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.
 
Hence the creatine graveyard, where various forms of creatine not CM go to die:


@Will Brink

As you are the expert: I still remain confused whether elevated creatinine with creatine use is a hazard. I have multiple health issues now, and have been having upper normal range creatinine, but low EGFR. I would love to use some kind of adjunct to gain some weight/muscle mass, but am leery of the effect of creatine on my creatinine and GFR. What can you tell me? Or have you already written about this?
 
@Will Brink

As you are the expert: I still remain confused whether elevated creatinine with creatine use is a hazard. I have multiple health issues now, and have been having upper normal range creatinine, but low EGFR. I would love to use some kind of adjunct to gain some weight/muscle mass, but am leery of the effect of creatine on my creatinine and GFR. What can you tell me? Or have you already written about this?

I do have a contraindication write up on creatine below. Elevated creatinine is not in itself an issue, and we know creatine is not "stressful" to the kidneys, but should not be ignored either. If it's elevated while on creatine, take a few weeks off, make sure to be well hydrated, and re test. If still elevated, then it's not the creatine and further tests should be done, but you already indicated you tested EGFR too.

 
I do have a contraindication write up on creatine below. Elevated creatinine is not in itself an issue, and we know creatine is not "stressful" to the kidneys, but should not be ignored either. If it's elevated while on creatine, take a few weeks off, make sure to be well hydrated, and re test. If still elevated, then it's not the creatine and further tests should be done, but you already indicated you tested EGFR too.


Thanks Will,

Yes, with my cancer and treatment, serial CMPs have shown decreasing trend in GFR, some under 60. This makes me very unconfident. I am not seeing this as safe for me.
 
Thanks Will,

Yes, with my cancer and treatment, serial CMPs have shown decreasing trend in GFR, some under 60. This makes me very unconfident. I am not seeing this as safe for me.

As always, risk/benefits exist. There's data to suggest creatine made cancar therapy more effective for example:


This is from a recent review also:

Does creatine cause kidney damage/renal dysfunction?​

Questions and concerns involving creatine supplementation and kidney damage/renal dysfunction are common. In terms of pervasive misinformation in the sport nutrition arena, the notion that creatine supplementation leads to kidney damage/renal dysfunction is perhaps second only to the myth that protein supplementation and high habitual protein intake causes kidney damage. Today, after > 20 years of research which demonstrates no adverse effects from recommended dosages of creatine supplements on kidney health, unfortunately, this concern persists. While the origin is unknown, the connection between creatine supplementation and kidney damage/renal dysfunction could be traced back to two things: a poor understanding of creatine and creatinine metabolism and a case study published in 1998.

In skeletal muscle, both creatine and PCr are degraded non-enzymatically to creatinine, which is exported to the blood and excreted in the urine []. Healthy kidneys filter creatinine, which would otherwise increase in the blood. Therefore, blood creatinine levels can be used as a proxy marker of kidney function. However, the amount of creatinine in the blood is related to muscle mass (i.e. males have higher blood creatinine than females) and both dietary creatine and creatinine intake []. Both blood and urinary creatinine may be increased by ingestion of creatine supplementation and creatine containing foods, such as meat. Creatine is normally not present in urine, but can reach very high levels (>10 g/day) during creatine supplementation []. There appears to be an unsubstantiated perspective that if the kidneys are “forced” to excrete higher than normal levels of creatine or creatinine, some sort of kidney “overload” will take place, causing kidney damage and/or renal dysfunction. In reality, transient increases in blood or urinary creatine or creatinine due to creatine supplementation are unlikely to reflect a decrease in kidney function. Additionally, one must exercise caution when using blood creatinine and estimated creatinine clearance/glomerular filtration rate in individuals who consume high meat intake or supplement with creatine. In a review of creatine supplementation studies, Persky and Rawson [] found no increase in serum creatinine in 12 studies, 8 studies showed an increase that remained within the normal range, and only 2 studies showed an increase above normal limits (although not different from the control group in one study).

In 1998, a case study of a young male with focal segmental glomerulosclerosis and relapsing nephrotic syndrome was reported []. The young male, who had kidney disease for 8 years and was treated with cyclosporine (i.e., immunosuppressant) for 5 years, had recently begun ingesting creatine supplementation (15 g/day for 7 days; followed by 2 g/day for 7 weeks). Based on increased blood levels of creatinine and subsequent estimate of calculated creatinine clearance, his kidney health was presumed to be deteriorating, although he was otherwise in good health. The patient was encouraged to discontinue creatine supplementation. At this time, it was already known that blood and urine creatinine levels can increase following ingestion of creatine containing food products, including creatine supplements []. This was ignored by the authors of this case study, as was the inclusion of two investigations which demonstrated that creatine supplementation did not negatively impact renal function [, ]. The dosage of creatine during the maintenance phase, which was also ignored, was only slightly higher than the daily creatine intake of a typical omnivore’s dietary intake, or in terms of food, a large hamburger or steak per day (meat contains about 0.7 g of creatine / 6 oz. serving; see []). In response to this case study, two separate teams of experts in creatine metabolism wrote letters to the editor of Lancet [, ]. However, the notion that creatine supplementation leads to kidney damage and/or renal dysfunction gained traction and momentum.

Since this case study was reported in 1998, experimental and controlled research trials investigating the effects of creatine supplementation on kidney/renal function has substantially increased [, –]. Overall, in healthy individuals, there appears to be no adverse effects from consuming recommended doses of creatine supplements on kidney/renal function [, –]. Interestingly, Gualano et al. [] reviewed a small number of case studies which reported renal dysfunction in individuals who were supplementing with creatine. Similar to the case report by Pritchard and Kalra [], these additional case reports were confounded by medications, pre-existing kidney disease, concomitant supplement ingestion, inappropriate creatine dosages (e.g., 100 X recommended dose), and anabolic androgenic steroid use.

It is prudent to be cautious when ingesting any dietary supplement or medication. Survey data indicates that creatine supplementation usage ranges between 8-74% in athletes and other exercising individuals (reviewed in Rawson et al. []). Even with a low estimate of 8% of exercising individuals using creatine supplements, this indicates thousands of exposures across several decades. If the link between creatine supplementation and kidney health was valid, there would be an expected increase in kidney damage / renal dysfunction in low risk (i.e. young, physically fit, healthy) individuals since 1992 after Harris et al. published their seminal work []. After nearly 30 years of post-marketing surveillance, thousands of exposures, and multiple clinical trials, no such evidence exists.

In summary, experimental and controlled research indicates that creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals.


 
Thanks again @Will Brink

Do you know if creatine has immune boosting effect on B-cells?

We need more data but from my write up "...As creatine is an essential molecule in energy production for all cells, it also acts as “molecular battery,” wherein stored energy helps these essential immune cells from simply running out of steam to fight on."

The “molecular battery" aspect no doubt applies to B-cells.
 
We need more data but from my write up "...As creatine is an essential molecule in energy production for all cells, it also acts as “molecular battery,” wherein stored energy helps these essential immune cells from simply running out of steam to fight on."

The “molecular battery" aspect no doubt applies to B-cells.

My B-cells need to die, not fight on. It's really messed up. Any immune boosting substance that increases B-cell proliferation, increases my cancer.
 
Blackhawk, you know that eGFR is calculated almost entirely on the creatinine concentration in blood, which is increased if you take creatine or a lot of protein. There is another test for kidney function that doesn't use creatinine to estimate GFR:

Cystatin C

Cystatin C is a low-molecular-weight protein that functions as a protease inhibitor produced by all nucleated cells in the body. It is formed at a constant rate and freely filtered by the kidneys. Serum levels of cystatin C are inversely correlated with the glomerular filtration rate (GFR). In other words, high values indicate low GFRs, while lower values indicate higher GFRs, similar to creatinine. The renal handling of cystatin C differs from creatinine. While glomeruli freely filter both, once cystatin C is filtered, it is reabsorbed and metabolized by proximal renal tubules, unlike creatinine. Thus, under normal conditions, cystatin C does not enter the final excreted urine to any significant degree. Cystatin C is measured in serum and urine. The advantages of cystatin C over creatinine are that it is not affected by age, muscle bulk, or diet, and various reports have indicated that it is a more reliable marker of GFR than creatinine, particularly in early renal impairment. Cystatin C has also been incorporated into eGFR equations, such as the combined creatinine-cystatin KDIGO CKD-EPI equation.

Cystatin C concentration may be affected by the presence of cancer, thyroid disease, and smoking.
 
If you have been on the same drugs, same protein and creatine consumption daily and your creatinine in blood starts increasing, that may signify a worsening kidney function.

On the other hand, if you have changed your drugs or have increased protein or creatine consumption, that by itself may cause increase of creatinine in blood which then is not a signal of decreasing kidney function.

Some drugs compete with creatinine filtration at the kidneys which increases creatinine concentration in blood but is not a sign of worsening kidney function. Some HIV drugs that I use do that and depending on the drug my creatinine concentration jumps up or down, with the corresponding jumps in the calculated eGFR. Because eGFR is just calculated from creatinine, I pay attention only to the creatinine concentration and I know what is the normal concentration for a particular HIV drug, so I am not worried if it jumps to that concentration. When I take another HIV drug that doesn't compete with creatinine that much, it's concentration in the blood drops, which means there was no real change in the kidney function.
 
Last edited:
Also, creatinine is produced by the breakdown of creatine or phosphocreatine by your muscles. During intense, short-duration exercise — such as weightlifting or sprinting — phosphocreatine is used to rapidly regenerate muscle energy, but is exhausted within approximately 10 seconds as seen below. Creatinine is the by product of the PCr energy system. After 10 seconds of exercise we revert to the glycogen system. Its kind of like shifting from 1st gear to 2nd gear.

atpbreakdown.gif


So lifting weight will naturally cause your blood creatine levels to be much higher. This in turn will cause your eGFR to be higher. Most doctors are totally unaware of this so you may have to lear to expain it to them. On average, it takes the body around 24 hours to clear the creatine produced in intense exercise back to base line. This time greatly depends on the amount of muscle mass you have as well.
 
 

Online statistics

Members online
3
Guests online
123
Total visitors
126

Latest posts

Back
Top