Creatine supplementation is one of the most debated, yet well-researched topics in sports and performance nutrition research. In fact, there are upwards of 500 peer-reviewed articles on the subject1.
Despite well-cited benefits to its usage, creatine monohydrate gets a bad rap for allegedly causing a negative shift in body composition, kidney damage, and more. This guide will address each of those allegations, explore the benefits of adding creatine to your nutrition regimen and provide general recommendations on best practices for use.
Creatine: An Overview
In 2017, the International Society of Sports Nutrition released a position stand on the safety of efficacy of creatine supplementation2. This section summarizes the information in that publication.
What is Creatine?
Creatine is a naturally occurring, non-protein amino acid compound that is in red meat and seafood, nutritionally. The human body stores it in the form of phosphocreatine (PCr) in skeletal muscle as it plays a prominent role in maintaining energy availability.
The most common form of creatine used for supplementation is creatine monohydrate, typically in powder or capsule form. This form of creatine compound appears to be more easily absorbed in the body and is very inexpensive relative to many other nutritional supplements.
Since creatine is abundant in meat-based protein sources, there are currently no sports organizations that ban its use. However, double-checking the label of all of your supplements with your sports dietician is the best practice and worth the extra step to remain compliant.
Why is it important?
Phosphocreatine is a primary source of energy metabolism, namely things that require near-maximal effort like sprints, jumps, heavy 1-2 rep lifts, and so on. However, creatine usage in the body is not limited to athletic events. Day to day, about 1-2% of intramuscular creatine is used and excreted as its “spent” substrate, creatinine.
In addition to buffering free phosphate ions to increase energy availability, creatine also assists the other energy systems indirectly to act as an antioxidant during glycolysis and aerobic oxidation. Overall, this means creatine is a much more important regulator of metabolism than it seems.
Benefits of Creatine Supplementation
High creatine stores in the muscle facilitate an increased capability for maximal-effort performances. The ability to perform one more set at a heavy weight or a few more sprints can, over time, lead to greater gains in strength, muscle mass, or speed that you are training for. Greater capacity for high-speed movements in intermittent-style sports (think: soccer, basketball, tennis, etc.) has also been observed following creatine loading phases in athletes.
When paired with high levels of glucose following an intense training session, creatine appears to assist in the restoration of muscle glycogen. This is crucial, especially for those who are undergoing an intense training cycle, as chronic glycogen depletion can lead to unrecoverable damage and overtraining syndrome3.
Other studies suggest there may be acute recovery benefits to creatine supplementation, like lower inflammatory markers and sustained muscular performance during the initial phases of an intensive training cycle.
Heat Tolerance During Exercise
It has also shown potential in acute intramuscular fluid retention - when the muscles uptake more water - piquing researchers’ interest in potential hydration benefits. Several studies have been done to explore this possibility, and strong evidence suggests those with higher creatine stores exhibit an improved thermoregulatory response during exercise in hot conditions.
Creatine supplementation has been cited as a neuroprotectant in acute and chronic neurodegenerative processes, a contributor to enhanced recovery from mild traumatic brain injuries and ischemic heart events, an effective tool for managing cholesterol as you age2, beneficial for post-menopausal women in the attenuation of muscle mass1, and more.
It is important to consult your doctor before starting a new supplement if you are unsure of its safety or if you have specific health conditions to consider.
Despite repeated success in a wide range of populations, naysayers seem to continually dominate the conversation around creatine supplementation and alleged adverse effects. In 2021, a group of internationally renowned nutrition research experts was assembled to review the literature, address these claims and answer other common questions surrounding creatine1. The following is a summary of some of their findings.
Water Retention: Though some studies show an increased amount of water retention in the early stages of creatine supplementation, the majority of research does not support the notion that total body water relative to muscle mass changes over time.
Kidney Dysfunction: While caution should be exercised when considering any dietary supplement, creatine does not cause renal dysfunction or kidney damage as commonly alleged.
Dehydration and Cramping: Creatine is an osmotic substance, and displays evidence of improved hydration status when used. Claims of dehydration and improved instances of cramping are not validated in research.
Increased Fat Mass: All literature cited by the committee saw no change or even decreased fat mass in populations who used a creatine supplement over short and long periods of time.
Like all peer-reviewed publications, the reliability of research must be considered when reviewing the conclusions of a study. In many cases, these creatine myths stemmed from one or few statements that have since been repeatedly disproven. Have you ever heard the saying, “you can’t unring a bell”?
Finally, here are some strategies for supplementation if you’ve decided that creatine is right for you.
How to Take Creatine
Creatine monohydrate is most commonly sold in its powdered, flavorless form. Research has shown that, when taken with high doses of glucose (a sports drink or fruit juice), the carbohydrates seem to aid in the absorption and delivery of creatine to its intramuscular stores.
When to Take It
There are two camps when it comes to the timing of creatine. Some experts say that timing your creatine supplementation post-workout is beneficial as you are replenishing your intramuscular and intracellular stores when they are low. Others disagree, stating that if you are taking creatine at the recommended dosage, it doesn’t matter much.
In all, the timing seems to be less crucial the longer you’ve been taking creatine since your stored levels are high after initial loaded absorption.
To Load or Not to Load?
Beginning creatine supplementation with a “loading” phase has been widely accepted as “the” way to get the largest and fastest benefit. The loading phase consists of taking 20-25 grams per day (or 0.3 grams per kilogram of bodyweight), usually broken into several servings throughout the day for five to seven days. The loading phase is then followed by the normal dosage of 3-5 grams per day for the duration of your creatine supplementation cycle.
The idea behind this method is that “loading” maximizes intramuscular creatine stores more quickly than normal supplementation without a loading phase.
Conversely, research cites plenty of success and benefits of supplementation without a loading phase being done. This is especially true for individuals who take creatine consistently and long-term.
The expert panel that participated in this review suggested that those who plan to take creatine for an acute period (less than 30 days) may realize its benefits more quickly if they load creatine for the first week of the cycle. In contrast, those who plan to consistently take creatine for longer than 30 days may skip the loading phase and see benefits all the same.
Creatine monohydrate is one of the most beneficial, well-researched compounds on the nutritional supplement market. It has undeniably been the victim of misunderstanding and incomplete information, leaving a lot on the table for those who have avoided its use.
Once vetted by your healthcare provider or sports dietician, dive into this affordable, safe performance enhancer to maximize your training capabilities and reach your goals!
Antonio, Jose, et al. “Common Questions and Misconceptions about Creatine Supplementation: What Does the Scientific Evidence Really Show?” Journal of the International Society of Sports Nutrition, vol. 18, no. 13, 8 Feb. 2021, https://doi.org/10.1186/s12970-021-00412-w.
Cheng, Arthur J., et al. “Intramuscular Mechanisms of Overtraining.” Redox Biology, vol. 35, 2020, p. 101480., https://doi.org/10.1016/j.redox.2020.101480.
Kreider, Richard B., et al. “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, vol. 14, no. 1, 2017, https://doi.org/10.1186/s12970-017-0173-z.