Author: Vivien Kurse

Editor: Benjamin Gheen

Although creatine has been one of the oldest supplements on the sports nutrition market for well over three decades, many physique and strength athletes alike still do not understand what the substance is and whether they should take it. Creatine is a natural occurring amino acid primarily found inside muscle cells. Similar to caffeine, creatine is considered an ergogenic aid meaning it acts as an energy buffer in cellular metabolism. In other words, creatine supplementation can increase your capacity for energy production particularly during heavy anaerobically-related exercise (e.g. resistance training).

Background

The majority of the body’s creatine stores are found in skeletal muscle (~95%) with small amounts found in the brain and testes (~5%). Each day roughly 1-2% of the creatine stored in our muscles is reduced and removed in our urine. As a result, the body needs to replenish about 1-3 grams of creatine per day to maintain normal creatine stores, depending on the amount of muscle mass an individual has. About half of the daily need for creatine can be obtained via an omnivore-based diet. For example, one pound (~450 grams) of uncooked beef and salmon provides between 1-2 grams of creatine. The remainder of creatine in our bodies can be synthesized by the liver. However, vegetarians have been shown to have lower creatine stores within the muscle due to the lack of meat consumption. In a normal diet that contains 1-2 grams per day of creatine, muscle creatine stores are about 60-80% saturated. Consequently, dietary supplementation of creatine can serve as a means to increase the body’s creatine stores by 20-40%, even more so for vegetarians.

How much does creatine supplementation improve strength and power-based activities?

A quick look at some of the available evidence seems to indicate performance improvements in strength and power around ~5-15% which may provide a minor incentive for physique athletes and strength athletes alike.

Does supplementing with creatine lead to greater hypertrophy?

Dietary supplements are defined as substances produced with the intention of providing nutrients to the body that it would otherwise get from your current diet. Supplements are commonly used to achieve recommended baselines of certain nutrients or to exceed levels of certain nutrients that likely would not be achieved normally by most diets to attain additional benefits.

In the case of creatine, numerous studies have determined that a combination of creatine supplementation and resistance training does result in greater gains in lean mass compared to resistance training and a placebo. However, lean mass is not a precise measure of skeletal muscle mass, it is merely a proxy to skeletal muscle mass, because lean mass includes all non-fat tissue including body water. Therefore, measuring lean mass unfortunately is not the best measure of skeletal muscle mass because it is not a ‘1-to-1’ measure. Measuring lean mass accounts for all non-fat tissues includes skeletal muscle tissue along with connective tissue, fluctuations in hydration etc. As a result, further research was needed to determine more representative data regarding benefits of combining creatine supplementation with resistance training. A question Burke and colleagues set out to answer in their 2023 systematic review and meta-analysis.

Based on the systematic review with meta-analysis by Burke et alfindings, the effect of combining creatine supplementation with resistance training is a ‘trivial to small’ magnitude of effect. The implications of the findings suggest that the significance on an individual level is likely small. Such findings should make sense since when reflecting on dietary supplements as a whole which are, by default, supplemental to providing the body with nutrients so we must consider the magnitude of effect when it comes to dietary supplements.

What are the different forms of creatine? Which form(s) of the supplement creatine are most effective?

Although many forms of the dietary supplement creatine do exist including creatine citrate, creatine serum, creatine ethyl ester, buffered forms of creatine, or creatine nitrate, none of these forms of creatine have been shown to be superior to creatine monohydrate. This is due to creatine monohydrate having the highest bioavailability, how well the body can absorb and utilize a substance.

What are creatine’s side effects?

There have been no substantial side effects found to supplementing creatine over a longer period of time and safe to you to improve performance in the gym. It is safe to use and so far only benefits have resulted in supplementing it.

As mentioned above, creatine aids in the synthesis of muscle tissue and helps us gain energy. However, one other common side effect is the retention of water in the body. It will often cause the weight on the scale to increase after taking creatine for a prolonged period of time. This common side effect, however, it is minor and should not be a cause for worry.

How much creatine should I take? What is the appropriate dosing of creatine?

If you perform resistance training routinely like a natural physique athlete or a strength athlete often does, creatine monohydrate may be a cost effectivecost-effective dietary supplement to consider. A daily dose of 3-5 grams of creatine monohydrate is enough to ‘fill up’ the body’s stored form of creatine (phosphocreatine) and hopefully lead to a slight performance benefit.

Should I load creatine?

Although creatine loading protocols are a viable option (5 grams 4x a day for 5-7 days), It is not necessary to undergo a loading phase to reap creatine’s benefits. Your body’s creatine stores will likely be close to saturation by 28 days at 5 grams per day. Additionally, once creatine stores in the muscle are elevated, it generally takes 4-6 weeks for creatine stores to return to baseline.

What are creatine’s side effects?

Creatine supplementation is well-established to be safe with short term and longer term (up to 30g/day for 5 years) supplementation being tolerated in healthy people. Supplementing with creatine does not lead to kidney damage nor renal dysfunction in healthy individuals. Also, the majority of evidence on creatine supplementation does not support a link to hair loss. However, creatine can lead to some water retentionretention, but this is more likely to occur during the initial loading phase if used.