What is creatine and what does it do?

Chances are you’ve heard of creatine. The most studied supplements are probably creatine and caffeine, so we know a fair bit about its benefits, dosage and drawbacks. If you don’t know anything about it – don’t worry, this guide will give you everything you need to know.

What is creatine and what does it do?

Creatine is a molecule produced in the liver and mainly stored in muscle. This means the main source of dietary creatine comes from meat. The reason it’s concentrated in muscle tissue is because it forms part of the energy systems that power movement.

You may have heard of ATP (adenosine triphosphate), often referred to as the fundamental energy currency in the body. I highlighted the “phosphate” in the previous sentence because this is the main component that powers all the processes that occur in a cell.

When ATP spends a phosphate group to power muscle contraction, it becomes ADP.

Adenosine triphosphate (3 phosphate groups) -> adenosine diphosphate (2 phosphate groups)

Cornell, B. 2016. Energy Conversion. [ONLINE] Available at: http://ib.bioninja.com.au. [Accessed 2 Dec 2019]

When we run out of ATP, we can no longer contract our muscles, so it’s very important that we add a phosphate back on to ADP to turn it back into ATP. We use the food we eat to regenerate ATP stores, and it occurs constantly.

It turns out that creatine can also carry a phosphate group, forming phosphocreatine. It can donate its phosphate group to reform ATP. Thus, creatine helps fuel muscle contraction during exercise.

Training is especially demanding on ATP stores. High intensity exercise rapidly depletes ATP, and creatine stores can act as a battery to quickly recharge and sustain a high work rate. By consuming more creatine, we can bolster stores in the muscle and better support ATP regeneration.

What are the benefits of taking creatine?

Increased power output: High effort, short-duration bursts benefit most from increased creatine stores. This typically means efforts under 5-8 seconds in duration, since that’s about as long as creatine stores can support ATP regeneration before running out.

Beyond this initial zone of high intensity effort, creatine has mixed results.

Muscle size: Creatine increases water retention in the muscles. This can be both a pro and a con. It means increased scale weight and slightly increased muscle fibre size.

Creatine may also increase factors that contribute to muscle fibre growth such as satellite cell activation and IGF-1.

You can read more about the importance of satellite cells to long terms gains here.

Cognitive benefits: Creatine is used in the brain as an energy carrier, and under specific circumstances it may improve cognition. Mental fatigue due to sleep deprivation is mitigated by phosphocreatine stores. Traumatic brain injury, whether due to concussion or stroke, can also be buffered against.

Note that creatine stores in muscle can be superloaded with supplementation, but in the brain it simply acts as a preventative against deficiency.

Dangers and side effects - is creatine safe?

Creatine should be taken with enough water to avoid an upset stomach. Sometimes taking a large dose of over 5g at once can cause nausea, but this can be avoided with smaller doses or by taking with food.

A common side effect is an increase in creatinine levels. Creatinine should not be confused with creatine – it’s a downstream byproduct that’s used as a marker of kidney function.

Creatinine typically increases with exercise and creatine supplementation, and this can be misinterpreted by medical professionals as a problem. There is no data to suggest that healthy individuals taking creatine have anything to worry about with regards to kidney function. If there is a prior kidney condition, then caution is advisable.

Aside from the above, creatine is considered extremely safe given the large volume of safety data that’s been collected.

There was one study that reported a risk of increased hair loss with creatine use. The researchers found that the hormone DHT was increased slightly, which is an androgen that contributes to male pattern baldness.

However, the increases in DHT were still within normal ranges. This study has not been replicated, and hair loss with creatine use has never been directly studied. Many other studies have shown no effect on hormone levels.

Who should take creatine?

Since the benefits are far-reaching and the side effects minimal, creatine can safely be used by most people. Since some populations have low dietary intakes of creatine (vegetarians, vegans, elderly), supplemental creatine may be particularly useful. In these instances of below-average levels of creatine, working memory may be enhanced.

There are situations where creatine use may not be warranted. These relate to the increases in bodyweight when first supplementing.

Athletes who compete in weight classes should be aware of this. Since the amount of weight gained is individual, it’s worth experimenting in the off-season to see how large the effect is.

Individuals actively dieting to lose weight should also be mindful of how creatine can affect weight. I usually recommend holding off on creatine supplementation until you’re weight stable so it doesn’t mess with your weigh-in data.

What form of creatine is best?

The cheapest form is creatine monohydrate. This has been used in most research studies and has proved most effective.

Other forms of creatine are also effective but cost more. Some forms have erroneous absorption claims. For example, buffered creatine (Kre-Alkalyn) and creatine hydrochloride (Con-Cret) are both converted into the same creatine molecule as any other form by stomach acid. They still work fine but due to cost are not a better option than other forms.

Creatine citrate and micronized creatine (Creapure) dissolve more easily in water but are otherwise as effective as creatine monohydrate.

Creatine ethyl ester performs worse than other forms since it’s partly degraded into creatinine in the intestines.

Pills, powder or capsules all work the same, so personal preference is recommended.

Creatine dosage and when to take

There are two methods of dosing creatine. It can be taken at any time – there’s no need to specifically use it before or after training, for example. Taking it alongside caffeine may interfere with its absorption but if this effect exists, it’s not large.

The first is a loading protocol where 0.3g per kilogram of bodyweight (0.14g per pound) is taken for about a week. This equates to around 15-25g per day for most people. Since large doses can cause nausea or stomach cramps, it’s best to split the daily amount up into 3-5g taken at once.

After loading, body stores become saturated and can be maintained with 2-5g per day.

The second approach is to simply take 2-5g per day indefinitely. Body stores will reach saturation more slowly but there’s less hassle involved.

Creatine is lost through the urine. The daily requirement for maintaining creatine stores is approximately 2-3g.

Creatine can be mixed with food or liquid. Be sure to drink some fluids alongside supplementing.

Creatine does not need to be cycled.

Hopefully this answers your questions. Creatine is a straightforward supplement to use. It's cheap, effective and safe - I recommend trying it if you perform resistance training or eat a diet low in animal products.