5 Reasons to use Creatine

5 reasons you should be using Creatine

Part of the Five that Work Series

Lanny Littlejohn, MD

Bigger, Stronger, Leaner, Faster…… and smarter and healthier too?

The Bottom Line Up Front: Creatine makes you

  1. Perform better physically (strength, power, and work performed)
  2. Increases muscle size
  3. Improves cognitive function (No, Really)
  4. Has a great track record of safety
  5. Has a role in endurance activities, not just training for size and strength


Probably the most effective legal supplement to gain lean body mass is creatine. It has been wildly popular for the past decade and for good reason. It increases strength and power, fat free mass, muscle size. [i],[ii],[iii]

But did you know it also has a role in endurance activities and even in cognitive performance???

Well that’s just bad ass. Read on.

There are tons of different creatine formulations out there on the market, not just forms such as monohydrate, pyruvate, effervescent, etc. There are also different combo products containing all kinds of other ingredients including caffeine, taurine, HMB, and essential amino acids.

Well…which one of these should I choose…and how should I use it?  But let us talk effects first.

Effect on Physical Performance

A 2003 meta analysis (study that lumps a lot of smaller studies together to supposedly increase its power) showed an average 8% improvement in performance of 1 rep maximum lifts and a 14% improvement in endurance strength (maximum number of reps done with a % of the 1RM) [iv]

Another meta-analysis showed an effect most prominent for those exercises lasting 30 seconds or less and this effect was greatest on the number of reps performed with a given % of the 1 RM with a significant, although less effect on the actual weight lifted. Other measures that were improved were work accomplished, weight lifted, time, force production, cycle ergometer revolutions/min, and power.[v]

The effect size of creatine supplementation on exercise durations that utilized the anaerobic glycolysis energy system (anaerobic endurance exercise) of 30s-150s was minimal with the effects being seen in work and power. Thus creatine has the most pronounced effect on short duration (<30s) high intensity intermittent exercise.

There was a significant increase in strength over 12 weeks of a heavy resistance training protocol when creatine was loaded at 25g/day followed by 5 g/ day maintenance the rest of the 12 weeks.

Effects on Muscle Hypertrophy

Creatine increases muscle fiber cross sectional area and increases contractile proteins.[vi]

These effects may be explained by satellite cell proliferation (HUGE for muscle growth), myogenic transcription factors (for protein synthesis)  and insulin-like growth factor signaling (I like GROWTH factor).[vii]

High intensity exercise should combine a high carbohydrate meal with creatine supplementation to achieve improved muscle glycogen stores[viii]

Effect on aerobic exercise

There is SOME evidence of a positive effect on endurance activities but this diminishes after 150 seconds. However, there may be some increase in long term steady state performance during prolonged exercise.

 There is a significant decrease in blood lactate accumulation (what makes your muscles burn and then fail) when exercising at lower intensities and an increase in lactate threshold, which would allow you to go longer without suffering the effect of high lactate.

Several markers of muscle damage were significantly decreased (CK, lactate among others) in iron man athletes after they consumed 20 g/d for 5 days leading up to the race.[ix]  Maybe I’ll become a triathlete after all..

Effect on range of motion 

Cr can totally make you less flexible.[x]  Creatine increases intracellular water. This may increase resistance to stretch as well as impede neural outflow from muscle spindles. So if you do decide to use Cr, make sure you stretch regularly and at the appropriate times!

Effects on Health

 Cr improves neurologic and cognitive function. Even in the setting of sleep deprivation, and in the steady decline due to age.[xi] There is also positive effect on the progression of neurodegenerative diseases.[xii] This is great news – I’ll take the formulation with the added caffeine please!  Is ephedra legal again yet?

Creatine exerts direct antioxidant activity via a scavenging mechanism in oxidatively injured cells.[xiii] It removes superoxide anion radicals and peroxinitrite radicals.[xiv] In humans, Cr attenuates the oxidation of DNA and lipid peroxidation after high intensity resistance training.[xv] This mumbo jumbo means Cr can help slow some of the damage due to aging. Now I can spread my Botox injections out just a little more….

Dosing Protocols

 The most well studied method for taking Cr in research protocols is: 20-25 grams per day for 5-7 days, followed by 5 grams per day for 7 weeks.1

 There is a variance in response (responders vs nonresponders). Responders tend to have a greater % of type II fibers and they had a lower concentration of intramuscular creatine prior to supplementation.[xvi] So if you load with Cr and you see no improvement in the first week….probably not going to help you ever. Sorry man.

Another research protocol used 15g/d for 3 weeks, followed by 5 g/d for 7 weeks.9

What is common here is the loading period. Just taking Cr without loading can have an effect, just a very weak one….want a weak effect? Don’t load.

Also… Studies that utilize creatine administered only on training days have failed to show significant results.[xvii] So forget the supplement that is recommended as a post workout drink with creatine in it unless you are actually taking creatine EVERY day. Don’t waste your money.

I mentioned that Cr is found commonly in products that are combinations of different supplements. The body retention of a 5 g dose of Cr is increased by 25% when consumed with 50 g of protein and 47 g of carbs or just 96 g of carbs alone (such as in a post workout recovery drink).[xviii]

Other formulations have included Taurine, HMB, Caffeine, and amino acids but have not shown improvement over regular CM.[xix]

The skinny on Creatine forms

 Cr Pyruvate seems to have the best evidence for the most increase in force production. Creatine Monohydrate is the most widely studied and is the most stable. Although esters are more bioavailable, the evidence shows that CM produces higher muscle levels. GI side effects of diarrhea with increasing doses of CM are not uncommon.  Polyethylene glycol form may be the best option for athletes in weight categories as the normal weight gain is not as pronounced with this form.  Effervescent form?  If you like bubbles.

Small differences in plasma Cr concentration between the different forms will likely not produce significant difference in effects.


 Ah…culture of safety…lovely…I guess we should talk about it.

Creatine is a natural compound that the body produces a gram of every day. A large steak has about 5 grams of creatine in it. Thus vegetarians seem to benefit the most from supplementation and this has panned out in the literature. If you consume most of your protein in the form of eggs, milk, or protein shakes, you would benefit greatly from Cr supplementation as well.

Taking Cr does increase urinary creatinine concentration (note the slight difference in spelling of these two compounds – Creatine is not Creatinine, but it is a precursor chemically). Creatinine is used as a marker for decreased kidney function. Elevated creatinine usually means renal insufficiency. Creatinine is elevated in kidney disease because the kidney is not “clearing” creatinine appropriately. If you look at a biologic pathway where A leads to B, if you give more substrate “A” you will get more B. This is how testosterone precursors work. Negative feedback loops aside, if you supplement with Cr you will also see your Creatinine levels rise. This is not due to the inherent function of the kidney as in someone who has renal insufficiency, but rather, simply due to more A (creatine) present to give more B (creatinine). One study has definitively shown this fact with elevated creatinine but no change in the creatinine clearance.[xx] A retrospective study of athletes supplementing for 1-4 years found no negative health effects .[xxi]

How I use it

  1. Load with at least 5 grams per serving for 4-6 servings a day (20g/day) for 7 days. The technical dose is 0.03g/kg of body weight so if you are 70-85 kg take 4 servings a day, 85-100 kg take 5 a day, >100 kg you’ll need 6 servings a day.
  2. Back off to 5 grams twice a day for 7 more weeks. Take it even on your rest days.
  3. On training days consume one of the servings with a post workout shake or meal that is high in carbs.
  4. Pound water

Creatine – safe, effective, use it appropriately and reap the rewards. Worth spending your money on as opposed to velvet deer antler.

To your strength,

Lanny Littlejohn, MD

[i] Buford T, Kreider R, Stout J, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr 2007;4:6.

[ii] Branch JD: Effects of creatine supplementation on body composition and performance: a meta analisis. Int J Sports Nutr Exerc Metabol 2003;13:98-122

[iii] Volek JS, Kraemer WJ: Creatine suplemetation: its effects on human muscular performance and body composition. J Strength Cond Res 1996;10:200-210.

[iv] Rawson ES, Volek JS: Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res 2003;17:822-831.

[v] Branch J. Effect of creatine supplementation on body composition and performance: a meta analysis. Int J Sports Nutr Exerc Metab. 2003;13:198-226.

[vi] Burke DG, Candow DG, Chilibeck PD, et al. Effect of creatine supplementation and resistance-exercise training on muscle insulin-like factor in young adults. Int J Sport Nutr Exerc Metab 2008;18:389-398.

[vii] Hespel P, Derave W. Ergonenic effects of creatine in sports and rehabilitation. Subcell Biochem 2007;46:245-259.

[viii] Opt Eijnde B, Urso B, Richter EA, et al. Effect of oral creatine supplementation on human muscle GLUT4 protein content after immobilization. Diabetes 2001;50:18-23.

[ix] Bassit RA, Pinheiro CH, Vitzel KF, et al. Effect of short-term creatine supplementation on markers of skeletal muscle damage after strenuous contractile activity. Eur J Appl Physiol 2010. 108:945-955.

[x] Sculthorpe N, Grace F, Jones P, et al. The effect of short-term creatine loading on active range of movement. Appl Physiol Nutr Metab. 2010;35:507-511.

[xi] Rawson ES, Venezia AC. Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Amino Acids. 2011;40:1349-1362.

[xii] Beal MF. Neuroprotective effects of creatine. Amino Acids. 2011;40:1305-1313.

[xiii] Sestili P, Martinelli C, Bravi G, et al. Creatine supplementation afford cytoprotection in oxidatively injured cultured mammalian cells via direct antioxidant activity. Free Radic Biol Med. 2006;40:837-849.

[xiv] Lawler JM, Barnes WS, Wu G, et al. Direct antioxidant properties of creatine. Biochem Biophys Res Commun 2002. 290:47-52.

[xv] Rahimi R. Creatine supplementation decreases oxidative DNA damage and lipid peroxidation induced by a single bout of resistance exercise. J Strength Cond Res. 2011;25:3448-3455.

[xvi] Greenhaff PL, Bodin K, Soderlund K, et al. Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. Am J Physiol. 1994;266:E725-E730.

[xvii] Bemben MG, Witten MS, Carter JM, et al. The effects of supplementation with creatine and protein on muscle strength following a traditional resistance training program in middle-aged and older men . J Nutr Health Aging 2010;14:155-159.

[xviii] Steenge G, Simpson E, Greenhaff P. Protein- and Carbohydrate-induced augmentation of whole body creatine retention in humans. J Appl Physiol. 2000;89:1165-1171.

[xix] Olsen S, Aagaard P, Kadi F, et al. Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. J Physiol. 2006;573:525-534.

[xx] Tarnopolsky M, Zimmer A, Paikin J, et al. Creatine monohydrate and conjugated linoleic acid improve strength and body composition following resistance exercise in older adults. PLoS One. 2007;2:e991.

[xxi] Schilling B, Stone M, Utter A, et al. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc. 2001;33:183-188.

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