Creatine: Everything You Need To Know

Well almost everything. These are the most common Qs I get, and I have done an extensive FAQ on creatine for readers to cut through the often confusing BS on this supplement:

What does creatine do?


In a nutshell, creatine works to help generate cellular energy. When ATP loses a phosphate molecule and becomes adenosine diphosphate (ADP), it must be converted back to ATP to produce energy. Creatine is stored in the human body as creatine phosphate (CP) also called phosphocreatine.


When ATP is depleted, it can be recharged by CP. That is, CP donates a phosphate molecule to the ADP, making it ATP again. An increased pool of CP means faster and greater recharging of ATP, which means more work can be performed. This is why creatine has been so successful for athletes. For short-duration explosive sports, such as sprinting, weight lifting and other anaerobic endeavors, ATP is the energy system used.

To date, research has shown that ingesting creatine can increase the total body pool of CP which leads to greater generation of energy for anaerobic forms of exercise, such as weight training and sprinting. Other effects of creatine may be increases in protein synthesis and increased cell hydration.


Creatine has had spotty results in affecting performance in endurance sports such as swimming, rowing and long distance running, with some studies showing no positive effects on performance in endurance athletes. Whether or not the failure of creatine to improve performance in endurance athletes was due to the nature of the sport or the design of the studies is still being debated.


Is creatine bad for me?


Creatine the most studied nutritional supplement that exists. Hundreds of studies to date have shown that creatine monohydrate is an amazingly non-toxic and safe supplement with numerous benefits. Further studies directly examining possible side effects, both prospective and long-term retrospective (up to five years), have failed to find any serious side effects of creatine supplementation (1-5) on various markers studied, such as renal function, hepatic function, and others.


Contraindications of creatine monohydrate:


Although creatine monohydrate is clearly safe for healthy people with a very low side-effects profile using up to 10 grams per day, are there specific groups who should not use it?

Again, the data suggest very few actual contraindications. The population who should avoid creatine supplements are those with a history of renal disease and/or those taking nephrotoxic (poisonous to the kidneys) medications. There’s been a handful of case reports that show very high doses of creatine (and the reports were not always clear as to what form of creatine was used) were associated with kidney dysfunction.(70) Typical for such a simple case report, it’s unclear what other medications were involved or pre-existing medical condition existed.


However tenuous the connection between high-dose creatine monohydrate and pre-existing kidney dysfunction, it’s prudent to advise people with a history of renal disease and/or those taking nephrotoxic medications to avoid creatine supplementation until more data exists examining that connection. As creatine monohydrate supplementation may cause a transient increase in creatinine levels in some individuals, it may act as a false indicator of renal dysfunction.


How should I take creatine, capsule/powder/with food/morning/afternoon/night?


Most cost effective way to take creatine is as a powder mixed into a warm liquid. Mixing in a warm liquid may not impact absorption and utilization, pre solubilizing creatine generally eliminates any gastrointestinal some may experience. Early studies mixed creatine hot tea and coffee. Timing does not appear to matter, although one small study suggested post workout was superior. Most take creatine post workout, but as creatine is a chronic effect (due to increased tissue levels of PC) vs. an acute effect such a caffeine does.


Should I/How should I take creatine if I only lift weights occasionally?



Because creatine works by elevating tissue levels of CP, vs an acute effect on any one workout (like taking a stimulant before a workout) creatine should be taken daily to maintain elevated tissue levels. Once higher tissue levels are reached, via a simple intake of 3-5g per day for at least 30 days, or a loading phase done, followed by maintenance dose, it’s possible creatine does not need to be taken daily. However, what dose at what schedule to maintain tissue levels is unclear at this time. I recommend simply taking 3-5 daily. For an extensive discussion on dosing schedule, see article by Monica Mollica HERE.


Does creatine help with muscle mass or overall health?



Yes and yes. Creatine does both assist in building muscle and or preserving muscle, as well as other tissues. Most know creatine as a “muscle building supplement” but are unaware of it’s potential health benefits and medical uses. If I didn’t exercise at all, I’d still use creatine personally. From my report on creatine, which is a free down load, which although in need of updating, was written for both clinicians and non looking for objective science based info:


This report will cover much of what creatine has to offer as a safe and inexpensive supplement with an exceptionally wide range of potential uses. Though I will go into depth about each, creatine may positively effect:

Sarcopenia (a loss of muscle mass due to aging)
Improve in brain function of healthy and damaged brains
Modulate inflammation.
Diseases effecting the neuro muscular system, such as muscular dystrophy (MD)
Wasting syndromes/muscle atrophy
Fatigue
Gyrate atrophy
Parkinson's disease
Huntington's disease and other mitochondrial cytopathies
Neuropathic disorders
Various dystrophies
Myopathies
Various brain pathologies.
May increasing growth hormone (GH) levels, to those seen with exercise
Reduce homocysteine levels
Possibly improving the symptoms of Chronic fatigue Syndrome
Improve cardiac function in those with congestive heart failure

Creatine is proving to be one of the most promising, well researched, and safe supplements ever discovered for an exceptionally wide range of uses.


A an updated article on the many potential benefits of creatine can be found HERE


What are the downsides to creatine?



There’s a risk/benefit to anything and everything we do, but I’m aware of no serious downsides that would outwigh the benefits in the vast majority of users at this time. Most reported downsides, such a dehydration or cramping and such, are mythology that has been studied and debunked in the studies, which actually found a slightly reduced rate of cramping and improved thermoregulation with creatine as an example.


What’s the best form of creatine?



Creatine monohydrate (CM) form is far and away the most extensively researched. To date, every “alternative” to CM claiming to be superior, once actually tested in a research setting has failed miseralbly to show any superiority to CM. Two, I recommend using Creapure, which testing continuous to show as the most consistently high quality and purity. Additional info on that can be found HERE.


Additional info From report of possible:



Section One


Creatine is formed in the human body from the amino acids methionine, glycine and arginine. The average person's body contains approximately 120 grams of creatine stored as creatine phosphate.
Certain foods such as beef, herring and salmon, are fairly high in creatine. However, a person would have to eat pounds of these foods daily to equal what can be obtained in one teaspoon of powdered creatine.
Creatine is directly related to adenosine triphosphate (ATP). ATP is formed in the powerhouses of the cell, the mitochondria. ATP is often referred to as the "universal energy molecule" used by every cell in our bodies.
An increase in oxidative stress coupled with a cell's inability to produce essential energy molecules such as ATP, is a hallmark of the aging cell and is found in many disease states.

Key factors in maintaining health are the ability to:

Prevent mitochondrial damage to DNA caused by reactive oxygen species (ROS)
Prevent the decline in ATP synthesis, which reduces whole body ATP levels.

It would appear that maintaining antioxidant status (in particular intra-cellular glutathione) and ATP levels are essential in fighting the aging process.



It is interesting to note that many of the most promising anti-aging nutrients such as CoQ10, NAD, acetyl-l-carnitine and lipoic acid are all taken to maintain the ability of the mitochondria to produce high energy compounds such as ATP and reduce oxidative stress.

The ability of a cell to do work is directly related to its ATP status and the health of the mitochondria. Heart tissue, neurons in the brain and other highly active tissues are very sensitive to this system.



Even small changes in ATP can have profound effects on the tissues' ability to function properly. Of all the nutritional supplements available to us currently, creatine appears to be the most



1: Kreider RB, et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem. 2003 Feb;244(1-2):95-104.

2: Poortmans JR, Francaux M. Adverse effects of creatine supplementation: fact or fiction? Sports Med. 2000 Sep;30(3):155-70.

3: Robinson TM, et al. Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function. Br J Sports Med. 2000 Aug;34(4):284-8.

4: Terjung RL, et al. American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc. 2000 Mar;32(3):706-17.

5: Groeneveld GJ1, et al. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005 May;26(4):307-13.
 
Creatine from creatinine? They are separated in that creatine does not test as creatinine.

Actually a doctor told me they're not separated. The reason I really ask doctors was because every time I took creatine my creatinine levels went way over range.
 
How would I know what's in a "scoop"? Follow dosing recs in the OP, 3-5g per day. Take that dose every day, and per above, timing does not appear to matter.
A scoop is 1gram. I will bump to 3 grams then. I currently take the HCL vs Monohydrate because I hear the Monohydrate is harder on the gut.
 
Actually a doctor told me they're not separated. The reason I really ask doctors was because every time I took creatine my creatinine levels went way over range.

News to me, but I'd have to look further into that one. We do know, in some, per above, it raises creatinine.
 
1g? You sure? That would be a tiny scoop. Gut issues of CM are addressed in the OP and easy to fix. I have also added HCL to the graveyard recently...

Do you think HCL should be in the graveyard or the undecided column. I consider you the expert so I ask, what is the basis for saying it should not be used? Cost? or some study that shows it is not effective. The only study I located was out of Brazil (the hot bed of medical and scientific breakthroughs) that showed equal results. Thanks.

This is the study. Someone smarter than me can tell if this study is rubbish.
https://file.scirp.org/pdf/FNS_2015122815333061.pdf
 
Do you think HCL should be in the graveyard or the undecided column. I consider you the expert so I ask, what is the basis for saying it should not be used? Cost? or some study that shows it is not effective. The only study I located was out of Brazil (the hot bed of medical and scientific breakthroughs) that showed equal results. Thanks.

This is the study. Someone smarter than me can tell if this study is rubbish.
https://file.scirp.org/pdf/FNS_2015122815333061.pdf

Not taken seriously by those in the supp research community for a variety of reasons. If it has equal results to CM, and CM considerably less $ and far better researched, then logic dictates it makes sense to use CM. Section #1 of article explains why HCL is in the graveyard. Of all the alternative forms of creatine sold to CM, HCL probably the most promising, but the fact producers and sellers are making hand over fist $ from it, yet don't put jack shit $ into doing any research to support it, is very telling to me. I suspect what they will find is, it's at best, equal in effects to CM, so it comes back to cost, and CM wins again on that front and the pre dissolving in a hot liquid solves the other issues.

HCL is not a scam like other forms of creatine are/were per se, it's just no better and more $, but the total lack of comparative data is the real issue

Hence it sits in the graveyard...
 
I don't know really which is one is better as I've only taken the HCL one but there seems to be different opinions on this. Monohydrate has been more researched but apparently you get 60 % more from HCL since it draws more water from the gut.

Pseudoscience BS. Opinions are like..well, you know. Published data is where the BS meets reality, anything else WAG to sell product. Not one iota of hard data to support any major claims of CM vs HCL. CM has no profit margins, hence the search for new magical forms that are superior...

BTW, everything he's saying in that vid was nicely disproved by that other "wonder" form of creatine everyone was convinced would be superior to CM, which was CEE. That all went to chit once it was actually tested per the graveyard article and what prompted me to put that together. Kre alk, same deal...

It's your $, I just bring the facts.
 
I like the Kre-Alk which is a lower amount of creatine combined with baking soda more or less. Baking soda has its own benefits per studies. At any rate it seems to work as well for me as taking larger amounts of powders which often upset my stomach.
 
Pseudoscience BS. Opinions are like..well, you know. Published data is where the BS meets reality, anything else WAG to sell product. Not one iota of hard data to support any major claims of CM vs HCL. CM has no profit margins, hence the search for new magical forms that are superior...

BTW, everything he's saying in that vid was nicely disproved by that other "wonder" form of creatine everyone was convinced would be superior to CM, which was CEE. That all went to chit once it was actually tested per the graveyard article and what prompted me to put that together. Kre alk, same deal...

It's your $, I just bring the facts.
Then it will be Monohydrate for me next time once I finish the HCL.
 
I like the Kre-Alk which is a lower amount of creatine combined with baking soda more or less. Baking soda has its own benefits per studies. At any rate it seems to work as well for me as taking larger amounts of powders which often upset my stomach.

It's a rip off per the claims made by sellers, and as with all the others to date like CEE, Serum, etc, crashed and burned once legit comparative studies done:

http://www.brinkzone.com/supplement-science/the-creatine-graveyard-update-2012/

Convincing people to paying that much for CM and soda ash is what keeps sellers laughing all the way to the bank at our/your expense.
 
An excellent review on the benefits to the brain:

Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury

Abstract

The ergogenic and therapeutic effects of increasing muscle creatine by supplementation are well-recognized. It appears that similar benefits to brain function and cognitive processing may also be achieved with creatine supplementation, however research in this area is more limited, and important knowledge gaps remain. The purpose of this review is to provide a comprehensive overview of the current state of knowledge about the influence of creatine supplementation on brain function in healthy individuals. It appears that brain creatine is responsive to supplementation, however higher, or more prolonged dosing strategies than those typically used to increase muscle creatine, may be required to elicit an increase in brain creatine. The optimal dosing strategy to induce this response, is currently unknown, and there is an urgent need for studies investigating this. When considering the influence of supplementation strategies on cognitive processes, it appears that creatine is most likely to exert an influence in situations whereby cognitive processes are stressed, e.g. during sleep deprivation, experimental hypoxia, or during the performance of more complex, and thus more cognitively demanding tasks. Evidence exists indicating that increased brain creatine may be effective at reducing the severity of, or enhancing recovery from mild traumatic brain injury, however, only limited data in humans are available to verify this hypothesis, thus representing an exciting area for further research.

https://www.tandfonline.com/doi/abs/10.1080/17461391.2018.1500644
 
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Studies suggest creatine may be helpful with depression and various mood disorders as well as being neuroprotective. Here's a new review worth a read:

The possible beneficial effects of creatine for the management of depression

Progress in Neuro-psychopharmacology & Biological Psychiatry 2018 September 4

Depression, a highly prevalent neuropsychiatric disorder worldwide, causes a heavy burden for the society and is associated with suicide risk. The treatment of this disorder remains a challenge, since currently available antidepressants provide a slow and, often, incomplete response and cause several side effects that contribute to diminish the adhesion of patients to treatment. In this context, several nutraceuticals have been investigated regarding their possible beneficial effects for the management of this neuropsychiatric disorder.

Creatine stands out as a supplement frequently used for ergogenic purpose, but it also is a neuroprotective compound with potential to treat or mitigate a broad range of central nervous systems diseases, including depression. This review presents preclinical and clinical evidence that creatine may exhibit antidepressant properties. The focus is given on the possible molecular mechanisms underlying its effects based on the results obtained with different animal models of depression.

Finally, evidence obtained in animal models of depression addressing the possibility that creatine may produce rapid antidepressant effect, similar to ketamine, are also presented and discussed.

Full paper:

http://sci-hub.tw/10.1016/j.pnpbp.2018.08.029
 
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