Does creatine work? When do I take this stuff? Will creatine cause my kidneys to explode? Is Company X's version of creatine better than everyone else's?
If you've been hanging around a gym long enough, you're bound to have heard these questions before. In fact, since we all had to start from somewhere, most of us asked questions like these at one time!
Well, it's time to weed through the crap and go back to fundamentals. In this article I'll answer several "classic" questions about creatine, plus I'll hit on more novel topics like creatine ethyl ester.
Let's dig in!
Despite a relatively long and prosperous existence, there's still considerable debate about when to take creatine. In fact, as time goes by, the subject of timing seems to get even more complicated. Some people take it only after workouts, some before workouts, while others say it doesn't matter. Let's have a quick look at the reasoning behind these ideas and hopefully put this baby to bed.
Taking creatine before a workout initially makes sense, because that way we'll have the creatine readily available during training. Of course, this novice thinking doesn't hold water because it takes a while for creatine to enter the muscle cell where it can enhance performance. In fact, it's been shown that pre-workout creatine consumption has no effect over placebo (19). What's more, we know that the anticatabolic effects of creatine are more long lived and don't suddenly take effect during a workout.
More recently, the pre-workout creatine theory got a big boost from the scientific literature. Tipton and buddies (27) showed that consuming a pre-workout meal enhanced muscle protein synthesis twice as much as the same meal consumed after a workout. This enhanced nutrient delivery and subsequent uptake could, some believe, apply to pre-workout creatine as well.
Unfortunately, we're comparing apples and oranges here. Carbohydrates stimulate blood flow and amino acids stimulate protein synthesis, but creatine does neither. We've also established that the effects of creatine occur long after the workout has occurred, while those of protein and sugars are far more acute. Sadly, the theory of a pre-workout creatine advantage doesn't seem to hold water any way you look at it.
As much as we love complicated scientific theories behind our practices, the post-workout creatine logic is quite simple: workouts deplete creatine, so post-workout we fill it back up. We can also take advantage of our post-workout insulin spike to drive the creatine into our muscles.
Perhaps the most important determinant of when to take creatine is the overwhelming mass of data available from the scientific literature. We have numerous studies showing that post-workout creatine consumption is effective, while the only study for pre-workout intake showed no acute effect.
Bottom Line: We have no scientific data to support pre-workout creatine use, but also none to suggest it's harmful. I'd stick with the tried and true method until evidence to the contrary arrives.
Creatine Ethyl Ester
The big hype behind CEE is that it has a special chemical structure that supposedly allows it to freely enter cells without the use of a transporter protein. Remember that normal creatine must have a specific protein sitting on the outside of the cell that grabs the creatine and brings it inside. Before we get to the scientific application, we really need to understand the pseudo-scientific implications of this theory.
If creatine really had all-access passes to the interior of our muscle, there'd be nothing to stop it from entering. Now because over-hyped CEE is like a spoiled celebrity, it would have to bring its entourage of water along with it – and it's this water inside our muscles that normally gives us a more muscular appearance.
While this all makes sense, you have to stop and think about when this process would stop. I mean, if creatine can just freely jump into our cells, then the more creatine we consume, the more we'd have accumulating inside. Coupled with the increased water entering our cells, eventually we'd get so big that we'd literally explode. Clearly this doesn't happen.
And what of other tissues? Creatine is used by many tissues, not just muscle. So what's to stop this super-creatine from jumping into every cell in our body and causing hyper-swelling? This would first happen with our GI tract, our liver, and then our blood vessels. Sounds great, huh? Fortunately, we know that none of this happens.
While it scares the hell out of me that people actually thought it would be a good idea to have a creatine that freely passed into our cells without using a transporter, we need to look at where this theory breaks down.
Open Door vs. Full House
Ultimately the "problem" lies in the use of the creatine transporter, which can be seen like an open doorway into an otherwise impenetrable cell. While CEE might theoretically obviate this function, the transporter serves a second important purpose: transporting creatine into the cell against a concentration gradient!
What this means is that we actually have so much creatine already inside our muscles that it takes the transporter to force more in. This is analogous to stuffing 1000 people into a phone booth and then opening the door for another person to enter. Ain't gonna happen! So despite having an "open door," there's no real room for the creatine to enter the cell (13).
So if there's no way for CEE to work the way it's supposed to, it's crap, right? Well, maybe not. The one advantage that CEE has is that, unlike creatine monohydrate, it's highly soluble in water. Now this sounds frivolous and softcore until you consider that some people experience bloating from regular creatine. One potential reason for this side effect is that people consume undissolved creatine, which could actually pull water into our GI tract and lead to bloating (11).
CEE minimizes this potential by simple virtue of dissolving in water very well. This means that when we drink it, we're drinking a mixed solution rather than water and a bunch of undissolved creatine powder – the latter of which may cause bloating.
To be completely fair, despite the vocal minority who may experience bloating, it's not as common as one might think. In fact, I don't know of a single person who has these effects, and they're virtually non-existent in the scientific literature. Most likely, people hear that creatine causes intramuscular water retention and psychologically transfers this effect to bloating out of sheer misunderstanding.
Having said that, if you think you have bloating and water retention from creatine monohydrate, then you may want to give CEE a try. While the cost of most supplements prevents the "give it a try" philosophy, CEE is pretty cheap.
One last point before you decide to try CEE: it tastes like ass. It's bitter enough to cause a reflexive wincing, and it ruins the taste of Surge®. It's also very acidic and leaves your teeth feeling like they were freshly scrubbed by a Brillo pad, so be sure to thoroughly wash your mouth out when you're done drinking.
Other than that, there's really nothing worth mentioning about CEE. If you're happy with regular creatine monohydrate, then you may be better off with it. For those of you who want to try CEE, save your regular creatine because you may find yourself going back to it.
Other "Magical" Creatines
Buffered creatine claims to be better because you use less of the product and have less conversion to the slightly toxic metabolite creatinine. Although it's not desirable to directly consume creatinine, the conversion from creatine in our bodies is insignificant and yields no toxic effects.
Creatine serum had its mystique destroyed years ago, but is still being sold. Those that have been studied scientifically have been shown to have no effect (9), which is likely due to the fact that creatine usually degrades in liquids. Anecdotal reports indicate that liquid creatine products contain virtually no creatine, but rather the mildly toxic metabolite creatinine.
Recently, independent labs investigated this phenomenon and found that Creatine Serum ATP Advantage (made by Muscle Marketing USA) contained 90% creatinine (14)! What's worse is that this product is still being sold and is advertised frequently.
To reiterate, not only are people being lied to, they're being sold a mildly toxic product. No wonder supplements are on the verge of being banned.
Seriously, what are people thinking with this one? "Hey let's throw a bunch of Alka-Seltzer bubbles in with our creatine and tell everyone that this makes it work better!"
To be fair, it's actually far more complicated and involves buffering the creatine to enhance its performance and absorption. One type of effervescent creatine (di creatine citrate) has also been shown to dissolve better in water (8).
Sadly, despite this test tube data, effervescent creatine has been shown to have no effect, even when combined with ribose and glutamine (6). It's also kind of nasty to use. Kids may like bubbles and fizzing, but I think it sucks.
Here's a type of creatine you've probably never heard of before. There's a reason for that. Despite an initial study suggesting that this type of creatine yielded enhanced performance benefits over monohydrate (2), these results couldn't be replicated (24).
Creatine Citrate/Tricreatine Malate
While these substances have zero data to back up their claims, there have been data on their hybrid: dicreatine citrate. Now if only we had actual human data on the individual creatine listed...
Glow in the Dark Creatine (Preemptive Strike)
Will be shown to cause impotence and liver damage without positively affecting performance. While this product may not actually exist yet, you can bet your ass that someone out there is going to come up with this crap. And teenagers will buy it.
Collecting Our Thoughts
Now, let's say for a minute that we believe all of the data on these supposed wonder creatines. Then it's obvious that we have a ton of info on how they improve the performance of creatine in a glass of water. Well, here's a kooky thought: why don't they tell us how creatine will affect performance in our bodies?
I need to know if buffered creatine will help me add 10 pounds to my bench, or if effervescent creatine can drop my 40 time, or make me look 5 pounds bigger. You see, this is where all of the research should ultimately go, but sadly, it's also where the research from these products breaks down.
We have lots of theories, but little follow through. This is because creatine monohydrate, the same old stuff that's been around for years, works, and it works well. Different "types" of creatine may have slightly different properties, but they appear to be superficial and have no impact on our actual performance.
Improving Your Performance
It's important to remember that novelty creatine products usually claim to enhance creatine absorption by the body. While absorption may be a problem with many supplements, this isn't the case with creatine.
You see, it really doesn't matter how much creatine we get into our blood; the real limit is the amount that can be taken up by our muscle. This is enhanced by carbohydrates/insulin (10), high doses of lipoic acid (3), and possibly exercise and sodium (30).
But What About Safety?
Another common point of contention is whether creatine is safe or not. While an entire article could be written on this topic alone, I'll just give a brief overview here.
The research unequivocally states that creatine is safe in the measured parameters (7, 12, 15, 20, 22, 23), although some people are quick to point out that no long-term studies (i.e. 10+ years) have been performed. Interestingly, so much research on safety has come out in the last few years that a couple of complete literature reviews have been performed on the topic (1, 31). For those who question the long-term effects on kidney and liver function, we have to think that if five straight years of use has zero negative effect, then the negative effect we're waiting for just won't ever happen.
Taking this one step further, a group of researchers decided to check out creatine use in animals with pre-existing kidney problems (25). Once again, creatine had no negative effect in subjects with kidney dysfunction – something that isn't even universally true for high protein diets!
Of course, we need long-term data on the effect of creatine supplementation on our hearts, as well as the natural creatine synthetic pathway, but so far the safety data look pretty convincing.
Actually Good For You?
On the complete opposite end of the spectrum, creatine is actually being used to treat a variety of medical conditions, including a form of muscular dystrophy (26) and Lou Gehrig's disease (5).
There are also positive effects of creatine on glucose tolerance when combined with resistance training and protein supplementation (4). This is a finding of incredible magnitude, because type II diabetes is one of the fastest growing diseases in the Western world! Who knows, in 20 years, part of the treatment may be to consume protein and creatine supplements along with working out!
Further strengthening the support for creatine use, we've seen that creatine supplementation can decrease the level of homocysteine, a toxic indicator for cardiovascular disease (16). This means that creatine has been shown to reduce the risk for the number one killer in the Western world.
Research has also shown that creatine may have an anti-inflammatory effect in vitro, but we don't know how strong this will be in humans (18). Another in vitro study showed that creatine possesses antioxidant activity (17), which is a very exciting prospect.
Lastly, creatine appears to have a nootropic effect. It's been shown to enhance memory and score on an intelligence test in vegetarians (21) and has been shown to reduce mental fatigue and enhance brain oxygen uptake (29). Clearly, the benefits of creatine extend far beyond the athlete!
In summary, creatine appears to not only lack negative health effects, it actually seems to be good for us in many ways!
Common Creatine Concerns: Cycling and Caffeine
One of the most commonly asked questions about creatine is whether it needs to be cycled or not. This question arose when researchers fed rats more creatine than humans could consume and noted a decrease in creatine transporter molecules. This may not be a realistic scenario, as human research with common dosages has shown no effect on creatine transporter.
Some people make it standard practice to cycle supplements every 12 weeks, but I don't cycle creatine. This is because I use the 3g post-workout protocol, as outlined in the Dangerous Creatine article, and thus maintain my elevated creatine levels rather than constantly overloading my body. This means I consume a maximum of 20g of supplemental creatine per week. Some people use this each day! In other words, creatine doesn't need to be cycled unless it's overused.
A final question involves the use of caffeine and its ability to impair the ergogenic effects of creatine (28). This study used relatively high doses of caffeine. Clear counteraction conclusion: Concurrent consumption of a couple cups of coffee or cans of Coke can't create or cause creatine complications. Of course, if you're already overusing caffeine then you have bigger problems than the impaired effects of a supplement.
Bottom Line: You don't need to cycle creatine, and common doses of caffeine (i.e. 100-150mg) will minimally affect the strength enhancing effects of this supplement.
Three Frequently Asked Questions
1 - Which brand of creatine should I use?
Most 100% pure creatine monohydrate products, without added ingredients, are quite similar. I often look for the Creapure label on many different brands, although this isn't necessary. Your choice doesn't have to be "micronized" (i.e. very fine powder), although many people prefer this.
Conclusion: Use the most cost-effective name brand "100% pure creatine monohydrate" available.
2 – Does creatine inhibit fat loss?
To date, we have no convincing data to suggest that creatine can directly affect cutting. Hypothetically, if creatine impaired fat loss, the preservation of muscle mass and maintenance of training intensity (in a calorie restricted state), would largely offset this.
Conclusion: Likely not.
3 – Does creatine need to be loaded?
No, absolutely not. In fact, I'd recommend that people not load creatine because we waste so much when doing so.
Conclusion: Skip the loading. It's not necessary and it saves money to boot.
Ten Take Home Points
- Taking creatine pre-workout is likely fine, although all of the current data show the benefits of post-workout creatine consumption.
- If its harsh taste, acidity, and higher cost aren't important to you, CEE may be a viable alternative for those few people who genuinely experience bloating with creatine supplementation.
- CEE doesn't get taken up by our muscles or enhance performance to a greater extent than creatine monohydrate.
- Despite many claims, novel or "fancy" creatines (including CEE) have no human performance data to back them up.
- Creatine transport into muscle is the critical regulator of creatine performance enhancement and may be improved by carbohydrates, alpha-lipoic acid, exercise, and sodium.
- To date, all short and intermediate length studies on creatine supplementation show the safety and efficacy of this supplement.
- Creatine has potential in helping with various diseases, including type II diabetes and cardiovascular disease.
- The nootropic effect of creatine is yet another way in which this supplement can enhance performance – mental performance.
- Based on the available data, you don't need to cycle creatine, although it's not a bad idea to do so from time to time (or use the 3g post-workout protocol).
- The caffeine contained in a couple cups of coffee (or cans of soda pop) a day, aren't likely to affect the performance enhancing effects of creatine.
- Bizzarini E, De Angelis L. Is the use of oral creatine supplementation safe? J Sports Med Phys Fitness. 2004 Dec;44(4):411-6.
- Brilla LR, Giroux MS, Taylor A, Knutzen KM. Magnesium-creatine supplementation effects on body water. Metabolism. 2003 Sep;52(9):1136-40.
- Burke DG, Chilibeck PD, Parise G, Tarnopolsky MA, Candow DG. Effect of alpha-lipoic acid combined with creatine monohydrate on human skeletal muscle creatine and phosphagen concentration. Int J Sport Nutr Exerc Metab. 2003 Sep;13(3):294-302.
- Derave W, Eijnde BO, Verbessem P, Ramaekers M, Van Leemputte M, Richter EA, Hespel P. Combined creatine and protein supplementation in conjunction with resistance training promotes muscle GLUT-4 content and glucose tolerance in humans. J Appl Physiol. 2003 May;94(5):1910-6.
- Ellis AC, Rosenfeld J. The role of creatine in the management of amyotrophic lateral sclerosis and other neurodegenerative disorders. CNS Drugs. 2004;18(14):967-80.
- Falk DJ, Heelan KA, Thyfault JP, Koch AJ. Effects of effervescent creatine, ribose, and glutamine supplementation on muscular strength, muscular endurance, and body composition. J Strength Cond Res. 2003 Nov;17(4):810-6.
- Farquhar WB, Zambraski EJ Effects of creatine use on the athlete's kidney. Curr Sports Med Rep. 2002 Apr;1(2):103-6.
- Ganguly S, Jayappa S, Dash AK. Evaluation of the stability of creatine in solution prepared from effervescent creatine formulations. AAPS PharmSciTech. 2003;4(2):E25
- Gill ND, Hall RD, Blazevich AJ. Creatine serum is not as effective as creatine powder for improving cycle sprint performance in competitive male team-sport athletes. J Strength Cond Res. 2004 May;18(2):272-5.
- Green AL, Simpson EJ, Littlewood JJ, Macdonald IA, Greenhaff PL.,Carbohydrate ingestion augments creatine retention during creatine feeding in humans. Acta Physiol Scand. 1996 Oct;158(2):195-202.
- Greenhaff PL. The nutritional biochemistry of creatine. J Nutr Biochem 8:610-618. 1997.
- Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial.
- Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci (Lond). 1992 Sep;83(3):367-74.
- Harris RC, Almada AL, Harris DB, Dunnett M, Hespel P. The creatine content of Creatine Serum and the change in the plasma concentration with ingestion of a single dose. J Sports Sci. 2004 Sep;22(9):851-7.
- Havenetidis K, Bourdas D. Creatine supplementation: effects on urinary excretion and anaerobic performance. J Sports Med Phys Fitness. 2003 Sep;43(3):347-55.
- Korzun WJ. Oral creatine supplements lower plasma homocysteine concentrations in humans. Clin Lab Sci. 2004 Spring;17(2):102-6.
- Lawler JM, Barnes WS, Wu G, Song W, Demaree S. Direct antioxidant properties of creatine. Biochem Biophys Res Commun. 2002 Jan 11;290(1):47-52.
- Nomura A, Zhang M, Sakamoto T, Ishii Y, Morishima Y, Mochizuki M, Kimura T, Uchida Y, Sekizawa K. Anti-inflammatory activity of creatine supplementation in endothelial cells in vitro. Br J Pharmacol. 2003 Jun;139(4):715-20).
- Preen D, Dawson B, Goodman C, Lawrence S, Beilby J, Ching S. Pre-exercise oral creatine ingestion does not improve prolonged intermittent sprint exercise in humans. J Sports Med Phys Fitness. 2002 Sep;42(3):320-9.
- Pline KA, Smith CL. Ann The effect of creatine intake on renal function. Pharmacother. 2005 Jun;39(6):1093-6.
- Rae C, Digney AL, McEwan SR, Bates TC. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. 2003 Oct 22;270(1529):2147-50.
- Rawson ES, Persky AM, Price TB, Clarkson PM. Effects of repeated creatine supplementation on muscle, plasma, and urine creatine levels. J Strength Cond Res. 2004 Feb;18(1):162-7.
- Schroder H, Terrados N, Tramullas A. Risk assessment of the potential side effects of long-term creatine supplementation in team sport athletes.Eur J Nutr. 2005 Jun;44(4):255-61
- Selsby JT, DiSilvestro RA, Devor ST. Mg2+-creatine chelate and a low-dose creatine supplementation regimen improve exercise performance. J Strength Cond Res. 2004 May;18(2):311-5.
- Taes Y. E. C., J. R. Delanghe, B. Wuyts, J. van de Voorde, and N. H. Lameire
Creatine supplementation does not affect kidney function in an animal model with pre-existing renal failure Nephrol. Dial. Transplant., February 1, 2003; 18(2): 258 - 264.
- Tarnopolsky MA, Mahoney DJ, Vajsar J, Rodriguez C, Doherty TJ, Roy BD, Biggar D. Creatine monohydrate enhances strength and body composition in Duchenne muscular dystrophy. Neurology. 2004 May 25;62(10):1771-7.
- Tipton KD, Rasmussen BB, Miller SL, Wolf SE, Owens-Stovall SK, Petrini BE, Wolfe RR. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. Am J Physiol Endocrinol Metab. 2001 Aug;281(2):E197-206.
- Vandenberghe K, Gillis N, Van Leemputte M, Van Hecke P, Vanstapel F, Hespel P.. Caffeine counteracts the ergogenic action of muscle creatine loading. J Appl Physiol. 1996 Feb;80(2):452-7.
- Watanabe A, Kato N, Kato T. Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res. 2002 Apr;42(4):279-85.
- Yoshizumi WM, Tsourounis C. Effects of creatine supplementation on renal function. J Herb Pharmcother. 2004;4(1):1-7