Creatine is an organic acid that helps provide energy to cells in the body, especially muscles. It can be made synthetically and can be taken naturally from red meat and fish. It is used to improve performance and muscle mass in athletes and the elderly. It helps muscles generate energy during weight lifting or high-intensity exercise. It is also useful in the treatment of diseases such as brain disorders, heart failure, fibromyalgia, depression, schizophrenia, Parkinson’s, muscle and nerve diseases, skin aging, multiple sclerosis (MS). Diarrhea and nausea may occur when overdosed. People with kidney problems are at high risk of causing side effects.
I am aware that I have to write about nutritional supplements. Athletes have been curious about supplements for a long time. One of the most popular supplements is creatine.
In this article? From the question, What is Creatine? What does creatine do? What Are the Benefits of Creatine? Creatine Side Effects, is creatine harmful? To the question, should I use creatine? From the question, how to use creatine? I will answer any questions until the question.
If you’re ready, I’m starting!
What is creatine?
Creatine is a compound found naturally in our body; It is also a dietary supplement used in athletes to increase muscle mass, energy production, and athletic performance. It is synthesized from the amino acids arginine, glycine, methionine in the liver, pancreas, and kidneys. It increases the production of adenosine triphosphate (ATP), which is an essential energy source for cellular functions.
It helps macronutrients ( carbohydrates, fats, proteins ) to be converted into ATP and used by tissues with high energy needs. It also protects against neurological diseases and is used to treat problems that arise when the body cannot metabolize creatine. ( 1 )
Let’s examine it.
- Meat consumption, exercise, muscle mass, testosterone level affect creatine stores.
- Approximately 95% is stored in the muscles in the form of phosphocreatine; 5% is found as free creatine in the brain, kidneys, liver, and heart.
- Cardioprotective properties can help protect the heart and blood vessels.
- It is a performance enhancer, a muscle builder.
- Pseudovitamin is effective (not a vitamin or mineral but acting similarly).
- It affects cognitive function.
- It is chemically known as non-protein nitrogen.
- Creatine in food is digested more slowly than supplements
- Food can disappear when cooked. ( 2 )
What does creatine do?
It plays a vital role in the transport and storage of cellular energy. It stores high-energy phosphate groups in the form of phosphocreatine, converting it into ATP, the main energy source. As it increases the body’s capacity to produce ATP, it helps maintain strength and performance by rapidly producing energy during intense exercise. Benefits include building lean muscle mass, reducing fatigue, improving mood, and increasing bone density.
While making a definition of creatine, I gave some information about the function. But I will examine all the effects in this title from the very beginning so that you can grasp the whole event.
Increases exercise performance.
I mentioned that creatine supports energy production mechanisms. This can be particularly beneficial for strength-based athletes.
The funny thing is that many people think that creatine is useless in endurance athletes. The situation is completely different. Studies show that C-monohydrate also increases performance in endurance-based athletes.
Twenty-five football players from the NCAA (National Collegiate Athletic Association) league join the study to investigate the effects of C-monohydrate on performance.
Athletes divided into three groups (placebo, creatine monohydrate, control) are observed during the nine-week study for bench press weight, power clean weight, squat weight, high-intensity anaerobic capacity, and many other factors.
At the end of the research, the athletes,
- Bench press 1RM weight is 5.2% more in creatine users than non-users,
- Power clean 1RM weight is 3.8% more in creatine users than non-users,
- Squat 1RM weight is 8.7% more in C-monohydrate users than non-users,
- High-intensity anaerobic capacity is 18.4% more in creatine users than non-users, seen.
As a result, it is clear that creatine use provides strength and anaerobic capacity increase in athletes.
It supports the anabolic environment.
It is obvious that creatine will increase muscle mass with an increase in strength. So, can creatine increase muscle mass with a different mechanism other than strength increase? The answer is yes.
C-monohydrate increases the release of many different anabolic hormones (mainly IGF-1 and IGF-2) and stimulates satellite cells around the muscle to accelerate muscle growth.
The research is conducted to show the change in anabolic signal intensity with the use of C-monohydrate by the participants.
The first group of participants divided into two groups is given a placebo (no active ingredient) beverage, while the other group is given a drink containing creatine. Biopsies are taken from the vastus lateralis muscle of the participants three and twenty-four hours after the exercise, and p70 (s6k) and 4E-BP1 signaling pathways are examined in these biopsies.
The p70 (s6k) and 4E-BP1 signaling pathways are among the pathways that produce important anabolic effects within the cell.
With the review,
- The IGF-1 level of the group receiving C-monohydrate was 24% higher at the third hour after exercise than the group that did not take creatine,
- The IGF-1 level of the group receiving creatine was 29% higher than the group that did not take creatine, in the twenty-fourth hour after exercise,
- Phosphorylation, which is an indicator of cell anabolism, was 150% higher in the group receiving post-exercise creatine compared to the group not receiving creatine, seen.
This research shows us that creatine also supports the formation of more muscle mass in athletes by strengthening the anabolic environment.
Increases muscle volume.
It increases the amount of intracellular fluid. Although this situation seems to be a structure that only affects muscle fullness and appearance, the situation is quite different. Because as the intracellular fluid level increases, cell catabolism is inhibited.
The logic of the anti-catabolism feature is actually quite simple. Oxidative stress that occurs inside the cell with exercise, intensifies with fluid loss and causes catabolism within the cell. Increasing intracellular fluid with creatine prevents catabolism by decreasing its effect together with the density of elements that cause oxidative stress.
Creatine Increases Muscle Strength.
Many studies have concluded that individuals taking it has significant improvements in maximal strength. Studies have shown that people who use C-monohydrate can repeat with a certain weight. In a 2003 study, researchers found that the average increase in repeats performed while taking creatine was approximately 15% greater than those who took a placebo, as a result of 16 studies.
In one study, it has been observed that adding creatine to the diet of a regular workout can increase muscle strength by 8%, weight lifting performance by 14%, and max reps by 43%. ( 3 )
What Are the Benefits of Creatine?
Increases athletic performance
It contributes to the body producing more energy and increases endurance performance in high-intensity training (HIIT). It benefits athletes who need short bursts of energy such as sprinting and weight lifting.
Increases muscle mass
It decreases age-related muscle loss, helps preserve muscle mass, and increases muscle strength. It helps you gain muscle in the following ways:
- It increases cell signaling that helps muscle repair and development.
- It aids in protein synthesis that enhances the growth of lean muscle mass.
- During intense exercise, quickly replenishes ATP stores and prevents fatigue.
- Increases hormones.
- It raises the water in muscle cells.
- It reduces high myostatin levels that inhibit new muscle growth. ( 4 )
Repairs damage after injury
After intense resistance training, it reduces muscle cramps with its antioxidant effect and accelerates the healing process in the brain and other injuries.
Help treat diseases that cause creatine deficiency
Some diseases can cause creatine deficiency. Studies show that creatine supplementation can reduce the symptoms of these diseases. Diseases that can cause deficiency:
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Multiple sclerosis (MS)
- Vision loss
- Muscular diseases such as muscular dystrophy, muscle atrophy, polymyositis
It reduces symptoms of depression
Studies show that it enhances the effects of antidepressants in women with major depression and may be a therapeutic approach in cases of comorbid methamphetamine addiction. ( 5 )
Prevents skin aging
Studies show that a cream containing creatine-folic acid improves sun damage and reduces sagging and wrinkles. ( 6 )
Protects brain functions
It supports cognitive development such as memory, concentration, attention and increases mental performance in older adults. It improves brain health and prevents neurological diseases by increasing phosphocreatine stores in the brain. Conditions that creatine supports include: ( 7, 8 )
- Huntington’s disease
- Ischemic stroke
- Brain or spinal cord injuries
- Head trauma
- Rett syndrome (nervous system disorder)
- Amyotrophic lateral sclerosis (ALS)
- Hereditary disorders that affect sensation and movement
There are many types of creatine on the market, some of these formulations and combinations; Reliable studies have not yet been published for those containing creatine phosphate, creatine nitrate, creatine ethyl ester, creatine + sodium bicarbonate, creatine-magnesium + chelate, creatine+ glycerin, creatine+ glutamine, insulin + effervescent and serum formulations. ( 9 )
Which is the best type of creatine?
The best researched, easy to digest, cheap, and effective form is C-monohydrate. Available in various forms such as powder, capsule, gel, candy, chewing gum; It is a common ingredient in sports drinks.
How to Use Creatine?
Our liver produces about 2 grams of creatine every day. We need 1-3 grams of creatine a day. About half comes from the diet, the rest is synthesized by the body. Supplements are safe when taken in lower doses of up to a maximum of 25 grams per day for up to 14 days, or 4-5 grams per day for up to 18 months.
Studies show that no side effects are observed for up to 5 years, but more research is needed for long-term use. ( 10 )
How is creatine used?
Many athletes and bodybuilders follow the loading protocol. It starts with a high dose to rapidly increase body stores and continues with a long-term maintenance dose to maintain the high level in the muscles. Skeletal muscle can retain a certain amount of creatine; adding more will not raise levels. The saturation point is reached in the first few days of the loading dose. Doses should be spread over the day and taken with plenty of water to prevent side effects. Absorption is facilitated when taken with foods containing carbohydrates and proteins.
- For age-related muscle loss and athletic performance: loading doses are 20 grams daily for 4-7 days. Maintenance doses after this period are typically 2-10 grams per day.
- For muscle strength: loading doses are about 20 grams daily for 5-7 days. After that, maintenance doses varying between 1-25 grams per day are taken. ( 11 )
Who should use creatine?
It is used for its muscle mass, strength profile, and anabolic effects, Especially.
- Vegetarians who don’t get enough creatine from their diet.
- The elderly
- Those at risk of neurological disease
- Athletes who need speed or muscle bursts in a short time, such as athletes, weightlifters, bodybuilders, can use creatine supplements.
According to the International Sports Nutrition Association (ISSN), athletes who do intense training may need to consume 5-10g per day to maintain their storage. Studies on its use in children and young people are insufficient. With proper precautions and doctor approval, it can provide young athletes with a nutritional alternative. ( 12 )
Who shouldn’t use creatine?
- It is recommended not to use for people with kidney disease or risk of kidney disease and people with diabetes. ( 13 )
- There are concerns that it may increase mania in those with bipolar disorder.
- Its safety has not been confirmed during pregnancy and breastfeeding. ( 14 )
- As it can cause weight gain, it can negatively affect athletes targeting certain weight categories.
Creatine kinase test
Creatine kinase (CK) test is performed in the presence of signs of inflammation in the muscles, sports injuries, or heart attack. Its level in the blood begins to rise in the first 4-6 hours after a heart attack, reaches the highest level in 18-24 hours, returns to normal within 2-3 days.
When CK, which is found in different organs and tissues such as skeletal muscle, heart, and brain, rises in the blood, the values in its forms according to the tissue are examined to find out where it originates; CK-MM is found in skeletal muscle, CK-MB in cardiac muscle, CK-BB mostly in smooth muscles such as the brain, small amounts of intestine and uterus.
Also known as creatine phosphokinase; It is an enzyme that can be produced by various tissues and cells and provides energy to the body. It accelerates the conversion of creatine to create phosphocreatine using ATP energy. ( 15 )
Serum creatinine level in the blood
Creatine kinase (CK) catalyzes the conversion of creatine. The CK value in adult males is 52-336 units per liter (U / L); adult females are expected to be 38-176 units (U / L). However, these values may vary depending on the person, the laboratory where the test is performed, the method used, and the device.
What if creatine is dangerous?
If the ratio of CK-MB to total CK (relative index) is higher than 2.5-3, a relative index below this value with higher CK suggests skeletal muscle damage. There can be an increase of up to 50 times in myocardial infarction and myopathies.
How does creatine fall?
The effects of creatinine decrease as the time spent exercising increases and decreases in intensity. Avoiding intense sports and alcohol, limiting salt intake and protein intake, and consuming fiber foods cause levels to decrease.
It is a bioactive substance and caution should be exercised when using it. It is thought that high doses may cause liver and kidney dysfunction. Its height in the blood generally means that muscle damage occurs.
Why does creatine rise?
It may increase due to excessive use of supplements, alcohol, dehydration, muscle trauma, bee stings, burns, high protein consumption, and heavy sports. At the same time, some diseases such as myocardial infarction, cerebrovascular events, myositis, polymyositis, and hypothyroidism cause the level to increase.
Is high creatine dangerous?
It is well regulated in the tissues, but if not used, the waste product creatinine can accumulate in the blood and cause gastrointestinal problems. It causes low blood sugar and can raise blood pressure, which can affect patients with diabetes or hypoglycemia. If your kidneys are healthy, you do not have any disease, if you are active enough, there is no scientific evidence that it is harmful in the short or long term when used as recommended. ( 16 )
Are creatinine, creatine, and keratin the same thing?
- Creatine is a naturally occurring amino acid that provides energy support to the body; It is transported to every tissue from the heart to the brain. It is used as a dietary supplement by athletes or bodybuilders.
- Creatinine is a waste product that is produced when creatine produced by the work of muscles is broken down, it is the result of daily muscle movements. It is filtered by the kidneys and excreted in the urine. Its levels in the blood are indicative of kidney function.
- Keratin is a fibrous protein that creates structures such as nails, hair, hair, skin, and teeth and increases their durability.
Keratin is a protein that protects from the sun’s harmful rays; Keratin care is done to correct damaged hair and protect its health. Keratin shampoo does not contain chemicals as it is naturally formulated. It prevents hair loss, nourishes by acting from the roots, reduces oily, dandruff, itching, provides shine and moisture to the hair.
Naturally occurring keratin in hair decreases gradually as a result of the processes and products used. Keratin deficiency in the hair over time causes hair loss at an early age. Prepared by natural methods, keratin oil helps to restore the proteins needed by damaged hair.
As a protein with restorative properties, it preserves the natural moisture balance and helps hair to be softer, silky, shiny, and lively. Penetrates deep into the hair; provides easy structuring of hair.
Is creatine harmful?
The most important reason I write this article about creatine is the amazing things I’ve heard about creatine harm. Many people were excitedly telling me about its incredible effects, from kidney damage to multi-organ failure.
This section is a great opportunity to give you accurate information instead of hearsay information.
There are many changes made to creatine. These,
- Weight gain (yes medically this is a side effect),
- Frequent and severe cramps,
- Stomach and intestinal problems,
- Kidney damage can be listed as.
I want to examine these accusations one by one.
- Weight gain:
Weight gain is an expected result of the use of creatine monohydrate because it creates fluid retention in the muscle. In addition, in the long term, the development of muscle mass is possible along with the increase in strength and anabolic profile.
With these, increasing weight is not a side effect, but the desired result.
- Frequent and severe cramps:
It is famous for pulling extracellular fluid into the cell. We’ve talked about this in many places. Mineral imbalances may occur with the fluid drawn into the cell, especially in the summer months when fluid loss is high and during long exercise marathons.
Although this causes cramping, the cramps will regress with appropriate fluid supplementation. Apart from this situation, it does not seem possible for creatine to cause cramping directly.
- Stomach and intestinal problems:
The frequency and severity of stomach and intestinal problems vary greatly from person to person. For this reason, it is quite difficult to say anything for sure. However, there are cases of diarrhea (diarrhea) reported in some (although rare) individuals taking high doses of creatine (10 grams or more per day).
Among these reports, there are individuals who are completely comfortable with purchases of 30 grams or more. As a result, the situation depends on the person’s stomach and intestinal sensitivity and the amount of dose taken.
If you have known stomach and intestinal diseases, you should be cautious when using creatine and start with a low dose. If you feel uncomfortable during use, you should stop using creatine and consult your doctor.
- Kidney damage:
There is a great fear of creatine and kidney damage from the past. The main reason for this fear is research done in 1998 on a single person.
In this study, renal function GFR is measured by administering C -monohydrate to a patient with glomerulonephritis and corticosteroid-sensitive nephritic syndrome. As a result of impaired kidney function due to severe kidney damage, the researcher publishes the study with a statement that creatine causes kidney damage.
As a result of the publication, many people fear that creatine can actually cause kidney damage in healthy individuals.
There is a point skipped here and proved by many types of research. This point is that creatine does not cause any kidney damage with recommended dosing in healthy individuals. This has been proven by years of clinical experience and research.
Of course, although each individual is different, it is a necessity to consult your doctor for all supplements. But as a physician, this is the result that I see in my own patients and athletes and decided by research.
Creatine side effects and harms
- The combination of creatine with caffeine and supplemental ephedra can increase the risk of stroke in athletes.
- Taking it with cyclosporine, aminoglycosides, non-steroidal anti-inflammatory drugs that can damage the kidneys may increase the risk of kidney damage.
- If taken in high doses, it can damage the liver, kidneys, or heart.
- It is not yet approved by the FDA; It may be safe for most people in small amounts, but long-term safety has not been proven.
- It may cause discomfort when taken before sleep.
- Studies show that it may be less effective in children and adolescents compared to adults.
- Stomach cramps if taken without enough water; In high doses, muscle cramps, nausea, diarrhea, dizziness, abdominal pain, dehydration, and fever may occur.
- It can cause weight gain.
Resources and References:
- Bird, S. P. (2003). Creatine supplementation and exercise performance: A brief review. Journal of Sports Science and Medicine. 2, 123-132
- Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M., …Antonio, J. (2007, August 30). International Society of Sports Nutrition position stand: creatine supplement and exercise. Journal of the International Society of Sports Nutrition, 4(6)
- Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012, July 20). Creatine supplementation with specific view to exercise / sports performance: An update. Journal of the International Journal of Sports Nutrition, 2012(9), 33
- Creatine. (2017, March 13)
- Creatine. (2014, June 26)
- Forbes, S. C., Sletten, N., Durrer, C., Myette-Côté, E , Candow, D., & Little, J. P. (2017, June). Creatine monohydrate supplementation does not augment fitness, performance, or body composition adaptations in response to four weeks of high-intensity interval training in young females. Human Kinetics Journals, 27(3), 285-292
- Hellem, T. L., Sung, Y. H., Shi, X. F., Pett, M. A., Latendresse, G., Morgan, J. … Renshaw, P. F. (2015, October 12). Creatine as a novel treatment for depression in females using methamphetamine: A pilot study. Journal of Dual Diagnosis, 189-202
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- Kley, R. A., Tarnopolsky, M. A., & Vorgerd, M. (2013, June 5). Creatine for treating muscle disorders. Cochrane
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- Lyoo, I. K., Yoon, S., Kim, T. S., Hwang, J., Kim, J. E., Won, W., Bae, S., & Renshaw, P. F. (2012, September). A randomized, double-blind placebo-controlled trial of oral creatine monohydrate augmentation for enhanced response to a selective serotonin reuptake inhibitor in women with major depressive disorder. American Journal of Psychiatry. 169(9):937-45
- Mayo Clinic Staff. (2013, November 1)
- McMorris, T., Mielcarz, G., Harris, R. C., Swain, J. P., & Howard, A. (2007, September). Creatine supplementation and cognitive performance in elderly individuals. Neuropsychology, Development, and Cognition. 14(5):517-28
- NCAA student-athlete substance use study: Executive summary August 2014. (2014, August)
- Powers, M. E., Arnold, B. L., Weltman, A. L., Perrin, D. H., Mistry, D., Kahler, D. M … Volek, J. (2003, January-March). Creatine supplementation increases total body water without altering fluid distribution. Journal of Athletic Training. 38(1): 44–50
- Report on an assessment of the risks of creatine on the consumer and of the veracity of the claims relating to sports performance and the increase of muscle mass. (n.d.)
- Twycross-Lewis, P., Kilduff, L. P., Wang, G., & Pitsiladis, Y. P. (2016, August). The effects of creatine supplementation on thermoregulation and physical (cognitive) performance: a review and future prospects. Amino Acids. pp 1843–1855
- Xiao, Y., Luo, M., Luo, H., & Wang J. (2014, June). Creatine for Parkinson’s disease. Cochrane. 17;(6):CD009646
- Yang, L., Calingasan, N. Y., Wille, E. J., Cormier, K., Smith, K., Ferrante, R. J., & Beal, M. F. (2009, June). Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson’s and Huntington’s diseases [Abstract]. Journal of Neurochemistry. 109(5):1427-39