-links than normal this can cause problems in the folding process and prevent these proteins from functioning properly and this is one of the main reasons that creatine supplementation has been shown to improve muscular strength and endurance.
Cross-links also cause connective tissue like tendons to become stiffer and less pliable. This can be a problem for athletes whose sports involve a lot of jumping, explosive movement or landing because this increased rigidity is placed on the joints.
When creatine is introduced into the body it attracts a large amount of water into the cells and causes the cross-links to break down into their separate components. When this occurs the cells become more flexible and better able to perform their proper functions. The increase in water also decreases muscle cell volume enabling them to contract faster and harder. This increased power output has been shown to improve sports performance in explosive athletes like Olympic weightlifters, American football and rugby players.
There are some people who have questioned the safety of creatine supplementation because in extreme amount it can be harmful to the kidneys. Current evidence suggests that the increase in kidney strain is minimal and well within the body’s ability to handle the increased workload even when a loading phase is used. This increase is also not uncommon with other supplements used by bodybuilders like vitamins or protein. There have been reports of muscle cramps, stomach discomfort and dehydration but these are also preventable and easily managed.
It is important to note that the use of creatine is not allowed in some sporting bodies like the Olympics. These bans have been put into place solely because they are afraid of the advantage it gives certain athletes so they have made it against the rules. Other supplements like protein and multivitamins are accepted even though they can be just as effective. This double standard is discriminatory and does not make sport fairer.
Nor is it likely to stop athletes from using it if they feel it will improve their performance.
Creatine supplements are most commonly available as a white powdered substance in jars that can be stored safely and easily. It is recommended to buy the purest form of the supplement with no additives and “fillers”. Creatine Monohydrate, which is the cheapest form available, has been shown to be effective in all types of exercise, but its effects can be enhanced by combining it with other supplements.
Creatine is most commonly used by athletes and individuals involved in heavy training. These groups can benefit greatly from its use because it allows them to achieve higher training intensities, which ultimately increases the results they see. This increase in performance can lead to greater capabilities and higher levels of achievement. Athletes and recreational exercisers, especially weight trainers and sprinters, can benefit from its ability to increase total work capacity.
In addition to the positive effects on exercise, it has also been shown to be therapeutic for patients with some neuromuscular disorders. People suffering from some types of Muscular Dystrophy have been found to benefit greatly from its use. These patients experience an increase in strength and cardiac output which leads to better quality of life.
Muscular Dystrophy is a disease in which the patients’ bodies become unable to repair muscle damage. This leads to a decreased ability to function and difficulties with even simple daily tasks. Due to the lack of energy the patients often lose weight, develop digestive issues and suffer from joint pain. The cardiac and respiratory functions also decline.
The disease can become so advanced in some patients that they become confined to a wheelchair. This is an especially serious issue in younger patients who have not reached their full adult height. Even simple activities like bathing or going to the bathroom require assistance and can be dangerous due to the increased risk of falls and choking. The disease also reduces life span and there is no current treatment.
Creatine has been shown to improve all of these functions by increasing the body’s overall energy levels. It has also been shown to delay the loss of muscle mass, leading to improved weight maintenance and strength. This is especially important for pediatric patients, a significant number of whom suffer from muscular weakness.
Young children who do not have access to a specialized diet or medicine containing creatine can be given daily doses of 5g per Kg of body weight to achieve similar results. Even those that are able to eat a normal diet can benefit in these ways.
It is important to note that there is no disease that creatine can cure. Rather, it has been shown to help the body repair itself. This means that while it can help slow the effects of Muscular Dystrophy, it cannot reverse them. However, it can substantially improve the quality of life for patients and allow them to lead relatively normal lives.
Creatine has also been investigated as a potential treatment for other diseases such as Alzheimers, Parkinsons, and some types of cardiomyopathy. However, more research is needed to determine if there are benefits in these groups.
Creatine is very safe when used in appropriate doses. However, there are still some risks and potential side effects that you should be aware of before beginning use. As with any supplement or medication, it is important to consult your doctor before starting use. This is especially true if you are currently pregnant or have a pre-existing medical condition.
The standard dosage ranges between 2-5 grams per day. Once in the body this is converted into creatine which is later used to allow the body to produce adenosine triphosphate (ATP). ATP is responsible for many of the energy requirements of cells. As a result, this allows an increase in energy and power output by muscles during activity.
A loading phase is recommended for the first week of use to speed up the initial “charging” process of creatine in your muscles. This involves taking anywhere from 5-20 grams per day for 5 days. After this, a maintenance dose of 2-5 grams per day is recommended. However, it’s been found that this is only really necessary for the first few months and after that, lower doses (1-2 grams) maintain your “supplemental” levels just fine.
While normal creatine monohydrate is the most common form, there are several other forms which are either more effective or easier to absorb. The most common of these options are:
Creamer’s Sodium Creatine – This is by far the cheapest form available and as a result it is the most commonly used. The only downside to this version is that you have to swallow a large amount of sodium with it which may cause problems for those that have high blood pressure.
Micronized Creatine – This form uses a specialized tool called an atomizer to break the creatine into smaller pieces. Your body is then better able to absorb it and there is significantly less waste, as a result you need to take less per serving.
Kre-Alkalyn – This buffered form does not require a loading or maintenance phase (as discussed below). Instead, you can take it once daily before exercise and see the same benefits. It is also claimed to have fewer side effects.
Liquid Creatine – This form is simply creatine in liquid form. It requires no loading phase, and can be simply added to any drink you like.
There are other forms but these are the most common ones used today. While not technically essential, a loading phase can increase the benefits of creatine. During the loading phase, you take 20 grams 4 times per day for 5 days. This is known to improve the uptake of creatine into your muscles and improve the performance increases achieved.
Without this loading phase, you can still achieve the same benefits over several weeks use.
Normally, after the loading phase, you go into a maintenance phase where you take 5-10 grams per day. However, studies have shown you can get the same benefits after a few weeks and this is what most people actually do.
Taking creatine with sugar reduces the amount able to be absorbed into the body by up to 50%. This means if you take 10 grams of creatine with any form of sugar (including fruit), only 5 grams will be absorbed. Taking it with glucose or sucrose is fine, as the extra insulin will increase its uptake.
An interesting addition to creatine is caffeine as this has been shown to improve strength and endurance gains when used in conjunction with creatine. However, the effects of caffeine are lessened if you are already a habitual user.
The most common side-effects of creatine are stomach discomfort, nausea and dehydration. Most of the time this can be avoided by taking it with a fruit juice (without sugar) or just after a meal. If you suffer from any of these problems then try lowering the amount you take or stop taking it altogether.
In terms of dosage, there is no maximum but most typical dose is between 5mg and 20mg per day.
Sources & references used in this article:
Muscle creatine loading in men by E Hultman, K Soderlund, JA Timmons… – Journal of applied …, 1996 – journals.physiology.org
Measurement of obesity by the creatinine coefficient by NB TALBOT, F BROUGHTON – American Journal of Diseases of …, 1938 – jamanetwork.com
Long-term creatine intake is beneficial to muscle performance during resistance training by K Vandenberghe, M Goris… – Journal of applied …, 1997 – journals.physiology.org
The carrier state in muscular dystrophy of the Duchenne type: Identification by serum creatine kinase level by AT Milhorat, L Goldstone – Jama, 1965 – jamanetwork.com