Creatine

TL;DR

Creatine provides a small but noticeable strength, power and endurance increase during resistance training and may reduce fatigue and recovery time afterwards, particularly for those who eat or drink little or no animal-based protein. Some research suggests it may be neuroprotective. It is safe to use by almost all adults on a daily basis.

Creatine is a compound found in meat (including fish) and other animal products, that is also produced in the body by the liver and kidneys. It is mostly stored in skeletal muscle and is involved in the recycling of adenosine triphosphate (ATP), which provides energy to support many cell processes (mainly in the mitochondria) such as muscle contraction and nerve impulse propagation.

Supplementing with a suitable amount of creatine can increase the creatine content of skeletal muscle by up to 20%.¹ Furthermore, carbohydrate consumption has been found to augment this effect.² The greater availability of creatine in the muscles provides improvements in muscle strength, power and endurance by 5% to 15% during resistance training.³⁴⁵ This in turn allows you to work your muscles harder when training, stimulating a greater adaptive response, which ultimately leads to stronger and/or bigger muscles depending on how you are training.

The synthetic creatine monohydrate used in most supplements is created with sodium sarcosinate and cyanamide, thus making it suitable for vegetarians and vegans as neither are of animal origin.⁶ It usually comes as a very fine powder which dissolves easily into liquids.

A number of research studies have been performed to test whether creatine supplementation improves bone health in older post-menopausal women and it appears it does not.⁷⁸

There is growing evidence creatine may improve outcomes for the treatment of depression when combined with CBT or SSRI/SRNI antidepressant medication. See Peter Attia's article: An emerging role for creatine supplementation in the treatment of depression. Just in case that article goes away, you'll find the studies he references in it at the bottom of this article, numbers 9-17.⁹ ¹⁰ ¹¹ ¹² ¹³ ¹⁴ ¹⁵ ¹⁶ ¹⁷

Myths

There is a belief that taking creatine causes hair loss, based on the results of a single study by van der Merwe et al in 2009, which measured blood DHT levels in a small number of male rugby players.¹⁸. The study's results have not been replicated and no other study on creatine (albeit with different aims) has reported an increase in hair loss.

Related to the above (as DHT is converted from free testosterone) many studies have found creatine supplementation does not increase total or free testosterone.¹⁹ ²⁰ ²¹

There is also a persistent myth that creatine can cause kidney damage (similar to the same myth around protein). Whilst creatine is degraded (in the form of creatinine in the blood) and excreted in urine via the kidneys, this is a part of their normal function and would not cause an 'overload' or damage in healthy individuals unless taken in extremely high doses.²² ²³ ²⁴

Forms/Types

Creatine can be produced in a number of forms including; ethyl ester, gluconate and nitrate. However, the monohydrate form is what you'll find in most supplements and what most scientific research studies use.

Quality

As with all supplements - buyer beware. It's quite common for supplements to be contaminated with a variety of impurities, often in the form of heavy metals, and/or contain far more or less of the ingredients stated on the label. There's no simple rule of thumb to avoid this, such as avoiding cheap or imported products; expensive or well-known brands produced in-country may be just as bad. Ideally you should take some time to find products (if you can) that;

have been laboratory tested on behalf of the manufacturer by a reputable body or company that operates in your country or region (here's an example of a Peak Supps creatine supplement available on Amazon in the UK which has been tested by Eurofins: Creatine Monohydrate Powder 1Kg | Pure Micronised | Packaging May Vary - see pictures 3 & 4)
have been laboratory tested by an independent testing company that ranks product purity and ingredient amount accuracy on behalf of consumers (usually funded by affiliate sales of those products). An example of this is Labdoor.

Dosage - How Much?

A dose of 3 g a day should suffice for most.¹ While the ideal amount will vary based on sex, age, diet and other factors, this level of intake is likely to be effective for everyone except those with a very rare requirement for more.

Ideally you'd take your dose just before, during or just after consuming some carbohydrates. We put mine in my morning protein shake (which we make with milk, which provides the carbohydrate).

There is no need for loading.¹

As with vitamins and minerals (such as calcium) avoid taking creatine and other supplements for 30-60 minutes after consuming coffee - it contains compounds (polyphenols) that limit the absorption of many micronutrients and other compounds.

Deficiency - Too Little

As creatine can be produced by the body, this is not a concern for most. There are a number of heritable genetic defects known as cerebral creatine deficiencies (CCDs) that can cause serious developmental and intellectual harm, but if you're able to read this article, you won't have one of them.

Toxicity - Too Much

As with anything, consuming extremely high amounts, particularly over an extended period of time, may have detrimental effects.

Side Effects

The most common are an upset stomach, diarrhea and muscle cramps, usually because the user has not taken it with a drink or is dehydrated.

Some water retention (and associated weight gain) may occur, particularly to begin with and this is usually short term.

When to Avoid Use - Interactions/Contraindications

Anyone with kidney function issues should consult a medical professional for advice.

Random Facts

First discovered in 1832 by the French scientist Michel Eugène Chevreul
Consists of three amino acids (but is not considered a protein);
- Arginine
- Glycine
- S-adenosyl Methionine (a derivative of Methionine)