The Creatine Facts

TAGS: Nick Tumminello, youth athletes, creatine, supplements

The Creatine Facts

One of the longest standing controversies in the world of health, fitness, and athletic performance is whether or not one should take creatine. I wrote the "Creatine Report: The Most Comprehensive, Unbiased Research-Based Resource on Creatine Ever Written"to separate fact from fiction.

It seems that every few months, the media blames creatine for causing everything from muscle tears to kidney damage. There’s a growing number of concerned parents who are just as worried about their kids taking creatine as they are about them using illegal drugs. Are these controversies over creatine and its safety founded in legitimate scientific evidence? Or are they spawned from confusion, misinformation, and unfounded claims?

In this article, there aren't any opinions or claims—just science-based facts on creatine from several leading peer reviewed research journals and some of the world's most respected sports supplement experts. If you think you can "handle the truth" about creatine, read on!

What is creatine?

Here’s what you need to know:

  • Creatine comes from animal products like meat and fish.
  • Creatine is derived from the amino acids glycine, arginine, and methionine.
  • It’s synthesized mainly in the liver and kidneys (and to a lesser extent in the pancreas).
  • Skeletal muscle contains 95 percent of all creatine.
  • The heart, brain, and testes hold the remaining 5 percent (1).

How does creatine work?

According to Jose Antonio, PhD, a professor at Nova Southeastern University and the CEO of the International Society of Sports Nutrition, “Creatine serves as a fuel source for rapid exercise through increased phosphocreatine (PCr) stores.”

Here’s some basic human physiology that will help you understand how creatine works as a fuel source: If you perform aerobic activity (like jogging), the main source of energy your body will use is glycogen. Glycogen comes from carbohydrates and is primarily stored in your muscles. When you perform anaerobic activity (like sprinting, jumping, weightlifting, or playing sports), your body gets its fuel from ATP and phosphocreatine. So the more creatine you have available, the more fuel you have in the tank to sustain intense activities. Studies show that“supplementation can increase phosphocreatine (PCr) and creatine (Cr) stores by 10–40%” (2).

“To date, creatine is clearly the single most effective dietary supplement for enhancing gains in anaerobic performance as well as increasing lean body mass and muscle fiber size.” — Jose Antonio PhD

Specifically, research has shown that creatine offers these benefits:

  • Increased fat-free mass
  • Improved maximal strength (as measured by a one-rep max bench press)
  • Improved muscular endurance
  • Increased anaerobic power and performance (shown in many activities including continuous jumping, jump squats, knee extensions, and repeated sprints by soccer players)
  • Increased hydration in extreme outdoor conditions (3–7)

In addition to its strength and performance benefits, Alan Aragon, MS (nutritional editor for Men’s Health and consultant to the Los Angeles Lakers, Los Angeles Kings, and Anaheim Mighty Ducks), notes: “Clinical and therapeutic use of creatine is a very interesting emerging area in research." For example, a recent study showed that creatine improves glycemic control in type 2 diabetics. “It’s also been shown to benefit those with knee osteoarthritis.”


Here’s some more of the surprising health benefits of creatine:

  • Fights inflammation following muscle damaging exercise
  • Improves brain performance
  • Improves long- and short-term memory for vegetarians
  • Speeds recovery in patients with chronic obstructive pulmonary disease
  • Helps mitigate symptoms for those with neuromuscular disorders
  • Prevents DNA mutations in aging cells (8–16)

Who can creatine help?

The short answer is everyone! Creatine helps all age groups and everyone from the athlete to the non-athlete and from power sports to endurance sports. Even those with injuries and illnesses can benefit from taking creatine.

Here are the hard science facts to prove it.

More muscle and less fat:

“Creatine supplementation during resistance training resulted in increased fat-free mass, thigh volume, muscle strength, myofibrillar protein content, and Type I, IIa, and IIx MHC mRNA expression compared to controls” (17).

“Increase in total body mass and lean mass with no gain in fat with creatine” (18).

Improved endurance:

This study was done on rowers: “Creatine supplementation improves endurance (expressed by the individual lactate threshold) and anaerobic performance…” (19).

This study was done on cyclists: “This study showed [that] creatine ingestion improves submaximal cycling efficiency from [an] increase in muscle phosphocreatine” (20).

Creatine as an anti-inflammatory

This study used triathletes and showed that creatine serves as an anti-inflammatory: “Creatine supplementation before a long distance triathlon competition may reduce the inflammatory response induced by this form of strenuous exercise” (21).

Better hydration for outdoor sports in hot weather conditions?

This study shows creatine helps keep you better hydrated in hot outdoor conditions: “The effects of creatine supplementation on cardiovascular, metabolic, and thermoregulatory responses during exercise in the heat in endurance-trained humans were positive” (22).

Better sports performance in teenage athletes

“Creatine supplementation enhances the dynamic strength and may increase anaerobic metabolism in the lower extremity muscles and improves performance in consecutive maximal swims in highly trained adolescent swimmers” (23).

What are the side effects of creatine?

OK, by now you’re probably thinking, “Creatine has some amazing, scientifically proven benefits, but what’s the catch? What kind of side effects do I have to worry about?"

According to Jose Antonio, PhD, “Creatine is perhaps the most studied ergogenic aid in history.  Plus, the science clearly shows that there are no harmful side effects of creatine supplementation.” He goes on to address the specific claims of negative side effects and even issues a challenge: “There is zero scientific evidence that creatine supplementation causes muscle cramps or tears, harms the kidneys, [or] causes dehydration or a myriad of other silly myths promulgated by the mainstream press. If these side effects exist, show me the science!”

For instance, one study clearly states,“From 3 to 30 grams per day over periods ranging from 10 months to 5 years, neither short-term, medium-term, or long-term oral creatine supplements induce detrimental effects on the kidney in healthy individuals” (24).

Jose Antonio, PhD, describes another study performed during one season of NCAA Division IA football training and competition: “It was discovered that creatine users had significantly less cramping, heat illness or dehydration, muscle tightness, muscle strains, and total injuries than non-users. Thus, even for athletes who are well trained, it is clear that regular creatine consumption does not cause harm and in fact may have a protective effect against certain exercise-related issues.”

What about creatine use for kids?

According to David Sandler, the senior director of education for the National Strength and Conditioning Association (NSCA), “Some of the first research studies on creatine were done on overly weak infants. So, yeah, it’s safe.”

A very small number of kids are born with an inborn error of creatine metabolism. It’s extremely rare, but if left untreated, the child could end up with severe neurological problems as well as cognitive problems like mental retardation or autistic disorders. Some of these children have been treated successfully with creatine monohydrate. One patient was given four to eight grams a day for 25 months, the equivalent of 80–160 grams a day for an adult. The patient experienced significant improvement, with brain and total body creatine levels rising to normal levels (26).

Additionally, Jose Antonio, PhD, notes, “Creatine has been shown to have beneficial effects in kids with traumatic brain injury, kids being treated for cancer, [and] kids with muscular dystrophy as well as teenage athletes.” Antonio then asks the question, “So why not give it to healthy kids who are training for a competitive sport or activity?”

Creatine has also been used on pediatric cancer patients undergoing chemotherapy. The corticosteroids they take to alleviate the side effects of the chemo are known to cause rapid gains in body fat. With creatine, that increase in fat was lessened greatly (28). With all this solid evidence of the amazing benefits creatine has for kids with severe health complications, Jose Antonio, PhD, drives home a key point: “What astounds me is that parents would rather give kids a sugar-filled soft drink than creatine. It makes no sense at all!”

How do you take creatine?

So now you know that creatine is 100 percent safe for everyone. You also know that it’s scientifically proven to work for everyone. All you need to know now is how to take it.

Experts like Antonio, Aragon, and Sandler all agree that for best results, take three to six grams of creatine monohydrate daily.

(Nerd) References:

  1. Terrilion K (1997) Int J Sports Nutr 7:138.
  2. Volek JS, Kraemer WJ (1997) J Strength Cond Res 10:200.
  3. Kreider RB, et al. (1998) JEP online 1.1.
  4. Willoughby et al (2001) Creatine supplementation (6 g/d for 12 weeks) during resistance training resulted in increased fat-free mass, thigh volume, muscle strength, myofibrillar protein content, and Type I, IIa, and IIx MHC mRNA expression compared to controls. MSSE 33:1674–81.
  5. Balsom P, et al (1995) Increase in total-body mass and lean mass with no gain in fat. Acta Phhysiol Scand 154:303.
  6. Grindstaff PL, et al (1997) Int J Sport Nutr 330–46.
  7. Sim L, et al (1999) Increased Type I and II muscle fiber hypertrophy CJAP 23(5):507.
  8. Chwalbinska-Moneta J (2003) Effect of creatine supplementation on aerobic performance and anaerobic capacity in elite rowers in the course of endurance training. Int J Sport Nutr Exerc Metab 13(2):173–83.
  9. Kilduff LP, et al (2004) The effects of creatine supplementation on cardiovascular, metabolic, and thermoregulatory responses during exercise in the heat in endurance-trained humans. Int J Sport Nutr Exerc Metab 14(4):443–60.
  10. Gualano B, et al (2011) Creatine in Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial. Med Sci Sports Exerc 43(5):770–8.
  11. Neves M Jr, et al (2011) Beneficial effect of creatine supplementation in knee osteoarthritis. Med Sci Sports Exerc [Epub ahead of print]
  12. Bassit RA, et al (2008) Creatine supplementation reduces plasma levels of pro-inflammatory cytokines and PGE2 after a half-ironman competition. Amino Acids 35(2):425–31.
  13. Rae C, et al (2003) Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci2 70(1529):2147–50.
  14. Bentonand D, Donohoe R (2011) The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores. British Journal of Nutrition 105:1100–05.
  15. Bender A, et al (2008) Creatine improves health and survival of mice. Neurobiol Aging 2008 (9):1404–11.
  16. Tarnopolsky MA (2007) Clinical use of creatine in neuromuscular and neurometabolic disorders. Subcell Biochem 46:183–204.
  17. Fuld JP, et al (2005) Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 60(7):531–7.
  18. Berneburg M, et al (2005) Creatine supplementation normalizes mutagenesis of mitochondrial DNA as well as functional consequences. J Invest Dermatol 125(2):213–20.
  19. Willoughby, et al (2001) MSSE 33:1674–81.
  20. Balsom P, et al (1995) Acta Phhysiol Scand 154:303
  21. Grindstaff PL, et al (1997) Int J Sport Nutr 330–46.
  22. Vandenberghe K, et al (1997) JAP 83:2055.
  23. Chwalbinska-Moneta J (2003) Int J Sport Nutr Exerc Metab 13(2):173–83.
  24. Murphy AJ, Watsford ML, Coutts AJ, Richards DA (2005) Effects of creatine supplementation on aerobic power and cardiovascular structure and function. J Sci Med Sport 8(3):305–13.
  25. Bassit RA et al (2008) Amino Acids. 35(2):425–31.
  26. Kilduff LP, et al (2004) Int J Sport 14(4):443–60.
  27. Juhász I, et al (2009) Creatine supplementation improves the anaerobic performance of elite junior fin swimmers. Acta Physiol Hung 96(3):325–36.
  28. Poortmans JR, Francaux M (1999) Long-term oral creatine supplementation does not impair renal function in healthy athletes. Med Sci Sports Exerc 31(8):1108–10.
  29. Gualano B et al (2008) Effects of creatine supplementation on renal function: a randomized, double blind, placebo-controlled clinical trial. Eur J Appl Physiol 103(1):33–40.
  30. Stockler S, et al (1996) Creatine replacement therapy in guanidinoacetate methyltransferase deficiency, a novel inborn error of metabolism. Lancet 348(9030):789–90.
  31. Tarnopolsky MA, et al (2004) Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology 62(10):1771–77.
  32. Bourgeois JM, et al (2008) Creatine monohydrate attenuates body fat accumulation in children with acute lymphoblastic leukemia during maintenance chemotherapy (2008) Pediatric Blood Cancer 51(2):183–7.
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