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Creatine is a very misunderstood fitness supplement that has recently become less intimidating due to more knowledge about it. It is typically used as a supplement to increase size and strength. There are dozens of myths surrounding what creatine is, how it affects the body, and side effects associated with its use. For these reasons, creatine has been avoided and criticized by many. However, these myths arise majorly from extreme cases or lack of information. Numerous studies have been done to research creatine and its effects; the information is out there, it just needs to be shared.
There are several forms of creatine that range from powder to pills. The most popular, cheapest, and most widely used type of creatine is creatine monohydrate—a powder form of creatine. It is consumed by mixing the powder with a beverage (usually water) and drinking the beverage soon after.
Almost all research has been completed using creatine monohydrate. It is also the most basic type of creatine and research has shown it is the most effective type. Other forms of creatine advertise better and faster benefits from their product, but most of these products become the basic creatine monohydrate molecule once they come into contact with stomach acid, so it’s just more expensive for the same product. Even the forms that absorb slightly faster haven’t shown any real benefits to being absorbed faster; rate of absorption is not a limiting factor with the benefits of creatine. Due to the miniscule difference between the dosage forms, throughout the rest of the article, “creatine” will specifically refer to creatine monohydrate.
One huge myth about creatine is that it is a type of steroid. Anabolic steroids are synthetic forms of testosterone—the male hormone. These are used to mimic testosterone in the body and can be used to promote muscle growth (along with a slew of side effects). Too much testosterone in the body upsets the natural hormone ratio and can cause the well-known side effects such as being easily angered, gynecomastia (developing man boobs), baldness, decreased size in the testis, as well as increasing risk for heart problems. However, creatine is not in any way related to steroids or testosterone; it is not even a hormone. Therefore, creatine does not have any of these side effects. Creatine is a naturally occurring amino acid that is constructed from arginine, glycine and methionine in the liver and kidneys. The three amino acids combine into creatine and are stored mainly in the muscles with the rest going to the heart, brain and various other organs. Creatine can also be acquired from diet. However, only about one gram of creatine daily is consumed on average. This is the reason that athletes supplement creatine.
MECHANISM OF ACTION
Muscle contraction is fueled by adenine triphosphate (ATP). ATP is the main energy source of most bodily processes. ATP is made up of an adenosine attached to a ribose sugar attached to three phosphate groups. The image shows the chemical structure of ATP. The last phosphate bond has copious amounts of energy held in it; the energy released when this bond is broken is about 30 kJ/mol. However, the next two phosphate groups do not supply as much energy. ATP is an unstable molecule—this is why it releases so much energy when the first phosphate group bond is broken. This also explains why each following bond that is broken releases less energy; the molecule is becoming more stable with each phosphate group lost. By severing the bond with the last phosphate group, the energy is released and captured by the cell/structure, in this case causing muscle contraction. Adenine diphosphate (ADP) is the byproduct of this reaction and not typically used to create more energy because it releases much less energy.
Creatine is a beneficial supplement in relation to ATP. In the body, creatine becomes phosphocreatine. The phosphocreatine donates its phosphate group to the ADP byproduct—creating more ATP. The image shows this process in a little more detail. The increased levels of ATP allows more anaerobic contractions to be performed because ATP is depleted mainly in the fast-twitch (type II) muscle fibers. Continuous utilization of creatine will eventually lead to increased muscle strength in fast-twitch muscle fibers from increased usage. This can lead to results such as faster sprints in a race to more weight lifted in a competition.
Another myth surrounding creatine is it is extremely harmful for your kidneys and liver. However, creatine is constructed in these structures and higher amounts will not harm them unless the individual has a pre-existing condition related to these organs.
One other effect that is rarely discussed because of its extremely low occurrence is an increased risk for certain types of cancers. The reason for this extreme side effect is that some natural bacteria in the gastrointestinal tract can create mutagens and carcinogens from creatine. However, these organisms typically appear in small amounts in the gastrointestinal tract of healthy individuals, and are easily kept in check by the body. This is definitely not something to worry about unless your immune system is already decimated, and if it is that depleted, you are probably facing much worse problems than creatine carcinogens. Probiotics are a strategy utilized to keep these organisms down to safe numbers. If you don’t like spending money on probiotics, fermented foods (kefir, sauerkraut, kimchi) as well as dairy products are a great alternative.
All of the side effects discussed above result from improper dosage of creatine, inadequate overall nutrition, or organ damage that was already present. Creatine, when taken in correct dosages and in combination with sufficient water and proper nutrition, appears to be safe with few or no side effects.
Creatine has also been observed to have several other benefits to the body beyond just building size and strength. One such experiment focused on the therapeutic value of creatine to assist in treating psychiatric disorders. Supplemental creatine was found to have “the ability to alter brain energetics, promote neurogenesis, and improve brain function safely and effectively.” In this particular experiment, creatine was found to increase the activity of nerve cells while also stimulating the growth of new nerve tissues and consequently improve brain function of psychiatric patients. In order for creatine’s full potential to be discovered related to treatment of psychiatric disorders, more experiments need to be performed with closer attention paid to the dose of creatine, the duration the creatine was supplemented, the age, sex, size, and psychiatric condition of the test subjects, and the changes in brain chemistry and structure related to mental and emotional dysfunction. This will give a much more accurate representation of the potential of creatine as a treatment of psychiatric disorders.
Another benefit not typically associated with creatine is as a treatment for depression. Continuing creatine consumption for extended periods of time will consistently produce an effect in female rats much like antidepressant medication. This was also seen in male rates, but not as consistently or profound as the female rats. Creatine has been found to have pathways in the brain that could relate to these antidepressant qualities; however, this discovery is in the early stages of research. The increased effectiveness of creatine for treating depression in females may also lead to finding a small connection between depression and female hormones such as estrogen or progesterone. This connection could lead to new, better antidepressants or other ways to utilize creatine. The potential of such findings could be infinite in the field of medicine. Creatine can now be open to future research studies as a possible antidepressant or a way to reduce side effects of current antidepressants.
To add another benefit of creatine to the brain, creatine has been found to improve cognition, specifically in sleep-deprived and vegetarian/vegan individuals. To give a basic idea of why, a sleep-deprived person has impaired cognition and decreased ATP stores and therefore could benefit from the extra ATP generated by creatine to fuel the brain. Vegetarians and vegans don’t consume meat, the main source of creatine for most people, so they wouldn’t be able to have the same amount of brain energy available compared to someone that had a higher storage of creatine from either eating meat or supplementing. This is not to say that sleep-deprived people and vegetarians/vegans are dumb, they just don’t have the same relative energy to fuel their brain’s processes. Think of it like Usain Bolt trying to compete in the 100 meter race after fasting for a week; he has the ability to perform well but lacks the energy stores.
One final benefit of creatine supplementation I will discuss because I find it to be incredibly interesting and unrelated to muscles or the brain: diabetes. Creatine was researched in a landmark study to look at its benefits to type 2 diabetics that were all on the same exercise program. The study found that the diabetics that were supplemented with creatine had better glucose control after meals and a lower A1C percentage. The mechanism of this benefit was found to be that creatine supplementation improved the efficacy of a glucose transporter on cell surfaces. This helped overcome the main problem of type 2 diabetics: that the cell has trouble extracting glucose. Even when considering non-diabetics, insulin sensitivity is beneficial, especially for athletes.
Creatine is commonly consumed in two phases: a loading phase lasting about one week and then a maintenance phase. The loading phase is where 20-30 grams are taken per day to initially saturate the muscles with creatine, while during the maintenance phase the individual will consume in the range of 2-5 grams. However, a loading phase is not necessary and more likely to cause gastrointestinal side effects and water retention, so I recommend against it. Another thing I’ve heard recommended is to cycle creatine—to give your body “time off” from it and perhaps prevent problems or increase efficacy. There is no need to cycle creatine and I’ve never seen or read about any benefits to it.
- Most of the myths concerning creatine arise from misinformation and fear of the unknown…like every other myth in existence.
- Creatine is not a steroid.
- Creatine is “natural” and legal to use in any competition.
- Creatine is not a supplement to fear; it has a plethora of benefits ranging from typical mass and strength increases to a viable supplementation for psychiatric disorders, depression, sleep-deprivation, and diabetes.
- There is no need to cycle off creatine.
- I recommend taking 2-5 grams of creatine monohydrate by mouth each day. This will help prevent any GI side effects or water retention while still receiving the full benefits.
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Patricia J. Allen, Kristen E. D’Anci, Robin B. Kanarek, Perry F. Renshaw, Sex-specific antidepressant effects of dietary creatine with and without sub-acute fluoxetine in rats. Pharmacology Biochemistry and Behavior. Volume 101, Issue 4, June 2012, Pages 588-601, ISSN 0091-3057, 10.1016/j.pbb.2012.03.005.
Gualano B, Salles Painneli V, Roschel H, et al. Creatine in type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Medicine and Science in Sports and Exercise. 2011 May;43(5):770-778. doi:10.1249/MSS.0b013e3181fcee7d.