In October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law in the USA. Under DSHEA, responsibility for determining the safety of the dietary supplements changed from government to the manufacturer and supplements no longer required approval from the U.S. Food and Drug Administration (FDA) before distributing product. Since that time manufacturers did not have to provide FDA with the evidence to substantiate safety or effectiveness unless a new dietary ingredient was added. It is widely believed that the 1994 DSHEA further consolidated the position of the supplement industry and lead to additional product sales.[6]
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.
Without supplementation, approximately 14.6mmol (2g) of creatinine, creatine’s urinary metabolite, is lost on a daily basis in a standard 70kg male ages 20-39. The value is slightly lower in females and the elderly due to a presence of less muscle mass.[35] This amount is considered necessary to obtain in either food or supplemental form to avoid creatine deficiency. Requirements may be increased in people with higher than normal lean mass.[35][198] Creatine excretion rates on a daily basis are correlated with muscle mass, and the value of 2g a day is derived from the aforementioned male population with about 120g creatine storage capacity.[35] Specifically, the rate of daily creatine losses is about 1.6%[199]-1.7%,[25] and mean losses for women are approximately 80% that of men due to less average lean mass.[35] For weight-matched elderly men (70kg, 70-79 years of age) the rate of loss of 7.8mmol/day,[49] or about half (53%) that of younger men. 

In regard to practical interventions, concurrent glycogen loading has been noted to increase creatine stores by 37-46% regardless of whether the tissue was exercised prior to loading phase.[176] It is important to note, however, that creatine levels in response to the creatine loading protocol were compared in one glycogen-depleted leg to the contralateral control leg, which was not exercised.[176] This does not rule out a possible systemic exercise-driven increase in creatine uptake, and the increase in creatine noted above[176] was larger than typically seen with a loading protocol (usually in the 20-25% range). Consistent with an exercise-effect, others have reported that exercise itself increases creatine uptake into muscle, reporting 68% greater creatine uptake in an exercised limb, relative to 14% without exercise.[153]
Over time, we naturally lose muscle mass in a process called sarcopenia. On average, men lose about 30% of their muscle mass during their lives. Usually, this begins in your 30s and progresses slowly as you age. But, don’t despair. You can rebuild and maintain muscle mass even as you age. Often, diet and exercise are enough. But, sometimes, if the above hormones play a role, your doctor may recommend medications and additional treatments (4).

When looking specifically at human studies, there has been a failure of creatine supplementation to induce or exacerbate kidney damage in people with amyotrophic lateral sclerosis (ALS). Subjects do not experience kidney damage for up to or over a year’s worth of supplementation in the 5-10g range.[505][506][507] Postmenopausal women,[517] people with type II diabetes,[518] people on hemodialysis,[313] otherwise healthy elderly,[519] young people,[454][520][521] and athletes do not experience kidney damage either.[324] Moreover, numerous scientific reviews on both the long- and short-term safety of supplemental creatine have consistently found no adverse effects on kidney function in a wide range of doses.[522][523][524][452][525][451][526][527] However, while doses >10 g/day have been found not to impair kidney function, there are fewer long-term trials using such high chronic daily intakes.[527] 

The creatine transporter (CrT) is positively regulated by proteins known to be involved in sensing and responding to the cellular energy state, including the mammalian target of rapamycin (mTOR[158]). Upon activation, mTOR stimulates SGK1 and SGK3[159][160] to act upon PIKfyve[161] and subsequently PI(3,5)P2[162] to increase CrT activity.[161] Beyond mTOR, SGK1 also is stimulated by intracellular calcium[163] and a lack of oxygen (ischemia).[164] Because transient ischemia is associated with increased reactive oxygen species (ROS) production after blood flow is restored (reperfusion) it has been hypothesized that muscle contraction may increase creatine uptake through a similar ROS-mediated mechanism.[165]
Creatine monohydrate is regarded as a necessity by most bodybuilders. Creatine monohydrate is the most cost-effective dietary supplement in terms of muscle size and strength gains. … There is no preferred creatine supplement, but it is believed that creatine works best when it is consumed with simple carbohydrates. This can be accomplished by mixing powdered creatine with grape juice, lemonade, or many high glycemic index drinks.[36]
The process of phagocytosis (a macrophage consuming a pathogen) in macrophages appears to be associated with an acute reduction in creatine phosphate stores (45%)[436] and an increase in creatine kinase activity,[290] although prolonged stimulation is met with an increase in creatine phosphate (20%).[290] The creatine kinase activity does not appear to be altered based on creatine availability,[290] but since ATP seems to be preserved in these instances,[436][290] the increase in phosphocreatine may be explained by an overall creatine pool paralleling that found in medium.[290]
Those are very reasonable starting percentages for your target calories. We can raise or lower your carbohydrate and fat numbers depending on your food preferences (i.e. if you’re more of a rice/potatoes guy… stick with 45% carbs; if you’re more of a bacon and eggs guy… lower your carbs to around 35% and bump your fat percentage to 30% total calories)
Creatine is used up as energy during high intensity exercise. Due to this usage, the amount of glucose required from glycogen is decreased a bit. This both preserves glycogen concentrations in skeletal muscle and reduces lactate production, which is produced when glucose is oxidized for energy. There do not appear to be any alterations in the bioenergetic status of muscle cells during low to moderate intensity exercise.
Now that you've got the training part down, it's time to stretch it out. (Can you say ahhh?) Stretching while your muscles are warm can help improve your flexibility, says Davis, not to mention it just feels phenomenal after you've pushed yourself hard. A light cool-down is also great for calming the nervous system. While dynamic stretches should be your go-to during a warm-up, the cool-down is where static stretching comes in—this means holding a stretch for 20-30 seconds. These four passive stretches will do nicely.
Guanidoacetate (made by AGAT) then receives a methyl donation from S-adenosyl methionine via the enzyme guanidinoacetate methyltransferase (GAMT), which produces S-adenosylhomocysteine (as a byproduct) and creatine. Deficiencies in GAMT are more severe (although equally rare) relative to AGAT, resulting in severe mental retardation and autism-like symptoms.[31]
Consuming sufficient high-quality protein is essential for building muscle. Current recommendations are to consume a minimum of 0.8g of protein for each kg of body weight, however, this is really only applicable to the average sedentary individual. Current evidence shows that to support muscle development, protein intake is the key, therefore the recommended 0.8g per kg should be increased to 1.5-2.0g of protein per kg of body weight. For an 80 kg individual, that would equate to 120-160 grams of protein per day.
This is one of the best workouts for your hamstrings and glutes. Start in a standing position, feet shoulder-width apart. Hold the bar in front of you. Lower it to just below your knees. You can lower it further if you can keep a flat back and stable spine. Slowly return to the starting position. Keep the bar close to your body to protect your lower back.
It’s perhaps best known for the aesthetic benefits. Creatine increases muscle size relatively quickly and while that’s in part due to an increase in muscle water content — a good thing, since it means we’re better hydrated — it does indeed appear to lead to actual hypertrophy over time. And bigger muscles aren’t just aesthetic: larger muscles can improve work capacity, explosiveness, fat oxidation, injury resilience, and recovery.

Rheumatoid arthritis. Early research shows that taking creatine by mouth daily increases lean muscle mass and may improve muscle strength, but does not improve physical functioning in adults with rheumatoid arthritis. In children, taking a specific supplement containing creatine and fatty acids twice daily for 30 days might reduce pain and swelling. But the effects of creatine alone are not clear.
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.
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