Supplements that work: Creatine

In part 3 of my Supplements that work series I am going to cover probably the most maligned and misunderstood supplements on the market, creatine. However, with the exception of caffeine, few, if any supplements have been more studied across populations than creatine. For the sake of brevity, I am going to only touch on the breadth of this research and focus on the efficacy of creatine supplementation for endurance athletes drawing on the 2007 International Society of Sports Nutrition‘s (ISSN) Position Stand (see below) and an update published in 2012. Therefore, some of the research I reference may not be cited in the text but can be found in these papers.

Creatine Myth’s and Misconceptions

In order to move on with the rest of this post, I wanted to put to rest some of the prevailing, and in many cases outlandish claims about creatine.

  • Creatine is NOT a steroid – simply compare creatine to testosterone and it’s clear this is wrong. While steroids like testosterone are built off of cholesterol (one reason why lo fat diets are a bad idea for athletes), creatine, also made in the liver and kidneys, is built from amino acids. It is largely used as a carrier for phosphate.
  • Creatine causes dehydration, heat intolerance, kidney damage, and any other crimes against humanity. The short answer here is not likely. Most of these claims come from media reports that involve athletes taking multiple supplements or illegal drugs, like amphetamines. The most common stories come from either baseball or wrestling from the 90’s. For example, in 1998 the FDA concluded that the deaths of collegiate wrestlers taking creatine was attributed to extreme dieting and ephedrine. Reports of kidney damage have likewise been disproven, and research from different labs has indicated that creatine might improve hydration and reduce muscle cramps (see ISSN 2012, pg 8).
  • Creatine is not an illegal drug, nor is it cost prohibitive.

How it works

The body has three energy systems; the aerobic, glycolytic and immediate energy system – made up of ATP and creatine phosphate (CP) . The last one is relevant to creatine because we only have enough store ATP for about 10 sec of maximal explosive movement, followed by another 10 sec stored phosphate supplied by that CP. One way to think of this is ATP are fighter jets and CP are refueling tankers. Once those tankers run out of fuel, fighter jets would need a slower method for refueling. Creatine supplementation allows us  to store extra phosphate, like a tanker carrying more fuel.

During exercise we can replenish ATP to a certain extent (~20 sec) then must rely more on the other systems. Ultimately, creatine allows us to be explosive more often, which each sprint closer to the level of the first, though fatigue diminishes each subsequent effort; the mechanisms of fatigue are complex and beyond this article. From a training standpoint, creatine supplementation may function as an adaptogen, by allowing more total work to be performed per session, and thus greater improvement over time. Moreover, creatine appears to elicit quantitative and qualitative improvements to skeletal muscle, beyond the simply water retention. In other words, creatine appears to actually improve muscle growth and function (ISSN, 2007).

While creatine’s impacts on sprint exercise are pretty straightforward, its effects in conjunction with resistance training are still evolving. The commonly held and incorrect belief is that creatine increases muscle size simply through water retention and has no real impact on muscle growth. Research in the last 5 years indicates that creatine supplementation may indeed be an adaptogen for training. In combination with resistance training, there appears to be an increase in gene expression and protein synthesis.

Creatine for endurance athletes

I will admit that I have long been a proponent of creatine supplementation based both on the literature and on my personal experience. It astounds me how many arguments I’ve been in where an individual has argued for a completely unsupported product and/or against creatine. I prefer to go where the evidence is first, as well as the experts. From this point, creatine supplementation for endurance athletes makes perfect, and cost effective sense. Why?

Assuming you’ve accepted the prevailing research (if you have not, there’s no point in reading further), then the boost in explosive power and preservation of lean mass, not to mention the improved heat tolerance make creatine monohydrate one of my top three supplements that work! In particular, if you are competing in a sport that requires repeated bursts of power (e.g., MTB, swimming, speed skating, road cycling) you are missing out on a 3-10% boost in sprint performance at a cost of about $20/year; actual improvement estimates are higher. Moreover, if you’re over the age of 50 you have likely seen a loss strength and power (and not seen the loss of fast twitch muscle fibers), which has been shown to be mitigated with creatine supplementation. But what about the weight gain?

What weight? I will not deny some folks will respond better to creatine, and similarly, some will be more sensitive to weight gain. However, my own experience has shown very little, if any weight gain. This is not surprising, as the preponderance of research indicates that increased muscle mass is driven when resistance training. Without the resistance training component I would estimate a weight increase of 1-2 lbs, which in the Tour de France is a lot, but for us normal folks that 1-2 lbs is easily off-set by the performance gain. Considering that many people over value carbohydrate loading, which easily adds 2-5 lbs for events where we require likely require more power. In my book, the weight gain argument is a non-starter.

Final recommendations

If you’re considering trying creatine but not sure how to get started, here are my quick start recommendations:

  • Source your supplement: There are numerous options and choices out there, but the standard for creatine remains creatine monohydrate (CM). It’s cheap, heat stable and easy to find. Health NOW and other reputable brands are generally good and a 1 kg container will last a year or more.
  • No loading needed: Forget that old advice of 20 g/day of loading. In fact, most of the short-term side-effects (heavy legs) result from this loading. Taking 3-5 g (~1/2 tsp) about every day will maximize your store.
  • Sugar and protein are your friends: creatine is best absorbed when taken in the presence of sugar and possibly protein, so adding it to your drink bottle or recovery shake is most convenient.
  • Fear not, to forget is human! Unlike many supplements, missing a dose or two, even on race day is nothing to worry about. Creatine stores stay high in the muscle even after more than a week of abstinence.

In concluding this article I want to emphasize that these are my own personal recommendations based on the available scientific literature, rather than rumor and fear mongering. Use of creatine has been shown to be safe and effective at improving functional performance in a variety of trained, untrained, and even some diseased populations. In the end, each athlete must decide where their money is best spent. Too often I encounter athletes dropping a small fortune on supplements that at best do not work. Here is a supplement costs pennies and yields discernible results quickly and overtime. If you’re still unconvinced, then consider this statement from the 2007 ISSN Position Statement on creatine supplementation:

“CM appears to be the most effective nutritional supplement currently available in terms of improving lean body mass and anaerobic capacity. To date, several hundred peer-reviewed research studies have been conducted to evaluate the efficacy of CM supplementation in improv- ing exercise performance. Nearly 70% of these studies have reported a significant improvement in exercise capacity, while the others have generally reported non-significant gains in performance.”  Buford, et al., JISSN, 2007.

Dr. Jose Antonio on Creatine

ISSN Creatine update 2012

ISSN Creatine Position 2007

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