Creatine: Benefits, Myths and Safety

Creatine, specifically and most commonly monohydrate, is a popular ergogenic aid that has been studied extensively aside from caffeine for its benefits including athletic performance, post-exercise recovery, injury prevention, rehabilitation as well as safety (Kreider et al. 2017). Supplementation with creatine has also been associated with improved cognitive functioning.

Creatine is a non-protein amino acid found mostly in skeletal muscle with small amounts in the brain and testes. Two-thirds of intramuscular creatine is phosphocreatine (PCr) with the rest being free creatine. Because about 2% of intramuscular creatine is degraded into creatinine and excreted in the urine, the body needs to replenish about 1-3g of creatine/day to maintain normal levels. According to Brosnan et al. (2016) about half of the daily need for creatine comes from a diet such as a pound of salmon which provides 1-2g (Balsom & Ekbolm, 1994).

Ergogenic Benefits

Studies have consistently shown ergogenic benefits from creatine supplementation such as increased work performed during sets of maximal effort, increased muscle mass and strength adaptations, increased single and repetitive sprint performance, increased anaerobic threshold, and more (Kreider & Jung, 2011). There have been several studies reporting that co-ingestions of creatine and carbohydrate provide enhanced recovery benefits (Kreider et al. 2017).

As said earlier, supplementing with creatine can help athletes who deal with clinical conditions recover from injuries. For example, Hespel et al. (2001) found that individuals with their right leg cast who were supplemented with creatine experienced greater changes in the cross-sectional area of muscle fiber and peak strength during the rehabilitation period.

Cognitive Functioning

There has also been a hypothesis about the association between creatine intake and cognitive functioning due to it being an essential brain compound. Although the research is still growing, a systematic review (Avgerinos et al., 2018) looked at randomized controlled trials (RCTs) investigating the cognitive effects of oral creatine supplementation in healthy individuals. According to Ferrier et al. (2000), recognition memory was enhanced by higher resting creatine levels.

Avgerinos et al. (2018) looked at memory, executive function, attention, and reasoning along with more complex functions such as mental fatigue, reaction time, and word fluency in the RCTs. From the six studies of 281 participants reviewed, short-term memory and intelligence/reasoning improvements. Interestingly, the younger population did not show much difference with creatine supplementation compared to the more elderly. It has been suggested that the older population is in more need of energy supply and they can achieve it through creatine supplementation (Toescu, 2005). Therefore, Avgerinos et al. (2018) came down to the conclusion that creatine supplementation may improve cognitive functioning more in those diseased, aged or stressed individuals than those who are younger and not as stressed. Overall, memory and intelligence may be improved, however, other functions such as attention, executive functioning, mental fatigue, and reaction time do not change as much. Because it’s been proven to be safe to take creatine, larger studies or studies with specific populations such as those with dementia can be conducted in the future.

Myths and Safety

As with most popular supplements, creatine has been questioned in terms of its safety. With over 1,000 studies being done, the only consistent side effect is weight gain (Kreider et al. 2017) but it is due to increased water in your muscles. Short and long-term studies supplementing healthy subjects and diseased subjects with .3-.8g/kg/day of creatine for up to 5 years show no adverse health risks and instead, show health and performance benefits.

Creatine supplementation was also not associated with musculoskeletal injuries (Kreider et al. 2003), dehydration, muscle cramping or gastrointestinal upset (Greenwood et al. 2003).

Considering the extensive and consistent research, creatine monohydrate is one of the few, credible nutritional supplements that have been proven safe.

References:

Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental gerontology, 108, 166–173. https://doi.org/10.1016/j.exger.2018.04.013

Brosnan, M. E., & Brosnan, J. T. (2016). The role of dietary creatine. Amino acids, 48(8), 1785–1791. https://doi.org/10.1007/s00726-016-2188-1

Ferrier, C. H., Alarcón, G., Glover, A., Koutroumanidis, M., Morris, R. G., Simmons, A., Elwes, R. D., Cox, T., Binnie, C. D., & Polkey, C. E. (2000). N-Acetylaspartate and creatine levels measured by (1)H MRS relate to recognition memory. Neurology, 55(12), 1874–1883. https://doi.org/10.1212/wnl.55.12.1874

Hespel, P., Op't Eijnde, B., Van Leemputte, M., Ursø, B., Greenhaff, P. L., Labarque, V., Dymarkowski, S., Van Hecke, P., & Richter, E. A. (2001). Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. The Journal of physiology, 536(Pt 2), 625–633. https://doi.org/10.1111/j.1469-7793.2001.0625c.xd

Kreider RB, Jung YP. Creatine supplementation in exercise, sport, and medicine. J Exerc Nutr Biochem. 2011;15(2):53–69. doi: 10.5717/jenb.2011.15.2.53. 

Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017 Jun 13;14:18. doi: 10.1186/s12970-017-0173-z. PMID: 28615996; PMCID: PMC5469049.

Toescu E. C. (2005). Normal brain ageing: models and mechanisms. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 360(1464), 2347–2354. https://doi.org/10.1098/rstb.2005.1771