Creatine: Benefits, side-effects, dosage and research

You have probably heard of creatine in supplement stores and maybe have considered taking it. Generally, creatine is safe to use and may work on your body or not – depending on your existing medications.

As a popular substance, several forms of creatine are produced to allow you to consume it easily; these are widely available on the market, and come in both powder and capsule forms.

Creatine promises to give you more muscle and improve your workout endurance, but before you reach for the creatine supplements, here’s everything you need to know.

What is creatine?

Creatine refers to a nitrogenous organic acid primarily responsible for helping supply energy to muscle cells throughout the body.

This substance works on your body by supplying a high-energy phosphate group to adenosine diphosphate (ADP), turning the ADP molecule into adenosine triphosphate (ATP).

Basically, ATP is a molecule that is responsible for carrying energy within cells, and it is our main source of energy during high-intensity exercise.

When your cells use ATP for energy, it is then converted to ADP. In the process, creatine can accelerate the recycling of ADP into ATP for more energy supply during intense physical activity. 

There are also different types of creatine, like creatine monohydrate and creatine nitrate. This acid can be obtained through food sources, naturally made in your body and supplements.

Among the sources of creatine, supplements are widely used to boost creatine in the body. Some studies suggest that creatine can mainly help people with multiple sclerosis (MS) to exercise, enhance cognitive ability, improve skin aging and treat muscle diseases.

Moreover, there are three amino acids that take up creatine, such as L-arginine, glycine and L-methionine.

One percent of the total volume of human blood is creatine, 95 percent of creatine in the body can be found in skeletal muscle while five percent [1].

Every day, around 1.5 and 2 percent of the body’s creatine store is converted for use by several body organs, such as the liver, the kidneys and the pancreas.

Creatine is transmitted within the blood and used by parts of the body that have high energy demands, specifically the skeletal muscle and the brain [2]. 

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Benefits of creatine

Creatine is popular with people who are in athletics or doing physical activities because of its muscle-improving properties.

There are numerous claims of creatine’s benefits for several purposes, which are supported by research evidence.

This substance can be generally used for body performance for athletes, increase muscle mass for old people and treat problems of a body that cannot metabolise creatine fully. Some other particular benefits of creatine are: 

Improves athletic performance

Consuming creatine by mouth tends to enhance physical performance like rowing, jumping and soccer.

However, taking creatine to help with some activities like sprinting, cycling, swimming or tennis is still not proven.

Creatine supplements are popularly used by athletes because of their effectiveness in high-intensity training, allowing the body to make more energy.

With more energy available, athletes can have better endurance for long and intensive training periods.

For non-athletic people, creatine can also help in boosting the body’s creatine pool and appears to enhance simple physical performance.

A 2003 meta-analysis study published in the Journal of Sports Science and Medicine found that creatine has the potential to enhance performance involving extreme and intense activity in a short period of time, particularly during repeated bouts. However, not all research has obtained the same results about the benefits of creatine [3].

In a more recent study in 2012, it was found that creatine can boost the effects of resistance training, particularly on strength and body mass.

Creatine can increase the quality and benefits of high-intensity intermittent speed training, while in aerobic exercise activities, it can enhance endurance performance that can last more than 150 seconds.

The conclusion also showed creatine might improve daily living performance, fat-free mass, power, strength, power and neurological function [4]. 

Boosts muscle strength

Your muscles can benefit from taking creatine as it boosts their strength in both younger and older adults. However, using creatine topically or through the skin is not yet backed up by research.

Creatine in a supplement form can further help in preventing muscle damage and enhancing the recovery process after having an injury due to intense physical activity.

It also has an antioxidant effect after an intense session of resistance training and can reduce cramping. 

Creatine boosts body strength

Increases body mass

Having increased creatine levels in muscles can also increase body mass. On the other side, a U.S. institution emphasised that creatine does not directly build muscles.

The claim that having high levels of creatine can increase body mass is only due to the substance can cause muscles to hold water [5]. 

Helps with disorders of creatine metabolism or transport

Taking creatine by mouth on a daily basis can increase your creatine levels in the brain, especially for children and young adults with conditions of GAMT deficiency or AGAT deficiency.

However, creatine has a limitation as it is not found to improve brain creatine levels for children with a disorder where creatine is not transported properly.

Helps with creatine and deficiency syndromes

Creatine is a natural substance that is significant for a range of body functions. Typically, there are 120 to 140g of creatine in store or pool in the body of a young man with 70 kilograms (kg) weight.

The amount of creatine in each of us actually depends partly on your muscle mass and the type of muscle fibre. 

Now, creatine deficiency, on the other hand, is associated with a range of conditions, such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), diabetes, fibromyalgia, muscle atrophy, multiple sclerosis (MS) and osteoarthritis.

Hence, taking creatine supplements can ease the conditions of creatine deficiency. However, this is yet to be proven by more research to gather enough evidence [6]. 

Improves creatine and muscular dystrophy

Improving the strength of people with muscular dystrophy may be possible with creatine. In a paper that reviewed 14 studies in 2013, it was found that people with muscular dystrophy who took creatine supplements had increased muscle strength by 8.5 percent in comparison to people who did not take creatine supplements.

Taking creatine every day for 8 to 6 weeks can improve muscle condition and reduce fatigue in patients with muscular dystrophy; however, not all studies have produced similar results [7]. 

Helps people with Parkinson’s disease

In an animal study conducted on mice, creatine was able to prevent the loss of cells that are typically affected by Parkinson’s disease.

It involves a combined treatment of coenzyme Q(10) and concluded that creatine might help treat neurodegenerative diseases, including Huntington’s disease [8].

However, one research with 1,700 human subjects published in JAMA Network suggests that treatment with creatine monohydrate for at least 5 years did not improve clinical outcomes compared with placebo [9]. 

Improves depression symptoms

In one study made in South Korea, there were 52 women with depression participated and took 5g creatine supplements every day as their antidepressant.

As early as 2 weeks, the participants experienced improvements in their symptoms, and this continued up to 4 to 8 weeks [10]. 

Boosts cognitive ability

In one study, the researchers found that creatine can boost mental performance. After taking a creatine supplement of about 5g every day within six weeks, over 45 participants scored better on working memory and intelligence tests, particularly in tasks taken under time pressure, compared to participants who took a placebo [11].

Side-effects of creatine 

Creatine is common in athletes, gym rats and other people who do intense physical activities.

It is generally not for all people as side effects may occur, especially for people with existing medications or allergies.

Hence, it is advisable to seek consultation with your doctor before taking creatine supplements because of their potential for side effects and interactions with medications. Side effects of creatine include:

  • Diarrhoea
  • Dizziness
  • High blood pressure
  • Kidney damage
  • Liver dysfunction
  • Muscle cramps
  • Muscle strains and pulls
  • Stomach upset
  • Weight gain

In addition, if you take creatine and experience the signs of allergic reactions, you may need to get emergency medical help: hives, difficulty in breathing, swelling of your face, lips, tongue or throat.

Furthermore, you need to stop using creatine if you experience worse side effects, as follows:

  • Dehydration symptoms like feeling very thirsty or hot, can’t urinate properly, heavy sweating or hot and dry skin 
  • Heartbeats are pounding fast or fluttering in your chest
  • Trouble breathing
  • Swelling and rapid weight gain
  • Signs of an electrolyte imbalance include dry mouth, increased thirst, drowsiness, restless feeling, confusion, nausea, vomiting, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting or seizure (convulsions)

For people with kidney disease, high blood pressure or liver disease, it is advisable not to take creatine supplements, as they may stop the body from creating its own natural stores. However, researchers still have yet to know the long-term effects.

Moreover, creatine may not be considered effective in enhancing strength or building muscle in elderly people over 60 years old.

Although creatine’s effects on unborn babies are still not known, it is still not recommended to use this product if you are pregnant.

Taking creatine while pregnant may pass the substance to your breastmilk and may harm a nursing baby.

For other side effects that still need research, some health practitioners say that creatine may cause irregular heartbeat or purpuric dermatosis–a skin condition– in some people.

Meanwhile, in another research, it was found significant side effects at the doses used for up to six months.

A breakdown of skeletal muscle tissue, Rhabdomyolysis, and sudden kidney failure was reported in one case involving an athlete taking more than 10g of creatine every day for six weeks.

Reports on contaminated creatine supplements were documented that may cause severe side effects. Hence, only take those that come from established companies. 

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What other drugs will affect creatine?

Taking high amounts of creatine may harm your kidneys. It may worsen if you happen to use other medicines, including:

  • Antivirals and injected antibiotics
  • Chemotherapy
  • Medicine for bowel disorders
  • Medicine to prevent organ transplant rejection
  • Injectable osteoporosis medication
  • Certain pain or arthritis medicines, such as aspirin, Tylenol, Advil and Aleve

Some other drugs may also interact with your creatine intake, especially prescription and over-the-counter (OTC) medicines, vitamins and herbal products. The following also may interact with creatine:

Caffeine

Consuming caffeine may make it hard for your body to use creatine and may increase your risk of dehydration. In fact, using creatine, caffeine and ephedra can increase your risk of having a stroke.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Taking creatine plus these pain relievers may hurt your kidney even further. NSAIDs include ibuprofen such as Motrin and Advil and naproxen like Aleve.

Diuretics (water pills)

Having diuretics with creatine is also not great in combination with your body. It may increase your risk of dehydration and kidney damage.

Cimetidine (Tagamet)

Tagamet with creatine in your body may increase your risk of kidney damage as well.

Probenecid

Treating your gout with probenecid while taking creatine may increase the risk of kidney damage.

It is best to ask your physician before taking creatine supplements as side effects may occur differently to people, especially for those with medications [10]. 

Dosage of creatine 

Creatine supplements can be consumed in different forms, such as powders, capsules, liquids, tablets, energy bars, fruit-flavoured chews and drink mixes.

A normal body can produce creatine as much as it needs; however, if you are lifting heavy weights, doing high-intensity workouts or eating a mainly vegan or vegetarian diet, you may need the additional support of creatine. 

Creatine dosage

You don’t have to take too much creatine to gain muscle growth. Your creatine intake should depend on the amount of muscle mass your body has.

The concept is if you have more muscle, your body can store more creatine. Generally, muscles in a normal body can hold about two to three grams of creatine per kilogram of muscle mass. 

Numerous studies found staying creatine intake in the range of three to 5g per day for maintenance is considered safe.

Higher levels of creatine have also been tested under acute conditions without adverse effects, and the researchers did not find sufficient evidence to determine long-term safety [11].

If you are really interested in taking a higher amount of creatine, you should talk with your doctor or dietitian first to make sure it is fit for your goals and health history. 

How to take creatine?

In paediatrics, creatine supplements are not recommended and prohibited for children or teenagers.

Adults need to ask for the right doses from their doctor. If you want to use creatine supplements to get bigger and stronger muscles, the safe method is through the ‘loading period’, where you gradually increase your creatine intake for a few days or weeks.

It can prime your muscles to get a high amount of creatine that they ‘hold’. You can take five grams of creatine four times with a maximum of 20g a day during the loading period.

After the period, you can then lower the amount of creatine for you to shift to a ‘maintenance’ level of three to 5g per day, as the recommended doses by the International Society of Sports Nutrition.

For example, adults aged 19 and older typically load a dose in exercise performance of around five grams of creatine monohydrate four times daily (20g total every day) for two to five days maximum.

For a maintenance dose in exercise performance at the same age, it is advisable to take two grams on a daily basis.

A normal body can absorb creatine much better when taken with carbohydrates, like fruits, fruit juices and starches.

The mentioned doses were tested frequently in athletes who have intense training on a regular schedule. However, the effects are still not known whether the dosages are similar to non-athletes.

Food sources of creatine

Aside from creatine supplements, there are natural sources of creatine from the food you eat. However, it is essential to note that cooking may lose some creatine in specific food sources.

Creatine can be naturally found in animal-based products; hence, your body can produce plenty of creatine as long as you consistently follow a balanced diet that includes animal-based products.

Protein sources such as beef, chicken, pork and fish can help your body produce the creatine it needs. 

Meats are the number one good food source of creatine, and cooking them too much may cause them to lose their creatine content.

The amount of creatine that will be taken out depends on the type and cut of meat; however, the time you cook the meat should also be considered.

The creatine contents of meats move to their juice during cooking, so it may help to consume them by creating a sauce or pouring it over the meat as you cook it. 

Typically, a 3-ounce serving of meat may have about 0.4 grams (g) of creatine. To be more specific in the amount of creatine, herring fillet in raw and dried forms has 1.1 grams, meats with 0.9 grams are raw beef patties, beef steak gravy with juice cooked from meat, salmon and beef burger, pork has over 0.7 grams, black pudding, blood sausage and dry-cured ham have 0.6 grams and 0.5 grams for top lamb round. 

Moreover, creatine can be produced by the liver and synthesised from amino acids, which are protein building blocks, such as arginine, glycine and methionine.

Some other sources of creatine for vegan and vegetarian people can be through the three amino acids. 

For arginine with creatine, vegetarians may want to eat dairy products like milk and cheese, and for vegans, you should consume seeds like pumpkin and sesame, nuts such as walnuts, almonds and pine nuts, legumes like beans and peas and seaweed.

Glycine can also be consumed through dairy products for vegetarians and seeds like sesame, pumpkin and pistachio, spirulina, seaweed, watercress and spinach for vegans.

Vegetarians can eat eggs, milk and ricotta cheese, and vegan sources are tofu, brazil nuts, white beans and quinoa to get methionine.

Nonetheless, a study has shown that vegetarians tend to acquire lower amounts of creatine in their muscles. Therefore, creatine supplementation can be particularly beneficial for vegan athletes.

Research relating to creatine

Creatine has not been evaluated by the U.S. Food and Drug Association (FDA) for safety, effectiveness or purity.

That is why it is still under supplements rather than medication; the potential risks and advantages of creatine as a medication is not yet known.

Also, there are no regulated and standard manufacturing practices in place for the compounds, resulting in some issues, like creatine herbal and health supplements sold are contaminated with toxic metals or other drugs.

Different creatine supplement products that are sold in commercial stores may vary in the quantity of creatine, quality and additional ingredients; hence, better choose the most trusted. 

In taking creatine, it is best to drink plenty of fluids to prevent dehydration. While taking creatine, you may experience heat-related illnesses, muscle cramps, reduced blood volume and electrolyte imbalances.

Hence, you must follow the instructions on the product label and package. If possible, consult the creatine product that you plan to take; this is to prevent occurrences of medical conditions, allergies or altering your current medications [12]. 

Is creatine safe to take? 

Creatine is truly safe; in fact, it is a well-studied supplement. Several studies have shown that taking creatine will not cause any detrimental health effects with everyday doses of up to 4 to 30 grams within 10 months to 5 years [13]. 

As mentioned earlier, there is a possibility of kidney failure in taking creatine; however, this is only for certain cases associated with certain medications, intake of substances and creatine overdoses.

In a 2011 study of patients with type 2 diabetes, which is basically a condition that impairs kidney function, creatine supplementation of about five grams on a daily basis within 12 weeks showed no harm to their kidney health [14]. 

While the study is beneficial to understanding the impact of creatine on kidney health, especially for vulnerable people, the period of the study is only short-term.

Thus, research studies on the long-term effects of consistent creatine supplementation are still lacking. 

Health experts are still yet to find the negative effects of creatine supplements on some other important body organ systems, including the heart, brain, liver and reproductive organs.

In relation, creatine effects when combined with some other OTC supplements, prescription drugs, vitamins and energy drinks are still not yet known. 

The use of creatine can make you gain weight, according to one study. As creatine is mostly used by athletes, they commonly acquire a negative impact on weight categories when used without proper amounts. It also affects their athletic performance, where the centre of gravity is an important factor.

In a 2003 review paper published by Cochrane, it was found that creatine had no serious health risks when taken moderately, and it is a viable supplement in enhancing physical performance in people who need maximal single effort or repetitive sprint bouts.

In another study four years later, the researchers emphasised that creatine is safe, effective and ethical for consumption.

The International Society of Sports Nutrition (ISSN) even recommended creatine for athletes to acquire an extra amount without consuming more fat or protein, a good alternative for boosting athletic performance [15].

In a more updated statement of ISSN in 2017, the officials concluded that creatine supplementation is still acceptable within recommended doses, especially for short-term use of competitive athletes who are essentially eating a proper, well-balanced diet. In overall conclusion, creatine must be taken appropriately to be considered safe. 

While the ISSN research is relatively on the positive side, one study in 2012 has a different opinion.

The 2012 study researchers cautioned that the ‘safe and ethical’ claim of creatine supplements could potentially change. Its safety is not 100 percent guaranteed with the studies, usually in short-term periods.

Future research on creatine’s effects should look into administering it for long periods of time to different populations. 

The health industry is still in the progress of determining the exact and specific effects of creatine–whether positive or negative–in various instances.

For example, one research suggests that creatine supplements can help in regulating the immune system, improve muscle-wasting diseases and enhance neurological conditions, while other research studies’ results said otherwise.

Hence, more research is still needed to have concrete and exact explanations in supporting the claims. 

Takeaways

While the health industry research studies are still divided about the real effects of creatine, it is recommended to consult your doctor before taking creatine supplements.

You may also try to consider eating food sources of creatine first to boost them in your body for sustainable healthy longevity.

By focusing on the natural process of creatine production in your body, you are lowering your risk of any negative side effects that supplements may have.

If you have decided to consume creatine supplements, take note that the commercial products available in the market have their own formulation that may contain other ingredients; hence, you better check the labels before taking them. 

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[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407788/ 
[2] https://www.webmd.com/vitamins/ai/ingredientmono-873/creatine 
[3] https://www.jssm.org/vol2/n4/1/v2n4-1pdf.pdf 
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407788/ 
[5] https://medlineplus.gov/druginfo/natural/873.html 
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407788/ 
[7] https://www.cochrane.org/CD004760/NEUROMUSC_creatine-for-treating-muscle-disorders 
[8] https://pubmed.ncbi.nlm.nih.gov/19476553/ 
[9] https://jamanetwork.com/journals/jama/fullarticle/2108890 
[10] https://www.mountsinai.org/health-library/supplement/creatine 
[11] https://pubmed.ncbi.nlm.nih.gov/16814437/ 
[12] https://www.drugs.com/creatine.html 
[13] https://www.ncbi.nlm.nih.gov/pubmed/10449011/ 
[14] https://pubmed.ncbi.nlm.nih.gov/20976468/ 
[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048496/

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