by Tania Houspian, PharmD 2011
You can picture it now: Your New Year’s resolution to get in shape finally realized. You’re on the beach in your Speedo with your muscles glistening in the sun. Ok, maybe that’s not exactly what you are imagining the finished product to look like. Perhaps your New Year’s resolution was geared more towards building bigger muscles and getting in better shape rather than becoming the next World’s Strongest Man (skin bronzer, shaving, and Speedos may not be your style). Nonetheless, you do want to become more muscular. If so then creatine is the one supplement all your Google searches for “build more muscle” will undoubtedly produce. Creatine is possibly the most widely used and talked about dietary supplement in the world of bodybuilding. It’s definitely something a lot of people come into pharmacies and nutrition stores looking for. The question, of course, is “Does it work?”
Before we answer that question here’s another one: What is creatine?
Creatine is not, I repeat, is NOT a steroid. Creatine is a protein your body (specifically your liver) makes. You also get creatine from foods like meat and fish. The creatine that is made by your liver or that is absorbed from food is then stored in muscles. An average 70kg (154 lbs) person has about 120g of creatine stored in their muscles and metabolizes about 2g of creatine each day (which is easily replenished from your diet or liver). In the muscles, creatine acts as a battery charger. In this case the battery is your body’s energy stores called ATP. When muscles use up ATP to perform an action it is converted into ADP. Creatine is able to convert ADP back into ATP, which can once again be used by your muscles to perform actions. This is a quick and easy way for the body to create more energy (twice as fast as the bodies normal way of deriving ATP from glucose). Sounds great, right? The downside is that the creatine is depleted pretty quickly and the body has to go back to breaking down glucose to make more ATP. So when an athlete takes creatine, their hope is that it will help their muscles maintain the ATP levels for a longer period of time subsequently allowing them to train longer before becoming fatigued.
Aside from increasing the amount of work your muscles can perform before becoming fatigued, there are other theories about how creatine helps build more muscle:
Creatine pulls water into muscle cells via osmosis (remember osmosis from high school chemistry?), helping keep muscle cells hydrated and making your muscles appear rounder and fuller…possibly the origin of the common gym phrase, “Getting swoll”
By delaying the muscles’ use of glucose to generate ATP, creatine also helps delay the creation of lactic acid (a byproduct of glucose use). Lactic acid is what makes your muscles burn and causes you to feel sore the morning after a tough workout (yes, lactic acid is to blame for the “I was just hit by a big rig” sensation).
So far we have discussed theories about creatine’s ability to improve muscle building. What we really want to know is if any of them have been proven. The answer is yes and no. Given the popularity of creatine as a workout supplement there have been hundreds of studies done to examine its efficacy and safety. The studies reviewed asked participants to consume 20 grams of creatine supplements a day for five days (called creatine loading). Then the subjects were asked to consume 5 grams of creatine per day for 21 days. Theoretically, this would increase the stores of creatine in their muscles. The participants were then asked to perform various exercises and their results were compared to their pre-supplementation results. The studies show that creatine does help increase body mass and it does help increase endurance in short-duration, high-intensity exercises (they specifically looked at number of bench press reps, leg press reps, and vertical jump height). However, creatine did not help the men in long endurance exercises such as running a 12 mile race (creatine actually hurt test subjects in long endurance exercises, possibly because they were carrying around excess body mass). Creatine also did not decrease the amount of post-workout soreness reported by the subjects. The amount of soreness felt was the same before using creatine and after the supplementation period.
The Verdict: Creatine is not a wonder supplement. You can’t take it, go to sleep, and wake up with bulging muscles. It is, however, something you can take if you are serious about working out as it may help you increase your stamina and strength with specific workouts.
Now to the most important information: Is it safe and are there any side affects?
Initially, there were reports of creatine causing dehydration, cramping, and kidney & liver damage. Athletes taking creatine were subsequently warned to not work out on hot days and to be cautious of any cramping the experienced. That sounds pretty ridiculous to us: if you’ve ever worked out hard you know that cramping is bound to happen from time to time. To test out these claims more studies were done. The main study on this subject was performed on 14 football players who were told to consume creatine for 8 weeks. They chose football players as the athletes to use as guinea pigs…I mean test subjects…because football is considered a high-intensity, short-duration exercise (which is exactly the kind of activity creatine is supposed to aid in). During the 8-week time period the athletes’ kidney function, liver function, and over health were closely monitored. Their results regarding creatine efficacy paralleled those of other previous studies showing that body mass increased and the athletes’ abilities to perform high-intensity, short-duration exercises did improve. As far as toxicity goes, no signs of kidney or liver damage were seen in any of the patients. In addition, none of the football players became dehydrated or had more cramping than they did at baseline.
Before we go waving our “Creatine is Safe” flag, a few things should be pointed out. First, the studies were done on healthy, young males. People who have liver or kidney problems to begin with should not further challenge their organs unless they are under the close supervision of a health professional. Studies have not been done with people who have kidney or liver problems so it is hard to say how it may affect them. Second, all these studies were short term (8 weeks was the longest one performed) so no one really knows the long-term effects of taking creatine. Many of the problems initially reported with creatine supplementation could have been due to impurities in the creatine supplement people were purchasing thus it’s always important to buy supplements made by a well known and trusted company (i.e. don’t order it off the web from some no name company just because shipping is free). In addition, be sure to consume plenty of water when using creatine. Remember that creatine pulls water into your muscles (and out of your body’s circulation). You need to make sure that you are replacing this displaced water while using creatine to prevent dehydration.
The Final Verdict: If you are serious about working out and are looking for a supplement to provide you with additional stamina to help you strength train for longer periods of time then creatine may be the way to go. Some things to keep in mind when shopping around:
Most of the studies used creatine monohydrate powder as their creatine source (there are more expensive formulations with fancy names but this formulation seemed to work well in the studies).
No consistent standards were set for the loading phase of creatine use but 20 grams per day (split into 4-5 grams doses throughout the day) for 5 days seemed to be the most common approach. Note, however, that consuming that much creatine is going to upset your stomach.
It was recommended that the average person who wants to gain body mass should supplement with 2-5 grams of creatine per day when working out.
Make sure you’re buying high quality creatine from a reputable manufacturer at a reasonable price.
Now go hit the gym mister.
Bemben M, Lamont H. Creatine Supplementation and Exercise Performance Recent Findings. Sports Med 2005; 35 (2): 107-125
Cancela P, Ohanian C, Cuitiño E, et al., Creatine supplementation does not affect clinical health markers in football players. 2008 Sports Med 42: 731-735 .
Dalbo V, Roberts M, Stout J, et al. Putting to rest the myth of creatine dehydration and supplementation leading to muscle cramps. Br J Sports Med 2008 42: 567-573
Herda T, Beck T, Ryan E, et al. Effects of Creatine Monohydrated and Polyethylene Glycosylated Creatine Supplementation on Muscular Strength, Endurance, and Power Output. 2008. The Journal of Strength and Conditioning Research.
Lopez R, Douglas C, McDermott B, et al. Does Creatine Supplementation Hinder Exercise Heat Tolerance or Hydration Status? A Systematic Review with Meta-Analyses. 2009; Journal of Athletic Training. 44(2), 215-223.