Creatine: What you NEED to know

Heard of creatine? Plan on taking it?

It’s one of the most studied sports supplements with countless claims of improved strength, muscle gains, and cognition.

But is it truly worth the hype?

Or does it cause hair loss and damage your kidneys?

In this article, we'll answer these questions, debunk some myths and explore the benefits and side effects.

But first, let’s clear up a couple of misconceptions.

Firstly, it’s not actually a muscle building supplement. (And it’s not an anabolic steroid for those worried parents.)

It’s an energy-boosting supplement and because of this, it can have a muscle building effect.

Essentially: more energy = greater capacity to lift weights in the gym = build more muscle.

So what is creatine?

Creatine is a molecule that is produced in the body from amino acids.

Specifically arginine, glycine and a derivative of methionine.

Amino acids are the building blocks of protein.

It's primarily made in the liver and kidneys and it’s a completely normal part of your metabolism.

Your body makes it every day.

About 1 to 2 grams per day.

And once it’s made, it gets transported to your muscles, heart, brain and other tissues.

Your brain can also make it’s own creatine.

It’s found naturally in foods like red meats and fish.

So if you want to supplement creatine, can you get enough of it from your regular diet?

Typically no.

To get 5 grams for example you’ll have to eat a kilo of steak each day which is obviously difficult to do for most people and expensive. This effect can be compounded if you’re veggie or vegan.

How does it work?

Our bodies use adenosine triphosphate (ATP) as the primary energy currency to fuel various cellular processes, including muscle contractions during exercise.

When we perform high-intensity activities like weightlifting or sprinting, our muscles require a rapid and substantial supply of ATP to meet the increased energy demands.

Now when muscles contract during exercise, ATP is rapidly broken down through a process called hydrolysis.

This occurs when water reacts with ATP, leading to the separation of one of the phosphate groups from the ATP molecule.

As a result the ATP gets converted to ADP or adenosine diphosphate.

This reaction is exergonic, meaning it releases energy.

And this energy release is used to power muscle contractions.

In our muscles, we have limited stores of ATP, which get rapidly depleted during intense exercise.

This is where creatine comes into play.

Creatine is converted to phosphocreatine by an enzyme called creatine kinase.

The reaction is reversible.

The phosphocreatine donates its phosphate groups to ADP leading to the reformation of ATP.

So you get more ATP to power muscle contractions.

And this leads onto the benefits on creatine.

There is a large body of compelling evidence that demonstrates that creatine can improve your power output during resistance exercise.

This can lead to improved high-intensity exercise capacity and lean body mass.

The improvements are most obvious in explosive physical activities that require short to moderate duration bursts of high intensity exertion.

So think weightlifting or explosive movements.

However, creatine supplementation does not confer as much benefit in endurance sports, which don’t rely as heavily on the ATP-creatine phosphate system for short-term energy production.

Creatine’s effects on anaerobic running capacity have been tested in lots of studies, the results of which have quite mixed results but overall they suggest that a small improvement in performance can be found.

The benefits of creatine extend beyond just improving exercise performance.

Studies have shown it can lead to increased muscle mass, enhanced muscle recovery, greater training tolerance and may even have some cognitive benefits like reducing mental fatigue.

I won’t go into huge detail about all the benefits but I’ll link some sources at the end if you want to read more.

Now we know what creatine does, let's discuss dosing.

There’s lots of different types of creatine on the market but creatine monohydrate is the cheapest, most studied and the most effective form.

Doses can vary but you’ll typically see 3 or 5 grams a day advertised as the suggested dose.

And this is probably enough for most people.

But this doesn’t factor in lean mass, activity levels and most importantly, your weight.

Men and women don’t weight the same.

So having a blanket 3 grams per day for everyone doesn’t really make sense...

Taking bigger doses like 7 to 10 grams a day may be more suitable for people with a high amount of muscle mass and high activity levels.

So it’s best to look for the safe upper limit of where you can get the most benefits with the least side effects.

It’s also pretty cheap and affordable which is a bonus.

You also might have heard that you need to “load creatine” if you’re starting to take it.

This is where you take 20 grams a day split into 4 doses for a period of 5 to 7 days.

The basic recommendation is that by loading you can saturate your muscles faster with creatine, leading to quicker benefits.

But there’s actually more evidence indicating that you do not have to ‘load’ creatine.

Lower daily dosages of 3-5 grams of creatine can be just as effective for increasing intramuscular creatine stores and improving muscle performance/recovery.

Also if you take 20-30 grams a day, you might get an upset stomach and this leads onto the side effects.

Lots of human trials with varying doses have been conducted and the main side effects have been limited to stomach disturbances from taking too much creatine at once and cramping, from not hydrating properly.

So yeah, you can get diarrhoea and nausea when too much creatine is taken at once, in which case the doses should be spread out throughout the day and taken with meals.

And going back to the loading protocol, if you think about it, you probably want to take creatine it for the long term benefits, so there’s not much in giving yourself a potentially upset stomach from taking too much each day.

But on the whole, it’s very safe to take.

The other question that gets asked is that does taking creatine lead to water retention?

This idea that taking creatine increases total body water was based on early research showing water retention with high doses of creatine. (Like 20 grams a day for six days.)

So in the short term, yes it can lead you to putting on weight in the first few days.

Creatine is osmotically active.

This basically means that once it’s introduced into muscle cells, it pulls water from the extracellular environment.

And this leads to an increase in the water content within muscle cells.

But this is not actually a bad thing.

About 75% of muscle content is water.

The enhanced hydration can help to with protein synthesis, and improve muscle function and performance.

Also longer exercise training studies (5-10 weeks) with creatine supplementation have shown no significant increases in total body water.

But if you’re competing in a sport that is weight-sensitive like boxing for instance, you might want to avoid taking heaps of creatine in the last week or two of your weight cut.

Separate to the water retention aspect, you might become heavier as a side effect of taking creatine.

Let me explain.

1. You take creatine for a while.
2. Your gym performance improves.
3. You become stronger.
4. Your muscle mass increases.
5. And your weight has increased as a result.

Is this a bad thing? Probably not...

The other question that gets asked is does taking creatine cause kidney damage?

The short answer is no.

Pretty much every single study on creatine supplementation has failed to find any significant damage to kidneys as a result of taking it.

The association probably stems from confusion and a lack of understanding about creatine metabolism.

Creatine is normally metabolised into creatinine, which is eliminated by the kidneys under normal conditions.

When the kidneys don’t function properly and can’t filter the blood as effectively, many metabolites get “backlogged” in the blood.

Creatinine is easy to measure and as because of this, it’s a biomarker of kidney damage.

We use this in a blood test in the hospital and if we see that creatinine levels are elevated, we may suspect some kidney damage.

If you take low-ish doses of creatine like 5 grams or less per day, you probably won’t see an increase in creatinine in normal adults.

But if you take high doses of creatine, you may cause a false positive. Meaning that the increase in creatinine is due to creatine turning into creatinine, which does not signify any actual damage to your kidneys.

The other thing related to this was when I first started taking it a few years ago, common gym chat was to cycle off it to prevent damage to kidneys. You don’t need to do this either. It’s safe for continuous use.

So when is the best time to take creatine?

Some recommend taking it before as a pre-workout while others suggest taking it afterwards.

The answer is it doesn’t actually matter. So long as you take it around to your workout time.

That’s when you’ll get the most benefit, as opposed to taking at other times of the day.

For instance, if you hit the gym in the mornings, you probably want to take it sometime in the morning, as opposed to taking it before you go to bed.

I don’t have a strict regime for this but I usually have mine after my workouts with a protein shake.

Don't stress too much about the perfect timing, just focus on making it a part of your routine.

The next talking point is a common one.

Does taking creatine cause hair loss?

This idea originates from the results of a randomised controlled trial in 2009.

They looked at college-aged male rugby players who took creatine for 3 weeks experienced a 41% increase in their blood levels of DHT relative to their baseline.

As a result, this theory gained momentum.

Regardless of this increase, the results were still well within the normal range of DHT levels.

So what is DHT?

DHT, or dihydrotestosterone, is a metabolite of testosterone.

Its formed through the action of an enzyme called 5-alpha-reductase.

In males, DHT can bind to androgen receptors in hair follicles and cause them to shrink, leading to hair loss.

So inhibitors of this enzyme like finasteride are used to treat hair loss in men.

Also as far as I’m aware, there are no studies looking at the effects of taking creatine on hair loss. It hasn’t been directly studied.

The evidence doesn’t indicate that creatine supplementation directly increases testosterone levels, DHT or even causes hair loss.

Quick summary.

• Creatine is an energy-boosting supplement produced from amino acids and your body makes it naturally.
• Creatine works by improving your power output during resistance exercise, which can lead to putting on muscle mass.
• It can also lead to enhanced muscle recovery, greater training tolerance, and may even have some cognitive benefits.
• Dosing varies from 3-10 grams a day but this varies depending on weight, lean mass, and activity levels. I take around 5 grams a day. Make a judgement call on what you think is best for you.
• It’s also cheap, very safe to take and doesn’t cause hair loss or kidney damage.

Hope this has been useful for you.

A quote from a great

Enjoy the day, it could be your last,

Z

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