Creatine is one of the most well-tested and popular supplements. What is it? Creatine is a molecule produced in the bodies of vertebrates from amino acids. It is therefore a naturally occurring substance in humans, and also a lot of the meat and fish that we eat. Vegetarians or people who eat less meat/fish may have lower amounts of creatine.
There are three different energy systems used by your body to produce movement. Creatine is a key player in one of them: the adenosine triphosphate/creatine phosphate (ATP-CP) system. At a chemical level, it stores high-energy phosphate groups in the form of phosphocreatine, facilitating the recycling of adenosine triphosphate (ATP), the body’s “energy molecule”.
Around 95% of it is stored in the muscle tissues, with the other 5% being found in your brain, kidneys and liver. Creatine is needed for muscles to generate energy during heavy or intense exercise.
For sudden and intense activities — like sprinting, jumping and very heavy lifting — your ATP-CP system kicks into play. It is the fastest energy system to respond, but its speed in activation is almost matched in its duration. You can only naturally store a small amount of ATP in your muscles, enough for about 6-10 seconds of max effort.
Training your muscles using the ATP-CP pathway more often will improve strength, speed and power, but it won’t increase the size of your stores. However, supplementing with creatine can.
Benefits of Supplementation
Creatine is already a naturally occurring substance in our bodies, and is even in some of the food we eat. What can be gained by taking more in a supplement?
Supplementing with creatine can further increase the concentration of creatine in muscle tissue, prompting an increase in the re-synthesis of phosphocreatine molecules, which increases the capacity for performance.
Let’s look at some of the direct benefits you can gain from supplementing with creatine...
Muscle and Strength
As we mentioned above, training the ATP-CP pathway more often will improve strength, speed and power but it won’t increase the size of your stores.
However supplementing can increases your stores of phosphocreatine, which can lead to production of extra ATP, providing an extra few seconds of power. This can give you a considerable boost when training!
Those extra few seconds can be enough to handle more load, or simply lift and last for longer, all of which can lead to more muscle protein synthesis (MPS).
But it’s not just about lifting extra weight or doing more reps. In the process of developing more muscle and strength, creatine can:
- Improve cell signalling
- Raise anabolic hormones
- Reduce muscle protein breakdown (MPB)
- Increase cell hydration
Aesthetically, this all leads to generally positive results too.
The boost in output will increase the stress stimulus for muscle protein synthesis, which on its own should lead to increased gains in both mass and strength. An increase in anabolic hormones will only help in this regard, and the reduction of MPB can help with intra-workout recovery.
Increased cell hydration can cause your cells to draw and hold onto more water, sometimes prompting the view that any mass gained from creatine supplementation is just “water weight”.
However the International Society of Sports Nutrition (ISSN) state that the claim all weight gain during creatine supplementation comes from water is a myth. Initially this can be the case, as building muscle takes time and consistency to a training program and dietary regime. However, in the long run it has been shown that muscle mass and muscle diameter both increase when creatine is combined with strength training.
A 6-week study found that creatine helped trainees add a 15% increase in weight to their 1-rep max bicep curls.
Another study on weight lifters found that creatine increased their maximum squat and bench press strength, and it also noted a 20% increase in testosterone levels from the creatine group, against 5% from the group not taking creatine. Creatine does not increase testosterone levels itself, However, resistance training, strength gains and muscle mass certainly can.
There are numerous high quality research papers that demonstrate creatine’s efficacy in this area, and it is considered the most studied sports supplement on the market.
High Intensity Performance
While creatine has not been shown to offer any benefits for longer duration aerobic exercise (for example, running a marathon), it has been demonstrated to be extremely effective for shorter duration higher intensity exercise. This makes sense when you understand exactly how creatine works and the energy system it feeds.
Hundreds of studies have been conducted on creatine’s effects on high intensity exercise, with about 70% of them showing positive effects, 30% showing small or insignificant effects, and to date no negative effects.
One study showed creatine significantly reduced the time taken to complete 40-meter sprints. Another study on cyclists found that following a 4 day loading period there was a 3.7% improvement in cycling power. It has also been shown to improve 5 and 15 meter sprint speeds with soccer players, and improve sprinting and jumping performance in athletes.
If you are an athlete or doing sports, then creatine may give you a useful boost.
Muscle Recovery
Along with boosting performance output, creatine also seems to help muscles recover fasterduring exercise. By increasing the rate of creatine phosphate re-synthesis during intense training sessions, it seems to lower the accumulation of blood lactate and ammonia, both by-products of intense training which can inhibit performance. This essentially means that by helping muscles recover faster during the workout, it reduces the onset of fatigue as the sets and reps progress.
Unfortunately, research shows that creatine doesn’t seem to help with post-workout recovery. Aside from not training too hard in the first place, a cure for those painful post-workout aches and pains that we call DOMS (delayed onset muscle soreness) is yet to be found.
Creatine for your brain
Creatine’s benefit is not limited to just your muscles. The brain consumes around 20% of resting energy, despite only accounting for around 2% of total body mass. Improving your energy systems therfore may have a benefit for the brain as well.
One of the more recent and interesting areas of research around creatine is in the cognitive benefits it appears to provide.
Creatine is vital for the re-synthesis of ATP — the primary molecule for the transfer of energy between cells — and some research suggests that creatine supplementation may help bolster cognition in times of heightened metabolic demand, such as sleep deprivation, mental health conditions or neurological diseases.
Antidepressant effects
More notably, it shows a lot of promise in helping people with anxiety and depressive disorders. Some previous research has shown that clinical depression may in fact be associated with low creatine concentrations in the brain, and this paper looked into this and found prefrontal creatine concentrations and grey matter volume seems to be negatively associated with depression, though concluded that while more research is still needed.
Another study on depressed women taking an antidepressant found that those who also took creatine had a better effect from the antidepressant. A recent meta-review of 193 papers on the effects of creatine for depression and anxiety disorders concluded:
“Clinical studies in neurological conditions such as personality disorder have indicated that creatine might have an antidepressant effect, and early clinical studies in depressive disorders—especially major depressive disorder—indicate that creatine may have an important antidepressant effect.”
Different Types of Creatine
Creatine Monohydrate
This is the most common form of creatine, and by far the most studied.
As the name suggests, it is made up of one creatine molecule and one water molecule, which is about 90% creatine by weight and 10% water.
It can be processed in a few different ways. If the water molecule is removed, is becomes creatine anhydrous, which is 100% creatine by weight, and sometimes it is mechanically processed to improve water solubility, which might improve absorption in the body. However, studies show that regardless of the processing involved, all of these forms are as effective as each other when doses are equated.
Being the most studied and most affordable, we generally recommend creatine monohydrate above other forms.
It can be a powder or a capsule. Either is fine, though as a capsule is probably the best option for ease of use.
Creatine Hydrochloride
This is creatine with hydrochloride attached instead of water, which significantly enhances water solubility and absorption. It is also more chemically stable than monohydrate. This study found it to be 38 times more soluble than monohydrate, which theoretically should mean you can take less of it for the same results. However, there is a distinct lack of human evidence focused on creatine hydrochloride, and what little research there is hasn’t shown any practical benefit to using it over monohydrate. Given the higher cost and lack of evidence, we still recommend using creatine monohydrate for most people.
Creatine Ethyl Ester
Creatine with the addition of ester salts. Although not common, some manufacturers claim creatine ethyl ester is better absorbed than creatine monohydrate. It is claimed that this happens by bypassing the creatine transporter to be absorbed directly into the cell, resulting in higher creatine levels and less water retention.
However this study and others conclude otherwise. Due to the lack of evidence supporting these claims, and the extra costs involved, we don’t generally recommend using this over creatine monohydrate.
Buffered Creatine
Buffered creatine is the addition of alkaline powder, in a bid to improve stability, increase potency and reduce side effects like bloating and stomach cramps.
However, this study looked at bench press and cycling output over 28 days and found no differences in effectiveness or side effects.
Again, with no evidence to show superiority, and an increased price point, creatine monohydrate still seems like the better choice for most people.
How to Take it
When supplementing with creatine, you’ll either be taking it in powder form, or capsules. Either way, the standard recommended dose is 3-5 grams per day, every day.
Very limited research suggests taking it post workout may be optimal for muscle and strength, but the most important thing to focus on is just taking it. Don’t worry too much about when.
The powder doesn’t taste of anything and can be mixed in juice or water. You can buy flavored powders, but we would recommend against this. It comes with unnecessary additives, and in our experience you get sick of the taste very quickly. If you have an issue with using the powder (some people don’t like the gritty texture) then we suggest going for capsules.
You have the option of going through a loading phase, which will saturate your cells faster and cause gains to begin sooner. This phase is totally optional, as just taking 3-5 grams a day will work, it will just take a little longer to see the benefits (around 2-3 weeks).
This is also the phase in which some people report discomfort, so if you find that happening, maybe stick to the maintenance dose and see if that helps.
1 Week Loading Phase
Take 20 grams a day for 1 week, then drop to 3-5 grams a day.
Take this 20 grams in 4 separate servings over the course of the day.
Side Effects and Potential Risks
Research continues to show daily and prolonged creatine use is safe for healthy individuals. This review concluded that as much as 30 grams a day (far more than you would ever take) has been shown to be safe for up to 5 years.
However, even in healthy individuals there can be some side effects, like with any supplement. Let’s look at these in more detail...
Water Retention
The increase in cell hydration, is what has often caused people to state things such as “creatine just builds excess water weight, not muscle” or “creatine will cause bloating and puffiness”. These statements are generally made with regards to creatine monohydrate, the most popular type of creatine and an osmotic substance, meaning it attracts and holds small amounts of water.
The truth is, while creatine does cause some water retention, this is not a bad thing, and in fact may also provide some benefits.
This randomized trial followed 32 strength athletes and monitored their total body water, intracellular water, and extracellular water. After 28 days of supplementation, participants taking creatine had gained just below 0.9 liters of total body water, significantly more than the placebo group. They concluded that when supplementing with creatine it is a good idea to increase water intake, especially when you first start taking it.
What the water increase feels like differs from person to person. Some do suffer from bloating, but this is usually at the beginning, and mainly during the loading phase. This is an optional period during which you take a higher amount of creatine for 1-2 weeks, to effectively saturate your system, before dropping to a maintenance dose.
However, it appears water retention may help performance in a few key ways:
Muscle Protein Synthesis
This paper suggests that increasing muscle cell volume may be an anabolic proliferative signal — effectively signalling to the cell to make more muscle protein, which would eventually increase strength, endurance, and performance.
Hydration
The International Society of Sports Nutrition (ISSN) states that supplementing with creatine could in fact be “an effective nutritional hyper-hydration strategy” for athletes that take part in high intensity activities in hot and humid environments.
Another paper found that the fluid retention from creatine supplementation can actually help athletes thermoregulate in extreme temperatures and high levels of exertion.
Weight Gain
It is well documented that creatine supplementation will likely cause an initial increase in body weight,. This is due to an increase in water retention, since water is heavy.
Over time, research does show that body weight often continues to increase at a greater rate in creatine users, but with the right intake of food and proper resistance training this should be from an increase in muscle growth, not body fat. *
Digestive Issues
Some people report digestive upset when taking creatine, such as bloating and diarrhea. However this tends to be during the loading phase, and also when taking more than the standard does of 3-5 grams at a time.
Even if you are loading with 20 grams a day, we suggest splitting this into 4 servings over the course of the day. When we look at the data, there is no real evidence that creatine causes digestive concerns when taken at low and recommended doses.
Kidney and Liver Health
This 4 year study, one of the longest of its kind, concluded that long-term creatine supplementation does not seem to result in adverse health effects.
Creatine supplementation can raise the levels of creatinine in your blood, and creatinine levels are often checked when diagnosing kidney or liver conditions. However, even if creatinine levels are raised it does not necessarily mean it is harming your liver or kidneys. There is to date no evidence that supplementing with creatine causes harm in healthy individuals.
However, we suggest being cautious if you have any issues or history of kidney or liver conditions. Speak to your doctor if you are thinking of taking creatine.
Should I take creatine?
It is one of the most popular and well-researched supplements.
There are three cases where creatine may be particularly beneficial:
- If you are vegetarian
- If you are strength training
- If you face anxiety or depression
For everyone else, it will probably still useful! Plus, everyone should be doing at least some resistance training.
Summary
Creatine is a well researched and safe supplement to use, for a number of benefits:
- Build strength and muscle
- Boost high intensity performance
- Improve intra-workout recovery
- Help with symptoms of anxiety and depression (research in early stages)
There are a number of forms on the market, but to date creatine monohydrate is the most used, most studied, and most affordable.
To take it, simply mix 3-5 grams in water and drink, or swallow if in a capsule!