Creatine is produced in the body, in the liver and brain, through reactions involving three amino acids—the building blocks of protein. Alternatively, creatine can be consumed in the diet—primarily from red meat and seafood—or for those on a vegan/vegetarian diet, through commercially manufactured creatine supplementation. While there are several marketed forms of creatine, creatine monohydrate is the
most researched and effective form of creatine for improving exercise and sports performance.
The vast majority of creatine research has been conducted on young healthy males, but creatine supplementation can also provide benefits to females across their lifespan, especially vegetarians, and during the aging process. Furthermore, emerging research indicates that creatine supplementation can improve measures of cognition and memory and treat symptoms from traumatic brain injury, including concussion. The vast majority of creatine – 95 per cent – is stored in skeletal muscle with less than five per cent stored in the brain. Creatine supplementation typically increases muscle creatine levels by 20-40 per cent compared to only 6-10 per cent in the brain. This discrepancy is partially explained by the brain being able to make creatine, thereby blunting uptake from the blood compared to skeletal muscle.
Creatine helps to maintain and replenish the energy currency of the cell (ATP or adenosine triphosphate) during and following exercise. Subsequently, this may allow an individual to perform more exercise over time leading to greater improvements in exercise and sports performance. Mechanistically, these benefits may be the result of creatine increasing processes involved in muscle growth and performance and by decreasing inflammation and cellular stress, thus improving recovery.
Creatine supplementation can enhance the benefits from performing resistance/weight training.
Since creatine needs to accumulate in muscle and/or the brain to be effective, frequent ingestion has to occur. In general, there are a few established creatine ingestion protocols for improving measures of muscle mass and performance. The most popular evidence-based strategies are to ingest ~ 20 grams of creatine in the creatine-loading phase: 4 x 5 grams throughout the day for 5-7 days, followed by 2-5 grams/day thereafter (the creatine maintenance phase) or simply ignore the creatine-loading phase and consume 3-5 grams/day. However, this lower daily dosage will take longer (~ 30 days) to top-up muscle creatine levels. Alternatively, 0.10-0.14 g/kg/day (~ 8-11 grams) has been shown to be effective over time.
The requirement to consume creatine at specific times each day to produce muscle benefits is not supported. However, prior muscle contractions from exercise increase creatine uptake into skeletal muscle, so an ideal time to consume creatine is likely before, during and/or after exercise. Thus, creatine can be consumed as a bolus or as smaller, more frequent dosages throughout the day. Further, creatine can be consumed daily, including non-exercise days.
Established creatine protocols for increasing brain creatine levels remain to be determined but there is some evidence that 20 grams/day for ≥ one week can be effective in healthy populations.
The response to creatine supplementation, from a muscle perspective, is primarily dictated by initial muscle creatine levels. Those with lower muscle creatine levels, such as vegans and vegetarians, will respond more favourably, thus seeing greater increases in muscle adaptations, compared to those like omnivores who have higher initial creatine stores. However, habitual dietary creatine intake—vegetarian vs. omnivore—does not influence brain creatine levels. Upon stopping creatine supplementation, elevated muscle creatine levels take up to 30 days to return back to pre-supplementation levels compared to ~ 90 days in the brain.
Improves endurance-type activities
It is well established that creatine supplementation can enhance the benefits from performing resistance/weight training. For example, creatine supplementation improves muscle/lean tissue mass, bone mineral/strength, muscle performance, i.e., strength, endurance, power, and recovery. However, a misconception about creatine supplementation is that it will not provide benefits to endurance-type activities.
On the contrary, creatine supplementation can reduce markers of inflammation following long-duration aerobic exercise. For example, short-term creatine supplementation (20 grams/day for five days) prior to running a 30-kilometre race or half-IRONMAN decreased inflammation post-exercise in young, trained athletes. Furthermore, a recent paper evaluated all research pertaining to creatine supplementation and endurance-type activities and concluded that creatine supplementation can, but not always, enhance sprint performance, exercise time-to-exhaustion, particularly ≤ three minutes, and cycling performance. There is also evidence that creatine can improve ice-hockey skating and 100-metre freestyle swim performance and measures of athletic ability in soccer players.
From a safety perspective, the International Society of Sports Nutrition paper on the safety of creatine supplementation in exercise, sport and medicine concludes that creatine, even at high dosages of 0.8 g/kg/day for five years poses no greater adverse effects compared to placebo.
In summary, creatine monohydrate supplementation is a safe and effective intervention for improving various aspects of exercise and sports performance across a variety of populations, especially vegans and vegetarians. For those needing to maximize muscle creatine levels quickly, i.e., high-performance athletes, a creatine-loading phase following by a low-dose maintenance phase – 2-5 grams/day thereafter – may be considered. Alternatively, consuming 3-11 grams/day (average ~ 5 grams/day) is a viable and effective strategy. While the timing of creatine supplementation is not a critical factor, ingestion in close proximity to exercise – before/during/after – is likely a good strategy. From a brain health and function perspective, emerging research suggests that creatine supplementation can increase brain creatine levels which may lead to improvements in memory and cognition. There is also the potential for creatine to help in the recovery from concussion. However, higher and longer duration creatine supplementation protocols are likely needed to produce these brain benefits.
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