Supplement Spotlight: Break Through with Creatine

Creatine is a useful supplement for building muscle and quick burst of energy

By: Michael Shadowen

What is Creatine?

Creatine is one of the body’s natural sources of energy for muscle contraction. Half of our stores comes from diet and the other half comes from the liver, kidneys and then delivered to the skeletal muscles for use. About 95% of creatine is in the skeletal muscle of the body for use during physical activity. It helps to maintain a continuous supply of energy to working muscles by keep production up in working muscles. Also, small amounts are present in your heart, brain and other tissues.

Creatine is predominantly found in foods such as milk, red meat and seafood. In a normal omnivorous/carnivorous diet, individuals consume 1-2 grams/day. Vegetarians may have lower amounts in their bodies due to the absence of these high-volume creatine foods.

Creatine exists in a steady state with a similar compound named creatinine measured in lab tests as a marker of kidney function. It is excreted via urine. This means your body must release stored creatine each day to keep normal levels, the amount depending on your muscle mass. Although creatine is created naturally in your body, you must keep up your levels through your daily diet.

Why supplement with Creatine?

Many professional and amateur athletes take creatine supplements as an ergogenic aid to improve their performance and recovery. Creatine creates “quick burst” energy and increased strength, which improves performance, especially for athletes who consistently train at high intensities and utilize weight training. Therefore, the majority of people taking these supplements are power sport athletes, such as football, wrestling, hockey, and bodybuilding. Vegan and vegetarian athletes may also greatly benefit from supplementing with creatine, and could see the highest increases in their phosphocreatine stores.

These professional sports associations allow this supplement: The International Olympic Committee and the National Collegiate Athletic Association (NCAA). Benefits occur in men and women, although historically most studies were conducted on men. Ultimately, the gains in muscle mass appear to be a result of an improved ability to perform high intensity exercise, allowing an athlete (amateur or professional) to train harder and thereby promoting greater training adaptations and muscle hypertrophy.

Which Version is the Best?

Creatine Monohydrate (CM) is one of the most researched supplements today with over 20 years of clinical and sports nutrition research supporting both its safety and effectiveness. Studies have consistently reflected increases in phosphocreatine stores translating to subsequent increases in power and strength in regards to CM supplementation.

Creatine monohydrate is a creatine molecule plus a water molecule. However, manufacturers commonly process this form in slightly different ways. For example, some manufacturers use micronized creatine, which involves slightly more processing to improve the supplement’s solubility. Other manufacturers leave the water molecule out completely. This creates anhydrous creatine, or 100 percent creatine. Although 100 percent sounds appealing, it is also more expensive. Plenty of research supports the effectiveness of every variation of CM. There is extensive evidence that shows how it increases energy, power and stamina during workouts. This form also brings more water into the muscle. It’s most effective to use a loading phase to build up stores in the muscle. Without this phase, the muscles and your workouts won’t reap all of the benefits.

Loading Phase: Dosage of 20 grams/day for 5-7 days

This dose is typically divided into four 5-gram servings throughout the day.
The loading phase can rapidly increase muscle stores, allowing you to reap the benefits faster

Maintenance Phase: Dosage of 3-5 grams/day

After the loading phase, maintain your creatine stores by taking a lower dose
This dose can be safely consumed for up to 5 years.

Here’s a refresher on how a supplementing works for muscle growth. First, remember that your muscles already store creatine from your diet. When released, creatine:

Improves exercise performance.
Increases insulin-like growth factor 1 (IGF-1), a hormone that helps with muscle growth.
Helps athletes tolerate heavy training loads by boosting energy, power, and endurance to get more out of workouts
Promotes better recovery after a workout.
Prevents and/or reduces the severity of injury.

Other Forms

There are actually several forms of creatine. Although the others aren’t quite as popular as CM, it’s worth discussing the key differences between these novelty forms:

Creatine Ethyl Ester – some claim that this form of creatine is better absorbed in fat. Marketed as an “advanced creatine” that is designed and marketed to enhance the uptake of creatine in cells – much more than that of CM. However, the limited research on this form actually suggests that more is excreted, which could be hard on the kidneys.
Buffered Creatine – the addition of a slightly basic “buffer” is claimed to decrease creatine breakdown in the stomach and therefore enhance absorption in the muscle. Essentially creatine with an alkaline buffer marketed to assist with stability in stomach acid, thus leading to better absorption and less creatine degradation.
Creatine Citrate – this form binds creatine with citrate. Although it is more water soluble, it’s not thought to be better absorbed.
Creatine Magnesium Chelate – this is simply creatine bound to magnesium. The magnesium may limit water retention. This form limited in the literature and not as extensively researched.
Creatine Malate – this form binds creatine and malic acid, which may improve stamina. . This form is also limited in the literature and not as extensively researched.

This is NOT to say that novelty creatines do not work. They do, however, appear to be less effective. As of right now, CM is the gold standard choice for supplementation.

Is it Safe?

Although creatine is present naturally in your body, taking additional supplements appears to be generally safe. The International Society of Sports Nutrition is on board with using a creatine supplement. In their position stand, they state that long and short-term creatine use is safe and well-tolerated by generally healthy people. However, the U.S. Food and Drug Administration does not regulate nutritional supplements. Products sold in stores vary in quantity of creatine supplement, quality and additional ingredients. Companies don’t have any safety and purity requirements; any testing is voluntary. It is a good idea to check with your healthcare provider about use of creatine supplements. Note that they might not specify which type is the best. Although creatine has many variants, the vast majority of peer-reviewed studies use creatine monohydrate.

Best Practices

Although several forms of creatine exist on the market, it is evident that CM is the most thoroughly-researched form. No matter the kind of creatine, remember that quality matters. Avoid fillers, sweeteners, and artificial ingredients as often as possible when shopping for fitness supplements. Pay for the supplement, not the unnecessary stuff. Finally, take creatine as recommended.

If you’d like to talk more about creatine or other supplements, including leucine/BCAAs, Vitamin D or probiotics, contact Dr. Schubert. To make sure you buy a safe version, learn how to pick supplements that have third party testing. If you want more consistent input, check out the Nutrition Coaching service and description.

References:

Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Int Soc Sports Nutr. 2013;10:36.
Candow DG, Chilibeck PD, Burke DG, Mueller KD, Lewis JD. Effect of different frequencies of creatine supplementation on muscle size and strength in young adults. J Strength Cond Res. 2011;25(7).
Candow DG, Forbes SC, Roberts MD, et al. Creatine O’Clock: Does Timing of Ingestion Really Influence Muscle Mass and Performance?. Front Sports Act Living. 2022;4.
del Favero S, Roschel H, Artioli G, et al. Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance. Amino Acids. 2012;42(6).
Hall M, Trojian TH. Creatine supplementation. Curr Sports Med Rep. 2013;12(4):240-244.
Jäger R, Purpura M, Shao A, Inoue T, Kreider RB. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011;40(5):1369-1383.

Jagim AR, Oliver JM, Sanchez A, et al. A buffered form of creatine does not promote greater changes in muscle creatine content, body composition, or training adaptations than creatine monohydrate. J Int Soc Sports Nutr. 2012;9(1):43.
Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis. Sports Med. 2017;47(1).
Spillane M, Schoch R, Cooke M, et al. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. J Int Soc Sports Nutr. 2009;6:6.
Vargas-Molina S, et al. A randomized open-labeled study to examine the effects of creatine monohydrate and combined training on jump and scoring performance in young basketball players, Journal of the International Society of Sports Nutrition, 2022; 19:1.
Woods B. Creatine monohydrate vs. hcl: Which One is best for you? Naked Nutrition. Published February 2021.
Zuniga JM, Housh TJ, Camic CL, et al. The effects of creatine monohydrate loading on anaerobic performance and one-repetition maximum strength. J Strength Cond Res. 2012;26(6):1651-1656.

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