Creatine is a natural compound of three amino acids, and it is used primarily as a supplement for building muscle.
Bottom-line assessment: Creatine monohydrate is a safe and effective supplement for improving muscle strength, particularly for males and vegetarians. It may also be useful for increasing cognitive abilities, particularly short-term memory for people over 50. Downsides: It may possibly cause cramping and worsen pre-existing kidney disease (unproven).
Dose: 3 grams once daily; take half before and half after exercise. Thorne and Creapure are reputable brands.
In-depth assessment: The body naturally makes its own creatine, approximately 1 gm per day. Non-vegetarians generally get 1 gm extra every day from eating meat or fish. 95% of creatine is transported to and used by the muscles. The brain also receives a small portion. Creatine is involved in ATP production, which is the primary source of energy. Other actions of creatine include boosting protein production, as well as antioxidant benefits.
In the world of sports, creatine monohydrate is the number one performance-enhancing supplement, because it has thus far proven to be safe and effective. It is used more by the athletes who need bursts of strength than by the endurance athletes. It primarily increases muscle mass, but it also reduces musculoskeletal injuries and shortens healing/recovery times. It is not banned by the regulatory agencies, presumably because it is not considered cheating due to the fact it does not automatically increase muscle mass like anabolic steroids; instead, creatine simply allows the athlete to work-out more and build more muscles naturally.
For normal folks, creatine can be used for general strength, but only when used with an increase in resistance exercise, such as weight-lifting, push-ups, cycling, swimming, power yoga, sprinting, etc.
There is growing evidence that creatine also supports cognitive abilities, particularly in people past 50. It may be good for fatigue, dizziness, generalized weakness, imbalance, and short-term memory loss. Creatine may also reduce headaches and other symptoms following Traumatic Brain Injuries, and it is being used as a treatment for several neuromuscular diseases.
Downsides: There was previously a concern that creatine could possibly cause kidney damage. This is because creatine is naturally reduced to creatinine, which happens to be a marker used to test kidney health, so there was initially some confusion. It turns out, pure creatine monohydrate only elevates the blood level of creatinine, but does not actually harm the kidney, particularly at doses of 3 grams daily. This has been shown in multiple quality studies and meta-analyses. However, it has not yet been absolutely proven that creatine does not cause worsening of pre-existing kidney disease, especially high-dose creatine that is not in the pure, unadulterated monohydrate form.
Side effects of creatine are the possibility of muscle cramping (stretching those extra muscles is important), water retention (usually just during the high-dose loading phase, which I do not recommend), and nausea (choose a reputable brand and use before the expiration date, and nausea shouldn’t be an issue).
Reputable Brands: Thorne and Creapure, which are both used by multiple sports franchises and Olympic squads. If you choose another brand, please do your research and make sure it is USP or NSF certified.
Type: Creatinine monohydrate is by far the best tested of the creatine types, and it is usually sold in a pure form. It is prudent at this time to avoid the ‘proprietary blends’ and other poorly-regulated and untested forms.
Please always remember that the most important sports supplement is a healthy diet. Focus on food and exercise first, then consider if creatine could be of some additional benefit.
I hope this can be of some help to you,
Brandon Heiberger, MD
HeibergerMD.com 