In patients with DM1 given a short loading phase (10.6g for ten days) followed by a 5.3g maintenance for the remainder of an 8-week trial noted that supplementation resulted in a minor improvement in strength (statistical significance only occurred since placebo deteriorated) and no significant difference was noted in self-reported perceived benefits.[565] Maintaining a 5g dosage for four months also failed to significantly improve physical performance (handgrip strength and functional tests) in people with DM1, possible related to a failure to increase muscular phosphocreatine concentrations.[566]
Cyclocreatine appears to be passively diffused through membranes and not subject to the creatine transporter, which can be beneficial for cases where creatine transporter function is compromised (creatine non-response and SLG6A8 deficiency). Similar to other forms of creatine, it buffers ATP concentrations, although its efficacy as a supplement in otherwise healthy people is currently unknown.
Based on the limited data on performance and safety, some authors have not identified any conclusions and do not recommend its consumption in regards to creatine supplementation in children and adolescents [52,54]. Conversely, according to the view of the ISSN [5], younger athletes should consider a creatine supplement under certain conditions: puberty is past and he/she is involved in serious competitive training; the athlete is eating a well-balanced caloric adequate diet; he/she as well as the parents approve and understand the truth concerning the effects of creatine supplementation; supplement protocols are supervised by qualified professionals; recommended doses must not be exceeded; quality supplements are administered.
One case study exists of a man with focal segmental glomerulosclerosis who experienced an accelerated rate of GFR decline during supplementation (5g thrice daily for loading, then a 2g maintenance for seven weeks) which was partially reversed upon supplement cessation. This was deemed strong circumstantial evidence, and the brand of supplement was not named.[616] Elsewhere, interstitial nephritis associated with creatine supplementation has been reported in a man, although symptoms arose four weeks after supplementation started with no evidence to support correlation.[617] Some studies involving athletes and various dietary supplements have attempted to draw a correlation with creatine and cases of rhabdomyolysis.[618][619][620][621] Finally, one study in a diabetic person ingesting both metformin and creatine resulting in metabolic acidosis has attempted to place causation on creatine, but it did not establish causation or circumstantial evidence.[622]
When it comes to building muscle, there are numerous theories, methods, and preferences. Whether the goal is improved health, aesthetics, performance, or a combination of all three, there is no shortage of advice to help you get there. So much so that it can sometimes become overly complicated and you forget about the basic facts. But, it’s simpler than it seems.
How to maximize its effects: Take 20 grams of whey protein powder in the 30 minutes before working out, and take 40 grams within 60 minutes after training. Also consider taking 20-40 grams of whey immediately upon waking every morning to kick-start muscle growth. Your best bet is to choose a whey powder that contains whey protein hydrolysates (whey protein broken down into smaller fragments for faster digestion) or whey protein isolate.
This is another thing I am very tired of hearing. 'No matter what I do or what I eat, I can't gain weight'. I have heard this countless times and I am here to tell you that you are dead wrong. That's OK, because I actually said the same thing until I realized the truth. Most people think they are eating a lot and you just may be. But no matter what you are eating, if you are not gaining, you are not eating enough. Most times, you should re-evaluate your diet as well and focus on more calorie dense foods. But you need to eat more if you are not gaining.
Fish oils are an excellent source of omega-3 fatty acids, which provide myriad benefits for the body. For strength athletes and bodybuilders, we're most concerned with their anti-inflammatory and antioxidant properties. Intense resistance training can cause microscopic tears in your muscle fibers, leading to muscle damage and inflammation. While some inflammation is desirable, too much can delay the post-exercise recovery process.

de Salles Painelli V, Alves VT, Ugrinowitsch C, et al. Creatine supplementation prevents acute strength loss induced by concurrent exercise. Eur J Appl Physiol 2014;114(8):1749-55.del Favero S, Roschel H, Artioli G, et al. Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance. Amino Acids 2012;42(6):2299-305. View abstract.
Those micro-tears that are such a key factor for muscle-building need rest to rebuild themselves and grow stronger. When do they do that? When you’re asleep! “You have to rest and feed your muscles between workouts or you will tear them down and they will become weaker,” says Olson. “Over time, you run the risk of over-training, which can result in injury, and possibly even more sleep troubles.”
^ Spillane M, Schoch R, Cooke M, Harvey T, Greenwood M, Kreider R, Willoughby DS (February 2009). "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. 6 (1): 6. doi:10.1186/1550-2783-6-6. PMC 2649889. PMID 19228401.
When you’re planning your high-protein meals, 20 grams of protein is the optimal amount generally accepted for muscle growth. Research has found that the body doesn’t use much more than 20 grams for muscle-building at any one sitting. Around 80 grams of protein per day (or, four meals containing 20-grams of protein each) is about right for most people.
In competitive bodybuilding, bodybuilders aspire to develop and maintain an aesthetically pleasing body and balanced physique.[16][17] In prejudging, competitors do a series of mandatory poses: the front lat spread, rear lat spread, front double biceps, back double biceps, side chest, side triceps, Most Muscular (men only), abdominals and thighs. Each competitor also performs a personal choregraphed routine to display their physique. A posedown is usually held at the end of a posing round, while judges are finishing their scoring. Bodybuilders usually spend a lot of time practising their posing in front of mirrors or under the guidance of their coach.
Kornblum, C., Schroder, R., Muller, K., Vorgerd, M., Eggers, J., Bogdanow, M., Papassotiropoulos, A., Fabian, K., Klockgether, T., and Zange, J. Creatine has no beneficial effect on skeletal muscle energy metabolism in patients with single mitochondrial DNA deletions: a placebo-controlled, double-blind 31P-MRS crossover study. Eur J Neurol 2005;12(4):300-309. View abstract.
Don’t take sets to the point of failure—where you absolutely can’t perform another rep. You should never get to where you’re turning purple and screaming like you’re getting interviewed by “Mean” Gene Okerlund before WrestleMania. Most of the time, you want to end your sets two reps before total failure. Not sure when that is? The moment your form breaks down, or you’re pretty sure it’s going to break down, end the set.
That pump is tangible, real-time biofeedback to let you know that blood is flowing to your muscle cells, beginning a chain of events that stimulates protein synthesis. Maybe that'’s why it's easy to overlook how important good nutrition is in the mass-building equation. When you choose to eat, say, chicken instead of ice cream, there'’s no immediate muscle gratification -- no pump to keep you motivated.
A meta-analysis of 16 studies conducted on creatine and its influence on power and strength,[368][369] (with or without exercise in all age groups above 16, but placebo controlled and without crossover[368]) compiled studies utilizing a 5-7 day loading period with continued maintenance thereafter and studies assessing 1-3 rep bench press strength in trained young men. Seven studies (four of which are online[370][371][372][373]) totaling 70 people using creatine and 73 people in placebo showed a 6.85kg increase in strength relative to placebo, the benefits of which peaked at 8 weeks.[368] This meta-analysis also quantified a significant increase in squat strength (9.76kg) yet failed to find a significant influence on peak bicep contraction power, which may have been influenced by the two null studies[374][375] being in elderly people while the positive study[376] was statistically outweighed, but noted an 1.8-fold increase in power associated with creatine over placebo. The other meta-analysis conducted the following year[369] calculated effect sizes for creatine supplementation and noted no significant differences between genders or when comparing trained and untrained individuals. The mean effect size of exercises lasting below 30s (those that use the creatine-phosphate system) was 0.24+/-0.02 and performed significantly better than placebo, where exercise increased performance by 4.2+/-0.6% while the addition of creatine enhanced this effect to 7.5+/-0.7%.[369]
Side-Effects: While the signs of a great body may make one think that there cannot be anything wrong with bodybuilding supplements, the facts speak otherwise. Bodybuilding supplements do have side-effects and you must listen to your trainer before giving in to the thoughts of buying one. Creatine can cause heart problems, kidney problems, dehydration, diarrhoea and muscle cramping. You must also discuss your medical history with the trainer. 

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
Cooke et al [41] observed positive effects of a prior (0.3 g/d kg BW) loading and a post maintenance protocol (0.1 g/d kg BW) to attenuate the loss of strength and muscle damage after an acute supramaximal (3 set x 10 rep with 120% 1RM) eccentric resistance training session in young males. The authors speculate that creatine ingestion prior to exercise may enhance calcium buffering capacity of the muscle and reduce calcium-activated proteases which in turn minimize sarcolemma and further influxes of calcium into the muscle. In addition creatine ingestion post exercise would enhance regenerative responses, favoring a more anabolic environment to avoid severe muscle damage and improve the recovery process. In addition, in vitro studies have demonstrated the antioxidant effects of creatine to remove superoxide anion radicals and peroxinitrite radicals [42]. This antioxidant effect of creatine has been associated with the presence of Arginine in its molecule. Arginine is also a substrate for nitric oxide synthesis and can increase the production of nitric oxide which has higher vasodilatation properties, and acts as a free radical that modulates metabolism, contractibility and glucose uptake in skeletal muscle. Other amino acids contained in the creatine molecule such as glycine and methinine may be especially susceptible to free radical oxidation because of sulfhydryl groups [42]. A more recent in vitro study showed that creatine exerts direct antioxidant activity via a scavenging mechanism in oxidatively injured cultured mammalian cells [43]. In a recent in vivo study Rhaini et al [44] showed a positive effect of 7 days of creatine supplementation (4 x 5 g CM 20 g total) on 27 recreational resistance trained males to attenuate the oxidation of DNA and lipid peroxidation after a strenuous resistance training protocol.
In contrast to the above null effects, ingestion of creatine both before and after a workout (alongside protein and carbohydrate) over 10 weeks seems to promote muscle growth more than the same supplement taken in the morning, farther away from the time of the workout.[386] The benefits of creatine around the workout, relative to other times, have been hypothesized[387] to be related to an upregulation of creatine transport secondary to muscle contraction, a known phenomena.[153]
Creatine is an energy substrate: a small peptide serving as a reservoir for high-energy phosphate groups that can regenerate ATP, the main currency of cellular energy. An increase in creatine intake (through food or supplementation) increases cellular energy stores, promoting the regeneration of ATP in the short term. Stores are limited, however, and glucose or fatty acids are responsible for ATP replenishment over longer durations.

Bodybuilders also understand how to diet. This is perhaps the most important aspect other athletes can learn from. I can’t think of any athlete that comes close to bodybuilders who know how to build massive amounts of muscle and then can diet with the type of precision that gets them absolutely shredded on a specific date. Most resistance training sports use weight classes to compete. It doesn’t take a rocket scientist to see that shedding body fat without losing muscle can be a major advantage. Competing at a lower weight class because you are leaner while maintaining strength and performance is a very valuable and effective strategy. Diet to build LEAN muscle to keep weight low for a competitive advantage.
The general sentiment among nutrition experts is that creatine monohydrate is, for most people, the best bet. It’s the cheapest form and more importantly, it’s the most well-researched. Hundreds of studies have been performed on creatine monohydrate and there’s no evidence of ill effects, whereas many of the more novel forms of creatine have one or sometimes no studies supporting them.
Due to the growing concerns of the high cost, health consequences, and illegal nature of some steroids, many organizations have formed in response and have deemed themselves "natural" bodybuilding competitions. In addition to the concerns noted, many promoters of bodybuilding have sought to shed the "freakish" perception that the general public has of bodybuilding and have successfully introduced a more mainstream audience to the sport of bodybuilding by including competitors whose physiques appear much more attainable and realistic.
According to the abstract, in the stratified analyses by forms of aerobic exercise, weekly resistance exercise of 1 time or 1-59 minutes was associated with lower risks of total cardiovascular events and cardiovascular disease, regardless of meeting the aerobic exercise guidelines. The analysis showed that resistance training reduced the risk of cardiovascular events in 2 ways: training had a direct association with cardiovascular risk, and resistance training indirectly lowered cardiovascular risk by decreasing body mass index.

Different forms of creatine in combination with other sports supplements as well as varying doses and supplementation methodology should continue to be researched in an attempt to understand further application of creatine to increase sports and exercise performance of varying disciplines. It is important to remain impartial when evaluating the safety of creatine ingested as a natural supplement. The available evidence indicates that creatine consumption is safe. This perception of safety cannot be guaranteed especially that of the long term safety of creatine supplementation and the various forms of creatine which are administered to different populations (athletes, sedentary, patient, active, young or elderly) throughout the globe.
The concentration in healthy controls (57+/-8 years) without supplementation of creatine appears to be around 1.24+/-0.26µM per gram of hemoglobin[292] and appears to decrease in concentration during the aging process of the erythrocyte.[294][295][296] Otherwise healthy subjects who take a loading phase of creatine (5g four times daily for five days) can experience a 129.6% increase in erythrocytic creatine concentrations from an average value of 418µM (per liter) up to 961µM with a large range (increases in the range of 144.4-1004.8µM),[297] and this effect appears to correlate somewhat with muscular creatine stores.[297]
The United States Army is about to undertake a dramatic and unprecedented overhaul to the way it tests, and promotes, military fitness. The man who headed the research into the new standards talks with us about how and why, as well as the future of Army nutrition and how the Army plans to circulate 80,000 kettlebells to bases around the globe. January 22, 2019 • 43 min read
Electrolytes derive mainly from minerals in the diet and they maintain fluid balance and assist the nervous system to perform muscle contractions. Electrolytes are sodium, potassium, magnesium, calcium and chloride, bicarbonate, phosphate, sulfate. Exercisers are particularly dependent on sodium and potassium balance. Carbohydrates are important for fueling exercise, including vigorous weight training, and in post-exercise energy replacement nutrition. Carbohydrates, mostly sugars, are formulated in sports drinks with electrolytes such as sodium chloride and potassium and sometimes magnesium.
Weight trainers commonly spend 5 to 20 minutes warming up their muscles before starting a workout. It is common to stretch the entire body to increase overall flexibility; however, many people stretch just the area being worked that day. The main reason for warming up is injury prevention. Warming up increases blood flow and flexibility, which lessens the chance of a muscle pull or joint pain.
Exercise is highly effective in increasing your lean body mass, which is essentially muscle. In a study published in 2012, progressive resistance training helped men ages 50 to 83 gain an average of 2.4 pounds of lean body mass over an average of 20.5 weeks. Progressive resistance training involves performing weight bearing exercises. In addition, you must slowly increase the challenge of the exercise over time by increasing the weight, reps and/or sets. Studies show that either increasing reps or weight amount will work. So, if you don’t want to lift more weight, you can just do more reps and still build muscle.
Our bodies store creatine in our muscles so that we have quick access to it for fast, high-intensity movements, like sprinting or powerlifting, explains Autumn Bates, a certified clinical nutritionist and sports nutritionist in private practice in Manhattan Beach, California. “It's a nonessential amino acid, meaning your body creates it and you don't need to primarily get it from food.”
Creatine helps create essential adenosine triphosphate (ATP). This is the energy source of muscle contractions. By upping your levels, you can increase the amount of energy available to your muscles, boosting your performance. Because your muscle strength and size increases when you add weight and reps, improving your performance can be a game changer in terms of increasing your muscle mass. If you’re able to lift longer and harder, your muscles will grow. Creatine is certainly a winner among muscle building supplements.
In standard dosages (5-10g creatine monohydrate) the bioavailability of creatine in humans is approximately 99%,[68][83] although this value is subject to change with different conjugates (forms) of creatine and dosages.[83] Coingestion of cyclocreatine (an analogue) can reduce uptake by about half[131] and coincubation of taurine, choline, glycine, or beta-alanine had minimal attenuation of absorption, which is likely not practically relevant.[131] The inhibition noted with cyclocreatine may be due to receptor saturation.
It is known that intracellular energy depletion (assessed by a depletion of ATP) stimulates AMPK activity in order to normalize the AMP:ATP ratio,[333][334] and when activated AMPK (active in states of low cellular energy[335] and colocalizes with creatine kinase in muscle tissue[336]) appears to inhibit creatine kinase via phosphorylation (preserving phosphocreatine stores but attenuating the rate that creatine buffers ATP). While phosphocreatine technically inhibits AMPK, this does not occur in the presence of creatine at a 2:1 ratio.[334] It seems that if the ratio of phosphocreatine:creatine increases (indicative of excess cellular energy status) that AMPK activity is then attenuated, since when a cell is in a high energy status, there is less AMP to directly activate AMPK.[334][336][337]
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