If you’ve ever stepped into a gym or read about fitness supplements, you’ve likely come across the term “creatine.” Widely known for its ability to enhance athletic performance and support muscle growth, creatine monohydrate has become one of the most researched and popular supplements on the market.  But what exactly is it, and how does it work in the body?  Whether you’re a seasoned athlete or someone looking to improve your workout results, understanding creatine monohydrate can help you make more informed decisions about your fitness routine and supplementation.

 

What is Creatine?

 

Creatine is a natural substance synthesized in the liver, kidneys, and pancreas, and is also obtained through the diet [1].  It is primarily found in protein-rich foods such as red meat and fish.  As an amino acid, 95% of creatine is stored in the skeletal muscles, where it plays a crucial role in muscle contraction during physical activity [1].

Creatine helps provide a steady supply of energy to muscles by rapidly converting ADP (adenosine diphosphate) into ATP (adenosine triphosphate), the primary source of cellular energy [2].  This process supports high-intensity exercise and contributes to overall muscle performance.

 

What is Creatine Monohydrate?

 

Creatine Monohydrate is one of the most studied and scientifically supported performance-enhancing dietary supplements for athletes [1].  The reported prevalence of creatine supplementation in recreational and elite athletes in survey-based studies is 9% to 46% [2]. 

 

The World Anti-Doping Agency, the International Olympic Committee, and the National Collegiate Athletic Association (NCAA) do not ban creatine use; however, the NCAA prohibits institutions from giving their athletes creatine [2].  The Food and Drug Administration does not regulate creatine.  In healthy individuals, many scientific studies have proven short-term and long-term supplementation to be safe and well-tolerated when used appropriately [2].  Generally, athletes should exercise caution when using any dietary supplementation due to possible contaminants, for example, in a mixed supplement product [2] and consult with their physician to ensure safety and appropriateness. 

 

Supplementation Protocols 

 

The goal of using dietary supplementation of creatine is to increase muscle creatine by 20-40%.  The average person consumes 1-2 g/day of creatine in a regular diet, and muscle creatine stores are about 60-80% saturated. 

 

In the rapid-loading method of creatine supplementation, the recommendation from the International Society of Sports Nutrition for increasing muscle creatine stores is to ingest 5 g of creatine monohydrate (or 0.3 g/kg body weight) four times daily for 5-7 days.  Once muscle creatine saturation is reached, these stores can be maintained by ingesting 3-5 g/day, with 5-10 g/day being necessary from some larger-sized athletes [1].

 

Another possible supplementation protocol is to consume 3 g/day of creatine monohydrate for 28 days [1].  This method will lead to slower development of distinguishable exercise gains because it will take longer to reach full saturation of creatine stores [1].  Additionally, consuming creatine supplements simultaneously with carbohydrates and/or protein will increase intramuscular creatine retention [3].

 

Potential Benefits of Creatine Monohydrate Supplementation 

 

Creatine’s ability to enhance exercise performance has been among the most researched topics in sports nutrition literature over the past 25 years [3].  Creatine monohydrate is an ergogenic dietary supplement.  Ergogenic is defined as enhancing physical performance, stamina, or recovery.  Some potential ergogenic benefits of creatine supplementation include increased muscle mass and strength adaptations during training, increased sprint performance, enhanced glycogen synthesis, increased anaerobic threshold, increased work capacity, enhanced recovery, and greater training tolerance [3].  These benefits extend beyond the athletic population; recreational fitness lovers, men, women, and younger and older individuals reap the same rewards [4].  Moreover, it is even recommended that individuals consume more creatine as they age due to its health benefits [1].

 

Potential Side Effects of Creatine Monohydrate Supplementation

 

Although the safety of creatine supplementation is highly supported, there are a few potential side effects.  A common and consistent side effect is weight gain after creatine loading [1].  This is primarily due to fluid shifts and decreased urine output [1].  Water retention, when it occurs, is highest in the early stage; however, creatine supplementation does not always lead to water retention [4].  Studies have shown that creatine supplementation does not affect total body water relative to muscle mass in the long term [4].  Several reports have associated creatine supplementation with potential side effects such as diarrhea, dehydration, cramping, and dizziness [5].  Additionally, two reports have raised concerns about creatine’s impact on renal function5; however, these claims have prompted further experimental and controlled research into creatine’s effects on kidney health.  Recent studies indicate that, in healthy individuals without pre-existing health conditions, creatine does not appear to have any adverse effects on renal function [4].  Still, it is essential to check with your physician or a trusted health professional before starting a new supplement. 

 

 

References

1. Hall, M., Manetta, E., & Tupper, K. (2021). Creatine Supplementation: An Update. Current sports medicine reports, 20(7), 338–344. https://doi.org/10.1249/JSR.0000000000000863 
2. Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., … Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14(1). https://doi.org/10.1186/s12970-017-0173-z
3. Wax, B., Kerksick, C. M., Jagim, A. R., Mayo, J. J., Lyons, B. C., & Kreider, R. B. (2021). Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations. Nutrients, 13(6), 1915. https://doi.org/10.3390/nu13061915
4. Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), 13. https://doi.org/10.1186/s12970-021-00412-w
5. Graham, A. S., & Hatton, R. C. (1999). Creatine: a review of efficacy and safety. Journal of the American Pharmaceutical Association (Washington, D.C. : 1996), 39(6), 803–877.