Creatine: Everything you need to know

Creatine is one of the most researched ergogenic supplements on the market. It has the most impact on short duration, high intensity exercise (Rawson and Perksy 2007), most notably increasing maximal strength (Peeling et al., 2018) and lean muscle mass (Rawson and Perksy 2007) and reduced muscle breakdown (Paris et al., 2001). Supplementation improves intramuscular creatine stores by ~30% (Harris et al., 1992) with the magnitude of the response inversely proportionate to the starting concentration (Volek & Rawson 2004) – but what does this actually mean, is it safe, and how am I supposed to take it? Welcome to my blog post about creatine: everything you need to know. So, what is creatine?

Creatine is synthesised in the kidneys from the amino acids glycine, arginine and methionine, and is found in skeletal muscle in two forms. Approximately 40% is in its free Creatine form, and the remaining 60% is in its phosphorylated form Creatine Phosphate (Demant and Rhodes 1999). The daily turnover rate is around 2g per day for males and females which can be bolstered through supplementation. Concentrations are greater in fast twitch muscle fibres due to the slow twitch fibres having greater resynthesises rates because of their increased aerobic capacity (Demand and Rhodes 1999). So, how is creatine used in the body?

Intense exercise lasting <10 seconds requires the use of the human body’s intramuscular stores of Adenosine Triphosphate (ATP) and phosphocreatine (PCr) (Williams et al., 1998). Within the muscle, creatine-kinase mediates the phosphorylation of creatine to PCr which is a key substrate for muscle force production (Greenhaff et al., 1993) in synthesising Adenosine Diphosphate (ADP) to ATP. During high intensity exercise such as weightlifting PCr levels decrease, meaning the rate of ATP synthesis from ADP falls (Rawson & Persky 2007) and the ability to retain maximal effort declines. However, because creatine supplementation improves intramuscular creatine stores (Hall et al., 2013) there is a greater rate of PCr resynthesis (Burford et al., 2007) and thus a greater force produced. This is seen in the gym by an obvious increased weight lifted in both single and repeated reps. So, how do you actually supplement creatine?

The method is unique, as it requires a 'loading' and 'maintenance' phase. The most effective strategy is consuming 20.9±4.5g/day (divided into 4 equal doses per day) for the first 5-7 days in the loading phase, and then a single 3-5g dose per day from then on (Lanhers et al., 2017). Further research has also suggested creatine consumption alongside 50g of protein and carbohydrate improves muscle creatine uptake via an insulin mediated effect (Steenge et al., 2000) - suggesting creatine is more beneficial when consumed alongside a meal.

However, there is an upper limit of creatine stores in human muscle (Greenhaff et al., 1995) which has been reported as high as 160g (Burford et al., 2007). Therefore athletes with full stores will not see any further enhancement in performance with supplementation, and individuals with low stores of creatine see a much larger response (Burke et al., 2003) such as gym novices or vegetarians (Demant and Rhodes 1999).

There is a common myth in the fitness industry that creatine is unsafe and should be avoided. However, when the correct loading protocol has been followed, there has been no reports of negative health effect of creatine supplementation in long term use of up to 4 years (Schilling et al., 2001), and it has actually been shown to enhance neurological brain function (Rae et al., 2015) and aid injury rehabilitation (Juhasz et al., 2018). The most notable side effect of creatine is increased body mass (Demant and Rhodes 1999), which is most likely caused by increased protein synthesis and water retention in the muscles. Some people have argued that, because of creatine's increased water retention, it leads to greater risk of dehydration, muscle cramping, kidney and liver issues. However, the scientific literature states when adequate hydration is supplied, athletes have equal risk of suffering with these issues whether supplementing with creatine or not (Greenwood et al., 2003; Kreider et al., 2003) - Greenwood and colleagues (2018) recently stated that creatine reduces the risk of cramping.

The International Olympics Committee is still allowing creatine to be used and refusing to place it on the banned list of substances. This is because its abundance in every day food such as meat and fish and there is no valid test to determine if athletes are taking it.

In summary, when creatine is loaded correctly (~20g per day for 5 days, then 5g following), creatine supplementation increases power output, lean muscle mass, water retention and performance of repeated bouts of exercise, through greater resynthesis of ATP.

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Thank you for taking the time to read this blog, I hope you enjoyed it and learnt something. Please see my website if you're interested in more blogs like this, where I am also selling my own training plans. You can find me on instagram @hb.fitt_

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Dictionary

Ergogenic - Increasing capacity for bodily or mental labour, especially by eliminating fatigue symptoms.

References

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Deminice, R., Rosa, F. T., Franco, G. S., Jordao, A. A., & de Freitas, E. C. (2013). Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition, 29(9), 1127-1132.

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Greenhaff, P. L., Casey, A., Short, A. H., Harris, R., Soderlund, K., & Hultman, E. (1993). Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clinical Science, 84(5), 565-571.

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Juhasz, I., Kopkane, J. P., Hajdu, P., Szalay, G., Kopper, B., & Tihanyi, J. (2018). Creatine supplementation supports the rehabilitation of adolescent fin swimmers in tendon overuse injury cases. Journal of Sports Science & Medicine, 17(2), 279.

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