Creatine is the most studied supplement on the planet. There are over 500 peer reviewed studies that have been published on the efficacy of creatine as a performance enhancer, and the general health benefits associated with it’s use as a supplement. 70% of these studies have shown promise as a performance enhancer and to my knowledge zero of these studies have shown it to be detrimental. With all of this information at our finger tips you’d think that it wouldn’t get a bad rap, but that hasn’t stopped uneducated dummies from trying to dissuade people from using one of the cheapest and most beneficial supplements on the market. Today we’ll talk all things creatine.

What is Creatine?

Creatine is another name for 2-[Carbamimidoyl(methyl)amino]acetic acid, or C4H9N3O2. That’s 4 Carbon ions, 9 Hydrogen ions, 3 Nitrogen ions and 2 Oxygen ions for you non-broscience nerds out there. Creatine is synthesized from the amino acids methionine, glycine and arginine. It’s naturally occurring in vertebrates and is necessary for certain kinds of energy production, but it’s not considered essential due to the fact that the body typically produces what is necessary for normal function.

Creatine is the rate limiting compound for quick bursts of energy while using the ATP-CP energy system, which is why it’s been so popular in the bodybuilding and athletics communities over the years as it helps with energy production of 5-15 seconds long. About 90-95% of creatine in stored in skeletal muscle for quick utilization when energy is needed (muscles require a lot of energy production!), the rest is stored in the brain and organs due to ATP being required for normal and healthy function. It has been used as a performance enhancing supplement for decades, but is now also showing a lot of promise with overall brain function as well.

The ATP-PC Energy System

You may have never heard of this term before but it’s the foundation for all energy production within the body. It’s name is adenosine triphosphate, or ATP for short. It’s commonly referred to as the “energy currency” of the cell, as it provides quick releasable energy for bodily functions. ATP is made up of an adenosine molecule bonded to three phosphate groups, and the breaking of these bonds is what creates energy within the cells of the body.

ATP is stored in the myosin cross-bridges of the muscle cell (these are protein structures within the muscle cell itself) and released when energy is needed for muscle contraction. The types of activities that utilize this energy system are ones that require short bursts of energy such as:

• 2-3 reps of the heaviest weight you can lift

• Sprinting under 100 meters

• Accelerating

• Vertical jumps

• Anything that requires maximal effort for a very short period of time

The chart shows how ATP is utilized for energy production in the body. Essentially your body is going to take substrates from the foods we eat to create phosphorus and eventually ATP. ATP is then broken down to adenosine diphosphate (or ADP for short) and a phosphate molecule. This breaking of the bond between this one phosphate molecule and ATP is what creates energy inside the cell. The now ADP needs to find another phosphate molecule to bond with to become ATP again and this is where creatine comes in.

In the muscle cell, creatine binds to this phosphorus to become creatine phosphate, also known as phosphocreatine. Creatine phosphate is then broken down via an enzyme called creatine kinase into creatine and phosphorus. This phosphorus ion is now available to bind to ADP to create ATP which will be broken down again yielding one phosphorus ion and ADP. It’s a cycle and creatine is the rate limiting factor of this process. If creatine concentrations are high, we have more creatine phosphate in the muscle which will allow this process to run smoothly. Simply put: if we have a larger pool of creatine, we can sustain high effort work for a little bit longer. This can lead to more efficient reps in the gym, faster sprint times and higher jump heights for longer. It’s also great for sports performance as pretty much every sport from tennis to football to hockey is played in spirts of 3-8 seconds at a time. Creatine allows for longer, more efficient high effort work to be done.

Creatine and Brain Function

There’s a lot of promise with use of creatine to help boost cognitive function in humans. In a systemic review back in 2018 published in Experimental Gerontology, Konstantinos et al. wanted to see if creatine could be used orally to increase cognitive function in healthy humans. What they found after sifting through many, many studies is that orally administered creatine can in fact improve short term memory as well as intelligence and reasoning in healthy human adults. This review also stated that creatine should studied in those with dementia due to the fact that it’s such a safe compound with huge potential benefits cognitively.

Now, the above literature was a systemic review of all the data we currently have on creatine and brain function. It was found to be not only effective but SAFE as well. In fact, there’s only one case study showing negative effects of creatine usage in healthy humans that I’ve been able to find. For the life of me I can’t find it but essentially a young male in his mid 20’s developed compartment syndrome after months of high dose creatine supplementation. When I say high dose, I mean HIGH DOSE. The kid was using upwards of 45 grams per day, which is 9-15 times the recommended dosage. There was no mention of anything else the kid was using, but I would venture to say that he was more than likely also taking other substances due to the fact that the mechanism for how creatine works, wouldn’t/shouldn’t cause compartment syndrome.

The brain takes up roughly 20% of our caloric expenditure while only accounting for about 2% of our overall bodyweight. Brain function takes tremendous energy due to the heavy cognitive load of our daily lives. Hell, studying and reading will burn more calories than watching TV. Our brains use the same energy pathways the muscles do as well, even though we can’t really quantify it in the same way. So it would make sense that the brain would benefit from creatine usage as well.

There’s a lot of emerging science where creatine use and cognitive function are concerned. There’s even some evidence to suggest that creatine usage can be used to combat things like anxiety and depression! That information is outside of the scope of this article, but it’s absolutely worth mentioning!

Creatine and Weight Gain

It’s been well documented that creatine can help you gain weight incredibly quickly. After a loading phase (more about that in a minute) it’s not atypical for you to gain 2-6 lbs over the course of 7-10 days of this loading phase. Now we ALL know that there’s no chance that you’re putting on that much muscle or fat mass in that short of a time frame, so what is the mechanism for this weight gain? It’s WATER!

Creatine helps the body pull more water into the muscle cell, increasing sarcoplasm and making the muscle appear larger. If you’ve read our posts on the HIT Method, or listened to our podcast on the HIT Method then you understand what sarcoplasmic hypertrophy is and how it can make the muscles appear larger. Now here’s where this growth differs from adaptations to the HIT Method: you can still train for strength and functional growth while benefiting from this increased sarcoplasm in the cell. This is a huge win!

One little known fact about hydration within the muscle cell is that if we’re even 5% under-hydrated our bodies will shut off anabolism (pronounced aNABolism). If the word anabolism sounds familiar that’s because it comes from the word anabolic, or rather the word anabolic comes from anabolism. While the word anabolic carries negative connotations due to its use in anabolic-androgenic steroids, all it means is “building”. Within our metabolism we have two functions: catabolism and anabolism:

• Catabolism - being in a catabolic state means to be breaking down.

• Anabolism - being in an anabolic state means to be building.

So creatine is going to pull more water into the muscle cell which is going to allow us to stay in an anabolic state more often. The initial and quick weight gain from creatine use is from water, but this water helps create an environment for growth long term which is a great thing!

Following this initial weight gain from mostly water, creatine allows us to perform more reps with higher intensity in the gym. This means that we’ll create more damage which will in turn create growth within the muscle cell’s protein structures. Early weight gain is mostly water, but over time this weight gain comes from actual muscle growth! This is again, a win win.

Creatine Doesn’t Cause:

I’ve heard it over and over again from overzealous “trainers” and “fitness gurus” talking directly out of their collective asses that creatine causes the following:

• Gout

• Kidney failure

• Baldness

• Acne

• Cramps

• Diarrhea

• Nausea

The answer to the above is a collective NOPE! Creatine does a lot of things, however the above side effects do not fall under the effects of creatine. Now you might be sitting there thinking “well my doctor told me that I shouldn’t take creatine because it can cause gout and kidney failure” and that’s great to listen to your doctor! However I would ask you to understand that your general internist more than likely had one 3 hour lecture on nutrition and (maybe) supplements. Their national boards may have one or two questions on nutrition as a whole as well. Supplements are not their specialty nor should it be. Hell I know doctors who have spouted this kind of info off and it’s mostly because there’s evidence that people who already have kidney dysfunction can develop worse dysfunction if they’re taking creatine and probenecid, which is used as a treatment for gout. Hearing this could cause one to conclude that creatine can cause the above problems, but when you unpack it all you see that it doesn’t.

• Gout

  • There is NO mechanism for this. While there is some correlative data to support increases in uric acid production with those taking creatine, there’s no data to support that a healthy human with healthy kidney function will deal with gout when supplementing with creatine.

    • Of note: taking creatine while using diuretics can EXACERBATE gout if you already have it, but there’s really no data to support that creatine can CAUSE gout.

• Kidney Failure

  • There is ZERO evidence that creatine can cause kidney failure/dysfunction/renal disease. However there is evidence that individuals with existing renal disease should use caution when taking creatine.

• Baldness

  • Another old wives tale with zero mechanism for it taking place within the body. This more than likely stems from people who use AAS (Anabolic/Androgenic Steroids) in conjunction with creatine. The creatine isn’t causing the baldness, but gets blamed for it.

• Acne

  • ZERO mechanism for this happening in the human body from creatine use. The above scenario with AAS usage is probably the culprit.

• Cramps

  • Believe it or not creatine actually does the opposite. Since it pulls water into the cell, it helps combat cramping and dehydration. This claim is so unbelievably wrong, but it still gets shouted at potential creatine consumers.

• Diarrhea

  • There is some evidence to support this one. However it has only been seen in chronic users supplementing with 10+ grams per day for prolonged periods of time. The effective dosage for creatine is closer to 3-5 grams per day, so there’s no real reason to take 10+ grams.

• Nausea

  • Same as the above. High dose creatine can cause gastrointestinal stress. Stay with between 3-5 grams to avoid this.

Creatine is safe when taken properly, and we’ll talk about the proper dosage in the next section.

Creatine Loading, Dosage and Timing

We’ll start off this section with one truth: if you’re consuming red meats and fish regularly you’re more than likely getting a good amount of creatine in your diet. You could have upwards of 60-80% of your creatine stores full based on your diet alone. A pound of fish, or a pound of red meat can yield roughly 5 grams of creatine, so if you eat steaks and fish regularly you’re more than likely ahead of the curve here.

You’ve probably heard of the term “loading phase” before if you’ve ever considered using creatine as a supplement. There is a suggested loading phase when first starting the use of creatine and it’s shown to jump start the process and fill our creatine stores quicker than taking the suggested 3-5 grams per day. There’s evidence to show that loading can increase creatine stores by 10-40% over a 5-7 day period. This can be great however it isn’t overly necessary, and if you choose not to do a loading phase your creatine stores will be as full as they’ll get within about 21 days. Your loading phase should look like this:

• 7 days long

• 20 grams of creatine per day

• 4 doses of 5 grams spread throughout the day

  • Do not take all 20 grams at once unless you want to deal with the potential for gastrointestinal distress. Outside of that it won’t hurt you.

In a loading phase, you’ll be taking roughly 140 grams of creatine spread out over the course of a week. This will lead to near optimal creatine levels within the muscle cells. We can also accomplish the same thing over the course of three weeks of normal 5g dosages, so don’t feel like loading is necessary. There’s actually some evidence to suggest that the loading phase was created by supplement companies to help sell more product. A 7 day loading phase will more than likely have you going through a full container in one week , which means they sell more product than if you spread all those out over the course of a month. Take that for what it’s worth but understand that a loading phase is completely safe for healthy humans.

Effective and safe creatine dosage typically lies somewhere between 3 and 10 grams, depending on the study you read. We’ve mostly narrowed it down to about 5 grams being safe and effective for the average consumer when you comb through all the texts, and that’s the typical dose on the back of your creatine bottles that you’ll buy from the local supplement store.

There’s been a ton of studies to take a look at the timing for taking creatine and there mostly all over the place. Some say prior to training, some say after training, and some say it doesn’t matter. I’m of the mindset that for the average individual it truly doesn’t matter since we’re talking about creating full creatine stores and that can be accomplished at any point during the day. I’ve found that the most effective timing for creatine for the majority oof my clients is to make it part of their every day routine. Since your athletes more than likely won’t train every day, it’s not the best idea to have it be part of their pre workout or post workout routine due to the fact that on non training days they may forget. Throw it in your evening shake, have it be part of your morning nutrition routine or something to that effect, just make sure it’s part of your every day routine so you can take full advantage of this wonderful supplement.

Now we know how much to take, and when to take it but that begs the question: how should I take it? That’s a great question because creatine NEEDS an insulin spike in order to pull it into the cell. It won’t enter the cell without the assistance of insulin so taking creatine with your water in the morning will more than likely be an exercise in futility. We can take it with a meal, with a protein shake or you can throw it into a juice of some kind (acidic juices like orange juice are not recommended though). Studies have shown that whey protein by itself will cause an increase in circulating insulin, so you can throw it into your shake in the morning or evening, or some days even after your workout. Creatine needs insulin, so make sure you include it within a meal or shake every time you take it.

One more thing of note. Creatine monohydrate is all you need. Just regular, cheap creatine. Companies have tried to develop “new” creatines in a effort to set themselves apart in the market and sell more product. From creatine chelates to KreAlkalyn and others, there’s zero evidence to support these more expensive forms of creatine are any better. Find an inexpensive creatine monohydrate powder and use that! You should get out of there for around 40 cents per dose.

Wrapping it All Up

Creatine is safe and effective for sports performance and as an added benefit it can help with cognitive function as well! Follow the above protocols if you’re looking to get the most out of your training and supplement regimen! As always, I would still consult with your physician when putting anything new into your body but I would also implore you to take advantage of the hundreds of peer reviewed studies on the safety and efficacy of creatine monohydrate.