This is your full guide on creatine monohydrate. Absolutely everything you need to know here.
If you’ve read my things before, you know that I never really encourage full dependence on supplements. In my eyes, being optimally healthy means not having to take any sort of supplement.
However, there is one supplement that is the exception to the rule. You’ve guessed it: creatine.
Because of my scepticism about taking supplements daily, I’ve researched creatine extensively. And I even surprise myself in saying that I have found very few well-researched and well-founded papers saying that creatine can be damaging. (I’ll talk about those, obvs.)
I’m happy to report that creatine is by no means exclusive to the athlete market. Truthfully, regardless of your background (both mental and physical), you should read this.
I think you’ll be pleasantly surprised.
This blog post is about everything you need to know on creatine monohydrate!
FULL GUIDE ON CREATINE MONOHYDRATE
Some information to get you started
Creatine started getting popular in the mid-1990s, mostly in the sports domain. Because creatine can be ingested through food, it was never banned.
Over time, the advantages of creatine were so positive, it started spreading like wildfire. Naturally, it was studied extensively. Today, over 1,000 peer-reviewed papers have been published, and billions of creatine servings have been ingested.
Basically, alcohol, tobacco and drugs use in high-performing athletes rapidly became a much more critical health concern than creatine use ever was.
Role of creatine in our bodies
This section will rapidly veer in nitty gritty chemical talk. However, I’ll try to keep it as simple as possible.
Creatine synthesis
Here’s how creatine is created!
- The process starts in the kidneys. The building blocks are arginine and glycine, both of which are amino acids
- The enzyme arginine:glycine amidinotransferase (AGAT) catalyzes the transfer of a piece of Argentine (its amidino group) to glycine.
- When glycine receives the amidino group, it becomes a new enzyme called guanidinoacetate (GAA), while arginine becomes ornithine (an amino acid).
- The GAA is then transported to the liver through the bloodstream. The blood circulates throughout the body, and when it passes through the liver, GAA is taken up by liver cells for the next step in creatine synthesis. This transportation process is largely passive, relying on the normal circulation of blood to move GAA from the kidneys to the liver.
- In the liver, the enzyme guanidinoacetate N-methyltransferase (GAMT) uses S-adenosyl methionine (a cosubstrate) as a methyl donor to convert GAA into creatine.
Energy shuttle
The CK/PCr energy shuttle is a crucial system in cells with high and fluctuating energy demands, such as muscle and brain cells. Its primary function is to facilitate the transport of energy within cells and to act as a temporal and spatial buffer for ATP, the primary energy currency of cells.
- Once synthesized, creatine is released into the bloodstream and taken up by tissues with high energy demands, such as the brain and muscles, via the creatine transporter (CRTR).
- In these tissues, one can find creatine kinase, an enzyme found in the mitochondria and cytosol of cells. CK catalyzes the transfer of a phosphoryl group (Pi) from adenosine triphosphate (ATP) to creatine, forming phosphocreatine (PCr) and adenosine diphosphate (ADP). This process is called phosphorylation.
- The CK/PCr system serves as a reservoir of high-energy phosphates, effectively shuttling energy from the mitochondria (where ATP is produced) to various parts of the cell (where ATP is consumed).
- When energy demand increases, PCr can donate its phosphoryl group back to ADP to regenerate ATP, a process called dephosphorylation. This is catalyzed by CK as well.
- The ATP can then be used to fuel cellular processes.
Is creatine monohydrate really the best?
I think that it’s heard often that creatine monohydrate is the one that you should be using. This doesn’t come as a surprise since it’s the most commonly studied form of creatine in the literature.
The reason that this belief has spread is because it is said that it has the best absorption level. In other words, creatine has to first be absorbed by the blood, and then by the tissues. And creatine seems to do that most efficiently.
But the question is: does it really? Well, the answer is no.
In fact, much (reliable) research has studied markers such as muscle phosphagen levels, whole-body creatine retention and/or performance are used to evaluate efficacy. And none of them found creatine monohydrate to be superior to other forms.
So creatine monohydrate, creatine citrate, creatine serum, creatine nitrate…. all the same.
Basically, the claim that creatine monohydrate is “better” than others is unfounded. Despite claims that some forms of creatine may degrade less or be taken up more by the muscles, there is no clinical evidence to support these assertions.
I hope you can sleep tonight.
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Benefits of creatine for athletes
"Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training."
There is an EXHAUSTIVE list of ways that creatine benefits athletes. I mean, REALLY long.
I’m going to go in a little more detail in the most interesting ones below, but here are some benefits of creatine for athletes:
- Increased single and repetitive sprint performance
- Increased work performed during sets of maximal effort
- Increased muscle mass & strength adaptations during training
- Enhanced glycogen synthesis
- Increased anaerobic threshold
- Possible enhancement of aerobic capacity via greater shuttling of ATP from mitochondria
- Increased work capacity
- Enhanced recovery
- Greater training tolerance
Better recovery
When you’re going through an intense workout, creatine storages naturally deplete. So a better recovery is partly about being able to fill these storages as efficiently as possible.
However, it isn’t only about filling creatine storages. It’s also about your glycogen storage.
And indeed, here are 3 studies that have highlighted an efficient way of doing so:
- Consuming creatine (5g) as well as carbs (95g – that isn’t a mistake) enhances creatine and glycogen storages in muscles
- Consuming creating (5g), carbs (47-97g) and protein (50g) enhances creatine retention
- Creatine and carb loading before exercise allowed for better recovery than carbs alone.
PS: why is there mention of carbs at all? Simply, glycogen is a key component in recovery, preventing overtraining & muscle damage and other such factors
But how do you quantify muscle damage and overtraining? Well, one way to do this is by measuring the levels of creatine kinase. Indeed, after a tough workout or an injury, more CK gets released into your blood. Therefore, high levels of CK in your blood can be synonymous do muscle damage.
And indeed, it has been shown that people who take creatine had lower levels of CK in their blood after they exercised. This suggests that their muscles weren’t as damaged by the exercise, or that they were able to recover more quickly.
Similarly, it has also been shown that creatine loading decreases inflammatory markers, both in long distance running and in high-intensity workouts.
Injury prevention & rehabilitation
Prevention
It has been rumoured that taking creatine can increase the number of sports injuries.
Well, I am glad to tell you that no peer-reviewed articles have come to that conclusion. In fact, quite the contrary.
These peer-reviewed articles have shown that taking creatine for extended periods (2+ years) has not been shown to cause any side effects when it comes to injuries. Rather, it has been shown that it can even decrease the number of injuries. These injuries include cases like dehydration, muscle cramping and tightness among others.
These studies have also found that combining creatine with carbohydrates and protein further decreases the risk of non-contact injuries
Rehabilitation
Naturally, creatine’s benefits in the process of injury rehabilitation have been studied as well. Studying this means looking at 2 things: how much muscle atrophy is recorded during time off due to injury, and how quickly one can fully recover.
As a matter of fact, people who take creatine have better results during the recovery period. As mentioned about, this is seen through lower levels of muscle atrophy and other detrimental effects on muscle following injury and subsequent immobilization.
Insofar as for the recovery, those who take creatine recuperate full muscle strength in a reduced amount of time.
Better heat tolerance
Creatine has osmotic properties, which help it retain water. For this reason, it has been studied as a method to keep athletes hydrated and heat-tolerant.
And what better way to test that than to make a ton of people work out under the sun?
And indeed, it has been reported that those who have supplemented in creatine have shown less thermoregulatory responses. Their responses are things such as changes in fluid-regulatory hormones, sweat rate and temperatures in various body parts.
Along the same lines, cardiovascular responses have also been reduced.
Both these elements highlight how creatine can promote hyper-hydration and more efficient thermoregulatory responses.
Furthermore, since carbohydrate also has osmotic properties, it naturally led to the study and conclusion that carbs and creatine make a good match for heat tolerance.
Brain and spinal cord neuroprotection
Creatine supplements might help protect the brain and spinal cord from injury. This is a big concern for athletes who play contact sports, where there’s a risk of getting a concussion or a spinal cord injury.
So, they’ve done a bunch of studies to look into this. For example, one study found that giving creatine to rats and mice for five days before a controlled brain injury reduced the amount of brain damage by 36 to 50%.
Another study found that rats that were fed creatine before and after a moderate spinal cord injury had better movement and less scar tissue after the injury.
There were also studies that found that creatine reduced the size of brain damage after a stroke by 40% and that it reduced the amount of swelling in the brain after a lack of oxygen.
Finally, a study found that rats that were fed a diet with added creatine for several weeks before and after a spinal cord injury had less loss of gray matter.
So all these rat experiments allow us to stipulate the following:
- Creatine helps keep the mitochondria working properly
- Creatine might help protect patients from spinal cord injury if given before surgery
- Creatine might be a safe and effective treatment for reducing brain damage in humans.
- Creatine might help limit the damage from concussions, traumatic brain injuries, and spinal cord injuries.
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Benefits of creatine in the medical field
It has been found that creatine can also be used in a clinical setting. Due to the implications that creatine has in the body, it has been considered as a means of treatment.
Here are some of those instances:.
Creatine synthesis deficiencies
You know how I talked about the two main functions that creatine has in our bodies? Well, creatine synthesis syndromes happen when your body cannot effectively do one of them: either it has a hard time endogenously synthesizing it or a hard time transporting it.
As a consequence, they tend to present with muscle myopathies, autism, movement disorders, speech delay, epilepsy, etc.
However, after taking high doses of creatine (~21-56g / day), the studies have shown improvement in clinical outcomes.
Why? Well, succinctly, the supplements have increased levels of creatine in the brain, thereby improving and/or stabilizing clinical symptoms.
Because these clinical trials were done on younger kids (-1-year-old), it also provides great evidence that creatine is tolerable and safe long-term, even at these high-doses.
Neurodegenerative diseases
Studies have also been carried out on patients with neuromuscular diseases such as Huntington’s disease, Parkinson’s disease or Lou Gehrig’s disease.
While some studies have shown that creatine supplementation has been beneficial, others have been less certain.
In fact, a particular study researching Huntington’s, Parkinson and ALS has found that while there were no clinical benefits of creatine for the latter two, creatine was able to slow down brain atrophy for Huntington’s.
Ischemic heart disease
Due to its function in maintaining myocardial bioenergetics during ischemic events, creatine has been studied as a way of reducing arrhythmias and general improvement of heart functions during ischemia.
And indeed, it has been suggested that supplementing in prophylactic creatine can have protective and preventative effects for patients at risk for myocardial ischemia or strokes.
Note that it has been reported to have maximal benefits when combined with cardioplegic solutions.
Aging
When it comes to ageing, creatine has been shown to have these benefits:
- lower cholesterol and triglyceride levels
- reduce fat accumulation in the liver
- reduce homocysteine levels
- increase muscle mass and minimize bone loss
- positively influence cognitive function
- and more!
The trifecta has actually been found when combining creatine supplementation, increase protein intake and resistance training. (!!!!!!!)
Let me reiterate: there has been an overwhelming amount of research that shows just how beneficial creatine is in minimising the side effects of ageing. Not only has it been proven to help physical markers, but it has also been extensively researched in helping cognitive functions such as working memory.
Creatine has also been shown to help those who have been sleep deprived. Regular markers of sleep deprivation such as random movement generator, choice reaction time and balance have all been significantly less affected when the person is supplemented with creatine.
Pregnancy
Creatine has been researched for pregnancy for 2 reasons:
- It has been shown to have neuroprotective properties, and can therefore help in proper neural development
- The fetus relies on the mom’s creatine until late in the pregnancy, and therefore there would logically be changes in creatine synthesis and transfer during pregnancy
There have indeed been studies reporting that creatine not only promotes fetal growth, development and overall health but also improves neonatal survival and organ function after birth asphyxia.
How to start supplementing on creatine
The majority of creatine is found in skeletal muscles (~95%), the rest being found in the brain and testes.
The creatine found in the muscles averages 120 mmol/kg of dry muscle mass for a 70kg individual. However (and this is the whole point of creatine supplementation), storage can go up to 160 mmol/kg.
Since 1-2% of intramuscular creatine is degraded into creatinine (which your body then throws away through urine), your body needs to replenish 1-3g of creatine per day.
Since 60-80% of that can be compensated via diet (red meat, fish). And that difference of 20-40% is what you need to make up via supplementation.
Protocol
Creatine supplementation
So, the protocol has to include two steps to maximize creatine storage in your muscles:
- Bring the level of creatine you currently have up to maximum capacity
- Keep that level high (because, as we saw, there is depletion)
So this is how you do it:
- You intake about 3-5g of creatine per day (or 0.3g/kg of body weight) 4 times per day, for about 5-7 days
- Now, your muscle creatine storages are full
- From now on, you just keep intaking those 3 – 5 g per day, but only once a day
This protocol is the fastest way to get you to full creatine capacity. However, it is also possible to skip steps 1-2 and jump straight to 3. It’ll just take a little longer to be at full capacity (about 1 month).
If you are an active athlete, some studies indicate that you should be ingesting larger amounts to keep those storage levels high, about 5-10g/day.
Obviously, there are exceptions to this rule, such as if you have creatine synthesis deficiencies.
There have been a decent amount of studies that report that ingesting creatine with carbohydrates, or creatine with carbohydrates and protein, promotes better creatine retention. (Another + for protein!)
There is also the question of what happens if you stop supplementing with creatine. Well, nothing really.
It takes about 4-6 weeks for creatine levels to go back down to baseline levels. And there is no evidence that suggests that the baseline will fall below the baseline from before supplementation.
Also, I should probably mention that if your creatine has been exposed to heat, don’t take it. Under heat, creatine converts to creatinine, that thing we mentioned early is considered waste.
So you definitely don’t want to be supplementing in creatinine. In fact, it has been shown that after one 3 days at 25°C, that creatine has already become creatinine.
Creatine monohydrate side effects
So, all sounds pretty good until now. But what are the negatives?
Truthfully, the only thing that has been found by peer-reviewed articles is that taking creatine can cause weight gain.
NOW, PLEASE. do not panic. Weight gain is NOT fat gain. There are two totally NOT fat-related reasons for weight gain.
- As I explained above, creatine has osmotic properties, which means that it binds to water. So naturally, you be holding a little more water.
- Also as explained throughout this blog, you can develop more muscle fibres while on creatine… so that’s just more “lean” weight.
However, besides weight gain, there really aren’t other substantiated negative side effects.
Studies have been done on all kinds of people, from babies to the elderly, and they’ve found that taking creatine is safe and can even have health and performance benefits. Even when people have reported bad side effects, these have been refuted by well-controlled studies.
There have been a few reports of people having high levels of creatinine or kidney problems after taking creatine. But these were people who were also taking other supplements.
Many studies have looked at whether creatine affects kidney function, and they’ve found that it doesn’t. For example, one study found that people who took creatine for up to five years didn’t have any changes in their kidney function.
In fact, creatine has been used to help reduce levels of a harmful substance called homocysteine in people with kidney disease and to help improve kidney function that had been deprived of oxygen at birth. Even people who have taken a lot of creatine for a long time haven’t had an increased risk of kidney problems.
Some critics have pointed out that some creatine products have warnings on their labels saying that people under 18 shouldn’t take them. But this is just a legal precaution, and there’s no scientific evidence that children and adolescents shouldn’t take creatine.
There you goooo, guys. I know it was a hefty amount but I wanted to cover as much ground as possible.
xx LS
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