Creatine Monohydrate for Muscle Performance Enhancement
Creatine monohydrate supplementation is recommended to improve high-intensity repeated sprint performance, muscle strength, power, and lean body mass, with a loading phase of 20 g/day divided into four doses for 5-7 days, followed by a maintenance dose of 3-5 g/day. 1
Mechanism of Action
Creatine works by increasing phosphocreatine stores within muscle cells by approximately 20%, which enhances rapid ATP resynthesis during high-intensity exercise. 2, 3 This catalyzes the reversible reaction of phosphocreatine to produce ATP, providing immediate energy during powerful, short-duration activities. 3
Performance Benefits
Creatine supplementation improves:
- High-intensity repeated sprint performance through increased muscle creatine stores and enhanced phosphocreatine resynthesis 1
- Training capacity and chronic training adaptations, including increased muscle strength, power, and lean body mass 1
- Maximal force or strength production during dynamic or isotonic contractions, regardless of sport, sex, or age 4
- Performance in activities involving jumping, sprinting, or cycling 4
Creatine is NOT effective for:
- Endurance sports or continuous aerobic activities 5, 6
- Isometric muscular performance 4
- Prevention or suppression of muscle damage or soreness 4
Recommended Supplementation Protocol
Loading Phase
20 g/day divided into four equal doses (5 g each) for 5-7 days 1, 2, 3
Maintenance Phase
3-5 g/day as a single dose for the duration of supplementation 1, 2, 3
Alternative Low-Dose Approach
2-5 g/day for 28 days may avoid the associated body mass increase while remaining effective 1, 2
Optimization Strategy
Concurrent consumption with approximately 50 g of protein and 50 g of carbohydrates may enhance muscle creatine uptake via insulin stimulation 1, 3
After discontinuation, approximately 4-6 weeks are required for creatine levels to return to baseline. 1
Expected Side Effects
The primary side effect is a predictable 1-2 kg increase in body mass, typically attributable to water retention or increased protein synthesis rather than pathological changes. 1, 2 This weight gain is not a health concern but may be undesirable for athletes in weight-class sports. 1
Safety Profile
No significant negative health effects have been reported when following appropriate supplementation protocols in healthy individuals across short-term (5 days), medium-term (9 weeks), and long-term (up to 5 years) studies. 2 Creatine supplementation up to 8 weeks has not been associated with major health risks. 5, 6
Critical Safety Considerations
If a patient has evidence of renal dysfunction, creatine supplementation must be discontinued. 2 While creatine may affect the evaluation of glomerular filtration rate (GFR) by altering exogenous creatinine generation, it does not affect actual kidney function in healthy individuals. 2
Common Pitfall: Interpreting CPK Levels
When interpreting creatine phosphokinase (CPK) levels in athletes taking creatine, levels above 3000 U·L⁻¹ have been detected after maximal resistance exercise without pathological significance. 2 Do not automatically assume elevated CPK indicates pathology in athletes using creatine and engaging in intense training.
Additional Potential Benefits
Creatine may support brain function by increasing phosphocreatine stores in brain tissue, potentially improving cognitive processing. 1, 2