Other areas of research include therapeutic uses of creatine to help patients with muscle wasting caused by disease states such as muscular dystrophy and amyotrophic lateral sclerosis (ALS). Small-scale preliminary studies show some gains in strength may be possible for these patients, which could improve their quality of life. One study of 81 patients with various neurologic diseases found that giving 10 g/day of creatine for five days, followed by 5 grams for another week, increases their muscle strength by about 10% [20]. Large-scale studies should be done before recommendations are made to such patients.
The benefits of weight training overall are comparable to most other types of strength training: increased muscle, tendon and ligament strength, bone density, flexibility, tone, metabolic rate, and postural support. This type of training will also help prevent injury for athletes. There are benefits and limitations to weight training as compared to other types of strength training. Contrary to popular belief, weight training can be beneficial for both men and women.
Multivitamin supplements may help you reach the recommended daily intakes for vitamins and minerals if you have a less than ideal diet, travel impairs your diet, or strenuous exercise increases requirements. I consider a multivitamin good insurance in these circumstances against possible deficiencies. Choose a reputable brand. You should choose a good all-around supplement with a balanced formula.
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]

The majority of creatine in the human body is in two forms, either the phosphorylated form making up 60% of the stores or in the free form which makes up 40% of the stores. The average 70 kg young male has a creatine pool of around 120-140 g which varies between individuals [10,11] depending on the skeletal muscle fiber type [1] and quantity of muscle mass [11]. The endogenous production and dietary intake matches the rate of creatinine production from the degradation of phosphocreatine and creatine at 2.6% and 1.1%/d respectively. In general, oral creatine supplementation leads to an increase of creatine levels within the body. Creatine can be cleared from the blood by saturation into various organs and cells or by renal filtration [1].
Although creatine is a natural component of food, the amount of food required to supersaturate the muscle with PCr may not be feasible. For example, it could require 22 pounds of meat daily [8]. If creatine monohydrate is proven to be a safe and effective ergogenic aid, creatine supplementation may be the simplest way to increasing muscle stores. It may be beneficial to avoid caffeine if taking creatine supplements. One study showed that caffeine diminished strength gains seen with creatine use [9].
This basic form of creatine comes in two forms, one of which involves the removal of the monohydrate (which results in creatine anhydrous) that converts to creatine monohydrate in an aqueous environment,[66][67] but due to the exclusion of the monohydrate it is 100% creatine by weight despite creatine monohydrate being 88% creatine by weight, as the monohydrate is 12%. This allows more creatine to be present in a concentrated formula, like capsules.[68]
Recommended Dose: In Shannon Clark's article, "6 Ways To Get More Energized For Your Workouts", Dr. Chris Lockwood recommends between 1.36 and 2.5 milligrams of caffeine per pound of bodyweight. That would be 200-375 milligrams for a 150-pound person. If that leaves you jittery, try less. Determine your tolerance and find the dose that works best for you.
Maughan RJ, King DS, Lea T. Dietary supplements. J Sports Sci. 2004 Jan;22(1):95-113.Kreider RB. Dietary supplements and the promotion of muscle growth with resistance exercise. Sports Med. 1999 Feb;27(2):97-110.Kerksick CM, Rasmussen CJ, Lancaster SL, et al. The effects of protein and amino acid supplementation on performance and training adaptations during ten weeks of resistance training. J Strength Cond Res. 2006 Aug;20(3):643-53.Update of Cochrane Database Syst Rev. 2001;(1):CD002946. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002946.AIS Sports Nutrition - AIS Sports Supplement Program 2007.
As scientific research progressed, it became apparent that the best types of protein came from milk and eggs. That led to the next great revolution in sports nutrition, namely the engineered food, pioneered by Scott Connelly, M.D., a critical care specialist from Northern California who teamed with a young entrepreneur named Bill Phillips from Golden, Colorado.
These terms combine the prefix iso- (meaning "same") with tonic ("strength") and plio- ("more") with metric ("distance"). In "isotonic" exercises the force applied to the muscle does not change (while the length of the muscle decreases or increases) while in "plyometric" exercises the length of the muscle stretches and contracts rapidly to increase the power output of a muscle.

A quantitative, comprehensive scientific summary and view of knowledge up to 2007 on the effects of creatine supplementation in athletes and active people was published in a 100 citation review position paper by the International Society of Sports Nutrition[5]. More recent literature has provided greater insight into the anabolic/performance enhancing mechanisms of creatine supplementation [15,25] suggesting that these effects may be due to satellite cell proliferation, myogenic transcription factors and insulin-like growth factor-1 signalling [16]. Saremi et al [26] reported a change in myogenic transcription factors when creatine supplementation and resistance training are combined in young healthy males. It was found that serum levels of myostatin, a muscle growth inhibitor, were decreased in the creatine group.


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The best way to know the real progress you’re making is by recording it on video or taking photos. “Photos mean everything because if you can take them in the same areas and in the same poses, you’ll see your strengths and weaknesses clearly,” says Heath. “Revise your training and diet programs to eliminate weaknesses.” Keep a file of your progress to see just how far you can take your fitness.
A retrospective study [81], that examined the effects of long lasting (0.8 to 4 years) CM supplementation on health markers and prescribed training benefits, suggested that there is no negative health effects (including muscle cramp or injuries) caused by long term CM consumption. In addition, despite many anecdotal claims, it appears that creatine supplementation would have positive influences on muscle cramps and dehydration [82]. Creatine was found to increase total body water possibly by decreasing the risk of dehydration, reducing sweat rate, lowering core body temperature and exercising heart rate. Furthermore, creatine supplementation does not increase symptoms nor negatively affect hydration or thermoregulation status of athletes exercising in the heat [83,84]. Additionally, CM ingestion has been shown to reduce the rate of perceived exertion when training in the heat [85].
It has been argued that purposely overtraining for a brief period can be beneficial. One article published by Muscle & Fitness magazine stated that you can "Overtrain for Big Gains". It suggested that if one is planning a restful holiday and does not wish to inhibit their bodybuilding lifestyle too much, they should overtrain before taking the holiday, so the body can recuperate and grow during the prolonged rest period. Overtraining can be used advantageously, as when a bodybuilder is purposely overtrained for a brief period of time to super compensate during a regeneration phase. These are known as "shock micro-cycles" and were a key training technique used by Soviet athletes.[53]

Duchenne’s Muscular Dystrophy (DMD) is associated with a reduction in intracellular creatine stores[554] known to only affects males. It is an X-linked progressive myopathy associated with abnormalities in the dystrophin gene.[555] The standard therapy at this moment involves corticosteroids such as prednisone.[556][557] Creatine is thought to be therapeutic since the known targetable abnormalities in DMD (impairment in protein synthesis associated with oxidative stress and increased protein breakdown) is a property of creatine and supplementation showed promise in the first case study[558] and benefit in a group of mixed dystrophinopathies.[559]

Creatine monohydrate is the most common form of creatine, and if not otherwise mentioned is the default form of creatine used in most studies on creatine.[64] It has fairly decent intestinal absorption[65][12] (covered more in depth in the pharmacology section) and is the standard form or “reference” form of creatine, which all other variants are pitted against.
So how does that play out in the real world? Well, if, for example, a woman adds 10 pounds of muscle and loses 10 pounds of fat, she’ll burn 40 extra calories per day. Forty calories a day isn’t nearly as significant as a dietary change could be, but for people who are looking to lose weight, it can still make a minor difference over the long term.
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]
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.
Tribulus Terrestris: A fruit from the Mediterranean, this supplement has been used in the Indian traditional medicine of Ayurveda. In addition to helping increase testosterone, many people take it to increase libido and as a cardioprotective aid. (10) Unfortunately, despite the fact that there are claims that tribulus terrestris can increase testosterone levels, studies don’t back up these claims.  There is some evidence, however, that it may improve athletic performance. If you want to choose one of the supplements for men, this should be your pick.
It’s true—your genes can play a role when it comes to building muscle. In general, there are two types of muscle fibers: Type I, which are slow twitch, and Type II, which are fast twitch. Depending on which you have more of, you may have an easier or harder time gaining muscle. “Fast twitch muscle fibers are two times as thick as slow twitch muscle fibers, lending to the overall thickness of the muscle without any activity,” explains Lovitt. “Those people with a genetic predisposition of a high percentage of these fibers can increase muscle size very easily while the people with a higher percentage of slow twitch muscle fibers have to work really hard to put on mass.” It’s the reason why a world-class sprinter genetically has more fast twitch muscle fibers than a world-class marathoner—it comes down to what we’re born with.

In today's extra-large society, we tend to focus on the admirable guys who train hard and switch up their diet to transform their bodies by losing weight. We highlight their quests to lead healthier lives every chance we get — but there's another side of the wellness scale that can be just as difficult, depending on your body's makeup: Gaining mass and muscle.
Creatine pyruvate (also known as creatine 2-oxopropanoate) in an isomolar dose relative to creatine monohydrate has been shown to produce higher plasma levels of creatine (peak and AUC) with no discernible differences in absorption or excretion values.[83] The same study noted increased performance from creatine pyruvate at low (4.4g creatine equivalence) doses relative to citrate and monohydrate, possibly due to the pyruvate group.
A push–pull workout is a method of arranging a weight training routine so that exercises alternate between push motions and pull motions.[28] A push–pull superset is two complementary segments (one pull/one push) done back-to-back. An example is bench press (push) / bent-over row (pull). Another push–pull technique is to arrange workout routines so that one day involves only push (usually chest, shoulders and triceps) exercises, and an alternate day only pull (usually back and biceps) exercises so the body can get adequate rest.[29]
According to BodyBuilding.com, adenosine triphosphate (ATP) is made up of a nucleotide bonded to three phosphate groups. When one of those phosphate groups is cleaved from the ATP molecule, a lot of energy is made available. That energy is used to fuel chemical reactions in cells, and ATP becomes adenosine diphosphate (ADP). Creatine enables the release of energy from stored ATP and is converted to creatinine.
Another double-blind study supplemented with 18.75 g/day of creatine monohydrate for 5 days prior to high-intensity intermittent work to exhaustion, and then 2.25 g/day during testing. The workouts consisted of cycling to exhaustion using several protocols: (a) nonstop, (b) 60 seconds work/120 seconds rest, (c) 20 seconds work/40 seconds rest, and (d) 10 seconds work/20 seconds rest. Creatine supplementation significantly increased the total work time for all four protocols [13].
Parameters of lung function (main cause of death in ALS is declining respiratory function) have not benefited after creatine supplementation, and when quality of life is measured, there is no benefit either. Despite one study failing to find any significant differences in mortality risk, two other studies have suggested that creatine may reduce the risk. The results were nonsignificant, but due to all treatments being well tolerated it is thought that creatine may still play a role as an adjuvant.
How to Take It: So, you want to give it a go? How much should you take and what should you look for in a supplement? Definitely opt for creatine monohydrate, as it performs better in studies than other varieties, as mentioned above. A standard dose is about 5 grams a day. You can try taking this muscle builder for about 4 weeks to boost your levels. Following this time, you can either cut out creatine or lower to a maintenance dose of 3-5 grams per day. However, you’ll notice if you read the fine print that subjects in studies often have a loading phase of five days where the dosage is upped to 20 g per day, prior to adopting a standard dose (7, 8).
This muscle-building, power-enhancing supplement has an extremely high safety profile and a plethora of evidence to support its efficacy. Creatine supplementation works by increasing the availability of creatine and phosphocreatine (PCr) within the muscle, helping to maintain energy during high-intensity exercise such as weightlifting. Furthermore, increasing the availability of PCr may help speed up recovery between sets.
In addition to the HIIT sessions, it’s always a good idea to go for a 30–60-minute walk as many days per week as you can. I recommend getting a minimum of 10,000 steps every day. Use a phone app to track them. If you’re into jogging, swimming, hiking, or some other form of long-duration, fairly low-intensity cardio, that is fine to do as well, and as often as you like.
Another supplement that’s ideal to take pre-workout is protein. Depending on your goals and your workout time, taking protein before your workout can help you keep your energy levels elevated while working out. Make sure you give yourself at least an hour between the time you take your protein and your workout time so that your body has time to digest.
Try this little exercise some time: follow the supplement plan provided above for at least three months. Then quit all supplement use for a further three months and watch what happens. Sure, most supplement marketing involves hype and some companies make laughably outrageous claims, but there is no secret as to why the supplement industry is booming. Supplements work.

^ Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM (June 2007). "A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed". Journal of the American College of Cardiology. 49 (24): 2329–36. doi:10.1016/j.jacc.2007.02.055. PMID 17572248.
Wilkinson, S. B., Tarnopolsky, M. A., MacDonald, M. J., MacDonald, J. R., Armstrong, D., & Phillips, S. M. (2007). Consumption of fluid skim milk promotes greater muscle protein accretion after resistance exercise than does consumption of an isonitrogenous and isoenergetic soy-protein beverage. The American Journal of Clinical Nutrition, 85(4), 1031-1040.
These effects were noted before in a preliminary study of depressed adolescents (with no placebo group) showing a 55% reduction in depressive symptoms at 4g daily when brain phosphocreatine levels increased.[231] Other prelimnary human studies suggest creatine might lessen unipolar depression[256] and one study on Post-Traumatic Stress Disorder (PTSD) noted improved mood as assessed by the Hamilton Depression Rating Scale.[232]

In today's extra-large society, we tend to focus on the admirable guys who train hard and switch up their diet to transform their bodies by losing weight. We highlight their quests to lead healthier lives every chance we get — but there's another side of the wellness scale that can be just as difficult, depending on your body's makeup: Gaining mass and muscle.
There’s no need to go overboard on creatine intake, though, in search of crazy muscle growth: “The maximum amount of creatine that you can hold depends on the amount of muscle mass you have,” explains Bates. “So if you have more muscle, then your body can store more creatine. In general, the muscle can hold about 2 to 3 g of creatine per kilogram of muscle mass. So the amount of creatine you use will depend on the amount of muscle mass you have.” (7)

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Aim to eat roughly 250 to 500 extra calories per day. To make sure that any weight gained is from muscle, Fitzgerald recommends that the bulk of those calories come from protein. In a 2014 Pennington Biomedical Research Center study, people who ate a high-calorie diet rich in protein stored about 45 percent of those calories as muscle, while those following a low-protein diet with the same number of calories stored 95 percent of those calories as fat.

Few supplements have the solid scientific foundation that creatine has. Studies show that it's effective for 80 percent of those who use it. Since creatine is found naturally in meat, the more meat you eat, the less likely you'll need creatine supplementation. Vegetarians or those who rarely eat meat, however, can get huge boosts from most creatine supplements.
Without a doubt, you can add muscle simply by eating right and lifting weights. But to truly maximize your growth potential, supplements are a requirement. Hence, we've compiled a rundown of the 11 best mass-gain supplements on which to spend your hard-earned cash. They're listed in order of priority, from the absolute most critical, can't-do-without supplements to the less crucial yet still highly effective ingredients for packing on size. The point is to help those on a tight budget decide which supplements to buy. If money is no object, then by all means knock yourself out and use them all as directed. Because after all, as far as we're concerned, you can never have too much muscle.

Another double-blind study supplemented with 18.75 g/day of creatine monohydrate for 5 days prior to high-intensity intermittent work to exhaustion, and then 2.25 g/day during testing. The workouts consisted of cycling to exhaustion using several protocols: (a) nonstop, (b) 60 seconds work/120 seconds rest, (c) 20 seconds work/40 seconds rest, and (d) 10 seconds work/20 seconds rest. Creatine supplementation significantly increased the total work time for all four protocols [13].
Safety. In general health terms, most medical opinion is that up to three cups of coffee a day are not harmful, and may even have some benefits, although some people respond to the stimulant properties with more problems than others. Heart palpitations and restlessness are experienced by some caffeine drinkers. In pregnancy, one or two cups each day are thought to be without harm to the fetus.
Cornelissen et al [80] analyzed the effects of 1 week loading protocol (3 X 5 g/d CM) followed by a 3 month maintenance period (5 g/d) on cardiac patients involved in an endurance and resistance training program. Although CM supplementation did not significantly enhance performance, markers of renal and liver function were within normal ranges indicating the safety of the applied creatine supplementation protocol.
In addition to the BBB, SLC6A8 is also expressed on neurons and oligodendrocytes,[192] but is relatively absent from astrocytes, including the astrocytic feet[193][194] which line 98% of the BBB.[195] Creatine can still be transported into astrocytes (as well as cerebellar granule cells) via SLC6A8, as incubation with an SLC6A8 inhibitor prevents accumulation in vitro. It seems to be less active in a whole brain model, relative to other brain cells.[196]
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.
In otherwise healthy bodybuilders, supplementation of creatine at 5g either immediately before or after a weight training session (with no directive on days without training) over the course of four weeks noted that while both groups improved, there was no significant difference between groups overall.[384] This null result has been found in another study with 0.1g/kg creatine thrice weekly over 12 weeks in otherwise healthy adults.[385] It has been suggested that post-workout timing may be favorable (based on magnitude-based inference) since more individuals experience benefits with post-workout when compared to pre-workout despite no whole-group differences.[384] 

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.
2-4 Minutes Rest: Ideal for “tension exercises,” which includes most primary compound exercises. I personally take 3 minutes for the big stuff, sometimes going into the 3-4 minute range depending on exactly what I’m doing and what I feel like I need at the time. Since making strength gains is the main focus of these exercises, longer rest periods like this will be optimal for making it happen.
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