What's the buzz on creatine?

We chatted to Nutrition Consultant and Registered Dietitian Sara Widdowson to get the low down on creatine.

"Creatine supplementation has been around for a long time but predominately promoted as beneficial for gym goers and athletes wanting to improve performance. Alongside its use in sports, creatine may also have benefits for cognition and mental clarity with many people turning to supplementation of creatine as they seek to combat brain fog associated with perimenopause and disrupted sleep with parenting. The increase in the interest in creatine has been steep but many are still left wondering what creatine is, how it used in the body and what the research currently says about creatine supplementation and benefits."

"Creatine is a natural compound that is produced by our bodies. Creatine is often confused as an amino acid which are building blocks of protein but creatine is a different compound altogether. Creatine is actually produced from 3 amino acids, arginine, glycine, and methionine by our liver and kidneys. Creatine is stored mostly in our skeletal muscles and is stored as creatine phosphate. In addition to making creatine, we can also consume creatine from some dietary sources of protein with the highest sources of dietary creatine being found in red meat, fish and poultry.  A typical diet gives us about 1 to 2 grams of creatine a day, and the body replaces about 1 to 3 grams a day to keep usual creatine stores.

Creatine has several roles in our body including:

Increasing energy production – Creatine helps our muscles to produce quick, short bursts of energy. Creatine is stored in our skeletal muscle and is able to increase muscle production of a form of energy called ATP (adenosine triphosphate) energy. You could think about creatine as a battery bank helping our systems to recharge when energy has been used. It is because of the role in creatine aiding in muscle energy that creatine is thought to have a benefit on sport and athletic performance, particularly for short and sharp muscle movements such as repetitive sprint sessions or weight lifting. 

Increases muscle growth: - The effect creatine has on muscle growth is mostly indirect because of the energy enhancing effect it has on muscles. This increased energy can help you to train harder which would result in increased muscle fibres. Creatine does also pull water into our muscle fibres which can give an appearance of larger muscles.

Improves Recovery: - Creatine is thought to improve recovery time after exercise. It increases replenishment of ATP energy, reduces the microtears to muscle fibres during work outs and also might help your muscles replenish their glycogen stores faster. Pairing creatine with carbohydrates helps your muscles to put back glycogen stores, a store of glucose, which is used during exercise. The quicker your glycogen levels replenish, the sooner your muscles recover from exercise load.

The use and benefit of creatine supplementation for sport and exercise has been clearly demonstrated in research but newer evidence suggests there may be a role for creatine supplementation outside of gym culture. Some of the additional benefits of creatine supplementation may include a protective effect against age related muscle mass loss. Creatine supplementation does not directly build muscle. However, creatine supplementation along with regular resistance training and a well-balanced diet (including adequate protein intake) may offset age related muscle loss otherwise known as sarcopenia. Muscle mass changes with age occurs for several reasons including change in activity level and hormone shifts such as falling oestrogen levels through perimenopause through to post menopause where periods stop. Research suggested that women lose between 3-9% of muscle mass per decade from the age of 35 years. Muscle mass is important for our metabolism, bone health and long-term mobility as we age. In conjunction with strength training and adequate protein intake, creatine helps preserve muscle mass.

There is also emerging evidence exploring the role creatine supplementation may have for brain health. While most of our creatine stores are in our muscles, around 5% is found in our brain. Creatine in the brain works in a similar way to creatine in our muscles, helping to support ATP energy of which our brain uses a lot of. The research regarding positive impact of creatine supplementation is not as clear as the research we have about performance and exercise with supplementation, but it is promising. Some early studies suggest that creatine supplementation might reduce symptoms of anxiety and depression and it already being recommended for head injuries such as concussion for improvement in recovery. It may take several weeks of daily, consistent consumption to see effects, as creatine builds up in the brain slower than in muscles. Studies have also indicated that creatine supplementation may aid in improvements of working memory and processing speed. This benefit seems to be of particular use during fatigue related decline in brain function, something you might recognise as “brain fog”."

"As well as memory and mood there is also a buzz around the role creatine supplementation might have in reducing the cognitive impairment so many of those with sleep deprivation will be familiar with. Sleep disruption is a common experience for parents of babies and young children as well as women of perimenopausal age where changing sex hormone levels can lead to frequent night waking or night sweats which interrupt rest. Sleep deprivation reduces our brains stores of creatine phosphate and as creatine supplementation increases our tissues stores of creatine, including our brain, it has been proposed that creatine supplementation might mitigate possible sleep related cognitive impairment. With sleep disruption common for many busy modern women the proposal of supplementation reducing the impact on brain power is exciting. However, it is important to remember the research is still unclear and has not focused on longer term sleep deprivation.

Who might benefit from creatine supplementation?

• People who strength train
• Perimenopausal women
• Those wanting to reduce aging effect of muscle mass loss
• Those wanting reduced fatigue and improved cognition

Supplementation need-to-knows:

If you are considering taking creatine then you will want to know what type of creatine is worth your time taking, how much and when to include this in your daily routine. For most people a daily dose of 3-5g per day of supplemental creatine monohydrate is recommended for sports performance, muscle recovery and brain health benefits. Higher doses of up to 20g per day, split into several 5g doses, can sometimes be taken for those wanting to “load” with creatine such as those using creatine for a sports performance benefit.

You may have heard of creatine gummies and other forms of creatine supplementation but these are unlikely to give you the benefits of consistent supplementation you’ve read about in this article and research. Creatine monohydrate is the form of creatine taken in supplement form which is well researched and considered safe for most.

Timing and consistency of creatine supplementation does matter when it comes to getting the most out of your supplement. Daily, consistent use is critical to maintaining high levels of brain and muscle. Taking it after exercise with carbohydrates or protein may enhance uptake, though consistent daily use is more important than timing.

One of the most common questions asked is will I gain weight when taking creatine in supplement form? Some people will retain a small amount of fluid during the first week they start creatine supplementation. But this is temporary, and studies of long-term use do not show a persistent problem with holding onto extra water. Bloating can be another symptom experienced with doses of creatine above 10g per day but isn’t likely to happen at the much smaller recommended daily “micro” dose of 3-5g per day. If you are taking a higher dose it is encouraged to split this dose into 3-5g lots through out the day to improve digestion and reduce digestion discomfort.

Another common concern is whether or not people with kidney issues can take creatine as a supplement? This is because creatine is filtered by our kidneys. Some older reports have suggested that creatine might worsen kidney function in people who already have kidney conditions. But studies in healthy people who take creatine haven't found that creatine harms kidney function when taken at recommended doses. Research on creatine use in people with kidney disease is limited. People with kidney disease may want to talk with their healthcare teams before using creatine.

For those of you who are pregnant or breastfeeding and are considering taking creatine as a supplement you may be wondering if it is safe to do so? We don’t have strong research in these populations yet and there are no large clinical trials proving safety or harm. Some early research suggests there may be some benefit to taking creatine in pregnancy and breastfeeding but the research is still preliminary. Supplementing with creatine when you are breastfeeding is likely low risk in healthy breastfeeding women, but always consult with your doctor.

Creatine supplementation has long been associated with gym-goers and improved sports performance. But new and exciting research suggests that there are likely additional benefits to adding creatine monohydrate to your supplement regime – including improved brain function and protection of muscle mass loss that comes with aging."

References:

Candow DG, Forbes SC, Chilibeck PD, Cornish SM, Antonio J, Kreider RB. Effectiveness of Creatine Supplementation on Aging Muscle and Bone: Focus on Falls Prevention and Inflammation. J Clin Med. 2019 Apr 11;8(4):488. doi: 10.3390/jcm8040488. PMID: 30978926; PMCID: PMC6518405.

Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2014 Feb 24;3(4):346-50. PMID: 24596700; PMCID: PMC3940510.

Bird SP. Creatine supplementation and exercise performance: a brief review. J Sports Sci Med. 2003 Dec 1;2(4):123-32. PMID: 24688272; PMCID: PMC3963244.

Wax B, Kerksick CM, Jagim AR, Mayo JJ, Lyons BC, Kreider RB. Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations. Nutrients. 2021 Jun 2;13(6):1915. doi: 10.3390/nu13061915. PMID: 34199588; PMCID: PMC8228369.

Forbes SC, Cordingley DM, Cornish SM, Gualano B, Roschel H, Ostojic SM, Rawson ES, Roy BD, Prokopidis K, Giannos P, Candow DG. Effects of Creatine Supplementation on Brain Function and Health. Nutrients. 2022 Feb 22;14(5):921. doi: 10.3390/nu14050921. PMID: 35267907; PMCID: PMC8912287.