Creatine

Creatine is a molecule that is produced in the body from amino acids. It's primarily made in the liver and (to a lesser extent) in the kidneys and pancreas.^[1][2] Creatine stores high-energy phosphate groups in the form of phosphocreatine. These phosphate groups are donated to ADP to regenerate it to ATP, the primary energy carrier in the body.^[3] This role in energy production is particularly relevant under conditions of high energy demand, such as intense physical or mental activity.

Creatine can be found in some animal-based foods and is most prevalent in meat and fish.^[4][5] Athletes commonly take it as a powder or in capsules.

The primary benefit of creatine is an improvement in strength and power output during resistance exercise. Creatine is well researched for this purpose, and the effects are quite notable for a supplement. When used in conjunction with resistance exercise, creatine may modestly increase lean mass. It has also been tested for effects on anaerobic running capacity in many studies, the results of which are rather mixed but generally suggest a small improvement in performance.

Although creatine has been researched far less for cognitive performance than physical performance, it may have benefits in some contexts. Creatine appears to reduce mental fatigue in scenarios such as demanding mental activity and sleep deprivation.^[6][7] Creatine may also improve working memory, though likely only for people with below-average creatine levels, such as vegetarians and older adults.^[8][9] More research is needed in these areas and on other cognitive measures before creatine can be said to be effective.

Diarrhea and nausea can occur when too much creatine is taken at one time, in which case the doses should be spread out throughout the day and taken with meals. Creatine supplementation typically results in weight gain, partly due to an increase in total body water.^[10] This may be of particular concern to individuals competing in weight-sensitive sports.

Creatine monohydrate is the cheapest, most well-researched, and most commonly used form of creatine. Another option is micronized creatine monohydrate, which dissolves in water more easily. Although several other forms of creatine have been marketed as more effective sources of creatine than creatine monohydrate, there is a lack of studies showing that these forms increase creatine storage in muscle to a greater degree than creatine monohydrate.

Creatine monohydrate can be supplemented with or without a loading protocol. In most studies that used a loading protocol, around 20 grams of creatine were taken every day for 5–7 days to saturate the muscle creatine stores, followed by a daily maintenance dose of 3–5 grams. Alternatively, the muscle creatine content can be gradually increased by taking 3–5 grams of creatine every day for approximately four weeks. Higher doses (up to 10 grams/day) may be beneficial for people with a high amount of muscle mass and high activity levels or for those who are nonresponders to lower doses.

Adenosine triphosphate (ATP) is a molecule that carries energy within cells and is the main fuel source for high-intensity exercise. When cells use ATP for energy, this molecule is converted into adenosine diphosphate (ADP) and adenosine monophosphate (AMP). Creatine exists in cells in the form of creatine phosphate (or phosphocreatine), which donates a high-energy phosphate group to ADP, thus turning this molecule back into ATP.

By increasing the overall pool of cellular phosphocreatine, creatine supplementation can accelerate the recycling of ADP into ATP, thereby making more energy available for high-intensity exercise. This increased availability of energy can promote improvements in strength and power output.^[11]

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