Creatine: From Muscle & Performance to Health Benefits

​There is little creatine can’t do for those trying to improve muscle size, strength, power and high-intensity performance. Creatine is one of the most studied supplements in the world and is one of the few that actually works, for most. Most would already know how powerful creatine can be for performance and muscle gains but what many don’t know is that it also has a myriad of health and well-being benefits. Creatine has been shown to help with things such as cognitive function and disease, pregnancy, fatigue, cardiovascular health, mood enhancement and mental health!

What is Creatine - Is It a Steroid?

Creatine is not a steroid! It’s not illegal; it’s not banned from any sport, and it’s extremely safe! Contrary to what many may think, creatine is not a steroid. In fact, you already have creatine in your body – right now! The body creates creatine naturally from three amino acids - glycine, arginine and methionine - but it can also be found in food sources such as meat and fish. Many will have a decent pool of creatine in their body but could benefit from increasing their body's stores, especially those who don't obtain a great amount from their diet, such as vegetarians and vegans.

The body’s energy currency (what it uses to create energy) is ATP (adenosine triphosphate). As the name suggests, ATP has three phosphates. When energy is required to carry out work, a phosphate group is cleaved off from ATP to release energy and, consequently, results in ADP (adenosine di-phosphate – i.e., it now only has two phosphates attached). ADP is practically useless for the body and must have a phosphate group reattached to recreate ATP. This is where creatine comes in. ​ When creatine is consumed from a supplement or the diet, or simply after the body creates creatine itself from the three amino acids, it binds to a phosphate to create what’s called phosphocreatine (1). Phosphocreatine can quickly donate this phosphate to ADP to recreate ATP. Now that ATP has been regenerated, it can serve to create energy again. That’s all that creatine is – a simple molecule that helps to recycle unusable ADP into a useable source of energy as ATP.

Performance & Muscle Benefits

The performance and muscle gain benefits of creatine have long been studied and include increased strength, power, speed, high-intensity performance and muscle mass.

Increased strength

A significant increase in strength performance has been shown after 12 weeks of supplementing with creatine in combination with resistance training (2). The increase in strength performance was due to an increase in the total creatine pool (i.e., amount of creatine in the working muscles), which allowed athletes to maintain higher training intensities and improve the quality of their workouts.

Improved High-Intensity Performance

Creatine supplementation has been shown to enhance high-intensity exercise performance. Improvements include:

• maximal power/strength by up to 15%,
• total work performed during maximal effort muscle contractions by up to 15%,
• single-effort sprint performance by up to 5%, and
• total work performed during repetitive sprint performance by up to 15% (3).

Due to its direct role in ATP production, it can improve power production, muscle endurance, sprint ability, resistance to fatigue, recovery, and cognitive performance in sport settings. The best part? It can give you performance benefits REGARDLESS of your current fitness level (4). How good is that?!

Increased Muscle Growth Potential

Creatine can boost the formation of proteins that create new muscle fibers and raise the levels of insulin-like growth factor-1 (IGF-1); a hormone that promotes increases in muscle mass (5). Some research also indicates that creatine decreases levels of myostatin; a molecule responsible for stunting muscle growth. Therefore, reducing myostatin could help you to build more muscle and possibly at a faster rate (6).

Creatine is basically a must-have for anyone wanting to improve their strength, speed, power, high-intensity performance, and muscle size.

Health-Specific Benefits

Unlike the muscle and performance benefits of creatine, the health benefits are relatively new and research is only just starting to show how powerful it can be for pregnancy, mood and mental health, cognitive function, fatigue, and cardiovascular and general health! ​

Healthy Pregnancy

This is a relatively new area of research so please, always consult with your healthcare provider before supplementing. During pregnancy, there is an increased demand for, and use of, creatine since the fetus has to rely on the mother’s creatine stores. Maternal creatine supplementation studies have shown that supplementing with creatine during pregnancy can have positive effects on fetal growth, can be useful to help promote healthy neural development, and can assist recovery from complications resulting from inadequate oxygen supply (7).

Improved Moods & Mental Health

Improvements in mood were seen in studies using 5 g of creatine per day over the course of 8 weeks. One of the leading explanations is that creatine acts on neurotransmitter balance and function in the brain (8).

Improved Cognitive Function

Creatine has been shown to help improve short-term memory and intelligence/reasoning, especially for the aging, highly stressed, and those who practice vegetarianism (9). Therefore, creatine can be highly beneficial for those with high-stress, high-pressure, and high-cognitive demand type of jobs, students studying, and those who do not consume a lot of meat or fish.

Athletes can also benefit from its cognitive improvements. It has also been shown to be effective at preventing cognitive fatigue after strenuous mental activity during moderate-intensity exercise (10). This is due to creatine helping to delay physical fatigue and, therefore, minimise oxygen deprivation to the brain.

Lastly, creatine is beneficial for those with a traumatic brain injury (TBI) (11) and may play an important role in the severity and progression of a wide variety of brain-related diseases including Huntington’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS) (12).

Fatigue

Creatine has been shown to reduce fatigue episodes from 90% to almost 10% in those with a TBI (10) and has been shown to reduce fatigue - although to a lesser extent - in those experiencing sleep deprivation (12). Therefore, creatine supplementation can be very beneficial for those who are prone to poor sleep, such as parents, shift workers, and even those who simply live busy lives and don’t get an ideal amount of sleep each night.

Cardiovascular & General Health

Creatine has been shown to lower cholesterol and triglycerides, reduce homocysteine (a marker of inflammation) levels, minimise bone loss, assist with blood sugar level management, improve cardiovascular function, and reduce fat accumulation in the liver as we age (8).

Creatine isn't just for building muscle and improving physical performance, it can help with many general health and disease conditions.

How to Supplement

Creatine monohydrate is the tried and tested version, however, other forms of creatine can also be used but are unlikely to result in better results. Liquid versions of creatine (e.g., creatine found in ready-to-go pre-workouts) are unstable and degrade quickly, consequently making them less effective.

You can ‘load’ creatine for a short period, such as a week, with mega-doses to saturate the cells faster (this is beneficial for those who are just starting to supplement with creatine and need the benefits of it within a matter of days or weeks) or simply supplement with smaller doses daily (this will result in maximum saturation of the cells within a few weeks). Taking up to 20 g per day in 4-5 divided doses is best for loading whereas 3-5g per day is sufficient for a gradual supplementation and maintenance dose. There is no best time to take creatine; just ensure to take it consistently each day to increase/maintain creatine concentration in the muscles.

Are There Any Side Effects?

There have been numerous studies conducted on the side effects of creatine supplementation and to date, they have been limited to stomach cramping that can occur when creatine is supplemented without enough water; so pay extra attention to your hydration status (13). Nausea and diarrhoea may occur when large doses of creatine are supplemented (e.g., during a loading period), however, spreading out the dosage as much as possible can help to minimise digestive discomfort.

Conclusion

Creatine remains to be one of the few nutritional supplements that research has consistently shown associated performance-related benefits. In more recent times, creatine supplementation has also been shown to have a host of health-related benefits; it’s not just for those training hard - it’s beneficial for a far more diverse population than we originally thought. Just about everyone can benefit from it, especially those who don't consume a great amount of meat or fish in the diet.

References

1. Wallimann T, Wyss M, Brdiczka D, Nicolay K, Eppenberger HM (January 1992). "Intracellular compartmentation, structure and function of creatine kinase isoenzymes in tissues with high and fluctuating energy demands: the 'phosphocreatine circuit' for cellular energy homeostasis". The Biochemical Journal., 281 (Pt 1): 21–40.
2. Volek J, Duncan N, Mazzetti S, Staron R, Putukian M, Gómez A, Pearson D, Fink W, Kraemer W. (1999). Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc., 31:1147–1156.
3. Kreider RB (2003) Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem., 244(1-2):89-94.
4. McNaughton LR, Dalton B, Tarr J. (1998) The effects of creatine supplementation on high-intensity exercise performance in elite performers. Eur J Appl Physiol Occup Physiol., 78(3):236-40
5. Deldicque L, Theisen D, Bertrand L, Hespel P, Hue L, Francaux M (2007). Creatine enhances differentiation of myogenic C2C12 cells by activating both p38 and Akt/PKB pathways, Am J Physiol Cell Physiol., 293(4):C1263-71.
6. Saremi A, Gharakhanloo R, Sharghi S, Gharaati MR, Larijani B, Omidfar K. (2010) Effects of oral creatine and resistance training on serum myostatin and GASP-1. Mol Cell Endocrinol., 317(1-2):25-30.
7. Dickinson H, Ellery S, Ireland I, LaRosa D, Snow R, Walker D. (2014) Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy, BMC Pregnancy Childbirth.,14: 150.
8. Kreider R, Kalman D, Antonio J, Ziegenfuss T, Wildman R, Collins R, Candow D, Kleiner SM, Almada A, Lopez H. (2017) International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr., 13;14:18.
9. Avgerinos K, Spyrou N, Bougioukas K, Kapogiannis D. (2018) Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Exp Gerontol., 108: 166–173.
10. McMorris T, Harris RC, Swain J, Corbett J, Collard K, Dyson RJ, Dye L, Hodgson C, Draper N. (2006) Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol. Psychopharmacology (Berl)., 185(1):93-103.
11. Sakellaris G1, Kotsiou M, Tamiolaki M, Kalostos G, Tsapaki E, Spanaki M, Spilioti M, Charissis G, Evangeliou A. (2006) Prevention of complications related to traumatic brain injury in children and adolescents with creatine administration: an open label randomized pilot study. J Trauma., 61(2):322-9.
12. Watanabe A, Kato N, Kato T. (2002) Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res., 42(4):279-85.
13. Lopez R, Casa D, McDermott B, Ganio M, Armstrong L, Maresh C. (2009) Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses. J Athl Train. 44(2):215-23.