Creatine supplementation appears to be somewhat similar to TMG supplementation in the sense that they both promote localized synthesis of phosphatidylcholine, effluxing triglycerides from the liver into serum and thus potently protecting from diet-induced fatty liver. The concentration at which this occurs is within the range supplemented by humans.
Eat 1.5–3 grams of carbs per pound of your body weight. As with fat, this amount can vary greatly, depending on your personal needs and preferences, so consider these numbers only a starting point. If you’re very skinny and feel that you handle carbs well (i.e. you can eat a lot of them without getting fat), go ahead and eat according to the higher end of the spectrum. The same applies if you’re desperate to gain weight—you should increase your carb intake. If you’re prone to weight gain or feel lethargic on higher carbs, you should eat fewer of them. Again, see our keto guide for more details and options.
In regard to carbohydrate oxidation during exercise, it appears that rats subject to intermittent physical exercise (which utilizes glycogen) have decreased lactate production during said exercise, suggesting a preservation of glycogen usage. This occurred alongside an increase in glycogen stores.[359] This is thought to be due to phosphocreatine donating phosphate to replenish ATP. Without any changes in whole body metabolic rate, it indirectly causes less glucose to be required to replenish ATP, due to a quota needing to be met during exercise and creatine phosphate taking up a relatively larger percentage of said quota.
Include cardio training. Good cardiovascular health improves blood flow, a requirement for muscle growth. Doing cardio also improves your cardiovascular fitness, which allows you to use your muscle gains for various sports and activities. The standard recommendation is 150 minutes of moderate cardio each week, or 75 minutes of vigorous cardio, or an equivalent combination of the two. A good place to start would be doing 30-60 minutes of cardiovascular activity every other day or 3 times a week. Examples of cardio include running, biking, swimming, and any sport that involves constant movement.
Carbohydrates play an important role for bodybuilders. They give the body energy to deal with the rigors of training and recovery. Carbohydrates also promote secretion of insulin, a hormone enabling cells to get the glucose they need. Insulin also carries amino acids into cells and promotes protein synthesis.[26] Insulin has steroid-like effects in terms of muscle gains.[27] It is impossible to promote protein synthesis without the existence of insulin, which means that without ingesting carbohydrates or protein—which also induces the release of insulin—it is impossible to add muscle mass.[28] Bodybuilders seek out low-glycemic polysaccharides and other slowly digesting carbohydrates, which release energy in a more stable fashion than high-glycemic sugars and starches. This is important as high-glycemic carbohydrates cause a sharp insulin response, which places the body in a state where it is likely to store additional food energy as fat. However, bodybuilders frequently do ingest some quickly digesting sugars (often in form of pure dextrose or maltodextrin) just before, during, and/or just after a workout. This may help to replenish glycogen stored within the muscle, and to stimulate muscle protein synthesis.[29]
A previous meta-analysis [28] reported an overall creatine supplementation effect size (ES) of 0.24 ± 0.02 for activities lasting ≤30 s. (primarily using the ATP- phosphocreatine energy system). For this short high-intensity exercise, creatine supplementation resulted in a 7.5 ± 0.7% increase from base line which was greater than the 4.3 ± 0.6% improvement observed for placebo groups. When looking at the individual selected measures for anaerobic performance the greatest effect of creatine supplementation was observed on the number of repetitions which showed an ES of 0.64 ± 0.18. Furthermore, an increase from base line of 45.4 ± 7.2% compared to 22.9 ± 7.3% for the placebo group was observed. The second greatest ES was on the weight lifted at 0.51 ± 0.16 with an increase from base line of 13.4 ± 2.7% for the placebo group and 24.7 ± 3.9% for the creatine group. Other measures improved by creatine with a mean ES greater than 0 were for the amount of work accomplished, weight lifted, time, force production, cycle ergometer revolutions/min and power. The possible effect of creatine supplementation on multiple high intensity short duration bouts (<30 s) have shown an ES not statistically significant from 0. This would indicate that creatine supplementation might be useful to attenuate fatigue symptoms over multiple bouts of high-intensity, short duration exercise. The ES of creatine on anaerobic endurance exercise (>30 – 150s), primarily using the anaerobic glycolysis energy system, was 0.19 ± 0.05 with an improvement from baseline of 4.9 ± 1.5 % for creatine and -2.0 ± 0.6% for the placebo. The specific aspects of anaerobic endurance performance improved by creatine supplementation were work and power, both of which had a mean ES greater than 0. From the findings of this previous meta-analysis [28] it would appear that creatine supplementation has the most pronounced effect on short duration (<30s) high intensity intermittent exercises.

Studies measuring extracellular water versus intracellular water note similar increases in both, associated with creatine. Creatine does not tend to disturb the ratios of water to dry mass in various tissues measured.[609] At least one study in older men (48-72 years) has failed to find a significant difference in both intracellular and extracellular water concentration after 14 weeks of 5g creatine daily (with gatorade) relative to gatorade in isolation, with the ratio being maintained.[615]
Collectively the above investigations indicate that creatine supplementation can be an effective strategy to maintain total creatine pool during a rehabilitation period after injury as well as to attenuate muscle damage induced by a prolonged endurance training session. In addition, it seems that creatine can act as an effective antioxidant agent after more intense resistance training sessions.
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