Creatine Supplementation Studies
While creatine has many applications to individuals of all gender, age,
mental and physical abilities, this paper is written for young, healthy men who
are active in sports or exercise. I have not taken into account the numerous
studies done for children, the elderly and middle aged, or women when writing
this article. All data and studies used in this paper are in reference to
healthy men between the ages of 18-40, who participate in physical activity
several times a week, unless otherwise stated.
Furthermore, I am neither a doctor, nor a pharmacologist. The
information, views, and advice contained within this paper are for educational
purposes only. Do not attempt any exercise plan, diet plan, or radical lifestyle
change without first consulting with a physician. The material in this paper
should not be construed for medical advice. Neither creatine, nor the methods of
supplementation discussed within should be used to treat any condition or
disease, unless instructed by a doctor.
The compound creatine has been hyped by supplement companies and
demonized by the media, and without proper study in the field of supplement
pharmacology, Primary Care physicians cannot offer any relevant information to
the consumer. It is not surprising that there is much confusion over the safety
and effects of creatine.
Creatine is a naturally occurring substance in human and animal bodies.
It is synthesized and consumed on a daily basis (the human liver can combine the
amino acids Arginine, Glycine, and Methionine to synthesize creatine). The
average 160 lb (72.5 kg) person stores approx. 120 grams of creatine in their
body. 95-98% of that creatine is contained within muscle tissue, while the rest
is stored within other body organs (including brain, heart and liver).
Creatine works by replenishing ATP. ATP (adenosine tri-phosphate)
is an energy-containing compound. The body can break ATP into ADP (adenosine di-phosphate)
and inorganic phosphate. This reaction releases energy, which can be used by the
body to fuel explosive, short burst of strength. The metabolism of carbohydrates
and fats take longer to convert into a useable energy source, so ATP is the most
used energy source during these high intensity movements. There is only enough
ATP for 10-15 seconds of maximum exertion, however, and so the problem arises as
to how to free up more energy. ADP is itself useless as a source of energy,
until it regains a phosphate atom. Creatine phosphate (CP), the form of creatine
found mostly in muscles, reacts with ADP. The phosphate is freed from creatine
and bonds with ADP to create ATP.
This purpose of creatine has been known for some time, however the
benefits or downfalls of exogenous supplementation of creatine on physical
performance, especially in the area of sports and exercise, has long been
glorified, but up until the past few years never substantiated with hard
science. The ignorance of health care professionals has obfuscated the subject
of creatine supplementation, and for many people the only information they hear
is the half-truths, propaganda, and lies of the media and supplement companies.
Many of the claims put forth about creatine’s safety focus on the idea
that it may harm the kidneys and liver. This is false. Creatine does not harm
the liver5, 24, 49, 80, or the kidneys1, 5, 8, 24, 49, 64, 80.
Some of these claims stem from the idea that creatinine levels are increased
with creatine supplementation (creatinine being a byproduct of renal failure).
Creatinine, while sometimes slightly elevated, is always within normal and safe
levels when creatine is used according to recommended guidelines2, 24, 29,
49, 64, 71, 80. A deleterious effect on cholesterol and lipid values is
another popular argument by critics of the supplement. While not studied as much
as other areas of safety, limited studies have shown no effect2, 5,
or a positive effect of cholesterol4. Blood values during creatine
supplementation have also been shown to be normal19, 49, 71, 80, as
well as effects on mood51.
A common complaint among sports coaches and players is that creatine may
increase injury rates. Some people have claimed this is due to increased
musculoskeletal stiffness. No studies have reported any signs of increased
injury with concomitant creatine use, and at least one has even tested the claim
and shown that there are no negative musculoskeletal changes with creatine use75.
On the other side of the spectrum, there are many claims of performance
enhancement with creatine use. Increased muscle mass2, 19, 26, 35, 37, 61,
71 is one proven effect of creatine use. Enhanced anaerobic capacity and
strength has shown to be beneficially effected6, 9, 16, 19, 26, 27, 28, 33,
34, 37, 40, 41, 46, 51, 52, 56, 59, 60, 61, 65, 86 in all but one68
study. The overwhelming data supporting increased strength, and to a lesser
degree muscle mass, makes creatine a wonder supplement. There are, however, many
more benefits to creatine supplementation that puts this supplement a step above
all others. Conflicting data shows that creatine may9, 10, 23, 69, 70
increase aerobic performance, or have no effect28, 50, 67, even
though body mass increases. The fact that aerobic performance increases are
possible in spite of increased body mass means that individuals training for
endurance, speed and strength may benefit from creatine without risking negative
changes in performance. Sprinting, studied in its numerous forms, also shows
mixed results with regards to creatine. While some show no effect12, 15,
20, 42, 43, 53, 56, 63, 73 the majority of studies have shown marked
increases in performance13, 19, 25, 28, 36, 38, 44, 57, 58, 62, 66, 79, 82.
Isometric strength increases22 and isometric strength endurance21,
anticatabolic47 and antioxidant31 properties, jumping
improvements59, 75, exercise recovery77, 78, performance
in hot conditions79, and time to neuromuscular fatigue81
are some of the other strength and endurance related benefits observed in some
of the studies. These benefits also come with another bonus: body fat percentage
has been shown to not change2, 61, 71 or decrease51 in
several studies that looked at body composition.
Creatine may also assist injured individuals who are recovering from
major injuries. After non-use and atrophy, creatine may increase GLUT-4 protein
concentration and translocation at cell membranes30 as well as
muscular performance recovery55. The intracellular water retention
creatine creates11, 26 may also help maintain an anabolic environment
and allow extra nutrient and glycogen to be stored in the recovering muscle.
Even though creatine has been show in some studies to have no effect on hormone
levels45, 49, one study studying Growth Hormone (GH) specifically has
shown an increase (within high normal levels) of GH with creatine use. GH has
anabolic properties, as well as healing properties, and this may be another
benefit of using creatine to help speed recovery from an injury. Another benefit
to individuals recovering from injury, and those that aren't, is that creatine
may stimulate satellite cell differentiation32, which may increase
muscle size and help heal injuries.
Creatine is also synergistic with many other substances. Creatine has
shown positive effects with pyruvate3, whey protein17,
caffeine18, carbohydrates34, 52, 74, l-glutamine37,
and magnesium72. Creatine stacked with HMB has produced good results48,
as well as no results14.
The dosing of creatine has also come into suspect since several animal
studies with ultra high doses of creatine produced creatine receptor down
regulation after several weeks of use. Considering these studies used extremely
high doses of creatine, and with at least one study showing no down regulation
with continued use in humans39, it appears now that cycling creatine
is not needed to keep your gains. Loading creatine in several small portions
throughout the day has given the best results and shown the most saturation of
the muscle amino acid pool with creatine76, and may be the best way
to take it during the loading phase.
Hopefully the stigma of creatine being a deadly drug that destroys
organs, increases injuries and increases fat will go away now that there are so
many studies showing the positive effects and lack of negative effects with
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