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Frequently Asked Questions About Creatine

1. What is creatine?

Creatine

Creatine is something that the body normally contains. The body either produces it naturally or it is obtained directly from the foods we eat. On average the body goes through about 2 grams of creatine each day.

Most of our body’s creatine is contained within skeletal muscle, although some is also present in the heart, brain and testes. Following ingestion (or synthesis) creatine is transported into our muscles where it serves to increase muscle energy levels. Creatine achieves this by increasing the availability of ATP, the cell’s energy molecule.

Recently it has become popular to supplement one’s diet with synthetically produced creatine in hopes of enhancing athletic performance. Synthetic creatine is sold as citrate, phosphate or monohydrate salts. Creatine monohydrate is the most commonly used form in athletics and is nothing more than a molecule of creatine accompanied by a molecule of water. A gram of creatine monohydrate contains more creatine than a gram of either creatine citrate or a gram of creatine phosphate.

We typically notice an improvement in exercise performance when our muscle creatine levels increase by at least 20% as a result of creatine supplementation.

2. How does creatine work?

Simply speaking, creatine increases the energy content of muscle cells. Creatine does this by increasing the availability of ATP, the energy currency of cells. Since our strength depends on how quickly ATP can be made available during exercise, creatine supplementation increases our strength.

3. How can I get creatine naturally?

In one form or another, creatine is normally obtained from the foods we eat.

Dietary Creatine: Creatine can be directly obtained by eating sources of skeletal muscle, i.e. meat and fish. During the digestive process the creatine contained within meat and fish is directly released into the blood stream where it is transported to skeletal muscle. For reference, approximately 2-3 pounds of raw meat or fish contain the equivalent of 5 grams of pure creatine monohydrate powder. Since heat degrades creatine, however, cooking reduces the creatine content of meat and fish. Therefore, you’ll need to eat more cooked meat to get the same amount of creatine as from uncooked sources.

Creatine Synthesis: When dietary creatine intake doesn’t meet the body’s needs, new creatine can also be synthesized from three amino acids; arginine, glycine and methionine. These amino acids are made available during the digestion of foods. Importantly, methionine availability sets an upper limit on creatine synthesis, since the body cannot produce it on its own. Methionine must, therefore, be provided in our diets. Since fish is one of the richest natural sources of methionine, eating fish provides both a direct source of creatine as well as an adequate supply of dietary methionine for new creatine synthesis.

Vegetarians: Vegetarians, whose animal protein intake is low, typically express lower than “normal” creatine levels, Creatine might therefore be advisable for athletes who purposefully restrict their animal protein intake.

4. How does creatine get into muscle?

From the blood creatine is transported into skeletal muscle by special transporter molecules on the muscle surface. The activity of these creatine transporters is influenced by the availability of creatine. For example, elevated plasma creatine interrupts creatine uptake into skeletal muscle via these transporters. The new production of creatine from amino acids is also stopped by elevated plasma creatine. These are examples of normal feedback regulatory processes that are common in biology. However, how exogenous creatine supplementation influences these processes in humans is still an open issue. This is why it is often recommended to periodically stop taking creatine to let the body recuperate. Other physiological processes also regulate transporter function.

For example, creatine transporter activity is enhanced by co-ingestion of highly glycolic foods, an effect mediated by insulin release. Therefore, taking measures to improve one’s insulin sensitivity should enhance creatine uptake into skeletal muscle.

5. Do all muscles respond the same to creatine?

Not all muscle types respond equally to creatine supplementation. Muscles can be loosely described as either fast or slow. As the name implies, fast muscle fibers mediate abrupt movements. Fast muscle fibers are also those that predominantly use creatine energy production. Hence, explosive movements respond best to creatine supplementation.

Slow muscle fibers, on the other hand, do not rely that heavily on creatine energy production. Slow muscle fibers are also those that play an important role during endurance exercise. It follows that endurance tasks are influenced less by creatine supplementation. In addition, many endurance sports may be adversely affected by the increase in weight associated with creatine supplementation.

6. Does everyone respond to creatine?

Not everyone responds to creatine supplementation. It is estimated that 20-30% of the population are nonresponsive to creatine use. This isn’t to say that many “nonresponders” couldn’t convert to “responders” given the right circumstances. Taking creatine with highly glycemic sugars helps in many instances.

It is also important to note that persons with naturally high creatine levels typically benefit less from creatine supplementation. Furthermore, the benefits you perceive from creatine use depend on the exercise task being used to measure its effectiveness. There is also some indication that creatine may be less effective in children and the elderly.

Finally, simple, every day, dietary habits, such as alcohol and caffeine consumption, can profoundly influence creatine’s effectiveness.

7. How much creatine and when should I take it?

First of all, do not over supplement!

Secondly, no single creatine dose is right for everyone. The creatine dose you choose depends on your weight; percent body fat, fitness goals, and the type and intensity of training.

Finally, as of yet, creatine doses have not been independently optimized for women, should this be necessary. Typical doses for pure creatine monohydrate cited in scientific studies range between 2-25 grams per day for an average sized male (70 kilograms/154 pounds). If, however, your particular creatine product contains additives, the recommended serving size would be accordingly greater. Read the label carefully.

As far as creatine is concerned, more isn’t necessarily better. The actual amount of creatine monohydrate taken in a single day should not exceed 25 grams for an average framed male. Creatine supplementation is typically divided into three stages, loading, maintenance and washout. These are described in more detail below.

Loading: For the first few days of supplementation take no more than 0.3 grams of creatine per kilogram (2.2 pounds) of body weight. Divide this amount into four equal parts. Take one part every four hours. This is known as the loading phase. Loading for more than five days consecutively is most likely a waste of creatine and cash!

Maintenance: Afterwards, the creatine dose can be reduced to just a few grams (0.03grams/kilogram body weight) a day for no longer than one month. This is known as the maintenance phase. The maintenance amount just needs to replace the amount of creatine degraded on a daily basis.

Dose: Translating these formulas into practical terms: a 154 pound person would take 21 grams of creatine per day during the loading phase and 2 grams per day during the maintenance phase. [Refer to Table (below)]


Creatine Dose
(/day)

Weight


Pounds

100

110

120

130

140

150

160

170

180

190

200


Kilograms

45.4

50.0

54.5

59.0

63.6

68.2

72.7

77.2

81.8

86.3

90.9

 


Dose
(approximate grams)


Loading

14

15

16

18

19

20

22

23

25

26

27


Maintenance

1.4

1.5

1.6

1.8

1.9

2.0

2.2

2.3

2.5

2.6

2.7

 

Below your weight is your corresponding creatine dose

When to Supplement: The best time to supplement is immediately after your workout. This is when the metabolic state of your muscles is most receptive to absorbing creatine from the blood.

Wash out: Following the loading and maintenance phases, a washout period is advised. Such a lay off period allows the body to recover from abnormally high creatine levels that it normally wouldn’t encounter. One month is typically advised for complete wash out.

Periodize: The cycling between loading, maintenance, wash out and subsequent loading has been termed periodizing in the fitness literature.

Is Loading Necessary? A loading phase may not be absolutely required. As little as 3 grams of creatine a day for a few weeks has been shown to increase muscle creatine levels sufficiently to detect a difference in physical performance.

8. How does creatine cause muscle growth?

Creatine may enhance muscle growth through two possible mechanism. These are outlined below.

Muscle Volumizing: The first involves the movement of fluids from the blood stream into skeletal muscle, causing our muscles to swell. This process has been termed volumizing in the scientific literature. This phase of muscle growth can account for as much as 1-2 kilograms of additional body mass within the first few weeks of supplementation.

Protein Synthesis: The second form of muscle growth involves creatine’s ability to increase exercise capacity. Since creatine allows us to exercise more intensely, it should be possible to develop muscle mass more rapidly.

Furthermore, some studies also suggest that muscle volumizing per se stimulates muscle protein synthesis.

9. Is it necessary to continue taking creatine to stay strong?

Unfortunately, some of your gains in strength will disappear after you stop taking creatine. This is inevitable and will take about one month. This is the time it takes for your muscle creatine levels to return to normal. However, since creatine supplementation allows one to exercise harder, which is the best stimulus for muscle growth, some gains in strength may persist after stopping creatine. In support of this notion, biochemical indicators of protein synthesis increase in response to creatine use, possibly indicating more muscle proteins are being produced.

However, there is no magic pill for building muscle. Even if supplementing with creatine, your muscles won’t grow without proper nutrition and sensible exercise.

10. Is creatine safe for women, children, the pregnant or the elderly?

Children: Since the long-term consequences of creatine supplementation are not well understood, it is best to avoid supplementation during childhood.

Elderly: Interestingly, this same panel of experts also deduced that creatine may be less effective in the elderly (greater than 70 years of age). Changes in muscle fiber composition, total muscle mass, or hormone levels may underlie these changes in creatine-sensitivity in the elderly.

Women: The vast majority of creatine studies have been conducted on males between the ages of 18 and 35 years old. Nevertheless, a few studies have also demonstrated enhanced exercise performance in women, which actually makes sense since creatine’s basic mechanism of action wouldn’t be expected to differ in women. Nevertheless, differences do exist in how creatine benefits men and women.

Pregnancy: It is not known whether creatine levels increase in breast milk during supplementation. Therefore, for precautionary reasons women nursing infants should abstain from creatine use.

11. Creatine side effects?

Numerous side effects have been reported. While some side effects have been substantiated by scientific investigation, others have not. Most of the accepted side effects associated with creatine use have to do with its propensity to draw water into the body compartments where it is located.

It is thus very important to remain well hydrated while taking creatine. Drink at least 1-2 ounces of water daily per kilogram of body weight while supplementing.

Volumizing: Weight gain is the most widely accepted side effect attributed to creatine use. As much as 3 kilograms (6.6 pounds) of added body weight have been reported during the first weeks of supplementation and is mainly due to the movement of water from the blood into skeletal muscle. This form of muscle growth has also been termed Volumizing because of the increase in muscle volume that ensues.

Dehydration: Again, it’s imperative to remain well-hydrated while taking creatine. This concern is valid since much of our body water follows creatine into skeletal muscle, possibly depriving our remaining tissues of much needed fluid, especially during intense exercise. Down the road this may lead to impaired thermoregulation and subsequent heat exhaustion, especially if training heavily in hot environments. This precaution is especially important in combative sports (in particular, wrestling) where athletes strive to make weight before competition. Weight loss under these circumstances is often achieved through fluid restriction that, in combination with creatine use, could lead to excessive dehydration.

Gastrointestinal Distress: Reports of gastrointestinal distress, stomach cramps, nausea and diarrhea have also been attributed to creatine use, especially when taken in large doses. These side effects are most likely due to undissolved creatine drawing water into the intestine and can often be circumvented by completely dissolving creatine in at least 16 ounces of water or juice. The large amounts of sugars often taken with creatine may also complicate gastric emptying.

Muscle strains, cramps and tears: There have been reports of muscle pulls, strains and cramps following creatine use. These injuries may be related to an electrolyte imbalance as a result of dehydration. Drink plenty of fluids while taking creatine!

Renal Stress: There is also some concern that creatine supplementation may place undue stress on the kidneys. These concerns are most valid during the loading phase when large quantities of creatine are taken. During loading the kidneys must work harder to clear unabsorbed creatine from the blood stream. Persons with pre-existing kidney disorders should abstain from creatine use.

Blood Pressure: There was some concern that creatine-induced fluid retention could increase a person’s blood pressure. This was the topic of a recent scientific study demonstrating that acute creatine use does not alter blood pressure.

Cholesterol and Protein Synthesis: Not all of creatine’s reputed side effects are detrimental. For example, creatine use may improve our cholesterol levels. In addition, muscle volumizing may directly stimulate the production of new muscle proteins. Both these effects, however, need to be further substantiated by additional scientific research.

Rumors: There are many misconceptions and rumors surrounding creatine use. Most of these stem from creatine being wrongly associated with steroid means of increasing muscle mass. These unsubstantiated side effects include breast formation in men (gynecomastia), a reduction in penis size, hair loss (men), hair growth (women) and stunted growth in children. Unexplained incidences of aggression and acne have also been linked to creatine use.

Misconceptions: Oh, Fat is Fat and Muscle is Muscle, “and never the twain shall meet”. Muscle does not convert to fat after stopping creatine supplementation; it can’t. Remember, our muscles grow with creatine as a result of muscle volumizing and possibly by increased protein synthesis. After stopping creatine supplementation some of the gains obtained in size and strength will be lost. This is unavoidable. However, the only way you can create more fat is to take in more calories than you burn with exercise.

12. Long term consequences of creatine use?

Creatine use in athletics is a relatively recent practice. As a consequence its long-term consequences aren’t sufficiently understood. Some of creatine’s alleged side effects, however, may have long-term ramifications, especially at the high doses typically prescribed for athletic purposes. For example, the time required for transporter function to fully recover after prolonged exposure to elevated creatine levels is simply not known for humans. This is why it’s not advised for children and pregnant women to use creatine.

Clinical situations, however, do exist where low doses of creatine have been used for several years with no signs of adverse side effects. For example, Gyrate Atrophy is a disease of the eye (retina) that is characterized by progressive narrowing of the visual fields. A secondary component of the disease is a deficiency in creatine synthesis. Consequently, this disease is also characterized by a reduction in the size of fast muscle fibers.

Creatine supplementation has been shown to alleviate the muscular symptoms associated with this disease although the visual symptoms persist. Other than mild weight gain, low doses of creatine (1.5 grams/day) when administered for the duration of several years produced no obvious adverse effects.

13. Does creatine cause cancer?

Recently there has been a lot of talk about creatine causing cancer. This concern initially arose from the fact that certain carcinogenic agents are produced in meats at high temperatures. Meats with higher creatine content produce more of these cancer causing agents when cooked. The French agency, AFSSA, thusly alleged that creatine supplementation, since it increases our muscle creatine content, increases our chances of developing cancer.

It still remains, however, to be clearly demonstrated that these same cancer causing agents are produced within the human body. In other words, in a person that isn’t cooked!

14. Can creatine help those with Muscular Dystrophy?

Creatine has been used in clinical trials for several classes of neuromuscular disorder. Although not a cure per se, creatine supplementation may improve the quality of life of those inflicted with these disorders. In fact, preliminary studies have demonstrated that creatine supplementation improves strength in patients with several classes of neuromuscular disorder.

Creatine has also been used postoperatively on patients recovering from orthopedic surgery.

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