In recent years, one supplement that has become very popular among body builders is Creatine. One reason for this popularity is that there are a large number of bodybuilders who swear by the effectiveness of Creatine supplements. In addition to this, some studies have also shown that Creatine can be very effective in achieving bigger muscle mass. However, not everyone fully appreciates what Creatine is and what it can do for their bodies. Given this, there is a need for people to be informed on Creatine so that they would be aware not only of what it can do for the body but also to help people know how to manage how they use Creatine supplements to achieve optimal results.
The International Society of Sport Nutrition (2007) recently published a very favorable position paper regarding Creatine supplementation, its use, and the effects on exercise. The following 9 points summarize the position of the ISSN :
- 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.
- Creatine monohydrate supplementation is not only safe, but possibly beneficial in regard to preventing injury and/or management of select medical conditions when taken within recommended guidelines.
- There is no scientific evidence that the short- or long-term use of Creatine monohydrate has any detrimental effects on otherwise healthy individuals.
- If proper precautions and supervision are provided, supplementation in young athletes is acceptable and may provide a nutritional alternative to potentially dangerous anabolic drugs.
- At present, Creatine monohydrate is the most extensively studied and clinically effective form of Creatine for use in nutritional supplements in terms of muscle uptake and ability to increase high-intensity exercise capacity.
- The addition of carbohydrate or carbohydrate and protein to a Creatine supplement appears to increase muscular retention of Creatine, although the effect on performance measures may not be greater than using Creatine monohydrate alone.
- The quickest method of increasing muscle Creatine stores appears to be to consume ~0.3 grams/kg/day of Creatine monohydrate for at least 3 days followed by 3–5 g/d thereafter to maintain elevated stores. Ingesting smaller amounts of Creatine monohydrate (e.g., 2–3 g/d) will increase muscle Creatine stores over a 3–4 week period, however, the performance effects of this method of supplementation are less supported.
- Creatine products are readily available as a dietary supplement and are regulated by the U.S. Food and Drug Administration (FDA). Specifically, in 1994, U.S. President Bill Clinton signed into law the Dietary Supplement Health and Education Act (DSHEA). DSHEA allows manufacturers/companies/brands to make structure-function claims; however, the law strictly prohibits disease claims for dietary supplements.
- Creatine monohydrate has been reported to have a number of potentially beneficial uses in several clinical populations, and further research is warranted in these areas.
As you can see, there are many positives to Creatine supplementation. In this article, the points listed above will be expanded upon in more detail, describing the benefits of Creatine and also talking about possible negative effects of Creatine.
What is Creatine?
Creatine is created in the human body from multiple amino acids which include methionine, glycine and arginine. [3,5] A person’s body, on average, contains about 120 grams of Creatine [3,5] stored as Creatine Phosphate (CP). There are certain foods which contain high amounts of Creatine such as red meat, and fish . However, in order to equal what can be obtained in one teaspoon of powdered Creatine, a person would have to eat tons of these foods to obtain the same amounts . A normal diet consists of approximately 1-2 grams per day of Creatine ingestion through foods. [1,5]
How Does Creatine Work?
Creatine is related directly to Adenosine Triphosphate (ATP). ATP is formed in the mitochondria, the powerhouses of the cell. ATP is used for energy by every cell in our bodies. [1,5] During short maximum effort exercise such as weight training or sprinting, ATP stored in the cells is the dominant energy source. However, levels of stored ATP are depleted rather quickly. To provide energy, ATP loses a Phosphate molecule and transforms into Adenosine Diphosphate (ADP). At this point, the ADP must be converted back to ATP to create energy from this energy system. [1,3,5]
After the stored ATP is depleted, it can be revitalized by Creatine, in the form of Creatine Phosphate. As exercise reaches 70% VO2max, muscle Creatine Phosphate content begins to decline.  Creatine works to help generate energy. That is, the CP contributes a Phosphate to the ADP making it ATP again. An elevated volume of CP means quicker and greater recharging of ATP and, therefore, more work can be performed for a short duration, such as sprinting, weight lifting and other explosive anaerobic exercise since ATP is the energy used for these events. [1,3,5]
What Are The Benefits Of Creatine?
There are many positive benefits of Creatine supplementation. One of the biggest benefits of Creatine (and one of the biggest reasons people use Creatine) is that when supplementing for just a short period (6 days with 20g), weightlifters see results. [1,2,3,5] Resistance training becomes more efficient by increasing body mass, overall maximal strength of muscles, and weight lifting performance. [3,5] Keep in mind though, that each person is different, and your mileage may vary.  Studies have also shown that using Creatine derivatives, such as Creatine Ethyl Ester , serum formulations , and Effervescent Creatine  do not provide any additional benefits than regular Creatine supplements.  Save your money!!!
Another effect of Creatine may be an increase in protein synthesis and increased cell hydration.  This would relate to the additional water intake needed during Creatine supplementation, as well as a slight gain in water weight. Creatine has shown positive results in affecting performance in endurance sports such as swimming, rowing, long distance running and cycling , with some studies showing no positive effects on performance in endurance athletes.  Similarly, with sports such as tennis, studies have shown no realized benefit to supplement with Creatine.  Whether or not the failure of Creatine to improve performance in endurance athletes was due to the nature of the sport or the design of the studies is still being debated. 
Creatine, in a recent study, showed a Glycogen sparing effect in rats during a 5-day supplementation period.  Since the body is using less glycogen, the anaerobic-glycolytic energy system is used less during bouts of intermittent exercise.  This increases the muscles ability to do more work than without the Creatine supplementation. In another study, it was shown that Creatine increased the amount of Glucose oxidation in muscles and a reduction of the amount of lactate produced by exercise in rats. [4,6] This also increases the amount of work the muscles can do before exhaustion.
Creatine when combined with carbohydrates has also showed an increased rate of recoverability of muscle tissue after exercise-induced muscle damage better than just carbohydrates alone.  This shows that Creatine supplementation can also help muscles recover from injury quicker and get muscles back to their full working state. Another study also shows that combining Creatine with carbohydrates results in greater post-exercise muscle Glycogen accumulation than just carbohydrates alone. 
What Are The Negative Effects Of Creatine?
There have been many concerns raised by today’s media that Creatine has several negative effect on supplement users. These potential effects include kidney and liver damage, gastrointestinal diseases, excessive cramping, and several others.  There has been much concern about theoretical negative effects of high dosages of Creatine ingestion on kidney and liver function because of the high excretion rates. Thus far, no negative side effects have been observed. [5,8] While users may exhibit these symptoms, literature suggests that they had no greater risk, and possibly lower risk, of those who do not use Creatine as a supplement .
There have been reports of gastrointestinal disturbances and muscle cramps in healthy individuals, but the effects have been negligible [5,8], and usually are caused by inadequate supplies of water when supplementing with Creatine. Drinking plenty of water is a necessity when using a Creatine supplement.
Another big concern is that the effects of long term Creatine usage are currently not known.  However, we can say the same about many prescription drugs currently in use for treating many different diseases. Widespread use of Creatine started in the early 1990’s. Since then, hundreds of peer-reviewed studies and reports on Creatine have been performed, with none of them reporting detrimental side effects.  Currently, long-term researchers are just starting to release their reports on long-term use, and no far there have been no observed long-term effects of Creatine use.  These long-term studies are bringing new uses of Creatine into the light, such as treatments for Muscular Dystrophy [1,5] and high cholesterol among others. 
Can Creatine Help Treat Diseases?
As previously stated, many of the long-term studies of Creatine supplementation have brought about several possible uses for Creatine other than an ergogenic aid. As cells get older, there is an increase in oxidative stress coupled with a cell’s inability to produce essential energy molecules such as ATP. This is common in an aging cell and is a symptom of many diseases. [1,5] Based on the findings that Creatine supplementation may reduce glucose oxidation [4,6], Creatine may be a great way to decrease this oxidation, along with an antioxidant regimen.
According to a recent study , “dietary supplementation with Creatine has been shown to enhance neuromuscular function in several diseases. Recent studies have suggested that Creatine can be beneficial in patients with Muscular Dystrophy and other mitochondrial cytopathies, and may attenuate sarcopenia and facilitate rehabilitation of disuse atrophy”.
There are other reported possible cases where Creatine supplementation can help treat symptoms of diseases, such as pulmonary disease, high cholesterol and brain/spinal cord injuries.  Although more research in these areas is needed, there seems to be a therapeutic benefit in certain populations. 
In conclusion, Creatine supplementation is one of the safest, most productive ergogenic aids you can buy for the money. It has many valuable positive effects, with virtually no detrimental side effects. If you are looking for that added “edge”, talk to your local performance nutrition specialist and find out more about Creatine supplementation.
- Creatine Monohydrate as a Therapeutic Aid in Muscular Dystrophy. Pearlman, Jared P., and Roger A. Fielding. Nutrition Reviews 64.2 (2006): 80. MasterFILE Premier. EBSCO. Web. 5 Nov. 2010.
- Effect of 28 days of Creatine ingestion on muscle metabolism and performance of a simulated cycling road race. Robert C Hickner, David J Dyck, Josh Sklar, Holly Hatley, and Priscilla Byrd J Int Soc Sports Nutr. 2010; 7: 26. Published online 2010 July 7.
- The effects of Creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle Creatine levels. Mike Spillane, Ryan Schoch, Matt Cooke, Travis Harvey, Mike Greenwood, Richard Kreider, and Darryn S Willoughby J Int Soc Sports Nutr. 2009; 6: 6. Published online 2009 February 19.
- Creatine supplementation increases glucose oxidation and AMPK phosphorylation and reduces lactate production in L6 rat skeletal muscle cells. Rolando B Ceddia and Gary Sweeney J Physiol. 2004 March 1; 555(Pt 2): 409–421. Published online 2004 January 9.
- International Society of Sports Nutrition position stand: Creatine supplementation and exercise. Thomas W Buford, Richard B Kreider, Jeffrey R Stout, Mike Greenwood, Bill Campbell, Marie Spano, Tim Ziegenfuss, Hector Lopez, Jamie Landis, and Jose Antonio J Int Soc Sports Nutr. 2007; 4: 6. Published online 2007 August 30.
- Creatine supplementation spares muscle glycogen during high intensity intermittent exercise in rats. Hamilton Roschel, Bruno Gualano, Marcelo Marquezi, André Costa, and Antonio H Lancha, Jr. J Int Soc Sports Nutr. 2010; 7: 6. Published online 2010 January 29.
- Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. Matthew B Cooke, Emma Rybalka, Andrew D Williams, Paul J Cribb, and Alan Hayes J Int Soc Sports Nutr. 2009; 6: 13. Published online 2009 June 2.
- Adverse Effects of Creatine Supplementation: Fact or Fiction. Jacques R. Poortsman Sports Medicine 2000;30:3 pp 155-170
- The effects of Creatine supplementation on selected factors of tennis specific training B M Pluim, A Ferrauti, F Broekhof, M Deutekom, A Gotzmann, H Kuipers, and K Weber Br J Sports Med. 2006 June; 40(6): 507–512.