Research Corner November 2014 – How to Optimize Creatine Supplementation For Enhanced Strength and Muscle Gains?
Among a wide variety of mass gainers, fat boosters, diet pills and other bogus supplements, the one sports supplement that has been shown to actually work time and time again rarely gets featured in the limelight.
Today we’re going to take a cold, hard look at the facts behind this one product that does enhance athletic performance – and the best part is, it won’t set you back financially by a fortune unlike many of the other supplements on the market with exceptional marketing tactics but woefully inadequate impact on strength levels and body composition.
Creatine is the most well researched supplement out there, with numerous studies showcasing its efficacy regarding increases in strength, power and muscle mass. [1-5]
Occurring naturally in the human body, 95% of the creatine pool is found in skeletal muscle, while the remaining 5% is located in the brain, liver, kidney, and testes. It can also be obtained from dietary sources, from both meat and fish. 
The benefits of creatine supplementation include increased muscular force and power, reduced fatigue in repeated bout activities, and increased muscle mass.
You’ll want to make sure you’re purchasing creatine monohydrate as dollar for dollar, it’s the most effective form of creatine. You can get a tub of creatine monohydrate that will last you several months for around 10 bucks in pretty much any supplement store or online.
Other forms of creatine may be more expensive, but studies have not found them to be more effective than creatine monohydrate. [7-9]
Some sources advocate initially using a higher “loading period” for 5-7 days with approximately 20 g/day before reducing intake to a standard dosage of 3-5 g/day.
It takes roughly 30 days of regular doses to reach muscle creatine contents that can be achieved in 5 days of high loading.
The results then normalize from there on out, so high loading is not necessary in long-term supplementation protocols. 
Around 2-3 g/day are then required to maintain full muscle creatine levels, and can be taken indefinitely.
Once creatine supplementation is stopped, muscle creatine levels will return to baseline levels in approximately four weeks.
In a first study of its kind, Antonio & Ciccone observed the effects of creatine timing on body composition and strength in 19 healthy recreational bodybuilders – one group of subjects consumed creatine immediately before and the other group immediately after exercise. 
The researchers found that the post-workout group fared significantly better than the pre-workout group in terms of increasing fat-free mass and bench press 1RM, which indicates that consuming creatine immediately after your strength training session is possibly more beneficial than before it.
Of importance is also the fact that not everybody responds favorably to creatine supplemenation.
Generally speaking, someone who has lower creatine levels in the body by nature, a relatively higher proportion of fast-twitch muscle fibers, and quite a way to go before reaching genetic size and strength limits, is very likely to witness notable performance and body composition improvements. 
What About Possible Side Effects?
Side effects of creatine supplementation have been reported both anecdotally as well as in the scientific literature. These side effects include:
- weight gain
- gastrointestinal distress
- renal dysfunction
- muscle cramps
As many male gym-goers and athletes seek weight gain in the form of fat-free mass, that side effect can indeed be very desirable.
But weight class athletes like wrestlers, boxers and weightlifters should keep this in mind when supplementing with creatine, especially near competition times and the weigh-ins prior to them.
Furthermore, gastrointestinal distress and muscle cramps have been reported anecdotally but little to no studies have been able to verify these adverse reactions to creatine supplementation, making the appearance of these particular side effects very dependent on the individual and rather limited in scope.
Studies have reported only two isolated incidents that have implicated creatine in renal dysfunction so far (including one patient that had a history of kidney disease).
However, in healthy athletes long-term creatine supplementation (2-30 g/day between 10 months and 5 years) has not been shown to induce detrimental effects on the kidneys. 
– Creatine is one of the safest and most effective sports supplements commercially available. Its propensity to enhance exercise performance and muscle mass has been well demonstrated, especially in conjunction with resistance training.
– The side effects associated with creatine usage are relatively mild, and even long-term supplementation (up to 5 years) has not been shown to cause adverse issues in healthy individuals.
– Don’t waste your money on novel forms of creatine (pyruvate or ethyl ester), no matter how hyped up their marketing message. Creatine monohydrate is cheaper and gets the job done better than any other form of creatine on the market.
– Shoot for 3-5 grams of creatine monohydrate intake per day if planning to ingest it over the long-term; 20 g/day if you intend to use it for only a week or so.
– Consume your daily dose immediately after training, as this may enhance strength and muscle gains.
– In some individuals creatine supplementation has no positive effects on strength and muscle gains (so called “non-responders”).
References Izquierdo, M. et al. Effects of Creatine Supplementation on Muscle Power, Endurance, and Sprint Performance. Medicine and Science in Sports and Exercise. 2002 Feb; 34(2):332-343.  Volek, JS. et al. Performance and Muscle Fiber Adaptations to Creatine Supplementation and Heavy Resistance Training. Medicine and Science in Sports and Exercise. 1999 Aug; 31(8):1147-1156.  Volek, JS. et al. Creatine Supplementation Enhances Muscular Performance During High-Intensity Resistance Exercise. Journal of the American Dietetic Association. 1997 Jul; 97(7):765-70.  Ziegenfuss, TN. et al. Effect of Creatine Loading on Anaerobic Performance and Skeletal Muscle Volume in NCAA Division I Athletes. Nutrition. 2002 May; 18(5):397-402.  Kreider, RB. Effects of Creatine Supplementation on Performance and Training Adaptations. Molecular and Cellular Biochemistry. 2003 Feb; 244(1-2):89-94.
Supplementation and Exercise. Journal of the International Society
of Sports Nutrition. 2007 Aug; 4:6.  Spillane, M. et al. The effects of Creatine Ethyl Ester Supplementation Combined with Heavy Resistance Training on Body Composition, Muscle Performance, and Serum and Muscle Creatine Levels. Journal of the International Society of Sports Nutrition. 2009 Feb; 19(6):6.  Jagin, AR. et al. A Buffered Form of Creatine Does Not Promote Greater Changes in Muscle Creatine Content, Body Composition, or Training Adaptations Than Creatine Monohydrate. Journal of the International Society of Sports Nutrition. 2012 Sep; 13(9):43.  Van Schuylenberg, R. et al. Effects of Oral Creatine-Pyruvate Supplementation in Cycling Performance. International Journal of Sports Medicine. 2003 Feb; 24(2):144-150.  Persky, AM. et al. Clinical Pharmacology of the Dietary Supplement Creatine Monohydrate. Pharmacological Reviews. 2001 Jun; 53(2):161–176.  Antonio, J. et al. The Effects of Pre Versus Post Workout Supplementation of Creatine Monohydrate on Body Composition and Strength. Journal of the International Society of Sports Nutrition. 2013 Aug; 10:36.  Aragon, Alan. Research Review. Jul 2008: 3.  Poortmans, JR. et al. Long-term Oral Creatine Supplementation Does Not Impair Renal Function in Healthy Athletes. Medicine and Science in Sports and Exercise. 1999 Aug; 31(8):1108-1110.
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