Creatine basic facts, risks and safety

Creatine Powder, Source Naturals  
 Creatine Monohydrate, 3 g per teaspoon 

Do you have any opinion on which is better, Creatine monohydrate, or creatine ethyl ester? I'm reading conflicting information on this.
   Almost all human studies have been done with creatine monohydrate. We are not aware of any significant research done in humans with creatine ethyl ester supplements. We are also not aware of any research comparing creatine monohydrate to creatine ethyl ester. Therefore, for the time being, we prefer to use creatine monohydrate since it works well, very well.

What is Creatine?
Creatine is not an herb, mineral, vitamin, hormone, or steroid. Creatine is a natural nutrient found in our bodies and the bodies of most animals. Approximately 95% of the body's creatine supply is found in the skeletal muscles. The remaining 5% of creatine is scattered throughout the rest of the body, with the highest concentrations in the heart, brain and testes.
    The human body gets most of the creatine it needs from food or dietary supplements. Creatine is easily absorbed from the intestinal tract into the bloodstream. When dietary consumption of creatine is inadequate to meet the body's needs, a limited supply can be synthesized from the amino acids arginine, glycine and methionine. This creatine production occurs in the liver, pancreas and kidneys.

Who Can Benefit From Creatine?
So far it appears that the greatest benefits of creatine occur in those who wish to put on muscle mass and increase strength.
   Athletes in bodybuilding, powerlifting, martial arts, and track and field events such as shot-put may benefit from the use of creatine due to greater strength. So could wrestlers and football players and perhaps baseball players with a more powerful swing or pitch. Body builders and anyone who wishes to have more muscle build will find creatine extremely helpful. Creatine may even be helpful in soccer players or sprinters (see study at bottom of page).
   It is still unclear whether athletes involved in endurance activities such as marathon running or long-distance bicycling will benefit from creatine supplementation. There have been anecdotal reports that people in these sports may benefit, although most studies show that creatine either does not help or may actually hurt. The difficulty in these situations appears to center on the increased muscle mass which creatine provides. While that's great if you're a bodybuilder or wrestler, it can be a detriment if you have to carry all that weight around during a marathon or triathlon. It becomes a tradeoff between the increased strength you get from creatine and the increased muscle mass. Further research will provide us with more definitive answers as to what role creatine supplementation plays in endurance-type sports.
   Creatine  is a legal substance for use in the Olympics or in professional competitions.

Additional benefits of Creatine
Creatine may be helpful in certain muscular dystrophies (facioscapulohumeral dystrophy, Becker dystrophy, Duchenne dystrophy, sarcoglycan-deficient limb girdle muscular dystrophy). A placebo-controlled trial did not find evidence of a beneficial effect of creatine monohydrate on survival or disease progression in patients with ALS. Creatine has not found to be helpful in those with Myotonic Dystrophy Type 1
   Creatine has been found to increase strength and muscle mass in older adults who took 5 grams of creatine daily for 3 months. Creatine helps older individuals in their daily activities such as getting out of a chair.

Form and timing of Creatine
Regular creatine monohydrate powder seems to work quite well. A new study shows creatine serum is not as effective as creatine powder for improving cycle sprint performance in competitive male team-sport athletes.
   As to the timing of creatine intake--whether before a workout, or after a workout--I have not seen any specific studies addressing this question. Creatine seems to work well for most people no matter when they take it, but it would seem logical that taking it right before, during, or after a workout may be a better option than taking it at a sedentary time. A recent study showed taking a protein supplement right after a workout helps increase muscle size to a greater extent than taking the protein two hours after a workout. Creatine supplements may work well combined with a protein powder supplement, either from soy or casein.
   Creatine can be taken with practically any fluid, and my preference is fruit or vegetable juices since they contain many vitamins and phytonutrients. One can add protein powder, and other health/vitamin/green powders. Creatine taken with a small amount of food reduces the nausea that sometimes happens when taken on an empty stomach. Drinking additional water may be helpful. It has been reported that simultaneous ingestion of creatine with caffeine reduces its effectiveness.
   Creatine will increase the size of muscles even without working out, but the gains are minimal compared to creatine supplements along with a workout. Muscle size will likely decrease a few days or weeks after stopping creatine use, particularly if one stops working out. How much of the benefits from creatine use will persist is not known at this time.
   The use of creatine supplements will increase body weight, in part due to water retention.
   It's possible that taking lipoic acid along with creatine improves the transport of creatine into muscle tissue.

Vegans and Creatine
Vegetarians, particularly those who are on a strict lacto-ovo-vegetarian (LOV) diet do not ingest much creatine since creatine is mostly found in meats, fish, and chicken. Creatine helps muscles stay bulky and strong.
   In a study published in the Journal of Sports Nutrition and Exercise Metabolism, thirty-two healthy men, who regularly consumed an omnivorous diet, were split into two groups. One group consumed a LOV diet while the other group had an omnivorous diet (they ate everything). The study lasted 26 days. In addition to their diet, on day 22 of the study, subjects were assigned in a double-blind manner to receive either creatine monohydrate 0.3 g per kilogram of body weight per day or an equivalent dose of placebo for 5 days. The results demonstrated that consuming a LOV diet for 21 days decreased muscle creatine concentration in individuals who normally consume meat and fish. However, the creatine content of muscle in the LOV group returned back to normal after a period of only 5 days.
   Creatine, 5 g a day for six weeks, has been shown to improve brain performance (memory and intelligence) in adults who are vegetarian.

Creatine Side Effects, safety and cautions
Nausea, stomach upset, dizziness or weakness, loose stools, diarrhea, and weight gain are the most common, and generally occur with creatine dosages greater than 5 grams a day.  Muscle cramping is also reported. Strains and sprains can occur (perhaps even muscle tears?) when individuals over enthusiastically and rapidly increase their workout regimen before their tendons and ligaments have adapted to the increase in muscle size and power. 
   Long-term consequences of daily creatine ingestion, especially in high dosages, are currently not known.  There is a possibility that excess creatine can put stress on the kidneys and liver.  Creatine converts into creatinine which, in high dosages, could act as a toxin. Whether there is a potential for increasing the risk of cancer with regular high dose use is currently not known. I discourage the regular, high dose use of creatine.  Individuals with kidney disease should not use creatine.
   One recent study shows long term creatine use for 21 months did not influence blood studies (metabolic markers, muscle and liver enzymes, electrolytes, lipid profiles, hematological markers, and lymphocytes). Kreider RB, et al. Long-term creatine supplementation does not significantly affect clinical markers of health in athletes.   Mol Cell Biochem. 2003 Feb;244(1-2):95-104.
   We have also come across a few anecdotes about high dose creatine causing anxiety or depression. Time will tell whether creatine is responsible for these cognitive changes.
   There are no reports to date that creatine influences the size of genital organs or has a significant effect, positive or negative, on sex drive. Creatine doesn't seem to have a direct effect on libido, although feeling good about one's toned body could influence self-image and how others react to us and make us feel more attractive and sexual. The influence of creatine on sperm count or motility, if any, is not known at this time.
   Short term creatine supplementation does not seem to affect blood pressure, heart rate, or kidney function. A small to modest amount of alcohol intake should not interfere with low dose creatine use. I don't advise taking creatine while pregnant. There are no reports of creatine having an influence on hair loss.

How does creatine work?
Creatine is an essential player in the primary energy source used for muscle contraction. It exists in two different forms within the muscle fiber: as free (chemically-unbound) creatine and as creatine phosphate. This later form of creatine makes up two-thirds of the total creatine supply. When your muscles contract, the initial fuel for this movement is a compound called ATP. ATP provides its energy by releasing one of its phosphate molecules. It then becomes a different compound called ADP. Unfortunately, there is only enough ATP to provide energy for about 10 seconds, so for muscle contraction to continue, more ATP must be produced. Creatine phosphate comes to the rescue by giving up its phosphate molecule to ADP, recreating ATP. This ATP can then be burned again as fuel for more muscle contraction.
   The bottom line is that your ability to regenerate ATP depends on your supply of creatine. More creatine, more ATP remade, and more ability to train your muscles to their maximum potential. It's that simple. This greater ATP synthesis also keeps your body from relying on another energy system called glycolysis, which has lactic acid as a byproduct. This lactic acid creates the burning sensation you feel during intense exercise. If the amount of acid becomes too great, muscle movement stops. But if you keep on using ATP because of all the creatine you have, you can minimize the amount of lactic acid produced and actually exercise longer and harder. This helps you gain strength, power and muscle size; and you won't get fatigued as easily.
   Creatine has also been shown to enhance your body's ability to make proteins, especially the proteins within the muscle fibers. Two of these proteins, actin and myosin, are essential to all muscle contraction. So when you build up your supply of these contractile proteins, you actually increase your muscle's ability to perform physical work. And the more work you do (whether it's lifting weights or running 100-meter dashes), the stronger you become over time. Creatine can also absorb intracellular water, thus resulting in a higher muscle volume. This could lead to the "pumped up" feeling and look. An additional way creatine increases muscle size is thought to be its fluid retention abilities within muscle tissue (see study at bottom of page).

 Is Creatine better utilized if taken with other nutrients?
 One study shows co-ingestion of alpha-lipoic acid with creatine and a small amount of sucrose can enhance muscle total creatine content as compared to the ingestion of creatine and sucrose or creatine alone.

Creatine usage emails
Q. I know you can't give medical advice but I was wondering if you have ever heard of Creatine use causing a higher than normal CPK level; for instance 1900?  I used the product Cell Tech which has 10g of Creatine per serving, but was off it for 7 weeks before having a CK test.  Any ideas would be helpful.
A. CPK stands for creatine phosphokinase. There are several types of CPK. CPK--BB (CPK1) is found primarily in brain tissue, CPK--MB (CPK2) is found primarily in heart muscle, and CPK--MM (CPK3) is found primarily in skeletal muscle. It would be helpful to know which type your doctor can find. I don't think it's farfetched that creatine ingestion has a role in influencing CPK--MM, but I have not come across this finding yet until the issue is clarified.

Q. I bought CREATINE:Nature's Muscle Builder about 6 years ago; second only to the BIBLE, this book helped me a great deal in achieving the results I saught. My question is regarding the shelf life of the following supplements: EAS Myoplex Delux protien, Betagen their creatine & HMB, Creatine HP, Next Nutrition's whey protien & Sport Pharma's Vanadyl & Thermadrene. I purchased these products & have a large quantity of them in my pantry (climate controled in the house). They are 4-5 years old. Would you be afraid to consume them at this point in time? They still look & smell fine. I hate to waste all the money spent on them. In college I worked in a pharmacy & was told that after a drugs "expiration date" they didn't become poison, but over time their potency would decline.
   A. It is difficult to estimate expiration dates on supplements, but many of them can decompose and either not be as effective or potentially decompose into undesirable substances. Health is more important than money. It would be preferable to take fewer supplements but of higher quality and freshness.

Q. Please add my son's experience to your list of adverse behavioral effects using creatine. My athletic 18-yr old son plays varsity sports in high school: soccer, basketball, and lacrosse. He works out and lifts weights daily. He also ingests about 4g of creatine daily (Phosphagen). He does not take steroids or any other protein supplement. We have noticed that he has become extremely short-tempered, argumentative, and stressed out about the most trivial things. Because this behavior is also typical teenage behavior, it was difficult to make a connection between the creatine and the hot-headed-behavior until we talked with other parents who had experienced the same symptoms in their teenage sons who were also taking creatine. These parents also noticed a big improvement in their kids' temperaments after they stopped taking creatine. With a great deal of resistance, we are also making our son stop taking creatine, and we hope to see his less-difficult personality re-emerge--our friends indicated that it took about a month for them to see a change in behavior after their sons stopped taking the creatine.
   A. Although creatine may be the culprit, we should keep in mind that many people who take creatine are also taking other supplements, such as hormones or stimulants, that may cause irritability, or perhaps the particular creatine product was not pure.

Q. I'm 16 and have high metabalism, i'm 6'2" tall and weigh 165. i'm really skinny and would like to build muscle but everything i try fails. Can you give me some pointers on gaining weight that i can turn into muscle? Would creatine help?
   A. Work out, work out, work out. Eat more protein, less junk carbs and bad fats, and use heavy weights with fewer repetitions. At this time I do not recommend creatine to teenagers unless supervised by their parents or physician.

Q. I have been using creatine off and on for 3 years and have noticed the following scenarios to be predictable. During the "creatine loading" dose week there is no doubt that I experienced a significant increase in muscle mass. I would say there is a drastic influence on muscle mass-- to the point that I'm not sure that I feel like "myself," after the loading week. I see casual photographs of myself that coincide with creatine loading and I look more like "angus" than approaching "aesthetic". I will attempt and lift heavier weights in squat, bench, and deadlift when loadng creatine. And invariably, I wind up with an injury, (ie. low back or groin tear) that requires a several week set back. I will attempt longer and more challenging road bike rides in the mountains than I would usually tackle...and I will cramp during the last quarter of a 70 mile ride. It is always surprisi

Q. I am an 18 year old creatine user. I have been using it for about 3 1/2 years. My parents and I have both noticed increased anger and irritability from the continued use of creatine. However, after short recesses in-between uses, the side-effects wore off. The side-effects have not been so bad as to stop me from using creatine, but I do think that if people are hot-tempered in nature, then they should exercise caution while using creatine for extended periods of time.

Q. If muscle mass is slowly decreased after the use of creatine if weight training is continued, then what is the point of creatine if you are back where you started before you started using the supplement?
   A. Good question. Creatine can be used at the start of an exercise program to motivate working out and overcoming the initial inertia that so often accompanies those who are just starting an exercise program. The motivation is due to the gains in muscle mass that come much quicker while on creatine. Many people don't stop using creatine completely but take 3 gm two to three times a week which seems to be enough to maintain the gain in muscle mass.

Creatine study
Creatine supplementation in young soccer players.
Ostojic SM. Sports Medicine Institute, Kikindska 13/11, Pancevo 26000, Yugoslavia. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103.
The purpose of this study was to examine the effects of acute creatine-monohydrate supplementation on soccer-specific performance in young soccer players. Twenty young male soccer players (16.6 +/- 1.9 years) participated in the study and were matched and allocated to 2 randomly assigned trials: ingesting creatine-monohydrate supplement (3 x 10-g doses) or placebo for 7 days. Before and after the supplementation protocol, each subject underwent a series of soccer-specific skill tests: dribble test, sprint-power test, endurance test, and vertical jump test. Specific dribble test times improved significantly in the creatine group after supplementation protocol. Sprint-power test times were significantly improved after creatine-monohydrate supplementation as well as vertical jump height in creatine trial. Furthermore, dribble and power test times, along with vertical jump height, were superior in creatine versus placebo trial at post-supplementation performance. There were no changes in specific endurance test results within or between trials (p > .05). There were no between-trial differences in the placebo trial. The main finding of the present study indicates that supplementation with creatine in young soccer players improved soccer-specific skill performance compared with ingestion of placebo.

Creatine monohydrate supplementation on body weight and percent body fat.
Kutz MR, Gunter MJ. Palm Beach Atlantic University, West Palm Beach, Florida 33416, USA.
J Strength Cond Res. 2003 Nov;17(4):817-21
Seventeen active young males participated in a study to examine the effects of creatine monohydrate supplementation on total body weight (TBW), percent body fat, body water content, and caloric intake. The TBW was measured in kilograms, percent body fat by hydrostatic weighing, body water content via bioelectrical impedance, and caloric intake by daily food log. Subjects were paired and assigned to a creatine or placebo group with a double-blind research design. Supplementation was given for 4 weeks (30 g a day for the initial 2 weeks and 15 g a day for the final 2 weeks). Subjects reported 2 days a week for supervised strength training of the lower extremity. Significant increases before and after the study were found in total body weight and body water content for the creatine group. No significant changes were found in percent body fat or daily caloric intake in the creatine group. No significant changes were noted for the placebo group. These findings support previous research that creatine supplementation increases TBW. Mean percent body fat and caloric intake was not affected by creatine supplementation. Therefore weight gain in lieu of creatine supplementation may in part be due to water retention.

Q. Tell me if Creatine Ethyl Ester HCL powders contain alcohol. Some say yes and some say no.
   A. Creatine Ethyl Ester is creatine monohydrate attached to an ester molecule. Esters are organic compounds that are formed by the reaction of carboxylic acid and alcohols. Some claim creatine ethyl ester hydrochloride is a more soluble form of creatine that leads to better absorption and fewer side effects. We have not seen any human studies with creatine ethyl ester to know whether this claim is true.

Q.  am currently 20 years old. I have been lifting weights for about 4 years now. When i first started to lift i was at 115 pounds. i took protein supplements and hit the gym hard. I then gained about 40lb in a matter of 6 months. I am now currently 160 but would like to get to about 170 or 175. I'm a little skeptical of creatine monhydrate supplement. I'm cautious about it because if your body already produces it wont it eventually stop since it is getting large amounts of it over a long period of time? I know a lot of people who have tried it and still use creatine monohydrate supplement
and swear by it. I know others who feel the complete opposite. Also not knowing anything long term kinda worries me too and makes me not want to take it. If you can give me any info or any help that would be greatly appreciated.
   A. Small amounts of creatine monohydrate supplement, such as about 3 grams 3 or 4 times a week with a week off each month appear to be safe. The final decision regarding the use of creatine supplements rests with you and your doctor.

Q. I'm competing in a natural bodybuilding show in June, 2009 in Azle Texas. Currently, I am eating only solid food, no replacement meal drinks, etc. with the only supplementation being a few multi-vitamins and some L-glutamine to help muscle recovery and prevent muscle wasting. Naturally, supplementation is limited in this class of bodybuilding and even an accidental usage of a substance could lead to disqualification. The show is on a Saturday and I intend to use a carb loading, sodium depletion method a few days before the show. I understand how creatine supplement works and its uses in explosive exercises such as weight lifting, etc. but my goal in using creatine monohydrate at this point is to more fully engorge the muscle with water along with the carb loading phase just prior to the show. This carb loading phase, along with the sudden increase in water intake and sodium depletion, pretty much all at the same time, engorges the muscle with glycogen, drops water from the skin (via the sodium depletion) which tightens up the skin over the engorged muscle. However, I thought that if I were to implement creatine monohydrate use at the same time this process is taking place, then that could only be a good thing. A concern however is that some water retention may actually take place in the skin, the very thing I'd NOT want to happen at that time. With your knowledge of creatine for muscle growth and the body, would you say this could happen (skin cell water retention)? Also, I hear about this 'bloat' issue but most sites I've visited seem to not be able to discern the word 'bloat' from what I believe they mean-which is the 'muscle engorging' with water. A later thought was that perhaps there is some bloating that takes place in the digestive tract or stomach that I'd want to obviously avoid for the show?
   A. We are not experts on this topic. One thought would be to try the creatine in the next few days as if you are preparing for the competition to see how it effects your skin. It may be a good idea to use half the dosage normally used. Keep us updated on your findings.

Would the use of tribulus herbal supplement increase the side effects of creatine or have a detrimental influence on the kidneys?
    We don't think there is a major interaction between the two supplements.

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