Creatine Update, 2006

Creatine is the most famous and most studied sports supplement in history. It's become a staple for most bodybuilders and athletes. It's inexpensive (these days at least), safe (despite what the Chicken Little media may think), and it works.

So, with years of research in the lab, on the playing field, and in the gym, what's the latest on creatine monohydrate? What's the final word on loading, delivery systems, and timing issues? We sat down with David Barr and Dr. Lonnie Lowery to find out.

T-Nation: Guys, let's go over some basic issues and see where you stand. First, let's talk about creatine loading. The old recommendation was to take 20 grams a day for five days and only 5 grams after that for "maintenance," then we heard that loading wasn't necessary. What's the latest word?

David Barr: Some people theorize that by loading you can "shock" your muscles to new levels of growth due to the rapid swelling. It sounds like 90's ad copy. Unfortunately, the studies that have looked at muscle protein synthesis and creatine have shown no anabolic effect, whether you load or not. In fact, these studies have pretty much put a damper on the whole idea of cell volume affecting muscle growth.

Although loading results in the elimination of most of your creatine through the urine (i.e. wasted intake), the supplement is now cheap enough that this isn't really a big deal. I'm officially the cheapest bastard on the planet, so if I can afford to piss out creatine, then you can too. Of course there's no real advantage to loading other than quicker results (you impatient sod).

Dr. Lonnie Lowery: Well, I think it depends on your goals. If you're looking for immediate muscle fullness and simply a cosmetic effect, the "traditional" loading phase of 5-6 grams per dose, four times daily, is viable.

My experience in the matter, however, is that the body water shifts and accumulation in skeletal muscle don't result in cosmetic changes (enhanced fullness, possibly vascularity) indefinitely. I've long found it interesting that although the muscles stay mostly "loaded" for several weeks after cessation (based on biopsy and NMR scans), the cosmetic pumps seem to dissipate much more rapidly – in about two to three weeks.

Some of the peripheral work I did early in grad school suggested that the creatine/fluid initially expanded the extracellular compartment (fluid under the skin), then moved to the intracellular compartment (muscle expansion). The sensitivity of that equipment wasn't great, however, and I'm not sure if this issue has been similarly pursued by others.

You can only be sure that creatine concentrations do significantly rise in supplemented muscle tissue and that total body water usually rises after a few days of loading. Nonetheless, when I competed last, I finished up creatine loading by Wednesday before a Saturday contest, just in case there was any unnecessary fluid hanging around outside of my muscles.

So, loading may have certain "benefits" for a physique enthusiast, but for general training purposes, cellular energy, and eventual performance enhancement, I think the old five grams per day (generally one tablespoon or a little less) approach is probably best.

T-Nation: Okay, Lonnie mentioned 5 grams, which was always the standard dose, but then we heard that 3 grams is all that's needed, even though some supplement companies recommend up to 10 grams per day just for maintenance. Honestly, I think they just want you to run out of product faster so you have to re-buy! What's the final word?

Barr: Ten grams a day is just more supplement industry bullshit, and it's no surprise that T-Nation is the place you'll find that myth debunked. After a few weeks of 3-5 grams daily use, the same dose after physical activity is fine for anyone 200 pounds or less.

If we're sitting on our asses doing nothing, then our muscle creatine levels will remain elevated for quite a while, so there's no real need to take more. Of course, if you're a 300 pound football player, then you'll need a lot more, but only after physical activity.

Lowery: I've personally seen traditional five-day creatine loads remain almost entirely intact after six weeks of no supplementation. The more heavily muscled, true carnivores among the subject pool especially held up well. My old advisor did that work using nuclear magnetic resonance spectroscopy and it woke me up to the push of marketers who love to suggest a full "reload' every few weeks.

I'm with David on this: 3-5 grams per day is enough to maintain a loaded state when you really need it. In fact, I'll also agree that this isn't something I'd do year-round, since I don't train with equal intensely or frequency year-round. Even though I recognize that there's no consensus on any reliable side effects in the literature (looking at healthy persons), my off periods are simply a "moderation" policy for me. The times I do supplement then become a more motivating event anyway.

For those who care, there was some research done by Wilder and colleagues about five years ago on the "tortoise versus hare" approach to dosing among football players. I believe it was published in an athletic training journal. Also, low-dose, short-term creatine administration (6 grams per day for six days) has only modest ergogenic effects, as described last year by Hoffman and colleagues.

This isn't a big surprise but it does suggest that, as many already know, you shouldn't expect noticeable effects until a month or so of low-dosing has passed.

T-Nation: Okay, now let's talk about timing. Lots of lifters like to take creatine before training because they say they can feel the pump more, but most experts recommend taking creatine after training. When's the best time to take it?

Barr: The idea of pre-workout creatine comes from a couple of sources, both of which have the common tie of misunderstanding. Basic thinking suggests that if we take creatine before we train, it'll have an acute impact on the workout that immediately follows. The problem with this is that it takes time for creatine to be absorbed by the gut and then enter the muscle where it can do its job.

The more "advanced" idea behind pre-workout creatine mistakenly follows the pre-workout nutrition principle. Due to the fact that pre-workout meals have such a tremendous positive impact on muscle protein synthesis and blood flow, greater even than that of a post-workout meal, some theorized that pre-workout creatine would follow this trend.

While it's not "wrong" to take creatine pre-workout, I can't imagine that it'll have the same effect as after a workout, when muscle creatine levels are sub-optimal. In other words, we take creatine after a workout to prepare for the next.

T-Nation: What's your take on pre-workout creatine, Lonnie?

Lowery: I'd simply suggest that since large doses of carbs (and proteins) jack-up insulin concentrations high enough to enhance muscular creatine uptake, the oft-discussed peri-workout period (pre-, mid-, post-lifting) is a real opportunity.

T-Nation: Now, when creatine first came out it was a plain white powder. Then the creatine-plus-simple-carbs drinks became popular because the insulin spike from the carbs helped with creatine transport. Is this spike necessary?

Barr: While it's not necessary to spike insulin when consuming creatine, this practice certainly helps to store more of this supplement in our muscles. If we're going to use creatine, then why not use this simple trick to optimize the effect?

I've written enough about Surge that I can already hear people groaning about my mention of it again, but the high quality of macronutrients in this product are ideal for assisting with creatine uptake.

T-Nation: What do you think, doc? Is the spike a necessity?

Lowery: The spike isn't absolutely necessary. It's interesting to note, though, that about 100 grams of carbs (when used alone) are reportedly necessary to get insulin high enough.

T-Nation: Okay, let's clarify this whole issue. The insulin spike isn't necessary, but it'll probably help get more creatine into the muscles, right? But if I'm understanding this correctly, you'll get plenty in there anyway with continued usage, correct?

Lowery: Yep, that's pretty much so. And since the 100 grams of carbs that's been reported for sufficient insulin action is pretty whopping, some low-carb guys may shy away from this approach.

Sometimes I take creatine with my fairly whopping post-exercise, high-carb drink, sometimes not. Call me fickle, but as we've said, the carbs aren't an absolute necessity for muscle uptake.

Barr: I don't completely agree with the absence of an insulin spike. I mean, taking creatine with just water is cute and everything, but seriously, how hard is it to use it while increasing insulin? Considering the ridiculous snake oil that sheeple are consuming these days, why would we not want to make use of one of the few scientifically supported methods that we have for improving the effectiveness of a supplement?

So is spiking insulin necessary? Of course not. But unless you're consuming a low carb diet then it just seems half-assed to me. Part of the reason I feel this way is because I don't think that insulin merely loads our muscles up to their peak faster. On the contrary, I believe that creatine actually elevates the ceiling or the maximum amount of creatine that can be loaded into muscle.

T-Nation: Interesting. Now, given the 100 grams of carbohydrate factoid that Lonnie mentioned, is Surge enough? The standard serving has 49 grams of carbs. What if you have your Surge with creatine added, then eat a carby post-workout whole meal 30 to 60 minutes later? Good enough?

Barr: Based on what I know about Dr. Berardi's research on Surge, one serving should be enough. It seems that the combination of readily absorbable carbohydrates, protein, and amino acids generates a HUGE insulin spike, such that our blood sugar drops sooner than half an hour after consumption.

To put that in perspective, my own research has shown that consuming a 75 gram glucose load merely dips blood sugar over an hour later, suggesting that we need to consider more than just carbohydrate quantity. Of course, exercise plays a role in blood sugar regulation, and hopefully creatine uptake, but the impact of Surge can't be ignored.

Lowery: Maybe it's best to think of creatine as being like circulating glucose itself. The body actually responds to them similarly in some ways. For example, workouts appear to enhance creatine's uptake into muscle tissue, similar to glucose. Also, insulin drives creatine into skeletal muscle, again, similar to glucose.

But creatine differs from glucose in the necessity of these uptake regulators. That is, in the case of creatine, there doesn't appear to be as much of a requirement for insulin or muscular contractions for it to "work." Muscle contractions throughout the day and obviously insulin action are really critical to glucose entry into muscle cells whereas creatine is simply helped along in these ways.

So yeah, a solid food, secondary post-workout meal would be helpful – just not 100% necessary.

T-Nation: Okay, next topic. I see this one a lot on our forums: Should you use creatine when dieting?

Lowery: I personally chose not to creatine load as I started dieting for that last contest in 2003. I did consume a tablespoon's worth about once per week, perhaps out of paranoia. The hope, I suppose, was to provide muscle cell energy during a time of negative calorie status and increasingly shrinking carb intake.

Then, in the final week before "game day" (week 21 or 22 into the "diet") I did a minor three-day creatine load while I carb-loaded, in an attempt to get that acute aesthetic fullness. Although highly subjective, my opinion is that it worked pretty well.

T-Nation: You looked pretty jacked in that contest, can't argue with that! What do you think, Barr? Should we take creatine when dieting?

Barr: While I don't think it'll have a huge impact either way, many people would rather cut with creatine. Although creatine doesn't seem to have a direct anabolic effect, I think that cell volumization in a specifically catabolic situation (like a calorie restricted diet) is where this supplement may really shine – not only from a cellular physiology standpoint, but also due to the fact that it'll help keep our strength higher than without.

And we can't ignore the psychological impact that this may have. From people who are cutting, I hear more complaints about muscles flattening out and squat weight going down than I do about hunger. Now, if creatine can help minimize both of these problems then it'll have a tremendous influence on how we feel overall, and that can make or break a diet.

T-Nation: Good points. Now, what's up with sodium's role in creatine utilization? Should we add sodium to our creatine or not?

Barr: Sodium is important to help the creatine get from the blood into the muscle. One study has shown sodium to be even more important than insulin in this regard!

While I think we generally have enough dietary sodium that we don't need to be too concerned about it, adding a little table salt to creatine is both cheap and easy enough to act as a bit of insurance. One of the cool things about Surge is that it has a little sodium, so you're already covered when using it with creatine.

T-Nation: Lonnie, what say you?

Lowery: Average Americans get almost ten times the sodium they actually need. (That is, based on actual need, about 500mg per day, not recommendations, which are just realistic limits set at several times this amount.)

Nonetheless, many T-Citizens don't live on processed foods like most Americans, so they may want to look at their diets, simply out of interest. I personally get plenty of sodium, and I have a family history of hypertension, so I sure won't be supplementing extra any time soon!

T-Nation: Interesting, something to think about for sure. Okay, now that creatine has been studied to death, what other non-bodybuilding, non-athletic uses are we finding for it?

Barr: When I found out that creatine was a smart drug, I was blown away, but it makes sense because we have creatine in our brains, just like in our muscles. Also, like muscle, it seems that increasing levels of creatine enhances performance – mental performance.

There are also implications for creatine being beneficial in muscle wasting diseases, including aging. If you consider the cognitive dysfunction that accompanies muscle wasting and inactivity as we age, creatine may be the best anti-aging supplement around.

As if that weren't enough, creatine seems to help with muscle insulin sensitivity! Considering that half of the people in the industrialized world are headed toward diabetes, this supplement could potentially have a greater impact, both human and financial, than any other supplement in history.

Lowery: Yeah, the cognitive enhancement is cool. And preliminary benefits for the sleep deprived (related to cognition) and those experiencing early overtraining ("over-reaching") have been described.

I'd like to add my two cents here regarding anabolic effects, since I've only touched on pumps and performance. Actually, back in the 90s, we did some stable isotope work in my lab looking for protein synthetic (or breakdown) effects pre- and post-creatine load. The results were pretty clear regarding muscle expansion (via MRI scans), but were much less conclusive as far as actual anabolism (or anti-catabolism). This cell hydration concept was initially going to be my thesis, in fact. It was cool and much less exaggerated and hyped back then.

Since those dark ages, as Dave pointed out, the promising possibilities of creatine monohydrate – including cell hydration and energy for protein synthesis – haven't panned out in some studies (e.g. pre- versus post-load over about a week). Still, one can find suggestions that longer-term creatine use may slowly enhance real gains.

These aspects include increased satellite cell activity (in rats), anti-catabolic effects (in humans), increased messenger RNA for IGF-1, and the "super-training effect" of lifting heavier weights over many months' time.

T-Nation: Cool info. Next subject: Is there a difference in quality when it comes to plain powdered creatine?

Barr: There are two main factors affecting quality: particle size and purity. It's pretty obvious that we don't want any drugs or other impurities, but particle size gets overlooked too often.

The finer the powder, the more easily it'll dissolve. Many people have a hard time dissolving creatine in water, and this has the potential to lead to uncomfortable side effects like bloating. Using a fine creatine powder like a micronized variety can help minimize any negative effects.

T-Nation: Yeah, I remember a small percentage of people complaining of stomach troubles with creatine when it first became widespread, but that disappeared once micronized creatine was introduced. What's your take, Lonnie?

Lowery: I'd just add that plain powdered creatine is the way I prefer it. I don't want to pay 40 bucks for a tub of 90% sugar and 10% creatine. Some expensive creatine supplements crack me up. I can save a ton of cash and have way more fun with sugar than that.

T-Nation: Okay, all the studies and sciency talk aside, how do you take your creatine? I just toss 3 to 5 grams into my post-training Surge.

Barr: Toward the end of my last school year I weighed just over 200 pounds. When I started training again, I found that 3 grams of creatine each day was enough until I was loaded, at which point I only took creatine post-training.

Now that I'm back up around 230, I'm using 5 grams after training. If I go for more than two days without training, I'll throw 5 grams into my morning Surge. Although this is probably not necessary for muscle, I like to ensure that brain creatine levels are always elevated.

Lowery: I just started taking creatine again after a year or more away from it. I'm using a tablespoon (about 5 grams) after workouts because it's a convenient time for me. I'm drinking-down the insulinogenic protein and carbs anyway at that time!

And I admit that the nootropic thing is always in the back of my mind as well. High-performance muscles are only half of the equation, after all.

T-Nation: Okay, good info. What I'd like to do is sum all this up, then plug the ever-lovin' snot out of the high-end German creatine we sell here at T-Nation. First, the usage summary, based on your discussion above:

• There's no need to load with mega-doses. Just take 3 to 5 grams a day for a couple of weeks. After that, take 3-5 grams only after training. No need to take it on off days after that.
• A full "reload' every few weeks isn't necessary.
• The best time to take creatine is after training.
• Always use micronized creatine.
• If you use a properly formulated post-training drink like Surge, toss your creatine in there. It's a darn good "delivery system."
• Sodium does help creatine get into the muscle, but you probably get enough already so no need to add this to your diet.
• Creatine has a "smart drug" effect that's pretty darn cool. You may want to use a little creatine just for that. Old folks may benefit from it too, as it can help combat muscle wasting that comes with aging.

And now the plug: If you haven't noticed, we started selling micronized creatine a few months ago. No fancy additions, no hype, just German CREAPURE creatine, the good, pharmaceutical grade stuff all the original studies used, not the knock-off Chinese crap.

When this stuff first hit the market, EAS sold it for $70 a tiny bottle and it wasn't even micronized. As a service to our readers, we have it for $12.99, and that's for 500 grams! Check the store for more info or to pick up a tub.

Thanks for the updated info, Lonnie and Dave!