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Supplements

creatine

What Is It?
Health Benefits
Forms
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Cautions
References

Evidence Based Rating Scale

What Is It?

Creatine is a nitrogen containing organic acid that is primarily made in the body from several amino acids. It assists muscles in producing adenosine triphosphate (ATP)—the substance that fuels bursts of energy on the cellular level. Creatine donates its high-energy phosphate to create the ATP, which muscles can then use for energy. Creatine is manufactured primarily in the liver, pancreas, and kidneys and also acquired from dietary sources such as fish and meat. It’s mostly found in skeletal muscle (95%) and in lesser amounts in other body tissues including the heart, brain, and retina. In recent years, creatine also has become available as a dietary supplement. Taken in this concentrated form, it is popular for enhancing athletic performance and is sometimes used by professional and collegiate athletes, amateur and recreational competitors, and body-builders.

When creatine is taken orally in the form of a powder or pill, it gets absorbed through the intestines and then enters the bloodstream. This provides a ready source of creatine that the body can draw upon during demanding exercise when muscles need quick supplies of ATP to keep on performing at peak levels.

Unfortunately, for reasons that include "overly enthusiastic" advertising, many people now have inflated expectations about what this supplement can do, and some end up taking more than is effective or safe. In addition, although experts still don't know exactly why, some athletes experience no performance boost at all after taking creatine.

Most creatine studies have been done in healthy young males between the ages of 18 and 35. Thus the safety and effectiveness of creatine in women and older individuals is not as well established.

Health Benefits

Some sources recommend taking creatine to treat symptoms of serious illnesses, such as the muscle weakness associated with congestive heart failure. Others contend it can benefit people suffering from neuromuscular disorders, such as muscular dystrophy, stroke, and the hardening of the arteries that feed the heart. There is ongoing research--but still limited evidence--for these uses.

The strongest evidence for taking creatine supplements is to fuel and enhance short bursts of high-energy exercise.

Specifically, creatine supplements may help to:

  • Enhance athletic performance that involves brief bursts of explosive, high-energy activity. The extra energy creatine produces lasts only a few seconds because the body rapidly exhausts its supply of ATP. For this reason, creatine supplements primarily benefit athletes who perform quick spurts (20 to 50 seconds) of intense activity followed by short periods of less instense activity such as resistance training or weight-lifting. (1, 2) Creatine significantly enhances the ability to generate higher muscular force and power for these critical energy bursts.

    Creatine has been shown to improve performance in high-output sports, such as swimming (in men only), jumping, and short-term cycling. (3-7) However, once saturated with creatine, the muscles can't absorb any more, and the excess creatine then gets excreted in the urine. For these and other reasons, creatine supplements don't benefit endurance sports.

    Studies are conflicting concerning the effects of creatine on sprinting. A 1995 study showed that taking 5g of creatine supplements four times per day for five days enhanced both single and multiple short sprint performance. (8) However, in a 2006 study, 42 physically active men were given 5g of creatine and 1g of maltodextrin four times per day for five days. The men experienced a 0.7kg increase in body mass and a 0.4% reduction in body fat when compared to the placebo group, but there were no differences in multiple sprint performances. (9)

    Special note on strength training: Many body-builders hope to develop bigger muscles by taking creatine supplements. And while creatine does indeed provide enhanced power for weight lifting, most people end up disappointed over the long run. Here's what generally happens: after taking creatine for a few days, urine production plummets and the body starts retaining fluids. The amount of creatine in muscles does increase, but the muscles become larger only temporarily because they're full of water. In contrast, strength training through activities such as weight lifting, involves physical stress on the muscles and actually increases the mass of the muscles by stimulating the growth of muscle cells. (10)

  • Improve muscle strength in congestive heart failure. In one study, 20 individuals suffering from congestive heart failure for at least six months were given either placebo or 5g creatine orally four times a day for six weeks in conjunction with standard medication. At the end of six weeks, the creatine group showed a significant increase in body weight and improvement in skeletal muscle strength compared to the placebo group. An earlier study also suggested creatine supplementation improved aerobic power but had no effect on heart function or structure. (11-12) In contrast, in a study done in Italy, intravenous creatine improved cardiac function in the hospital setting when given along with conventional pharmacologic therapy. (21)

  • Slow vision loss from gyrate atrophy of the choroid and retina. This chromosomal abnormality affects the light sensing tissue known as the retina that lines the inside of the eye and the thin vascular layer between the retina and the white of the eye  known as the choroid. Individuals experience progressive vision loss with total blindness usually occurring between the ages of 40 and 60. In small studies, daily supplementation with 1.5-2.0 grams of creatine for 1-15 years appeared to slow vision loss (13).

  • Relieve symptoms of McArdle's Disease. McArdle's Disease is a rare inherited muscle condition in which the muscles cannot convert stored glycogen to glucose for energy. Individuals experience fatigue and are unable to complete strenuous exercise due to muscle pain and cramping. There is conflicting evidence for the benefit of creatine in McArdle’s Disease. In one small study, a daily high dose of creatine supplement (150mg/kg of body weight) decreased muscle pain resulting from exercise and increased exercise capacity in some individuals suffering from McArdle's Disease. (14) However, a Cochrane review of studies showed the same dose of creatine supplementation increased muscle pain in patients with McArdle's Disease. (15)

  • Alleviate symptoms of various muscular dystrophies. The group of disorders known as muscular dystrophy involves loss of muscle tissue and muscle weakness that becomes worse over time. In one study, 36 individuals received either creatine supplements or placebo for eight weeks. Individuals who received supplements experienced mild but significant improvement in muscle strength and ability to perform daily activities. (16)

  • Enhance effects of resistance training in individuals with Parkinson's Disease (PD). Individuals with Parkinson’s Disease experience decreased muscle mass and strength and increased fatigue. In one study, 20 individuals received resistance training combined with either placebo or 20g creatine per day for five days followed by 5g each day thereafter. After twelve weeks, the creatine group showed significant improvement in muscle strength. (17) In another study of 60 individuals with PD, creatine supplementation improved mood and led to a smaller increase in dosage of dopamine—a common treatment used in Parkinson's Disease.  (18)

Forms

  • powder
  • liquid

Dosage Information

Special tips:
--Although you may see different types of creatine on the shelves of health-food stores (including creatine citrate and creatine phosphate), try to buy creatine monohydrate; it's the form used in most of the clinical studies done on creatine.

--Stick to recommended dosages. The body can only absorb and use a limited amount of supplemental creatine; taking excess amounts is therefore pointless, expensive, and even potentially unhealthy for the liver and kidneys, since they will try to process this compound. A point to remember: extra creatine never reaches the muscles—it is simply excreted in urine.

--One teaspoon of creatine monohydrate is equivalent to 5 grams.

  • For enhanced exercise performance: Start with 2 to 4 teaspoons of creatine monohydrate daily for five days, then reduce the daily dose to 1 teaspoon (5 grams). It is unlikely that there will be any additional benefit in taking more than 20 grams of creatine a day beyond 5 to 7 days.

  • For congestive heart failure. 5g four times per day for six weeks (11)

  • For gyrate atrophy: 1.5g per day (13)

  • For McArdle's Disease: 150mg/kg body weight daily for 5 days followed by 60 mg/kg per day for 5 weeks (14)

  • For Muscular Dystrophy: 10g per day for adults and 5g per day for children (16)

  • For Parkinson's Disease. 20g per day for five days followed by 5g per day for 12 weeks (17)

Guidelines for Use

  • Opt for pure creatine products. Products that combine creatine with other compounds (e.g. caffeine, vitamins, minerals, taurine, herbal extracts,) do not appear to provide any added benefit. There is even evidence that the caffeine in coffee, sodas and other products may make creatine less effective, so try to avoid combining different substances.

  • Don't overdo it. The body retains most of the creatine taken in supplement form within the first few days. With continued daily consumption, 90% or more of the added creatine is excreted because the muscles have absorbed all that they can from the blood. Creatine levels return to baseline after 28 days without supplementation. (19)

  • Stay hydrated. Because creatine may have a mildly dehydrating effect in some people, drink plenty of water when taking it.

General Interaction

  • Muscle creatine levels increase more when creatine is taken with simple carbohydrates than when taken in isolation. This has led to the development of sports drinks that combine the two. (22)

  • There is some concern that creatine taken with either caffeine or ephedra (Ma huang) may increase the risk of serious side effects such as ischemic stroke. (20)

Possible Side Effects

  • No serious side effects have been reported with creatine supplements. However, a lack of adverse effects does not mean that this compound is necessarily safe. In particular, it remains unclear what negative health effects creatine supplementation may have when taken over months or years, particularly by adolescents whose bodies are still growing and changing.

  • Side effects related to creatine use include some cases of brief but acute dehydration, diarrhea, and stomach cramps. Muscle cramps have been reported to occur in as many as 25% of male college athletes using the substance. Although these reports are anecdotal, regular creatine users should be aware of such possible problems.

  • Another common side effect, especially at higher than commonly recommended doses, is water retention. Many users mistake this retention for true, long-lasting muscular weight gain.

Cautions

  • More is not better when it comes to taking creatine supplements. In fact, just because a little creatine can sometimes boost performance, it's potentially hazardous to the health to take very high doses of creatine for a prolonged period of time. Experts caution that extended high doses can lead to kidney and liver problems.

  • Don't take high doses of creatine immediately before or during exercise: cases of nausea, vomiting, and diarrhea have been reported.

  • Avoid taking creatine when exercising outdoors in the heat. When entering the muscles, creatine draws water from the blood along with it as well: this may lead to dehydration, heat exhaustion, muscle cramps, and other problems. (Instead, be sure to drink plenty of water and electrolyte-enhanced fluids to replace what the body loses under such circumstances.)

  • Long-term use of high doses of creatine could potentially damage the kidneys. Don't take creatine if your kidney function is impaired.

  • Avoid taking high doses of creatine with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin or ibuprofen because doing so may put added stress on the kidneys.

References

1. Vandenberghe K, Goris M, Van Hecke P, Van Leemputte M, Vangerven L, Hespel P. Long-term creatine intake is beneficial to muscle performance during resistance training. J Appl Physiol. 1997 Dec;83(6):2055-63.
2. Kerksick CM, Wilborn CD, Campbell WI, Harvey TM, Marcello BM, Roberts MD, Parker AG, Byars AG, Greenwood LD, Almada AL, Kreider RB, Greenwood M. The effects of creatine monohydrate supplementation with and without D-pinitol on resistance training adaptations. J Strength Cond Res. 2009 Dec;23(9):2673-82.
3. Leenders NM, Lamb DR, Nelson TE. Creatine supplementation and swimming performance. Int J Sport Nutr. 1999 Sep;9(3):251-62.
4. Bosco C, Tihanyi J, Pucspk J, et al. Effect of oral creatine supplementation on jumping and running performance. Int J Sports Med 1997;18:369-72.
5. Bemben MG, Lamont HS. Creatine supplementation and exercise performance: recent findings. Sports Med. 2005;35(2):107-25.
6. Birch R, Noble D, Greenhaff PL. The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man. Eur J Appl Physiol Occup Physiol. 1994;69(3):268-76.
7. Prevost MC, Nelson AG, Morris GS. Creatine supplementation enhances intermittent work performance. Res Q Exerc Sport. 1997 Sep;68(3):233-40.
8. Dawson B, Cutler M, Moody A, Lawrence S, Goodman C, Randall N. Effects of oral creatine loading on single and repeated maximal short sprints. Aust J Sci Med Sport. 1995 Sep;27(3):56-61.
9. Glaister M, Lockey RA, Abraham CS, Staerck A, Goodwin JE, McInnes G. Creatine supplementation and multiple sprint running performance. J Strength Cond Res. 2006 May;20(2):273-7.
10. Williams MH, Branch JD. Creatine supplementation and exercise performance: an update. J Am Coll Nutr. 1998 Jun;17(3):216-34.
11. Kuethe F, Krack A, Richartz BM, Figulla HR. Creatine supplementation improves muscle strength in patients with congestive heart failure. Pharmazie. 2006 Mar;61(3):218-22.
12. Murphy AJ, Watsford ML, Coutts AJ, Richards DA. Effects of creatine supplementation on aerobic power and cardiovascular structure and function. J Sci Med Sport. 2005 Sep;8(3):305-13.
13. Persky AM, Brazeau GA. Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacol Rev. 2001 Jun;53(2):161-76.
14. Vorgerd M, Grehl T, Jager M, et al. Creatine therapy in myophosphorylase deficiency (McArdle disease): a placebo-controlled crossover trial. Arch Neurol 2000;57:956-63.
15. Kley RA, Vorgerd M, Tarnopolsky MA. Creatine for treating muscle disorders. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004760.
16. Walter MC, Lochmuller H, Reilich P, et al. Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study. Neurology 2000;54:1848-50.
17. Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair. 2007 Mar-Apr;21(2):107-15.
18. Bender A, Koch W, Elstner M, Schombacher Y, Bender J, Moeschl M, Gekeler F, Müller-Myhsok B, Gasser T, Tatsch K, Klopstock T. Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial. Neurology. 2006 Oct 10;67(7):1262-4.
19. Febbraio MA, Flanagan TR, Snow RJ, et al. Effect of creatine supplementation on intramuscular TCr, metabolism and performance during intermittent, supramaximal exercise in humans. Acta Physiol Scand 1995;155:387-95.
20. Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
21. Ferraro S, Codella C, Palumbo F, et al. Hemodynamic effects of creatine phosphate in patients with congestive heart failure: a double-blind comparison trial versus placebo. Clin  effects. J Am Diet Assoc 1999;99:593-5.Cardiol 1996;19:699-703.
22. Green AL, Simpson EJ, Littlewood JJ, et al. Carbohydrate ingestion augments creatine retention during creatine feeding in humans. Acta Physiol Scand 1996;158:195-202.
23. Juhn MS, O'Kane JW, Vinci DM. Oral creatine supplementation in male collegiate athletes: a survey of dosing habits and side

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Athletic performance

   

Creatine supplements are most effective for improving muscular strength during quick spurts of intense athletic activity followed by periods of rest. (1-2)

Congestive Heart Failure  
In one study, 5g creatine taken four times a day for six weeks in conjunction with standard medication improved skeletal muscular strength compared to placebo. (11)

Muscular Dystrophy   Date Published: 04/18/2005
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