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.
Increased Thermoregulation and Hydration Capabilities
Due to creatine's ability to retain water, studies have been done to observe the effects have on exercise performance under adversely hot conditions.
One study in particular assessed the cardiovascular, renal, temperature and fluid-regulatory hormonal responses to intense exercise during 35 minutes of physical activity in the heat with the addition of creatine. The results showcased increased performance times under these conditions compared to controls, likely due to the increased water retention which in turn supported higher cardiac outputs (4).
Taking things one step further, this has particular relevancy for endurance athletes exercising in the heat where it can be used as a hydration strategy along with increased fluid intake to retain more water to better tolerate exercise in the heat, thereby increasing race times and limiting the risk of heat-related illness.
Side Effects of Creatine Supplementation
It is the position of Shift to Strength that creatine supplementation is safe for most individuals. As always, it is best to discuss with a fitness or health professional who possesses knowledge in the area before trying new supplements.
The most consistent side effect reported in the literature is weight gain, which is primarily attributed to the water retained. It's surprising to hear that it is actually the only “adverse” effect from creatine recorded that holds merit since it was first studied in the 1990s. In fact, over 1,000 studies, both short- and long-term, ranging from infants to the elderly, taken in recommended doses for an average of 5 years in well-controlled clinic settings continually disprove that creatine does not
increase the incidence of musculoskeletal injuries,
dehydration,
muscle cramping,
stomach issues,
renal dysfunction,
long-term detrimental effects.
Dosage Recommendations for Creatine Supplementation
The most effective dosage of creatine varies depending on the individual's body weight and goals. The following are dosage recommendations based on type, amount, and loading strategies:
Creatine Type
The most extensively studied form of creatine is creatine monohydrate, which is the purest form of the supplement. It’s recommended to stick to a monohydrate version as it does not have any additional supplements or additives, as in most cases, additions to this supplement are just marketing tactics. Creatine monohydrate also happens to be the cheapest form of supplement.
Primary Loading Protocol
When you first start taking creatine, a loading phase is highly recommended. This loading phase consists of having 0.3g/kg of your body weight per day, four times daily, for 5-7 days (6). Once your bodily stores become saturated after the aforementioned timeframe, these elevated stores can be maintained by ingesting approximately 5g per day (4).
Alternate Loading Protocol
Alternatively, you can follow a loading protocol of 3g/day for 28 days. However, this method is inferior to the previous method as it will result in a more gradual increase in creatine stores, resulting in delayed benefits which become fully elucidated at 2 weeks (4).
Loading With Adequate Protein and Carbohydrates
Dosing creatine along with a meal containing adequate protein and carbohydrates has been reported to promote greater creatine retention over time. For example, Steenge et al. reported that having 5g of creatine with 47–97g of carbohydrate and 50g of protein-enhanced creatine retention (4).
Conclusion
Creatine is a naturally occurring compound used to provide energy for muscle contractions. Creatine supplementation has been shown to have numerous benefits, including increased muscle mass, improved strength, and enhanced exercise performance.
While creatine is generally considered safe for most individuals, it is important to be aware of potential side effects such as gastrointestinal issues, kidney damage, dehydration, and weight gain.
If you are considering taking creatine, it is recommended to speak with a healthcare professional to determine if it is right for you and to determine the appropriate dosage based on your individual needs and goals. Additionally, it is important to purchase creatine from a reputable source to ensure its purity and quality.
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References
Nunes, J. P., Ribeiro, A. S., Schoenfeld, B. J., Tomeleri, C. M., Avelar, A., Trindade, M. C., ... & Cyrino, E. S. (2017). Creatine supplementation elicits greater muscle hypertrophy in upper than lower limbs and trunk in resistance-trained men. Nutrition and health, 23(4), 223-229.
Wu, S. H., Chen, K. L., Hsu, C., Chen, H. C., Chen, J. Y., Yu, S. Y., & Shiu, Y. J. (2022). Creatine supplementation for muscle growth: a scoping review of randomized clinical trials from 2012 to 2021. Nutrients, 14(6), 1255.
Lanhers, C., Pereira, B., Naughton, G., Trousselard, M., Lesage, F. X., & Dutheil, F. (2017). Creatine supplementation and upper limb strength performance: A systematic review and meta-analysis. Sports Medicine, 47, 163-173.
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