The supplement industry is a dark place, full of dreams, outlandish claims, and bogus promises. Some things are pure snake oil, while others if not used properly can be potentially dangerous. When it comes to regulation by the FDA, supplements are treated as food and given the “safe until proven unsafe” treatment (as opposed to drugs, which are given the inverse, “unsafe until proven safe”). And occasionally, supplements can be contaminated; there have even been cases off-the-shelf supplements being cross-contaminated with medication. Some of you may even remember the BALCO scandal, where illegal performance-enhancing drugs were found in their commercially available products. All the negativity surrounding supplements does not mean all supplements are bad. Of the plethora of options available out there, one has been studied inside and out, upside and down, and all the research strongly suggests that everyone would benefit from taking it: Creatine.
Creatine was first discovered in skeletal muscle in the 1830s. About 80 years later in 1912, Harvard researchers discovered that ingesting creatine could increase creatine in the muscle stores. (1) However, it wouldn’t be until the 1990s that creatine usage became prevalent among athletes looking for performance enhancement.
Creatine is a well-studied ergogenic aid, with it’s most common form being creatine monohydrate. Typically, creatine comes in powdered form on its own, or combined with other substances like amino acids or beta-alanine. Despite the overwhelming evidence of its benefits, some still question the efficacy and safety of creatine. There are a lot of myths surrounding creatine, and you’ve probably heard a few of them: it damages kidneys, it is a steroid, you will retain water, you need to cycle on and off. These are all bullshit.
Creatine is mostly stored in skeletal muscles, with smaller amounts in the brain and other organ tissues (2). It is mainly used for gaining muscle mass and enhancing performance, particularly for strength, power, sprinting, and high-intensity workouts, and appears to be less effective for endurance activities. However, there is more to creatine than these situations. Due to its involvement in cellular energy production, more and more studies have begun looking into its uses beyond performance. From these studies, there is emerging evidence that creatine can have a positive influence on injury prevention, healing concussions, spinal cord protection, staving off neurodegenerative diseases, assisting glycemic control for type 2 diabetics, easing the affects fibromyalgia, slow some of the degenerative effects of aging, assist in managing depression, and protecting the fetus’ brain during pregnancy. Age, sex, fitness, or health are not limiting factors. (2)
Efficacy – Yes, It Really Works
Creatine is one of the most thoroughly studied supplements on the market, and its efficacy is well known. A 2019 study of 22 recreational trained subjects (16 males and 6 females) found that a multi-ingredient supplement, which included creatine and electrolytes, improved their strength and power production over six weeks (3). Hummer, et al. tested performance in the back squat and bench press; the results of the creatine group improved significantly compared to the placebo. The International Society of Sports Nutrition’s position statement concluded that “creatine monohydrate remains one of the few nutritional supplements for which research has consistently shown has ergogenic benefits.” (4)
Performance is not the only reason to take creatine. Given the effectiveness of creatine, its role in energy metabolism, and muscle building, research expanded to health and longevity. As we age, sarcopenia, the loss of muscle mass and function occur. Numerous studies have researched the use of creatine for slowing sarcopenia and bone mineral loss for seniors. The combination of banging weights and creatine supplementation is a powerful hedge against muscle loss and fighting father time. (5)
Safety – Yes, It’s Really Safe
Creatine monohydrate supplementation is not only safe but has been reported to have many therapeutic benefits in healthy and diseased populations, ranging from infants to the elderly. There is no compelling scientific evidence that the short- or long-term use of creatine monohydrate (up to 30g/day for 5 years) has any detrimental effects on otherwise healthy individuals. (4) In the past, some studies have linked renal issues with creatine use. However, this is putting the cart before the horse. Creatine does not cause renal issues, but if a person already has diseased kidneys, it may exacerbate them. If an individual has a healthy renal system, creatine monohydrate is completely safe to consume.
Gender does not affect safety either. In a recent review study, de Guingand et al. searched for adverse outcomes in females, with no adverse effects were found across various dosing strategies. (6)
Finally, age is also not a factor in creating usage. Most supplement companies will put warning labels that the products are not for people under the age of 18. However, there is evidence that supplementing with creatine is safe for any age, including adolescents, younger children, and the elderly. It is important, especially with younger athletes, that they are involved in supervised/competitive sports, eat a well-rounded high-quality food diet, are instructed on proper dosage and usage of creatine, and do not exceed the recommended dosages. (4) It could even be particularly beneficial to adolescents who participate in sports where concussions and spinal cord injuries it is shown to support brain health and injury repair.
Which Kind Of Creatine Should I Take?
Simple creatine monohydrate is the best thing to take. While it is safe to consume, there are steps you should take for purity. Supplements can contain contaminated substances. Stick with bigger name well-established brand names, as they have more to lose from consequences of contamination. Secondly, look for a seal such as USP (United States Pharmacopeia) Informed-Choice, or NSF International. Or you can look at their websites for information about different products. This isn’t the equivalent of the “organic” label at the grocery store; if the seal is on the product, you will know that the ingredients are truly the ingredients.
Do not be fooled by other creatine products. Creatine monohydrate is as effective, if not more so, than any other forms of creatine (ex. creatine ethyl ester or buffered creatine). These versions are likely more expensive and unnecessary.
Getting Started and Staying The Course
If you have not been using creatine, you need to have a loading period. The loading period is the best and quickest way to saturate the muscles. For 3 to 5 days take 5g of creatine four times a day. After the loading period, 5g a day is plenty for most people. If you are a larger athlete, you should take 5g twice a day. You will likely see a slight weight gain, especially during the loading phase. Taking creatine with carbohydrates helps with absorption.
After the loading phase, you should go on a maintenance dose schedule. Take 5g daily, not just on workout days. Larger athletes should take 5 g twice a day. And despite what Vinny in the locker room told you, the timing is not important. You can take it any time between when you wake up and when you go to sleep, just take it daily.
If you are prone to bloating, loading may not be the best way to get started. You can start with 5 to 10 g a day like the maintenance dose. The saturation will take about 4 weeks. A loading phase is the quickest way to saturate, but you can do either and get the same results.
I got back on creatine over 3 years ago and will take it for the rest of my life. Given that I am in my 50’s, I am fighting father time daily and want to stack the deck in my favor. Strength and muscle mass retention are important components for my longevity goals. There is ample evidence that creatine is a good tool to improve a variety important health and strength marker. On a recent podcast, John mentioned that he believed every vertebrate on the planet should be on creatine, and I am firmly in the same camp. To reiterate, as long as you have healthy kidneys, there is no reason not to take it and reap the benefits.
Based on the current research, the future looks promising for the health benefits of creatine, beyond just trying to be be powerful, strong, and jacked. So if you are on the fence, it is time to choose the right side. Get your daily creatine dose!
Got more supplement questions? Reach out using the form below and get in touch with one of our nutrition coaches, who can get you the answers you’re looking for and help you truly start to unlock your athletic potential.
PODCAST: PA Radio Episode 495- Too Young For Creatine & BCAA?
BLOG: What the Science Says: Creatine by Ben Skutnik
BLOG: From Boredom To Buy-In by Dave Shirley
BLOG: Vans- A Power Athlete Tribute by Colby Wartman
COACHING: Power Athlete Nutrition Coaching
Folin, O., & Denis, W. (1913). Protein metabolism from the standpoint of blood and tissue analysis. Journal of Biological Chemistry, 14(1), 29–42. https://doi.org/10.1016/s0021-9258(18)88619-7
Gualano, B., Rawson, E. S., Candow, D. G., & Chilibeck, P. D. (2016). Creatine supplementation in the aging population: Effects on skeletal muscle, bone, and brain. Amino Acids, 48(8), 1793-1805. doi:10.1007/s00726-016-2239-7
Hummer, E., Suprak, D. N., Buddhadev, H. H., Brilla, L., & San Juan, J. G. (2019). Creatine electrolyte supplement improves anaerobic power and strength: A randomized double-blind control study. Journal of the International Society of Sports Nutrition, 16(1). doi:10.1186/s12970-019-0291-x
Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., . . . Lopez, H. L. (2017). International society of sports Nutrition POSITION STAND: Safety and efficacy of creatine supplementation in EXERCISE, sport, and medicine. Journal of the International Society of Sports Nutrition, 14(1). doi:10.1186/s12970-017-0173-z
Candow, D. G., Chilibeck, P. D., & Forbes, S. C. (2013). Creatine supplementation and aging musculoskeletal health. Endocrine, 45(3), 354-361. doi:10.1007/s12020-013-0070-4
De Guingand, D. L., Palmer, K. R., Snow, R. J., Davies-Tuck, M. L., & Ellery, S. J. (2020). Risk of adverse outcomes in females taking oral creatine monohydrate: A systematic review and meta-analysis. Nutrients, 12(6), 1780. doi:10.3390/nu12061780
Rob has been in the fitness/strength and conditioning industry for 21+ years. For the last 12 years, he has owned and operated CrossFit West Houston. Through CrossFit, Rob found Power Athlete the methodology course and earning his Block One. Nutrition is a passion which lead him to currently pursuing a Masters program in Nutrition at Lamar University and Power Athlete Nutrition coach.
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