Creatine Supplementation: Benefits and Common Misconceptions

If you are interested in supplementing with Creatine, there is a good chance that one of your primary goals is to build muscle mass. 

Out of the thousands of supplements on the market, Creatine is one that has been widely researched … and for a good reason! Research supports that short- and long-term supplementation of creatine can provide several health benefits, especially in conjunction with short, high-intensity intervals. These benefits include increases in performance and strength and better post-exercise recovery.

However, there are a lot of common questions and misconceptions revolving around the use of Creatine as a supplement. So let’s break some of them down and see what the evidence really shows.

Does Creatine Lead to Water Retention? 

• There is some evidence to suggest that creatine increases intracellular volume over the short-term, but several studies show no evidence that creatine leads to water retention over long periods of time. 
• Intracellular volume is an important signal for protein synthesis, thus, drives muscle mass over long periods of time 
• In conclusion, creatine supplementation may not lead to water retention

Is Creatine an Anabolic Steroid?

• Anabolic steroids are a synthetic version of testosterone, an androgenic hormone which is produced in the body. They have been used to help increase muscle mass and strength in conjunction with resistance training
• Anabolic steroid are drugs with a different chemical structure than creatine and are Class C, Schedule III controlled substances regulated by the FDA
• Creatine is a dietary supplement and falls under the Dietary Supplement Health and Education Act of 1994 (DSHEA)
• In conclusion, creatine is not an anabolic steroid since it has a completely different chemical structure 

Does Creatine Lead to Dehydration/Muscle Cramping?

• The physiological rationale suggesting that creatine supplementation may cause dehydration and muscle cramping is based on the premise that creatine is an osmotically active substance found primarily in skeletal muscle and may alter whole-body fluid distribution by preferentially increasing intracellular water uptake and retention, particularly over the short-term
• In situations of body water loss, such as severe sweating from exercise and/or increased environmental temperature, the bound intracellular fluid, in theory, may be detrimental to thermal regulation and lead to extracellular dehydration, electrolyte imbalance and muscle cramping or other heat-related musculoskeletal issues
• In conclusion, no research shows that creatine supplementation causes dehydration/muscle cramping

Does Creatine Increase Fat Mass?

• There is concern that creating supplementation causes increased fat mass. This theory comes from the idea that some individuals experience a gain in body mass when using creatine
• Several short-term studies lasting 6-8 weeks found no changes in fat mass from creatine supplementation
• ​​In longer studies lasting 8 weeks or more, percent body fat mass and fat mass were unaffected or decreased
• In conclusion, creatine supplementation does not increase fat mass across a variety of populations

Is a Creatine ‘Loading-Phase’ Required?

• Creatine ‘loading’ is defined as supplementing with oral creatine for 5–7 days with a dosage of 20–25 g/day, often divided into smaller doses throughout the day (e.g., four to five, 5 g servings/day). The ‘loading’ phase of creatine supplementation is followed by a daily ‘maintenance’ phase often ranging from daily 3–5 g servings/day
• A common misconception regarding creatine supplementation is that individuals must ‘load’ with creatine to increase intramuscular creatine stores and subsequently experience the purported ergogenic benefits of creatine supplementation. However, lower daily creatine supplementation dosing strategies (i.e., 3-5 g/day) are well established throughout the scientific literature for increasing intramuscular creatine stores leading to greater improvements in muscle mass, performance and recovery compared to placebo
• ​​Athletes who are carrying out a creatine loading phase (i.e., 20 g/day) should emphasize the smaller dosing strategies (e.g. less than or equal to 10 gram servings) throughout the day, as dosages of greater than 10 grams may potentially lead to gastrointestinal distress (i.e., diarrhea)
• In conclusion, evidence shows that you do not need to ‘load’ creatine. Lower daily dosages 3-5 g/day are effective for increasing intramuscular creatine stores, muscle accretion, and muscle performance/recovery

Is Creatine Beneficial for Older Adults?

• There are numerous studies that show creatine supplementation can be beneficial for older adults who suffer from age-related sarcopenia
• Creatine alone is unlikely to result in substantial muscle gains but when combined with resistance training, it can enhance training volume and/or intensity, which may influence muscle protein kinetics, growth factors, satellite cells, inflammation and/or oxidative stress, ultimately resulting in greater skeletal muscle adaptations
• In conclusion, evidence shows that creatine supplementation combined with resistance training provides musculoskeletal and performance benefits in older adults

Is Creatine Only Useful for Resistance/Power Activities?

• There are numerous studies that show creatine supplementation can be beneficial for older adults who suffer from age-related sarcopenia
• Creatine alone is unlikely to result in substantial muscle gains but when combined with resistance training, it can enhance training volume and/or intensity, which may influence muscle protein kinetics, growth factors, satellite cells, inflammation and/or oxidative stress, ultimately resulting in greater skeletal muscle adaptations
• In conclusion, evidence shows that creatine supplementation combined with resistance training provides musculoskeletal and performance benefits in older adults

Is Creatine Only Effective for Males?

• Creatine kinetics may vary between healthy male and females
• Females may have higher intramuscular creatine concentrations possibly due to lower skeletal muscle mass. Potentially, the higher resting intramuscular creatine concentration in females (based on the upper limit of intramuscular creatine storage) may help explain some research showing diminished responsiveness and/or performance effects on females
• Accumulating research over the past decade in postmenopausal females demonstrates that creatine supplementation during a resistance training program can improve muscle mass, upper- and lower-body strength, and tasks of functionality. Creatine supplementation appears to be a viable option for post-menopausal females to improve muscle quality and performance. In addition to its beneficial effects on aging muscle, creatine supplementation may also have favorable effects on bone in postmenopausal females, if combined with resistance training
• In conclusion, there is accumulating evidence that creatine supplementation has the potential to be a multifactorial therapeutic intervention across the lifespan in females, with little to no side effects

Are Other Forms of Creatine Similar or Superior to Monohydrate and is Creatine Stable in Solutions/Beverages?

• Creatine monohydrate powder has been the most extensively studied and commonly used form of creatine in dietary supplements since the early 1990s
• These studies indicated that orally ingested creatine monohydrate (e.g., 3–5 g/day) increases blood concentrations of creatine for 3-4 hours after ingestion thereby facilitating the uptake of creatine into tissue through diffusion and creatine transporters. Additionally, it is well established that ~99% of orally ingested creatine monohydrate is either taken up by tissue or excreted in the urine as creatine through normal digestion
• A number of different forms of creatine (e.g., creatine salts, creatine complexed with other nutrients, creatine dipeptides, etc.) have been marketed as more effective sources of creatine than creatine monohydrate. However, there are no peer-reviewed published papers showing that the ingestion of equal amounts of creatine salts or other forms of creatine increases creatine storage in muscle to a greater degree than creatine monohydrate
• In conclusion, while some forms of creatine may be more soluble than creatine monohydrate when mixed in fluid, evidence-based research shows that creatine monohydrate is the optimal choice

In addition to all of these common questions and misconceptions, it is important to note (especially as dietitians!) that Creatine CAN be obtained from food. Natural food sources of Creatine mostly include red meat, fish and chicken. Smaller amounts can be found in milk. 

So are you still thinking about adding Creatine in? Here are some final thoughts.

Athletes who perform high-intensity intermittent intervals with short recovery times can benefit the most. This can include, but is not limited to weightlifting, sprinters, hockey, football, lacrosse and wrestling. Additionally, those following a plant-based diet may also benefit since Creatine is primarily found in animal products.

There are different types of creatine, but creatine monohydrate is the one that has been the most widely researched and evidence shows it to be the most effective. We recommend consuming creatine in cycles where you would use it for 12 weeks, then take 4-6 weeks off. During your 12 week cycle, you want to consume 3-5 grams (about 1 teaspoon) post-workout with a carb such as a post-workout protein shake with fruit, sport beverage or a glass of juice. This does not include an initial loading phase.

Lastly, consult a registered dietitian and/or a sport nutrition professional to learn more about how to properly supplement with it and see if it’s right for you! 

Resource:

Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), 13. https://doi.org/10.1186/s12970-021-00412-w