Creatine – I am the Greatest!
Jose Antonio, PhD, CSCS

So said Cassius Clay, aka Muhammad Ali, about himself of course. Creatine can rightly make the same claim. Why? Because like Bruce Lee, creatine can easily kick very other supplement’s proverbial ass based on safety, efficacy, and science. (1-14)

Performance Boost for Muscle Men
Unless you’ve been handcuffed to a chair and forced to watch re-runs on the View channel, then you probably know that supplementing with creatine can make you bigger and stronger. In a thorough scientific review published in the Journal of Strength and Conditioning, the looked at 22 published studies; the average increase in muscle strength vi following creatine supplementation plus resistance training was 8% greater than the average increase in muscle strength following placebo ingestion during resistance training (20 vs. 12%). Also, the average increase in weightlifting performance (maximal repetitions at a given percent of maximal strength) following creatine supplementation plus resistance training was 14% greater than the average increase in weightlifting performance following placebo ingestion during resistance training (26 vs. 12%). The increase in bench press 1RM ranged from 3 to 45%, and the improvement in weightlifting performance in the bench press ranged from 16 to 43%. So if you want to get stronger and bigger, take creatine.(15)

Creatine as Brain Food!
In one study, scientists tested the hypothesis that oral creatine supplementation 5 grams daily for six weeks would enhance intelligence test scores and working memory performance in 45 young adult, vegetarian subjects in a double-blind, placebo-controlled, cross-over design. And guess what? Creatine supplementation had a significant positive effect on both working memory (backward digit span) and intelligence (Raven's Advanced Progressive Matrices), both tasks that require speed of processing.(16) More recently, scientists found a significant effect of creatine supplementation on mental tasks in the elderly.(17)

Creatine as a health food?
Believe it or not Mr. Ripley, creatine supplementation has clinical benefits. Doctors take note. Creatine supplementation has neuroprotective effects in neurological diseases such as Huntington's disease, Parkinson's disease, or amyotrophic lateral sclerosis.(18) Jeff Stout, Ph.D. of Florida Atlantic University found that 5 grams of creatine supplementation daily coupled with resistance training (3 x per week for 15 weeks) improved physical function in a 26 year old man with myasthenia gravis. This man had a 7% increase in body weight, 4% increase in fat free mass, and improved peak strength up to 37%!(14) Another investigation found that creatine supplementation improves skeletal muscle function in patients with McArdle disease.(19)

Side Bar - Creatine – is it better in meat form?
Red meat and fish contain about 2 to 5 g of creatine per pound. But is the stuff absorbed well? Or is it better to just buy the powder, mix it with juice and swig it like it’s your 10th shot of tequila? Let’s see what the good doctor has to say. Roger Harris, perhaps the pre-eminent scientist in the field of creatine research, compared the effects of consuming 2 grams of creatine in 250-300 ml of cold water versus 2 grams of creatine obtained from 0.9 lbs of meat. They found that the 2 g of creatine in solution caused a quicker and greater rise in blood creatine levels but a quicker drop also. On the other hand, eating meat caused a less dramatic rise but the increase was sustained for a longer period of time. In fact, when they compared the net increase in blood creatine, there was NO difference! Does this mean anything? Well, maybe. The next step is to see if these different absorption patterns result in different uptake into skeletal muscle fibers. I mean let’s face it, who gives a rats ass how much gets into your blood; it needs to get into skeletal muscle! My advice: Eat lean sources of meat frequently and take 1 tsp of creatine daily.Harris RC et al. Absorption of creatine supplied as a drink, in meat, or in solid form. J Sport Sci 2002;20:147-151

Creatine and Parkinsons
Persons with Parkinson disease (PD) exhibit decreased muscular fitness including decreased muscle mass, muscle strength, and increased fatigability. Twenty patients with idiopathic PD were randomized to receive creatine monohydrate supplementation plus resistance training (CRE) or placebo (lactose monohydrate) plus resistance training (PLA), using a double-blind procedure. Creatine and placebo supplementation consisted of 20 g/d for the first 5 days and 5 g/d thereafter. Both groups participated in progressive resistance training (24 sessions, 2 times per week, 1 set of 8-12 repetitions, 9 exercises). They discovered that chest press strength and biceps curl strength improvement was significantly greater for the creatine supplemented group.(21) So for all you knuckleheads who think creatine is so harmful, why in hell would you give it to a PD patient if it were so bad?

Safety data
Short term (5 days), medium term (9 weeks) and long term (up to 5 years) oral creatine supplementation has been studied in small cohorts of athletes whose kidney function was monitored and scientists did not find any adverse effects on renal function.(22)
Richard Kreider, Ph.D. the Editor-in-Chief of the Journal of the International Society of Sports Nutrition completed a study in which he examined, over a 21-month period, 98 Division IA college football players who consumed in an open label manner creatine or non-creatine containing supplements following training sessions. Subjects who ingested creatine were administered 15.75 g/day of creatine monohydrate for five days and an average of 5 g/day thereafter in 5-10 g/day doses. What did he find? Nada darn thing. According to his study, “long-term creatine supplementation (up to 21-months) does not appear to adversely effect markers of health status in athletes undergoing intense training in comparison to athletes who do not take creatine.”(23)

Responders versus Non-Responders
If you go through the scientific literature and talk to athletes, you’ll find that there is a minority of individuals who get no benefit from creatine. That’s not surprising. For instance, no drug works for everyone. Individual responses should be expected. A study examined this very question. This study indicated that there were 3 levels of response to five days of creatine loading: responders, quasi responders, and nonresponders. Responders had the lowest initial levels of creatine and phosphocreatine, greatest percentage of type II fibers or fast twitch fibers, and the greatest preload muscle fiber CSA and fat-free mass. Responders also showed improvement in 1RM leg press scores following the 5-day loading period. NR had higher preload levels of Cr + PCr, less type II or fast twitch muscle fibers, small preload muscle CSA, and lower fat-free mass and had no improvements in 1RM strength scores. Thus, getting an ergogenic effect from creatine favors those with more fast-twitch muscle fibers, muscle mass, muscle fiber size, and have initially lower levels of intramuscular creatine and phosphocreatine.(24)

The Moral of the Story:
- Creatine enhances athletic performance in the strength-power sports.
- Creatine promotes gains in lean body mass and muscle fiber hypertrophy (growth).
- Creatine may help neuromuscular function in those with various metabolic diseases.
- Creatine may improve memory and assist various neural functions.
- Creatine has long-term safety data.
- Creatine works, period.

References
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2. Volek JS, Mazzetti SA, Farquhar WB, Barnes BR, Gomez AL, Kraemer WJ. Physiological responses to short-term exercise in the heat after creatine loading. Med Sci Sports Exerc 2001;33:1101-8.
3. Volek JS, Ratamess NA, Rubin MR, et al. The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching. Eur J Appl Physiol 2003.
4. Tarnopolsky MA. Potential benefits of creatine monohydrate supplementation in the elderly. Curr Opin Clin Nutr Metab Care 2000;3:497-502.
5. Tarnopolsky MA, MacLennan DP. Creatine monohydrate supplementation enhances high-intensity exercise performance in males and females. Int J Sport Nutr Exerc Metab 2000;10:452-63.
6. Tarnopolsky MA, Parise G, Yardley NJ, Ballantyne CS, Olatinji S, Phillips SM. Creatine-dextrose and protein-dextrose induce similar strength gains during training. Med Sci Sports Exerc 2001;33:2044-52.
7. Volek JS, Rawson ES. Scientific basis and practical aspects of creatine supplementation for athletes. Nutrition 2004;20:609-14.
8. Volek JS, Ratamess NA, Rubin MR, et al. The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching. Eur J Appl Physiol 2004;91:628-37.
9. Volek JS, Duncan ND, Mazzetti SA, et al. Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc 1999;31:1147-56.
10. Willoughby DS, Rosene J. Effects of oral creatine and resistance training on myosin heavy chain expression. Med Sci Sports Exerc 2001;33:1674-81.
11. Willoughby DS, Rosene JM. Effects of oral creatine and resistance training on myogenic regulatory factor expression. Med Sci Sports Exerc 2003;35:923-9.
12. Ziegenfuss TN, Rogers M, Lowery L, et al. Effect of creatine loading on anaerobic performance and skeletal muscle volume in NCAA Division I athletes. Nutrition 2002;18:397-402.
13. Stout J, Eckerson J, Ebersole K, et al. Effect of creatine loading on neuromuscular fatigue threshold. J Appl Physiol 2000;88:109-12.
14. Stout JR, Eckerson JM, May E, Coulter C, Bradley-Popovich GE. Effects of resistance exercise and creatine supplementation on myasthenia gravis: a case study. Med Sci Sports Exerc 2001;33:869-72.
15. Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res 2003;17:822-31.
16. Powers ME, Arnold BL, Weltman AL, et al. Creatine Supplementation Increases Total Body Water Without Altering Fluid Distribution. J Athl Train 2003;38:44-50.
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18. Wyss M, Schulze A. Health implications of creatine: can oral creatine supplementation protect against neurological and atherosclerotic disease? Neuroscience 2002;112:243-60.
19. Vorgerd M, Grehl T, Jager M, et al. Creatine therapy in myophosphorylase deficiency (McArdle disease): a placebo-controlled crossover trial. Arch Neurol 2000;57:956-63.
20. Harris RC et al. Absorption of creatine supplied as a drink, in meat, or in solid form. J Sport Sci 2002`;20:147-151
21. Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair 2007;21:107-15.
22. Poortmans JR, Francaux M. Adverse effects of creatine supplementation: fact or fiction? Sports Med 2000;30:155-70.
23. Kreider RB, Melton C, Rasmussen CJ, et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem 2003;244:95-104.
24. Syrotuik DG, Game AB, Gillies EM, Bell GJ. Effects of creatine monohydrate supplementation during combined strength and high intensity rowing training on performance. Can J Appl Physiol 2001;26:527-42.

 

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