Creatine

1) What is creatine? 

Creatine is a nitrogenous organic compound made up of three amino acids (arginine, glycine, and methionine) and plays an integral role in human health and performance.  Creatine is synthesized in the kidneys, liver, and pancreas, and it can also be found naturally in some dietary sources – primarily red meat and fish.  However, you would need to eat several pounds of meat each day to reach an optimal and performance enhancing dose of creatine.  For this reason, creatine supplementation has become very popular, and it is likely even more beneficial for individuals who do not consume animal based protein sources.   

Creatine is predominantly stored in the skeletal muscle (up to 95%), with small amounts found in cardiac and smooth muscle, brain, bones, and testes.  Intramuscular creatine and phosphocreatine act as a reserve of high-energy phosphate that is used to rapidly convert ADP (adenosine diphosphate) back to ATP (adenosine triphosphate).  ATP is the energy currency of the body used to power several processes including muscle contraction, via distinct metabolic systems.  The most rapid and powerful energy system, known as the phosphagen system, relies on creatine to facilitate speedy ATP regeneration during high-intensity, short duration exercise.  In fact, the ability of the phosphagen system to contribute to high-intensity exercise performance is highly dependent upon concentrations of creatine and phosphocreatine within the muscle.  However, creatine stores in humans do not appear to be fully saturated – even in individuals who eat a normal omnivore diet. Therefore, supplementing with creatine to increase muscle creatine stores can enhance high-intensity exercise capacity and the ability to perform repeated bouts of high-intensity effort.

Creatine is a nitrogenous organic compound made up of three amino acids (arginine, glycine, and methionine) and plays an integral role in human health and performance.  

2) Evidence for effectiveness 

Body Composition
Endurance
Energy
Focus
Mood
Pump
Strength

3) Pre-workout benefits of creatine. 

The phosphagen system (otherwise known as the phosphocreatine-ATP system) plays an important role in maintaining energy availability during exercise.  During muscle contraction, ATP is degraded into ADP and Pi to provide free energy for metabolic activity.  Phosphocreatine is used as a buffer to rapidly resynthesize ATP and maintain energy availability – particularly during high-intensity, short duration activity such as weightlifting and sprints.  However, the phosphagen system has a low capacity because of the limited supply of phosphocreatine stored in the muscle.  The primary mechanism by which creatine supplementation can improve sports performance is by increasing muscle creatine and phosphocreatine stores, thereby enhancing ATP replenishment via the phosphagen system allowing for better high-intensity work capacity.  Thus, creatine plays an essential role in the optimal functioning of muscle and other tissues with high energy demands.  

Although creatine is commonly found in pre-workout formulas, a single supplemental serving of creatine would not be expected to offer an acute performance enhancing effect.  After taking a creatine supplement, it must be absorbed into the bloodstream and then taken up by the muscle to meaningfully impact muscle creatine stores and exercise performance.  While this process requires daily creatine supplementation for days to weeks, muscle creatine stores can increase by 20-40% in most individuals following a supplementation protocol.  The most efficient means of saturating muscle creatine stores is to follow a “loading protocol” of 20-25 grams of creatine (split into 4-5 daily doses) for 5-7 days.  Fortunately, these types of high doses are not required in pre-workout supplements because reports have shown that regular intake of lower doses (i.e.., 3-5 grams) can also saturate muscle creatine stores – it just takes longer.  While the “loading protocol” will increase muscle creatine concentrations rapidly within 7 days, adhering to a lower dose protocol will gradually increase muscle creatine concentrations to full saturation within about 4 weeks.  Either way, once full saturation of muscle creatine is achieved, creatine stores can be maintained by ingesting 3-5 grams daily. 

Regular creatine supplementation (3-5 grams per day) can significantly increase muscle creatine stores, enhance ATP replenishment via the phosphagen system, and boost high-intensity work capacity.  

4) The latest science 

Because of its role in cellular metabolism, creatine has become the most highly studied dietary supplement for its potential to improve exercise and sport performance.  Leading organizations have reported that creatine is currently the most effective dietary supplement for increasing high-intensity exercise capacity.  It is also the most beneficial supplement for increasing muscle size and strength when combined with a resistance training program.  In summary, creatine supplementation promotes greater levels of creatine in the muscle which can boost anerobic energy capacity, improve training tolerance, and benefit performance during repetitive high-intensity actions such as weightlifting and sprints.  By enhancing training sessions that rely on the phosphagen system, creatine supplementation can increase muscle mass and strength adaptations over time.  

There is a strong scientific evidence that creatine supplementation is effective for improving several aspects of health and fitness.  Recent meta-analyses and reviews of the scientific literature report that regular creatine supplementation can improve upper-body strength, lower-body strength, anaerobic power, gains in muscle size, and several strength and power sporting events in both men and women.  The magnitude of strength improvements has been reported to be nearly 2- to 3-fold greater in athletes supplementing with creatine compared to a placebo.    Other potential benefits of creatine supplementation include increased sprint performance, enhanced glycogen resynthesis, and increased work capacity.  Additionally, creatine supplementation may speed up recovery time between high-intensity exercise sessions by reducing muscle damage.

Although there are hundreds of scientific publications showing the benefits and safety of creatine supplementation, several myths and misconceptions still prevail.  A recent review debunked several of these common concerns.  For example, creatine supplementation does not simply lead to fluid retention; creatine does not result in kidney or renal dysfunction; and creatine does not cause hair loss, muscle cramping, or fat gain. 

In summary, creatine is the most effective dietary supplement for individuals participating in high-intensity training or strength and power sports.  Inclusion in a pre-workout formula is a simple means of increasing dietary intake to saturate muscle creatine stores. 

There is a strong scientific evidence that creatine supplementation is effective for improving several aspects of health and fitness. Most notably, creatine supplementation has been reported to increase muscle creatine and phosphocreatine concentrations, enhance acute exercise capacity, and improve training adaptations.  

5) Other health benefits of creatine 

Most fitness enthusiasts supplement with creatine for the well-established performance benefits.  However, research on creatine supplementation has expanded into several other areas of health and wellness.  Interestingly, studies indicate that creatine may offer several general health benefits and potential therapeutic roles in several health-related conditions.  The general health benefits of creatine supplementation include, but are not limited to, managing blood lipid levels, enhancing glycemic control, reducing the risk of heart disease, enhancing rehabilitation outcomes, aiding bone health, and improving cognitive function. Creatine may also offer immune support, neuroprotection, anti-cancer properties, and anti-depressive effects.  Overall, the benefits of including creatine in your pre-workout go well beyond increasing muscle creatine levels and enhanced training adaptations.

Creatine supplementation may offer several general health benefits and potential therapeutic roles in several health-related conditions.  

6) What to look for on the label.

Supplement companies are continually marketing novel forms of creatine with claims of improved efficacy.  However, almost all the research conducted on creatine showing a wide array of benefits have used creatine in the form of creatine monohydrate.  Alternative forms of creatine (such as creatine citrate, creatine HCl, creatine nitrate, etc.) have not been shown to promote greater creatine retention than creatine monohydrate.  Very few studies have compared alternative forms of creatine to creatine monohydrate.  Therefore, there is currently no evidence to suggest that novel forms of creatine would result in better performance benefits as compared to creatine monohydrate.  A recent review of alternative forms of creatine concluded that creatine monohydrate remains as the most extensively studied form of creatine that shows efficacy and safety.  Also, the use of alternative forms of creatine drives up the cost of pre-workout supplements without merit.  Fortunately, creatine monohydrate is relatively cheap to include in a supplement formula.  Creatine stores can be maintained by supplementing daily with 3-5 grams of creatine monohydrate, yet many pre-workout formulas will underdose this ingredient, use untested alternative forms of creatine, or include an undisclosed dose in a proprietary blend.

Creatine monohydrate is the most studied form of creatine.  There is no evidence to suggest that alternative forms of creatine would result in better performance benefits as compared to creatine monohydrate.  A proper daily dosage of creatine monohydrate would be 3-5 grams.

7) Synergistic Effect with Other Pre-workout Ingredients?

It is likely that creatine works synergistically with other pre-workout ingredients.  First, several studies have shown that creatine is very effective when combined with other ingredients such as beta-alanine or when incorporated into a multi-ingredient pre-workout supplement.  However, there has been a small amount of evidence suggesting that post-workout creatine supplementation may be marginally superior to pre-workout supplementation.  There has also been some speculation that supplementing creatine with caffeine may blunt the ergogenic effect of creatine.  Nevertheless, regular consumption of at least 3 grams of creatine, even as part of a caffeine-containing pre-workout supplement, is likely sufficient to enhance exercise performance and improve training adaptations. More research is needed in these areas before making definitive conclusions.

The combination of creatine with other performance enhancing ingredients may enhance the effectiveness of the pre-workout.