Creatine

Creatine Supplementation—Necessary or Just Beneficial?

"Creatine is the safest, most effective ergogenic aid available right now."- Darren Candow, PhD

The body produces about 1–2 grams of creatine per day in the liver and brain and obtains another 1–3 grams per day from dietary sources including red meat, poultry, and fish—but none from plants. While creatine is not essential, it's considered conditionally essential because supplementation provides widespread benefits beyond muscle including brain function, bone health, and immune support. Because plant-based diets are devoid in creatine, supplementation can be beneficial for vegans and vegetarians especially. 95% of our body's creatine is found in skeletal muscle, with the other 5% distributed across the brain and bones. So, why supplement? According to Dr. Darren Candow, the thinking is that by obtaining extra creatine by supplementing with 5–10 grams or more per day, muscle stores can become saturated, allowing creatine to "spillover" into the brain and bones.

Creatine for Muscle Performance & Exercise

"Creatine increases intramuscular phosphocreatine stores, which allows for faster regeneration of ATP. This leads to better performance and muscle function during repeated high-intensity efforts."- Darren Candow, PhD

Creatine's ability to enhance muscle performance and exercise capacity is well-established. Its role extends from supporting explosive power and muscle growth to improving recovery, particularly in anaerobic and high-intensity aerobic contexts.

How does creatine work?

Creatine increases muscle phosphocreatine (PCr) stores, critical for regenerating ATP rapidly during high-intensity exercise, thus delaying muscular fatigue. Supplementation can boost total muscle creatine stores by approximately 20–30%, enabling sustained ATP production and prolonged high-intensity performance during anaerobic activities such as sprinting, lifting, and HIIT workouts as well as during prolonged steady-state endurance exercise.This appears to be particularly evidence during the second, third, and fourth sets of exercise.

Creatine for strength and hypertrophy

Extensive meta-analyses have shown that creatine supplementation results in approximately 1.1 kg greater lean body mass gain on average compared to placebo, but only when combined with resistance training—creatine won't make you stronger on its own. That's because creatine enhances training volume—allowing more repetitions per set—thereby facilitating greater hypertrophic responses, especially notable in type II (fast-twitch) muscle fibers. Type II fibers preferentially store creatine, making supplementation particularly beneficial for explosive strength and power performance . A hallmark study in older adults noted that creatine users gained roughly twice the muscle mass compared to placebo after a 12-week resistance training program (6.3% vs. 3.1%), attributed primarily to enhanced training capacity and cellular hydration . Studies using ultrasound also show that creatine enhances regional measures of muscle hypertrophy (size and thickness) compared to placebo.

Creatine for exercise recovery

Between efforts

Creatine significantly accelerates PCr resynthesis during short rest intervals between high-intensity efforts, allowing quicker recovery and sustained performance in subsequent sets. For instance, after creatine loading, PCr levels can recover 30–40% faster, enabling athletes to maintain higher training intensity throughout a workout session . Creatine not only enhances energy production between sets, but also** between individual muscle contractions!**

After intense exercise

Creatine supplementation reduces muscle breakdown and inflammation markers post-exercise, particularly beneficial after aerobic endurance events. Notably, after a half-Ironman competition, athletes supplemented with creatine experienced lower inflammation (TNF-α, IL-1β, PGE2) compared to placebo . While creatine does not directly increase muscle protein synthesis like dietary protein, it significantly decreases markers of protein breakdown, particularly in young males, suggesting an important anti-catabolic effect .

Creatine and Aging

"What is interesting is that creatine seems to mitigate the age-related loss of muscle and strength, even in people who are sedentary."- Darren Candow, PhD

Aging leads to progressive muscle loss (sarcopenia), decreased strength, and functional decline, significantly affecting quality of life. Creatine supplementation, particularly combined with resistance training, has emerged as a valuable nutritional strategy to mitigate these negative consequences of aging.

Age-related muscle loss (sarcopenia)

Aging disproportionately reduces type II (fast-twitch) muscle fibers, crucial for explosive movements and daily tasks (e.g., rising from a chair, stair climbing, preventing falls). Type II fibers are primary storage sites for creatine, explaining the benefit older adults derive from supplementation. Meta-analyses confirm older adults supplementing with creatine and resistance training achieve significantly greater muscle mass (approximately 1 kg more on average) and strength gains compared to resistance training alone. Improvements include upper-body strength and performance in functional tests, directly translating into enhanced mobility and independence.

How does creatine improve muscle function?

• Enhanced muscle recruitment and power:Creatine improves neuromuscular efficiency, allowing older adults to better recruit muscle fibers, especially type II, which enhances muscle strength, power, and functional performance. Creatine supplementation facilitates higher training intensities, improving long-term adaptations.

• Calcium handling: Creatine improves calcium uptake in muscle cells, enhancing muscle contraction and relaxation speed—critical factors that decline with aging. Better calcium handling translates into improved muscle function, reduced fatigue, and greater overall muscle performance in older adults.

• Indirect effects on bone health: By supporting muscular strength, creatine indirectly promotes bone health, as stronger muscles produce greater mechanical stress on bones, stimulating bone maintenance and reducing fracture risks among seniors.

Creatine for Recovery and Injury Rehabilitation

"One of the more novel effects of creatine is its ability to enhance recovery, especially when there is muscle damage. You recover faster, get back to training sooner, and see better performance over time."- Darren Candow, PhD

Creatine supplementation is increasingly recognized for its benefits in accelerating recovery after injury or surgical immobilization. How does it do this?

First, by maintaining muscle strength during immobilization. During injury-related immobilization (such as casting or surgery), creatine supplementation helps preserve muscle mass and strength, reducing the typical loss observed during prolonged inactivity. Research indicates that creatine maintains muscle strength, prevents muscle breakdown, and aids rehabilitation following surgery or significant injury. Second, creatine has anti-cabolic properties and offers cellular protection.Creatine reduces muscle protein breakdown markers (leucine oxidation, 3-methylhistidine) and oxidative stress during recovery phases. This supports faster muscle repair, less muscle atrophy, and improved cellular preservation during stress conditions, aiding recovery from injuries and surgical interventions. Finally, creatine may offer pre-surgery benefits—emerging theories suggest creatine supplementation prior to elective surgeries or injury-risk scenarios could potentially minimize muscle loss and enhance recovery outcomes, facilitated by the expression of myogenic transcription factors.

Creatine and Bone Health

"There is some interesting evidence that creatine, especially when combined with resistance training, might improve bone mineral density or at least attenuate loss, particularly in postmenopausal women."- Darren Candow, PhD

Creatine's potential to positively influence bone health has become an exciting area of research, particularly when combined with exercise that mechanically loads the skeleton. Creatine exerts both direct and indirect effects on bone.

Creatine supplementation directly promotes osteoblast activity (bone-building cells) by potentially enhancing cellular energy availability. Preliminary in vitro studies indicate creatine might upregulate bone formation enzymes like alkaline phosphatase, although in vivo evidence remains indirect and exercise-dependent. Creatine also appears to have an anti-catabolic effect on bone, potentially reducing osteoclast activity (bone breakdown cells), comparable in principle to bisphosphonate drugs. While creatine alone has minimal direct influence on bone mineral density (BMD), its primary benefit is preventing bone loss, particularly significant at sites vulnerable to osteoporosis-related fractures like the hip and spine in postmenopausal women.

It's important to note that creatine's bone benefits depend entirely on concurrent mechanical loading via resistance training or impact-based exercises. Creatine amplifies the mechanical stimulus of exercise by increasing muscle strength and power output, indirectly promoting bone adaptation and preservation. Clinical studies demonstrate modest but significant increases in bone cross-sectional area and density at weight-bearing sites (e.g., tibia) when combined with long-term resistance training. So, despite encouraging findings, creatine supplementation alone is not sufficient to substantially improve BMD without exercise. For individuals with severe osteoporosis, standard medical treatments remain far more effective. Creatine should therefore be seen as a complementary nutritional strategy rather than a standalone therapy for bone health.

Dosing creatine for bone health may also be different from dosing for strength and performance. While typical muscle-oriented creatine supplementation protocols (3–5 grams daily) can benefit bone indirectly through increased muscle mass, emerging evidence suggests that higher doses (up to ~8–10 grams/day) might be optimal for maximizing creatine's potential bone benefits in aging populations, especially when paired with weight-bearing exercise.

Creatine and Brain Health

"The brain has creatine transporters, and there is a growing body of evidence suggesting creatine can support cognitive function, especially during sleep deprivation or stress. The more that the brain is stressed, the more that creatine seems to come to the rescue."- Darren Candow, PhD

Creatine supplementation has emerged as a powerful nutritional strategy to support cognitive performance, enhance brain resilience under stress, and potentially mitigate the effects of neurological and psychiatric disorders. The brain has high energy demands, accounting for approximately 20% of the body's total daily energy consumption. Creatine and phosphocreatine (PCr) are critical in rapidly replenishing ATP in neurons, particularly during high cognitive demand or metabolic stress like sleep deprivation, aging, and intense cognitive tasks. Creatine supplementation (typically 5–10 grams daily) can increase brain creatine stores by approximately 5–10%, translating into measurable cognitive improvements. Systematic reviews and meta-analyses show consistent enhancements in memory, processing speed, attention, and reduced mental fatigue, particularly noticeable under cognitive stress conditions such as sleep deprivation or exhaustive mental work.

Creatine also has significant neuroprotective potential for a variety of conditions:

• Traumatic brain injury (TBI) and concussion: Animal studies consistently indicate reduced neuronal death, inflammation, and enhanced functional recovery post-injury. Human clinical studies on children with TBI demonstrated improved cognitive and functional outcomes when creatine was administered shortly after injury, highlighting creatine's therapeutic promise in acute brain trauma scenarios.

• Neurodegenerative diseases: While clinical trials show mixed results, creatine appears safe and may help buffer energy deficits observed in conditions like Parkinson's and Huntington's disease. Its role remains supportive rather than curative, but ongoing research continues to investigate creatine's long-term neurological benefits.

• Depression and anxiety: Emerging research suggests creatine supplementation can significantly enhance the effectiveness of antidepressant therapies. A notable randomized trial found that women with clinical depression supplemented with creatine (5 grams/day) alongside SSRIs experienced faster symptom relief and higher remission rates compared to SSRIs alone. Potential mechanisms include improved brain bioenergetics, increased brain-derived neurotrophic factor (BDNF), and reduced neuroinflammation.

• Sleep deprivation: During situations of extreme sleep deprivation, a dose as high as 0.35 g/kg (25–30 grams of creatine) has been shown to improve memory, cognition, and brain creatine levels . With this dosing regimen, creatine works rapidly, peaking in the blood within three hours and being absorbed by the brain when under stress.

• Enhanced sleep during training: Recent findings suggest creatine supplementation (approximately 5 grams/day) may improve sleep quality and duration, particularly following intense training sessions. Athletes using creatine have reported significantly increased sleep duration(nearly an hour longer per night), likely due to reduced muscular fatigue, better physical recovery, and improved overall energy status. The overarching theme when it comes to creatine in the brain is that it improves brain bioenergetics and mitochondrial health—all of which are implicated in brain dysfunction and cognitive decline.

Creatine and Cardiometabolic Health

"Some studies show improvements in glucose control, inflammation markers, and even triglycerides. It is not a magic bullet, but creatine might have modest cardiometabolic benefits."- Darren Candow, PhD

Creatine supplementation is beginning to demonstrate potential benefits for cardiometabolic health, including improved vascular function and metabolic parameters, which can be particularly relevant for individuals managing cardiovascular disease, diabetes, or metabolic syndrome.

Creatine may positively influence vascular endothelial cells, improving macrovascular (arterial) and microvascular (capillary) health. Preliminary studies suggest creatine supplementation can modestly improve endothelial function, which is critical for vascular tone, blood pressure regulation, and cardiovascular health.

Creatine supplementation can enhance glucose disposal and improve insulin sensitivity by increasing the expression of GLUT-4 glucose transporters in muscle cells. Clinical studies demonstrate improved glycemic control and reduced blood sugar levels in individuals with type 2 diabetes who combined creatine supplementation with regular exercise compared to exercise alone. Evidence regarding creatine's influence on cholesterol or triglyceride levels is currently limited and mixed. While creatine does not appear to significantly influence lipid profiles directly, its indirect effects via improved muscle mass, physical activity, and metabolic health warrant further exploration.

Creatine and Male Fertility

"There is currently no evidence that creatine harms male fertility. In fact, early research suggests it may support sperm health by enhancing mitochondrial function and cellular energy production—two key factors in male reproductive performance."- Darren Candow, PhD

The research is still in its early stages, but existing data suggest that creatine may actually support, rather than harm, male fertility. Animal studies have shown that creatine supplementation can improve sperm motility and enhance mitochondrial function—both of which are critical for reproductive performance. Since sperm cells are highly energy-dependent, relying on ATP to power their movement, creatine's role in regenerating ATP through the phosphocreatine system may be particularly relevant for sperm health. Importantly, there is no scientific evidence to suggest that creatine negatively affects testosterone levels, sperm count, or fertility in men. On the contrary, early research points toward potential benefits. However, Dr. Candow emphasized that human trials are still limited, and more high-quality research is needed before making definitive claims about creatine as a fertility-enhancing supplement.

Still, based on current knowledge, there's no reason for concern that creatine impairs male reproductive function. If anything, it may support energy metabolism in sperm and promote better mitochondrial efficiency—making it an intriguing area for future study.

Creatine Supplementation Protocols

"You do not have to load creatine. A daily dose of 3 to 5 grams is sufficient to saturate muscle stores in about four weeks. The loading phase—20 grams for 5 to 7 days—can get you there faster, but it is not essential."- Darren Candow, PhD

Proper dosing and supplementation protocols are critical for maximizing creatine's benefits across muscle, brain, bone, and overall health contexts.

Standard dosing strategies

• Loading phase (rapid saturation): A traditional creatine supplementation protocol involves an initial loading phase of 20 grams/day, divided into four doses of 5 grams each, for 5–7 days to rapidly saturate muscle creatine stores (increasing by approximately 20–30% within a week), followed by a maintenance dose of 3–5 grams/day. \

• Maintenance dose only (slow saturation):Alternatively, individuals can skip the loading phase, opting instead for a consistent maintenance dose of 3–5 grams/day. This approach achieves similar muscle saturation levels, typically within 3–4 weeks, with fewer gastrointestinal side effects. Most experts agree that unless one needs to quickly elevate muscle creatine stores, the loading phase isn't necessary.