What are the benefits and recommendations for creatine (creatine monohydrate) supplementation?

Creatine Supplementation Benefits and Recommendations

Creatine monohydrate supplementation provides comprehensive benefits for training capacity and performance, with strong evidence supporting its use for improving muscle strength, power, and lean body mass through increased muscle creatine stores and phosphocreatine resynthesis. 1

Benefits of Creatine Supplementation

Performance Benefits

• Improves high-intensity repeated sprint performance 1
• Enhances training capacity and promotes chronic training adaptations in:
  • Muscle strength
  • Power output
  • Lean body mass
• Increases muscle creatine stores and phosphocreatine resynthesis 1
• Improves time to exhaustion during high-intensity endurance activities 2
• Particularly beneficial for activities requiring multiple surges in intensity or end spurts 2
• Beneficial for resistance exercise in various populations including:
  • Women
  • Older individuals
  • Patients with cardiovascular conditions 3

Additional Benefits

• May enhance glycogen resynthesis and content when co-ingested with carbohydrates 2
• Can lower inflammation and oxidative stress 2
• Potential to increase mitochondrial biogenesis 2
• Improves physical function in older adults and those with physical frailty 3
• May improve walking endurance, walking speed, and dynamic balance in older adults 3

Recommended Dosage Protocols

Standard Protocol

• Loading phase: ~20 g/day divided into four equal doses (5g four times daily) for 5-7 days
• Maintenance phase: 3-5 g/day as a single dose 1
• Concurrent consumption with protein/carbohydrate (~50g each) enhances muscle creatine uptake

Alternative Protocol

• Lower dose approach: 3-5 g/day without loading phase
• Can achieve similar increases in muscle phosphocreatine over time
• May minimize side effects like initial weight gain 1

Safety Profile

Side Effects

• Most common side effect is transient water retention (1-2 kg body mass increase) after loading phase 1
• Gastrointestinal disturbances may include:
  • Mild abdominal discomfort
  • Nausea
  • Flatulence (typically mild and transient) 1

Safety Considerations

• Available evidence from studies up to 5 years shows no adverse effects in healthy individuals 1
• Creatine monohydrate is the most studied form with the best established safety profile 1
• Individuals with pre-existing kidney disease, diabetes, hypertension, or reduced glomerular filtration rate should avoid high-dose creatine supplementation (>3-5 g/day) 1
• Maintain adequate hydration when using creatine 1
• Consider discontinuing use if experiencing unusual symptoms 1

Special Populations

Athletes

• Particularly beneficial for sports requiring repeated high-intensity efforts such as:
  • Cross-country skiing
  • Mountain biking
  • Cycling
  • Triathlon
  • Short-duration events where end-spurts are critical (rowing, kayaking, track cycling) 2

Older Adults

• Improves physical function in older individuals 3
• Enhances walking endurance (15% improvement) 3
• Improves walking speed and dynamic balance 3
• May reduce falls in older men and women 3
• Even beneficial in nursing home residents (mean age 87 years) 3

Patients with Cardiovascular Conditions

• Well tolerated in patients with coronary heart disease 3
• Associated with improvements in quality of life, strength, and endurance when added to exercise programs 3

Important Considerations

Form Selection

• Creatine monohydrate is the most studied and recommended form 1, 4
• Other forms have not consistently shown superior benefits 4

Potential Limitations

• May increase body mass, which could offset benefits in weight-bearing activities 2
• Not all individuals respond similarly to creatine supplementation 5
• Effects diminish as exercise duration increases 2, 5

Contraindications

• Should be discontinued if evidence of renal dysfunction appears 3
• Caution advised for individuals with pre-existing kidney conditions 1

Creatine supplementation represents one of the most well-researched and effective ergogenic aids available, with a strong safety profile when used appropriately. The evidence strongly supports its use for improving various aspects of physical performance and potentially offering additional health benefits across diverse populations.