xEndurance’s Creatine-JB is a fantastic, all-natural creatine for athletes. It’s a little expensive at a dollar per serving, but it has a really pleasant citrus flavor and it contains a gram of lactate, which has been shown in some studies to improve time to exhaustion in short duration, high intensity workouts. It’s also third party tested by Labdoor and Informed Choice.
In well-trained endurance runners, creatine (with glycerol for hyperhydration) caused a relatively large increase in body weight gain (0.90+/-0.40kg) and water weight (0.71+/-0.42L) but failed to negatively influence performance over 30 minutes in the heat.[3] This failure to improve physical performance in the heat with creatine loading (despite water retention) has been noted elsewhere.[346]

That soreness you feel post-strength session may seem like a setback. Yet over time, you’ll come to acknowledge that it signifies you’re getting stronger. “You think, ‘I’ve done something worthwhile. My body is telling me I’ve had a workout.’ You look forward to the fatigue and interpret it in a positive way,” says John Spence, PhD, professor of physical education and recreation at the University of Alberta in Canada, who wrote a review on the effect of exercise on self-esteem. (Wondering how sore is too sore to work out? Here’s your answer.)
Reducing creatine synthesis by supplementing it has preliminary evidence supporting its ability to reduce homocysteine concentrations in the body, since the synthesis of creatine would normally produce some homocysteine as a byproduct. This may apply to a certain subset of people (MTHFR TT homozygotes, about 10% of North Americans) but at the moment there is not enough evidence to suggest that this occurs in all people supplementing creatine.
This ingredient also plays a major role in cell growth, recovery, and communication. Increasing the amount of creatine stored in your muscles can speed up the growth of new muscle and help prevent current muscles from being degraded during exercise. By reducing muscle breakdown, creatine can speed up the healing and recovery processes, as there will be less damage to repair.
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]

As mentioned, protein is essential for building muscle. If you are unable to consume the recommended amount of protein through diet alone, add protein powder for building muscle as a supplement. This applies to nearly anyone hoping to gain muscle mass since it’s not easy to pack in nearly 100 grams of protein a day through chicken, eggs and legumes alone.
Studies of so-called "smart drugs" have also been taken out of context. Some "smart" nutrients, available over the counter, are marketed as a way to "increase mental focus and concentration during training." The problem is that the studies they're based upon involved either animals or people with brain pathology. In normal people the effects of smart drugs remain unproven, except anecdotally.
As mentioned earlier, supplementation of creatine in youth has been noted to improve the swim bench test (a thirty second sprint followed by another after a five minute break).[398] One study noted improvement when examining a 400 meter test after 10g of creatine was taken over seven days with some orange juice. The improvement was mostly attributable to increased performance on the last 50m stretch.[405]
If you are doing this on your own, but are overwhelmed and confused about strength training, I know how that feels. It can be scary enough to keep MOST people from starting, which is actually why we created our 1-on-1 Coaching Program. Our coach gets to know you, builds a program based on your experience and goals, will check your form on each movement (via video), and keep you accountable and on track!

Bodybuilders may supplement their diets with protein for reasons of convenience, lower cost (relative to meat and fish products), ease of preparation, and to avoid the concurrent consumption of carbohydrates and fats. Additionally, some argue that bodybuilders, by virtue of their unique training and goals, require higher-than-average quantities of protein to support maximal muscle growth.[19][20][21][22][23][24][25] However, there is no scientific consensus for bodybuilders to consume more protein than the recommended dietary allowance.[18][26] Protein supplements are sold in ready-to-drink shakes, bars, meal replacement products (see below), bites, oats, gels and powders. Protein powders are the most popular and may have flavoring added for palatability. The powder is usually mixed with water, milk or fruit juice and is generally consumed immediately before and after exercising or in place of a meal. The sources of protein are as follows and differ in protein quality depending on their amino acid profile and digestibility:
Kerksick, C. M., Wilborn, C. D., Campbell, W. I., Harvey, T. M., Marcello, B. M., Roberts, M. D., Parker, A. G., Byars, A. G., Greenwood, L. D., Almada, A. L., Kreider, R. B., and Greenwood, M. The effects of creatine monohydrate supplementation with and without D-pinitol on resistance training adaptations. J.Strength.Cond.Res. 2009;23(9):2673-2682. View abstract.
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Glycogen synthesis is known to respond directly and positively to cellular swelling. This was demonstrated in an earlier study, during which rat muscle cells were exposed to a hypotonic solution in vitro to induce cell swelling, which increased glycogen synthesis by 75%. In contrast, exposing these same cells to a hypertonic solution hindered glycogen synthesis by 31%. These changes were not due to alterations in glucose uptake, but are blocked by hindering the PI3K/mTOR signaling pathway.[112] It was later noted that stress proteins of the MAPK class (p38 and JNK) as well as heat shock protein 27 (Hsp27) are activated in response to increasing osmolarity.[113][114] Furthermore, activation of MAPK signaling in skeletal muscle cells is known to induce myocyte differentiation[115] via GSK3β and MEF2 signaling, which can induce muscle cell growth.[116][117]
Gordon, P. H., Cheung, Y. K., Levin, B., Andrews, H., Doorish, C., Macarthur, R. B., Montes, J., Bednarz, K., Florence, J., Rowin, J., Boylan, K., Mozaffar, T., Tandan, R., Mitsumoto, H., Kelvin, E. A., Chapin, J., Bedlack, R., Rivner, M., McCluskey, L. F., Pestronk, A., Graves, M., Sorenson, E. J., Barohn, R. J., Belsh, J. M., Lou, J. S., Levine, T., Saperstein, D., Miller, R. G., and Scelsa, S. N. A novel, efficient, randomized selection trial comparing combinations of drug therapy for ALS. Amyotroph.Lateral.Scler. 2008;9(4):212-222. View abstract.
A child’s ability to regenerate high energy phosphates during high intensity exercise is less than that of an adult. Due to this, creatine supplementation may benefit the rate and use of creatine phosphate and ATP rephosporylation. However, performance in short duration high-intensity exercise can be improved through training therefore supplementation may not be necessary [54].
Of the three, protein will of course play the most important role in the muscle building process (like calories, it’s one our required “supplies”), although fat and carbs will still be important for other reasons which range from optimizing hormone production (e.g. testosterone, the muscle building hormone) to enhancing training performance and recovery.
Bench Press. The bench press is about as American as apple pie, fireworks, or bald eagles. If you’re in a gym on a Monday, then you can pretty guarantee at least 85% of the males in the building will be benching. With good reason though, variations such as the flat bench barbell or dumbbell press and the incline bench barbell or dumbbell press are very effective mass builders for the chest, shoulders, and triceps.
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This period also saw the rise of anabolic steroids in bodybuilding and many other sports. In bodybuilding lore, this is partly attributed to the rise of "mass monsters", beginning with Arnold Schwarzenegger, Sergio Oliva, and Lou Ferrigno in the late 1960s and early 1970s, and continuing through the 1980s with Lee Haney, the 1990s with Dorian Yates, Ronnie Coleman, and Markus Rühl, and up to the present day. Bodybuilders such as Greg Kovacs attained mass and size never seen previously but were not successful at the pro level. Others were renowned for their spectacular development of a particular body part, like Tom Platz or Paul Demayo for the leg muscles. At the time of shooting Pumping Iron, Schwarzenegger (while never admitting to steroid use until long after his retirement) said that "you have to do anything you can to get the advantage in competition".[citation needed] He would later say that he does not regret using anything.[8]

Carducci, C., Birarelli, M., Leuzzi, V., Carducci, C., Battini, R., Cioni, G., and Antonozzi, I. Guanidinoacetate and creatine plus creatinine assessment in physiologic fluids: an effective diagnostic tool for the biochemical diagnosis of arginine:glycine amidinotransferase and guanidinoacetate methyltransferase deficiencies. Clin Chem 2002;48(10):1772-1778. View abstract.


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.

You're aiming to kick start muscle hypertrophy, the cellular process that spurs growth. Researchers have found that the best way to initiate that process is by performing two or three sets of an exercise for six to 12 repetitions, with about 30 to 60 seconds' rest between sets. You're damaging the muscles with the work — then the protein you've been consuming will help build them back up even bigger.
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.
Synthesis primarily takes place in the kidney and liver, with creatine then being transported to the muscles via the blood. The majority of the human body's total creatine and phosphocreatine stores is located in skeletal muscle, while the remainder is distributed in the blood, brain, and other tissues.[17][18][20] Typically, creatine is produced endogenously at an estimated rate of about 8.3 mmol or 1 gram per day in young adults.[16][17] Creatine is also obtained through the diet at a rate of about 1 gram per day from an omnivorous diet.[17][18] Some small studies suggest that total muscle creatine is significantly lower in vegetarians than non-vegetarians, as expected since foods of animal origin are the primary source of creatine. However, subjects happened to show the same levels after using supplements.[21]
In particular situations, a coach may advise performing the valsalva maneuver during exercises which place a load on the spine. The vasalva maneuver consists of closing the windpipe and clenching the abdominal muscles as if exhaling, and is performed naturally and unconsciously by most people when applying great force. It serves to stiffen the abdomen and torso and assist the back muscles and spine in supporting the heavy weight. Although it briefly increases blood pressure, its is still recommended by weightlifting experts such as Rippetoe since the risk of a stroke by aneurysm is far lower than the risk of an orthopedic injury caused by inadequate rigidity of the torso.[10] Some medical experts warn that the mechanism of building "high levels of intra-abdominal pressure (IAP)...produced by breath holding using the Valsava maneuver", to "ensure spine stiffness and stability during these extraordinary demands", "should be considered only for extreme weight-lifting challenges — not for rehabilitation exercise".[11]
If you’re a beginner, you should train with three full-body workouts per week. In each one, do a compound pushing movement (like a bench press), a compound pulling movement (like a chinup), and a compound lower-body exercise (squat, trap-bar deadlift, for example). If you want to add in 1–2 other exercises like loaded carries or kettlebell swings as a finisher, that’s fine, but three exercises is enough to work the whole body.
The motor proteins actin and myosin generate the forces exerted by contracting muscles. Current recommendations suggest that bodybuilders should consume 25–30% of protein per total calorie intake to further their goal of maintaining and improving their body composition.[30] This is a widely debated topic, with many arguing that 1 gram of protein per pound of body weight per day is ideal, some suggesting that less is sufficient, while others recommending 1.5, 2, or more.[31] It is believed that protein needs to be consumed frequently throughout the day, especially during/after a workout, and before sleep.[32] There is also some debate concerning the best type of protein to take. Chicken, turkey, beef, pork, fish, eggs and dairy foods are high in protein, as are some nuts, seeds, beans, and lentils. Casein or whey are often used to supplement the diet with additional protein. Whey protein is the type of protein contained in many popular brands of protein supplements and is preferred by many bodybuilders because of its high Biological Value (BV) and quick absorption rates. Whey protein also has a bigger effect than casein on insulin levels, triggering about double the amount of insulin release.[33] That effect is somewhat overcome by combining casein and whey. Bodybuilders are usually thought to require protein with a higher BV than that of soy, which is additionally avoided due to its claimed estrogenic properties. Still, some nutrition experts believe that soy, flax seeds and many other plants that contain the weak estrogen-like compounds or phytoestrogens, can be used beneficially, as phytoestrogens compete with estrogens for receptor sites in the male body and can block its actions. This can also include some inhibition of pituitary functions while stimulating the P450 system (the system that eliminates hormones, drugs and metabolic waste product from the body) in the liver to more actively process and excrete excess estrogen.[34][35] Cortisol decreases amino acid uptake by muscle, and inhibits protein synthesis.[36]
“Imagine you've fasted for over eight hours,” he says. “At breakfast, you're firing your metabolism off really high. If you don't eat for another five hours, your metabolism starts to slow right down and you have to try and kickstart it again with your next meal. If you eat every two and a half to three hours, it's like chucking a log on a burning fire.”

Bodybuilders may supplement their diets with protein for reasons of convenience, lower cost (relative to meat and fish products), ease of preparation, and to avoid the concurrent consumption of carbohydrates and fats. Additionally, some argue that bodybuilders, by virtue of their unique training and goals, require higher-than-average quantities of protein to support maximal muscle growth.[19][20][21][22][23][24][25] However, there is no scientific consensus for bodybuilders to consume more protein than the recommended dietary allowance.[18][26] Protein supplements are sold in ready-to-drink shakes, bars, meal replacement products (see below), bites, oats, gels and powders. Protein powders are the most popular and may have flavoring added for palatability. The powder is usually mixed with water, milk or fruit juice and is generally consumed immediately before and after exercising or in place of a meal. The sources of protein are as follows and differ in protein quality depending on their amino acid profile and digestibility:
Creatine is one of the most popular and widely researched natural supplements. The majority of studies have focused on the effects of creatine monohydrate on performance and health; however, many other forms of creatine exist and are commercially available in the sports nutrition/supplement market. Regardless of the form, supplementation with creatine has regularly shown to increase strength, fat free mass, and muscle morphology with concurrent heavy resistance training more than resistance training alone. Creatine may be of benefit in other modes of exercise such as high-intensity sprints or endurance training. However, it appears that the effects of creatine diminish as the length of time spent exercising increases. Even though not all individuals respond similarly to creatine supplementation, it is generally accepted that its supplementation increases creatine storage and promotes a faster regeneration of adenosine triphosphate between high intensity exercises. These improved outcomes will increase performance and promote greater training adaptations. More recent research suggests that creatine supplementation in amounts of 0.1 g/kg of body weight combined with resistance training improves training adaptations at a cellular and sub-cellular level. Finally, although presently ingesting creatine as an oral supplement is considered safe and ethical, the perception of safety cannot be guaranteed, especially when administered for long period of time to different populations (athletes, sedentary, patient, active, young or elderly).

Most people require around 20 calories per pound (or 44 kcal / kg) of bodyweight to gain muscle mass. Using a 180-pound (82kg) male as an example, the required daily calorie intake is 3600 calories (20 kcal x 180 lb = 3600 kcal). When it comes to gaining weight, it is likely that you may put on a few pounds of fat along the way, but if you do find your body fat increasing, either increase the amount of aerobic exercise (moderate intensity) you are doing or slightly reduce the total number of calories you are consuming. Remember you can’t force feed muscle gain!
Free weights include dumbbells, barbells, medicine balls, sandbells, and kettlebells. Unlike weight machines, they do not constrain users to specific, fixed movements, and therefore require more effort from the individual's stabilizer muscles. It is often argued that free weight exercises are superior for precisely this reason. For example, they are recommended for golf players, since golf is a unilateral exercise that can break body balances, requiring exercises to keep the balance in muscles.[27]
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.

Contrast loading is the alternation of heavy and light loads. Considered as sets, the heavy load is performed at about 85-95% 1 repetition max; the light load should be considerably lighter at about 30-60% 1RM. Both sets should be performed fast with the lighter set being performed as fast as possible. The joints should not be locked as this inhibits muscle fibre recruitment and reduces the speed at which the exercise can be performed. The lighter set may be a loaded plyometric exercise such as loaded squat jumps or jumps with a trap bar.
The creatine kinase system appears to be detectable in endothelial cells.[314][315] Under basal conditions, creatine itself is expressed at around 2.85+/-0.62μM[316] (three-fold higher than HUVEC cells[314]). When incubating the medium with 0.5mM creatine, endothelial cells can take up creatine via the creatine transporter (SLC6A8) and increase both creatine (almost doubling) and phosphocreatine (nearly 2.5-fold) concentrations.[316]
While it'’s okay to chow down on the occasional fast-food choice for convenience, a mass-gain program isn'’t an excuse to gorge on pizza and chocolate sundaes. “"Rebuilding muscle tissue broken down by training requires energy -— in other words, calories,"” says bodybuilding nutritional guru Chris Aceto. "“But many people, including many nutritionists, overestimate the energy needs for gaining mass, encouraging extreme high-calorie intakes. This often leads to an increase in bodyfat, making you bigger, for sure, but also leaving you fat." In general, aim for 300-500 more calories every day than your body burns through exercise and normal functioning (multiply bodyweight by 17). And that'’s divided among six meals a day.
Earlier during your workout, you might have thought you were starting to see some muscle definition. "Called transient hypertrophy, or a muscle pump, this physiological phenomenon occurs when blood rushes to your muscles to supply them with workout-powering fuel and even jump-start the recovery process," explains certified strength and conditioning specialist Samuel Simpson, co-owner and vice president of B-Fit Training Studio in Miami. He notes that this muscle pump often starts mid-workout and subsides within a few hours after leaving the gym. And as the muscle pump deflates, it's easy to lose determination.
It is regularly reported that creatine supplementation, when combined with heavy resistance training leads to enhanced physical performance, fat free mass, and muscle morphology [18-22]. A 2003 meta analysis [8] showed individuals ingesting creatine, combined with resistance training, obtain on average +8% and +14% more performance on maximum (1RM) or endurance strength (maximal repetitions at a given percent of 1RM) respectively than the placebo groups. However, contradicting studies have reported no effects of creatine supplementation on strength performance. Jakobi et al [23] found no effects of a short term creatine loading protocol upon isometric elbow flexion force, muscle activation, and recovery process. However, this study did not clearly state if creatine supplementation was administered concurrent with resistance training. Bemben et al [24] have shown no additional benefits of creatine alone or combined with whey protein for improving strength and muscle mass after a progressive 14 weeks (3 days per week) resistance training program in older men. These conflicting results can be explained by the possibility that the supplemented groups were formed by a greater amount of non-responders or even because creatine supplementation was administered on the training days only (3 times a week). This strategy has not been adequately tested as effective in middle aged and older men for maintaining post loading elevated creatine stores [5].
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]

For the bench press, start with a weight that you can lift comfortably. If you are a beginner, try lifting the bar along with 5lbs or 10lbs on each side. With arms at shoulder-width apart, grab onto the bar and slowly lower the bar until it's at nipple level; push up until your arms are fully extended upwards. Do 8–10 repetitions (reps) like this for three sets (3 x 8), adding additional weight each set. Once you have a few months of practice, slowly increase weight and go down to 6–8 reps per set, aiming to reach muscle failure at the end of the third set.
The 100% Grass-Fed Whey Protein Isolate comes in the form of powder and can be mixed with any liquid. While the protein powder can be mixed well with water, try mixing it with milk for added calories and protein. You can even add this to smoothies and baked goods to increase the protein profile. Recommended protein intake for adults is 0.8 grams per kilogram. Some athletes may need as much as 1.2-2 grams protein per kilogram. For your specific needs, always consult a registered dietitian.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Creatine ethyl ester increases muscle levels of creatine to a lesser degree than creatine monohydrate.[72] It may also result in higher serum creatinine levels[73] due to creatine ethyl ester being converted into creatinine via non-enzymatic means in an environment similar to the digestive tract.[74][75] At equal doses to creatine monohydrate, ethyl ester has failed to increase water weight after 28 days of administration (indicative of muscle deposition rates of creatine, which are seemingly absent with ethyl ester).[76] 
"Eating well" is tough to objectively quantify. One can eat "well" but that doesn't necessarily mean that you are eating enough to build muscle or recover adequately from workouts. Also, taking protein shakes doesn't guarantee that one will start to accrue massive slabs of lean body mass. Muscle anabolism is a fairly complex metabolic process which has a number of contributing factors at the cellular level and can't be reduced to a single supplement or dietary component.
Do you know what happens when a person attempts to build muscle faster than they legitimately can? They fail, and then they wonder why it’s not working as quickly as they thought it would. From there, they’ll jump from workout to workout, diet to diet and useless supplement to useless supplement in the hopes of finally finding the missing link that will make it happen. But they’re never going to find it. They’ll just keep wasting their time, effort and money searching for something that doesn’t exist.
We’ll be talking more about this later, but for now, just give it a shot! In strength training you can see your progress so clearly that as you can do more and more, you’ll also be rewarded by seeing your strength progress from level 1 to level 50! If you aren’t a fan of the downtime, put on a book on tape or throw on your favorite playlist while circuit training to ensure you’re always moving (instead of sitting and waiting in between sets).
While training intensity can be accomplished trough a targeted training program and an ability to adequately stimulate our muscles is something the motivated and determined bodybuilder often has no problem doing, muscle recovery is another issue. It is especially important at a time of the year when social demands and incorrect eating combine to stifle our progress.
This claim has not been demonstrated at this time, and a recent comparative study of buffered creatine against basic creatine monohydrate found no significant differences between the two in 36 resistance trained individuals, in regard to the effects or the accumulation of creatine in muscle tissue.[71] There also were no significant differences in the amount of adverse side-effects reported.
According to the two meta-analyses on the topic, creatine significantly increases power when supplemented in both sexes over a period of time up to 8 weeks, during which improvement over placebo is maintained, rather than being enhanced further. The rate at which power is derived from a resistance training regimen appears to be up to 78.5% greater with creatine relative to placebo, and in active trained men who are naive to creatine, this can be quantified at about 7kg for the bench press and 10kg for the squat over 8 weeks.
Studies that use a dosage range typical of creatine supplementation (in the range of 5g a day following an acute loading period) note increases to total body water of 6.2% (3.74lbs) over 9 weeks and[608] 1.1kg over 42 days.[609] Interestingly, some studies comparing creatine paired with training against training itself fail to find a significant difference in percentage of water gained (which is inherently to activity) with standard oral doses of creatine[609][607][610] (although low dose creatine supplementation of 0.03g/kg or 2.3g daily doesn’t appear to increase water retention[611]) despite more overall water weight being gained, due to an equal gain of dry mass in muscles. One study has quantified the percentage increase in mass of muscle cells to be 55% water, suggesting the two groups are fairly equal.[609]
Creatine is old school and definitely hit a pop culture zenith, but that doesn’t make it out-dated or irrelevant today. Creatine supplementation gets results. For starters, one study from Medicine and Science in Sports and Exercise confirms that creatine supplementation can enhance physical performance, claiming that it “exhibits small but significant physiological and performance changes.”
Sculthorpe et al (2010) has shown that a 5 day (25g/d) loading protocol of creatine supplementation followed by a further 3 days of 5 g/d negatively influence both active ankle dorsiflexion and shoulder abduction and extension range of movement (ROM) in young men. There are two possible theories to explain these effects: 1) Creatine supplementation increases intracellular water content resulting in increased muscle stiffness and resistance to stretch; 2) Neural outflow from the muscle spindles is affected due to an increased volume of the muscle cell. The authors highlight that the active ROM measures were taken immediately after the loading phase and the reduced active ROM may not be seen after several weeks of maintenance phase [45]. Hile et al [46] observed an increase in compartment pressure in the anterior compartment of the lower leg, which may also have been responsible for a reduced active ROM.
One study on 27 otherwise healthy men supplementing creatine (0.3g/kg loading for a week, 0.05g/kg thereafter for 8 weeks) with a thrice weekly exercise regiment noted that alongside greater increase in lean mass and power relative to placebo at 4 and 8 weeks, myostatin in serum decreased to a greater extent with creatine (around 17% at 8 weeks, derived from graph) than it did with placebo (approximately 7%).[356] Increases in GASP-1, a serum protein that inhibits the actions of myostatin by directly binding to it,[357] were not different between groups.[356]
McArdle’s disease is a myopathic disorder associated with fatigue and contractile dysfunction as a result of alterations in the release of glucose from glycogen (via defects in myophosphorylase enzyme function) resulting in an inability to conduct high intensity work as easily.[548] Creatine is thought to be therapeutic because beyond the general strength enhancing properties of creatine, people with McArdle’s disease have an upregulation of phosphofructokinase (PFK) enzyme activity [570] and increasing phosphocreatine storages suppresses the activity of this enzyme.[571]

This suppression of creatine synthesis is thought to actually be beneficial, since creatine synthesis requires s-adenosyl methionine as a cofactor and may use up to 40-50% of SAMe for methylation[35][36][122] (initially thought to be above 70%, but this has since been re-evaluated[122]) though the expected preservation of SAMe may not occur with supplementation.[487] Reduced creatine synthesis, via preserving methyl groups and trimethylglycine (which would normally be used up to synthesize SAMe), is also thought to suppress homocysteine levels in serum,[37] but this may also not occur to a practical level following supplementation.[487]
It is possible that females could benefit more than males due to a combined lower creatine kinase activity as well as having altered purine metabolism during depression,[257] but no human comparative studies have been conducted yet. One rat study noted that creatine monohydrate at 2-4% of feed had 4% creatine able to exert anti-depressive and anxiolytic effects in female rats only.[228]

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]
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