Creatine is a naturally occurring substance in the body that facilitates the recycling of ATP, an energy-carrying molecule, during periods of high energy demand such as physical activity.
To maintain physical function, creatine stores are naturally replenished; the average male has a creatine pool of ~120-140 grams, and females ~90-110 grams.
However, supplementing with creatine is now extremely common within athletic populations in attempts to maximize creatine stores within muscle tissue. This is due to the vast amounts of research demonstrating the beneficial effects of raising creatine levels beyond their naturally occurring levels.
In fact, creatine is easily within the top 3 most researched sports supplements of all time.
More recent data for creatine supplementation also indicates that its effects may surpass just having a physically enhancing effect, and can even influence brain activity and function.
Creatine Benefits (Science-Backed)
Improved Anaerobic Performance
For short periods (<30 seconds) of high-intensity exercise, creatine supplementation has consistently shown to improve performance by ~7.5% .
Its benefits are mainly seen during resistance exercises such as within a gym environment, but also show themselves during more functional activities such as sprinting.
Specifically, creatine supplementation is most useful for attenuating acute symptoms of fatigue during repeated high-intensity bouts of exercise. This makes it an ideal supplement for those competing in sports such as crossfit, football, basketball, rugby, and tennis.
The mechanisms by which creatine supplementation improves anaerobic functioning is by enlarging the creatine pool within muscle fibers, which is critical for resynthesizing ATP – the energy-carrying molecule used in cells for intense muscular contraction.
Further, creatine supplementation may facilitate the reuptake of calcium into muscle cells which enables force to be produced more rapidly.
Greater Muscle Gains
Significant improvements in lean body mass and muscle fiber cross-sectional area have been demonstrated with creatine supplementation in healthy resistance-trained individuals .
Although creatine by itself will not automatically stimulate muscle gains, when it is combined with correct training protocols it can have a synergistic effect on muscle growth.
As creatine increases anaerobic performance, the main reason why it can benefit muscle growth is by increasing the amount of tension on a given muscle during a training session – ultimately leading to greater adaptations from exercise.
Data also reveals that creatine supplementation alongside heavy resistance training can also trigger further increases in the concentrations of anabolic protein hormones such as IGF-1 by ~25% . Despite this, the rise in muscle IGF-1 content is likely as a result of the higher metabolic induced by more intense training sessions, rather than the other way around.
However, interesting findings have shown that creatine supplementation may potentially favor muscle growth by inducing changes to gene expression and creating a more anabolic environment . More data is needed in this area for clarification.
It May Improve Endurance Performance
Although creatine supplementation has been shown to be more effective during anaerobic exercise, there may also be positive effects on endurance activities.
This possible benefit diminishes as the duration of the activity increases over 150 seconds .
The reason creatine might improve endurance performance is by decreasing the accumulation of blood lactate in muscle cells, and increasing one’s lactate threshold .
It is not currently established why creatine might have this specific effect.
It May Improve Cognitive Function
More recent evidence demonstrates that creatine supplementation may provide a neurological and cognitive benefit, especially in elderly or stressed individuals .
This is due to higher brain creatine levels being associated with improved neuropsychological performance such as short-term memory and intelligence.
The physiological reasons for this are not well understood, however it’s clear there must be some improvement in overall cellular bioenergetics with the expansion of the phosphocreatine pool.
At best, limited evidence suggests that creatine may have antioxidant properties in the brain, reducing mental fatigue, and protecting against neurotoxicity. This could theoretically prevent neurological disorders like depression and bipolar.
More Beneficial for Vegetarians and Vegans?
As animal products are a significant contributor to creatine stores, those that choose to eliminate these foods from their diet have lower resting creatine concentrations.
Further, despite the ability to naturally synthesize creatine, the 3 amino acids needed for this are slightly lower in vegetarian diets; glycine, arginine and methionine.
Based on this, it is logical to assume that vegetarians will have a more pronounced effect to creatine supplementation as their relative increase in the phosphocreatine pool will be greater.
Accordingly, studies that analyze vegetarians conclude they have larger increases in muscle mass from creatine supplementation compared to non-vegetarians .
Creatine Doesn’t Work For Everyone
Approximately 1/3rd of individuals will not respond to creatine supplementation.
Those that respond well to creatine are generally those that have the highest percentage of type II fibers and larger cross-sectional areas of type I, IIa and IIx muscle fibers .
The best responders are also those with the lowest initial levels of creatine stores, with subjects whose creatine levels are already above 150 mmol/kg dry mass not showing significant increases in muscle creatine saturation from creatine supplementation.
Stick to Creatine Monohydrate
There are many forms of creatine available; creatine anhydrous, creatine ethyl ester, creatine pyruvate, creatine citrate, creatine malate, and creatine phosphate, to name a few.
The form of creatine depends on the compound that manufacturers bind to the creatine molecule, such as salts, citric acid, baking soda, and glucose. Compounds are bound in attempts to raise the bioavailability and effectiveness of creatine.
However, there is no evidence that alternatives to creatine monohydrate (the standard form of creatine) provide any additional benefit to raising muscle creatine stores. Therefore these variations of creatine do not show better improvements in body composition, muscle mass, strength, or power  .
This being said, there is a potential unique advantage of creatine salts over creatine monohydrate, in that they may have greater solubility in liquid solutions and could therefore reduce potential gastrointestinal issues in susceptible individuals.
Creatine Safety and Side Effect Information
For unknown reasons, the media have created a strong reputation that creatine supplementation is dangerous to health.
This is partly based on a few reports that creatine is associated with kidney disorders .
However, in most cases, these instances are linked to prior kidney issues or from individuals not sticking to daily recommended amounts.
Creatines poor public reputation also stems from unsubstantiated anecdotal reports and misinformation published on the Internet.
Given, there are rare side effects such as bloating, dehydration, muscle cramps, and digestive problems associated with creatine supplementation.
However, long-term use of creatine monohydrate in healthy individuals at recommended dosages has not shown to cause negative health effects or safety concerns .
Despite this, the safety of its use is currently not guaranteed, and is the reason why its legality varies between countries.
It is recommended that people do not use creatine if they are pregnant, breastfeeding, or have previously had kidney issues.
Creatine monohydrate supplementation in adolescent athletes is acceptable, but should only be considered if they compete in high-level sport, consume a well-balanced diet, and are knowledgeable regarding the appropriate use of creatine.
How To Correctly Take Creatine
Users of creatine should consume 3-5 grams per day, in the form of creatine monohydrate, to maintain high muscle creatine stores.
This may be preceded by 7 days of consuming a higher dosage – defined as 0.3 grams per kilogram of body weight per day. This initial high dose has been reported to lead to a faster saturation of creatine within muscle cells and therefore decrease the time it takes to notice performance-enhancing effects.
Starting with the standard 3-5 gram dose per day will still eventually lead to high muscle creatine stores, however the time in which it takes to achieve this is extended (3-4 weeks) compared to the utilization of an initial creatine ‘loading’ phase with a higher dosage.
Creatine monohydrate should be mixed well into 250-500ml of a liquid solution, preferably water, before being consumed.
Also, despite common practice to take creatine pre- or post-exercise to enhance its uptake into the muscle, it is not required to take creatine at any specific time of day. Users should just ensure the appropriate dosage is consumed every 24 hours to increase and maintain muscle creatine stores.
Creatine is a naturally occurring substance within the human body.
There is conclusive evidence that creatine supplementation can improve anaerobic performance and muscle growth.
Creatine supplementation may also potentially improve cognitive function and endurance performance, although more data is needed for clarification.
It is best to consume 20 grams of creatine monohydrate for 7 days, after which 5 grams per day is needed to maintain the elevated creatine stores.
To consume creatine, mix the appropriate amount into a liquid solution until fully dissolved.
Long-term use of creatine at recommended dosages is safe in healthy individuals. It is recommended that people do not use creatine if they are pregnant, breastfeeding, or have previously had kidney issues.