The Benefits of Creatine

by Matt Durkin
MSc Nutrition Specialist
01/12/2018

Despite being one of the most heavily researched topics in the field of nutrition, there still seems to be much confusion that surrounds the topic of creatine supplementation. Because of this, we have created this latest SimplyGo article to be your go-to-guide, covering all aspects of creatine including what it is, how it works and how to take it to experience the best results.

What is Creatine?

Creatine is a molecule that can be naturally produced in the body and one that can be obtained through a small number of foods. Creatine is created in the kidneys and liver by the amino acids glycine, arginine and methionine and then transported to the muscles where it is stored as phosphocreatine, otherwise known as creatine phosphate.

Our muscles and every other cell in our body are fuelled by adenosine triphosphate or ATP for short. To provide this energy, ATP releases one of its phosphates, which then leaves adenosine diphosphate (ADP). As we only have enough ATP at any one time to provide enough energy for 2-3 seconds, our body has numerous ‘energy systems’ that it can call upon to resynthesise ATP and thus continue the flow of energy. 

One of these is something we have already mentioned, the phosphocreatine energy system. This pathway provides rapid energy and so almost exclusively fuels the first 10-15 seconds of intense exercise.

But how does this system work? Quite simply, phosphocreatine donates its phosphate to ADP, turning it back into ATP, allowing muscle contractions to continue. Therefore, by increasing our stores of phosphocreatine we can boost performance during high-intensity exercise.

Our body also creates ATP through the breakdown of glucose, glycogen (stored glucose), fats and a small number of amino acids. Although these provide energy at a relatively slow rate, they can provide much more energy than the creatine phosphate system and therefore provide the bulk of energy during longer exercise bouts.

Now we have covered what creatine is and the science of how it works to improve energy production, let’s look at how we can manipulate our diet to improve the performance of this energy system.

What are Good Sources of Creatine?

As we have already discovered, the body can naturally synthesise creatine through 3 amino acids. Therefore, consuming sufficient protein will ensure our muscles contain some creatine. Certain protein containing foods also provide creatine, with the best sources being red meat, poultry and fish.

The term ‘best sources’ is quite misleading though, as you would need to consume 1.1kg of beef or 1.5kg of chicken to obtain the same amount of creatine as you would find in a 5g scoop of 100% creatine monohydrate powder.

So although there are lots of nutrients that we can obtain in sufficient amounts through a well-structured eating pattern, without the need for supplementation, creatine is unfortunately not one of them. 

As meat-eaters typically consume more protein, their bodies create more creatine. Similarly, a regular intake of meat and fish results in meat-eaters obtaining a certain amount of creatine through the diet as well. For these reasons, vegetarians and vegans typically get even bigger performance increases from creatine supplementation.

There are numerous types of creatine on the market, but the cheapest and most researched is creatine monohydrate. Over the years there have been different types that have popped up, promising even bigger performance increases. However, these have not stood up to scientific scrutiny and therefore we have no reason to recommended anything but the tried and tested monohydrate form.

What is the Best Way to Take Creatine?

You may be one of the many people who has decided to add creatine to your supplement regime, but you are unsure of the best way to take it. If you have done a bit of research you may have noticed that there are numerous ways that people take creatine, but which one is best?

Thankfully, the methods that we are going to explore in detail below have all been validated by peer-reviewed scientific studies, meaning there is no right or wrong way and therefore you can choose the method that best suits your needs.

Arguably, the most popular way to take creatine is to start with a ‘loading phase’ before transitioning to a ‘maintenance dose’. Recommended loading phases tend to change in the dose and the length of time administered, but the overriding aim is the same – to maximise intramuscular creatine stores.

Loading phases usually last between 4-7 days and typically recommend 20-25g of creatine daily or 0.3kg per kg of body weight. For example, a 70kg person would, therefore, be recommended to take 21g of creatine daily. As you can see, the difference between the two typically recommended loading phases are minimal, so it is personal preference to which type you choose.

To maximise creatine stores and avoid any gastrointestinal issues, it is recommended to take multiple doses spaced throughout the day. Taking 5g, four times per day is a regular pattern. After the loading phase, intramuscular creatine stores should be at maximum capacity, meaning you will now just require 3-5g per day to maintain this (maintenance dose). 

Some people choose not to load creatine and would rather just take 5g per day upon beginning supplementation. Although this does not quickly saturate the muscles like a loading phase, consistently taking 5g per day will see people achieve similar levels after roughly 4 weeks.

Another question that nutritionists are often asked is when is the best time to take creatine. As we have already mentioned it is best to spread it out through the day if you are completing a loading phase.

Creatine also has an interesting relationship with the hormone insulin, which we can use to our advantage. Among other important functions, insulin is responsible for shuttling nutrients (like glucose) into the cells.

Research has consistently shown that taking creatine alongside a glucose drink or a carbohydrate-rich meal can increase the amount of creatine that gets into the muscle. This is because the influx of glucose into the body stimulates insulin secretion, which helps glucose and creatine get into the muscles.

Exercise is also known to improve insulin sensitivity and augment glucose uptake. Because of this, creatine uptake can increase following an exercise bout when compared to those taking creatine in the rested state.

So, it is certainly advised to take creatine within a glucose based drink or following a meal containing carbs. As it is good practice to consume carbohydrates following exercise, this would be an ideal time to take creatine, potentially maximising creatine absorption given that the body will be in a prime state to respond to insulin.

It is also important to ensure you are consuming enough fluid when supplementing with creatine. This is because creatine needs to be bound to water inside the cell. Due to this, those who saturate their muscles with creatine can often gain 2kg of bodyweight during a loading phase.

Typically, the more water-weight you gain during a loading phase, the better you will respond to supplementation, as the significant weight gain indicates you have increased your creatine stores quite drastically.

What are the Performance Benefits of Creatine?

Creatine has the ability to improve the performance of the vast majority of athletes, regardless of their sporting discipline and their level of ability. Although creatine does not improve aerobic exercise performance (long distance running for example), most athletes from endurance sports incorporate weight-training and sprint-type exercise into their training regime. Therefore those who respond well to creatine will be able to improve certain aspects of their training by supplementing with it.

As we mentioned in the introduction, creatine has been researched extensively for decades, covering a plethora of sporting disciplines. For this reason, there are too many studies to discuss individually and therefore we will provide a short overview of studies conducted in a variety of different scenarios.

Creatine for Team Sports

Team sports such as rugby, football and hockey may be fundamentally different, but they all have similar patterns of play. This is because they consist of periods of intense exercise followed by active rest; sports that can be classified as ‘repeated-sprint’ sports. As these types of sports rely quite heavily on the phosphocreatine energy system, it should come as no surprise that there are many studies that have reported positive findings of creatine supplementation.

Unfortunately, it is very difficult to study the effects of a nutritional intervention in team sport performance thanks to the range of variables influencing the end result. However, researchers can simulate game-play situations by analysing performance changes in key aspects of sporting performance such as sprinting, jumping and power output.

One such study looked at the effects of creatine on sprinting speed, speed endurance and jumping ability in well-trained football players. It was found that those who loaded creatine (5g, four times per day for 6 days) improved their 5m and 15m sprint performance, their repeated sprint ability and maintained their jumping performance more effectively compared to the placebo group.

This study’s particular strength was that it used a testing protocol that closely resembled the demands of a football match. It was also double-blinded; meaning neither the participants nor the researchers knew who received the creatine and who was given a placebo.

Creatine has also been shown to be beneficial in elite ice-hockey players. In a squad of players (16 males), 8 randomly received a placebo and the remaining 8 took 20g for 5 days followed by 5g per day for 10 weeks. At the start and the end of the intervention period, the participants performed repeated sprints on a bike and completing six, 80-m sprints on the ice with rest periods of 30 seconds between sprints.

As expected, the group receiving a placebo did not significantly improve their performance. However, the group who supplemented with creatine improved their average power output on the bike by around 20% - a very impressive finding. But that wasn’t all, as the athletes also shaved a significant amount of time off their sprint performance on the ice.

Given that these results have been seen in elite athletes – people who do not gain chunks of performance easily - this should be enough to encourage team sports athletes to supplement with creatine if it is something they have been contemplating.

Despite the myriad of research studies that have validated the use of creatine, the support has not been unanimous. Typically, when studies fail to see a significant benefit, this is because of two key reasons.

Firstly, if studies recruit people with a high meat intake, the participants may already have impressive creatine stores, rendering supplementation less effective. Secondly, creatine is well-known to increase body mass through both water-weight and muscle gain. For weight-bearing exercises such as running, jumping and cycling up-hill, the performance increases can often be negated by the increase in body weight, resulting in no net performance gain.

Despite these caveats, creatine supplementation has still been shown to be effective in the majority of published studies and so shouldn’t discourage anyone from considering a creatine supplement.

Creatine for Muscle & Strength Gain

Creatine is lauded by gym-goers all over the world because of its ability to support muscle and strength gain. To increase muscle size and strength we have to put our muscles under a strain that they have not experienced before. The body then super-compensates by building bigger muscles to deal more effectively with the stressor.

The only way we can do this is through progressive overload. By lifting heavy weight, by completing more reps/sets or by having a shorter rest period, we make it harder for our body, forcing us to adapt.

As resistance training consists of repeated bouts and is highly intense, it also relies heavily on energy being provided by the phosphocreatine energy system. Therefore, creatine is widely regarded as the best (legal) supplement to support muscle gain. This statement has been validated by research studies such as those that we will touch on now.

As creatine supplementation has been studied extensively in this area, there have been numerous meta-analyses conducted. Meta-analysis studies collate the results of numerous investigations that aimed to answer the same research question and use advanced statistical methods to come to a valid conclusion.

One of these meta-analyses, conducted in 2002, evaluated 16 studies which aimed to quantify the effects of creatine supplementation on maximal strength. Impressively, it was found that after 8 weeks of daily supplementation, bench press strength increased by almost 7kg with squat performance improving by almost 10kg compared to those who were given a placebo.

A huge meta-analysis published in the International Journal of Sports Nutrition & Exercise Metabolism analysed 100 studies (yes one hundred) which looked at creatine’s ability to influence muscle mass. It was found that creatine supplementation led to significant increases in lean body mass and also power output. Interestingly, this study showed those who underwent a loading phase tendered to gain more muscle than those who didn’t.

Although universally popular with younger adults, creatine is growing in popularity with older individuals. This is thanks to the plethora of research showing how resistance training can strengthen bones, muscles and the cardiovascular system whilst supporting longevity and independence.

One study of note, published in the Journal of Sports Science & Medicine in 2006, recruited 44 adults between the ages of 55-84. Participants were given either creatine or a placebo daily whilst partaking in 3 resistance training sessions weekly.

After the 12-week resistance training programme was completed, participants completed 1 repetition maximum tests for the leg press, leg extension, leg curls, bench press, lat pull down and arm curls. As expected, the creatine group increased in strength significantly more than the group taking a placebo for all exercises apart from the bench press.

Because of these impressive findings and the results of scores of other investigations, the European Food Safety Authority – the governing body that regulates food and supplements – has authorised the health claim: “Daily creatine consumption can enhance the effect of resistance training on muscle strength in adults over the age of 55”.

Therefore, if you are an adult of any age and you are looking to increase your muscle mass and strength, creatine supplementation alongside a structured diet and exercise regime is highly recommended.

What are the Health Benefits of Creatine?

The vast majority of research has looked at creatine through a sports performance lens. However, this field has been exhausted in a certain sense as it has been proven beyond a doubt that it is beneficial for high-intensity exercise.

Now, research is focussing on its ability to improve brain function in older adults. As there are now almost 12 million people in the UK over the age of 65, addressing cognitive decline in this population is of big interest.

Although still a growing topic, there have already been studies that have shown creatine can reduce mental fatigue and improve cognitive functions such as memory and verbal proficiency. Interestingly, these benefits are accentuated in older adults who are chronically tired or stressed.

One study published very recently analysed six studies in this area, which in total researched 281 adults. It was found that creatine improved short-term memory, intelligence and reasoning, whilst most studies also supported improvements in attention, word fluency, reaction time and mental fatigue.

What is fascinating is that there were heightened benefits in vegetarians who obviously had lower baseline levels of phosphocreatine. Although not all 6 studies were in agreement, the researchers believe that this can partly be put down to the different dosage strategies employed.

It has been suggested that higher doses of creatine are needed daily to improve cognitive functioning in older adults compared to that needed for athletic performance gain. However future work will be needed to confirm this.

Besides healthy aging, another contemporary topic is how nutrition, exercise and lifestyle can affect our mental health. A small collection of research studies have shown that 3-5g of creatine per day can decrease symptoms of depression when taken alongside a group of anti-depressive medication known as selective serotonin reuptake inhibitors (SSRIs).

One study of note, which was a randomised, double-blind controlled trial recruited 52 women with major depressive disorder and gave them either 5g of creatine monohydrate or a placebo for 8 weeks. What is encouraging is that those taking the creatine saw significant improvements in as little as 2 weeks, with these being maintained throughout the length of the intervention. There were also fewer ‘adverse events’ in the participants taking creatine.

As the research in this area is in its infancy, it is certainly recommended to speak to your doctor before taking creatine alongside medication. However, the preliminary results are impressive and we eagerly await future advancements.

Are There Any Side Effects of Creatine Supplementation?

Creatine has no significant side-effects, especially when consuming the recommended amount. The only side-effects seem to occur when too much has been taken at once (gastrointestinal distress) or you are not sufficiently hydrated (muscle cramps). There have been rumours that creatine can damage the liver, kidneys and cause hair-loss. Thankfully, there is no strong evidence that this is at all the case.

The notion that creatine cannot be taken continuously and needs to be cycled is also a myth. Researchers have followed groups of people who have taken creatine daily for over 2 years and failed to note any side-effects or worrying biomarkers at all.  Therefore, if you are thinking of supplementing with creatine, the worry of harmful side-effects should not hold you back.

Summary

To conclude, creatine is a tried and tested supplement which is both safe and effective. Although research has traditionally looked at this compound from a sports performance perspective, there has been a burgeoning interest in how it can improve mental well-being and cognitive functioning in older adults. As this is a relatively new area of interest we will be sure to update you on future advancements. But for now, here are the key take-home messages of this article:

· Creatine is a compound which can naturally be created by the body and is found in small amounts in meat and fish. As it is impractical to boost creatine stores through food alone, supplementation is universally popular.

· There are numerous types of creatine supplements on the market, but none are more effective or better researched than creatine monohydrate. In addition to this, it is one of the most cost-effective forms and is therefore widely recommended.

· Creatine is stored in the muscles as creatine phosphate. It helps to turn ADP back into ATP to keep the cells energised. By increasing our stores of creatine, we increase our ability to provide rapid energy.

· There are numerous ways to take creatine. The most popular method is to have a 5-day loading phase (4 x5g) and then maintain this by consuming 3-5g daily thereafter. As insulin helps to drive creatine into the muscles, it is best to take it alongside a carbohydrate-rich meal and/or following an exercise session.

· Because creatine provides rapid energy for a brief period of time, it is of most benefit to muscle and strength gain or those who play sports which consist of repeated sprints. Even though it does not improve endurance exercise performance, it can be of benefit to endurance athletes who complete sprint and resistance training.

· Aside from its performance benefits it can also support health. Preliminary evidence has shown it can boost cognitive functioning in older adults and can complement SSRI medication to decrease symptoms of depression.

· Thankfully creatine has a very impressive safety profile, with mild side effects such as stomach complaints and muscle cramps being the most commonly reported. These are remedied by taking the recommended amount and by staying adequately hydrated.  

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