Have you heard that creatine supplementation can cause kidney failure? What about how it’s as dangerous for kids to take as steroids? Or, has the meathead at your local supplement store been tirelessly trying to sell you on the new creatine because it will give you bigger #gainz? Well, I’m here to give you the ammo you need to call “bullshit” on all of that.

The following article is going to review the science, not opinion, on all things good and bad about creatine supplementation. But, spoiler alert, there isn’t much bad to say about it.

What is creatine?

Creatine is the most extensively researched supplement in sports nutrition. A naturally occurring non-protein nitrogen (think NOS for your body) compound, stored primarily in skeletal muscle, the use of creatine started gaining traction in the early- to mid-1990’s. Since then, there have been plenty of anecdotal reports surrounding the supplement. Today, we are going to dispel the anecdotes and look at what the data says.

What does creatine do?

First reported in 1926(1), we’ve known that ingestion of creatine helps increase phosphocreatine (PCr) stores, which is the energy substrate required for high intensity bouts of exercise (sprints, throws, jumps, lifting, etc). The more you have, the better. In theory, this will not only help performance on game day, but allow for greater training adaptations due to the ability to train at a higher intensity. What doesn’t get stored as PCr will remain in the body as “free creatine”. Total body PCr + free creatine content averages about 120g for a 155 lbs man, but the 155 lbs man has the potential to store ~160g(2). Daily, we use about 1-2g of those stores, which will be replaced if animal protein is a staple of your diet. But that still means your stores are only ~75% full at any given time. 75% is mediocre, and we destroy mediocrity.

How much creatine is enough creatine?

In order to fully empower performance, we need to maximize our stores. The most effective way to do that is to take ~0.3g of creatine per kg of body weight for three days, followed by 3-5g/day thereafter(3). During the loading phase it’s best to break that ~20g per day over four separate doses…which is NOT the same as taking 20g four times daily, right @John?

While the increase in stored creatine is dependent on your baseline amount(4), research shows a correlation of increased performance with increased stores(5) regardless of magnitude. Technically, the initial loading phase is not necessary but without it the increases in PCr storage, and performance, will be gradual compared to using the a loading protocol from above(6). Once supplementation begins, there is no known need, medical or otherwise, to ever stop taking it(7,8). In fact, the data shows that the risk of many common anecdotal side effects of long term supplementation are increased in those NOT taking creatine(9,10,11).

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The fear of kidney failure can be pinpointed to a case-study of a 25 year old man already suffering signs of the disease(12). An elevation in the biomarker creatinine, which is used as a marker of kidney function, was the justification for these claims. But, when compared to non-athletes, athletes show a higher level of creatinine, regardless whether they take creatine or not, but it is accompanied by a proper clearance rate(10).

What kind of creatine should I take?

There are many formulations of creatine available on the market. While some show promise of additional performance benefits, there isn’t enough data to say they are any better than simple creatine monohydrate(13). There is a building body of literature that suggests the addition of a beta-alanine(14,15) or HMB(16) supplement to a creatine regimen may elicit greater performance benefits. However, HMB must be in free acid form, and many supplements (due to cost) instead use HMB in calcium salt form (Calcium-HMB, HMB-Ca, CaHMB).

When it comes to choosing a container off the store shelves, since there is no patent on creatine monohydrate you can find it pure for relatively cheap. Especially compared with brands using additives to make proprietary blends which require you to shell out more dough to grow.

So find creatine monohydrate in its simplest form without all the bullshit.

Is it dangerous for youth athletes?

Many questions revolve around the use of creatine supplementation in youth athletes. While this butts up against the topic of ethics and morals, science has done its part in trying to answer these questions.

It must be noted, however, that it is EXTREMELY difficult to experiment on healthy children. Because of this, much of the data deals with children affected by some sort of neuromuscular or creatine synthesis specific disorder. In those populations, creatine supplementation has shown plenty of benefits(16,17). Though sufficient data does not exist, the following guidelines have been developed to gauge if a youth athlete should supplement(3):

1. The athlete is past puberty and is involved in serious/competitive training that may benefit from supplementing;
2. The athlete is eating a well-balanced, performance-enhancing diet;
3. The athlete and his/her parents understand the truth concerning the effects of creatine supplementation;
4. The athlete’s parents approve that their child takes supplemental creatine;
5. Creatine supplementation can be supervised by the athletes parents, trainers, coaches, and/or physician;
6. Quality supplements are used; and,
7. The athlete does not exceed recommended dosages.

If the athlete meets these requirements, supplementing creatine may allow for a safe nutritional alternative to illegal anabolic steroids or other illicit performance enhancing drugs.

Creatine supplementation is no panacea and will not make up for the benefits of proper rest, nutrition, and training. However, the use of creatine as a nutritional supplement within established guidelines should be seen as a safe, effective, and ethical choice to increase performance. Despite any myths surrounding the use of creatine supplementation, hundreds of studies have demonstrated the effectiveness as a means to increase anaerobic capacity, strength, and lean body mass while possibly preventing injury.

Bottom line:

If your nutrition is in check, and you’re hitting a serious training program, creatine supplementation will safely take you to the next level.

Sources

1. Chanutin A: The fate of creatine when administered to man. J Biol Chem 1926, 67:29-34.
2. Greenhaff P: The nutritional biochemistry of creatine. J Nutrit Biochem 1997, 11:610-618.
3. Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M., … & Antonio, J. (2007). International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), 6.
4. Kreider, R. B. (2007). Creatine in Sports. Essentials of Sport Nutrition & Supplements.
5. Greenhaff, P. L., Bodin, K., Soderlund, K., & Hultman, E. (1994). Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. American Journal of Physiology-Endocrinology And Metabolism, 266(5), E725-E730.
6. Hultman, E., Soderlund, K., Timmons, J. A., Cederblad, G., & Greenhaff, P. L. (1996). Muscle creatine loading in men. Journal of applied physiology, 81(1), 232-237.
7. Vandenberghe, K., Goris, M., Van Hecke, P., Van Leemputte, M., Vangerven, L., & Hespel, P. (1997). Long-term creatine intake is beneficial to muscle performance during resistance training. Journal of Applied Physiology, 83(6), 2055-2063.
8. Candow, D. G., Chilibeck, P. D., Chad, K. E., Chrusch, M. J., Davison, K. S., & Burke, D. G. (2004). Effect of ceasing creatine supplementation while maintaining resistance training in older men. Journal of aging and physical activity, 12(3), 219-231.
9. Greenwood, M., Kreider, R. B., Melton, C., Rasmussen, C., Lancaster, S., Cantler, E., … & Almada, A. (2003). Creatine supplementation during college football training does not increase the incidence of cramping or injury. Molecular and cellular biochemistry, 244(1), 83-88.
10. Kreider, R. B., Melton, C., Rasmussen, C. J., Greenwood, M., Lancaster, S., Cantler, E. C., … & Almada, A. L. (2003). Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Molecular and cellular biochemistry, 244(1), 95-104.
11. Greenwood, M., Kreider, R. B., Greenwood, L., & Byars, A. (2003). Cramping and injury incidence in collegiate football players are reduced by creatine supplementation. Journal of athletic training, 38(3), 216.
12. Pritchard, N., & Kalra, P. (1998). Renal dysfunction accompanying oral creatine supplements. The Lancet, 352(9123), 233-234.
13. Greenwood, M., Kreider, R., Earnest, C., Rasmussen, C., & Almada, A. (2003). Differences in creatine retention among three nutritional formulations of oral creatine supplements. Journal of exercise physiology online, 6(2).
14. Stout, J. R., Cramer, J. T., Mielke, M., & O’kroy, J. (2006). Effects of twenty-eight days of beta-alanine and creatine monohydrate supplementation on the physical working capacity at neuromuscular fatigue threshold. Journal of strength and conditioning research, 20(4), 928.
15. Hoffman, J., Ratamess, N., Kang, J., Mangine, G., Faigenbaum, A., & Stout, J. (2006). Effect of creatine and ß-alanine supplementation on performance and endocrine responses in strength/power athletes. International journal of sport nutrition and exercise metabolism, 16(4), 430-446.
16. Felber, S., Skladal, D., Wyss, M., Kremser, C., Koller, A., & Sperl, W. (2000). Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31 P magnetic resonance spectroscopy study. Neurological research, 22(2), 145-150.
17. Tarnopolsky, M. A., Mahoney, D. J., Vajsar, J., Rodriguez, C., Doherty, T. J., Roy, B. D., & Biggar, D. (2004). Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology, 62(10), 1771-1777.

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