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Creatine Supplementation: What do you need to know?

nutrition Jan 13, 2021
Creatine Supplementation.
Creatine supplementation is widely practiced among athletes both professional and those of the amateur realm.  Creatine is also one of the most tested supplements in the world and offers a strong body of evidence for its efficacy, safety, and application of use.  There are different forms of creatine, however creatine monohydrate is the most tested and most common.
What is creatine?
Supplemental creatine enhances your body’s phospho-creatine stores as part of an energy system responsible for explosive energy for efforts under 10 seconds.  Increasing the availability of creatine will improve performance in explosive sports and activities, in addition to faster regulation of adenosine triphosphate (energy) between high intensity exercises.
Creatine supplementation provides a plethora of benefits to the human body not limited to sporting performance, with proven benefits in performance during sleep deprivation and management of the effects of age induced sarcopenia (involuntary reduction of muscle mass and strength through age).
How Much?
Most creatine supplementation regimens consist of a loading and maintenance phase, where creatine if supplemented in higher doses (20-30g) for 5-7 days, followed by a lower (5g) maintenance phase of several weeks.  Supplementation with creatine has regularly shown to increase strength, fat free mass, and muscle mass with concurrent heavy resistance training more than resistance training alone [1].  There are also benefits to foregoing the loading phase and subsequent creatine ‘breaks’ and maintaining a 5g/day dose for those outside of a competitive sporting arena.
Brain Function.
Interestingly, in studies that have monitored the effects of sleep deprivation, creatine has also played a positive role in cognitive performance. Sleep deprivation has a negative effect on cognitive performance and mood state, in a study focusing on the effects of brain creatine levels, it was concluded that following 24-h sleep deprivation, creatine supplementation had a positive effect on mood state and tasks that place a heavy stress on the prefrontal cortex [2].
Similarly, in a systematic review of randomized control studies focusing on oral creatine supplementation in healthy individuals, it was concluded that oral creatine administration may improve short-term memory and intelligence/reasoning of healthy individuals [3].  It is important to note here that there is limited research on the effects of creatine on the wider range of neurodegenerative diseases and cognitive disorders, but this is an exciting development open to vast further explorations.  The underlying theme here is that creatine is indeed safe and has been shown to improve cognitive and physical performance.
Aging Populations.
One area in which creatine has a number of positive benefits in the control of symptoms of age induced sarcopenia.  Defined as a progressive and generalised skeletal muscle condition that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability, and mortality, age related sarcopenia is a condition that effects up to 13% of those aged 50-60 years and up to 50% of those aged 70+ [4].  Creatine is not the sole contributor to these positive effects, and it should be noted here that regular exercise is the primary intervention to reverse such effects, but when combined with creatine ingestion increases the muscles ability to work at higher intensities, assisting in the higher levels of anabolic resistance in aging muscles.
Age related sarcopenia is something that should be tackled on multiple fronts and this blog does not aim to suggest creatine alone is the answer.  However, increased resistance exercise, increased dietary protein and the supplement of creatine monohydrate will work together to compound significant benefits.
Who is it for?
Strength athletes:  If you are partaking in regular strength and power exercises, you are likely to benefit from the supplementation of creatine monohydrate due to its effect on maximal strength performance, glycogen sparing capacity and lean muscle mass development.
Aging populations:  Creatine supplementation along with increased protein and resistance exercise is proven to help manage the symptoms of age related sarcopenia.
Physically active and mentally taxed:  Although a broad spectrum, but if you are in a mentally demanding job and also partake in regular exercise (as should be the lifelong prescription to all), then you are likely to benefit from the neurological benefits of creatine and working memory and intelligence [5].
Shift workers:  Creatine's benefits on cognitive ability and sleep deprivation make this an ideal supplement for those on shift patterns that impact circadian rhythms [6].
Vegetarians and vegans:  Those who choose to consume a diet devoid of animal proteins are likely to benefit significantly from a creatine supplementation. Naturally occurring dietary creatine is largely found in animal products, therefore there is an increased risk of deficiency than in those on a completely plant based or vegetation diet.  It is not currently known whether brain creatine levels are lower in vegetarian subjects than omnivores [7], however, it is known that plasma levels are lower in vegetarians, but creatine supplementation of vegetarians has been shown to produce similar increases in muscle performance to that seen in omnivores.
Endurance athletes?  Endurance athletes and creatine supplementation raises certain questions and contrarian studies. Creatine supplementation has been shown to improve endurance capacity in terms of lactate threshold [8], equally, there are studies that suggest that endurance time to exhaustion is not affected by creatine supplementation, including that taken during exercise [9]. 
As such there is room for particular interpretation and an analysis of individual training stressors, goals, and requirements.  Endurance training in the sense of 10km to half marathon where the intensity is usually higher than that of a marathon or longer distance events, are likely to benefit for the lactate threshold improving characteristics of creatine supplementation [10].
With longer events, there is no significant effect of creatine on time to exhaustion and therefore suggests that the positive effects of creatine are not seen in longer endurance events such as that of a marathon or ultra-distance.  In addition, there is so the added consideration that creatine commonly leads to water retention and subsequent weight gain.  Initial weight gain of ~1-1.5kg is common in most individuals, sometimes increasing to ~3kg over a longer term and must be stressed as not the result of fat mass gain, but water retention.  In the most part, this will make you look leaner and result in a greater ‘pump’.  These are potentially detrimental to those in longer endurance events whereby extra weight is a negative factor.
In terms of the endurance athlete, there are factors to be considered with intervention and one blanket recommendation is not optimal for all.  If the intensity is higher in the chosen endurance exercise such as a 10km race or elite half marathon, whereby the athlete is exercising at or close to the lactate threshold, creatine is likely to be beneficial.  For those participating in longer events or at a lower intensity, it is likely that creatine could be foregone.  Considerations such as the age of the athlete (considering age related sarcopenia), the current weight of the athlete (creatine can add water retention weight) and the requirement of the sport (making weight or weight categorised) need to be explored.
Creatine monohydrate is clearly a very beneficial supplement for certain populations, but this does not necessarily mean that it is a blanket recommendation for everyone.  As we have covered above, there are certain areas in which supplementation could be questioned and there are other circumstances where it simply isn’t necessary.  Ultimately as with any nutritional intervention, a healthy balanced diet should be the foundation.  We are in a society of supplementation and hyper doses as the answer to our issues, when in reality we could be simply creating expensive urine or masking the underlying issue.  Supplements are exactly that, supplemental to a healthy. Balanced diet with plenty of variety.
Aging populations, shift workers, strength athletes or those participating in high intensity activities may benefit from such supplementation, as well as those who are trying to remain highly active daily (12k steps, 3-5 gym sessions per week etc) while balancing a mentally taxing job.
As with all nutritional interventions, 1:1 consideration is critical, everyone reacts differently, has different circumstances, and demands a personalised approach, but the guidelines are there from the research to help us understand our requirements.
As ever, evidence forms the principles and experience denotes the methodology.


[1] Butts, Jessica et al. “Creatine Use in Sports.” Sports health vol. 10,1 (2018): 31-34. doi:10.1177/1941738117737248

[2] McMorris, T et al. “Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisol.” Psychopharmacology vol. 185,1 (2006): 93-103. doi:10.1007/s00213-005-0269-z

[3] Avgerinos, Konstantinos I et al. “Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials.” Experimental gerontology vol. 108 (2018): 166-173. doi:10.1016/j.exger.2018.04.013

[4] Abellan van Kan, G. “Epidemiology and consequences of sarcopenia.” The journal of nutrition, health & aging vol. 13,8 (2009): 708-12. doi:10.1007/s12603-009-0201-z

[5] [6] Avgerinos, Konstantinos I et al. “Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials.” Experimental gerontology vol. 108 (2018): 166-173. doi:10.1016/j.exger.2018.04.013

[7] Rae, Caroline et al. “Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial.” Proceedings. Biological sciences vol. 270,1529 (2003): 2147-50. doi:10.1098/rspb.2003.2492

[8] Chwalbiñska-Moneta, Jolanta. “Effect of creatine supplementation on aerobic performance and anaerobic capacity in elite rowers in the course of endurance training.” International journal of sport nutrition and exercise metabolism vol. 13,2 (2003): 173-83. doi:10.1123/ijsnem.13.2.173

[9] Vandebuerie, F et al. “Effect of creatine loading on endurance capacity and sprint power in cyclists.” International journal of sports medicine vol. 19,7 (1998): 490-5. doi:10.1055/s-2007-971950

[10] Mielgo-Ayuso, Juan et al. “Effects of Creatine Supplementation on Athletic Performance in Soccer Players: A Systematic Review and Meta-Analysis.” Nutrients vol. 11,4 757. 31 Mar. 2019, doi:10.3390/nu11040757