Creatine is one of the most talked about and widely used supplement in the health and fitness industry. However, what exactly is creatine? “Creatine is an amino acid compound”2, that is commonly found in red meat, seafood, pork, and poultry. “Dietary intake of creatine varies, but, in meat-eaters, averages 1-2g per day. Your body primarily stores creatine in your skeletal muscles, with the small remaining amounts being stored in the brain, heart, and testes.

            So, if creatine is so popular why would anyone take it? There are tons of benefits from supplementing creatine such as; “enhancing athletic and physical performance, but also improve bioenergetics of exercise training, improve body composition, attenuate muscular atrophy and recovery from injury, attenuate exercise induced muscle damage, enhance cognitive function, and function as a neuroprotective agent in athletes”.2

            When creatine is broken down in the body, “the energy released by breaking its high-energy phosphate bond can be used to add the phosphate group to adenosine diphosphate”2, thus giving us adenosine triphosphate, our body’s natural energy currency. In relation to improving athletic performance, creatine has shown to improve numerous factors which contribute to this outcome such as; “lean muscle mass, and improvement in body composition, muscle strength, weightlifting performance, growth factor/gene expression, muscle fiber size (hypertrophy), glycogen synthesis and storage capability, satellite cell number, intramuscular and intracellular water, and sprint performance”.2

            Creatine can be extremely beneficial to not just your skeletal muscles, but your brain as well! According to Patel et. al, 2019, roughly less than five percent of total creatine resides in the brain. Even though the brain only accounts for two percent of your body’s total mass, it is responsible for twenty percent of your basal metabolic rate (the rate at which your body uses energy for vital functions such as breathing and staying warm), and brain creatine is vital in regards to energy production in the brain.2 Anytime there is decreased energy production or a increase in demand for energy, creatine can intervene in the brain the same way it does in our muscles by rapidly supplying it with more ATP. Creatines beneficial effects on the brain appear to be inflated in certain people that tend to face stressful situations that tend to lead to acute decrease of brain creatine (e.g., mental fatigue, exhaustive exercise).2 If we are suffering from mental fatigue that is onset by exercise, your physical fatigue will be exacerbated. Shallow levels of creatine have been associated with the onset of severe fatigue, and increasing the brains supply of creatine through supplementation may reduce or delay mental fatigue similarly to muscular fatigue.2

            Despite the hundreds of studies regarding creatine being safe, there are still many controversial claims from the media and rare case reports that detail adverse effects that say otherwise. Some of the wild claims that have been reported in regards to; “dehydration, muscle cramps, kidney damage, GI issues, long-term supplementation, increased body weight, youth athlete supplementation, and compartment syndrome”.2 There has been no evidence or studies suggesting that creatine causes dehydration, muscle cramps, or kidney damage.

Regarding Gastrointestinal issues, some have reported issues such as nausea or diarrhea, but evidence point towards mistimed or improper dosing of the creatine protocol.2 Long-term studies have reported no variation in health status.

During the initial/loading phase of creatine supplementation, intracellular water is increased which can cause a minor weight gain of up to 2.7kg per body weight. This can have an impact on the performance of athletes who compete at a specific body weight/size in certain sports such as wrestling, or mixed martial arts.

There are no peer-reviewed studies that show creatine supplementation to be harmful to youth. Although it appears safe to youth, some special considerations is necessary to follow before giving your child the go ahead; “the athlete is past adolescence and participating in exercise training that may benefit from supplementation with creatine, the athlete is eating a nutritious, well-balanced diet, the athlete and their parents understand the effects of creatine supplementation and approve of it, supplementation is supervised by the athlete’s parents, trainers, coaches, and physician and they are well versed in the appropriate dosing and timing protocol, a high quality third-party tested supplement is used, and the athlete abides by the appropriate supplement protocol and dose”.2

“Compartment syndrome is defined as a painful condition that occurs when pressure within the muscles build to dangerous levels”.1 Due to the increase of intracellular water caused by creatine supplementation, it can result in increased anterior compartment pressures at rest and after exercise.2 If the compartment pressure lasts potential side effects include, “a burning sensation, tightness, cramping, or aching over the affected area”.1 “Even though creatine may contribute to an increase of anterior compartment pressure, current literature suggests that athletes have no greater risk of these symptoms as increases in compartment pressure have been exhibited without creatine supplementation”.2

“To this day, creatine is recognized as the most extensively studied scientifically validated nutritional ergogenic aids for athletes”2 Supplementation of creatine may play a role in not only improving athletic performance, but also recovery, and improvement of brain cognition and functioning. It is also important to remember that supplementation can be utilized in numerous ways but is not always warranted for every athlete. It is our job as strength coaches to be aware of our athletes that could benefit from it.

References

1.      N/A. “Compartment Syndrome - OrthoInfo - AAOS.” OrthoInfo, 2009, orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/.

2.      Patel, Pratik. “Creatine Supplementation for Athletes.” National Strength and Conditioning Association (NSCA), NSCA, 15 Nov. 2019, www.nsca.com/education/articles/nsca-coach/creatine-supplementation-for-athletes/.