Creatine is one of the most popular and commonly used sports supplements available today. According to the International Society of Sports Nutrition, creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training. Recent opinions by the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine on nutrition for athletic performance all drew similar conclusions. 1, 18, 19, 20
Aside from improving exercise performance, a number of health-boosting proprieties and clinical applications of creatine supplementation have been studied. These studies provide a large body of evidence that creatine may play a role in preventing and/or reducing the severity of injury, enhancing rehabilitation from injuries, improving mental performance, decreasing fatigue, and protecting cardiovascular health. In addition, creatine may represent a potential adjunctive therapeutic supplement to treat a number of diseases including neurodegenerative diseases (e.g., muscular dystrophy, Parkinson’s, Huntington’s disease), diabetes, osteoarthritis, fibromyalgia, aging, brain and heart ischemia and depression.18
CREATINE IMPROVES PHYSICAL PERFORMANCE
Short-term creatine supplementation has been found to increase maximal power/strength by 5–15%, increase work performed during sets of maximal effort muscle contractions by 5–15%, and increase work performed during repetitive sprint performance by 5–15%. 1, 4, 18
Meanwhile, long-term creatine supplementation has been reported to improve the overall quality of training, leading to 5 to 15% greater gains in strength and performance. 1, 4, 18
Potential ergogenic benefits of creatine supplementation: 1-13, 18, 19, 20
- Increased single and repetitive sprint performance,
- Increased work performed during sets of maximal effort muscle contractions,
- Increased muscle mass & strength adaptations during training,
- Enhanced glycogen synthesis,
- Increased anaerobic threshold,
- Possible enhancement of aerobic capacity via greater shuttling of ATP from mitochondria,
- Increased work capacity,
- Enhanced recovery,
- Greater training tolerance.
In addition, studies indicate that creatine supplementation may increase body mass by about 1 to 2 kg in the first week of loading, while in longer term, subjects taking creatine supplements typically gain about twice as much body mass and/or fat free mass than non-supplemented subjects. 1, 4, 13
CREATINE IMPROVES MENTAL PERFORMANCE
Creatine is involved in brain and neural function and bioenergetics. Its effects on neurological and cognitive function have been extensively investigated. 13, 14, 15, 16, 17 It has been found that higher brain creatine is associated with improved neuropsychological performance, and creatine supplementation has been shown to increase brain creatine and phosphocreatine. 21
A controlled trial led by researchers at the University of Sydney found that oral creatine supplementation (5 grams/day for six weeks) improved intelligence test scores, and working memory performance. 14
Studies have demonstrated that cognitive processing, that is either experimentally (following sleep deprivation) or naturally (due to aging) impaired, can be improved with creatine supplementation. 21 In a study published in Neuroscience Research, creatine supplementation (8 grams/day for 5 days) reduced mental fatigue when subjects repeatedly perform a simple mathematical calculation. 15
INJURY PREVENTION AND REHABILITATION
In two separate studies specifically designed to assess the safety of creatine supplementation, researchers found that American collegiate football players supplementing with creatine experienced less incidence of cramping, heat illness/dehydration, muscle tightness, muscle strains/pulls, non-contact injuries and total injuries/missed practices than those not taking creatine. 18, 22, 23
In a study published in the Journal of the International Society of Sports Nutrition, researchers found an improved rate of recovery of knee extensor muscle function after injury. 24
In addition, it has been found that creatine may exert a beneficial effect even after an injury has happened. Researchers showed that creatine supplementation attenuated the loss in muscle mass and strength during periods of physical inactivity and immobilization. 25
CREATINE PROTECTS THE HEART
Elevated LDL-cholesterol and triglyceride levels are considered independent risk factors for cardiovascular disease. In this regard, creatine supplementation has been reported to help lower cholesterol and triglyceride levels. 18, 26, 27
In a study from Texas Woman’s University, men and women ranging in age from 32 to 70 years. received either a creatine supplement (5 g of creatine) or placebo for 56 days. Significant reductions in plasma total cholesterol, triacylglycerols and VLDL-hoclesterol occurred within the creatine group. 26
Another risk factors for cardiovascular disease is elevated homocysteine levels. Studies of the general population have suggested that high homocysteine levels are associated with cardiovascular morbidity and mortality. According to some new evidence creatine supplementation may reduce homocysteine levels, and may help with cardiovascular protection. 18, 28
A growing body of evidence supports the notion that creatine supplementation may improve health status and daily functioning in aging individuals. In this regard, the position stand of the International Society of Sport Nutrition lists the following potential benefits of creatine supplementation: 18
- reduced cholesterol and triglyceride levels,
- reduced fat accumulation in the liver,
- reduced homocysteine levels,
- improved antioxidant capacity,
- enhanced glycemic control,
- slower tumor growth in some types of cancers,
- increased strength and/or muscle mass,
- minimized bone loss,
- improved functional capacity in patients with osteoarthritis and fibromyalgia,
- improved cognitive function,
- in some instances, improved mood, and anti-depressant effect. 18
In addition creatine has been shown to have beneficial effects on Parkinson’s disease, Huntington’s disease, Alzheimer’s disease, mitochondria-related diseases, muscular dystrophies, amyotrophic lateral sclerosis, ischemic stroke, epilepsy, brain or spinal cord injuries. 29-58
Regarding the safety of creatine, the updated position stand of the International Society of Sports Nutrition concluded that short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly. Moreover, significant health benefits may be provided by ensuring habitual low dietary creatine ingestion (e.g., 3 g/day) throughout the lifespan. 18
- Buford TW, Kreider RB, Stout JR, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition. 2007;4:6. doi:10.1186/1550-2783-4-6.
- Felber S, Skladal D, Wyss M, Kremser C, Koller A, Sperl W. Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31P magnetic resonance spectroscopy study. Neurol Res. 2000;22:145–50. [PubMed]
- Tarnopolsky MA, Mahoney DJ, Vajsar J, Rodriguez C, Doherty TJ, Roy BD, Biggar D. Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology. 2004;62:1771–1777. [PubMed]
- Kreider RB.: Effects of creatine supplementation on performance and training adaptations. Mol Cell Biochem. 2003 Feb;244(1-2):89-94.
- Mujika I, Padilla S, Ibanez J, Izquierdo M, Gorostiaga E. Creatine supplementation and sprint performance in soccer players. Med Sci Sports Exerc. 2000;32:518–25. doi: 10.1097/00005768-200002000-00039. [PubMed] [Cross Ref]
- Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004;14:95–103. [PubMed]
- Theodorou AS, Cooke CB, King RF, Hood C, Denison T, Wainwright BG, Havenitidis K. The effect of longer-term creatine supplementation on elite swimming performance after an acute creatine loading. J Sports Sci. 1999;17:853–9. doi: 10.1080/026404199365416. [PubMed] [Cross Ref]
- Preen D, Dawson B, Goodman C, Lawrence S, Beilby J, Ching S. Effect of creatine loading on long-term sprint exercise performance and metabolism. Med Sci Sports Exerc. 2001;33:814–21. [PubMed]
- Volek JS, Duncan ND, Mazzetti SA, Staron RS, Putukian M, Gomez AL, Pearson DR, Fink WJ, Kraemer WJ. Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Med Sci Sports Exerc. 1999;31:1147–56. doi: 10.1097/00005768-199908000-00011. [PubMed] [Cross Ref]
- Claudino JG, Mezêncio B, Amaral S, et al. Creatine monohydrate supplementation on lower-limb muscle power in Brazilian elite soccer players. Journal of the International Society of Sports Nutrition. 2014;11:32. doi:10.1186/1550-2783-11-32.
- Manna I., Lal Khanna G.: Supplementary Effect of Creatine on Cardiovascular Adaptation and Endurance Performance in Athletes. Indranil and Khanna, Sports Nutr Ther 2016, 1:1 DOI: 10.4172/2473-6449.1000106
- Abdi H., Naghibi SH., Faraeen M., Alizadeh B.: Effects of creatine supplementation and aerobic training on VO2 Max. European Journal of Experimental Biology, 2014, 4(3):336-338
- Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition. 2012;9:33. doi:10.1186/1550-2783-9-33.
- Rae C, Digney AL, McEwan SR, Bates TC. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proceedings of the Royal Society B: Biological Sciences. 2003;270(1529):2147-2150. doi:10.1098/rspb.2003.2492.
- Watanabe A., Kato N, Kato T.: Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res. 2002 Apr;42(4):279-85.
- Andres RH., Ducray AD, Schlattner U, Wallimann T, Widmer HR.: Functions and effects of creatine in the central nervous system. Brain Res Bull. 2008 Jul 1;76(4):329-43. doi: 10.1016/j.brainresbull.2008.02.035. Epub 2008 Mar 24.
- Adhihetty PJ, Beal MF. Creatine and Its Potential Therapeutic Value for Targeting Cellular Energy Impairment in Neurodegenerative Diseases. Neuromolecular medicine. 2008;10(4):275-290. doi:10.1007/s12017-008-8053-y.
- Kreider RB., et al.:. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine Journal of the International Society of Sports Nutrition201714:18 https://doi.org/10.1186/s12970-017-0173-z
- Rodriguez NR, et al. Position of the American Dietetic Association, dietitians of Canada, and the American college of sports medicine: nutrition and athletic performance. J Am Diet Assoc. 2009;109(3):509–27.
- 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. J Acad Nutr Diet. 2016;116(3):501–28.
- Rawson ES1, Venezia AC.: Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Amino Acids. 2011 May;40(5):1349-62. doi: 10.1007/s00726-011-0855-9. Epub 2011 Mar 11.
- Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem. 2003;244(1–2):83–8.
- Greenwood M, et al. Cramping and injury incidence in collegiate football players Are reduced by creatine supplementation. J Athl Train. 2003;38(3):216–9.
- Cooke MB, et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. 2009;6:13.
- Johnston AP1, Burke DG, MacNeil LG, Candow DG.: Effect of creatine supplementation during cast-induced immobilization on the preservation of muscle mass, strength, and endurance. J Strength Cond Res. 2009 Jan;23(1):116-20.
- Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci (Lond). 1996;91(1):113–8.
- Kreider RB, et al. Effects of creatine supplementation on body composition, strength, and sprint performance. Med Sci Sports Exerc. 1998;30(1):73–82.
- Deminice R, et al. Creatine supplementation prevents hyperhomocysteinemia, oxidative stress and cancer-induced cachexia progression in Walker-256 tumor-bearing rats. Amino Acids. 2016;48(8):2015–24.
- Hass CJ1, Collins MA, Juncos JL.: Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair. 2007 Mar-Apr;21(2):107-15.
- Matthews RT1, Ferrante RJ, Klivenyi P, Yang L, Klein AM, Mueller G, Kaddurah-Daouk R, Beal MF.: Creatine and cyclocreatine attenuate MPTP neurotoxicity. Exp Neurol. 1999 May;157(1):142-9.
- Bürklen TS, Schlattner U, Homayouni R, et al. The Creatine Kinase/Creatine Connection to Alzheimer’s Disease: CK Inactivation, APP-CK Complexes, and Focal Creatine Deposits. Journal of Biomedicine and Biotechnology. 2006;2006:35936. doi:10.1155/JBB/2006/35936.
- Prass K1, Royl G, Lindauer U, Freyer D, Megow D, Dirnagl U, Stöckler-Ipsiroglu G, Wallimann T, Priller J.: Improved reperfusion and neuroprotection by creatine in a mouse model of stroke. J Cereb Blood Flow Metab. 2007 Mar;27(3):452-9. Epub 2006 Jun 14.
- Rambo LM1, Ribeiro LR, Oliveira MS, Furian AF, Lima FD, Souza MA, Silva LF, Retamoso LT, Corte CL, Puntel GO, de Avila DS, Soares FA, Fighera MR, Mello CF, Royes LF.: Additive anticonvulsant effects of creatine supplementation and physical exercise against pentylenetetrazol-induced seizures. Neurochem Int. 2009 Sep;55(5):333-40. doi: 10.1016/j.neuint.2009.04.007. Epub 2009 Apr 22.
- Ogborn DI, et al. Effects of creatine and exercise on skeletal muscle of FRG1-transgenic mice. Can J Neurol Sci. 2012;39(2):225–31
- Louis M, et al. Beneficial effects of creatine supplementation in dystrophic patients. Muscle Nerve. 2003;27(5):604–10.
- Banerjee B, et al. Effect of creatine monohydrate in improving cellular energetics and muscle strength in ambulatory Duchenne muscular dystrophy patients: a randomized, placebo-controlled 31P MRS study. Magn Reson Imaging. 2010;28(5):698–707.
- Felber S, et al. Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31P magnetic resonance spectroscopy study. Neurol Res. 2000;22(2):145–50.
- Radley HG, et al. Duchenne muscular dystrophy: focus on pharmaceutical and nutritional interventions. Int J Biochem Cell Biol. 2007;39(3):469–77.
- Tarnopolsky MA, et al. Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology. 2004;62(10):1771–7.
- Adhihetty PJ, Beal MF. Creatine and its potential therapeutic value for targeting cellular energy impairment in neurodegenerative diseases. Neuromolecular Med. 2008;10(4):275–90
- Verbessem P, et al. Creatine supplementation in Huntington’s disease: a placebo-controlled pilot trial. Neurology. 2003;61(7):925–30
- Dedeoglu A, et al. Creatine therapy provides neuroprotection after onset of clinical symptoms in Huntington’s disease transgenic mice. J Neurochem. 2003;85(6):1359–67.
- Andreassen OA, et al. Creatine increase survival and delays motor symptoms in a transgenic animal model of Huntington’s disease. Neurobiol Dis. 2001;8(3):479–91
- Ferrante RJ, et al. Neuroprotective effects of creatine in a transgenic mouse model of Huntington’s disease. J Neurosci. 2000;20(12):4389–97.
- Matthews RT, et al. Neuroprotective effects of creatine and cyclocreatine in animal models of Huntington’s disease. J Neurosci. 1998;18(1):156–63.
- Bender A, et al. Long-term creatine supplementation is safe in aged patients with Parkinson disease. Nutr Res. 2008;28(3):172–8.
- Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair. 2007;21(2):107–15.
- Bender A, et al. Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial. Neurology. 2006;67(7):1262–4.
- Komura K, et al. Effectiveness of creatine monohydrate in mitochondrial encephalomyopathies. Pediatr Neurol. 2003;28(1):53–8.
- Tarnopolsky MA, Parise G. Direct measurement of high-energy phosphate compounds in patients with neuromuscular disease. Muscle Nerve. 1999;22(9):1228–33.
- Tarnopolsky MA, Roy BD, MacDonald JR. A randomized, controlled trial of creatine monohydrate in patients with mitochondrial cytopathies. Muscle Nerve. 1997;20(12):1502–9.
- Andreassen OA, et al. Increases in cortical glutamate concentrations in transgenic amyotrophic lateral sclerosis mice are attenuated by creatine supplementation. J Neurochem. 2001;77(2):383–90
- Choi JK, et al. Magnetic resonance spectroscopy of regional brain metabolite markers in FALS mice and the effects of dietary creatine supplementation. Eur J Neurosci. 2009;30(11):2143–50.
- Derave W, et al. Skeletal muscle properties in a transgenic mouse model for amyotrophic lateral sclerosis: effects of creatine treatment. Neurobiol Dis. 2003;13(3):264–72.
- Drory VE, Gross D. No effect of creatine on respiratory distress in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord. 2002;3(1):43–6.
- Ellis AC, Rosenfeld J. The role of creatine in the management of amyotrophic lateral sclerosis and other neurodegenerative disorders. CNS Drugs. 2004;18(14):967–80.
- Mazzini L, et al. Effects of creatine supplementation on exercise performance and muscular strength in amyotrophic lateral sclerosis: preliminary results. J Neurol Sci. 2001;191(1–2):139–44.
- Vielhaber S, et al. Effect of creatine supplementation on metabolite levels in ALS motor cortices. Exp Neurol. 2001;172(2):377–82.