Creatine is a nitrogenous organic acid that is made by our liver pancreas and kidneys. It is also available in red meat and fish. We can also obtain it through supplements. In fact, it is one of the most popular performance-enhancing drugs used by athletes and bodybuilders. Various studies have shown that creatine helps increase muscle mass and improve exercise performance (1, 2). Some studies have also suggested that creatine can prevent skin ageing, enhance cognitive ability, treat Parkinson’s disease, muscle diseases and even help treat multiple sclerosis (3, 4).

The supplement is quite readily available at the supermarkets in the form of powders, tablets, energy bars and drink mixes. Though many people believe creatine is unsafe, there is not much scientific evidence to prove this. Let us learn what is creatine, how it works, its uses and side effects.

What is creatine?

Creatine is made up of three amino acids – L-arginine, glycine and L-methionine. Around 95 percent of creatine in the human body is stored in skeletal muscle in the form of phosphocreatine, and the remaining five percent is stored in brain, kidneys and liver (5).

Several factors like meat intake, muscle mass, exercise and testosterone can affect our body’s store of creatine. Creatine helps your muscles to produce energy during training.  This is why many bodybuilders and athletes take creatine supplement to improve their performance.

When you take supplements, you increase your body’s stores of phosphocreatine and this helps our body to produce more adenosine triphosphate (ATP). ATPs are high energy molecules that help our body perform better during exercise.

How does creatine work?

Creatine helps improve strength, increase lean muscle mass and helps muscles recover more quickly after exercise. It increases the phosphocreatine stores in the muscles, which is then used to produce more adenosine triphosphate. ATP is the critical energy source for training and heavy lifting (6).

Creatine helps you to exercise more efficiently and for longer and also aids in muscle growth (7). Creatine supplements can also increase the satellite cell signalling. This helps with the repair of the muscles and new muscle growth (8).

These supplements also cause a rise in hormones like IGF-1 (9). Creatine helps increase the water content in muscle cells which aids in muscle growth. This supplement reduced the muscle breakdown (10).

Myostatin is a protein that can inhibit the growth of muscle. Creatine supplements can reduce the levels of myostatin and hence help in muscle growth (11).

Types of creatine

Here are some of the commonly used creatine supplements:

Monohydrate

You need to take sugar with this supplement for it to be absorbed in the body.

Ethyl Ester

This is a newer version of creatine, and you need not take sugar with it. It is available as a pill and a powder.

Buffered Creatine

Also known as Kre-Alkalyn, this version requires lesser creatine per serving and does not cause any gastric discomfort.

Tri-creatine malate

This supplement is made from three creatine molecules attached to one molecule of malic acid. This supplement is more water soluble than others.

Micronized Creatine

This version of the supplement gets absorbed faster than the others.

Conjugated Creatine

This is the latest version of creatine on the market. It has superior absorption and no side effects.

Effect of creatine on muscle growth

Creatine is beneficial for adding muscle mass. Other than athletes and bodybuilders, it can benefit the elderly and sedentary people.

According to a study, 28 healthy men and women over the age of 65 participated in a resistance training programme that involved exercising three days per week for 14 weeks. Adding creatine supplement to their diet helped these people improve their leg strength and muscle mass (12).

In another trial, 19 bodybuilders were given creatine over a period of 12 weeks. These men increased their muscle fibre growth two or three times than what they would have with exercise alone. Their increase in body mass also doubled (13).

Effect of creatine on exercise performance

Creatine’s effect on ATP stores in the muscles means that it helps to improve our exercise performance (14).

According to a research review, adding creatine to training programme helped increase strength by 8 percent, weightlifting performance by 14 percent and bench press reps by 43 percent (15).

According to another study, when trained athletes were given creatine supplements for 28 days, it improved their bench press performance by 6 percent and bike sprinting performance by 15 percent (16).

Effect of creatine on brain

Creatine supplements are helpful in improving brain functioning. Specific studies have seen that creatine supplementation has a positive impact on working memory and intelligence (17).

Research also suggests that creatine helps in the treatment of Alzheimer’s, Parkinson’s, Huntington’s disease, Ischemic stroke, epilepsy, spinal cord injuries and motor neuron disease (17, 18, 19). Since most of this research has been done on test animals, further human research needs to be done.

One study was done on the effects of creatine on 39 children with traumatic brain injury. The study discovered that there was a 70 percent reduction in fatigue and 50 percent reduction in dizziness due to the creatine supplementation (20).

Studies have also found that creatine can be beneficial for seniors who are at the risk of neurological diseases (21, 22).

Even vegetarians can benefit from the use of creatine. A study found that supplementing improves their memory by 50 percent and intelligence by 20 percent (23).

Other benefits

Though we need further research on these, some studies suggest that creatine can improve glucose tolerance (24). It can also be used to treat fatty liver disease (25).

How much should you take? – Creatine dosage

Creatine is an odourless and tasteless white powder. During the loading phase (first week of use) most manufacturers recommend that you take 20 grams a day split into four five-gram servings (26). If you wish to skip the loading phase, you can take 3 to 5 grams of protein a day. It will take your around four weeks to reach the same levels of creatine store as those who go through loading.

During the maintenance phase (after the first week) take 3 to 5 grams of creatine a day to maintain the elevated levels of creatine in the muscles.

Side effects of creatine

Creatine has been highly researched and is safest and most effective supplements available. There is no evidence to suggest that it has any side effects though some myths are surrounding this supplement (27).

There is no evidence to suggest that it harms liver or kidneys. People who have pre-existing liver and kidney ailments should consult a doctor before they start taking this supplement (28).

Another common myth associated with creatine is that it causes dehydration and muscle cramps. This is not true. In fact, research shows that creatine consumption reduces muscle cramps and dehydration during endurance exercise (29).

Conclusion

Creatine is one of the safest performance-enhancing drugs used by athletes. It helps improve strength and lean muscle mass. It also has many beneficial effects on muscle growth, exercise performance and brain health. With no evidence to suggest any significant side-effects, it is also quite safe to use.