Uses and Recommendations for Creatine Supplementation
Creatine monohydrate supplementation effectively increases muscle strength, power, and lean body mass by enhancing phosphocreatine stores within muscle cells, providing immediate energy during high-intensity exercise. 1
Mechanism of Action
- Creatine works by increasing phosphocreatine stores in muscle cells, enhancing rapid ATP resynthesis during high-intensity exercise 1, 2
- It catalyzes the reversible reaction of phosphocreatine to produce ATP, providing immediate energy during intense physical activities 2
- Supplementation increases muscle creatine stores by approximately 20%, critical for ATP regeneration during intense exercise 1
Recommended Supplementation Protocol
- Standard loading protocol: 20g/day divided into four equal doses (5g each) for 5-7 days, followed by maintenance dose of 3-5g/day 1, 3
- Alternative approach: Lower dose protocol of 2-5g/day for 28 days without loading phase, which can effectively increase muscle creatine stores with less water retention 1, 2
- Taking creatine with protein and carbohydrates (approximately 50g each) may enhance muscle uptake via insulin stimulation 1, 2
- After cessation, it takes approximately 4-6 weeks for creatine levels to return to baseline 1
Performance Benefits
- Improves high-intensity, short-duration exercise performance by enhancing energy availability 1, 4
- Enhances training capacity and promotes chronic adaptations including increased muscle strength, power, and lean body mass 1, 4
- Most effective for repeated sprint performance and resistance training rather than endurance activities 1, 3
- May support brain function, though this mechanism is less well understood in athletic contexts 1
Clinical Applications
- Potential therapeutic benefits in neurodegenerative diseases (muscular dystrophy, Parkinson's, Huntington's disease) 4, 5
- May help in rehabilitation from injuries and enhance post-exercise recovery 4
- Beneficial for older adults to maintain muscle mass and function 4, 6
- Shows promise for concussion and spinal cord neuroprotection 4
- May enhance muscle protein synthesis and inhibit muscle protein breakdown in various clinical conditions 2
Safety Considerations
- Generally well-tolerated in both short and long-term supplementation (up to 30g/day for 5 years) 4
- Primary side effect is a potential 1-2kg increase in body mass, typically due to water retention or increased protein synthesis 1, 6
- No significant negative health effects when following appropriate supplementation protocols 1, 4
- Reports have linked creatine to cramping, dehydration, diarrhea, and dizziness, though these are relatively uncommon 3
- Concerns about renal dysfunction exist but are supported by limited evidence (only two case reports published) 3
Monitoring Considerations
- Creatine Phosphokinase (CPK) levels are commonly used as markers of muscle damage but have a complex relationship with creatine supplementation 1, 7
- CPK levels above 3000 U·L⁻¹ have been detected after maximal resistance exercise training without pathological significance 7
- Exercise-induced increases in CPK may peak between 24-120 hours post-exercise, complicating interpretation 7
- Individual factors such as muscle mass, ethnicity, and exercise intensity significantly influence baseline enzyme levels and responses 7, 1