Position Stand: Creatine Supplementation

Creatine is one of the most researched and well-known supplements in the fitness industry. A naturally occurring compound found in our bodies, creatine is used to provide energy for muscle contractions. Creatine has been shown to have numerous benefits, including increased muscle mass, improved strength, and enhanced exercise performance.

This position stand aims to provide an evidence-based review of the benefits, potential risks, and dosage recommendations for the supplement, as well as give our current position on the supplement.

Company Position Statement

It is the current position of Shift to Strength that creatine supplementation is both safe and effective for healthy individuals looking to increase muscle mass, improve strength, enhance recovery, increase thermoregulation and hydration capabilities, and aid in injury management.

What is Creatine?

Creatine is a nitrogenous organic acid that is naturally produced in the body. It is primarily synthesized in the liver and stored in the muscles, where it is used to provide energy during high-intensity exercise.

Creatine is a combination of three amino acids: arginine, glycine, and methionine. It is converted into phosphocreatine, which is then used to produce adenosine triphosphate (ATP), the primary source of energy for muscle contractions.

While creatine is naturally occurring in our bodies, it can also be obtained through dietary sources, like meat and fish. However, the amount of creatine obtained through diet alone is relatively small compared to the amount that can be obtained through supplementation.

Benefits of Creatine Supplementation

Increased Muscle Mass

One of the most well-known benefits of creatine supplementation is its ability to increase muscle mass. A study conducted by Nunes et al in 2017 assigned 43 resistance-trained men to either a creatine or placebo group taken over an 8-week period. During this time, both groups underwent the exact same, 4-day resistance training program. The results show a significantly greater increase in muscle favouring the creatine group versus the placebo as measured by dual-energy X-ray absorptiometry, known as the gold standard in body composition testing (1).

One of the main arguments for this increase is creatine can help increase muscle protein synthesis, which is the process by which new muscle tissue is formed. Additionally, creatine has been shown to increase the water content of muscle cells, which can contribute to an increase in muscle size (1,2). Other mechanisms include the potential to overload and perform more work both during sets while offering better recovery in between bouts, which will be discussed more in detail coming up.

Improved Strength

Creatine has also been shown to improve strength in both trained and untrained individuals. Studies have found that creatine supplementation can lead to an increase in one repetition max (1RM) strength, which is the maximum weight that can be lifted for one repetition. A recent systematic review published in the Journal of Sports Medicine in 2017 that includes 53 studies and over 1,100 participants assessing the impact creatine has on strength gains clearly demonstrated a significant increase in strength in random control trials (3).

Additionally, creatine has been shown to increase muscle endurance, allowing individuals to perform more reps at a given weight. Creatine is particularly beneficial for high-intensity exercise lasting 0-10 seconds as that is where the alactic energy system, the energy system that calls on creatine monohydrate to produce ATP, is stored and activated. Activities that can especially benefit from creatine supplementation include strength training, sprinting, and explosive power sports.

Injury Management

Evidence suggests that creatine can reduce muscle damage as well as enhance recovery from intense exercise. For example, it has been reported that creatine kinase, a marker of muscle damage, was significantly lower (-84%) after 2, 3, 4, and 7 days of recovery following a heavy strength training session when creatine was supplemented (4).

Furthermore, a study following an American collegiate football team that consumed creatine over the course of the season experienced significantly less muscle tightness, strains and total injuries compared with controls (4).

Finally, due to creatine's additive effects on muscle and strength, researchers have postulated how it can aid in enhancing the rehabilitation process from injury. One study supplemented creatine on rehabilitation outcomes in patients who had their right leg cast for 2 weeks. These individuals supplemented 5g of creatine per day for 10 weeks, which resulted in greater muscle growth versus controls who followed the same strength program (4).

Now although not all studies show increases in recovery times and reductions in injuries, it's our position that at the very least, creatine supplementation may support injury management.