Everything you need to know about creatine

With its many ergogenic benefits, it is no surprise that creatine has been named the most effective supplement currently available for increasing high-intensity exercise capacity and lean body mass during training (1,2).

Although you probably consume creatine every day through the foods you eat such as meat, taking creatine supplements has become progressively popular in the world of health and fitness due to the associated performance-enhancing benefits.

What is creatine?

Creatine is a substance that is found naturally in our muscle cells in the form of phosphocreatine and is one of the body’s natural sources of energy.

It is formed of three amino acids: arginine, glycine, and L-methionine and makes up 1% of the total volume of human blood. About 95% of your body’s creatine stores are in your muscles and the remaining 5% is found in your brain, kidneys and liver (3).

Several influences can affect your creatine stores, including your meat intake, exercise, amount of muscle mass, and your levels of hormones, including testosterone and IGF-1 (3).

How do creatine supplements work?

When creatine enters your body in the form of a supplement and when it is produced by the body naturally, it binds to a phosphate molecule to form phosphocreatine.

Phosphocreatine then works together with the body’s energy source, adenosine triphosphate (ATP), which is a molecule responsible for driving various cellular processes. However, to provide this energy, ATP must hydrolyse a phosphate group. When the phosphate group is hydrolysed the energy, which is given off in the form of heat, is used to drive whichever process is being performed.

At this point, one phosphate has been lost from the ATP and is now known as adenosine diphosphate (ADP). ADP is pretty much useless in the body unless it is converted back into ATP.

The creatine supplement you have just taken now comes into play by donating its phosphate group to the ADP to re-create ATP. The transition from ADP to ATP then increases your ATP stores, thus allowing you to train harder and longer.

As phosphocreatine is also found in your brain, taking supplements has also been found to improve brain health and prevent neurological disease (4,5,6).

Three benefits of creatine 

1. Aids muscle gain

Due to the increase of ATP when supplementing with creatine, you will have more energy to expend on heavy lifting and high-intensity exercise which can help in gaining muscle.

Creatine can also aid muscle gain in the following ways:

• Boosted workload: Enables more total work or volume in a single training session, which is a key factor in long-term muscle growth (7).
• Increased cell hydration: Lifts water content within your muscle cells, which causes a cell volumising effect that may play a role in muscle growth (8,9)
• Lower myostatin levels: Elevated levels of the protein myostatin can slow or inhibit new muscle growth. Supplementing with creatine can reduce these levels, increasing growth potential (10).

Creatine supplements can be effective for both long-term and short-term muscle growth in many different people including sedentary individuals, other adults and elite athletes (11). A 14-week study on older adults found that supplementing creatine whilst weight-training significantly increased leg strength and muscle mass (12).

Another study found that weightlifters who took creatine supplements over 12 weeks saw muscle fibre growth increase 2-3 times more than training alone (13).

2. Improves strength and exercise performance

Normally, ATP becomes depleted after 8–10 seconds of high-intensity activity. However, because taking creatine supplements can help you produce more ATP, you can maintain optimal performance for a few seconds longer (14,15).

In one study, participants found their strength increased by 7%, weightlifting performance by 14% and bench press one-rep max by up to 43% when adding creatine to their training program, compared to training alone (16).

Additionally, when well-trained strength athletes took creatine supplements for 28 days, they saw a 15% increase in bike-sprinting performance and bench-press performance by 6% (16).

3. Improve brain function

As your brain also stores phosphocreatine and requires plenty of ATP for optimal function, taking creatine supplements may also improve several conditions including; Alzheimer’s disease, brain and spinal cord injuries and memory and brain function in older adults (17, 18, 19). A six-month study in children with traumatic brain injury detected a 70% reduction in fatigue and a 50% reduction in dizziness (20).

Research also suggests that creatine supplements can aid vegetarians. As vegetarians do not consume meat, which is the main natural dietary source of creatine, they tend to have low creatine stores. Yet, one study identified that when vegetarians supplemented creatine it caused a 50% improvement in a memory test and a 20% improvement in intelligence test scores (5).

Is creatine safe?

Many studies have been completed to test the safety of taking creatine and it has been established to have no adverse effects. One of the most in-depth studies measured 52 blood markers and observed no adverse effects following 21 months of supplementing (21). While some people have experienced side effects like stomach aches, this is often due to taking too much of the supplement at once or taking it on an empty stomach.

People have also associated creatine with dehydration and cramps, yet, research doesn’t support this link. Studies suggest it can reduce cramps and dehydration during endurance exercise in high heat (22).

Sports performance blood tests

Here at Medichecks, we have a wide range of fitness blood tests that test for up to 57 blood markers which can help to optimise your training and performance. Our Advanced Fitness Blood Test offers an advanced insight into muscle mass (testosterone), anaemia (iron and vitamin B12), as well as stress and over-training (cortisol) and it also includes tests for important nutritional markers which, if low, can affect your training progress.

Creatine kinase (CK) is an enzyme found throughout the body. CK is sometimes included as part of a health screen to investigate signs of muscle damage and high levels in the blood can indicate recent muscle damage. If you're interested to know more on CK, read our guide on what CK is and what it can tell you about your health. 

References

1. Buford, T., Kreider, R., Stout, J., Greenwood, M., Campbell, B., Spano, M., Ziegenfuss, T., Lopez, H., Landis, J. and Antonio, J. (2007). International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), p.6.
2. Kreider, R. (2003). Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem, 244(1-2).
3. Persky, A. and Brazeau, A. (2001). Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacol Rev, 53(2), pp.161-76.
4. Matthews, R., Ferrante, R., Klivenyi, P., Yang, L., Klein, A., Mueller, G., Kaddurah-Daouk, R. and Beal, M. (1999). Creatine and Cyclocreatine Attenuate MPTP Neurotoxicity. Experimental Neurology, 157(1), pp.142-149.
5. Rae, C., Digney, A., McEwan, S. and Bates, T. (2003). Oral creatine monohydrate supplementation improves brain performance: a double–blind, placebo–controlled, cross–over trial. Proceedings of the Royal Society of London. Series B: Biological Sciences, 270(1529), pp.2147-2150.
6. Dechent, P., Pouwels, P., Wilken, B., Hanefeld, F. and Frahm, J. (1999). Increase of total creatine in human brain after oral supplementation of creatine-monohydrate. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 277(3), pp.R698-R704.
7. Becque, M., Lochmann, J. and Melrose, D. (2000). Effects of oral creatine supplementation on muscular strength and body composition. Medicine & Science in Sports & Exercise, 32(3), pp.654-658.
8. Häussinger, D., Roth, E., Lang, F. and Gerok, W. (1993). Cellular hydration state: an important determinant of protein catabolism in health and disease. Lancet, 22(341), pp.1330-2.
9. Schoenfeld, B. (2010). The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training. Journal of Strength and Conditioning Research, 24(10), pp.2857-2872.
10. Saremi, A., Gharakhanloo, R., Sharghi, S., Gharaati, M., Larijani, B. and Omidfar, K. (2010). Effects of oral creatine and resistance training on serum myostatin and GASP-1. Molecular and Cellular Endocrinology, 317(1-2), pp.25-30.
11. Nissen, S. and Sharp, R. (2003). Effect of dietary supplements on lean mass and strength gains with resistance exercise: a meta-analysis. Scandinavian Journal of Medicine and Science in Sports, 13(4), pp.272-272.
12. Volek, J., Duncan, N., Mazzetti, S., Putukian, M., G??mez, A., Staron, R. and Kraemer, W. (1999). PERFORMANCE AND MUSCLE FIBER ADAPTATIONS TO 12 WEEKS OF CREATINE SUPPLEMENTATION AND HEAVY RESISTANCE TRAINING. Medicine & Science in Sports & Exercise, 31(Supplement), p.S103.
13. Greenhaff, P., Bodin, K., Soderlund, K. and Hultman, E. (1994). Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. American Journal of Physiology-Endocrinology and Metabolism, 266(5), pp.E725-E730.
14. Harris, R., Söderlund, K. and Hultman, E. (1992). Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical Science, 83(3), pp.367-374.
15. Rawson, E. and Volek, J. (2003). Effects of Creatine Supplementation and Resistance Training on Muscle Strength and Weightlifting Performance. The Journal of Strength and Conditioning Research, 17(4), p.822.
16. Earnest, C., Snell, P., Rodriguez, R., Almada, A. and Mitchell, T. (1995). The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition. Acta Physiologica Scandinavica, 153(2), pp.207-209.
17. Kaemmerer, W., Rodrigues, C., J. Steer, C. and Low, W. (2001). Creatine-supplemented diet extends Purkinje cell survival in spinocerebellar ataxia type 1 transgenic mice but does not prevent the ataxic phenotype. Neuroscience, 103(3), pp.713-724.
18. Bürklen, T., Schlattner, U., Homayouni, R., Gough, K., Rak, M., Szeghalmi, A. and Wallimann, T. (2006). The Creatine Kinase/Creatine Connection to Alzheimer's Disease: CK Inactivation, APP-CK Complexes and Focal Creatine Deposits. Journal of Biomedicine and Biotechnology, 2006, pp.1-11.
19. McMorris, T., Mielcarz, G., Harris, R., Swain, J. and Howard, A. (2007). Creatine Supplementation and Cognitive Performance in Elderly Individuals. Aging, Neuropsychology, and Cognition, 14(5), pp.517-528.
20. Sakellaris, G., Nasis, G., Kotsiou, M., Tamiolaki, M., Charissis, G. and Evangeliou, A. (2007). Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study. Acta Paediatrica, 97(1), pp.31-34.
21. Kreider, B., Melton, C., Rasmussen, J., Greenwood, M., Lancaster, S., Cantler, C., Milnor, P. and Almada, A. (2003). Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem, 244(2), pp.95-104.
22. Greenwood, M., Kreider, R., Melton, C., Rasmussen, C., Lancaster, S., Cantler, E., Milnor, P. and Almada, A. (2003). Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem, 244(2), pp.83-8.