Creatine: Is This Fitness Supplement Worth the Hype?

lifting dumbbell

Story at-a-glance -

  • Creatine is a naturally occurring amino acid (not a steroid) that’s found in meat and fish, although it is also made by the human body in the liver, kidneys and pancreas
  • Creatine is typically used by body builders and competitive athletes
  • Read this page to learn more on how creatine works and what the studies say about this particular supplement

By Dr. Mercola

First discovered by a French scientist named Chevreul in 1835, creatine is named after the Greek word for "flesh," or "kreas." It wasn't until 1847 that creatine was first linked to its potential effects on muscle tissue. Eventually, other studies focusing on creatine were conducted by Roger Harris, Ph.D.,1 and Alfred Chanutin2 from the 1920s to the 1990s.3 Continue reading to learn more about the potential benefits and uses of creatine.4

What Is Creatine?

Creatine is a naturally occurring amino acid (not a steroid5) that's found in meat and fish, although it is also made by the human body in the liver, kidneys and pancreas. It is converted into creatine phosphate or phosphocreatine, with 95 percent of the body's phosphocreatine stored in the muscles where it's used for energy, and 5 percent deposited in the brain, kidneys and liver.6,7

An estimated 1.5 to 2 percent of the body's creatine is converted into creatinine daily.8 How creatine works for the body begins when phosphocreatine is converted into a major energy source for the body called adenosine triphosphate (ATP), during high-intensity and short-duration exercises. In effect, this yields a host of positive effects (more on this to come later). There are multiple creatine supplements today that people may use. These are:9,10

Creatine monohydrate

Creatine hydrochloride

Creatine HCI

Creatine nitrate

Di-creatine malate

Magnesium creatine chelate

Tri-creatine malate


Natural Sources of Creatine

You can increase your body's creatine stores by obtaining it from natural sources. Grass fed beef and other meats are abundant in creatine, with a pound of grass fed beef delivering 5 grams of creatine. Grass fed chicken and turkey breast, lamb, venison and ostrich also contain creatine, albeit in lesser amounts.11

Fish like herring, wild Alaskan salmon and tuna are also good sources. However, you're better off avoiding tuna, given its track record of being contaminated with mercury and other harmful chemicals that can damage the body.12

What Does Creatine Do?

Creatine is typically used by body builders and competitive athletes, with Americans spending an estimated 14 million dollars a year on creatine supplements.13 Krissy Kendall, Ph.D., says that women who use creatine supplements may increase their strength without bulking up (although weight gain is a possibility), as opposed to the common train of thought that creatine can lead to this effect.14

Generally, creatine is mainly used for the resynthesis of adenosine triphosphate, or ATP, the "power" that drives muscular abilities. Around 40 percent of the body's creatine stores are free creatine (CR), while the remaining 60 percent is stored as creatine phosphate (CP).15

When a muscle needs to contract, the bonds in the ATP molecule split, producing ADP or adenosine diphosphate. The energy released by the breaking of this bond powers the muscle contraction.

Once ATP is eliminated in the cell, the muscle can no longer contract. Fortunately, there are several methods to rebuild ATP levels. The fastest method to replenish the body's ATP stores, without oxygen, is via CP that's "split" to yield the phosphate portion required for ATP. Phosphate bonds to the ADP, turning it back to ATP. If the CP stores in the cell are depleted, the body must turn to other methods to refill the body's ATP stores.

In effect, creatine supplementation boosts Cr and CP content within muscles, and enhances the muscles' ability to regenerate ATP, enabling preservation of the body's "power output" during brief periods of high-intensity exercise. Unfortunately, these periods are brief as the cell's ability to store CP is limited, so the body will eventually search for other methods to rehash the ATP stores.

What Are the Benefits of Creatine?

Creatine is said to potentially increase muscle mass and boost athletic performance, regardless of a person's fitness level, during high-intensity and short-duration exercises like high jumping and weight lifting. Creatine can enable you to train harder and longer, potentially leading to improved performance, strength or muscle growth.16 Other health benefits linked to creatine include:17,18

Assisting muscle cells with increased energy production: Creatine is known to increase muscles' phosphocreatine stores.

Phosphocreatine is a vital component in ATP production, which the cells use for energy and basic life functions.

ATP is broken down during exercise, but increasing phosphocreatine levels can enable you to create more ATP to serve as muscle fuel during a high-intensity workout.

Supporting other muscle functions: Creatine plays multiple roles in improving muscles, and can change cellular pathways that result in new muscle growth.

Creatine can boost the formation of proteins that create new muscle fibers, increase your body's IGF-levels and stimulate the Akt/PKB pathway, consequently signaling your body to build more muscle mass.

Certain creatine supplements can also increase muscles' water content (cell volumization) and increase muscle size.

Reducing fatigue and tiredness: Multiple studies discovered that creatine can deliver additional energy and increase dopamine levels.

Improving brain function: Because creatine may increase ATP levels, it can help the brain produce more ATP and aid brain function through increasing dopamine levels and mitochondrial function.

Multiple studies also pointed out creatine's potential in helping with brain function, lessening age-related loss of muscle and strength and protecting against neurological diseases among the elderly.

More research, however, is needed among young and healthy individuals who eat meat or fish on a regular basis.

Helping combat neurological diseases: Creatine has a potential to aid with reducing or slowing down progression of neurological diseases.

Animal studies highlighted creatine's potential in improving conditions among mice with Huntington's disease, Alzheimer's disease, Ischemic stroke, epilepsy and brain or spinal cord injuries.

Additional studies still need to be conducted on creatine's effects among patients with these diseases.

Reducing risk for sarcopenia or age-related muscle loss: As people age, fast-twitch fibers and an anabolic hormone called IGF-1 residing in muscles begin to deteriorate.

Taking creatine into adulthood can lead to a lower risk of the degenerative effects of age-related muscle wasting, since it boosts fast twitch muscle fiber integrity and allows the body to boost levels of IGF-1.

Decreasing triglyceride levels: Preliminary studies highlighted creatine's potential to help with reducing triglyceride levels in men and women with high concentrations of these unhealthy fats.

Lowering the body's homocysteine levels: Creatine was reported to assist with reducing the body's levels of homocysteine, an amino acid19 that's linked to heart disease, including heart attack and stroke.

Enhancing the methylation process: Creatine was shown to provide a powerful anabolic boost by enhancing systemic methylation status.

Methylation involves the regulation of gene expression, protein synthesis and RNA metabolism via catalyzation, and is a process that's vital for supporting life itself.

It involves a molecule called S-Adenosyl Methionine (SAM), the body's principal methyl donor, and a breakdown in SAM can affect whole-body anabolism.

Creatine is known to drain the body's SAM reserves, greatly impacting methylation status by reducing the drain in the liver and kidneys, and helping the body synthesize creatine from amino acids.

Boosting bone healing: Creatine can be beneficial for bone development and maintenance because it can improve cellular energy production.

In fact, a study by Gerber and co-researchers at the Institute of Cell Biology in Switzerland found that creatine may be used as an adjuvant therapy for bone fracture healing or as osteoporosis treatment.20

The in-vivo study showed creatine was able to significantly enhance the activity of alkaline phosphate or ALP, an important marker for bone growth.

Studies on Creatine

Preliminary studies have linked creatine supplementation to improvements in strength and muscle mass, as well as increased muscle size and added performance gains.21 However, additional research still has to be conducted on creatine because:22

  • Positive results in studies were mainly seen among young people who are at least 20 years old.
  • Researchers are still not clear on how creatine supplements improve performance, despite the fact that these enable the body to use more fuel effectively during a workout and boost muscle production.
  • Creatine's positive effects may only be limited to a specific type of exercise, as it does not seem to boost performance among workouts that involve endurance, such as running or non-repetitive exercise.

Researchers have tried to find other possible benefits of creatine apart from improving muscle growth and fitness levels. They discovered that creatine may pose these potential effects:23,24,25

Helping reduce blood sugar levels and fight diabetes: Studies have shown that creatine can reduce blood sugar levels. This occurs through increasing the function of a transporter molecule that brings blood sugar into muscles called GLUT4. However, research is still needed to discover the long-term effects of this supplement towards blood sugar control and diabetes.

Helping combat the effects of Parkinson's disease: This condition is characterized by reduced levels of dopamine, a key neurotransmitter, in the brain. Results from an animal study showed that creatine had positive effects among mice with Parkinson's disease by preventing 90 percent of the drop in dopamine levels.

Another study revealed that creatine combined with weight training improved strength and daily function of Parkinson's patients, which could be very helpful in regaining muscle function and strength.

Potentially improving health of people with chronic obstructive pulmonary disease (COPD): A study discovered that COPD patients who took creatine increased muscle mass, muscle strength and endurance, and enhanced health status compared to those who took a placebo. However, creatine supplementation didn't increase exercise capacity.

Improving health among people with heart failure: In a few studies among patients with heart failure, those who took creatine alongside standard medical care were able to increase the amount of exercise they accomplished before becoming fatigued, compared to those who took a placebo.

Another study of 20 people with heart failure highlighted that short-term creatine supplementation plus standard medication assisted in increasing body weight and improving muscle strength. However, other studies did not show this improvement.

Enhancing post-exercise muscle regeneration properties: A 2004 study conducted by Santos and colleagues from the University of Sao Paulo uncovered creatine's ability in helping promote recovery from intense exercise, making it beneficial for athletes.26

The team studied creatine supplementation's effects on muscle cell damage among experienced endurance athletes running a 30-kilometer race. Samples taken from 18 male athletes who used 20 grams of creatine monohydrate daily for five days mixed with 60 grams of maltodextrin were closely monitored for several markers of cell damage.

The researchers discovered that the levels of these markers decreased after the race, compared to the levels of the 16 control subjects who only took maltodextrin.

Side Effects of Creatine

Prior to taking a creatine supplement, consult your physician first, since there are side effects linked to it, namely:27

Weight gain

Muscle cramps

Muscle strains and pulls

Stomach upsets

Diarrhea

Dizziness

High blood pressure

Liver dysfunction

Kidney damage

Irregular heartbeat or a skin condition called purpuric dermatosis (although more research is needed to establish this link)

If you experience any of these severe side effects, stop using creatine immediately:28

  • Allergic reaction, especially hives, swelling or trouble breathing
  • Rapid heartbeat
  • Feeling dehydrated
  • Seizures or fainting
  • Dizziness, drowsiness, weakness or confusion

There are also reports that the body may stop making its own natural stores upon taking creatine supplements, although researchers have yet to discover what the long-term effects of this situation are. An athlete also experienced rhabdomyolysis (breakdown of skeletal muscle tissue) and sudden kidney failure after taking more than 10 grams daily of creatine for six weeks. Take note that there are also no studies on the significant side effects to long-term creatine use (up to six months).

People with kidney or liver disease or high blood pressure levels are ill-advised to take creatine. If you are using any of the medications below, avoid using creatine unless you've talked to a physician or health expert first, as this supplement may interact with these drugs:

  • Non-steroidal anti-inflammatory drugs, Probenecid, Cimetidine (Tagamet) and drugs that affect the kidneys: Taking creatine supplements alongside any of these medications can raise a person's risk for kidney damage.
  • Caffeine: This can make it difficult for the body to use creatine and can increase dehydration risk too. Meanwhile, a combination of creatine, caffeine and ephedra (a now-banned substance in the U.S.) may increase the possibility of stroke.
  • Diuretics (water pills): Your risk for dehydration and kidney damage increases if you take creatine alongside diuretics.

Creatine is not recommended for children, as well as women who are either pregnant or breastfeeding, because there is a lack of evidence surrounding creatine's safety for these groups of people.29

How Much Creatine Should You Take?

Creatine dosing isn't a one-size-fits-all. Total bodyweight, lean muscle composition and other factors play a role in how much creatine should be taken.30

For adults aged 19 and older, experts generally recommend 5 grams of creatine monohydrate for four times a day (a 20-gram daily total) during a loading phase lasting two to five days. Afterwards, for the maintenance stage, adults must take 2 grams of creatine daily. These doses were tested frequently among athletes, although it's not sure whether these doses have the same effects on non-athletes.31

Carbohydrates from fruits and healthy starches (like resistant starches) may allow the body to absorb creatine better. As for when you should take creatine, this supplement can be taken before and after working out.32 Take note, however, that these are just recommendations. The best way to know the creatine dosage that is right for your body is by consulting a physician or a health expert. There are also creatine calculators that you can find online.

Note: Exercise Cannot Be Replaced With Supplements

Whether you choose to obtain creatine through supplements, remember that these methods are not substitutes for proper exercise. Supplements are not instant "exercise potions" that can prompt muscles to provide the complex physiology needed for the body to function well.

Most people think that exercise can only trigger physical effects on the body, such as increased strength, but studies have shown that it can positively impact the body's defense against numerous diseases and enhance vital life support processes. Furthermore, while fitness supplements can mimic a specific biological effect that working out produces, these will not deliver ALL the health benefits that exercise provides, especially synergistic effects that are crucial for the body and mind.

Frequently Asked Questions About Creatine

Q: Is creatine safe? Is it bad for you?

A: Numerous studies have shown creatine's potential when it comes to improving health markers,33 but remember that creatine supplementation can prompt side effects like weight gain, muscle cramps, muscle strains and pulls, diarrhea or stomach upsets, especially when taken excessively. It can also interact with medicines for certain conditions.

Before taking creatine, talk to a physician or health expert first to check if your situation would allow you to take this fitness supplement.

Q: How do you take creatine?

A: Creatine is usually taken before and after a workout.34 A typical creatine dose is 5 grams of creatine for four times a day, for a total of 20 grams, during a loading phase of two to five days. During the maintenance phase, the dose can be lessened to 2 grams daily.35 However, creatine doses aren't the same for every person. A doctor or health expert can help determine the ideal amount of creatine a person should take.

Q: How do you use creatine?

A: Creatine usually comes in powder form. However, there are liquids, tablets, capsules, energy bars, fruit-flavored chews, drink mixes and other preparations available.

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