Creatine Powder: Top 7 Scientifically Proven Effects

Creatine Monohydrate is the most studied and proven effective supplement in sports. You can find this supplement in a form of creatine powder or pills. Still, many gym-goers find this substance “harmful” and “unhealthy“. Let’s drop down the theory behind the creatine powder (you can find it here) and proceed to the real-life effects!

Creatine Powder and Popular Myths

Creatine Monohydrate for Women

Creatine Monohydrate is accepted with equal success not only by men but also by women. Previous research has shown that adding creatine to the diet can improve athletic performance, reduce the risk of injury, improve rehabilitation, and reduce the risk of disease in young, middle-aged, and older age groups. Creatine works by increasing muscle phosphocreatine stores, which increases the availability of energy in actively working cells [1, 2, 3].

When discussing nutrition for women, the menstrual cycle must be considered as hormonal changes occur throughout the cycle. Several studies acknowledge a literature gap associated with creatine supplementation in women and have found that creatine powder may be effective during menstruation, pregnancy, and the postpartum period. In addition, as women age, creatine has been found to be beneficial for improving their mental health, bone health, and physical function [4].

While many studies highlight creatine’s ability to increase performance, creatine also has benefits for overall health, especially brain health. Creatine may help cognitive performance, regulate mood, reduce depression, and provide neuroprotection, especially in women [5]. Recent literature has shown that creatine supplementation can protect the brain from traumatic brain injury and help recover from previous trauma [5].

Although men appear to be more sensitive to creatine supplementation, improved athletic performance and increased lean body mass have been observed in both sexes [4, 6, 7]. Moreover, in a study on high-intensity interval training (HIIT), men and women who consumed creatine monohydrate had increased peak and relative peak anaerobic cyclic power, maximum moment of voluntary back contraction (MVC), and increased lactate levels [8].

Creatine supplementation has also been shown to improve average strength and endurance in team sports in women [9].

Does Creatine Cause Hair Loss/Baldness?

The vast majority of hypotheses about a link between creatine powder supplementation and hair loss/baldness stem from one study by van der Merwe et al [12] where college-age male rugby players who supplemented their diet with creatine (25 g / day for 7 days, and then 5 g / day for an additional 14 days) experienced an increase in serum dihydrotestosterone (DHT) concentration over time.

Specifically, DHT increased 56% after a 7-day load period and remained 40% above baseline values ​​after a 14-day maintenance period. These results were statistically significant compared to when the subjects took a placebo (50 g of glucose per day for 7 days, then 30 g / day for 14 days thereafter). Given that changes in these hormones, especially DHT, have been associated with some cases of hair loss [13], the theory that creatine supplementation leads to hair loss has gained some momentum, and this potential link continues to be a common issue/myth today.

It is important to note that the results of van der Merwe et al [12] have not been subsequently replicated and that intense resistance exercise alone can cause an increase in these androgenic hormones.

DHT is a testosterone metabolite formed when the enzyme 5-alpha-reductase converts free testosterone to DHT [14]. In men, DHT can bind to androgen receptors in sensitive hair follicles and cause them to shrink, ultimately leading to hair loss. However, van der Merwe et al [12] found no increase in total testosterone in all men who completed the study.

Free testosterone was not measured. Moreover, increases in DHT and DHT: testosterone ratio remained within normal clinical limits. In addition, before supplementation, DHT levels were 23% lower in the creatine group (0.98 nmol / L) compared to the placebo group (1.26 nmol / L).

Thus, a slight increase in DHT in the creatine group (+ 0.55 nmol / L after 7 days of supplementation and + 0.40 nmol / L after 21 days of supplementation) combined with a slight decrease in DHT response in the placebo group (-0. 17 nmol / L after 7 days of supplementation and -0.20 nmol / L after 21 days of supplementation) explains the “statistically significant” increase in DHT noted by van der Merwe et al [12].

Although it is possible that creatine powder supplementation increased 5-alpha reductase activity in these men (potentially leading to increased DHT production). No studies have reported on hair loss in humans. To date, 12 other studies have examined the effects of creatine supplementation, i.e. doses ranging from 3-25 g / day for 6 days to 12 weeks, on testosterone.

Two studies reported small, physiologically insignificant increases in total testosterone after six and seven days of supplementation, while the remaining ten studies reported no change in testosterone concentration. In five of these studies [13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23], free testosterone, which the body uses to produce DHT, was also measured and no increases were found.

Find more about testosterone here – Natural Ways to Boost Testosterone

Does Creatine Increase Fat Mass?

The theory that creatine supplementation increases fat mass is of concern to people who exercise, possibly because some experience weight gain from creatine supplementation. However, randomized controlled trials (ranging from one week to two years) do not support this statement. Acute creatine supplementation (7 days) had no effect on fat mass in young and old people, but the fat-free mass was increased [24, 25]. In addition, three weeks of creatine supplementation had no effect on swimmers’ body composition [26]. Adding creatine to high-intensity interval training had no effect on body composition in active women [27].

In addition, the effects of creatine supplementation during resistance training had no effect on fat mass [28]. Moreover, in a group of healthy performing male bodybuilders, 5 grams of creatine per day, consumed before or after training, had no effect on fat mass [29].

Other short-term studies, lasting 6-8 weeks, found no changes in body fat from creatine supplementation. Becque et al [30] found no change in body fat after six weeks of supplementation plus strength training. In another 6-week study, there were no significant differences in body fat mass or percentage of body fat after creatine supplementation [31]. In addition, creatine supplementation during the 8-week football season also had no effect on body fat [32].

It can be assumed that 8 weeks or less of creatine supplementation is not enough to reach a definitive conclusion about the effect of creatine on fat mass. However, there are several studies that have used much longer time frames. For example, healthy trained men were randomly assigned a creatine supplement (20 g / day for 1 week followed by 5 g / day for 11 weeks) or a placebo. Lean body mass and muscle fiber size increased, and body fat and body fat were not affected during the 12-week training period [33]. In older men (~ 70 years), 12 weeks of creatine supplementation during strength training had no effect (compared with placebo) on fat mass [34].

In addition, Gualano et al evaluated the effect of creatine supplementation (24 weeks), with and without resistance training, in older women. The results showed no effect of creatine on fat mass [34]. Candow et al [35] studied the effects of creatine supplementation in the elderly (50-71 years) over a 32-week treatment period. Study participants were randomized to receive creatine or placebo before or after strength training (3 days per week).

Over time, there was an increase in muscle tissue and strength with a decrease in fat mass. From a clinical point of view, children with acute lymphoblastic leukemia who received additional creatine (0.1 g / kg/day) for two consecutive periods of 16 weeks showed a significant decrease in fat mass. In contrast, children who did not consume creatine gained fat mass.

In two studies in postmenopausal women, Lobo et al [36] found no change in absolute or relative body fat after one year of low-dose creatine supplementation.

In addition, two years of creatine supplementation also had no effect on fat mass [37]. Recently, Forbes et al [38] conducted a systematic review and meta-analysis of randomized controlled trials involving creatine supplementation in combination with strength training and effects on fat mass in the elderly (≥ 50 years). 19 studies were included, involving a total of 609 people. Participants taking creatine had a greater reduction in body fat percentage.

There was no significant difference in absolute fat loss, however, the creatine group lost 0.5 kg more fat mass compared to the placebo group.

Does Creatine Powder Cause Water Retention?

Aside from the personal observations of consumers, which may be subjective and distorted by the placebo effect, the information that creatine powder supplementation retains water in the body is probably related to early studies. They showed that creatine at a dose of 20 g / day for six days has been associated with water retention [39]. Apparently, the most common adverse effect of creatine supplementation is water retention in the early stages (the first few days) [40].

For example, studies have shown that three days of creatine supplementation increased total body water (TBW), extracellular body water (ECW) [3], and intracellular water (ICW).

Unfortunately, based on these short-term reactions, it is widely believed that creatine increases water retention in the long term [41]. Creatine is an osmotically active substance. Thus, an increase in the body’s creatine content could theoretically lead to an increase in water retention.

Several studies of exercise (eg 5-10 weeks) that include creatine supplementation have not shown an increase in total body water (TBW). For example, resistance-trained men who received creatine at a dose of 0.3 g / kg lean body mass per day for 7 days (approximately 20 g / day), followed by 4 weeks at a dose of 0.075 g / kg lean body mass per day for within 28 days (approximately 5 g / day) did not experience significant changes in ICW, ECW or TBW [44].

In addition, resistance-trained men who consumed creatine supplements (20 g / day for seven days, then 5 g / day for 21 days) did not have significant increases in ICW, ECW, or TBW [45]. Similarly, men and women taking creatine (0.03 g / kg/day for six weeks) did not experience significant increases in TBW [46].

Six weeks of creatine supplementation in trained men at 0.3 g / kg lean body weight for five days followed by 0.075 g / kg lean body weight for 42 days did not significantly change TBW [47].

In contrast, when evaluating TBW, ICW, and ECW before and after 28 days of creatine supplementation in healthy men and women (n = 32), Powers et al [48] showed that creatine supplementation was effective in increasing muscle creatine levels. , which was associated with an increase in body weight and TBW, but did not change ICW or ECW volumes.

In a recent study looking at the effects of creatine supplementation in combination with exercise on strength training for 8 weeks, Ribeiro et al [49] found significant increases in TBW (7.0%) and ICW (9.2%) volume compared with placebo ( TBW: 1.7%; ICW: 1.6%), with both groups similarly increasing ECW (Creatine: 1.2% vs Placebo = 0.6%). The ratio of skeletal muscle mass to ICW remained the same in both groups.

It should also be emphasized that ICW – intracellular fluid volume is an important cellular signal for protein synthesis and thus leads to an increase in muscle mass over time [50].

Therefore, while there is some evidence that creatine supplementation increases water retention, primarily by increasing intracellular volume, there are several other studies over a short period of time suggesting that it does not alter total body water (intracellular or extracellular ) in relation to muscle mass for longer periods of time.

As a result, creatine supplementation may not result in water retention.

Does Creatine Powder Cause Kidney Damage/Renal Dysfunction?

Issues and concerns related to creatine powder supplementation and kidney damage / renal dysfunction are common. In terms of the pervasive misinformation in the sports nutrition arena, the notion that creatine supplementation leads to kidney damage / renal dysfunction is perhaps second only to the myth that protein supplementation and high consumption of regular protein cause kidney damage.

Today, after more than 20 years of research showing no side effects of recommended doses of creatine supplementation on kidney health, unfortunately, this concern persists. Although the origin is unknown, the link between creatine supplementation and kidney damage / renal dysfunction can be traced back to two things:

• a poor understanding of creatine and creatinine metabolism;
• a case study published in 1998.

Cause #1

In skeletal muscle, both creatine and creatine phosphate are non-enzymatically degraded to creatinine, which is exported into the blood and excreted in the urine [51]. Healthy kidneys filter creatinine that would otherwise build up in the blood. Thus, the level of creatinine in the blood can be used as a proxy marker of kidney function.

However, the amount of creatinine in the blood is associated with muscle mass (ie, men have higher blood creatinine levels than women) and both dietary creatine and creatinine intake [52].

Blood and urine creatinine can be elevated with creatine supplements and creatine-containing foods such as meat. Creatine is not usually present in urine but can reach very high levels (> 10 g / day) during creatine supplementation [3]. There seems to be an unreasonable prospect that if the kidneys are “forced” to excrete higher than normal levels of creatine or creatinine, then a kind of “overload” of the kidneys occurs, causing kidney damage and/or impaired kidney function.

In fact, short-term increases in blood or urine creatine levels from creatine powder supplementation are unlikely to reflect decreased kidney function. In addition, caution should be exercised when using blood creatinine and calculated creatinine clearance, glomerular filtration rate in individuals consuming a large intake of meat or creatine powder supplements.

In a review of creatine supplementation studies, Persky and Rawson [54] found no increase in serum creatinine in 12 studies, 8 studies showed an increase that remained within the normal range, and only 2 studies showed an increase above the normal range, although not different from the control. groups in one study.

Cause #2

In 1998, a study was carried out on a young man with focal segmental glomerulosclerosis and recurrent nephrotic syndrome [55]. A young man who had kidney disease for 8 years and had been treated with cyclosporine (an immunosuppressive drug) for 5 years recently started taking a creatine supplement (15 g / day for 7 days; then 2 g / day for 7 weeks).

Based on the elevated blood creatinine level and subsequent assessment of the calculated creatinine clearance, it was assumed that his kidney condition was deteriorating, although he was otherwise healthy. The patient was advised to stop taking creatine supplements.

At the time, it was already known that creatinine levels in blood and urine may rise after ingestion of creatine-containing foods, including creatine supplements [52]. This was ignored by the authors of this case study, as was the inclusion of two studies that showed that creatine supplementation did not adversely affect renal function [56, 57].

The creatine dose during the maintenance phase, which was also ignored, was only slightly higher than the daily creatine intake of a typical omnivore, or in terms of food, a large hamburger or steak per day (meat contains about 0.7 g creatine / 6 oz serving) …

In response to this case study, two separate groups of creatine metabolism experts wrote letters to the editor of the Lancet [57, 58]. However, the notion that creatine supplementation leads to kidney damage and/or renal dysfunction has gained traction.

Since this case study was published in 1998, experimental and controlled studies examining the effects of creatine supplementation on kidney function have increased significantly [54, 59, 60, 61].

In general, healthy people do not appear to have any side effects of the recommended doses of creatine supplementation on kidney function [54, 59, 60, 61]. Interestingly, Gualano et al [61] reviewed a small number of case studies that reported renal dysfunction in individuals who took a creatine supplement.

Similar to the report by Pritchard and Kalra [55], these additional case reports have been distorted by medication for preexisting kidney disease, concomitant supplementation, inappropriate creatine dosages (eg, 100 times the recommended dose), and use of anabolic-androgenic steroids.

It is prudent to be careful when taking any dietary supplement or medication. Survey data shows that creatine supplementation use ranges between 8-74% in athletes and other exercising people.

Even at a low score of 8% of exercising people using creatine supplementation, this indicates thousands of exposures over several decades. If the link between creatine supplementation and kidney health were significant, then since 1992, after Harris et al. [60] published their seminal work, an increase in kidney damage would be expected in low-risk individuals (ie, young, fit, healthy).

After nearly 30 years of post-marketing surveillance, thousands of ultrasound exposures, and numerous clinical trials, there is no such evidence.

Is Creatine Powder Harmful to Children and Adolescents?

Occasionally, there are concerns about the safety of creatine powder supplementation for children and adolescents. The vast majority of data in the adult population indicate that creatine supplementation, both short-term and long-term, is safe and generally well tolerated [61].

However, the question of whether this is true for children and adolescents remains relatively unclear. The physiological rationale for the potential benefits of creatine supplementation in children and adolescents was first postulated by Unnithan and colleagues in 2001 [62], which laid a solid foundation for the future use of creatine in young athletes.

Most recently, in a comprehensive review of the safety of creatine supplementation in adolescents, Jagim et al. [63] summarized several studies that looked at the efficacy of creatine supplementation among different groups of adolescent athletes and found no evidence of side effects.

From a clinical perspective, creatine powder supplementation has the potential to provide health benefits with minimal adverse effects in younger populations. Hayashi et al. [64] found improvements in pediatric patients with systemic lupus erythematosus and reported no adverse changes in laboratory parameters for hematology, renal function, liver function, or markers of inflammation after 12 weeks of creatine supplementation. Tarnopolsky et al [65] reported significant improvements in lean mass and grip strength in 30 pediatric patients with Duchenne muscular dystrophy after 4 months of creatine supplementation.

Importantly, the creatine supplementation protocol was well tolerated and did not adversely affect laboratory markers of kidney function, oxidative stress, and bone health [64, 65, 66]. In addition, Sakellaris et al. 66 reported a significant improvement in traumatic brain injury outcomes in children and adolescents who received oral creatine supplementation (0.4 g / kg/day) for 6 months.

These neurological benefits have potential applications for young athletes involved in sporting collisions, which pose a major risk of concussions. In addition, some of these clinical trials applied rigorous clinical surveillance measures, including continuous monitoring of laboratory markers for kidney health, inflammation, and liver function. None of these were adversely affected by appropriate creatine powder supplementation activities. These results support the hypothesis that creatine supplementation is likely safe for children and adolescents.

However, perhaps the strongest supporting evidence for the safety of creatine comes from the recent grading of creatine as Generally Recognized Safe (GRAS) by the US Food and Drug Administration (FDA) at the end of 2020.

Ultimately, this classification indicates that the current scientific evidence regarding the safety of creatine is sufficient and has been agreed upon by a consensus of qualified experts, thereby defining creatine as safe under the conditions of its intended use. Even though infants and young children are excluded from GRAS, this still applies to older children and adolescents.

Most nutritional supplement survey data indicate that a relatively high percentage of young and adolescent athletes are currently or previously using creatine. For example, Kayton et al. [67] found that in a sample of 270 high school boys and girls, 21% of boys and 3% of girls reported this. In addition, in a sample of elite Olympic level young German athletes (14-18 years old), 12% of respondents reported supplementing the diet with creatine [68].

Thus, these trends require more research to determine with greater certainty whether creatine supplements, both acute and long-term, are safe for children and adolescents. Based on limited evidence, creatine supplementation appears to be safe and potentially beneficial for children and adolescents.

See more kids-related insights here – Exercise for Kids: Is There Any Bad Impact on Health

Does Creatine Powder Lead to Dehydration and Muscle Cramps?

It has been suggested that creatine supplementation causes dehydration and muscle cramps [69, 70].

In the early 2000s, with limited data and mostly speculation, the American College of Sports Medicine (ACSM) recommended that people who control their weight and exercise vigorously or in hot conditions avoid using creatine supplements [71].

The physiological rationale suggesting that creatine powder supplementation can cause dehydration and muscle cramps is based on the premise that creatine is an osmotically active substance found primarily in skeletal muscle and can alter fluid distribution throughout the body, preferably increasing intracellular water uptake and retention. especially in the short term [72].

In situations of water loss by the body, such as excessive sweating during exercise and/or elevated ambient temperatures, associated intracellular fluid could theoretically be detrimental to thermoregulation and lead to extracellular dehydration, electrolyte imbalances, and muscle spasms, or other body-related musculoskeletal problems. -motor apparatus [73].

In a survey of 219 athletes, 90 participants reported creatine powder use, with 34 of them (38%) reporting perceived negative effects such as seizures (27%) [74]. Similarly, at the National Collegiate Athletic Association (NCAA), baseball and Division 1 (N = 52) players using creatine reported muscle cramps in 25% of cases and 13.5% reported symptoms of dehydration. Importantly, these studies were unable to control the use of other supplements and the dosage of creatine taken by mouth.

Greenwood et all [74] noted that 91% of participants exceeded the recommended maintenance dose of creatine of 5 g / day. However, these self-reported surveys contradict experimental and clinical evidence. Greenwood et all [75] monitored injuries in football players of the IA NCAA student division (N = 72, age: 19.7 ± 1.0 years), where environmental conditions were hot (27.3 ± 10.90V) and with high humidity (54.2 ± 9.7%).

Participants chose either creatine powder (n = 38: 0.3 g / kg / day for 5 days; then 0.03 g / kg / day for 115 days) or a placebo sports drink (n = 34) throughout the football season. Injuries recorded by the sports coaching staff were observed.

Creatine users had significantly fewer seizures, overheating, dehydration, and general injury. Non-contact joint injuries, contact injuries, illnesses, missed training due to injuries during the season did not differ between the groups. In a clinical setting, hemodialysis patients (n = 10) who frequently reported muscle cramps were given creatine (12 g) 5 minutes before hemodialysis [76].

Creatine powder supplementation reduced the incidence of symptomatic muscle cramps by 60% [77]. These beneficial effects of creatine can be attributed to fluid distribution and electrolyte imbalances, as previously discussed.

Thus, experimental and clinical studies do not support the notion that creatine supplementation causes dehydration and muscle cramps.

When to take?

There are two effective strategies for increasing creatine stores:

• The load phase, which requires an oral dose of 0.3 g / kg of body weight four times a day with protein-carbohydrate food for 5-7 days, followed by a “maintenance” phase of 3-5 g / day.
• A daily dose of 3-5 g with protein-carbohydrate food (in this case, it takes more time to increase creatine stores) [6, 10].

These dosing strategies will increase muscle creatine stores as well as the previously mentioned health benefits.

Creatine Powder Side Effects

One potential side effect of creatine powder supplementation is associated with increased body weight due to increased total body water. Weight gain with creatine supplementation is more common in men, but for women, weight gain may be more likely during the luteal phase due to hormone-related changes in fluid balance [11]. However, this is likely to happen only at the loading dose.

See more topics: 

• How to Lose Weight Fast — In-Depth Guide
• How to Build Muscle With Scientific Approach
• Creatine: What It Is, What It Does, and Its Side Effects – menshealth.com

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