[Craig Kleinberg is an Exercise Physiology master’s student at the University of North Carolina and is an Athletic Development Intern at Athletic Lab.]

Along with whey protein, creatine is one of the most researched performance supplements on the market. The science is pretty clear, yet there is still much confusion over the safety of this supplement. The official position of the International Society of Sports Nutrition states that there are little to no detrimental effects from supplementation and that it is one of the most beneficial aids for high intensity exercise capacity (1). Not only does strength improve, but there are also reports of up to a 30% increase in training volume (2,3). Additionally, supplementation has been shown to increase bone mineral concentration and density, thereby decreasing the risk of fractures that may eventually lead to bed rest and potentially mortality (4).

Not only does creatine benefit the musculoskeletal system, there is a host of benefits for the brain. Studies show that upon activation of the brain, ATP remains constant but there is an immediate drop in phosphocreatine indicating an increased demand for energy (5). Similar to skeletal muscle, the energy byproduct lactate accumulates leading to decreased performance on cognitive tasks, also known as mental fatigue (6). Supplementation with creatine has been shown not only to decrease mental fatigue, but also increase performance on cognitive tasks (8,9).

Where creatine really shines is the research starting to show improved recovery from traumatic brain injuries. Due to some obvious ethical issues, a majority of studies have been done in rat models, but the results look promising. To simplify the science, upon impact, there is a brief decrease in blood flow to injured area of the brain. This decrease in blood flow does not allow for the cells to meet the energy demand, and eventually this leads to cell death. Creatine helps stabilize the cell membrane and provides an energy buffer thereby preventing the signaling for apoptosis or cell death (O’Gorman et al. ; Sullivan et al. 2000).

The only question left is how to supplement creatine. There are two common supplementation protocols. The first will provide more immediate results, but you may experience water retention and corresponding weight gain. Typically this is not permanent and you should return to normal shortly after completing the loading. The second protocol takes about a month for complete saturation, but weight gain/water retention will be minimal. Protocols are as follows:

Loading/Maintenance Protocol

  • Loading Phase (5-7 days): 15-20g creatine split into even doses throughout the day
  • Maintenance Phase (Continued): 5g creatine with a meal
  • Low Dose Protocol
    • 5g/day with a meal
    • Continue supplementation as long as desired

Here are some take-home points:

  • Creatine is safe and effective
  • Increased strength and training volume (up to 30%)
  • Potential increased in bone mineral concentration/density
  • Energy buffer in the brain leading to
    • Decreased lactate accumulation leading to mental fatigue
    • Improved performance on cognitive tasks
  • Decreases damage and improve recovery from traumatic brain injury

 

References:

1.) Buford, Thomas W., Richard B. Kreider, Jeffrey R. Stout, Mike Greenwood, Bill Campbell, Marie Spano, Tim Ziegenfuss, Hector Lopez, Jamie Landis, and Jose Antonio. “International Society of Sports Nutrition Position Stand: Creatine Supplementation and Exercise.” Journal of the International Society of Sports Nutrition 4.1 (2007)

2.) Chrusch, Murray J., Philip D. Chilibeck, Karen E. Chad, K. Shawn Davison, and Darren G. Burke. “Creatine Supplementation Combined with Resistance Training in Older Men.” Medicine & Science in Sports & Exercise 33.12 (2001): 2111-117.

3.) Gotshalk, Lincoln A., Jeff S. Volek, Robert S. Staron, Craig R. Denegar, Fredrick C. Hagerman, and William J. Kraemer. “Creatine Supplementation Improves Muscular Performance in Older Men.”Medicine & Science in Sports & Exercise 34.3 (2002): 537-43.

4.) Chrusch, M. J., P. D. Chilibeck, K. E. Chad, K. S. Davison, and D. G. Burke. “Effect Of Creatine Supplementation Combined With Resistance Training On Whole Body Bone Mineral In Older Men.” Medicine & Science in Sports & Exercise 33.5 (2001): S17

5.) Rango M, Castelli A, Scarlato G. Energetics of 3.5 s neural activation in humans: a 31P MR spectroscopy study. Magn Reson Med 1997;38:878 83.

6.) Frahm, Jens, Gunnar Krüger, Klaus-Dietmar Merboldt, and Andreas Kleinschmidt. “Dynamic Uncoupling and Recoupling of Perfusion and Oxidative Metabolism during Focal Brain Activation in Man.” Magnetic Resonance in Medicine 35.2 (1996): 143-48.

7.) Ferrier CH, Alarcon G, Glover A, Koutroumanidis M, Morris RG, Simmons A et al (2000) N-acetylaspartate and creatine levels measured by (1)H MRS relate to recognition memory. Neurol- ogy 55(12):1874-1883.

8.) Watanabe, Airi, Nobumasa Kato, and Tadafumi Kato. “Effects of Creatine on Mental Fatigue and Cerebral Hemoglobin Oxygenation.” Neuroscience Research 42.4 (2002): 279-85.

9.) O’gorman, Eddie, Giesela Beutner, Max Dolder, Alan P. Koretsky, Dieter Brdiczka, and Theo Wallimann. “The Role of Creatine Kinase in Inhibition of Mitochondrial Permeability Transition.” FEBS Letters414.2 (1997): 253-57.

10.) Sullivan, Patrick G., Jonathan D. Geiger, Mark P. Mattson, and Stephen W. Scheff. “Dietary Supplement Creatine Protects against Traumatic Brain Injury.” Annals of Neurology 48.5 (2000): 723-29.