Creatine: Not Just for Muscle

 

If you’re involved in sports that require speed, power, and strength, then you’ve likely come across creatine before. The supplement gained prominence in the early 1990s as a method of enhancing strength, and since then research has continued to explore its use as a sports performance aid.

Beyond muscle, creatine is a supplement that can optimize performance across many different realms, says @craig100m. Share on X

In this article, I’ll give an overview of the research underpinning creatine’s use as a training aid, but also focus on some of the more novel findings regarding creatine. This includes its use as an agent to prevent disuse atrophy in injured athletes, as a cognitive enhancer, and as a potentially important agent in the recovery from concussion. Given these important new findings, we can no longer just consider creatine from the perspective of muscle, but instead view it as a supplement that can optimize performance across a number of different realms.

What Is Creatine?

Creatine is a naturally occurring, nitrogen-containing molecule that tends to be found in animal flesh. Creatine’s main role in humans is as part of the ATP-PC energy system—the method by which we produce energy rapidly during high-intensity exercise, such as in sprinting or lifting heavy weights. Our body utilizes adenosine triphosphate (ATP)—the “energy currency” of the cell—to power muscle contraction; here, the breaking of a bond between one of the phosphate molecules and adenosine creates the energy required for contraction.

This leads to a buildup of adenosine diphosphate (ADP), which the body can’t utilize for energy quite as readily. Instead, it needs to add an additional phosphate molecule to ADP, recycling it back to ATP. This reaction requires an additional phosphate molecule to be found from somewhere, and the most readily available source is from phosphocreatine, one of the major ways creatine is stored in the body.

Creatine Supplementation for Performance

Given that we need energy to train, and given that the majority of speed, strength, and power adaptations come from high-intensity exercise, a logical step was for researchers to take a closer look at whether creatine supplementation could increase muscular levels of creatine. If it could, then in theory we would have greater amounts of phosphocreatine available, and so could both sustain high-intensity exercise for longer and also recover from it quicker.

An early study from 1992 was one of the first to test this hypothesis. In this case, the researchers recruited 17 males and females of differing ages (ranging from 20-62 years old), and differing levels of fitness. It was found that 5g of creatine (the amount found in just over 1kg of steak) resulted in a decent increase in blood plasma levels of creatine, and that supplementation of 5g four to six times per day for at least two days led to a substantial increase in creatine levels within the muscle.

Subsequent research indicated that, following a loading phase comprised of six days of consuming 20g of creatine per day, the increased creatine levels could be maintained with an intake of just 2g per day. A daily dose of 3g per day, with no loading phase, was found to be similarly effective at increasing and maintaining creatine levels, such that, today, most athletes skip the loading phase and just consume creatine at a set dose.

But do increased creatine stores lead to enhanced performance? Well, the short answer is yes—this has been exceptionally well-researched over the years, such that we can now be very confident that creatine supplementation can enhance performance in exercise tasks lasting less than 30 seconds (where the ATP-PC system plays a large role), strength, and strength endurance, as well as potentially aiding in improvements in body composition. There is also some evidence that creatine supplementation may enhance aerobic endurance performance, potentially due to an increased ability to train at higher workloads.

Creatine Supplementation for Recovery

Alongside its clear and replicated performance benefits, there is also the potential that creatine can act to support recovery from exercise, which a number of different studies have explored. Such a positive effect of creatine supplementation has been shown for recovery from sprint-based exercise, resistance training, endurance exercise and competition, and eccentric loading protocols. In particular, it appears to enhance the repeated bout effect, whereby we experience less soreness following prior eccentric loading.

Although not all studies show such a positive effect, none show a negative effect, and so creatine supplementation may be a worthwhile consideration as a recovery agent. Furthermore, chronic ingestion of creatine enhances muscle glycogen resynthesis following prolonged exercise, illustrating that it might be a useful method of enhancing recovery between repeated bouts of endurance exercise, such as those seen in heats and finals at major championships, or in team sports that compete on a weekly basis.

Creatine Supplementation and Injury

Creatine has also shown promise as an agent that may enhance the post-injury rehabilitation process. This can be especially true when immobilization has to occur, for example when a cast is worn. In a 2009 study published in the Journal of Strength and Conditioning Research, researchers recruited seven male subjects and had their arm placed in a plaster cast for seven days on two different occasions. On one occasion they received a placebo, and on another they consumed 20g of creatine per day for the duration of immobilization.

Creatine has shown promise as an agent that may enhance the post-injury rehabilitation process, says @craig100m. Share on X

The researchers found that creatine supplementation maintained lean muscle mass to a greater extent than placebo following immobilization, which in turn was associated with better maintenance of strength and strength endurance. These results have since been replicated—although an effect is not always found—and, given that increasing the strength of an injured body part post-injury is a crucial part of the return-to-play process, it’s easy to understand how a better maintenance of muscle mass and strength during the early injury immobilization phase may be worthwhile.

Creatine Supplementation and the Brain

Given what I’ve reviewed so far, it’s clear that creatine has a multitude of positive physiological effects on performance across a variety of different domains, from strength to sprints to endurance training. But its positive effects don’t just end there. While the majority (~95%) of the creatine in our bodies is found in our muscles, a smaller proportion can be found in the brain, where, as in muscle, it has a role to play in the production of energy.

This gives creatine the potential to be a useful neurocognitive enhancer. A great example of this is creatine’s use in the management of Parkinson’s disease. It is believed that Parkinson’s develops through mitochondrial dysfunction, indicating that there is a breakdown in the optimal production of energy in the brain. Because creatine can help offset this metabolic dysfunction, it may well be useful here, and is in fact undergoing testing in clinical trials. Such cognitive effects have also been shown in non-diseased subjects, including the elderly and those who may consume lower-than-normal dietary levels of creatine, such as vegetarians.

Perhaps one of the more exciting neurocognitive uses of creatine, from a performance perspective, is that it appears to mitigate some of the negative effects of insufficient sleep. This could be important when it comes to sports that have a higher neurocognitive demand, characterized by the need to make many decisions in a short period of time, as in many team sports.

One exciting neurocognitive use of creatine—it may lessen some adverse effects of inadequate sleep, says @craig100m. Share on X

This was shown in a neat 2011 study, published in the Journal of the International Society of Sports Nutrition. Here, researchers put 10 elite rugby players through a rugby passing skill test on 10 different occasions. Half of the times the subjects undertook the passing test, they had slept for between seven and nine hours the previous night; the other times, they had slept for between three and five hours. Ninety minutes before the start of each trial, they took a placebo, creatine (either in a dose of 50 or 100 mg/kg), or caffeine (in a dose of 1 or 5 mg/kg).

The results indicated, unsurprisingly, that sleep deprivation negatively affected skill execution, but that the use of either creatine or caffeine reduced this negative effect. Regarding the creatine, subjects taking the higher dose (100 mg/kg, equivalent to 8g creatine in an 80kg individual) performed slightly better than those taking the 50 mg/kg dose. As such, while we all understand the importance of getting a good night’s sleep, for times when this hasn’t happened—perhaps due to travel, or pre-competition nerves—creatine represents a potentially useful avenue to at least rescue some of the expected performance loss.

While it is obvious to state that exercise depletes energy stores, and that this is a cause of fatigue, we are starting to understand that there is in fact a two-way interaction between the brain and body when it comes to determining how fatigued an individual is during exercise. (The excellent book Endure by Alex Hutchinson explores this particularly well.) Briefly, it is thought that fatigue—defined as the inability to maintain a certain workload—occurs, in part, through the brain’s interpretation of a multitude of signals, including those measuring energy stores. There is the possibility here that additional muscular creatine, derived through supplementation, could act to “trick” the brain into thinking there is more energy available, allowing the athlete to exercise for longer.

Additionally, physical exercise also causes cognitive fatigue and, given that creatine supplementation can enhance cognitive function, it may also improve cognitive function towards the end of prolonged training and competition events, enhancing decision-making under fatigue. This could be especially important in team sport tournaments that have the possibility of extra time or overtime, and even penalty shootouts; here, the enhanced skill levels of the players with less cognitive fatigue (augmented by creatine supplementation) might be the difference between winning and losing.

Creatine and Concussion

So far, we have looked at how creatine supplementation may be able to enhance performance, but the most recent aspect of creatine research has been exploring how it might act as a neuroprotective agent when it comes to recovering from concussions. Following a concussive injury, research has shown that creatine concentrations in the brain decrease, and this, in turn, causes changes in metabolism within the brain cells, lengthening recovery time. Additionally, there is the potential that creatine can act as an antioxidant within the brain, supporting the recovery from concussive events.

The use of creatine as a neuroprotector has been tested experimentally, both in animal models and, more recently, in humans. The results from the animal models were positive: supplementation with creatine prior to the concussive event was associated with up to 50% less damage to the brain cells, which was mediated by creatine’s protective effects on the mitochondria. In the human studies, children who were suffering from a concussion were infused with ~0.4 grams of creatine per kilogram of bodyweight (a substantial creatine dose) every day for six months. They tended to showed improvements in memory, communication, and behavior, and had shorter hospital stays, when compared to the placebo group.

Though more studies are needed, creatine appears to improve the recovery from concussive injuries, says @craig100m. Share on X

While these early results are promising, clearly there needs to be a greater amount of research carried out in this field before we can make more concrete statements. However, even based on the preliminary work undertaken so far, it does appear that creatine supplementation can enhance the recovery from concussive injuries—and certainly doesn’t seem to be negative. Based on the animal studies, there may be an additional protective advantage from creatine supplementation prior to the concussion happening, which is perhaps an added consideration for those athletes competing in contact sports.

Tentative Creatine Supplementation Recommendations

When it comes to the form of creatine to be used, there are many different types out there. The “original” form is creatine monohydrate; the research base suggests that this form is both safe for long-term use and also effective. As a small caveat here, given the fairly recent advent of creatine supplementation, the majority of studies are carried out over short time periods. As such, there are actually very few studies examining the effects of long-term (i.e., years) creatine supplementation, although data does suggest that continuous use for five years is not associated with any negative consequences in healthy individuals. Based on this, it seems sensible to suggest that those consuming creatine should have periods of time where they don’t utilize supplemental creatine. I tended to have eight continuous weeks per year in the off-season where I didn’t consume any supplemental creatine.

There is much less research on the alternative forms of creatine, so it’s difficult to ascertain their long-term safety and effectiveness. However, from the research that I have seen, they appear to offer no real advantages over creatine monohydrate. Therefore, given that this form is the cheapest, it seems the most sensible route for consumption.

A further consideration is that there is likely individual variation in the response to creatine supplementation. For many people, creatine will be readily available from diet. In people who consume meat on a daily basis, about half of their daily creatine requirements (2-3g) could be coming from dietary sources, with a pound of uncooked meat generally providing somewhere between 1 and 2 grams of creatine. As a result, many people likely need to supplement with less creatine than they might think.

A study from 2017 further explored this individual variation. Here, the researchers recruited 15 children (aged 10-12 years old), 31 adults (18-45 years old, of which just under half were vegetarian), and 18 elderly subjects (aged between 62 and 84 years). The subjects were given a placebo for seven days, and then switched to creatine (at 0.5 grams per kilogram of body mass) for seven days. At baseline, the adult vegetarians had the lowest levels of dietary creatine intake, which is unsurprising given that creatine is found in animal flesh. The adult omnivores had the highest intakes, with the children and elderly adults having similar intakes.

Creatine supplementation increased the muscle creatine content of both the children and the elderly subjects, and also the vegetarian adults, but was found to have a less-robust effect in adult omnivores. This demonstrates that the impact of creatine supplementation can vary as a function of regular diet, with those who consume the least creatine through dietary sources responding the best. There were no differences between the male and female subjects in this study, suggesting that sex has no impact on the responsiveness to supplementation.

Based on all the above, what advice could we give to people considering creatine supplementation? First, creatine has been shown to be effective at enhancing both performance in, and longer term training adaptations from, high-intensity exercise, including sprint and resistance training. Therefore, for athletes involved in sports that require high levels of performance in these traits, creatine represents a potential avenue for performance enhancement. There is less evidence that it may support aerobic endurance performance, although, again, as far as I am aware there are no studies demonstrating a negative effect of creatine supplementation. Given that athletes of all sports should be utilizing some resistance training, there is the potential for creatine to be effective.

The two methods commonly utilized when supplementing with creatine are either a loading method, which usually involves doses of around 25g per day for about a week, followed by a maintenance phase of 3-5g per day, or just ingestion of the maintenance dose (3-5g per day). Anecdotally, I always preferred just dosing with a smaller amount, but for extended periods of time.

Alongside creatine’s impact on training, it also has beneficial effects on post-exercise recovery, and potentially as a neurocognitive enhancer. As such, creatine is now present in many pre- and post-exercise ready-made mixes, which athletes might wish to consider. The combination of creatine and caffeine pre-competition (or even during competition, if the competitive bout is prolonged) may enhance the decision-making ability, and offset feelings of fatigue. Similarly, following a maximal exercise bout, such as during competition, supplementation with creatine may boost recovery.

The optimal dose for both these scenarios is dependent on the athlete’s current intake of creatine, both through diet and supplementation. If the athlete is already consuming supplemental creatine at the maintenance dose of 3-5g per day, then doses above this are unlikely to offer any additional effect. However, if they are not currently consuming creatine (many athletes reduce creatine intake prior to competition), then larger doses of 10-20g might be appropriate.

If an athlete suffers an injury, creatine supplementation might be a worthwhile intervention, says @craig100m. Share on X

When it comes to recovery from injuries, creatine supplementation has been shown to mitigate the losses of muscle mass and strength following disuse. As such, if an athlete suffers an injury, creatine supplementation might be a worthwhile intervention. The dose used in many studies was 20g per day, although if the athlete is already consuming creatine such a loading phase may not be required.

Finally, athletes in contact sports, particularly those that may predispose to head trauma and concussion, might be interested in the neuroprotective aspect of creatine supplementation. Some studies suggest that supplementation prior to a head injury is required to reap the full benefits, pointing to an advantage to keeping creatine stores topped up throughout the competitive season in these players. However, post-injury supplementation has also been shown to be effective, often using doses of 15-20g per day. To my knowledge, no study has compared the impact of pre-injury supplementation with that of post-injury supplementation, so it’s unclear which, if either, is more effective.

How I Used Creatine

I started using creatine in 2005, just after I won the European Junior Championships and was looking to take my training to the next level. In my first year, I utilized a loading phase of 5 x 5g doses per day for seven days. I personally didn’t like this—I found that I had gastrointestinal distress, and my muscles also felt very “full,” although this is completely anecdotal. The following years, I hit on a schedule that worked for me:

• Training Phase: During my training phases, I would consume 5g of creatine, usually post-workout, roughly on a six-weeks-on, two-weeks-off cycle.
• Pre-Competition Phase: In the run-up to competition, I would stop taking creatine perhaps four to five days before a race. I did this initially on the advice of a successful training partner, although I’m not sure this is necessary. Anyway, creatine stores are typically well-maintained for a few days after stopping supplementation and, given that training intensity was low, I can’t imagine they degraded too much.
• Immediately Pre-Race: As part of my pre-race stimulant drink, which I would take roughly 60 minutes prior to racing, I would consume around 3g of creatine.
• Immediately Post-Race: Here, I would consume a slightly larger bolus dose of creatine, usually around 10g, in order to “top up” my stores and enhance recovery
• Off-Season: I stopped consuming creatine for six to eight weeks during my off-season, just as a way of periodizing my approach.

Recommendations for Creatine Supplementation

 In summary, creatine appears to be an effective nutritional aid to support not just performance, but also recovery—from both exercise and injury. As more recent research shows, creatine may also impact the brain, as both a neurocognitive enhancer and a neuroprotective agent.

Supplementing with creatine, most commonly in the form of creatine monohydrate, can increase both muscular and brain stores of creatine, which allow it to exert its benefits. Because creatine is found in the diet through consumption of animal flesh, those that consume large amounts of meat on a regular basis may not respond as well to creatine supplementation as those who don’t consume much creatine through dietary sources, such as vegetarians, children, and the elderly.

People who eat meat regularly may not react as well to creatine supplementation as those who don’t, says @craig100m. Share on X

A loading phase of ~20-25g per day for seven days can rapidly increase creatine stores, which should then be followed by a maintenance dose of 3-5g per day. Alternatively, athletes may wish to just follow the maintenance protocol, which will increase creatine stores, albeit at a slower rate.

Finally, creatine supplementation appears safe for healthy individuals, as long-term continuous intakes of up to five years have shown no negative side effects. However, I would always recommend having periods within the year where the athletes periodizes their intake as per their need.

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