The topic of whether to take over-the-counter supplements as a way of gaining an athletic edge often sparks debates on both sides of the fence. Creatine, a substance naturally produced in the human body, typically tops the list of supplements for bodybuilders as well as competitive athletes. In the United States, athletes spend close to $14 million every year on creatine supplements. Here we discuss the efficacy, safety and potential health risks of consuming this product.
What Drives the Popularity of Creatine?
Creatine monohydrate supplementation aims to deliver a greater and prolonged accrual of athletic gains. The attraction of creatine lies in its purported potential to increase lean muscle mass and enhance athletic performance, particularly during sports that demand short bursts of high intensity work (for example, high jumping, sprinting and weightlifting). Competitive athletes hope that such increases will ultimately play a vital role in maximizing workouts, thereby allowing for greater and ongoing sports-specific muscle adaptations.
How Creatine Works
Creatine, produced by the human body in the liver, kidneys, and pancreas, gets converted into creatine phosphate or phosphocreatine. This compound resides within the muscles, where it serves as an energy source. During high-intensity, short-duration exercise, phosphocreatine gets called upon to help produce adenosine-triphosphate (ATP), the predominant carrier of energy throughout the human body.
As a result of such all-out high-intensity activities lasting 4-15 seconds in duration, ATP gets rapidly depleted; however, it declines very little until stores of phosphorylated creatine get exhausted. Therefore, phosphorylated creatine, armed with its high-energy phosphoryl transfer potential, serves to maintain intracellular adenosine triphosphate (ATP) levels. Creatine elevates anaerobic capacity considerably by raising the natural levels of the phosphorylated form of the compound, allowing intracellular concentrations of ATP to remain at higher levels for longer periods, permitting athletes to maintain greater training intensity and quality/quantity with each workout.
Creatine tends to increase the water content in muscle cells. This leads to the appearance of swollen muscle bellies, or the “pump” that so many weightlifters seek in the mirror at the gym. Such swelling may produce signals for muscle growth to occur, largely by increasing levels of the growth hormone IGF-1.
Scientific Research Seems Positive
Volumes of data exist attesting to the success of creatine supplementation. Studies show that taking creatine in appropriate amounts delays fatigue by lessening the decreases in muscle pH brought on by intense exercise, thereby allowing less reliance on the process of glycolysis. Diminished fatigue often goes hand -in- hand with improved complete recovery, a key aspect for any dedicated athlete. Supplementing with creatine may also foster the reduction of certain types of muscle damage resulting from high intensity resistance training and endurance exercise. Creatine increases the metabolic capacity of the target tissues, such as the capability of a muscle to contract more powerfully for a longer duration.
Other Applications
In addition to potentially enhancing athletic abilities, research shows that creatine supplementation may foster better injury prevention, thermoregulation and “neuroprotection” in the case of concussion. This potentially opens the door for some clinical applications of creatine supplementation; studies have already looked at neurodegenerative diseases (e.g., muscular dystrophy, Parkinson’s and Huntington’s disease), diabetes, osteoarthritis, fibromyalgia, aging, brain and heart ischemia, and adolescent depression. Much more research will help shed light on more possible medicinal uses of creatine.
Some research studies indicate that creatine may can play a role in preventing the severity of an athletic injury, even possibly enhancing the all-important rehabilitation process following an injury. Most likely this occurs as a result of the anti-inflammatory and anti-catabolic characteristics of creatine.
Bone Strength
Personal trainers as well as physicians recognize that strength training can have a positive effect upon bone strength, attenuating bone loss that potentially leads to osteopenia and/or osteoporosis. Emerging research indicates that creatine supplementation may have favorable effects on measures of bone biology, caused largely by creatine’s ability to influence high-energy phosphate metabolism, growth factors, muscle protein kinetics, and the bone remodeling process.
In one study, creatine supplementation given to growing rats at 5 weeks of age over the course of 8 weeks significantly increased lumbar bone mineral density and distal femur bone strength when compared with a placebo. The authors speculate that creatine may have influenced the development of trabeculae during bone formation. Trabeculae, or the inside spongy part of bone, act like a network of supporting beams to provide strength and support to the bones.
Heart Disease
Preliminary studies suggest that creatine supplements may help lower elevated levels of triglycerides (fats in the blood) in both men and women. In studies involving individuals with prior heart failure, those who took creatine in addition to their standard medical care increased the amount of exercise they could perform before fatigue set in, compared to those taking a placebo. Tiring easily ranks as a primary indication of heart disease. Another study of 20 subjects with heart failure found that short-term creatine supplementation in addition to standard medication helped to increase body weight and improve muscle strength. Creatine also boasts the ability to lower circulating levels of homocysteine, a compound associated with heart disease, heart attack and stroke.
Creatine for Women
A woman’s body, and a female athlete’s body in particular, reacts to creatine differently than what we see in men. Admittedly, the use of creatine among females has not received quite as much attention or research. Typically, women’s bodies possess smaller amounts of creatine than their male counterparts; yet some emerging evidence indicates that taking creatine can increase strength, bone health and exercise performance, especially as women age. Some studies show promise for creatine supplementation as positively helping with mood and cognitive processing by elevating energy levels in the brain. The possibility exists that creatine may have even more benefit for women than for men. More study in the near future will reveal exactly how creatine works in women of different ages.
Obtaining Creatine Through Food
Even though the human body itself produces creatine, some athletes turn to supplementation in a more holistic manner. Certain foods naturally contain higher levels of creatine, most notably those rich in protein ~
- Pork
- Beef
- Fish/Shellfish
- Animal milk, including cow, sheep, and goat
Whether or not one can derive levels of creatine from savvy food choices equivalent to that which over-the-counter supplementation offers remains up for debate.
Types of Creatine Supplements
As with many other kinds of supplements, one can obtain creatine in any number of different chemical forms ~
- Creatine monohydrate – the most common type found in supplements. This form receives more research attention than any other.
- Creatine ethyl ester – studies suggest that it does not perform as well as creatine monohydrate.
- Creatine hydrochloride – dissolves in water better than creatine monohydrate, but lacks evidence that it works any better to build muscle.
- Creatine magnesium chelate – has not received much study.
- Buffered creatine monohydrate – one study considered whether a buffered form of creatine monohydrate would enter the muscle better to improve exercise capacity. Results failed to support this hypothesis.
- Liquid creatine – same as the powdered form only in a liquid.
The majority of large-scale research studies have looked at creatine monohydrate. Not much evidence exists to endorse other forms of the compound. As with any athletic supplement, consulting with a trusted medical expert prior to use always proves prudent.
Side Effects of Creatine Use
Although the vast majority of competitive athletes who choose to utilize creatine supplementation experience little to no disturbing side effects, it can in fact have negative repercussions, especially when one exceeds suggested dosages. The following list outlines some of the more commonly reported side effects ~
- Weight gain
- Anxiety
- Breathing difficulty
- Fatigue
- Fever
- Headache/dizziness
- Nausea/vomiting/diarrhea
- Rash
- Muscle cramps
- Muscle strains/pulls
- Stomach upset
- High blood pressure
- Liver dysfunction
- Kidney damage
Ingesting caffeine and ephedra along with creatine can often heighten the risk of side effects.
What Happens Upon Cessation of Creatine Supplements?
If an athlete has tried creatine for a short while and then decides not to continue its use, circulating levels will decrease over the course of a few weeks. The body will continue to manufacture it as always, albeit to a lesser extent at first; however, one may notice side effects as the body readjusts to having less creatine. These include ~
- Fatigue
- Muscle loss
- Weight loss
If one continues his regular weightlifting regimen, he may retain his strength, but may lack the ability to continue making great strides in strength gains.
Safeguarding Kidney Function
Creatine use has the potential to exacerbate existing kidney disease. Always consult with a physician if a familial history of kidney problems might prove detrimental. If kidneys seem to function normally, most experts do deem it safe to go forward with creatine use. Studies show that consuming no more than 5 grams of creatine/day may confer some strength and overall health benefits.
Frequently Asked Questions Regarding Creatine Supplementation
- Does creatine increase testosterone?
Studies have addressed this issue, but with mixed results. A study of rugby players found no change in testosterone among creatine users. However, levels of dihydrotestosterone did increase.
- When should one ingest creatine?
Some evidence suggests the supplement may work better following heavy exercise rather than before. A dearth of data exists on this point, so currently experts feel the timing may not make a significant difference.
Additional Concerns
Since the human body does manufacture creatine, many individuals feel safe taking it as a supplement. However, “naturally occurring” does not necessarily mean “safe”. Since over-the-counter supplements do not need to conform to the same FDA standards as medications, it proves difficult to know exactly what goes into a product or in what quantities.
Taking creatine as a supplement to foster an edge in athletic prowess can potentially increase muscle creatine content by as much as 40% beyond its normal levels. Scientists continue to debate this result as safe or not.
Researchers still do not agree on the long-term effects of taking creatine supplements in individuals under the age of 19. Some supplements market directly and specifically to teens, claiming to help alter their body composition even in the absence of exercise. As a result, one survey conducted with college students found that teen athletes frequently exceed the recommended loading and maintenance doses of creatine.
For individuals living with liver disease or diabetes, creatine use sends up an immediate red flag. Children under the age of 18 as well as women who are pregnant/nursing should likewise avoid use. There are no data documenting the safety of creatine in children or adolescents. The American Academy of Pediatrics and the American College of Sports Medicine warn that teens should not use performance-enhancing supplements, including creatine, because of the possible health risks.
One might choose to consult with a pharmacist if he currently takes any medication or supplement that could affect blood sugar, because creatine may also affect blood sugar levels. Also, creatine use may exacerbate manic episodes in those individuals living with bipolar disorder.
Key Factors to Consider Prior to Purchasing/Using Creatine for Strength Gains
Whether or not one chooses to pay attention to the aforementioned potential risks of creatine use, we suggest heeding the following ~
- Thoroughly examine product labels
- Learn about the source, purity, and potency of key ingredients
- Choose only products backed by scientific research
- Check for potential allergens contained in the supplement
The Bottom Line
While it certainly may have its strengths, not all human studies show that creatine improves athletic performance, nor does every person seem to respond the same way to creatine supplements. Individuals who tend to have naturally high stores of creatine in their muscles do not seem to derive any energy-boosting effect from extra creatine. Creatine may improve strength, increase lean muscle mass, and help muscles recover more quickly following exercise. This muscular boost particularly helps athletes achieve bursts of speed and energy, especially during short bouts of high-intensity activities such as weightlifting or sprinting. However, scientific research on creatine continues to show mixed results. Although some studies show that it does help improve performance during short periods of athletic activity, no evidence proves that creatine helps with endurance sports like running longer distances. Do some research prior to making any definitive decisions…then, supplement wisely.
References:
https://www.healthline.com/nutrition/supplements-for-muscle-gain#creatine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469049/
https://pubmed.ncbi.nlm.nih.gov/27328852/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839648/
https://www.mountsinai.org/health-library/supplement/creatine
https://www.webmd.com/vitamins/ai/ingredientmono-873/creatine
https://www.webmd.com/vitamins-and-supplements/creatine
https://blog.nasm.org/supplements-for-muscle-growth
https://www.sciencedirect.com/science/article/pii/S1279770723019541
Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!
