Creatine Review

Author: Craig Coghlin CPT (CanfitPro), CSCS, BSc
Nutritional supplements have grown immensely over the past decade. People search out these ergogenic aids in hopes of gaining an edge, whether it is for competition, or for recreation. As a society we are constantly trying to find ways to become better, faster, stronger, through the easiest way possible. Marketers of sport supplements thrive off this fact, offering sometimes-outlandish claims in the hopes the consumer will buy their product. The world of dietary supplements has grown to become a $14 billion industry in 2000, with growth seen for the future (Persky and Brazeau, 2001). In the early 1990’s creatine gained popular press after Olympic performances were attributed to supplementation with creatine (Jacobs, 1999). Since then, creatine has grown to make up over $200 million of the dietary supplement world (Persky and Brazeau, 2001). But creatine is not that new of a supplement; studies can be dated back as far as 1915. Over the past few years, creatine has become commonplace in gyms and athletic facilities around the world, but how many of the people using creatine really know why they are using it, or what functions it serves?

Creatine Background
By definition, creatine is a nitrogen-containing compound that can be found in food sources such as beef, chicken, and fish, as well as formed endogenously from amino acids glycine, methionine, and arginine in the liver and kidneys. Creatine is delivered to the working muscles where it combines with phosphate to form phosphocreatine. Phosphocreatine, or Creatine Phosphate, is the high-energy compound that is used in the ATP-PCr cycle to give energy in short bursts at a high intensity. This is achieved when phosphocreatine degrades and donates its phosphate to the ADP molecule, allowing it to become ATP (energy), and therefore replenish stores. Thus it is theorized that by increasing the availability of phosphocreatine in the body, one would be able to increase the amount of ATP being resynthesized. Yet it should be noted that the ATP-PCr cycle can only function for a maximum of thirty seconds. In total, there is approximately 120 grams of creatine in an average seventy kilogram body, 85% of which is found in the muscle. An average person excretes creatine at a rate of two grams per day and only takes in one gram per day, so the need for supplementation is apparent.

Well super, but what does this mean to me? In a nutshell, by supplementing with creatine, one would hypothetically be able to exercise harder, recover faster, and have more energy for their workout. But why do I mention hypothetically? Simply stated, not all athletes who supplement with creatine will notice a difference. The creatine concentration within the muscle pre-supplementation will have a strong effect on whether the athlete notices an improvement, as will the type of activity in which the athlete participates (Casey and Greenhaff, 2000). These are not the only factors, but other explanations are beyond the scope of this article. It is thought that a person with a higher pre-supplementation level of endogenous creatine will notice less effect, yet in a study by Casey and Greenhaff (2000), two individuals with the same pre-supplementation level of creatine did not experience the same increase in stores of creatine after identical supplementation. In fact there was a six-fold difference in the two subjects, possibly pointing to dietary or hormonal differences between subjects. It should also be recognized that these increases in creatine occur principally in type II fibres, which are associated with brief, yet intense exercise, as opposed to type I fibres, associated with low intensity, long duration performances. These type II fibres are used in sports such as hockey or sprinting in which maximal exertion is sustained for brief or intermittent periods of time.

Sign me up for Creatine Supplementation!
So you’re probably thinking that this all sounds very promising, and it is, but if you don’t know how to supplement properly you will not be able to reap these benefits. It is very important before you supplement with anything that you first do some research on the subject, and if you’re reading this article for that reason, you’ve made a great start. There are many different protocols for creatine supplementation, from small to mega doses, to creatine loading, to combination doses. Creatine loading typically involves an intake of twenty to thirty grams per day, achieved through four doses of five grams each. Persky and Brazeau (2001) point out in their study that after approximately two days of this loading dose your intramuscular stores of creatine are at a maximum. Therefore continuing with this dose is possibly a waste of your time, and more importantly if you’re a student like me, a waste of money. Yet in a study by Casey and Greenhaff (2000), creatine loading for six days was found to be beneficial, which again points to the vast individual differences present with creatine supplementation. It has been established by many studies, though, that there is no potentiating effect of increasing above twenty to thirty grams per day, which means there is a ceiling effect as to how much creatine the body can store and use (Persky and Brazeau, 2001). This is why so-called mega doses are not recommended, although frequently practiced by those who feel more of a good thing has to be better. These people are literally pissing away money as the excess is simply excreted by the body. After the initial loading phase, a maintenance dose of anywhere from three to five grams per day has been found to be beneficial. Persky and Brazeau (2001) are also quick to point out that similar intramuscular creatine stores can be achieved by simply taking a three gram dose, once a day, for thirty days. They also noted that creatine levels could remain elevated up to four weeks after cessation of supplementation.

Several combinations have been studied in attempts to find more effective ways to take advantage of creatine supplementation. One of the most popular combinations involves caffeine. Caffeine is commonly used, both in pill form and liquid form, in attempts to get an energy boost, which many of you can likely relate to this when you reach for your large double double from Timmy’s. By combining the two compounds, one would think that it would be possible to get double the energy boost. This is not the case at all. For reasons unknown, caffeine seems to negate any beneficial effects of creatine supplementation, or at the very least, shows no significant effect (Persky and Brazeau, 2001). So, to be blunt, don’t bother with it.

Another combination that has been utilized involves ingestion of phosphocreatine with a carbohydrate solution. A study by Green, Simpson, Littlewood, Macdonald,
and Greenhaff (1996) used a simple, commercially available glucose polymer solution (similar to a concentrated version of Gatorade) to dissolve the creatine dose. It was discovered that this group significantly increased whole body creatine retention, which was explained through the carbohydrate’s effect on insulin. Exercise was also used in combination with creatine ingestion in this study. It was found that by participating in exercise and ingesting creatine there was a 37% increase in creatine concentration in the body as compared to creatine supplementation alone. Yet this same study found that when the creatine was ingested with carbohydrate, exercise became unnecessary to increase intramuscular creatine concentration.

The Four Forms of Creatine (

Creatine Monohydrate
Creatine monohydrate is the most commonly used form of creatine and is made up of 88% creatine and 12% water per gram. This means that if you are taking five grams, you are technically only taking 4.4 grams of pure creatine.
Creatine Phosphate
Creatine phosphate has the creatine molecule already bound to the phosphate group. So you’re thinking, great, this is the form it has to be in to be used by the muscle; true, but it’s not that simple. It turns out that creatine phosphate is only 62% creatine, and 38% phosphate. Plus, creatine phosphate is more expensive, and you’re actually getting less creatine per serving.
Creatine Citrate
Creatine citrate is the most water-soluble form of creatine. But again, it is more expensive than monohydrate, and like creatine phosphate, you get less creatine per serving. In summary, in a five gram serving here’s how much creatine you really get: monohydrate, 4.4 g; phosphate, 3.12 g; citrate, 2 g. So you can see why monohydrate seems to be the most popular choice, and it also points out the need for caution as a consumer; just because the label says it is better doesn’t mean it is.
Serum Creatine
Recently, creatine serum has been aggressively marketed as being the ultimate in creatine. It claims no side effects, no water retention, no need for loading, and a faster absorption rate, among other things. Truth is, there’s actually only 2% of the creatine in the bottle as to what is claimed (Dash and Sawhney, 2002). Most of the creatine is rapidly converted to creatinine, a useless byproduct of creatine degradation, before it even reaches the store. And at $65 for 150ml it hardly even seems worth considering. As for the claims of more rapid absorption, only a small amount of creatine, if any, can actually be absorbed through bypassing the digestive system. In the case of serum creatine, considering there is hardly any creatine in it to begin with, absorption will likely be close to zero.

Does it do anything else?
We’ve mentioned that creatine can potentially increase one’s ability to exercise during maximal, short duration activities. But creatine does have additional effects on the body. Creatine has been found to increase the average mass of subjects by two kilograms after a loading dose (Becque, Lockmann, and Melrose, 2000). This can be attributed to either water weight or and increased fibre size, or a combination of the two. This study also concluded that total body water increases linearly in relation to intramuscular creatine. These changes spill over into skeletal muscle hydration. This means your muscles retain more water, making them look bigger. And unless you’re in a sport with weight classes, this weight gain will likely be a welcome addition to your body. The hyperhydration mentioned above can be a signal stimulating protein synthesis (Haussinger, Lang, and Gerok, 1994), which has been shown to cause an increase in fibre size (Persky and Brazeau, 2001). The size can also simply be attributed to being able to exercise supramaximally due to an alteration of energy levels after creatine supplementation. So, if you have more energy, you can lift more, and go longer, stimulating more growth.

Creatine can also act as a protective mechanism to the cells. It can potentially prevent damage upon binding to a part of the cell membrane, thus preventing any losses from the cell. Also, creatine supplies energy for the cell until oxygen supply can meet demand, and thus decreases damage to the cell under hypoxic conditions (Persky and Brazeau, 2001).

Side Effects of Creatine?
I am sure many of you have heard of the many “side effects” of supplementing with creatine, ranging from cramps, to severe kidney problems. Persky and Brazeau (2001) point out that claims of muscle cramps and kidney dysfunction have only been anecdotally reported. The only cases in which there were actual kidney problems occurred in subjects who had a pre-existing kidney disorder that was aggravated by creatine supplementation (due to the increased protein concentration in the blood). No studies have documented gastrointestinal distress, vomiting, or diarrhea. The only documented side effect is rapid weight gain; this is a subjective side effect as many welcome the added mass. But this is not to say that creatine supplementation is fine for everyone. If you’re 100% certain you have no family history or kidney disorders, you should still only experiment with small doses of creatine in your off-season and discontinue supplementation and consult a professional if any abnormalities are sensed.

The bottom line with creatine is that it has been proven to be beneficial under certain conditions, yet it is still a supplement that needs to be administered with caution and knowledge. The industry of sport supplements is a very poorly regulated one, thus competitive athletes need to research before they supplement with anything. Many compounds sold in stores can contain very little of what is actually claimed, and in many cases contain compounds not listed on the label. This occurs due to cross contamination of supplements during manufacturing. There have been occasions where athletes have been banned from competition after testing positive for a banned metabolite that they claim they have never taken. This could very well be true, yet this metabolite may have been present in an otherwise “safe” dietary supplement. If you are considering taking creatine, or you already are, you may wish to delve into the vast amount of research that exists on creatine to see if your supplementation goals are attainable. It may also be a good idea to research the company you are buying from and find out what procedures they follow, if any, to prevent cross contamination of their products. So in the words of Van Wilder, “it’s best to test the quality of the turf before you step out on to the field.”