In 2009 alone, it was estimated that creatine-containing supplements constituted 2.7 billion dollars (US) of sales in the sports supplement industry. Furthermore, in 2014, the NCAA reported the most popular sports supplement male athletes consumed was creatine i.e., Baseball 28.1%; Basketball 14.6%, Football 27.5%; Ice Hockey 29.4%; Lacrosse 25.3%; Soccer 11.1%; Swimming 19.2%; & Wrestling 28.5%, to name a few. Compared to female athletes, their rates across all sports dropped significantly to only 0.2% to 3.8% usage. Studies have also shown that high school athletes have a similar distribution of supplement usage. With prevalence high in creatine supplementation, the bulk of literature is on the effects it has on exercise performance; therefore, in this post, we will cover potential performance benefits. This includes the effects on recovery, environmental training, and just pure data highlighting the benefits on lean body mass and strength levels.

Last week, we learned how creatine works, even included a weird/funny video to help with the concept. However, we learned the potential benefits creatine has on the ATP-PCr energy system. If you need a reminder of what this energy system is, refer to last weeks post, Creatine Part I: The Introduction!

Furthermore, we learned the overwhelming data from various ages and dosages that support creatine benefits. Even Willimann (2011) claimed 3 g/day throughout our lifespan is excellent for general health benefits. Now, let’s take a look at some of the many benefits.

Protein/Carbohydrate Addition.

There seems to be a positive effect in carbohydrate and creatine storage in the muscle when supplementing with creatine+carbohydrates. Furthermore, when you add a dosage of protein in the mix, protein+carbohydrate+creatine, retention of carbs is more significant, which can promote enhanced recovery. This is due to carbohydrate (glycogen) levels affects on performance. When performing activities like sports or weight training/intense exercise for long periods of times, you risk depleting your carbohydrate stores. When this occurs, you experience the “hit the wall” or “bonking” effect as you cannot use protein or fats for energy in muscular contraction (directly), only carbohydrates. So, when carb stores are low/consistently low, you may have a harder time to recover from intense events/training periods. Thus, it seems when combining carbs, protein, creatine you can optimize carb stores and maintain optimal levels which could translate to positive performance benefits, in the moment and for recovery. For example, Kreider et al. had football athletes consume 20 or 25 g/day of creatine with a carbohydrate/protein drink, while training during offseason conditioning. For those who consumed the drink, all increased strength, and muscle mass more than those who did not consume the drink.

This outlines the most apparent benefit of creatine supplementation, in general, is the improved performance in both strength and power movements/exercises. This encompasses 20 seconds sprints or lifting multiple sets of heavy squats/bench press/deadlifts, for example as this supplementation can change these performance events to something as dramatic as 10 to 20% improvement, depending on the magnitude of muscle creatine storage.

Enhanced Recovery.

As researchers were exploring creatines effects on performance and the storage mechanism of carbs and creatine, they also hypothesized potential benefits on recovery, and it turns outs evidence supports this theory. Investigators, Cooke 2009 & Santos 2004, showed that supplementation was able to improve the recovery time of force your muscle can create post-training. Furthermore, the bodies inflammation process post-exercise was downregulated (this is a good thing, as the body did not view exercise as tiring/stressful) as markers of stress were lower in participants who supplement with creatine compared to those who did not. Also, Volek 2001 was able to evaluate a dosage of 0.3 g/kg/day of creatine for participants during an intensive 4-week training program which showed that supplementation could help tolerate increased training volume. All of which could relate to the effects creatine has on carb storage levels.

Injury prevention.

Side effects have been periodically reported when using creatine, for example, dehydration to muscle cramping; however, no study has been able to prove this occurs. Even individuals consuming 15-25 g of creatine monohydrate a day, up to 12 weeks, engaged in heavy resistance training, showed no ill effects. Furthermore, over 21 months of 5-10g/day (which is a typical dosage in a gym, per conversation) no significant differences between individuals supplementing and not supplementing, per investigating markers, such as renal functions, muscle and liver enzymes, electrolytes, and urine volume were observed. Users exhibited less occurrence of cramps, heat illness or dehydration, muscle strains, muscle tightness, or missed practice times per Greenwood and team, 2003. If the data supports anything, it may be suggesting that athletes who consume creatine during training/competition may experience lower incidences of injuries compared to athletes who do not supplement.

Training in the Heat.

Creatine monohydrate has been observed to have osmotic properties (ability to push water/pull water where it goes) that help retain a small amount of water. This was associated with the first reports of weight gain that occurs when supplementing with creatine, as this short-term water retention caused temporary weight gain. However, when hypothesizing the benefits of this observation, endurance activities or activities in heat were now being investigated. Therefore, Kilduff and crew evaluated individuals in 86 degree heat during running loads at 63% of their maximum exertion while supplementing with 20g/day for seven days. Their observation showed that heart rate and sweat rate, for example, were reduced and that cell hydration was increased. This means individuals who supplemented with creatine had a more efficient response to the prolonged exercise in the heat.

Dosage?

If you want to make sure your creatine stores are top notch, there seems to be evidence that 0.3 g/kg/day for 5-7 days, followed by 3-5g total a day after the initial mega dosage, keeps creatine levels elevated for benefits.

Let’s use coach Dan as an example.

Weighs 200 pounds

Convert to kg: 200/2.2 = 90.9 kg

90.9 kg x 0.3 g of creatine = approximately 27 g of creatine per day

So, if Coach Dan wants to increase creatine stores, he would consume roughly 27 g of creatine per day. As you wish to have a supercompensation phase (this can be done for carbohydrates, as well, i.e., carb loading) This does not mean it has to be all through supplementation as there is creatine in red meats, for example. After this 5-7 day (supercompensation) period, it is best to consume the suggested 3-5 g of creatine per day. In the clinical setting, however, upwards of 56g/day for a 70 kg individual up to for four years have been performed with no adverse effects from creatine supplementation.

Youth Safety.

As stated in the introduction, there seems to be strong evidence high school athletes, especially males, consume creatine as a supplement for performance benefits. Therefore, it is naive to think because the label indicates those should avoid consumption under 18 years of age, this will be followed, moreso science supporting this notion. Especially with surveys showing roughly 38% of athletes listen to their coach as their primary source of dietary supplement knowledge. Consumption might be relatively high. So, one could suggest there is a higher prevalence of supplement usage in teenagers across all supplements, depending on their coaches thoughts/education, but especially in regards to creatine.

With that being said, there is no supporting evidence both anecdotally or scientifically to support the dangers of creatine. It has only proven benefits. Thus, it is not a surprise a large proportion of athletes in various sports, to different ages, to gym goers use the supplement. Furthermore, even with all of this information presented, it is best to conduct your thorough research or consult with someone with the knowledge, even if it is not at Clutch Dietetics & Performance, about how to incorporate creatine into your diet, if you are interested (i.e., medical provider). As individuals like my old PE teacher informing his various classes over the year that creatine is dangerous or even worse, a steroid is scientifically wrong.

There you have it! Creatine, in a nutshell, it’s a great supplement that has been proven to work and is a relatively a low-cost supplement, as well. Key takeaways are that it is safe across all age ranges, and if you are looking to increase your performance in quick/high-intensity events like weight lifting or sprints, this is your supplement. It may even have benefits for performance in endurance/training in the heat. So if you have any DM the page and if you are interested in any other aspect of creatine supplementation let us know!

To Your Health,

Your Clutch Team

References

Cooke M, Rybalka E, Williams A, Cribb P, & Hayes A. (2009) Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr, 6(13).

Santos R, Bassit R, Caperuto E, & Costa Rosa L. (2004). The effect of creatine supplementation upon inflammatory and muscle soreness markers after a 30km race. Life Science, 75(16), 1917-1924.

Volek J, Mazzetti S, Farquhar W, Barnes B, Gomez A, & Kraemer W. (2001). Physiological responses to short-term exercise in the heat after creatine loading. Med Sci Sports Exerc, 33(7), 1101-1108.

Kreider, et al. (1999). Effects of nutritional supplementation during off-season college football training on body composition and strength. J Exerc Physiol Online. 2(2), 24-39.

Greenwood M, et al. (2003). Cramping and injury incidence in collegiate football players Are reduced by creatine supplementation. J Athl Train, 38(3), 216-219.

Kilduff L, et al. (2004). The effects of creatine supplementation on cardiovascular, metabolic, and thermoregulatory responses during exercise in the heat in endurance-trained humans. Int J Sport Nutr Exerc Metab, 14(4), 443-460.

Jager R, et al. (2011). Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids, 40(5), 1369-1383.

NCAA National Study of Substance Use Habits of College Student-Athletes. 2014.

Scofield D, & Unruh S. (2006). Dietary supplement use among adolescent athletes in central Nebraska and their sources of information. J Strength Cond Res, 20(2): 452-455.

Jagim A, Stecker R, Harty P, Erickson J, & Kerksick C. (2018). Safety of creatine supplementation in active adolescents and youth: A brief review. Front Nutr, 5, 115.