Creatine – What It Is and How It Works

Creatine powder and capsules next to dumbell

Creatine is among the most tested bodybuilding supplements for increasing workout gains and performance. It has been shown to increase muscle mass, boost strength and enhance workout performance.(1)

Creatine also provides numerous other health benefits, including protection from neurological diseases.(2) Although there is a belief by some that creatine is not safe and/or is associated with negative side effects, there is no evidence to support these claims.

To the contrary, it is one of the most researched fitness supplements and has demonstrated itself to be very safe to use.(3) Continue reading to learn everything you need to know about creatine.

What Is Creatine?

Creatine is a naturally-occurring substance located in muscle cells, and it helps the muscles generate energy during high-intensity exercise and heavy lifting. Among bodybuilders and sports athletes, creatine use as a supplement is a common practice in order to build muscle, increase strength and improve athletic performance.

It is chemically very similar to amino acids. In fact, the body can produce it’s own creatine from the amino acids arginine and glycine.

The body’s supply of creatine can be affected by several factors, such as meat consumption, exercise, muscle mass and certain hormone levels, such as IGF-1 and testosterone. The vast majority of creatine (around 95%) is stored as phosphocreatine in the muscles, while the remaining 5% is located in the brain, liver, and kidneys.

Through supplementation, the stores of phosphocreatine are increased. Phosphocreatine is a type of stored energy in the cells, and it assists the body in producing greater amounts of ATP.

ATP is high-energy molecule often referred to as the energy currency of the body. Increased levels of ATP allow for greater performance during exercise.

Additionally, creatine optimizes a number of cellular processes that contribute to muscle growth, greater strength, and improved recovery.(4)

Key Points
Creatine is a naturally-occurring substance found in the body, primarily in muscle cells. It is commonly used as a  fitness supplement.

How It Works

Creatine can increase athletic performance and overall health in a number of ways. Its main function is to boost the stores of phosphocreatine in the muscles when the body is engaged in high-intensity exercise.(5)

These increased stores can then be utilized to create more ATP, the essential source of energy needed for high-intensity exercise and heavy lifting. Creatine also helps with muscle growth in the following ways:

  • Increases workload: Allows for greater total work or volume per workout session, which plays a key role in long-term muscle growth.
  • Enhances cell signaling: Enhances satellite cell signaling, which helps with muscle repair and the growth of new muscle.
  • Boosts anabolic hormone Levels: Research shows an increased levels of certain hormones, including IGF-1 and testosterone, after creatine supplementation.
  • Improves cell hydration: Raises the water content inside muscle cells, which volumizes the cells that could contribute to muscle growth.
  • Decreases breakdown of protein: Could increase overall muscle mass by decreasing the breakdown of muscle.
  • Reduces myostatin levels: Increased levels of a protein called myostatin can decrease or completely prevent the growth of new muscle. Creatine supplementation can decrease these levels, increasing the potential for  new growth.

Additionally, supplementing with creatine can increase phosphocreatine stores within the brain, which could increase brain health and decrease the risk for neurological disease.(6)

Key Points
Creatine supplies the muscles with more energy and promotes changes in cell function that lead to enhanced muscle growth.

Benefits to Muscle Growth

Creatine works well for improving muscle growth, both short-term and long-term. It is beneficial for a wide variety of individuals, from the elderly and those who are sedentary, to bodybuilders elite athletes.

One research study involving older adults found that combining creatine with a weight-training program substantially increased both muscle mass and leg strength.(7)

In a 3-month study of weightlifters, creatine was shown to increase muscle fiber growth at a rate of 2 to 3 times greater than training alone. Increases in bench press and squats were greater in those using creatine by 24% and 32%, respectively.(8)

A comprehensive scientific review of the most commonly-used supplements found creatine as being the single most beneficial supplement for increasing muscle mass.(9)

Key Points
Creatine supplementation can lead to substantial increases in muscle mass, whether taken by untrained individuals or seasoned athletes.

Benefits to Strength and Workout Performance

Creatine has been shown to enhance power, strength, high-intensity exercise performance.

In one studies review, it was determined that combining creatine with a workout program increased weightlifting performance by 14%, strength by 8%, and bench press one-rep max by as much as 43%, compared to exercise alone.(10) In a study among well-trained strength athletes, a 15% increase in bike-sprinting performance and a 6% increase bench-press performance was observed after a month of supplementation.(11)

Creatine also enhances strength and workout performance while increasing muscle growth with intense over-training. The primary reason for these notable benefits is due to the body’s greater ability to produce ATP.

ATP usually becomes depleted within 8 to 10 seconds of high-intensity activity. However, since creatine supplementation helps to produce higher amounts of ATP, it allows you to sustain optimal performance for a few additional seconds.

Key Points
Creatine is among the very best supplements for increasing strength and performance during high-intensity workouts. This happens by increasing the body’s capacity to produce energy from ATP.

Effects on the Brain

The brain is similar to the muscles, in that it stores phosphocreatine and needs enough ATP to function optimally. There is evidence that supplementation can improve certain brain and neurological conditions, including:(12)

  • Alzheimer’s disease
  • Huntington’s disease
  • Parkinson’s disease
  • Injuries to the brain or spinal cord
  • Ischemic stroke
  • Epilepsy
  • Motor neuron disease
  • Memory and cognitive function in the elderly

Although creatine may have some benefits in treating neurological conditions, the majority of the available research has been conducted with animals.

A 6-month study involving children with traumatic brain injuries showed a 70% decrease in fatigue and a 50% decrease in dizziness.(13) Studies show that creatine may also be beneficial for the elderly, vegetarians/vegans, and people at high risk of developing neurological diseases.(14)

Because the main natural dietary source of creatine is meat, vegetarians tend to have lower creatine levels. One research study showed that vegetarians supplementing with creatine saw a 50% increase on a memory test, and a 20% increase in test scores measuring intelligence.(6)

Creatine can be beneficial for older adults or those with lower creatine stores, but in otherwise healthy adults it appears to have no effect on brain function.

Key Points
Creatine might be able to decrease symptoms and/or slow down the progression of certain neurological diseases, but additional research is needed in humans.

Additional Health Benefits

Studies also suggest that creatine could provide the following benefits:(15)

  • Decrease blood sugar levels.
  • Enhance muscle function and quality of life in the elderly.
  • Aid in the treatment of non-alcoholic fatty liver disease.

However, further research into these areas is necessary.

Key Points
Creatine could potentially enhance muscle function and quality of life in the elderly, and help treat high blood sugar and fatty liver disease.

Creatine Supplements

The most commonly-used and scientifically-researched form of creatine is called creatine monohydrate. A number other types are also available, some of which may be more effective – however, further research is needed in this area.

Creatine monohydrate is inexpensive and is backed by hundreds of clinical research studies. Unless new evidence proves differently, it appears to be the all-around best form of creatine.

How to Take

It’s common for individuals to supplement by starting out with a loading phase, leading to a quick boost of creatine muscle stores.

You can load creatine by taking 20g per day for 5-7 consecutive days. The daily intake should be divided into four 5-gram meals.

Absorption may be slightly improved with a carb- or protein-based meal due to the related release of insulin.

Following the loading period, take 3–5 grams per day to maintain high levels within your muscles. As there is no benefit to cycling creatine, you can stick with this dosage for a long time.

If you choose not to do the loading phase, you can simply consume 3–5 grams per day. However, it may take 3–4 weeks to maximize your stores.

Since creatine pulls water into your muscle cells, it is advisable to take it with a glass of water and stay well hydrated throughout the day.

Key Points
To load with creatine, take 5 grams four times per day for 5–7 days. Then take 3–5 grams per day to maintain levels.

Risks and Side Effects

Creatine has been the subject of extensive research and there have been no harmful side effects in studies that have been ongoing for as long as four years.(16) One of the most thorough studies measuring 52 blood markers found no adverse effects after subjects supplemented for 21 months.(17)

One potential side effect that some users may experience is bloating, which sometimes occurs during the loading phase when first starting with creatine. Users can typically expect to gain 1–2% of body mass during the loading phase, which is partly due to water weight.

However, water gain due to creatine supplementation is only short term and usually disappears within a few weeks after loading. Although not all users experience bloating, you can try to prevent or limit it by not starting with a loading phase and simply follow a 3–5 grams daily maintenance dose from the beginning.

One common misconception is that creatine is harmful to the kidneys or liver, however there is no evidence to support this claim. Nevertheless, if you have a preexisting kidney or liver condition, you should probably consult with a physician prior to supplementation.

Another negative side effect that people sometimes associate with creatine use is cramps and dehydration, but there is no clinical evidence to support this. To the contrary, research indicates that it can reduce dehydration and cramps in those engaging in endurance exercise under high heat conditions.(18)

Research conducted in 2009 demonstrated that supplementing with creatine led to an increase in the powerful hormone DHT, which has been linked to hair loss.(19) Further research is necessary, but those who may be genetically predisposed to hair loss may want to keep this mind.

Key Points
Creatine has not been shown to cause harmful side effects. Although it’s frequently believed to cause muscle cramps and dehydration, the research does not support this.

Conclusion

The bottom line is that creatine is one of the most effective, safest and least-expensive nutritional supplements available.

It helps to improve quality of life in the elderly, increases cognitive function and brain health, and boosts exercise performance. Vegetarians and vegans, who may not get enough creatine from food, as well as seniors, may find supplementation especially beneficial.

Creatine monohydrate is probably the best type. Give creatine a go and see how well it works for you.


References:

  1. https://pubmed.ncbi.nlm.nih.gov/12701815/
  2. https://pubmed.ncbi.nlm.nih.gov/10222117/
  3. https://pubmed.ncbi.nlm.nih.gov/10222117/
  4. https://pubmed.ncbi.nlm.nih.gov/11356982/
  5. https://pubmed.ncbi.nlm.nih.gov/10731009/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1691485/
  7. https://pubmed.ncbi.nlm.nih.gov/12560406/
  8. https://pubmed.ncbi.nlm.nih.gov/10449017/
  9. https://pubmed.ncbi.nlm.nih.gov/12433852/
  10. https://pubmed.ncbi.nlm.nih.gov/14636102/
  11. https://pubmed.ncbi.nlm.nih.gov/7778463/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1510941/
  13. https://pubmed.ncbi.nlm.nih.gov/18053002/
  14. https://pubmed.ncbi.nlm.nih.gov/17828627/
  15. https://pubmed.ncbi.nlm.nih.gov/24304199/
  16. https://pubmed.ncbi.nlm.nih.gov/11224803/
  17. https://pubmed.ncbi.nlm.nih.gov/12701816/
  18. https://pubmed.ncbi.nlm.nih.gov/12701814/
  19. https://pubmed.ncbi.nlm.nih.gov/19741313/
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