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"Creatine: More than a sports nutrition
By Will Brink, author of:
Muscle Building Nutrition
Muscle Gaining Diet, Training Routines by Charles Poliquin & Bodybuilding
Diet Supplements Revealed
Real World Fat Loss Diet & Weight Loss Supplement Review
"Creatine: More than a sports nutrition
Although creatine offers an array of benefits, most people think of it simply as
a supplement that bodybuilders and other athletes use to gain strength and
muscle mass. Nothing could be further from the truth.
A substantial body of research has found that creatine may have a wide variety
of uses. In fact, creatine is being studied as a supplement that may help with
diseases affecting the neuromuscular system, such as muscular dystrophy (MD).
Recent studies suggest creatine may have therapeutic applications in aging
populations for wasting syndromes, muscle atrophy, fatigue, gyrate atrophy,
Parkinson's disease, Huntington's disease and other brain pathologies. Several
studies have shown creatine can reduce cholesterol by up to 15% and it has been
used to correct certain inborn errors of metabolism, such as in people born
without the enzyme(s) responsible for making creatine. Some studies have found
that creatine may increase growth hormone production.
What is creatine?
Creatine is formed in the human body from the amino acids methionine, glycine
and arginine. The average person's body contains approximately 120 grams of
creatine stored as creatine phosphate. Certain foods such as beef, herring and
salmon, are fairly high in creatine. However, a person would have to eat pounds
of these foods daily to equal what can be obtained in one teaspoon of powdered
Creatine is directly related to adenosine triphosphate (ATP). ATP is formed in
the powerhouses of the cell, the mitochondria. ATP is often referred to as the
"universal energy molecule" used by every cell in our bodies. An increase in
oxidative stress coupled with a cell's inability to produce essential energy
molecules such as ATP, is a hallmark of the aging cell and is found in many
disease states. Key factors in maintaining health are the ability to: (a)
prevent mitochondrial damage to DNA caused by reactive oxygen species (ROS) and
(b) prevent the decline in ATP synthesis, which reduces whole body ATP levels.
It would appear that maintaining antioxidant status (in particular intra-cellular
glutathione) and ATP levels are essential in fighting the aging process.
It is interesting to note that many of the most promising anti-aging nutrients
such as CoQ10, NAD, acetyl-l-carnitine and lipoic acid are all taken to maintain
the ability of the mitochondria to produce high energy compounds such as ATP and
reduce oxidative stress. The ability of a cell to do work is directly related to
its ATP status and the health of the mitochondria. Heart tissue, neurons in the
brain and other highly active tissues are very sensitive to this system. Even
small changes in ATP can have profound effects on the tissues' ability to
function properly. Of all the nutritional supplements available to us currently,
creatine appears to be the most effective for maintaining or raising ATP levels.
How does creatine work?
In a nutshell, creatine works to help generate energy. When ATP loses a
phosphate molecule and becomes adenosine diphosphate (ADP), it must be converted
back to ATP to produce energy. Creatine is stored in the human body as creatine
phosphate (CP) also called phosphocreatine. When ATP is depleted, it can be
recharged by CP. That is, CP donates a phosphate molecule to the ADP, making it
ATP again. An increased pool of CP means faster and greater recharging of ATP,
which means more work can be performed. This is why creatine has been so
successful for athletes. For short-duration explosive sports, such as sprinting,
weight lifting and other anaerobic endeavors, ATP is the energy system used.
To date, research has shown that ingesting creatine can increase the total body
pool of CP which leads to greater generation of energy for anaerobic forms of
exercise, such as weight training and sprinting. Other effects of creatine may
be increases in protein synthesis and increased cell hydration.
Creatine has had spotty results in affecting performance in endurance sports
such as swimming, rowing and long distance running, with some studies showing no
positive effects on performance in endurance athletes. Whether or not the
failure of creatine to improve performance in endurance athletes was due to the
nature of the sport or the design of the studies is still being debated.
Creatine can be found in the form of creatine monohydrate, creatine citrate,
creatine phosphate, creatine-magnesium chelate and even liquid versions. However,
the vast majority of research to date showing creatine to have positive effects
on pathologies, muscle mass and performance used the monohydrate form. Creatine
monohydrate is over 90% absorbable. What follows is a review of some of the more
interesting and promising research studies with creatine.
Creatine and neuromuscular diseases
One of the most promising areas of research with creatine is its effect on
neuromuscular diseases such as MD. One study looked at the safety and efficacy
of creatine monohydrate in various types of muscular dystrophies using a double
blind, crossover trial. Thirty-six patients (12 patients with
facioscapulohumeral dystrophy, 10 patients with Becker dystrophy, eight patients
with Duchenne dystrophy and six patients with sarcoglycan-deficient limb girdle
muscular dystrophy) were randomized to receive creatine or placebo for eight
weeks. The researchers found there was a "mild but significant improvement" in
muscle strength in all groups. The study also found a general improvement in the
patients' daily-life activities as demonstrated by improved scores in the
Medical Research Council scales and the Neuromuscular Symptom scale. Creatine
was well tolerated throughout the study period, according to the researchers.1
Another group of researchers fed creatine monohydrate to people with
neuromuscular disease at 10 grams per day for five days, then reduced the dose
to 5 grams per day for five days. The first study used 81 people and was
followed by a single-blinded study of 21 people. In both studies, body weight,
handgrip, dorsiflexion and knee extensor strength were measured before and after
treatment. The researchers found "Creatine administration increased all measured
indices in both studies." Short-term creatine monohydrate increased high-intensity
strength significantly in patients with neuromuscular disease.2 There have also
been many clinical observations by physicians that creatine improves the
strength, functionality and symptomology of people with various diseases of the
Creatine and neurological protection/brain injury
If there is one place creatine really shines, it's in protecting the brain from
various forms of neurological injury and stress. A growing number of studies
have found that creatine can protect the brain from neurotoxic agents, certain
forms of injury and other insults. Several in vitro studies found that neurons
exposed to either glutamate or beta-amyloid (both highly toxic to neurons and
involved in various neurological diseases) were protected when exposed to
creatine.3 The researchers hypothesized that "? cells supplemented with the
precursor creatine make more phosphocreatine (PCr) and create larger energy
reserves with consequent neuroprotection against stressors."
More recent studies, in vitro and in vivo in animals, have found creatine to be
highly neuroprotective against other neurotoxic agents such as N-methyl-D-aspartate
(NMDA) and malonate.4 Another study found that feeding rats creatine helped
protect them against tetrahydropyridine (MPTP), which produces parkinsonism in
animals through impaired energy production. The results were impressive enough
for these researchers to conclude, "These results further implicate metabolic
dysfunction in MPTP neurotoxicity and suggest a novel therapeutic approach,
which may have applicability in Parkinson's disease."5 Other studies have found
creatine protected neurons from ischemic (low oxygen) damage as is often seen
after strokes or injuries.6
Yet more studies have found creatine may play a therapeutic and or protective
role in Huntington's disease7, 8 as well as ALS (amyotrophic lateral sclerosis).9
This study found that "? oral administration of creatine produced a dose-dependent
improvement in motor performance and extended survival in G93A transgenic mice,
and it protected mice from loss of both motor neurons and substantia nigra
neurons at 120 days of age. Creatine administration protected G93A transgenic
mice from increases in biochemical indices of oxidative damage. Therefore,
creatine administration may be a new therapeutic strategy for ALS." Amazingly,
this is only the tip of the iceberg showing creatine may have therapeutic uses
for a wide range of neurological disease as well as injuries to the brain. One
researcher who has looked at the effects of creatine commented, "This food
supplement may provide clues to the mechanisms responsible for neuronal loss
after traumatic brain injury and may find use as a neuroprotective agent against
acute and delayed neurodegenerative processes."
Creatine and heart function
Because it is known that heart cells are dependent on adequate levels of ATP to
function properly, and that cardiac creatine levels are depressed in chronic
heart failure, researchers have looked at supplemental creatine to improve heart
function and overall symptomology in certain forms of heart disease. It is well
known that people suffering from chronic heart failure have limited endurance,
strength and tire easily, which greatly limits their ability to function in
everyday life. Using a double blind, placebo-controlled design, 17 patients aged
43 to 70 years with an ejection fraction <40 were supplemented with 20 grams of
creatine daily for 10 days. Before and after creatine supplementation, the
researchers looked at:
1) Ejection fraction of the heart (blood present in the ventricle at the end of
diastole and expelled during the contraction of the heart)
2) 1-legged knee extensor (which tests strength)
3) Exercise performance on the cycle ergometer (which tests endurance)
Biopsies were also taken from muscle to determine if there was an increase in
energy-producing compounds (i.e., creatine and creatine phosphate).
Interestingly, but not surprisingly, the ejection fraction at rest and during
the exercise phase did not increase. However, the biopsies revealed a
considerable increase in tissue levels of creatine and creatine phosphate in the
patients getting the supplemental creatine. More importantly, patients getting
the creatine had increases in strength and peak torque (21%, P < 0.05) and
endurance (10%, P < 0.05). Both peak torque and 1-legged performance increased
linearly with increased skeletal muscle phosphocreatine (P < 0.05). After just
one week of creatine supplementation, the researchers concluded: "Supplementation
to patients with chronic heart failure did not increase ejection fraction but
increased skeletal muscle energy-rich phosphagens and performance as regards
both strength and endurance. This new therapeutic approach merits further
Another study looked at the effects of creatine supplementation on endurance and
muscle metabolism in people with congestive heart failure.11 In particular the
researchers looked at levels of ammonia and lactate, two important indicators of
muscle performance under stress. Lactate and ammonia levels rise as intensity
increases during exercise and higher levels are associated with fatigue. High-level
athletes have lower levels of lactate and ammonia during a given exercise than
non-athletes, as the athletes' metabolism is better at dealing with these
metabolites of exertion, allowing them to perform better. This study found that
patients with congestive heart failure given 20 grams of creatine per day had
greater strength and endurance (measured as handgrip exercise at 25%, 50% and
75% of maximum voluntary contraction or until exhaustion) and had lower levels
of lactate and ammonia than the placebo group. This shows that creatine
supplementation in chronic heart failure augments skeletal muscle endurance and
attenuates the abnormal skeletal muscle metabolic response to exercise.
It is important to note that the whole-body lack of essential high energy
compounds (e.g. ATP, creatine, creatine phosphate, etc.) in people with chronic
congestive heart failure is not a matter of simple malnutrition, but appears to
be a metabolic derangement in skeletal muscle and other tissues.12 Supplementing
with high energy precursors such as creatine monohydrate appears to be a highly
effective, low cost approach to helping these patients live more functional
lives, and perhaps extend their life spans.
Creatine is quickly becoming one of the most well researched and promising
supplements for a wide range of diseases. It may have additional uses for
pathologies where a lack of high energy compounds and general muscle weakness
exist, such as fibromyalgia. People with fibromyalgia have lower levels of
creatine phosphate and ATP levels compared to controls.13 Some studies also
suggest it helps with the strength and endurance of healthy but aging people as
well. Though additional research is needed, there is a substantial body of
research showing creatine is an effective and safe supplement for a wide range
of pathologies and may be the next big find in anti-aging nutrients. Although
the doses used in some studies were quite high, recent studies suggest lower
doses are just as effective for increasing the overall creatine phosphate pool
in the body. Two to three grams per day appears adequate for healthy people to
increase their tissue levels of creatine phosphate. People with the
aforementioned pathologies may benefit from higher intakes, in the 5-to-10 grams
per day range.
About the Author - William D. Brink
Will Brink is a columnist, contributing consultant, and writer for various
health/fitness, medical, and bodybuilding publications. His articles relating to
nutrition, supplements, weight loss, exercise and medicine can be found in such
publications as Lets Live, Muscle Media 2000, MuscleMag International, The Life
Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body
International, Power, Oxygen, Penthouse, Women?s World and The Townsend Letter
He is the author of Priming The Anabolic Environment and Weight
Loss Nutrients Revealed. He is the Consulting Sports Nutrition Editor and a
monthly columnist for Physical magazine and an Editor at Large for Power
magazine. Will graduated from Harvard University with a concentration in the
natural sciences, and is a consultant to major supplement, dairy, and
He has been co author of several studies relating to sports nutrition and health
found in peer reviewed academic journals, as well as having commentary published
in JAMA. He runs the highly popular web site BrinkZone.com which is
strategically positioned to fulfill the needs and interests of people with
diverse backgrounds and knowledge. The BrinkZone site has a following with many
sports nutrition enthusiasts, athletes, fitness professionals, scientists,
medical doctors, nutritionists, and interested lay people. William has been
invited to lecture on the benefits of weight training and nutrition at
conventions and symposiums around the U.S. and Canada, and has appeared on
numerous radio and television programs.
William has worked with athletes ranging from professional bodybuilders,
golfers, fitness contestants, to police and military personnel.
See Will's ebooks online here:
Muscle Building Nutrition
A complete guide bodybuilding supplements and eating to gain lean muscle
Diet Supplements Revealed
A review of diet
supplements and guide to eating for maximum fat loss
He can be contacted at: PO Box 812430
Wellesley MA. 02482.
1. Walter MC, et al. Creatine monohydrate in
muscular dystrophies: A double blind, placebo-controlled clinical study.
Neurology 2000 May 9; 54(9): 1848-50.
2. Tarnopolsky M, et al. Creatine monohydrate increases strength in patients
with neuromuscular disease. Neurology 1999 Mar 10; 52(4): 854-7.
3. Protective effect of the energy precursor creatine against toxicity of
glutamate and beta-amyloid in rat hippocampal neurons. J Neurochem 1968-1978;
4. Malcon C, et al. Neuroprotective effects of creatine administration against
NMDA and malonate toxicity. Brain Res 2000; 860(1-2): 195-8.
5. Matthews RT, et al. Creatine and cyclocreatine attenuate MPTP neurotoxicity.
Exp Neurol 1999; 157(1): 142-9.
6. Balestrino M, et al. Role of creatine and phosphocreatine in neuronal
protection from anoxic and ischemic damage. Amino Acids Abstract 2002; 23(1-3):
7. Matthews RT, et al. Neuroprotective effects of creatine and cyclocreatine in
animal models of Huntington's disease. J Neurosci 1998; 18(1): 156-163.
8. Ferrante RJ, et al. Neuroprotective effects of creatine in a transgenic mouse
model of Huntington's disease. J Neurosci 2000; 20(12): 4389-97.
9. Klivenyi P, et al. Neuroprotective effects of creatine in a transgenic animal
model of amyotrophic lateral sclerosis. Nat Med 1999; 5(3): 347-50.
10. Gordon A, et al. Creatine supplementation in chronic heart failure increases
skeletal muscle creatine phosphate and muscle performance. Cardiovasc Res 1995
Sep; 30(3): 413-8.
11. Andrews R, et al. The effect of dietary creatine supplementation on skeletal
muscle metabolism in congestive heart failure. Eur Heart J 1998 Apr; 19(4):
12. Broqvist M, et al. Nutritional assessment and muscle energy metabolism in
severe chronic congestive heart failure-effects of long-term dietary
supplementation. Eur Heart J 1994 Dec; 15(12): 1641-50.
13. Park JH, et al. Use of P-31 magnetic resonance spectroscopy to detect
metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis
Rheum 1998 Mar; 41(3): 406-13.
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