By, Rene Scott O2X Nutrition Specialist
Note – When determining if a supplement is a good choice, consider
The amount of peer – reviewed research that has been conducted on the supplement.
Secondly, consider the bioavailability, general safety and efficacy of the supplement; and if it has a negative impact on any medical conditions you may have
Consider if it is certified for purity or recognized by a third-party group
Lastly, consider the cost-benefit ratio to get a good bang for your buck
Background – Creatine is a type of amino acid (composed of the amino acids glycine, methionine, and arginine) that supplies energy to your muscles. The body naturally synthesizes about half of your body’s creatine mostly in the liver and kidney. The other half of your body’s supply of creatine is from your diet (especially protein-rich foods) and is stored mostly (95%) in skeletal muscle with smaller amounts stored in the brain, liver, and kidney. Natural sources of creatine come from milk, eggs, fish, mollusks, and red and white meat. Your body stores creatine in the muscle as phosphocreatine to rapidly regenerate ATP (adenosine triphosphate), the compound that gives cells energy. This allows on-demand energy when needed in short-duration, high intensity exercise.
Creatine, as an oral supplement, is one of the most widely researched natural supplements for over 20 years. Micronized creatine monohydrate (CM) is the most popular form and is ingested orally; it has been shown to improve physical and cognitive performance. Supplementation (in specific doses) when combined with heavy resistance training has been shown to improve physical performance, fat-free mass, and muscle hypertrophy. Creatine also may have an antioxidant effect which makes it supportive of muscle repair due to injury or exercise stress.
Creatine uptake in the body may be optimized by ingesting creatine following a carbohydrate or carbohydrate/protein meal or following exercise when stores have been depleted. The combination of a high carbohydrate meal with supplementation also achieves heightened glycogen stores. Excess supplemented creatine which is not absorbed by the tissues is excreted in the urine.
Safety – The current available evidence suggests that creatine consumption is safe in recommended doses, but safety cannot be guaranteed on all populations or for years of extended use. Use in humans under 18 years of age is not recommended, due mainly to the lack of research. Due to lack of FDA oversight, a product may contain contaminants if not tested for purity.
Dosing Protocols – Most studies demonstrate that a loading phase is effective at maximizing muscle creatine. The loading phase is 20 grams for 5-7 days split into at least 4 daily doses. The maintenance dose is a single dose of 5 grams daily. Another protocol involves no loading phase and recommends 5 grams daily. Most studies show a slower ergogenic effect of about 2 weeks without the loading phase, especially in untrained athletes.
Commercial Forms – The type of creatine mostly used in research to establish safety and efficacy is a micronized creatine monohydrate made by AlzChem in Germany (Creapure). It is 99.9% pure CM and is the gold standard. CM may come from sources in China that have been reported to have numerous contaminants. It is common practice for creatine supplement manufacturers to use evidence from studies conducted on sources such as Creapure to substantiate their claims of the effectiveness of their product. Creatine is also manufactured in salt form: creatine pyruvate, creatine citrate, creatine phosphate and other alternative forms of creatine.
Side Effects – may be alleviated by taking a smaller dose more times throughout the day. Side effects may include:
Weight gain due to water retention or increased lean body mass
Nausea or diarrhea
Dividing the amount taken into smaller doses and taking that throughout the day instead of all at once may help alleviate side effects.
Results of Discontinuation – Studies show participants are sluggish for a week or two when supplementation is discontinued, but the muscle and strength gained is not lost as long as the strength training continues.
Cost – A study conducted on 175 creatine products on the market calculated the price per gram of creatine products. The products that contained only CM had a cost of approximately $0.12 price per gram. Products that were another form of creatine other than CM had a cost of approximately $0.26 price per gram. The alternative forms, on average, cost 116% more than micronized creatine monohydrate.
Summary – Creatine is one of the most well-studied supplements over the last 25 years. Micronized creatine monohydrate is the form that has been most studied. Supplementation has been shown to have positive effects on enhancing strength, muscle mass, power, daily living performance and neurological function. Creatine may increase the body’s creatine stores and provide favorable physiologic adaptations such as glycogen storage, increased plasma volume, and improvements in oxygen consumption. Micronized creatine monohydrate is inexpensive and safe in recommended doses.
Branch J.D., Effect of creatine supplementation on body composition and performance: a meta-analysis. International Journal of Sport Nutrition and Exercise Metabolism. 2003. 13:198-226.
Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition 2012, 9:33. http://www.jissn.com/content/9/1/33.
Escalante G, Gonzalez A, Mart D, Torres M, et al. Analysis of the efficacy, safety, and cost of alternative forms of creatine available for purchase on Amazon.com: are label claims supported by science?. Heliyon 8 (2022) e12113
Jager R, Purpura A, Shao T, Kreider R. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011. 40:1369-1383.
Kreider R, Kalman D, Antonio J, Ziegenfuss T, Wildman R, et al. 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. 2017. 14:18
Sahelian, R 1997. Creatine Nature’s Muscle Builder. Garden City Park, New York. Avery Publishing.
About O2X Specialist Rene Scott:
Rene Scott is an O2X Nutrition Specialist. Dr Scott holds a Doctor of Dental Surgery (DDS) from Texas A&M Dental School, a Doctor of Philosophy (PhD) in Nutrition and Food Science from Texas Woman’s University, and she recently retired from the US Army Reserves as a Colonel with 21 years of service. Dr. Scott also owned her own general dentistry practice for over 25 years. She taught Sports Nutrition at the University of North Texas and she taught undergraduate Food Science at Texas Woman’s University. She deployed twice to Iraq and mobilized in 2020 to Philadelphia in response to the Covid-19 pandemic. COL Scott served as the liaison between the Urban Augmentation Medical Task Force (UAMTF) and the Pennsylvania FEMA, Pennsylvania National Guard, the city of Philadelphia, and the hospitals of Philadelphia. She served as a commander for 6 years and as a brigade operations officer for 4 years.
About O2X Human Performance:
O2X Human Performance provides comprehensive, science-backed programs to hundreds of public safety departments, federal agencies, and the military. O2X works with clients to elevate culture, improve mental and physical wellbeing, support healthy lifestyles, and reduce healthcare costs associated with injuries and illnesses. Driven by results and cutting edge research, O2X programs are designed and delivered by a team of Special Operations veterans, high level athletes, and hundreds of leading experts in their respective fields of human performance.