What are the benefits of taking creatine (creatine monohydrate) supplements for athletic performance?

Benefits of Creatine Supplements for Athletic Performance

Creatine monohydrate supplementation improves high-intensity repeated sprint performance, enhances training capacity, increases muscle strength and power, and promotes gains in lean body mass, making it one of the most evidence-based performance supplements available for athletes. 1

Primary Performance Benefits

High-Intensity Exercise Performance

• Creatine significantly improves performance during repeated bouts of short-duration, high-intensity exercise by increasing muscle phosphocreatine stores, which enhances rapid ATP resynthesis during intense physical activities. 2, 3
• The supplement increases muscle creatine stores by approximately 20%, providing critical energy for ATP regeneration during intense exercise. 2
• Performance improvements are most pronounced in activities involving jumping, sprinting, and cycling. 4

Strength and Power Gains

• Creatine supplementation consistently increases maximal strength (low-speed strength), maximal work output, and power production (high-speed strength). 3
• It enhances chronic training adaptations, including increased muscle strength, power, and lean body mass when combined with resistance training. 1, 2
• Evidence strongly supports improvements in dynamic or isotonic force production regardless of sport, sex, or age. 4

Body Composition Changes

• Creatine supplementation increases fat-free mass and lean body mass as a training adaptation. 1, 3
• The typical side effect is a 1-2 kg increase in body mass, primarily due to water retention or increased protein synthesis, which occurs especially during the loading phase. 1, 2

Additional Performance Applications

Recovery Enhancement

• Creatine may promote muscle glycogen resynthesis in the first 24 hours post-exercise when 20g is consumed (5g doses on four occasions beginning the same day as fatiguing exercise). 1
• The supplement may speed recovery between intense exercise bouts by mitigating muscle damage and promoting faster recovery of force-production potential. 3
• However, evidence for preventing or suppressing muscle damage or soreness following muscular activity remains limited. 4

Endurance Performance Considerations

• Creatine increases time to exhaustion during high-intensity endurance activities, likely by increasing anaerobic work capacity. 5
• The supplement appears most effective for endurance events requiring multiple surges in intensity and/or end spurts, such as cross-country skiing, mountain biking, cycling, triathlon, rowing, and track cycling. 5
• Evidence remains contradictory for continuous endurance activities, and the body mass increase may hinder performance in weight-bearing endurance sports. 4, 5

Cognitive Function

• Creatine may support brain function by increasing phosphocreatine stores in brain tissue, though this mechanism is less well understood in athletic contexts. 1, 2, 6

Recommended Supplementation Protocol

Loading Phase Approach

• Loading phase: 20 g/day divided into four equal doses (5g each) for 5-7 days. 1, 2, 6
• This rapidly saturates muscle creatine stores for immediate performance benefits. 1

Maintenance Phase

• Maintenance phase: 3-5 g/day as a single dose for the duration of supplementation. 1, 2, 6
• This maintains elevated muscle creatine stores after the loading phase. 1

Alternative Low-Dose Protocol

• Lower dose approaches of 2-5 g/day for 28 days may avoid the associated body mass increase while still being effective. 1, 2, 6
• This gradual loading approach is preferable when body mass gain is undesirable. 1

Optimization Strategy

• Concurrent consumption with a mixed protein/carbohydrate source (~50g of each) may enhance muscle creatine uptake via insulin stimulation. 1, 2, 6
• When co-ingested with carbohydrates, creatine enhances glycogen resynthesis and content, supporting high-intensity aerobic exercise. 5

Washout Period

• After cessation of supplementation, approximately 4-6 weeks are required for creatine levels to return to baseline. 1, 2, 6

Safety Profile

Established Safety

• No significant negative health effects have been reported when following appropriate supplementation protocols. 1, 2, 6
• Short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and various patient populations ranging from infants to the elderly. 7
• Creatine supplementation is relatively well tolerated, especially at recommended dosages of 3-5 g/day or 0.1 g/kg body mass/day. 8

Clinical Considerations

• Creatine may affect evaluation of glomerular filtration rate (GFR) by altering exogenous creatinine generation, but does not affect actual kidney function. 6
• 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
• Elevated enzyme levels should be interpreted in context of training history, muscle mass, ethnicity, and timing of blood collection. 2

Important Caveats

Supplement Quality Concerns

• Studies show 15-25% of sports supplements may contain undeclared prohibited substances, highlighting significant contamination risks. 1
• Athletes should only use supplements provided or recommended by sports nutritionists or team doctors, preferably from third-party tested sources (e.g., Informed Sport, Kölner Liste). 1
• Contamination may result from deliberate adulteration of otherwise ineffective products with anabolic steroids, stimulants, and other banned substances. 1

Individual Response Variability

• Creatine should be trialed and monitored in training before competition use due to large interindividual variability in response. 1
• The body mass increase may be undesirable for athletes in weight-class sports or where increased mass hinders performance. 1, 5