Myotonic Dystrophy type I (DM1) is an inhereted muscular disorder caused by an expanded CTG repeat in the DMPK gene on chromosome 19q13.3 (genetic cause of the disorder[561]) resulting in muscular degeneration and myotonia. The related myopathy, Myotonic Dystrophy type II (DM2) which is also known as proximal myotonic myopathy (PROMM) is due to a CCTG repeat on 3q,[562] and is less affected by myotonia and more by muscular pain and weakness. There is no cure for either because they are genetic disorders, so current therapies are aimed at reducing side-effects. Therapies include modafinil for the somnolence[563] and perhaps creatine for the reduction in strength and functionality.[548]
Another category of muscle-building supplements that lifters and bodybuilders use to improve their results are branched-chained amino acids (BCAAs), or BCAAs. Of the 20 amino acids that make up protein, just three are referred to as BCAAs: leucine, isoleucine, and valine. These are the specific amino acids that have been shown to stimulate protein synthesis and help regulate protein metabolism.
In weight training, as with most forms of exercise, there is a tendency for the breathing pattern to deepen. This helps to meet increased oxygen requirements. Holding the breath or breathing shallowly is avoided because it may lead to a lack of oxygen, passing out, or an excessive build up of blood pressure. Generally, the recommended breathing technique is to inhale when lowering the weight (the eccentric portion) and exhale when lifting the weight (the concentric portion). However, the reverse, inhaling when lifting and exhaling when lowering, may also be recommended. Some researchers state that there is little difference between the two techniques in terms of their influence on heart rate and blood pressure.[8] It may also be recommended that a weight lifter simply breathes in a manner which feels appropriate.

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]

A typical creatine supplementation protocol consists of a loading phase of 20 g CM/d or 0.3 g CM/kg/d split into 4 daily intakes of 5 g each, followed by a maintenance phase of 3-5 g CM/d or 0.03 g CM/kg/d for the duration of the supplementation period [5]. Other supplementation protocols are also used such as a daily single dose of around 3 – 6 g or between 0.03 to 0.1 g/kg/d [15,55] however this method takes longer (between 21 to 28 days) to produce ergogenic effects [5]. Sale et al [56] found that a moderate protocol consisting of 20 g CM taken in 1g doses (evenly ingested at 30-min intervals) for 5 days resulted in reduced urinary creatine and methylamine excretion, leading to an estimated increase in whole body retention of creatine (+13%) when compared with a typical loading supplementation protocol of 4 x 5 g/d during 5 days (evenly ingested at 3 hour intervals). This enhancement in creatine retention would lead to a significantly higher weight gain when people follow a moderate protocol ingestion of several doses of small amounts of CM evenly spread along the day.


If you're serious about putting on some muscle, then the most efficient way to do it is with three intense resistance training sessions and two lighter intensity workouts per week. “You need to have consistency in a workout program, hitting at least each muscle group two times a week to build muscle,” explains Lovitt. If you’re looking to switch up exercises, Olson suggests swaps such as sumo squats instead of traditional squats; step-ups on a bench instead of lunges; and then rotating back to the former. “These types of variation can be very effective in developing muscles, but the weights must still be fairly heavy that you’re using,” she says.
We hear this from 30 year olds and 60 year olds alike…and, like “I don’t have time,” it is a big fat lie! Even for the frail elderly, studies have shown that drastic results are possible in just 10 weeks of weightlifting (for both men and women in their 70s through their 90s). In fact, weight training has also been shown to delay Alzheimer’s and stave off dementia. So, if you think you might be “too old,” you’re probably the exact type of person that SHOULD be strength training!
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]
In humans, studies that investigate links between serotonin and creatine supplementation find that 21 trained males, given creatine via 22.8g creatine monohydrate (20g creatine equivalent) with 35g glucose, relative to a placebo of 160g glucose, was found to reduce the perception of fatigue in hot endurance training, possibly secondary to serotonergic modulation, specifically attentuating the increase of serotonin seen with exercise (normally seen to hinder exercise capacity in the heat[233]) while possibly increasing dopaminergic activity (conversely seen to benefit activity in the heat[234]).[155]
Beta-alanine is a naturally occurring non-essential amino acid that comes into the body through foods that are rich in protein. The performance-enhancing aspect of beta-alanine (BA) is due to its ability to increase intra-muscular levels of carnosine. Increasing beta-alanine through supplementation may raise carnosine levels by over 60 percent in as quickly as four weeks.[6]
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.

It’s not just about lifting—it’s about lifting safely and correctly. And if you’re not performing exercises properly, it’s impossible to make any progress. “When someone is just starting to work out, it can help to work closely with a knowledgeable personal trainer in order to learn proper form,” says Ingram. But that goes for experienced lifters, too. If you aren’t sure about a movement, it’s better to ask. “If you’re not working the correct muscles, you can’t expect them to grow,” explains Ingram.
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.”

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.
A: The literature supports roughly 0.8-1 gram per pound of bodyweight in young adults. Can you eat more? As long as you have healthy, functioning kidneys, yes. Will you receive any further physiological benefit from it? Most likely, no. Not only that, since our calories are set, if we choose to overconsume protein then we must reduce either carbohydrates and/or fat in order to keep caloric expenditure within our set range. Once protein needs are met (~0.8-1g/lb of bodyweight) you will likely see greater benefits from higher carbohydrate consumptions given the influence they have on anabolism and the anaerobic energy pathway. However, as I mentioned above, these recommendations will differ for older trainees given the blunted anabolic response from the ingestion of amino acids. 
Sports where strength training is central are bodybuilding, weightlifting, powerlifting, and strongman, highland games, hammer throw, shot put, discus throw, and javelin throw. Many other sports use strength training as part of their training regimen, notably: American football, baseball, basketball, football, hockey, lacrosse, mixed martial arts, rowing, rugby league, rugby union, track and field, boxing and wrestling.
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].

You don’t have to, but you can. The typical creatine dose is 5 grams once or twice per day, but it’s sometimes suggested that one should “load” creatine by taking 20 to 25 grams per day for the first week of usage. This is then followed with 3 to 4 weeks of 5 grams per day, then a break for a week or two, then repeat. This may bring about more acute increases in strength and muscle size — creatine will “work” more quickly, in other words — but it’s not necessary.


A: At the end of the day, the most important variable regarding weight gain or loss is calorie consumption. However, meal frequency and timing around activity can both influence workout intensity and duration thus potentially allowing for further improvements in body composition. Remember, muscle growth isn’t a pulsatile process, it doesn’t just acutely spike and then return to baseline so if there aren’t circulating amino acids within the blood stream then they’ll have to be broken down from muscle as this is the highest form of concentrated amino acids within the body. That being said, it would probably be a good idea to consume anywhere from 3-6 meals spread throughout the day depending upon your schedule and preference. Ideally, we want to stimulate anabolism through food every 3-5 hours.
The majority of your workouts should be comprised of compound exercises. Common examples include squats, deadlifts, lunges, bench presses, rows, pull-ups, lat pull-downs, overhead presses, and so on. Isolation exercises should definitely also be a part of your program, just a smaller part in comparison. Common examples include bicep curls, tricep extensions, chest flies, lateral raises, leg curls, leg extensions, calf raises, and so on.

Age-related muscle loss: Many different dosing regimens have been used; however, most use a short-term “loading dose” followed by a long-term maintenance dose. Loading doses are typically 20 grams daily for 4-7 days. Maintenance doses are typically 2-10 grams daily. Older adults seem to only experience benefits from creatine supplementation when it is combined with resistance training.
While I’m not well-versed in DNP, it is important to note that most supplements are not regulated by the FDA. The FDA has minimal standards for governing supplements before they make it to the shelves. All supplementation should be a case-by-case basis and under the discretion of a doctor and/or registered dietitian who knows your personal needs. Also, if you are consuming a well-rounded, healthy diet, supplementation may not be needed, even for making gains at the gym.

A meta-analysis found that creatine treatment increased muscle strength in muscular dystrophies, and potentially improved functional performance.[57] Creatine treatment does not appear to improve muscle strength in people who have metabolic myopathies.[57] High doses of creatine lead to increased muscle pain and an impairment in activities of daily living when taken by people who have McArdle disease.[57]

The maximum amount of creatine the body can store is about 0.3 gram per kilogram of body weight [6]. The creatine content of skeletal (voluntary) muscles averages 125 millimoles per kilogram of dry matter (mmol/kg/dm) and ranges from about 60 to 160 mmol/kg/dm. Approximately 60% of muscle creatine is in the form of PCr. Human muscle seems to have an upper limit of creatine storage of 150 to 160 mmol/kg/dm. Athletes with high creatine stores don't appear to benefit from supplementation, whereas individuals with the lowest levels, such as vegetarians, have the most pronounced increases following supplementation. Without supplementation, the body can replenish muscle creatine at the rate of about 2 g/day [7].


One case study on a subject with a methylentetrahydrofolate reductase (MTHFR) 677TT homozygote, a relatively common genetic mutation known as “mild MTHFR deficiency,” which causes mild homocysteinemia,[310] has seen benefits due to creatine supplementation where homocysteine was approximately halved (49% reduction) while CT heterozygotes and CC homozygotes (n=9) were unaffected.[311] Additionally, one rat study suggested a possible role for creatine in reducing homocysteine levels in a model of high uric acid levels (model for end stage renal disease[312]) but this was not replicated when investigated in humans.[313]
In the following article I will outline the supplements that have helped me to add a massive 10 kilograms (22lbs) of solid muscle to my physique over the past year—taking my body weight from 80 kilograms (176lbs) to 90 kilograms (198lbs)—and explain how these have helped me to improve my performance and enhance my size as a natural bodybuilder, aged 35.
Creatine Ethyl Ester, or CEE for short, is a powdered form of creatine which has an ethyl group attached to the creatine. This is said to make the creatine more easily absorbed in the human body which would allow you to benefit the most. The studies have not been entirely conclusive as to whether CEE is better than creatine monohydrate. Since Creatine monohydrate is the single most researched form of creatine, it is
Research shows that strength training is especially effective at raising EPOC. That’s because, generally speaking, strength-training sessions cause more physiological stress to the body compared to cardiovascular exercise, even higher-intensity cardio intervals. However, it’s worth noting that overall exercise intensity is what makes the biggest impact on EPOC. So squats, deadlifts, and bench presses with heavy weights are going to be much more effective at raising EPOC compared to bicep curls and triceps extensions with light weights.
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