Creatine is Having a Moment

Creatine has been on the market for decades.  Well-researched for decades.  Established as safe and effective, for decades.   So I don’t know why it’s having its moment in the sun right now.  Why the New York Times and the BBC covered it within a week of each other this May.     

But here we are.  And here it is.  And here I am, writing about creatine again.   

First, we’ll talk about what creatine is (and is not).  We’ll talk about how creatine works.  Then we’ll jump into what creatine does: support strength and fitness, add nourish the brain

What is Creatine?   

Let’s start by dispelling some myths.  Creatine has been called a steroid (it isn’t).  It has been called a stimulant (it is not).  It has been called a testosterone booster (it is not; it has zero hormonal activity).  My best guess is that creatine originally came to market through bodybuilders and football players, and that triggered some stereotypes.   There’s no basis in reality for any of these scares.   

Creatine is a simple, safe, natural substance.  We both get it from the diet (mostly meat), and make it in our bodies.  On average, without supplements, we get around 2 grams a day.   

Who is Creatine For?  

A lot of the original research on creatine vs. physical function focused on college football players, weight lifters, etc.  Almost exclusively male.   

However, creatine can be for everyone.  There’s nothing gendered about it.  It’s not going to turn female (or male) users into ungainly hulking giants.  It can build strength for regular people who try to exercise sometimes.  Plenty of research now looks at adults over 50, and senior citizens who don’t exercise.  We see benefits in people with low muscle mass.  We see benefits in neuromuscular disorders.  The brain benefits are also available to everyone. 

But what is it – how does it work – and what does it do? 

To answer that, we need to talk biochemistry.  And we need to talk about how creatine relates to one of the most important molecules in the body: adenosine triphosphate, or ATP.  You probably know that protein, fats, and carbohydrates all have calories, which is to say energy.  Well, before that energy can fuel our cells, it has to be converted into ATP.  In other words, ATP is the common energy currency in the body.  Like I said: important. 

For something so important, we have surprisingly little of it.  Our muscles only hold  enough for 4-6 seconds of maximal exertion.  That’s not as dire as it sounds, because we’re constantly replenishing it.   Except during intense exertion, when we can’t replenish it fast enough. 

Normally, we replenish ATP through a process called aerobic metabolism – metabolism with oxygen.  However, we can only deliver oxygen to the tissues so fast.  When our energy needs outpace that delivery, our cells switch to anaerobic metabolism – metabolism without oxygen.  This buys us some time, but at a cost.  Anaerobic metabolism is exponentially less efficient, and throws off a waste product called lactic acid, which makes muscles achy and sore. 

Here’s where creatine comes in.  Creatine recharges ATP.   Remember, our ATP reservoir holds enough for 4-6 seconds of maximal exertion.  Creatine can add an extra 5-10 seconds before we’re pushed into anaerobic metabolism.  (Of course, it ends up being more than that, because we’re refilling the reservoir while we’re emptying it).   

Let’s put this in perspective: a few more seconds is useless in the context of a marathon.  But it can make all the difference in the world if you’re trying to add 3-4 more reps to your workout.  Or to hold the offensive line in football.  Or to struggle from point A to point B if you’re in a  weakened state.  And since creatine regenerates just like ATP, you get your “extra seconds” back during little periods of rest in between bouts of exertion.  Again, great for strength training and football; less so for marathons. 

Creatine and Physical Performance 

Down to brass tacks, creatine may get us a few extra reps, or a little extra power at the gym.   Creatine makes us stronger, and adds to our endurance, but only as long as we’re taking it.  Soon after we stop taking it, those benefits evaporate.  BUT – and this is an important “but” – if you use those temporary increases in strength to work out harder, you translate those temporary gains to real, lasting ones.  Short-term creatine supplementation may increase strength and performance increases around 5-10%.  Using it combined with strength training for 1-3 months may show increases up to 20%.  We also see increases in lean muscle.   

Beyond athletics, creatine can help weekend warriors, and even those of us who aren’t warriors at all.  There’s a standard test, often applied to elderly folks, called the Sitting-to-Standing Test.  You sit in a chair, stand up, sit back down, etc…  People are scored on how fast they can do it, how steady or unsteady they are… Creatine improves function even here.   

Creatine and the Brain 

There’s a lot of research here, but it’s not quite as overwhelming or conclusive as the research on physical function.  A large recent meta-analysis (statistical summary) of 16 clinical trials showed benefit across a number of cognitive abilities.  The researchers conclude that the evidence is reasonably strong that creatine can improve memory; a little weaker on attention time and processing speed.   There was no benefit on executive function or overall cognitive function.  On average, people seemed a little likely to do better with creatine if they had preexisting problems or disorders.  

How Much to Take 

When I first learned about creatine in 1999, I was taught to use loading doses of 20 g a day for 1 week, then go down to 5 g a day.  These days, we tend to forego loading doses, and just take ~5 g a day for athletic performance, 5-10 for cognitive benefits.  Usually, initial benefits will be noticed within a week. 

Safety and Side Effects 

Creatine is remarkably safe.  In theory, you may want to approach it with just a little caution if you have preexisting kidney impairment.  The major side effect is, creatine can hold a little more water in the muscle cells.  This may make you 1 or 2 pound heavier.   Considering the water  gathers where the muscles are, this is usually a cosmetic bonus.  However, that extra weight may do more harm than good in some endurance sports.  Again, not the best supplement for running marathons.