Without question, creatine is the gold standard by which all strength-related supplements are judged.
Creatine can be thought of as a quantitatively limited, but fairly instantaneous, reservoir for the replenishment of ATP (the fuel for muscles). The purpose of creatine supplementation is to increase the amount of stored creatine, thereby bolstering the capacity of this rapid ATP-generating energy system. In addition, creatine has been shown to increase lean body mass, presumably due to increased intramuscular fluid retention and improved resistance training capacity.
But, what other benefits does creatine provide?
- Effects on Bone Health
While a recent meta-analysis did not support the hypothesis that the addition of creatine would enhance bone mineral density in resistance trained populations, the actual studies included suggest that hope is not entirely lost (if a few factors are considered).
When considering training frequency and dosage, the results would suggest that creatine is most likely to benefit bone in the context of higher frequency resistance training (at least three days per week), when dosed at ~0.1 g/kg of body weight.
- Effects on Brain Health
We have long known that creatine plays a critically important role in the brain.
Even in the absence errors in creatine synthesis or transport deficiencies, researchers have suggested that creatine may play an important role in the severity and progression of a wide variety of brain-related pathologies, including traumatic brain injuries, Huntington’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS).
A recent systematic review summarized the effects of creatine supplementation on cognitive function in healthy people; results indicated that creatine improved performance on tests pertaining to short-term memory and intelligence/reasoning fairly consistently. While some positive findings have been reported for other cognitive outcomes, such as long-term memory, spatial memory, response inhibition, reaction time, and mental fatigue, these outcomes are improved less consistently.
Studies tend to show that creatine has minimal effects on cognitive function in relatively unstressed states, but its effects become more apparent in the context of stressors. Acute stressors include sleep deprivation, fatigue, hypoxia, and concussions; chronic stressors include things like inborn creatine deficiency, depression, and aging.
- Effects on Inflammation, Oxidative Stress, the Immune System, and Lung Function
Animal and human studies show that creatine supplementation attenuate both acute and chronic inflammation. For example, creatine has been shown to have favorable effects on the progression of arthritis using two different rodent models, as well as reduced markers of inflammation following multiple long distance running events.
With all these benefits, there must be side effects, right?
If you Google creatine side effects, a pretty wide range of results tend to pop up. Muscle cramping, kidney issues, liver issues, dehydration, weight gain, and gastrointestinal symptoms are listed most frequently.
Creatine does not appear to induce kidney damage, liver damage, rhabdomyolysis, dehydration, muscle cramping, or muscle strains in otherwise healthy individuals. There are some select kidney and liver pathologies in which creatine supplementation may be contraindicated, so anyone with a pre-existing liver or kidney issue would be wise to consult with a physician before beginning creatine supplementation.
Some people consider weight gain via water retention to be a side effect, and this certainly occurs for most individuals. It’s also fairly common to observe gastrointestinal discomfort with creatine supplementation; this effect is likely exacerbated if the creatine is poorly dissolved, consumed in large doses, or simultaneous ingested with a lot of caffeine.
Overall, the side effects are minimal and I would consider them to be outweighed by the benefits. In fact, despite the negative press, the International Society of Sports Nutrition regards creatine as extremely safe, concluding that it is one of the most beneficial sports supplements available.
Do I have you convinced to start taking creatine? If so, here are my recommendations.
No form of creatine has been shown to meaningfully and consistently outperform creatine monohydrate.
For best results, the best course of action would be to purchase creatine in solid (powder or capsule) form, store it in room temperature conditions (or colder), and consume it immediately after mixing it into a liquid solution.
As far as dosage, while high-dose loading protocols (20-25 grams per day for 4-7 days in a row followed by a maintenance dose of 2-5 grams per day) achieves full saturation more rapidly, you can still obtain the same degree of saturation by taking a more conservative maintenance dose of 3-5 grams per day for 3-4 weeks and get the same effects.
If you really, really need your results to be maximized within seven days of supplementation, loading would be the way to go. However, mild gastrointestinal discomfort is often observed with creatine supplementation; if your stomach struggles with taking in 20-25 grams of creatine over the course of a day, then loading would not be your best bet, and a more patient approach would be preferable.