SNI: We know that regular creatine supplementation enhances body composition and exercise performance. What are some of the other benefits of creatine supplementation?

Dr. Jäger: Creatine makes you stronger, faster and smarter. Yes, it does more than help build muscles and improve exercise performance. New science shows that it also boosts brainpower. It helps you stay physically strong and mentally sharp at all stages of your life. Creatine crosses the blood-brain barrier and creatine supplementation has been shown to increase brain  creatine concentrations by approx. 9%.  Consequently, creatine has been shown to improve cognitive performance that is temporarily impaired due to sleep deprivation or permanently impaired due to aging. Even short-term creatine supplementation benefits brain function, as 8g of creatine monohydrate for 5 days prevented mental fatigue in a serial calculation task.   

Creatine has marked neuroprotective effects and is being investigated in clinical trials of Parkinson’s and Huntington’s disease. Every day we are learning more about the non-energetic mechanism-of-action of creatine, such as the increase in the sodium pump activity. From our understanding of the sodium pump and its relevance to disease, creatine supplementation might be beneficial for neurological disorders, pulmonary conditions, diabetes and metabolic disorders, cardiovascular health or fetal development.  Creatine has been shown to be effective in animal models of asthma and to increase longevity of animals. In addition, creatine seems to make certain drugs more efficient. The addition of creatine to an antidepressant resulted in more rapid and efficacious responses in women with major depressive disorders.  If you break your arm or a leg, make sure to grab your creatine on the way to the hospital. Cast immobilization results in muscle disuse atrophy, the loss of muscle mass. Creatine supplementation has been shown to help maintain lean body mass, strength, and endurance during immobilization. 

SNI: Would you recommend creatine supplementation for endurance athletes?

Dr. Jäger: The answer is yes.  Creatine supplementation can improve the quality of endurance athletes’ workouts and improvements  in workout quality leads to improvements in competitive performance. In addition, creatine supplementation may reduce muscle damage and inflammation during endurance exercise and thereby facilitate recovery. Runners who took creatine for five days before running a 30km race exhibited less muscle soreness and inflammation afterwards compared to runners who took a placebo. But there is still that nagging problem of weight gain.  Sometimes, it’s beneficial, since athletes want to go into the race before the big race with additional weight; however, most of the time, it’s not. Endurance athletes want to be lean and don’t want to carry any additional weight around. Try to increase your creatine stores with lower doses over a little bit more time, since that has been shown to minimize the weight gain.

SNI: What are the benefits (if any) in using forms of creatine other than monohydrate?

Dr. Jäger: Newer forms of creatine have been marketed with alleged better bioavailability, efficacy and/or safety profiles than creatine monohydrate. However, there is little to no evidence that any of those newer forms are safer or more effective than creatine monohydrate.  I personally use 100-percent pure creatine monohydrate powder and will continue to do so until I can find a research article in a peer-reviewed journal showing physiologically meaningful improvements in a head-to-head comparison over creatine monohydrate. As for now, save money and buy creatine monohydrate powder and mix it with fruit juice. The sugar in the juice raises insulin levels, which helps increase creatine uptake into the muscle. You need about 70 grams of simple sugars for every five grams of creatine, that’s approx. 22 fl oz of orange juice.

Creatine monohydrate might be hard to dissolve in cold water and if there is residue at the bottom of your glass after you drink it, try a different brand, or look for products with increased solubility, a creatine salt like creatine citrate for example. The acidity of the citric acid increases the solubility of the creatine in water. You want the creatine to end up in your muscles, not to stay in the glass. I would take it easy on the esophagus and would stay ways from strong acids, maybe look for a buffered effervescent product.  Why anyone would use a creatine product that has its ingredients listed in a proprietary blend is beside me. Not listing the amounts of actives is even more reason to stay away from the product. Know what you are putting in your body. Say no to proprietary blends and products that do not specify the amount of creatine.

SNI: Does creatine supplementation have ANY negative side effects?

Dr. Jäger: Common side effects include gains in strength and improved brain function, which sometimes can lead to feeling overconfident. Besides that, creatine is one of the most researched supplements out there. If there were any major adverse side effects, after more than 20 years of research and widespread use, we should have seen them by now. One thing is almost certain, if you take creatine, you will gain weight. The initial weight gain of about 1 to 2 kilogram during the first week of supplementation is water; however,  hit the gym and subsequent gains are muscle mass due the heavier workload you can handle and the increase in muscle protein synthesis.  Anecdotal claims link creatine to an increase in the incidence of muscle cramps or muscle pulls, gastrointestinal distress, dehydration, or kidney and liver damage.  However, there are no controlled studies demonstrating such adverse effects. Does an athlete taking creatine cramp or pull a muscle once in a while? Absolutely yes, but research has shown that your chances of experiencing any of those symptoms are not greater, and potentially even lower in comparison to athletes not supplementing with creatine. When taken within the recommended usage guidelines, creatine monohydrate supplementation appears to be safe; however, we know little to nothing about the safety of chemically modified forms of creatine.

SNI: What are your thoughts on ‘cycling’ on/off creatine and on ‘loading of creatine?’

Dr. Jäger: Athletes want to see results fast. Load your muscles with creatine by consuming 5 grams of creatine three to five times per day for five days followed by a daily maintenance dose of 2 to 5 g. Similar increases in muscle creatine can be achieved by using 3 g per day for 28 days. Without a maintenance dose, creatine levels return to baseline after 3 to 4 weeks. The more the better? Not true for creatine. The body has a ceiling on the amount of creatine that it will store in skeletal muscles. Muscle creatine levels will stay elevated as long as you consume the maintenance dose. There is no scientific reason to cycle creatine. Creatine levels drop slowly, so if your wallet needs a break, take a week or two off and then go back on it again.

BIO – Dr. Ralf Jäger is co-founding partner of Increnovo LLC, a global independent consulting firm, based in Milwaukee, WI. A postdoctoral scholar in bio-organic chemistry at the California Institute of Technology (Caltech) in Pasadena, Calif., Dr. Jäger originally earned his Ph.D. in organic chemistry from the University of Bonn in Germany.  He began his professional career as a head of a laboratory for SKW/Degussa, the leading supplier of creatine products. He is an award-winning speaker and has authored numerous scientific papers on sports nutrition and brain, joint, heart, and gut health, for both peer-reviewed scientific journals and industry publications/mainstream media. He is a certified sports nutritionist (CISSN) and fellow of the International Society of Sports Nutrition (FISSN), and is a member of the editorial board of the leading peer-reviewed  Journal of International Society of Sports Nutrition (JISSN). In recent years, he has consulted with professional sports teams, elite athletes and Olympians in various athletic disciplines.