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Research shows creatine is an amino acid that is made naturally by the human body. It is found primarily in the muscles, but is also present in the brain and bodily organs. Creatine can be obtained through dietary choices of red meat or seafood.  A meta analysis of creatine metabolism shows that creatine is primarily metabolized in the liver and kidneys as the waste product creatinine. Natural levels of creatine can be increased by using commercially produced creatine supplements.

Forms of Creatine

Creatine supplements are available in a multitude of different oral and cream forms. While creatine monohydrate (CM) is the most popularly used type of creatine with the vast majority of research studies based on usage of this variety, chemical creatine is also available as creatine anhydrous, a form created by removing the water molecule naturally found in creatine monohydrate (CM) to amplify the level of creatine concentration.

Creatine is commercially produced in numerous salt forms as creatine citrate, creatine malate, creatine phosphate and creatine pyruvate. Various combined creatine products offered for retail consumption include magnesium creatine, creatine orotate and creatine combined with baking soda sold as Kre Alkalyn. Creatine supplementation is also produced in ester form as creatine ethyl ester (hydrochloride) and as creatine combined with gluconate as creatine gluconate — which is a form of creatine bound to glucose. Creatine effervescent is a form of creatine monohydrate (CM) or creatine citrate combined with a mixture of citric acid and bicarbonate.

Benefits of Creatine Use

Creatine is frequently used by athletes and fitness enthusiasts because it is known to increase body mass by promoting muscle mass growth. Creatine is a popular dietary supplement due to its demonstrated ability to improve muscle strength and amplify performance in athletic activities including high-intensity aerobic exercise and heavy resistance training such as bench pressing. Studies1 suggest that in addition to an increase in muscle mass, creatine supplementation and exercise are also linked to extended endurance times.

The daily recommended allowance of creatine supplement is 20 grams, which may be divided into four doses of 5 grams.1 Studies suggest creatine supplementation is safe for as long as five years.

How to Use Creatine Supplements

Research studies suggest creatine supplementation at 20 grams per day may be advantageous in sports competition as creatine increased muscle mass and endurance levels in aerobic exercise and weightlifting performance.Creatine supplementation is approved by professional sports leagues and is sanctioned by major sporting associations including the International Olympic Committee and the National Collegiate Athletic Association (NCAA). Older adults may benefit from creatine supplements as a way to increase muscle mass, which normally becomes depleted as age advances.

Oral creatine supplementation is indicated for creatine deficiency syndrome which may affect brain function, the aging process and bone mass density (BMD). The use of creatine supplements has also been shown to be beneficial in the treatment of multiple disease states including chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, fibromyalgia, depression, various diseases affecting the muscles and nerves such as Parkinson’s disease, multiple sclerosis and muscle atrophy. Other medical conditions where creatine supplementation may be indicated include schizophrenia, amyotrophic lateral sclerosis (ALS) commonly known as Lou Gehrig's disease, rheumatoid arthritis, osteoarthritis, Rett syndrome, gyrate atrophy (an eye condition) and various genetic disorders that diminish the senses and movement abilities.

Symptoms of Creatine Deficiency

Medical conditions including poor muscle or liver function can cause creatine deficiency. Decreased creatine levels also frequently occur during pregnancy. Symptoms of creatine deficiency include decreased muscle mass, which can result in poor muscle strength and problems with exercise. Nausea, fatigue and pain occurring in the upper, right abdomen are signs of liver disease which contributes to creatine deficiency. Malnutrition, a common cause of creatine deficiency, is often characterized by weight loss and dizzy or fainting spells.

Who is at Risk for Creatine Deficiency?

Vegetarians are most at risk for creatine deficiency due to the lack of red meat and seafood in the vegetarian diet. Certain medical conditions and disease states can cause the body's natural production of creatine to become deficient.

Risks and Warnings Associated with Creatine Supplements

Creatine supplementation is counter-indicated in individuals with kidney problems as creatine use has been linked to possibly causing these conditions to worsen. Likewise, people with bipolar disorder are warned that usage of creatine supplements may cause maniac episodes to increase. Those suffering from Parkinson’s Disease are also warned that the use of creatine supplements may promote further progression of the illness. Creatine supplementation can potentially cause weight gain due to increased water retention. 

Foods that Contain Creatine

Creatine levels can be increased through a diet rich in red meats and seafood.

Citations and Sources

Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. J Int Soc Sports Nutr. 2012;9(1):33. [PubMed]
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