Creatine: The properties of an amazing ingredient

If we could choose one nutritional supplement that we could keep on our shelves forever and recommend to most of the population, it would be... creatine. You might wonder why. Perhaps you've heard it in conversations of people who are frequent gym-goers or adolescents who haven’t finished school yet. Maybe, if your grandmother saw your creatine supplement in the kitchen, she'd think you'd fallen hard for "hard" anabolic steroids. Maybe, when you hear the word "creatine", you'd think of swollen muscles and exercise equipment. However, things aren't what they sound or look like most of the time...or at least that's not all they are. In this article, we'll talk about the most misunderstood and yet the most well-studied supplement, creatine, and analyze everything you need to know about it!

Creatine. What is it?

Shall we start of what it isn't? Creatine is not an anabolic steroid, nor a banned ingredient (in this case it would belong to the official list of banned ingredients of the World Anti-Doping Agency, WADA). It is not dangerous, neither toxic! Oh, and it's not something foreign to our bodies.

What is it then? Creatine is a non-protein amino acid which is naturally present in the human body. Our body has the ability to synthesize creatine endogenously in the liver, kidneys and pancreas (about 1g/day), involving 3 amino acids, glycine, methionine and arginine. Once creatine is produced, it is directed to its "stores", which are the muscles and the brain. Creatine can also be obtained through dietary intake, particularly from meat, fish, eggs and dairy products, at about 1-2g per day, leading to muscle saturation of 60-80%, a rate that can vary considerably between individuals. In vegetarians & vegans, due to the exclusion of meat and fish from their diet, reduced intramuscular creatine levels are observed, and men, compared to women, also appear to have a superiority in stored creatine in skeletal muscle.

However, it seems that dietary sources cannot lead to complete saturation of muscle stores, and for this reason, creatine supplementation is a great tool for those who want to enjoy its benefits, by supplementing 20-40% of the reserves within the skeletal muscle.

But what are they?

Creatine & Exercise: The Benefits of Creatine on Athletic Performance

One of the key roles of creatine is its contribution to immediate and rapid energy production. Imagine that the body uses certain substrates ("fuel molecules") to produce energy and shows a particular affinity for substrates that don't need many reactions to synthesize ATP, the key molecule that is constantly being recycled and "burned" to yield energy. Such substrates are phosphocreatine (creatine's bond with phosphate groups) and glucose, the carbohydrates’ reference point. This is followed by fat, as well as protein, which are used for energy under specific conditions. Therefore, it is largely advantageous for the body to produce energy using creatine, especially under specific conditions that require it. It is no coincidence that 95% of all creatine is found within our muscles.

The 2nd main reason an athlete will benefit from creatine supplementation is its contribution to muscle mass growth, when combined with systematic anaerobic exercise. Muscle mass is one of the most important parameters for improving athletic performance in almost all sports. In addition, creatine supplementation appears to increase intermittent intensity exercise performance as well as sprint performance, enhances phosphocreatine and glycogen synthesis (thus not only providing energy, but also continuously enhancing energy recycling), helps in more immediate muscle recovery, reduces inflammation and oxidative stress, acts as a protective factor in the occurrence of injuries, and acts as a facilitator of faster recovery from injury.

Sports where creatine supplementation can be extremely beneficial, offering the unique set of benefits mentioned above, are the following:

Short-duration, high-intensity sports in which phosphocreatine metabolism predominates. The list includes track and field sports such as 60 to 800 meters (including 100, 200 & 400 meter hurdles), long jump, high jump, pole vault, and throwing (shot put, javelin, discus, hammer).
Team sports, combining endurance and explosive bouts, with intermittent periods of high intensity exercise, such as football, rugby, basketball & volleyball. Jumping in volleyball and basketball, shooting in soccer and constant alternating movements in rugby are largely fueled by the creatine-phosphocreatine system.
Weightlifting & Martial Arts.
Swimming (especially 100 & 200 meters).
Skiing

Finally, creatine supplementation will likely further enhance muscle creatine stores in both female and vegetarian populations, due to the initial lower levels.

Creatine & General Health: Did you think creatine only benefits those who exercise?

The benefits of creatine monohydrate don't stop in the realm of sports. Its neuroprotective role, as well as its vital involvement in muscle and brain energy metabolism have stimulated scientific interest among researchers in whether creatine can be used in the context of treating neurodegenerative diseases as well as myopathies, and whether it can improve the quality of life of middle-aged, elderly, premenopausal and menopausal women.

Indeed, creatine supplementation appears to be beneficial in Huntington's disease as well as in Parkinson's disease, where research protocols show that creatine supplementation for 4 months contributed to a reduction in further DNA damage in Huntington's disease on the one hand and to a better outcome in Parkinson's disease, while taking medication on the other hand. In addition, evidence in favor of reduced cognitive decline and improved brain function, continues to emerge with creatine administration in geriatric populations. More specifically, the systematic review by Prokopidis and colleagues demonstrated that creatine supplementation appears to improve memory markers in people between 65-75 years of age, compared to those not receiving creatine, and its effects on concentration, decision-making and more efficient processing are more than promising. With regard to menopause, creatine is a potential "gateway" to improving the quality of life of menopausal women, as it appears to help improve mood swings, reduce depressive symptoms, and contribute to the maintenance of muscle and bone mass.

Creatine, type & dosage. Which is the correct way to take creatine?

As for all the supplements, there is a specific formula and dosage of creatine that gives us the aforementioned benefits. Creatine monohydrate is the most well-studied type, promising us safety and more likely effectiveness. The protocol for creatine monohydrate administration is as follows:

Loading phase (optional). The loading phase has been shown to increase creatine and phosphocreatine stores in muscle, faster, than the maintenance phase. However, it is optional, as the same muscle reserves will be achieved, after administration of 3-5g for approximately one month.

20-30g for the first 5-7 days

(or 0.3g/kg body weight), in 4-5 separate doses, throughout the day.

e.g. a 70 kg man should take 21g (4-4.5g in 4 doses) of creatine in the 1st week of use.

The loading phase is recommended for professional or semi-professional level athletes, who desire to fill in the muscle stores rapidly, in occasions when time is running out e.g. close to competition season.

Maintenance phase. Whether it follows the loading phase or not, the maintenance phase is the stage of protocol that everyone who decides to take a creatine supplement should follow.

3-5g for the next 8-11 weeks

(or 0.03g/kg body weight)

e.g. a 70 kg man should take 2-3g of creatine in the maintenance phase.

Finally, the recommended timing is 1 hour before or after exercise. For maximum absorption, do not forget to hydrate properly, as it is stored in the presence of water, and to eat enough, as it seems that accompanying carbohydrates and proteins in our meals helps the absorption even more. Another reason not to skip adequate quality meals and snacks.

When creatine is taken, outside of a sporting context, the dosage ranges from 3 to 5g per day, at any time of the day.

Creatine & side effects. What should I watch out for, when preparing to take creatine?

The extremely remarkable thing about creatine - in addition to its countless benefits - is its safety of administration. In most dietary supplements, it is considered important to discontinue use after a finite period of months, as most ingredients have been studied on a short-term basis of a few weeks or a few months. In contrast, creatine becomes extremely safe and in much higher doses, in the order of 20-30g of continuous use for 5 years. This does not mean that we are not following the recommended administration protocol, but that we have a very important piece of information around its safety. The most prevalent side effect of long-term creatine use is mild weight gain as creatine is stored in skeletal muscle, with the help of water, and mild gastrointestinal distress at high doses. Finally, creatine administration is considered safe in children and adolescents,

According to recent scientific data, and while creatine is among the safest and best tolerated ingredients in dietary supplements, for optimal results, periodic use annually, with short breaks between 4-5 months of use, is recommended.

Disclaimer: There has been a myth that creatine is harmful to kidney health and causes hair loss, but these are facts that have not been scientifically proven. The use of creatine by healthy adults should be based on its protocol. In case of kidney or any disease, the doctor’s advice are considered necessary.

In conclusion

Creatine, a naturally produced substance in the human body, has evolved into a safe and very well-tolerated dietary supplement, which benefit a very large portion of the population. Creatine firstly emerged in the field of sports and in the last decade, it starts to follow clinical paths, those of quality of life in people of advanced age, where it acts cardio- and neuroprotectively. Although the data has not yet been confirmed, it is now more than likely that in the upcoming years, not only will our grandmothers not be afraid of creatine, but possibly, creatine will accompany their breakfast!

Scientific References

Arazi, H., Eghbali, E., & Suzuki, K. (2021). Creatine supplementation, physical exercise and oxidative stress markers: a review of the mechanisms and effectiveness. Nutrients, 13(3), 869.

Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental gerontology, 108, 166-173.

Gutiérrez-Hellín, J., Del Coso, J., Franco-Andrés, A., Gamonales, J. M., Espada, M. C., González-García, J., ... & Varillas-Delgado, D. (2024). Creatine Supplementation Beyond Athletics: Benefits of Different Types of Creatine for Women, Vegans, and Clinical Populations—A Narrative Review. Nutrients, 17(1), 95.

Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., ... & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14(1), 18.

Mielgo-Ayuso, J., Calleja-Gonzalez, J., Marqués-Jiménez, D., Caballero-García, A., Córdova, A., & Fernández-Lázaro, D. (2019). Effects of creatine supplementation on athletic performance in soccer players: a systematic review and meta-analysis. Nutrients, 11(4), 757.

Prokopidis, K., Giannos, P., Triantafyllidis, K. K., Kechagias, K. S., Forbes, S. C., & Candow, D. G. (2023). Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. Nutrition reviews, 81(4), 416-427.

Xu, C., Bi, S., Zhang, W., & Luo, L. (2024). The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Frontiers in Nutrition, 11, 1424972.