Creatine has been exhaustively covered in the athletic world. And for good reason. It is considered the “most popular ergogenic aid for athletes”. So you might wonder, “why write another piece about it?”

While creatine HAS been extensively covered, it’s difficult to find anything that clearly reviews its claims, suggested usage, and target athlete audience. THAT is the purpose of these monthly reviews. 

Yes, monthly. I want to clearly review supplements and strategies so athletes understand the practical applications and make informed decisions. So, without further ado, on to Creatine.

Introduction – The What’s and How’s of Creatine

How did creatine become such a popular ergogenic aid? Well, it was first popularized when Linford Chistire, creatine’s first “satisfied customer”, unexpectedly won gold in the Barcelona Olympic Game’s 100m race. That was the athletic community’s first look into the nitrogenous compound’s benefits as a performance-enhancing supplement. Since then, a monumental amount of research has been conducted to conclude creatine’s effectiveness, dosing strategies, and safety.

What does creatine actually do though? Essentially, and specifically for athletes, creatine is indirectly used as an energy source in our muscles. Creatine binds with a phosphate group (Pi) to form phosphocreatine (PCr). Our muscles then stores creatine as either PCr (2/3) or free creatine (1/3). Our muscles use PCr to generate ATP (3 phosphates), which you may have heard about, by transferring PCr’s Pi to ADP (2 phosphates). That reaction helps restore ATP levels for our muscles to use as energy. Therefore, creatine isn’t energy itself, but it allows us to create more energy.

What makes this useful to athletes is the rate at which PCr can resynthesize ATP. During exercise, our muscles breakdown ATP into ADP. Since PCr can generate ATP much faster than any glucose-related pathways, like glycolysis, muscle tissues are capable of performing at a higher capacity. This is particularly useful when performing maximal effort sprints, lifts, or other short-duration, high-intensity drills because the other energy pathways cannot keep up with ATP demand.

Why supplement creatine then? The strategy aims to increase PCr storage in the muscle so as to enhance the muscle’s ability to resynthesize ATP faster. Even though a normal carnivorous diet provides 1-2 g of creatine per day, this just replenishes stores, keeping muscles only 60-80% saturated. Supplementing creatine aims to increase saturation above normal levels, and has shown to raise muscle creatine content by 20-40%. This suggests supplementation could reduce fatigue during high-intensity, intermittent activities AND improve recovery from those activities.

Claims – Why is Creatine Supplementation Note-Worthy?

So now we know what creatine is, what is does, and the aim of supplementing. But what performance characteristics does supplementation claim to enhance? Well, creatine has shown to accomplish exactly what it aims to do, and more: 

1. Improve short-duration, high-intensity exercises that rely on the PCr system

2. Increase lean body mass (LBM)

3. Improve strength and power gains

4. Enhance performance in team sports that utilize a combination of aerobic and anaerobic energy systems

5. Improve the quality of training

Starting with (1), creatine claims to improve a specific form of exercise: short-duration, high-intensity events. This is exactly what researchers expected creatine supplementation to accomplish because of its inherent function in the muscle. Therefore, we should expect to see improvements in activities like repeated sprints or high-intensity resistance training. Why though? During the recovery period of these activities (i.e. between sprints or sets), PCr can be replenished up to 50-70% within 30 seconds or 100% in 3-5 minutes. This allows your muscles to bounce-back and maintain their performance in subsequent sprints or sets. Since creatine muscle content becomes elevated from supplementation, there is a relatively higher amount of creatine replenished during recovery periods. Thus, there is more creatine available for you to drive energy production in subsequent sprints or sets. However, studies suggest that supplementation may NOT improve performance for single-bout sprints. Why? It seems sprinting improvements may be too small to detect or PCr isn’t a limiting factor for performance in those events. Therefore, it appears supplementation is MOST useful when athletes must maintain their high-intensity performance levels with opportunities for recovery.

Secondly, studies have indicated creatine supplementation increases LBM. How, however, is still not completely known. LBM may increase in response to fluid shifts as a result of supplementation. In this case, as creatine is taken up by the muscle cell it causes a change is osmotic pressure that forces fluid into the cell, increasing intracellular water within the muscle. This gets read by body composition tests as an increase in LBM. Supplementation may also increase LBM by improving the quality of training (or claim 5). Consider this, if you are capable of performing an extra 2-3 reps or lift 5% heavier during your workouts, would you not expect better results? Therefore, effectively using creatine to improve resistance training, specifically, should enhance the rate and amount of LBM improvement expected from the training program.

That’s where creatine supplementation appears to provide its greatest influence to athletes, and why we also expect to see improved strength and power gains. Since athletes are able to improve the quality of their training, we should also expect them to make larger gains in strength and power. In fact, studies have shown that, compared to a placebo, creatine supplementation improves gains in:

• 1 RM lifts

• Muscular power

• Number of reps at a given load

• Muscular endurance

• Total force production

It is worth noting that these improved performances are training-specific for athletes. That is, they describe an improvement in training exercises and not sport-specific abilities. So, while we DO see improvements in strength and power, it’s also necessary for the athlete to be able to transfer these abilities into their respective sport. For lift-specific athletes, like powerlifters or weightlifters, however, it becomes more obvious how effective creatine is in enhancing performance.

            For Team Sports, that typically utilize a combination of aerobic and anaerobic energy systems, creatine supplementation helps buffer the negative effects of aerobic training on strength and power. Because these athletes must participate in some form of aerobic training, we would expect those adaptations to interfere with strength and power gains. Therefore, creatine’s ability to improve strength and power can help partially nullify the negative effects of aerobic training.   

            Finally, and most importantly, creatine supplementation improves the quality of training. This appears to be the primary mechanism by which creatine can improve performance. By improving training sessions, athletes are able to accumulate and tolerate greater volumes and intensities, thereby stimulating greater adaptations. You might ask how –

Improved Recovery

By improving recovery between sets of reps or sprints, athletes can maintain their intensity and effort for longer. For example, consider a sprint session where a wide-receiver is programmed repeated 25-yard sprints with minimal rest. Prior to creatine supplementation, sprint time may increase 5-10% as fatigue sets in and the WR cannot maintain their maximal sprint speed. Through creatine supplementation, we would expect a smaller increase in sprint time, maybe 2-5%. Therefore, the WR ends up accumulating a more volume of maximal performance, generating a greater stimulus for adaptations.

Superior Sets

Creatine supplementation increases the pool of PCr available to generate energy during sets. This does 2 things: (1) enhance the rate at which PCr can generate energy, and (2) prolong the need for glycogen in anaerobic glycolytic pathways. By enhancing the rate of energy generation, PCr supplementation facilitates greater power output by the muscle because energy for muscular contraction can be generated a faster rate. Additionally, maximal effort can be prolonged because glycogen is reserved and tapped into at a later time. Therefore, not only does supplementation maintain effort in subsequent sets, but it also increases the power the athlete can generate and prolong their ability to maintain high-intensity outputs.

Note – This does, however, come with some caveats. Creatine supplementation has shown to not improve single-bout sprint performances. While this suggests supplementation would not increase power generation within sets, it’s important to note that creatine may not be the limiting factor in improving sprint performance. For instance, technique, and not energy generation, may limit the athlete from increasing sprint speed.

            All in all, the research does indicate that creatine supplementation can have a significant positive impact on performance via improved quality of training. This is mostly useful for athletes whose sport utilizes and prioritizes the PCr energy system, which includes short-duration, high-intensity periods. For that reason, aerobic-based and endurance athletes would not see a significant improvement in performance because the PCr system contributes very little to their sport. Additionally, since many endurance sports favor lighter athletes, creatine supplementation could negatively affect their performance with its inherent weight gain. Therefore, creatine supplementation may actually hurt endurance performances.

Use – What Creatine should you use and How?

            So, you might be excited about creatine now. I know I was. But where do you go from here? What product are you looking for? How much should you take? When? And should you be worried about side-effects? Well, you’ll see soon enough that creatine supplementation doesn’t need to be complicated, and it’s readily available to you.

Products

            In regards to what product you’re looking for, the supplement should be providing Creatine Monohydrate. I would personally opt for products that don’t have an endless list of ingredients; but, that’s because I’m picky about keeping unnecessary additives out of my diet.

Note – For athletes regulated by anti-doping laws, like the NCAA or IOC, it’s necessary to choose products that are NSF-Certified for Sport or third-party tested. This means that an outside lab has verified ALL the ingredients in the product and found no additives not indicated on the label. This is important, as supplements are not strongly regulated and non-third-party tested products may have illegal substances that fail your next doping test.  

            Below, I’ve assembled a list of NSF-certified and non-third-party tested creatine products currently available (this is a short list compared to what actually exists). For athletes not restricted by anti-doping laws, be aware that NSF-certified products can be more expensive, so it’s up to you to weigh the pros and cons between price and purity. 

Dosage

            Now, how do you get the benefits of creatine? What dose are you looking for to enhance your performance? While difference creatine products may recommend their own dosing pattern, research has shown the most benefit from 2 different approaches:

1. Rapid Loading Protocol – In the Rapid Loading approach, athletes consume high levels of creatine monohydrate for 5-to-7 days to saturate their muscles. Then, a maintenance dose is consumed thereafter to maintain the higher-than-normal saturation.

Rapid Loading = 20-25 g (or 0.3 g/kg) of Creatine/day. Consume via 4-5x 5 g doses throughout the day. Continue for 5-7 days. Most studies indicate that 5 days is sufficient for saturation.

Example: 70 kg (or 154 lb) Athlete

Maintenance: Consume 3-5 g of Creatine/day, or 0.03 g Creatine/kg/day. For extremely large athletes, a maintenance dose of 5-10 g/day may be necessary. A 3-5 g dose can be consumed at one time, while a 5-10 g dose could be split into two occasions.

2. Slow Loading Protocol – Athletes can also consume 3 g of Creatine/day for 28 days to saturate their muscles. This, however, will slow when athletes notice improvements because it takes a longer time for the muscle to become saturated.

            Once supplementation has been ceased, it generally takes 4-6 weeks until creatine concentration returns to baseline. At this time, there are have not been any side-effects identified with chronic use of creatine, and so supplementation can continue for as long as your goals are creatine-relevant.

Timing

            Just as protein has an optimal timing, we have to wonder if there’s a specific time to consume creatine. We know that creatine monohydrate is absorbed into the blood with plasma levels peaking around 60 minutes after ingestion. However, there is no definitive evidence of when creatine might be most effective. Therefore, here are some practical recommendations when considering creatine timing:

1. Rapid Loading – Space out your 4 doses of 5g evenly throughout the day. That is, use even intervals between your doses. For example, doses could be consumed every 4 hours: 8am, 12pm, 4pm, and 8pm. Be sure to consume creatine with food to help reduce any GI discomfort.

2. Pre- or Post-Exercise? – Since timing around training does not appear to affect creatine’s effectiveness, we might consider other factors. For instance, creatine may be absorbed in similar pathways to amino acids and peptides. This would suggest that consuming creatine with your lowest protein meal would help improve creatine absorption. Why? Essentially, your intestinal transporters won’t be over-saturated by high levels of protein and can focus on transporting creatine. While this hasn’t been studied, there are minimal-to-no consequences to following this loading pattern since creatine absorption and uptake is unaffected by training.

Side Effects

            Creatine supplementation is associated with a few minor side effects: Weight gain, cramping, nausea, and diarrhea. Weight gain is associated to the fluid shifts into the muscle cell. This causes a retention of water, which increases body weight. This side-effect, however, is mostly pertinent to athletes in sports with weight-categories or sports that see performance deficits with weight gain (such as endurance running and cycling).

            The gastrointestinal (GI) side effects are generally experienced during the Rapid Loading Phase due to the high levels of creatine in the GI. This can be offset by following the Slow-Loading protocol; however, this will limit the rate at which muscles are saturated. In addition, because of these symptoms, it’s not recommended to start a Rapid Loading Phase when important events are scheduled within that time-period. Otherwise, the athlete risks hindering their performance from GI discomfort.

Safety

            Extensive creatine research has not indicated any safety issues for short- or long-term use. Creatine is considered safe without significant adverse effects. Due to the lack of research in elderly and adolescents, it is difficult to truly know of any contraindications or specific issues regarding creatine in those populations. However, adolescent athletes should consider fully developing their performance through natural means (training and diet) before they decide to use supplements. Why? Because supplements can appear as shortcuts instead of putting the real work in. Of utmost importance, particularly for professional athletes following anti-doping laws, is verifying the product’s brand and ingredients. This way, athletes can ensure they aren’t consuming ingredients that are dangerous to their bodies or illegal within their sport.

Special Considerations

            A special caveat to creatine is relevant to most supplements (and many other interventions to be honest). Consider this, when studies are reported to the population we hear about an intervention, x, having a significant impact on an outcome, y. However, what usually isn’t presented is the range of outcomes. We’re typically shown that the average outcome showed benefits, however, that doesn’t mean ALL participants improved. In fact, some may have even seen performance decrements.

            This describes the effect of Responders versus Non-Responders. The Responders will be influenced by the intervention and change, while the Non-Responders will not. Research readers are presented the results of both groups averaged out. So, when supplement studies claim to improve performance, just realize that the effect has a range, and that it might (or might not) work for you. 

            But, why would creatine supplementation not work for you? Research indicates that everyone has varying baseline levels of creatine saturation. Therefore, athletes with LOW baseline levels would likely see a LARGE RELATIVE INCREASE in creatine levels post-supplementation. Why? Because their muscles have more room for creatine storage. Therefore, low-baseline athletes would be Responders.

            Who are the Non-Responders? Athletes with naturally HIGH creatine stores. These athletes are already training and performing with high creatine saturations, and so the benefits of increasing creatine higher are only marginal.

            Take this into consideration if you decide to try creatine. If there’s no change post-supplementation, you may have naturally-high creatine saturation and won’t benefit from additional consumption. Weigh the pros and cons to determine if it’s for you. And realize that every individual will respond differently, and so it’s up to you to find interventions most effective for your goals.

            Finally, one group of individuals likely to benefit from creatine supplementation are vegetarians and vegans. Their food choices limit creatine consumption, preventing normal saturation of their muscles. Therefore, creatine supplementation would ensure they consume normal or higher-than-normal levels, which could benefit their performances.

 Practical Application – What Sports would Benefit?

            Okay, so we now know the what’s, why’s, when’s, and how’s. But, WHO is creatine for? Remember, creatine improves the performance of short-duration, high-intensity exercise, increases LBM, improves strength and power, and improve quality of training. Therefore, supplementation would be specific to non-endurance athletes. Additionally, individuals pursuing specific goals would also benefit from supplementation. Check out the table below for an easy overview of who might find creatine Useful, Potentially Useful, or Not Useful.

If you fall into the “Useful” category, consider trying creatine! You might find that it helps you through a plateau. For athletes in the “Potentially Useful” category, weigh the pros and cons! You might find your training benefits from supplementation. Just be wary about training carrying over into your performance. Finally, for athletes in the “Not Useful” category, creatine supplementation probably isn’t for you. The physiological effects of creatine just don’t hit the right organelles and cellular pathways to improve upon the physiology YOU rely on to compete. And that’s fine, there are plenty of other interventions available to you that can help you perform better.

Conclusion

            The intention of this article was to provide a complete overview of creatine for athletes to use in their decision-making process. No supplement should just be started on a whim; that’s why we should:

1. Understand the function and claims – Determine whether the supplement is relevant to an athlete’s sport. If a supplement doesn’t target physiology related to an athlete’s performance then there’s no need to consider it. However, if the supplement does improve sport-specific performance, then athletes must analyze the pros and cons of supplementation.

2. Weigh the risks, benefits, and costs – Supplements come with some baggage. They might have side-effects or safety concerns that must be known prior to starting them. They can also be costly, both monetarily and professionally. Loading up on an extensive supplement protocol could break your bank, but also opting for cheaper products could put your professional career at risk through failed doping tests. So, before you start, understand exactly what you’re taking. Then, consider if the benefits of supplementation truly outweigh the risks and costs.  

            In regards to creatine, we’ve seen that supplementation can in fact improve the performance of short-duration, high-intensity events, increase LBM, strength, and power gains, and improve your quality of training. These benefits are relevant and useful to a specific set of athletes that utilize the PCr system or rely on LBM, strength, and power gains from training. Thus, creatine supplementation is an effective supplement for this set of athletes.

            If YOU are considering creatine as a supplement, try to think all these factors. It’s important to bring critical thought into your nutrition plan. Without it, we risk blindly following inaccurate or irrelevant claims and beliefs, and that’s when supplements become dangerous. If you have more questions, reach out to Preston Performance for a consult! We can discuss anything and everything that’s on your mind. We want to ease any hesitation or settle any inner disputes you might have. To anyone now sold on creatine, good luck with your experience! I hope you’re a Responder and see all the benefits we expect. To athletes realizing creatine isn’t for you, DON’T WORRY! We’ve got plenty of other ergogenic aid articles coming down the pipeline.

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Works Cited

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• Burke, L. (2007). Practical Sports Nutrition. Champaign, IL: Human Kinetics.

• Butts, J., Jacobs, B., & Silvis, M. (2018). Creatine Use in Sports. Sports health, 10(1), 31–34. https://doi.org/10.1177/1941738117737248

• Clark, N. (2014). Nancy Clark's Sports Nutrition Guidebook (5th ed.). Champaign, IL: Human Kinetics.

• Hargreaves, M., Spriet, L.L. Skeletal muscle energy metabolism during exercise. Nat Metab 2, 817–828 (2020). https://doi.org/10.1038/s42255-020-0251-4

• Kerksick CM, Wilborn CD, Roberts MD, et al. ISSN exercise & sports nutrition review update: research & recommendations. J Int Soc Sports Nutr. 2018;15(1):38. Published 2018 Aug 1. doi:10.1186/s12970-018-0242-y

• Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance [published correction appears in J Acad Nutr Diet. 2017 Jan;117(1):146]. J Acad Nutr Diet. 2016;116(3):501-528. doi:10.1016/j.jand.2015.12.006