Ending the Creatine Confusion

Creatine-Loading-CycleEnding the Creatine Confusion

In an effort to gain maximal size, strength, and stamina,many athletes turn to popular ergogenic aids to supplement their training routines. One of the most popular of these supplements is creatine which in its supplemental form has become rather widespread. The discovery that the creatine and phosphocreatine content in human muscle can be increased by oral ingestion of supplemental creatine monohydrate has led to numerous studies examining its benefits on exercise performance. Another potential benefit that is of particular interest to strength athletes-including bodybuilders and physique athletes is an increase in lean body mass which results from the ingestion of creatine monohydrate.

Whether you’ve used creatine monohydrate yourself or know of others taking it there tends to be a great deal of confusion surrounding its safety, efficacy and proper use as a performance supplement.
The purpose of this article is to provide answers tomany of the common questions about creatinein order for athletesto make informed decisions that are based on researched evidence as opposed to a misinformed trainer, coach or biased supplement distributor. In order to provide accuracy and clarity, I sought out the expertise of Eric Rawson PhD.
Over the past decade and a half, Dr. Rawson’s research has focused on the interactions between nutrition and skeletal muscle.  In particular, Dr. Rawson has extensively studied the effects of the dietary supplement creatine on muscle function.  In fact, if you were to do a peer-reviewed journal search using the keyword “creatine”, Eric Rawson’s name would appear quite frequently. He is currently an Associate Editor for Applied Physiology, Nutrition, and Metabolism, Amino Acids, the Journal of Strength and Conditioning Research, the ACSM's Health & Fitness Journal®, and has reviewed articles for more than 30 peer-reviewed journals. Rather than simply attempt to interpret his research, I decided to address him directly. Thankfully, he was kind enough provide me with answers to some common questions about creatine as well as to cite some of the research which supports them.

Despite the fact that no scientific studies prove any adverse side effects, there have been anecdotal reports of potential side effects-including muscle cramping or spasms, diarrhea, gas, and bloating and even kidney disease.
It is important to note that dietary supplements do not undergo the same pre-market testing as pharmaceutical drugs,however,there are many published research studies that demonstrate the safety of creatine monohydrate.  And as Dr. Rawson notes, “the available evidence indicates that creatine monohydrate supplements have an excellent safety profile.”
While there are always more studies to be done in order to ensure safety from every angle there is always apotential side effect with any type of substance we put into our bodies. But as of now, creatine monohydrate, when ingested at recommended doses, appears to pose no serious threat to healthy athletes and bodybuilders.

Some athletes continue to remain skeptical about the legitimacy of creatine monohydrate as ergogenic aid.And someargue that creatine does little more than add water weight.So I asked Dr. Rawson based on his extensive research of creatine’s effect on muscle function, if creatine was in fact an effective supplement for increasing strength and lean body mass.

According to Dr. Rawson, “Increasing muscle creatine and phosphocreatine levels through creatine monohydrate supplementation has both indirect and direct effects on skeletal muscle.  For instance, creatine monohydrate supplements allow athletes to train with increased training volume and recover more rapidly during brief, high-intensity, intermittent exercise (e.g. resistance training).  Also, creatine monohydrate supplements increase expression of a variety of growth factors involved in skeletal muscle hypertrophy and function.”
Some research indicates that creatine may also be effective for people with certain medical conditions, including heart patients, and on some types of neuromuscular disease or orthopedic injury if taken at recommended doses.

Types of creatine
There a few different types and forms of creatine, but the most popular by far is creatine monohydrate in powder fospoonful-creatinerm, though it can be found in pill form as well. Other types of creatine include, phosphate, citrate, malate, and ester. However, nearly all of creatine research is on creatine monohydrate, including safety and efficacy studies. In addition,the absorption of creatine monohydrate is almost 100%, and the overall costis modest compared to other types.A word of caution, creatine monohydrate is not stabile in liquid and rapidly degrades to creatinine (Harris, R. C., Almada, A. L., Harris, D. B., Dunnett, M., Hespel, P.The creatine content of Creatine Serum and the change in the plasma concentration with ingestion of a single dose.J Sports Sci. 2004 Sep;22(9):851-7.).So, liquid creatine monohydrate supplements are not recommended.  Also, there is some research indicating that creatine ethyl ester supplements are pro-creatinine (i.e. they convert to creatinine following ingestion) (Giese, M. W., Lecher, C. S.Non-enzymatic cyclization of creatine ethyl ester to creatinine.BiochemBiophys Res Commun. 2009 Oct 16;388(2):252-5.  Based on this information,there doesn’t appear to be any benefit to using any other forms of creatine supplements.

When you hear about creatine supplements, you probably also hear about loading and maintenance phases. What does this mean?

Traditional creatine supplementation protocols include a brief 5 day high-dose of 20 grams per day or a longer-duration 4–6 week low-dose of 3 grams per day. Both the short-duration and high-dose and the longer-duration low-dose creatine supplementation methods have been proven effective at increasing muscle creatine content by about 20%, and both methods have been shown to improve exercise performance. (Hultman, E., Söderlund, K., Timmons, J. A., Cederblad, G., Greenhaff, P. L.Muscle creatine loading in men.J Appl Physiol. 1996 Jul;81(1):232-7.)

However, according to Dr. Rawson, differences in body composition, training goals, and competitive challenges could affect how creatine is best used. “Consider the differences between a pre-contest physique athlete (i.e. a bodybuilder) and an offensive lineman in gridiron (American) football.  Both could be categorized as strength and power athletes, but they have very different needs and goals.  Some simple guidelines for creatine monohydrate loading would be to consume about 0.3 grams/kg of body mass per day for five days.  This should be divided into four equal servings throughout the day.  Muscle uptake will be enhanced with a transient insulin spike induced through feeding.  A large athlete, who is not concerned with caloric intake, could consume up to 50 grams of carbohydrate and 50 grams of protein with each serving of creatine monohydrate.  This can be accomplished by combining the creatine monohydrate supplement with a meal (e.g. grilled chicken, brown rice, vegetables) or with a protein/carbohydrate (e.g. whey/dextrose) supplement.  If caloric intake and the maintenance of low body fat are important, it would be best to consume creatine monohydrate after regular meals, instead of adding kilocalories to the diet.  Muscle creatine uptake is also enhanced with exercise, so consuming creatine monohydrate supplements along with the immediate post-workout meal (food or supplement) may be helpful.”

Maintenance and Cycling
Human muscle appears to have an upper limit of Creatine storage which, once achieved, with diet or supplementation, cannot be exceeded.
As Dr. Rawson notes; “Once muscle creatine is elevated with short-term high-dose creatine monohydrate supplementation, elevated muscle creatine can be maintained with a low daily dose.  The exact dose will vary and is based on meat intake and body size.  Generally, the ingestion of 2 to 5 grams per day or 0.03 grams per kilogram of body mass per day is sufficient to maintainelevated muscle creatine level.“This is less than what many supplement labels recommend.

Although there is no physiological rationale for either cycling on and off creatine or for continuous useDr. Rawson believes there may be some practicality.
“If athletes use creatine monohydrate supplements to enhance their sports performance during the competitive season, they may consider not taking the supplement during the off season.  Similarly, if athletes ingest creatine monohydrate during the off season (or during a hypertrophy phase for a physique athlete) they may consider not taking the supplement during the competitive season.”

Water Retention
Many physiqueathletes and their coaches will avoid using creatine prior to a competition in fear of it causing water retention and a softer puffy appearance. What I find somewhat amusing about this concern is that in my experience many of these same athletes and/or coaches will use or recommend anabolic androgenic agents that are KNOWN to cause water retention however they don’t seem to have the same concern to eliminate those substances during the pre-contest phase.And although creatine supplementation causes a small increase in total body water, there is no evidence that this will leave the athlete with a softer or less defined appearance. In fact, if intracellular fluid expands muscle volume, the muscles will more than likely have a fuller harder appearance. So unless water weight is stored just under the skinit wouldn’t result in a softer look.

Given the widespread use of creatine among bodybuilders and other athletes, the findings of Dr. Rawson as well as the other research cited supply reliable scientific information to athletes, trainers and coaches regarding the risks, benefits and effective protocols for the use of creatine monohydrate. Overall, creatine monohydrate, when ingested at recommended doses, appears to be a relatively safe and effective ergogenic aid. Hopefully, this information will allow athletes to make better decisions about the use of creatine to aid their training and muscle building needs.

Train smart and good luck!




·    Gualano, B., Roschel, H., Lancha, A. H., Brightbill, C. E., Rawson, E. S.  In Sickness and in health: The widespread application of creatine supplementation.  Amino Acids.  2012;43(2):519-29.
·    Lopez R. M., Casa D. J., McDermott B. P., Ganio M. S., Armstrong L. E., Maresh C. M.  Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses.  J. Athl. Train.  2009;44(2):215-23.
·    Persky, A. M. and Rawson, E. S.  Safety of creatine supplementation in health and disease. In: Creatine and Creatine Kinase in Health and Disease.  Eds: Gajja J. Salomons and Markus Wyss. Springer, Dordrecht, pp. 275-289, 2007.
·    Rawson, E. S. and Persky, A. M.  Mechanisms of muscular adaptations to creatine supplementation.  Int. SportMed. J. 2007;8(2):43-53.
·    Rawson, E. S. and Volek, J. S.  The effects of creatine supplementation and resistance training on muscle strength and weightlifting performance.  J. Strength Cond. Res.  2003;17(4):822-31.
·    Jäger, R., Purpura, M., Shao, A., Inoue, T., Kreider, R. B.  Analysis of the efficacy, safety, and regulatory status of novel forms of creatine.  Amino Acids. 2011;40(5):1369-83
·    Gualano, B., Hamilton, R., Lancha, A. H. Jr.,Brightbill, C. E., Rawson, E. S.; In sickness and in health: the widespread application of creatine supplementation. Amino Acids.  2012;43(2):519-29.
·    Rawson, E. S., Stec, M. J., Frederickson, S. J., Miles, M. P.  Low dose creatine supplementation enhances fatigue resistance in the absence of weight gain.  Nutrition.  2011;27(4):451-45.



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