Creatine: (Everything You Need To Know)

[BurnabyRenos]

Creatine baby!! Its 2020, should be no debate on this.

[BoreDefer]

Various brands use Creapure. Barring some kind of mixed formula, does that mean that each of these brands is selling the exact same creatine, and the only difference is in labeling/cost?

[kimimissy]

Thank you for this and the other stickies on this information, taking it all in before asking dumb questions! Well written and informative!

[WillBrink]

Various brands use Creapure. Barring some kind of mixed formula, does that mean that each of these brands is selling the exact same creatine, and the only difference is in labeling/cost?

If it says Creapure as the source, then yes, they're all selling the same creatine produced in Germany. If not, then various Chinese manufacturers ranging from good to not so good...

[Cristian000]

Hello,

I have been taking creatine(creapure) for almost 6 months now. 3 grams a day without a loading period.
Is it safe for me to keep taking it? Should i go without it for a while?



Thank you

[Corbets]

Hello,

I have been taking creatine(creapure) for almost 6 months now. 3 grams a day without a loading period.
Is it safe for me to keep taking it? Should i go without it for a while?



Thank you

Your answer is at the start of this very thread.

[WillBrink]

Hello,

I have been taking creatine(creapure) for almost 6 months now. 3 grams a day without a loading period.
Is it safe for me to keep taking it? Should i go without it for a while?



Thank you

Read OP...

[WillBrink]

Bit of a "no duh" review and finding at this point, but amazing as it is, there's still people - some educated enough to know better - that claim creatine is dangerous in 2020. This review looks specifically at women:

Risk of Adverse Outcomes in Females Taking Oral Creatine Monohydrate: A Systematic Review and Meta-Analysis

Abstract

Creatine Monohydrate (CrM) is a dietary supplement routinely used as an ergogenic aid for sport and training, and as a potential therapeutic aid to augment different disease processes. Despite its increased use in recent years, studies reporting potential adverse outcomes of CrM have been mostly derived from male or mixed sex populations.

A systematic search was conducted, which included female participants on CrM, where adverse outcomes were reported, with meta-analysis performed where appropriate. Six hundred and fifty-six studies were identified where creatine supplementation was the primary intervention; fifty-eight were female only studies (9%). Twenty-nine studies monitored for adverse outcomes, with 951 participants. There were no deaths or serious adverse outcomes reported. There were no significant differences in total adverse events, (risk ratio (RR) 1.24 (95% CI 0.51, 2.98)), gastrointestinal events, (RR 1.09 (95% CI 0.53, 2.24)), or weight gain, (mean difference (MD) 1.24 kg pre-intervention, (95% CI −0.34, 2.82)) to 1.37 kg post-intervention (95% CI −0.50, 3.23)), in CrM supplemented females, when stratified by dosing regimen and subject to meta-analysis.

No statistically significant difference was reported in measures of renal or hepatic function.

In conclusion, mortality and serious adverse events are not associated with CrM supplementation in females. Nor does the use of creatine supplementation increase the risk of total adverse outcomes, weight gain or renal and hepatic complications in females. However, all future studies of creatine supplementation in females should consider surveillance and comprehensive reporting of adverse outcomes to better inform participants and health professionals involved in future trials.


https://www.mdpi.com/2072-6643/12/6/1780

[WillBrink]

Creatine Safety Study:

Already well established, so file under "no duh" but there's still those who think creatine "gonna make your kidneys fall out" so:

Creatine Supplementation Improves Performance, but Is It Safe? Double-blind Placebo-Controlled Study

J Sports Med Phys Fitness. 2020 Jul;60(7):1034-1039.

Abstract

Background: Creatine represents a natural supplement and ergogenic aid for sport performance, but there are several concerns regarding its safety for health. The present double-blind placebo-controlled study evaluated the effect of creatine monohydrate supplementation on a panel of blood and urine health indicators in resistance training practitioners.

Methods: Eighteen males performing resistance training three times per week were supplemented with 0.3 g/kg per day creatine monohydrate for 7 days and compared with matched controls supplemented with dextrosol. Blood and urine samples were collected pre- and 30 days post-supplementation to evaluate 41 biochemical parameters and renal function.

Results: Creatine monohydrate supplementation did not cause adverse events and, as expected, promoted an increase of the performance and body weight. No modification of red blood cells parameters, white blood cells profile, blood lipid profile, metabolic and urine markers, hepatic and renal function were observed in the supplemented group.

Conclusions: Despite the expected weight increase, the creatine monohydrate supplementation is safe for health and no detrimental effects on different organs and physiological systems were observed in our cohort of volunteers.

https://pubmed.ncbi.nlm.nih.gov/32597619/

[WillBrink]

This is a potentially ground break paper. It's very dense paper if you can get your hands on a copy. Creatine has a long list of potential benefits, and much of that only just being recognized and researched:

Creatine metabolism: energy homeostasis, immunity and cancer biology

Lawrence Kazak & Paul Cohen

Nature Reviews Endocrinology volume 16, pages421–436(2020)

Abstract

Perturbations in metabolic processes are associated with diseases such as obesity, type 2 diabetes mellitus, certain infections and some cancers. A resurgence of interest in creatine biology is developing, with new insights into a diverse set of regulatory functions for creatine. This resurgence is primarily driven by technological advances in genetic engineering and metabolism as well as by the realization that this metabolite has key roles in cells beyond the muscle and brain.

Herein, we highlight the latest advances in creatine biology in tissues and cell types that have historically received little attention in the field. In adipose tissue, creatine controls thermogenic respiration and loss of this metabolite impairs whole-body energy expenditure, leading to obesity. We also cover the various roles that creatine metabolism has in cancer cell survival and the function of the immune system. Renewed interest in this area has begun to showcase the therapeutic potential that lies in understanding how changes in creatine metabolism lead to metabolic disease.

Key points

Mitochondria in brown adipose tissue are capable of normal oxidative phosphorylation, with P:O ratios similar to those of other tissues.

Atypical actions of creatine involve phosphocreatine transport into colorectal cancer cells, super-stoichiometric ADP liberation to trigger respiration in thermogenic adipocytes and chromatin remodelling to modulate macro****e polarity.

Cyclocreatine and creatine can both inhibit tumour progression, suggesting that the pro-cancer role of creatine is independent of its function in energy buffering.

The mitochondrial network transduces energy over long distances, thus minimizing the requirement for metabolite diffusion, whereas cells with a disrupted mitochondrial network might buffer energy via the creatine kinase–phosphocreatine circuit.

Source:

https://www.nature.com/articles/s41574-020-0365-5

[WillBrink]

An interesting study. I was most interested and impressed by the biomarkers in stress-induced depression that were tested vs their only doing behavioral testing. As creatine has good data as having beneficial effects on mood, It’s unclear what additive effects the taurine had, but it makes sense taurine would be beneficial:

Creatine and taurine mixtures alleviate depressive-like behaviour in Drosophila melanogaster and mice via regulating Akt and ERK/BDNF pathways
Scientific Reports 2020 July 9, 10 (1): 11370

We investigated the antidepressant effect of creatine (CRE) and taurine (TAU) mixtures on behavioural changes and biomarkers in stress-induced depression in Drosophila melanogaster and a mouse model. Following CRE/TAU mixture administration in the Drosophila model, depression-like state induced by vibration, locomotion, climbing activity, and survival rate were measured. The normal stress (NS) group demonstrated decreased movement than the control (CON) group; movements in the CRE/TAU-treated group (particularly 0.15/0.5%) returned to the CON levels.

Antidepressant effects of CRE/TAU mixtures were confirmed in a depressive mouse model induced by chronic mild stress. In behavioural assessments, movement and sucrose preference of the CRE/TAU group increased to a similar level as in the positive control group; hippocampal catecholamine and serotonin levels increased significantly. Stress-related hormones (adrenocorticotropic and corticotropin-releasing hormones) and inflammatory factors (IL-1β, IL-6, and TNF-α) increased in the NS group but significantly decreased in the CRE/TAU-treated group. Brain signalling protein expression ratio of phosphorylated protein kinase B (p-Akt)/Akt, phosphorylated extracellular signal-regulated kinase (p-ERK)/ERK, and brain-derived neurotrophic factor (BDNF) significantly increased in the CRE/TAU-treated group. These results indicate that CRE/TAU-induced antidepressant effects are associated with increased behavioural patterns and downregulation of stress hormones and cytokines, mediated through Akt and ERK/BDNF pathways in vertebrate models.

https://read.qxmd.com/read/32647316/...-bdnf-pathways

PS, I have updated my creatine and depression review with the above study:

https://brinkzone.com/creatine-and-depression-review/

[WillBrink]

First thought is, why? Creatine is effective, safe, and cheap orally. Two, why? Three, I'm very skeptical that a physiological relevant dose is transported topically. I have not read the full paper however. This one does not pass the smell test for me and I have a pretty good sense of smell on such things at this point:

Repeated Application of a Novel Creatine Cream Improves Muscular Peak and Average Power in Male Subjects

Journal of Strength and Conditioning Research: July 16, 2020

Abstract

Repeated application of a novel creatine cream improves muscular peak and average power in male subjects. J Strength Cond Res XX(X): 000–000, 2020—Using a multicenter, randomized controlled trial, (N = 123, age 23 ± 4 years) we sought to determine whether administration of a novel, topical creatine supplement could improve muscular performance after acute and repeated (7-day) exposure.

To study the acute performance enhancing effects of the supplement, subjects completed 5 sets of 15 maximal concentric single-leg knee extensions with and without the application of a low- (low dose [LD]-3.5 ml) or high-dose (high dose [HD]-7 ml) topical creatine cream. After a wash-out period, subjects had one leg randomized to receive either the creatine or placebo cream, with further randomization into an oral creatine or placebo supplement group.

Subjects completed 5 sets of 15 maximal concentric single leg knee extensions before and after the supplementation protocol. After acute application, no significant differences in peak power (LD: 252 ± 93 W, HD: 261 ± 100 W, p = 0.21), average power (LD: 172 ± 65 W, HD: 177 ± 69 W, p = 0.78), or fatigue index (LD: 13.4 ± 10.6%, HD: 14 ± 11.9%, p = 0.79) were observed between experimental and placebo creams (peak power: LD: 244 ± 76 W, HD: 267 ± 109 W; average power: LD: 168 ± 57 W, HD: 177 ± 67 W; fatigue index: LD: 12.4 ± 9.6%, HD: 12.8 ± 10.6%) or when controlling for sex.

After the 7-day supplementation protocol, a significant increase in average power (creatine: 203 ± 61–220 ± 65 W, placebo: 224 ± 61–214 ± 61 W) and peak power (creatine: 264 ± 73–281 ± 80 W, placebo: 286 ± 79–271 ± 73 W) in the leg receiving creatine cream was observed in male subjects.

No differences were observed in female subjects. The topical creatine cream did not enhance measures of muscle performance after acute application, but was able to improve peak and average power in male subjects after 7 consecutive days of application.


https://journals.lww.com/nsca-jscr/A...eam.94302.aspx

[WillBrink]

Here's my short write up on the International Society of Sports Nutrition (ISSN) conference I just attended in Daytona Beach FL. There's several studies on creatine I posted poster sessions from:

https://brinkzone.com/2020-issn-conference-report/

[WillBrink]

This is actually not the first study to find this:

Semen Creatine and Creatine Kinase Activity as an Indicator of Sperm Quality

Clin Lab. 2020 Sep 1;66(9).

Abstract

Background: The role of creatine (Cr) and creatine kinase (CK) in sperm function remains unclear. The study aimed to assess Cr and CK in seminal plasma and test their association with sperm characteristics.

Methods: The study included 62 males with couple's infertility and 26 males who have already fathered children. Semen Cr and CK were assessed by GC-MS and spectrophotometry, respectively. Seminogram parameters were analyzed using conventional methods.

Results: Cytomorphologic analysis of sperm showed normozoospermia in 53 men (NS) and an asthenozoospermia (AS) in 35 men. Semen Cr was high with no significant difference between the two groups (791 ± 342 and 744 ± 422 µmol/L, respectively). However, semen CK activity was higher in AS group (1,360 ± 1,050 vs. 830 ± 580 U/L, p = 0.013). Semen Cr was positively related to progressive motility (r = 0.284; p = 0.010). Semen CK was negatively correlated with sperm concentration (r = -0.29; p = 0.01), progressive motility (r = -0.26; p = 0.03), and the percentage of abnormal spermatozoa (r = -0.28; p = 0.02).

Conclusions: Semen contains high amounts of Cr and increased CK activity. Low semen Cr is associated with reduced sperm motility while high CK activity is associated with poor sperm quality. The findings suggest that Cr is of importance for sperm metabolism and that Cr supplementation could be useful in males with poor quality sperm.

https://pubmed.ncbi.nlm.nih.gov/32902220/

[WillBrink]

An interesting review hot off the presses:

The Evolving Applications of Creatine Supplementation: Could Creatine Improve Vascular Health?

Nutrients 2020, 12(9), 2834; https://doi.org/10.3390/nu12092834
Abstract

Creatine is a naturally occurring compound, functioning in conjunction with creatine kinase to play a quintessential role in both cellular energy provision and intracellular energy shuttling. An extensive body of literature solidifies the plethora of ergogenic benefits gained following dietary creatine supplementation; however, recent findings have further indicated a potential therapeutic role for creatine in several pathologies such as myopathies, neurodegenerative disorders, metabolic disturbances, chronic kidney disease and inflammatory diseases.

Furthermore, creatine has been found to exhibit non-energy-related properties, such as serving as a potential antioxidant and anti-inflammatory. Despite the therapeutic success of creatine supplementation in varying clinical populations, there is scarce information regarding the potential application of creatine for combatting the current leading cause of mortality, cardiovascular disease (CVD). Taking into consideration the broad ergogenic and non-energy-related actions of creatine, we hypothesize that creatine supplementation may be a potential therapeutic strategy for improving vascular health in at-risk populations such as older adults or those with CVD. With an extensive literature search, we have found only four clinical studies that have investigated the direct effect of creatine on vascular health and function. In this review, we aim to give a short background on the pleiotropic applications of creatine, and to then summarize the current literature surrounding creatine and vascular health.

Furthermore, we discuss the varying mechanisms by which creatine could benefit vascular health and function, such as the impact of creatine supplementation upon inflammation and oxidative stress.

Full paper:

https://www.mdpi.com/2072-6643/12/9/2834/htm

[adomanim]

I have not seen a single study nor legit article connecting CM with an increased risk of prostate cancer.

[WillBrink]

I have not seen a single study nor legit article connecting CM with an increased risk of prostate cancer.

Holy random comment Batman! You aint seen one because there is none...

[WillBrink]

Medicine Learns From The 'Muscle Heads'? Is this the vindication the bbing community deserves? Where's my apology letter for "dangerous" advice I was giving out over the decades outlining/recommending all this? 🤔

How to Increase Muscle Mass in Critically Ill Patients: Lessons Learned from Athletes and Bodybuilders.
Curr Nutr Rep. 2020 Oct 24.

Abstract

Purpose of review:

Decades of research on nutrition and exercise on athletes and bodybuilders has yielded various strategies to promote anabolism and improve muscle health and growth. We reviewed these interventions in the context of muscle loss in critically ill patients.

Recent findings:

For critically ill patients, ensuring optimum protein intake is important, potentially using a whey-containing source and supplemented with vitamin D and leucine. Agents like hydroxyl β-methylbutyrate and creatine can be used to promote muscle synthesis. Polyunsaturated fatty acids stimulate muscle production as well as have anti-inflammatory properties that may be useful in critical illness. Adjuncts like oxandralone promote anabolism. Resistance training has shown mixed results in the ICU setting but needs to be explored further with specific outcomes.

Critically ill patients suffer from severe proteolysis during hospitalization as well as persistent inflammation, immunosuppression, and catabolism syndrome after discharge. High protein supplementation, ergogenic aids, anti-inflammatories, and anabolic adjuncts have shown potential in alleviating muscle loss and should be used in intensive care units to optimize patient recovery.

https://pubmed.ncbi.nlm.nih.gov/33098051/

[billboybill]

hi what about creatine malate is it any better

[WillBrink]

hi what about creatine malate is it any better

Short answer, no. Long answer, linked in OP.

[xuerebx]

Thanks for the information in the first post, ties in nicely with the content Eric Helms wrote in the "The Muscle and Strength Pyramid: Nutrition"!

I have a question on loading which you have touched upon in the OP, and linked to in this article.

I'm cutting and bought creatine monohydrate. Generally I've read that loading phases aren't necessary in the long term, but I guess in order to reduce fluctuations in my weight since I'm cutting, loading creatine for the first week - "supplement with 0.3 g creatine/kg body weight/day for 5-6 days to maximize muscle creatine stores." - and then maintain at around 0.04g/kg/day thereafter would be recommended, right? Just to be sure - purely to reduce the time effort to bring my weight to the new baseline.

Thanks!

[WillBrink]

Below is new write up and collection of studies suggesting creatine will be a benefit in TBI:

2020 Updates. Several papers and reviews of interest examining the data and possible mechanisms of how creatine is a potential benefit to Traumatic Brain Injury (TBI) as well as being generally neuro-protective worth reading:

Potential for use of creatine supplementation following mild traumatic brain injury

Another review just published – Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury – follows below.

Finally a very important paper just published looked directly at the brains of NFL players using magnetic resonance spectroscopy and found that In symptomatic former NFL players “… there was a direct effect between repetitive head impacts (RHI) and reduced cellular energy metabolism (i.e., lower creatine).”

This is the first study to find a direct correlation with severity of RHI/TBI and cellular energy and creatine status I’m aware of and combined with additional emerging data that continues to mount in favor of creatine being beneficial to a wide range of brain insults. It should be noted however that cause and effect can’t be established by that brain scan study.

Traumatic Brain Injury (TBI) has been getting a great deal of attention recently due to vets, NFL, Combat sports, etc, and the DOD identified creatine as a nutrient of interest for TBI over a decade ago for military populations yet little follow up far as I know.

Also below, a recent study looking at creatine and TBI in adolescents, and suggest that creatine is highly neuro-protective with both acute (TBI) and chronic injury. Taken alone, this study is not impressing being a Open Label/Pilot Study, but when added to the growing lit showing the various brain related benefits of creatine posted on this page and elsewhere on this site, it’s a “no brainer” (bad pun intended!) to use in my view for a wide range of potential benefits, most of which are covered on this site.

To be sure, more data is needed to be definitive as to the potential benefits of creatine specific to TBI, what is exists is very compelling and growing rappidly.

Cont:

https://brinkzone.com/creatine-and-tbi/

[WillBrink]

Thanks for the information in the first post, ties in nicely with the content Eric Helms wrote in the "The Muscle and Strength Pyramid: Nutrition"!

I have a question on loading which you have touched upon in the OP, and linked to in this article.

I'm cutting and bought creatine monohydrate. Generally I've read that loading phases aren't necessary in the long term, but I guess in order to reduce fluctuations in my weight since I'm cutting, loading creatine for the first week - "supplement with 0.3 g creatine/kg body weight/day for 5-6 days to maximize muscle creatine stores." - and then maintain at around 0.04g/kg/day thereafter would be recommended, right? Just to be sure - purely to reduce the time effort to bring my weight to the new baseline.

Thanks!

I'm unclear why you feel during a cutting phase loading is more helpful. You can do the slow and steady approach or the quicker approach, to achieve tissue saturation per article you linked.

[xuerebx]

I'm unclear why you feel during a cutting phase loading is more helpful. You can do the slow and steady approach or the quicker approach, to achieve tissue saturation per article you linked.

Apologies I didn't elaborate. What I meant was that wouldn't loading the creatine for the first week "shoot up" my weight, but will then remain relatively stable the following weeks (so it's easier for me to track my weight loss progress after the first week) vs. maintaining steadily but would probably take a few weeks before my weight stabilises?

[WillBrink]

Apologies I didn't elaborate. What I meant was that wouldn't loading the creatine for the first week "shoot up" my weight, but will then remain relatively stable the following weeks (so it's easier for me to track my weight loss progress after the first week) vs. maintaining steadily but would probably take a few weeks before my weight stabilises?

Cutting, if done right = loss of fat, not weight per se. Hence, tracking fat loss/BF% body comp changes is what matters, and weight - unless you have to make a weight class for a sport - irrelevant.

[xuerebx]

Agreed, but tracking bodyfat losses and maintaining muscle in a cut is easier done through tracking the scale and keeping consistent strength during training. So making sure the scale keeps showing consistent weight loss is part of what I do to track progress - and why I asked the question regarding creatine loading. The quicker the bump in weight the better for me to continue tracking.

[WillBrink]

Agreed, but tracking bodyfat losses and maintaining muscle in a cut is easier done through tracking the scale and keeping consistent strength during training. So making sure the scale keeps showing consistent weight loss is part of what I do to track progress - and why I asked the question regarding creatine loading. The quicker the bump in weight the better for me to continue tracking.

The scale offers no body comp info at all and of the methods of tracking success, the least valuable. Even something like accumeasure calipers (google it) is more valuable of BF% and bodycomp changes. Don't use BIA scales and such as they are worthless.

[WillBrink]

Great review:

Variables Influencing the Effectiveness of Creatine Supplementation as a Therapeutic Intervention for Sarcopenia
Review ARTICLE

Front. Nutr., 09 August 2019

Sarcopenia is an age-related muscle condition characterized by a reduction in muscle quantity, force generating capacity and physical performance. Sarcopenia occurs in 8–13% of adults ≥ 60 years of age and can lead to disability, frailty, and various other diseases.
Over the past few decades, several leading research groups have focused their efforts on developing strategies and recommendations for attenuating sarcopenia. One potential nutritional intervention for sarcopenia is creatine supplementation.

However, research is inconsistent regarding the effectiveness of creatine on aging muscle. The purpose of this perspective paper is to: (1) propose possible reasons for the inconsistent responsiveness to creatine in aging adults, (2) discuss the potential mechanistic actions of creatine on muscle biology, (3) determine whether the timing of creatine supplementation influences aging muscle, (4) evaluate the evidence investigating the effects of creatine with other compounds (protein, conjugated linoleic acid) in aging adults, and (5) provide insight regarding the safety of creatine for aging adults.

https://www.frontiersin.org/articles...019.00124/full

[WillBrink]

Small but potentially valuable study:

Creatine supplementation plus neuromuscular electrical stimulation improves lower-limb muscle strength and quality of life in hemodialysis men


Einstein (Sao Paulo). 2020; 18: eCE5623.
Published online 2020 Nov 18. doi: 10.31744/einstein_journal/2020CE5623

Hemodialysis leads to sarcopenia, a syndrome characterized by the progressive loss of skeletal muscle mass with reduction of physical performance.(,1) Likewise, neuromuscular electrical stimulation (NMES) has been used as strategy for improvement in muscle mass and strength.(,2,3) We performed a prospective, short-term and single-arm study that evaluated adult men (38.18±12.86 years) undergoing hemodialysis for 40.73±36.98 months ( Table 1 ). Of 15 patients, four women were excluded and 11 men met the inclusion criteria ( Figure 1A ).

Cont:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687919/

[MaDFroG88]

A friend of mine told me to take 2 pills before and 2 pills after workout on training days. On non-training days just 2 pills.... but on the box it says 1 before 1 after :-/ Im asking about this product https://bg.bodybuilding.com/store/aa...l?skuId=AAP003 (120 tablet size). I am 183cm/6'0 tall and 78kg/174 pounds.