Creatine Questions and Answers

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Q1. What is creatine?

Creatine is a substance found naturally within the human body. Although found in numerous organs, the majority of creatine is stored within the skeletal muscle cells. Put simply, creatine or creatine phosphate is used to restore the cells energy source, a compound called Adenosine Tri-Phosphate or ATP for short. The remarkable thing about muscle creatine stores is that they can be increased simply by supplementing the diet with additional creatine (Hultman et al., 1996). Therefore creatine supplements provide you with a means of increasing your muscle creatine stores.

Q2. Can creatine make you stronger?

A number of studies have suggested that creatine may enhance muscular strength within a very short period of time. In fact a recent study compared the maximum amount of weight able to be lifted for one repetition in the bench press exercise prior to and after seven days creatine supplementation (Volek et al., 1999). This strength based test commonly referred to as a "1RM" is a measure of maximal muscular strength. As shown in the graph below (figure 1), after only seven days creatine supplementation muscle strength had increased significantly.

Figure 1: Strength changes after 7 days creatine supplementation.

Q3. Does Creatine help build muscle?

Numerous studies have reported that when combined with a resistance training program creatine can enhance the gains in fat free mass and lean body mass to a degree that is significantly greater than would be associated with training alone (Volek et al., 1999; Bemben et al., 2001). This is likely attributed to a combination of factors including:

1. Cell volumisation - Creatine causes the water inside the muscle cell (intracellular fluid) to increase, which causes the cell to swell (Bemben et al., 2001). This is believed to be an anabolic signal, which may promote protein synthesis (Haussinger et al., 1993). Cell volumisation can be indirectly detected by an increase in muscle cross sectional area within a matter a days after beginning creatine supplementation (Ziegenfuss et al., 1997). This may be subjectively felt as a "tightness" or "pump" in the muscle by many users.

2. Enhanced Training Capacity - Creatine enhances the resynthesis of the cells energy source, Adenosine Triphosphate (ATP). This can allow a higher training intensity to be maintained which may ultimately lead to a greater stimulus for muscle growth (Volek et al., 1999).

Q4. Is creatine only beneficial to young people?

Creatine can be of benefit to people of any age wishing to increase their strength and lean mass. In a recent study creatine was shown to enhance lean tissue mass, leg strength and endurance during a 12-week resistance training study in men averaging 70 years of age (Chrusch, et al, 2001). Given that the aging process is associated with a loss in muscle mass and strength (Welle, 2002), creatine combined with a strength training program appears to be a promising combination for aging individuals.

Q5. Is creatine effective in females?

Due to the fact that the majority of research has been conducted on male subjects, much less is known about the effects of creatine in female athletes. However, research has reported creatine to enhance high intensity intermittent performance, strength and fat free mass in females (Vanderberghe et al., 1997), suggesting that creatine is also effective in female athletes. However, weather the magnitude of the responses to creatine supplementation in females is comparable or equal to that of males is unknown. Preliminary research would suggest that the increases in body mass and fat free mass following creatine may be lower in females compared to males (Mihic, 2000).

Q6. Could creatine be used as an aid to injury recovery?

Injuries are an unfortunate fact of life. However, with advances in modern medicine treating and rehabilitating injuries has come along way. With many injuries, loss of muscle mass and strength occurs as a consequence of the fact that the injured limb muscle or joint often has to be immobilised for a period of time. This lost muscle mass and strength must be regained during the rehabilitation process. This is where creatine may offer significant benefit. In a recent scientific study a plaster cast was used to immobilise the right leg of 22 healthy volunteers (Hepel et al., 2001). The two weeks immobilisation period resulted in a loss of muscle size and strength. After the plaster casts were removed, all volunteers began a 10-week rehabilitation program to regain their lost muscle size and strength. However, during the rehabilitation training only half the volunteers were ingesting creatine and the remaining subjects were administered an inactive placebo (sugar). What the researchers found was that during the rehabilitation program the creatine group recovered their lost strength and muscle mass at a much faster rate than the placebo group. This study clearly illustrates that creatine may have broad therapeutic potential within the field of injury rehabilitation.

Q7. What does creatine look like?

Creatine is generally sold as a white powder and is simply mixed with water and consumed as a solution. Other forms of creatine are available such as creatine chewing gum, creatine lollies, creatine bars, liquid creatine and effervescent creatine. However although a lot of marketing hype surrounds many of these new creatine products, very few have scientific backing to match their marketing claims.

Q8. What is the best way to use Creatine?

There are two main ways to use creatine that both have scientific backing.

Method 1. Creatine loading
Creatine loading consists of ingesting a relatively high dose of creatine (20g) per day for five days (see table 1). This 20g dose is divided into five-gram dosages and consumed at four equally spaced intervals across the day. Research has shown this method to be a rapid way to increase creatine concentrations within human skeletal muscle (Hultman et al., 1996). After the five-day loading period you move into a phase known as maintenance. The purpose of the maintenance phase is to simply maintain the increased muscle creatine stores that were achieved during the loading phase. Most scientific studies use between 2 and 5 gram daily dosages during the maintenance phase (Hultman et al, 1996; Bemben et al., 2001).

Method 2. Continual low dose
Instead of loading you can basically just go straight into maintenance and consume a continual low dose of creatine (3 grams) once per day (Hultman et al., 1996). When compared to loading you will ultimately increase your muscle creatine concentrations by about the same amount, only this method will take a little longer. Using this method it will take approximately one month to achieve the same muscle creatine concentrations as is possible with a five day loading period (Hultman et al., 1996).

Table 1: A creatine loading protocol

Q9. Is creatine best consumed before or after exercise?

A small amount of research has indicated that the uptake of creatine into the skeletal muscle may be augmented by exercise (Harris et al., 1992). Therefore consuming creatine post exercise is possibly more efficient than other ingestion times. However, regardless of when creatine is consumed, as long as it is consumed consistently in line with scientific recommendations, athletes should receive benefit.

Q10. Is it true some people don't respond to creatine?

The scientific research often classifies individuals into either responders or non-responders (Kilduff et al., 2002). Basically, following creatine supplementation some individuals don't seem to be able to increase their muscle creatine concentrations to the degree that is necessary to see any benefits in performance. If you have previously used creatine and have not experiences results, don't despair. Body Science has developed a new creatine formulation that may allow you to experience the benefits of creatine. In fact a recent independent scientific study indicated that all athletes using this new creatine formulation increased their bench press performance, upper arm girth and body mass after only 6 days (Rogerson et al., 2003). To learn more about this product and the research see Myocytin .

Q11. Is it true that creatine serum is a more effective way to take creatine than creatine powder?

While this is a popular claim of many manufacturers of creatine serum it does not appear to be supported by the available research. In fact a recent study compared muscle creatine concentrations before and after ingesting high (8 x manufacturers recommended daily intake) and low dosages (manufacturers recommended daily intake) of creatine serum against the consumption of creatine monohydrate powder (Kreider et al, 2003). Results indicated that the creatine powder was superior to both dosages of creatine serum. In fact the scientists conducting the study concluded "these findings indicate that creatine serum is a completely ineffective form of creatine to promote creatine retention and that creatine monohydrate is a significantly better form of creatine than creatine serum to promote creatine retention". Consequently it would appear that athletes wanting to experience the benefits of creatine are best advised to consume creatine in powder form.

Q12. Is Creatine safe?

There is a lot of hype surrounding the safety of creatine supplementation, particularly on the Internet. It is almost as though many people believe that creatine is too good to be true and must be associated with some as yet seen adverse effects. However given that creatine has been commercially available for over a decade, one would imagine that long-term side effects, if they existed, would be beginning to surface. Many health professionals may be unfamiliar with this compound and therefore unable to adequately inform the public at large when questioned about the efficacy and safety of creatine supplementation (Ransone et al., 2002). However, those health professionals familiar with the scientific research to date will be aware that the only documented side effect of creatine in healthy individuals is weight gain (Schilling et al, 2001; Robinson et al, 2000). Given that most individuals using creatine are aiming to gain lean mass then this can hardly be considered a side effect. However, you should consult with your general practitioner prior to beginning a new supplement regime to ensure that you are in good health prior to beginning to use creatine.

Q 13. Will creatine result in a positive drug test?

No, creatine is not a drug or banned substance. Creatine is not listed on the current World Anti Doping Agencies (WADA) prohibited list (WADA, 2004). Therefore, creatine can be considered a safe and legal method of enhancing athletic performance, even in elite athletes subjected to regular drug testing.

References:
1. Bemben, M.G., Bemben, D.A., Loftiss, D.D. and Knehans, A.W. Creatine supplementation during resistance training in college football athletes. Med. Sci. Sports Exerc. 33:1667-1673, 2001.
2. Chrusch, M.J., Chilibeck, P.D., Chad, K.E., Davison, K.S. and Burke, D.G. Creatine supplementation combined with resistance training in older men. Medicine and science in sports and exercise 33:2111-2117, 2001
3. Hespel, P., Op't Eijnde, B., Van Leemputte, M., Urso, B., Greenhaff, P.L., Labarque, V., Dymarkowski, S., Van Hecke, P. and Richter, E.A. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. Journal of Physiology. 536:625-33, 2001
4.Harris, R.C., Soderlund, K. and Hultman, E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical science 83:367-374, 1992.
5.Haussinger, D., Roth, E., Lang, F. and Gerok W. Cellular hydration state: an important determinant of protein catabolism in health and disease. Lancet. 341:1330-2, 1993
6.Hultman, E. Soderlund, K. Timmons, J.A. Cederblad, G. and Greenhaff, P.L. Muscle creatine loading in men. Journal of Applied Physiology. 81:232-7, 1996
7.Kilduff L.P., Vidakovic, P., Cooney, G., Twycross-Lewis, R., Amuna, P., Parker, M., Paul, L. and Pitsiladis, Y.P. Effects of creatine on isometric bench-press performance in resistance-trained humans. Med. Sci. Sports Exerc. 34:1176-1183, 2002.
8.Kreider, R.B., Willoughby, D. Greenwood, M. Parise, G. Payne, E. and Tarnapolsky, M.A. Effects of serum creatine supplementation on muscle creatine and phosphagen levels. Journal of Exercise Physiology Online. 6(4). Available online at: http://www.css.edu/users/tboone2/asep/KreiderV2.pdf
9.Mihic S. MacDonald JR. McKenzie S. Tarnopolsky MA. Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women. Journal Article. Medicine & Science in Sports & Exercise. 32:291-6, 2000
10.Ransone, J.W., Lefavi, R.G. and Jacobson, B.H. Efficacy and safety of creatine supplementation: a review and recommendation. International sports journal 6:31-47, 2002.
11.Robinson, T.M., Sewell, D.A., Casey, A., Steenge, G. and Greenhaff, P.L. Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function. British journal of sports medicine 34:284-288, 2000.
12.Rogerson, S, Weatherby, R.P. and Nicholson, V. A comparison of two commercially available creatine supplements on Performance, Anthropometric and Morphological Measures. Journal of Science and Medicine in Sport. 6(4);S39, 2003.
13.Schilling, B.K., Stone, M.H., Utter, A., Kearney, J.T., Johnson, M., Coglianese, R., Smith, L., O'Bryant, H.S., Fry, A.C., Starks, M., Keith, R. and Stone, M.E. Creatine supplementation and health variables: a retrospective study. Medicine and science in sports and exercise. 33:183-188, 2001
14.Welle, S. Cellular and molecular basis of age-related sarcopenia. Canadian journal of applied physiology 27:19-41, 2002
15.Vanderberghe, K., Goris, M., Van Hecke, P., Van Leemputte, M., Vangerven, L. and Hespel, P. Long-term creatine intake is beneficial to muscle performance during resistance training. Journal of applied physiology 83:2055-2063, 1997.
16.Volek, J.S., Duncan, N.D., Mazzetti, S.A., Staron, R.S., Putukian, M., Gomez, A.L., Pearson, D.R., Fink, W.J. and Kraemer, W.J. Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Medicine and science in sports and exercise. 31:1147-1156, 1999.
17.Ziegenfuss, T.N., Lemon, P.W.R. and Rogers, M.R. Acute creatine ingestion: effects on muscle volume, anaerobic power, fluid volumes, and protein turnover. Medicine and science in sports and exercise. 29:s204, 1997.
18.World Anti Doping Agency prohibited list (2004). Available online: http://www.wada-ama.org/en/t1.asp