Different forms of creatine in combination with other sports supplements as well as varying doses and supplementation methodology should continue to be researched in an attempt to understand further application of creatine to increase sports and exercise performance of varying disciplines. It is important to remain impartial when evaluating the safety of creatine ingested as a natural supplement. The available evidence indicates that creatine consumption is safe. This perception of safety cannot be guaranteed especially that of the long term safety of creatine supplementation and the various forms of creatine which are administered to different populations (athletes, sedentary, patient, active, young or elderly) throughout the globe.
Creatine is an organic acid naturally occurring in the body that supplies energy to muscle cells for short bursts of energy (as required in lifting weights) via creatine phosphate replenishment of ATP. A number of scientific studies have shown that creatine can improve strength, energy, muscle mass, and recovery times. In addition, recent studies have also shown that creatine improves brain function. and reduces mental fatigue. Unlike steroids or other performance-enhancing drugs, creatine can be found naturally in many common foods such as herring, tuna, salmon, and beef.
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. 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.
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There is some research that suggests that creatine can help people with type 2 diabetes by improving insulin sensitivity, glucose uptake into the cells, and glycemic control. This has led many people with T2 to start supplementing their diets with pure creatine to try and reap the benefits. At this time there has been no conclusive research done into the effectiveness of creatine for type 1 diabetics.
You’ll Feel Better: Not only will you find yourself with more energy and confidence, less stress and anxiety, and a better overall mood, but you’ll actually begin to think better (resistance training has been proven to help increase cognitive function). And while training too close to bedtime can be a bad idea, exercising earlier in the day has been proven to help prevent sleep apnea and insomnia. I even improved my posture – when I started lifting, I was 5’4”. Now I’m 5’5.5”.
When Katula started his research on whether weight training would improve quality of life for seniors, he realized that many had never even picked up a dumbbell. “They first had to learn how to use these big intimidating weights and machines,” he says. He recalls the story of one woman who protested that she couldn’t do the leg press machine. Finally, Katula persuaded her to sit in the machine and set the weight at 50 pounds. “I couldn’t believe how fast she whipped out 10 reps,” he says, “When she got out of that machine, she was two inches taller just from increased pride.”
A maintenance phase of 2g daily appears to technically preserve creatine content in skeletal muscle of responders either inherently or after a loading phase, but in sedentary people or those with light activity, creatine content still progressively declines (although it still higher than baseline levels after six weeks) and glycogen increases seem to normalize. This maintenance dose may be wholly insufficient for athletes, a 5g maintenance protocol may be more prudent.
Creatine is a hydrophilic polar molecule that consists of a negatively charged carboxyl group and a positively charged functional group . The hydrophilic nature of creatine limits its bioavailability . In an attempt to increase creatines bioavailability creatine has been esterified to reduce the hydrophilicity; this product is known as creatine ethyl ester. Manufacturers of creatine ethyl ester promote their product as being able to by-pass the creatine transporter due to improved sarcolemmal permeability toward creatine . Spillane et al  analyzed the effects of a 5 days loading protocol (0.30 g/kg lean mass) followed by a 42 days maintenance phase (0.075 g/kg lean mass) of CM or ethyl ester both combined with a resistance training program in 30 novice males with no previous resistance training experience. The results of this study  showed that ethyl ester was not as effective as CM to enhance serum and muscle creatine stores. Furthermore creatine ethyl ester offered no additional benefit for improving body composition, muscle mass, strength, and power. This research did not support the claims of the creatine ethyl ester manufacturers.
I’m going to cover this in detail in a bit, but for right now, just know this: it’s VERY possible (and common) to gain weight fast in the hopes of gaining muscle fast. The problem, however, is that the majority of the “weight” a person in this scenario will end up gaining will be body fat rather than muscle mass. This is something that needs to be avoided at all costs, and I’ll show you how a little later.
One case study exists of a man with focal segmental glomerulosclerosis who experienced an accelerated rate of GFR decline during supplementation (5g thrice daily for loading, then a 2g maintenance for seven weeks) which was partially reversed upon supplement cessation. This was deemed strong circumstantial evidence, and the brand of supplement was not named. Elsewhere, interstitial nephritis associated with creatine supplementation has been reported in a man, although symptoms arose four weeks after supplementation started with no evidence to support correlation. Some studies involving athletes and various dietary supplements have attempted to draw a correlation with creatine and cases of rhabdomyolysis. Finally, one study in a diabetic person ingesting both metformin and creatine resulting in metabolic acidosis has attempted to place causation on creatine, but it did not establish causation or circumstantial evidence.