Everything you’ve ever wanted to know about creatine: Who’s it for, what are the benefits, and are there risks?
I posted about creatine on my instagram the other day and received an overwhelming response with questions pouring in my DM’s about how to take it, how much and whether it was safe to take longterm, so to answer some of the most frequently asked questions, I put them together in a blog so you can do your own research. There will be a link to several peer-reviewed papers at the bottom of this blog.
What is creatine?
Creatine is naturally found in the body, and is created by the liver, pancreas and kidneys at a rate of 1-2g per day. Energy is created when a phosphate molecule is donated from a bond turning ATP (adenosine triphosphate) into ADP (adenosine diphosphate).
In order for this to happen our bodies need an enzyme called creatine kinase to break the chemical bond between the creatine molecule and phosphate molecules (that are attached in a phosphocreatine), thus turning the 2 phosphates into 3 phosphates.
This ATP turnover is where energy happens, meaning that the more creatine we have in our bodies, the more potential ATP there is.
In sports performance, this translates to power and speed in anything that requires rapid movements like weight lifting and sprinting rather than long and arduous tasks like slow and steady movements.
There is overwhelming evidence that confirms creatine can help athletes increase performance and recovery, but even after decades of research the same questions emerge over and over again, as to whether creatine supplementation is truly safe, and exactly how much is considered safe, so let’s dive in…
Can creatine supplementation cause kidney damage?
Over the past few years there have been suggestions that creatine supplementation could cause “kidney overload” as it would force the kidneys to produce too much creatine resulting in renal damage.
Currently there is no evidence that suggests this is true. Perhaps the confusion was caused by a study in 1989 where two males who were already suffering from kidney disease discovered that their kidneys had continued to deteriorate as a result of ingesting 15g of creatine supplement.
It’s important to note that this is well above the recommendation of daily intake and the two men were already suffering from kidney disease.
A meta analysis in 2021 concluded that “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” (Antonio et al, 2021).
Does it make you gain weight?
Perhaps one of the biggest concerns about taking creatine is the possibility of weight gain.
Creatine is an osmotically active substance which means that it has the potential to cause water retention. The total body water increase is often the case with a “loading” period where athletes take anywhere up to 20g of creatine per day in the initial stages of supplementation.
Because most of the research in the early stages were conducted on a short term basis, these results often became misunderstood to mean that the same outcome would persist longterm. It doesn’t and whatever water weight you gain in the intial stages of supplementing, often begins to level out.
What about fat mass?
There have been several studies that have found that there is no correlation between creatine supplementation and an increase in fat mass, in fact during one study, it was found that children with acute lymphoblastic leukemia who supplemented with creatine were able to lose fat mass (Bourgeois et al 2008).
During a systematic review and meta analysis, it was found that creatine supplementation together with strength training in adults over 50 years of age actually decreased total body fat (Forbes et al 2019).
Even though there was an increase in water weight in various studies, the evidence shows that taking the recommended dose without a “loading” phase doesn’t seem to cause any water retention, which leads us nicely into the next question…
How much do you need to take?
A supplementation of 3-5g per day or 0.1g/kg of body weight is the currently recommendation and research has also shown that combined with resistance training an help enhance strength and muscle growth. It can be taken everyday even on rest days.
Although a “loading” phase is often practiced and recommended by athletes, it is not necessary and depends on each person’s goal and preferences. If your goal is to “maximise the ergogenic potential of creatine in a very short period of time” then they might benefit from a “loading” phase defined as a 2-4 week period of consuming up to 25g of creatine per day (Antonio et al, 2021).
However for those looking to just maintain strength or for whom might need to stabilise their weight for a meet weigh-in it may be preferential to take the normal dose of 3-5g to avoid a sudden water weight gain.
Is creatine only suitable for strength athletes?
Nope. Creatine can be effectively used by athletes of all disciplines since it helps encourage greater muscle glycogen storage, which is what you need during intense periods of training or competition.
There is also growing evidence that creatine supplementation can help athletes recover from muscle damage, inflammation and delayed muscle soreness.
Because creatine is an osmotically active substance, it means that it can help athletes hyper-hydrate during trainings in intense heat where lots of body water is loss. This means that athletes will be able to recover much easier from dehydration which could impact performance.
Most excitingly however is that there is evidence that suggests creatine can help reduce the severity of spinal cord injuries and brain damage. The evidence was so strong that even the Internal Society of Sports Nutrition recommend any athletes involved in impact sports that could risk concussions or spinal cord injury, supplement with creatine.
There is evidence that creatine helps peri and post menopausal women retain muscle.
A topic very close to home, since I am slowly but surely descending into the world of peri-menopause.
If you’re a regular reader of mine you’ll know just how much I talk about resistance training or strength training as a strategy to help build strength and slow down the impending process of sarcopenia (muscle deterioration as a result of old age).
Resistance training can help slow this process down, and now research has emerged that supplementing with creatine can also help increase muscle mass.
Furthermore, there is also evidence that suggests that creatine supplementation in menopausal women can also have favourable effects on bone density.
As women enter menopause they become at risk of osteoperosis. Creatine with the help of strength training has been found to improve bone health. Studies have found that in older females, supplementation of up to 0.3g/kg a day “significantly improved” performance, strength and fat free mass. (Antonio et al, 2021).
Does creatine work for everyone?
Because creatine is found in high amounts in animal protein (in particular red meat) those following a vegan or vegetarian diet have been shown to respond well to taking supplements.
However, not everyone will respond to creatine. Research suggests that about 20% of the population are “non responders”, due to their already high rate of consumption through animal protein. Most people however, who want to see an improvement in sports performance can still benefit from taking supplements.
Take aways
Creatine is safe for healthy individuals at the recommended dose and can vastly improve sports performance in many disciplines.
Overall, creatine supplementation can:
Improve strength, power and muscle hypertrophy with the assistance of resistance training
Improve high intensity intermittent performance
Improve endurance performance
Aid in recovery and help minimise muscle damage
Decrease the effects of sarcopenia in older adults
Possibly help in improving the health of bone mass in menopausal women
Some people may be classed as “non responders”, while those on a plant based diet may benefit more from taking it.
Finally for those wondering whether creatine is an anabolic steroid, the answer is no. Both supplements may create similar results however steroids are a synthetic version of testosterone, that help create bigger muscles when used in conjunction with resistance training.
Creatine on the other hand is created when a phosphate molecule is donated from a tri-phosphate to a di-phosphate resulting in energy (ATP to ADP), so the mechanics of the two supplements are very different, not to mention steroids are classed as a drug.
As explained by Antonio et al, “the physiological and performance outcomes of anabolic steroids and creatine can be similar, their mechanisms of action and legal categorization are not.”
References
Forbes, S.C.; Candow, D.G.; Krentz, J.R.; Roberts, M.D.; Young, K.C. Changes in Fat Mass Following Creatine Supplementation and Resistance Training in Adults ≥50 Years of Age: A Meta-Analysis. J. Funct. Morphol. Kinesiol. 2019, 4, 62. https://doi.org/10.3390/jfmk4030062
Jacqueline M. Bourgeois MD,Kim Nagel BScN,Erin Pearce BA,Marilyn Wright Med.,Ronald D. Barr MD,Mark A. Tarnopolsky MD, PhD Creatine monohydrate attenuates body fat accumulation in children with acute lymphoblastic leukemia during maintenance chemotherapy https://doi.org/10.1002/pbc.21571
Antonio, J., Candow, D.G., Forbes, S.C. et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. J Int Soc Sports Nutr 18, 13 (2021). https://doi.org/10.1186/s12970-021-00412-w
Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. J Int Soc Sports Nutr. 2012 Jul 20;9(1):33. doi: 10.1186/1550-2783-9-33. PMID: 22817979; PMCID: PMC3407788.
