Creatine

Creatine is a vital substance with many potential health benefits. Creatine plays a is critical role in energy production, especially under oxygen deficient circumstances, such as intense, vigorous exercise. Some research also suggests creatine can act as an anti-inflammatory, anti-oxidant, and acid neutralizer. 


Creatine is derived from  the amino acids arginine, methionine, and glycine and is synthesized predominantly in the liver, kidneys, and pancreas. Most people produce around 1 g per day, but can excrete up to 3 g per day. Therefore, supplementation through dietary sources or nutritional products might make sense. Good news for you carnivores and pescatarians, creatine is concentrated in animal and fish products. Thus, diet can be a valuable resource to replenish lost creatine stores.  For example,  1 lb. of uncooked beef or 1 lb. of uncooked salmon contains 1 g of creatine.  Unfortunately for pure vegetarians, creatine is absent from most, if not all food items that are usually consumed in a vegetarian type diet. Therefore,  many vegetarians have significantly lower creatine stores and blood levels compared to meat and fish eaters.

Creatine is primarily stored in muscle, underscoring creatine’s potential contribution to muscle and joint health. Furthermore, significant creatine stores are found in the brain, suggesting an important role for creatine in brain health.

Potential Benefits of Creatine for Musculoskeletal Health*

The exact mechanism in which creatine promotes musculoskeletal health is not fully understood. However, many experts believe optimal creatine levels maintain robust cellular energy levels during both intense and normal activity allowing for a greater stimulatory signal for growth and repair. Additionally, creatine’s antioxidant and anti-inflammatory attributes protect against excessive cellular damage by oxygen based free radicals that are generated during activity.

 

Creatine may improve function in individuals with chronic joint disease*7

Research demonstrates that creatine supplementation increases leg strength, decreases stiffness, and improves quality of life in individuals with knee osteoarthritis.

Brazilian researchers examined the effect of creatine supplementation combined with strengthening exercises in knee osteoarthritis. The authors concluded creatine supplementation improves physical function, lower limb lean mass, and quality of life in postmenopausal women with knee OA undergoing strengthening exercises. (Neves et al. Beneficial effect of creatine supplementation in knee osteoarthritis.Med Sci Sports Exerc. 2011 Aug;43(8):1538-43.)

 

Creatine may help prevent Injury* 8,9

Research has shown that creatine users experience less incidence of muscle cramping, dehydration, muscle tightness, muscle strains, and total injuries.

Researchers at Baylor University evaluated the effect of creatine supplementation on the incidence of cramping and injury on collegiate football players. The authors concluded the incidence of cramping or injury in Division IA football players was significantly lower or proportional for creatine users compared with nonusers. (Greenwood et al. Cramping and Injury Incidence in Collegiate Football Players Are Reduced by CreatineSupplementation.J Athl Train. 2003 Sep;38(3):216-219.)

 

Creatine may accelerate rehabilitation from injury* 10,11,12,13

Review of multiple research articles suggests creatine supplementation acts as a bulwark against muscle atrophy and other negative effects on muscle associated with immobilization. Moreover, creatine supplementation promotes greater gains in strength and function during rehabilitation.

Dutch investigators examined the effect of creatine supplementation during leg immobilization and rehabilitation on leg muscle volume and function. The authors concluded that oral creatine supplementation stimulates muscle hypertrophy during rehabilitative strength training. (Hespel et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans.J Physiol. 2001 Oct 15;536(Pt 2):625-33.)

 

Creatine reduces inflammation and muscle damage*14,15

Researcher suggests that creatine supplementation reduces some of the markers of muscle damage and may diminish the production of key catalysts in the inflammation pathway.

Brazilian researchers examined the effect of creatine supplementation on oxidative stress and inflammation markers after acute repeated-sprint exercise in humans. The investigators found that Cr supplementation reversed the increase in TNF-α and CRP as well as LDH induced by acute exercise, all indices of inflammation. (Deminice R et al. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013 Sep;29(9):1127-32.)

 

Creatine improves  strength, muscle mass, and performance* 16,17,18,19

Creatine supplementation increases creatine availability for muscle use,  allowing for greater effort during training. Examples would be more reps performed  at greater weight or more sprints ran at top speeds. This can lead to greater gains in strength, muscle mass and performance.

Brazilian investigators evaluated the effect of longterm creatine supplementation combined with resistance training on the strength, motor functional performance, and body composition in older women. The researchers found that Cr supplementation group gained significantly more fat-free mass and muscle mass and were more efficient in performing submaximal-strength functional tests than the placebo group. (Aguiar AF et al. Long-term creatine supplementation improves muscular performance during resistance trainingin older women. Eur J Appl Physiol. 2013 Apr;113(4):987-96.)

Creatine is an antioxidant* 20,21,22,23

Creatine potentially acts as a direct and/or indirect antioxidant combating the production of high energy free radicals that cause muscle and joint damage.

Iranian investigators evaluated creatine’s effects on oxidative stress response and oxidative DNA damage in male athletes during resistance training. The author found that Cr supplementation reduced indices of oxidative stress and concluded that Cr supplementation reduced oxidative DNA damage and lipid peroxidation induced by a single bout of resistance. (Rahimi R. Creatine supplementation decreases oxidative DNA damage and lipid peroxidation induced by a single bout of resistance exercise. J Strength Cond Res. 2011 Dec;25(12):3448-55.)

 

Creatine may help you recover faster from exercise* 24,25

Creatine supplementation may help replenish the large amounts of complex sugars lost during intense exercise at a more rapid and efficient rate.

Researchers at LSU examined the effect of creatine supplementation on muscle glycogen. The investigators concluded that pre exercise Cr supplementation increased the post exercise uptake of muscle glycogen. (Nelson AG et al. Glycogen supercompensation is enhanced by prior creatine supplementation. Med Sci Sports Exerc. 2001 Jul;33(7):1096-100.)

 

Safety First 26,27,28,29

Review of the scientific evidence suggests that the short-term or long-term use of creatine monohydrate is safe. Some researchers have expressed concerns about the negative effect of creatine on kidney function; however, further investigation has not convincingly substantiated those concerns. However, prior to starting any supplementation discuss with a qualified medical professional familiar with your unique health history and needs. Discontinue use and consult your doctor is any adverse reactions occur.

*These statements have not been evaluated by the Food and Drug Administration. These statements are not intended to diagnose, treat, cure or prevent any disease.
 

 

 

Research

  1. Schlattner U, et al. Cellular compartmentation of energy metabolism: 
creatine kinase microcompartments and recruitment of B-type creatine 
kinase to specific subcellular sites. Amino Acids. 2016;48(8):1751–74. 

  2. Ydfors M, et al. Modelling in vivo creatine/phosphocreatine in vitro reveals 
divergent adaptations in human muscle mitochondrial respiratory control 
by ADP after acute and chronic exercise. J Physiol. 2016;594(11):3127–40.
  3.  Neves Jr M, et al. Beneficial effect of creatine supplementation in knee osteoarthritis. Med Sci Sports Exerc. 2011;43(8):1538–43.
  4. Balsom PD, Soderlund K, Ekblom B. Creatine in humans with special reference to creatine supplementation. Sports Med. 1994;18(4):268–80.
  5. Brosnan ME, Brosnan JT. The role of dietary creatine. Amino Acids. 2016;  48(8):1785–91.

  6. Benton D, Donohoe R. The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores. Br J Nutr. 2011;105(7): 1100–5. 

  7. Kreider RB, Jung YP. Creatine supplementation in exercise, sport, and medicine. J Exerc Nutr Biochem. 2011;15(2):53–69.
  8. Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem. 2003;244(1–2):83–8.
  9. Greenwood M, et al. Cramping and injury incidence in collegiate football players Are reduced by creatine supplementation. J Athl Train. 2003;38(3):216–9.
  10. Hespel P, Derave W. Ergogenic effects of creatine in sports and rehabilitation. Subcell Biochem. 2007;46:245–59. 

  11. Hespel P, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536(Pt 2):625–33. 

  12. Op’t Eijnde B, et al. Effect of oral creatine supplementation on human muscle GLUT4 protein content after immobilization. Diabetes. 2001;50(1): 18–23. 

  13. Jacobs PL, et al. Oral creatine supplementation enhances upper extremity work capacity in persons with cervical-level spinal cord injury. Arch Phys Med Rehabil. 2002;83(1):19–23. 

  14. Cooke MB, et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. 2009;6:13.
  15. Deminice R, et al. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013;29(9):1127–32.
  16. Aguiar AF, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013;113(4):987–96. 

  17. Rawson ES, Clarkson PM. Acute creatine supplementation in older men. Int J Sports Med. 2000;21(1):71–5. 

  18. Wiroth JB, et al. Effects of oral creatine supplementation on maximal pedalling performance in older adults. Eur J Appl Physiol. 2001;84(6):533–9. 

  19. Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults-a meta-analysis. Med Sci Sports Exerc. 2014;46(6):1194–203.
  20. Campos-Ferraz PL, et al. Exploratory studies of the potential anti-cancer effects of creatine. Amino Acids. 2016;48(8):1993–2001. 

  21. Balestrino M, et al. Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease. Amino Acids. 2016;48(8):1955–67. 

  22. Saraiva AL, et al. Creatine reduces oxidative stress markers but does not protect against seizure susceptibility after severe traumatic brain injury. Brain Res Bull. 2012;87(2–3):180–6. 

  23. Rahimi R. Creatine supplementation decreases oxidative DNA damage and lipid peroxidation induced by a single bout of resistance exercise. J Strength Cond Res. 2011;25(12):3448–55. 

  24. Green AL, et al. Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. Am J Physiol. 1996;271(5 Pt 1):E821–6.
  25. Nelson AG, et al. Muscle glycogen supercompensation is enhanced by prior creatine supplementation. Med Sci Sports Exerc. 2001;33(7): 1096–100.
  26. Geller AI, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373(16):1531–40. 

  27. Zorzela L, et al. Serious adverse events associated with pediatric complementary and alternative medicine. Eur J Integr Med. 2014;6:467–47. 

  28. FDA. CFSAN Adverse Event Reporting System (CAERS). 2017. [cited 2017 March 27, 2017]; Available from: https://www.fda.gov/Food/ 

  29. Kreider et al. Journal of the International Society of Sports Nutrition (2017) 14:18

 Lucas J. Bader MD

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