What is the use of creatine (Creatine Monohydrate) supplements?

Creatine Supplementation: Primary Uses and Applications

Creatine monohydrate supplements are primarily used to enhance muscle strength, power, and performance during high-intensity, short-duration, repeated exercise activities by increasing intramuscular phosphocreatine stores that rapidly regenerate ATP. 1, 2

Mechanism of Action

Creatine works by increasing phosphocreatine stores within muscle cells by approximately 20%, which enhances the rapid resynthesis of ATP during intense physical activities. 1, 2 It catalyzes the reversible reaction of phosphocreatine to produce ATP, providing immediate energy during high-intensity exercise. 1, 2

Primary Performance Benefits

Creatine supplementation is most effective for:

• High-intensity, intermittent sprint performance - Increases available energy for short-duration, powerful movements 1
• Resistance training adaptations - Enhances training capacity and promotes chronic adaptations including increased muscle strength, power, and lean body mass 1
• Repeated surge activities - Particularly beneficial for sports requiring multiple surges in intensity and end spurts (e.g., cross-country skiing, mountain biking, cycling, triathlon, rowing) 3
• Anaerobic work capacity - Increases time to exhaustion during high-intensity endurance activities 3

Evidence-Based Supplementation Protocol

Loading Phase:

• 20 g/day divided into four equal doses (5g each) for 5-7 days 1, 4, 2

Maintenance Phase:

• 3-5 g/day as a single dose for the duration of supplementation 1, 4, 2

Alternative Lower-Dose Approach:

• 2-5 g/day for 28 days can avoid the associated increase in body mass while remaining effective 1, 4, 2

Optimization Strategy:

• Concurrent consumption with protein and carbohydrates (~50g of each) may enhance muscle creatine uptake via insulin stimulation 1, 4, 2
• After cessation, creatine levels return to baseline in approximately 4-6 weeks 1, 4

Potential Cognitive Benefits

Creatine may support brain function by increasing phosphocreatine stores in brain tissue, though this mechanism is less well understood than its athletic performance benefits. 1, 4

Important Clinical Considerations

Expected Side Effects:

• Primary side effect is a 1-2 kg increase in body mass, typically due to water retention or increased protein synthesis 1, 4
• This weight gain may offset benefits in weight-bearing endurance activities 3

Safety Profile:

• No significant negative health effects have been reported when following appropriate supplementation protocols 1, 4
• Creatine is relatively well tolerated in short-term trials 5

Laboratory Interpretation Caveat:

• Creatine may affect the evaluation of glomerular filtration rate (GFR) by altering exogenous creatinine generation, but does not affect actual renal function 4
• CPK levels above 3000 U·L⁻¹ have been detected after maximal resistance exercise in creatine users without pathological significance 1

When Creatine Is NOT Effective

Creatine supplementation does NOT improve:

• Exercise capacity, muscle strength, or health-related quality of life in individuals with COPD receiving pulmonary rehabilitation 6
• Pure endurance sports performance (though it may help with surge activities within endurance events) 3, 5

Quality and Safety Warnings

Commercially marketed creatine products do not meet the same quality control standards as pharmaceuticals, raising concerns about impurities or inaccurate dosing. 5 Athletes should use only supplements provided or recommended by qualified sports nutritionists or team physicians to minimize contamination risk with banned substances. 6