What is the protocol for creatine (creatine monohydrate) supplement loading?

From the Guidelines

Creatine supplement loading should be done with a dose of 20 g/day, divided into four equal daily doses, for 5–7 days, as this approach has been shown to effectively saturate muscle creatine stores. This recommendation is based on the most recent and highest quality study available, which suggests that this loading phase can be followed by a maintenance phase of 3–5 g/day to sustain elevated creatine levels 1.

Key Points to Consider

• The loading protocol involves taking 20 g/day of creatine, divided into four equal doses, for 5–7 days, to quickly saturate muscle creatine stores.
• After the loading phase, a maintenance dose of 3–5 g/day is recommended to sustain elevated creatine levels.
• Consuming creatine with a mixed protein/CHO source may enhance muscle creatine uptake via insulin stimulation, as noted in the study by Collins et al. 1.
• It's worth noting that lower dose approaches (2–5 g/day) for 28 days may avoid the associated increase in body mass, and ~4–6 weeks are required following chronic creatine supplementation for levels to return to baseline.

Practical Considerations

• Common side effects during loading may include water retention and digestive discomfort, which typically subside during the maintenance phase.
• Staying well-hydrated is important while supplementing with creatine.
• The study by Collins et al. 1 provides guidance on the use of creatine supplementation in elite football players, and the recommended loading and maintenance doses can be applied to other populations as well.

From the Research

Creatine Supplement Loading

• The effective dosing for creatine supplementation includes loading with 0.3 g·kg·d for 5 to 7 days, followed by maintenance dosing at 0.03 g·kg·d most commonly for 4 to 6 wk 2
• However, loading doses are not necessary to increase the intramuscular stores of creatine 2
• Some studies suggest that creatine supplementation is relatively well tolerated, especially at recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day) 3
• The question of whether a creatine 'loading-phase' is required is still debated, with some evidence suggesting it is not necessary 3

Safety and Efficacy

• Creatine monohydrate is the most studied form of creatine, and other forms such as creatine ethyl ester have not shown added benefits 2
• Creatine is a relatively safe supplement with few adverse effects reported, the most common being transient water retention in the early stages of supplementation 2
• Some studies have reported gastrointestinal complaints, muscle cramps, and an increase in body weight as adverse effects of creatine supplementation 4
• However, most studies have found that creatine supplementation is safe and well tolerated in healthy individuals, with no evidence of deleterious effects on liver or kidney function 5, 6

Dosage and Forms

• The recommended dosage of creatine supplementation is 3-5 g/day or 0.1 g/kg of body mass/day 3
• Creatine monohydrate has been evaluated by different competent authorities, and a daily intake of 3 g creatine per person is unlikely to pose safety concerns 4
• Other forms of creatine, such as creatine pyruvate, creatine citrate, and creatine malate, have limited data available on their safety and efficacy 4