THE CREATINE REPORT

PART 1: WHAT CREATINE IS AND HOW IT WORKS

WHAT IS CREATINE?

Here’s what you need to know:

  • Derived from the amino acids glycine, arginine, and methionine
  • Synthesized mainly in the liver and kidneys (and to a lesser extent in the pancreas)
  • Stored primarily as free creatine, or bound to a phosphate molecule in skeletal muscle
  • Skeletal muscle contains 95% of all creatine
  • The heart, brain, and testes hold the remaining 5%

WHAT DOES CREATINE DO?

Strength coach David Sandler sums up the benefits of creatine supplementation: “Creatine allows you to have a longer and larger work volume. It helps you get one more rep. Supplementation can increase phosphocreatine and creatine stores by 10 to 40%.” Specifically, research has shown that creatine offers these benefits:

  • Increases fat-free mass
  • Improves maximal strength (as measured by 1RM bench press)
  • Improve muscular endurance
  • Increases anaerobic power and performance (shown in many activities, including continuous jumping, jump squats, knee extensions, and repeated sprints by soccer players)
  • Helps keep you hydrated in extreme outdoor conditions

Creatine supplementation (6 g/d for 12 weeks) during resistance training resulted in increased fat-free mass, thigh volume, muscle strength, myofibrillar protein content, andType I, IIa, and IIx MHC mRNAexpression compared to controls.

CAN CREATINE HELP WITH FAT LOSS?

When one of my athletes needs to lose fat, our first and most effective tactic is to lengthen his sets and shorten his rest periods, with the goal of doing more work in a defined amount of time. It burns more calories both during and after the workout, thanks to a phenomenon called EPOC (excess post-exercise oxygen consumption).The harder you can work, the greater the effect.

We know from the research already cited that creatine helps you get an extra rep or two per set, and also leads to strength increases that allow you to use heavier weights throughout your workouts.You work more and work harder, giving you two powerful tools for fat loss.

We also know that creatine helps you gain and retain metabolically active lean muscle tissue. Put simply, the more muscle you have on your body, the harder you can work in the weight room, and the more calories you can burn both during and after your training sessions.

Creatine also helps elevate your metabolism more directly, through its hydration properties. “Awell-hydrated cell tends to be more metabolic,” Antonio says.

CAN CREATINE IMPROVE ENDURANCE?

“Unlike creatine’s consistent benefit for strength and power sports, its track record in the scientific literature for improving endurance is a mixed bag of positive and negative results,”Aragon says. Does that mean creatine is useless for all endurance sports? Not at all,Aragon says. Many of those sports are performed at a mix of intensities. “Any type of training that combines brief bursts of high-intensity output with prolonged steady-state work can potentially benefit from creatine supplementation, as long as net weight gains don’t neutralize performance,” he explains. “In the case of endurance athletes, it’s really an individual matter of trying it out and seeing if it benefits your individual sport.”

PART 2: HOW TO USE CREATINE

WHAT TYPE OF CREATINE IS BEST?

There are several kinds available:

  • Creatine monohydrate
  • Creatine ethyl ester
  • Creatine phosphate
  • Creatine citrate

I recommend creatine monohydrate to my clients and athletes. More specifically: micronized creatine monohydrate.

“Creatine monohydrate is definitely the way to go,”AlanAragon says. “Not only is it less expensive than other forms, it’s actually been shown to have better bioavailability.” Other forms of creatine marketed as superior to monohydrate have been shown to rapidly degrade into the inert waste product called creatinine, while regular creatine monohydrate maintains its active form, and thus its effectiveness. Aragon adds that you want to make sure the product you get has the Creapure seal. That way you know you’re getting the highest-quality creatine available.

HOW MUCH SHOULD I TAKE?

The research shows benefits with doses ranging from 3 to 6 grams per day. More isn’t better; once your muscles are saturated, your body gets rid of the excess.

DO I NEED TO DO A LOADING PERIOD?

Maybe yes, maybe no. It depends on how fast you’d like to see results. “If you’re seeking a fairly rapid improvement in anaerobic performance and lean body mass, it would be sensible to do a loading phase with creatine,”Antonio says. If time isn’t an issue,Antonio recommends taking a maintenance dose every day, which should fully saturate your muscles within a month. If you decide to load, experts recommend 20 grams a day for 7 to 14 days.

DO I NEED TO TAKE CREATINE WITH A CARBOHYDRATE SOURCE?

Fifteen years ago, the answer was “yes.” Everyone was told to take their creatine with fruit juice or some other carbohydrate-rich drink.Today, it depends on your training goal.

“The use of high-glycemic sugars to potentiate the uptake of creatine has good support in the scientific literature,”Antonio says. But a high dose of liquid carbs may not be the best choice for your waistline.

Thus, if your main goal is low body fat, or if you’re a power athlete in a weight-class sport, you’ll want to use creatine without the sugar.Antonio says you’ll still get significant elevations in total intramuscular creatine concentrations.At worst, it won’t happen as fast.

Alan Aragon also notes that no one needs to take creatine with carbs once they’re past the loading stage, or after they’ve been taking maintenance doses for at least a month. At that point your muscles are fully saturated, and the carbs are just extra calories.

SHOULD I CYCLE CREATINE OR USE IT CONTINUOUSLY?

Most people don’t have to worry about this issue. Continual use offers continual performance benefits. However, fighters and other weight-class athletes may need to cycle off creatine from time to time. Creatine helps your cells retain water, which is good for performance. But it does give you a higher body weight.

I recommend cycling off creatine 6 weeks before a weigh-in.

PART 3: THE EFFECTS OF CREATINE ON HEALTH AND WELL BEING

In the time I’ve been training athletes, I’ve noticed an increasing interest in health.Ten or 15 years ago, I rarely heard a physique competitor talk about the long-term health consequences of his or her training and diet. Partly it’s because young athletes feel invulnerable. But also I think society correlated outward appearance with health. If you look good, you must also be healthy.

Today we all know it’s more nuanced than that. Someone who looks great on the outside can feel bad, due to chronic injuries, overtraining, or poor dietary choices. We’ve known or heard of athletes who died at ridiculously young ages. Sometimes these premature deaths come from undiagnosed genetic conditions, but in other cases the deaths were avoidable.

The athletes themselves are acutely aware of this.They ask more questions than ever about how their dietary choices, particularly their dietary supplements, will affect their health.What’s the point of being stronger, leaner, and better looking than almost anyone else if you can’t live long enough to enjoy it?

Some of the surprising health benefits of creatine:

  • Fights inflammation following muscle-damaging exercise
  • Improves brain performance
  • Improves long- and short-term memory for vegetarians
  • Speeds recovery in patients with chronic obstructive pulmonary disease
  • Helps mitigate symptoms for those with neuromuscular disorders
  • Prevents DNAmutations in aging cells

“Clinical and therapeutic use of creatine is a very interesting emerging area in the research,”Aragon notes. For example, a recent showed that creatine improves glycemic control in type 2 diabetics. “It’s also been shown to benefit those with knee osteoarthritis.”

PART 4: CREATINE SIDE EFFECTS

You’ve probably heard the scary stories about creatine. Kidney damage! Muscle tears! Cramps! Funny thing is, no research has shown creatine to have any side effects at all, other than weight gain. For most athletes who use creatine, that’s a feature, not a bug.

Here’s the research debunking the scare tactics.

DOES CREATINE CAUSE CRAMPS OR MUSCLE INJURIES?

According to research at Baylor University, “The incidence of cramping or injury in Division IAfootball players was significantly lower or proportional for creatine users compared with nonusers.”

DOES CREATINE ADVERSELY AFFECT YOUR KIDNEYS?

Many studies show no negative effects:

  • Looking at doses ranging from 3 to 30 grams per day over periods ranging from

10 months to 5 years, “Neither short-term, medium-term, nor long-term oral creatine supplements induce detrimental effects on the kidney in healthy individuals.”

  • Looking at subjects who were either given 10 grams a day or a placebo for 3 months, “Creatine supplementation over 3 months does not provoke any renal dysfunction in healthy males undergoing aerobic training.”The same study suggests that moderate aerobic training by itself may improve renal function.

DOES CREATINE CAUSE DEHYDRATION, MUSCLE TIGHTNESS, STRAINS, OR OTHER INJURIES?

During one season of NCAADivision IAfootball training and competition, it was discovered that creatine users had significantly less cramping; heat illness or dehydration; muscle tightness; muscle strains; and total injuries than nonusers.Thus, even for athletes who are well-trained, it is clear that regular creatine consumption does not cause harm, and in fact may have a protective effect against certain exercise- related maladies.

The following comes from Brad Schoenfeld’s website, in response to a report claiming that creatine is related to a specific type of injury:

“Arecent article in the New York Daily News suggested that the dietary supplement creatine may be linked to the current oblique injury epidemic.According to Lewis Maharam, a sports physician and former president of the NewYork chapter of the American College of Sports Medicine, creatine ‘adds water molecules to muscle fibers, which causes the fibers to separate.This makes for easier muscle tears and slows the repair process, leaving them on injured reserve longer.’

“These are some bold claims. However, with all due respect to Dr. Maharam, I could not locate one peer-reviewed study that even suggests such a cause-effect relationship. Sure, creatine increases intracellular hydration, but this shouldn’t pose any negative effect on muscle tissue. In fact, studies show that increasing water content in a cell has a positive impact on cellular integrity. Hydration-induced cell swelling causes both an increase in protein synthesis and a decrease in protein breakdown, which ultimately strengthens the cell’s ultrastructure (1). If Dr. Maharam or anyone else has evidence to the contrary, I would certainly like to see it.”

This is from the study Brad cites in his post:

“Alterations in cellular hydration not only contribute to metabolic regulation, but also critically determine the cellular response to different kinds of stress.Whereas cell swelling triggers anabolic pathways and protects cells from heat and oxidative challenge, cellular dehydration contributes to insulin resistance and catabolism and increases the cellular susceptibility to stress induced damage.”

The Cellular Hydration State:ACritical Determinant for Cell Death and Survival. Schliess F and Häussinger D. Biological Chemistry 2002 March-April; 383(3-4): 577–583

PART 5: CREATINE AND KIDS UNDER 18

IS CREATINE SAFE FOR CHILDREN?

There’s a long history of using creatine supplements with children, even infants.Avery small number of kids are born with an inborn error of creatine metabolism. It’s extremely rare, but if left untreated the child could end up with severe neurological problems, as well as cognitive problems like mental retardation or autistic disorders.

Some of these children have been treated successfully with creatine monohydrate. One patient was given 4 to 8 grams a day for 25 months, the equivalent of 80 to 160 grams a day for an adult.The patient experienced significant improvement, with brain and total-body creatine rising to normal levels.

As David Sandler says, “Some of the first research studies on creatine were done on overly weak infants. So, yeah, it’s safe.”

ARE THERE ANY CONDITIONS IN WHICH CREATINE HELPS CHILDREN?

Yes, creatine has been used successfully in kids with muscular dystrophy. In one study, kids who took creatine monohydrate for four months gained strength and muscle mass, experienced less bone breakdown, and had no side effects.

It’s also been used on pediatric cancer patients undergoing chemotherapy.The corticosteroids they take to alleviate the side effects of the chemo are known to cause rapid gains in body fat.With creatine, that increase in fat was attenuated.

DOES CREATINE IMPROVE PERFORMANCE IN HEALTHY YOUNG ATHLETES?

In a study of 16 elite male swimmers in their middle teens, half were given a loading dose of creatine (5 grams, 4 times a day for 5 days) or a placebo. It did indeed improve strength and performance in kids who were already in peak shape and highly trained for their sport.

CONCLUSION

It’s pretty simple:

  • Creatine is safe
  • Creatine works

Proven benefits include:

  • Increased lean body mass
  • Increased muscle fiber cross-sectional area (muscle density)
  • Fat loss
  • Improved hydration
  • Improved performance in strength, power, speed, and endurance
  • Improved exercise response in the heat
  • Improved functional capacity in patients with various neuromuscular diseases
  • Better cognitive capacity
  • Alleviated brain injury secondary to acute trauma
  • Improved cognitive and motor function in infants with inborn errors of creatine metabolism
  • Better outcomes for patients with COPD (chronic obstructive pulmonary disease)

In addition, creatine can offer a mild antioxidant effect in vitro, and has a positive effect on mood state and task completion after 24 hours without sleep.

But it doesn’t …

  • Cause cramping or heat stress
  • Cause oblique muscle strains
  • Impair kidney function

For best results …

  • Take 3-6 grams of creatine monohydrate daily for maintenance
  • If you choose to load for the fastest possible benefits, take 10 to 20 grams daily for a period of 7 to 14 days
  • Weight-class athletes should stop creatine use at least 6 weeks before their next weigh-in

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