# Creatine – what form, dose and supplementation strategy?



## K1 (Feb 4, 2013)

by Monica Mollica 

Creatine is one of the few dietary supplements that have a very solid scientific support for its efficacy in increasing strength, explosive performance and muscle mass. So the question in not whether it is effective, but rather how to supplement it to reap maximal effectiveness?

There are several theories on how to take creatine; some say your should load and then lower the dose, while others say you can get good results by a low dosage regimen without loading. Yet others say you should cycle the creatine and take breaks from it in between cycles. And then we have the issue of dosages. In addition there is a lot of confusion about the myriad for creatine forms that claim to be superior over the golden standard creatine monohydrate. Are the new fancy creatine-super-duper formulations really worth their price?

Let’s review it all here, and see what the research is saying.

*Creatine forms*

When creatine first came out on the market it was creatine monohydrate. This is also the form of creatine that has been used in all the scientific studies that showed its performance enhancing and muscle growth stimulating effects. Because creatine rapidly became so popular, manufacturers came up with different creatine variants and started to make specific claims that their creatine formula is superior. Not so! Don’t let yourself get fooled and ripped off! Stick to the golden standard creatine monohydrate. For more info, check out Will’s article The Creatine Grave Yard.

*Creatine supplementation protocols*

There are basically three creatine supplementation protocols. Here’s an overview of them with recommended effective dosages:

Loading / Maintenance protocol

Loading phase:

Supplement with 0.3 g creatine/kg body weight/day (0.14 g/lb/body weight/day) for 5-6 days to maximize muscle creatine stores.

Maintenance phase:

Supplement with 0.03 g creatine/kg body weight/day (0.014 g/lb/body weight/day) thereafter to maintain elevated muscle creatine stores.

Low-Dose protocol

Supplement with 3-5 g creatine per day for at least 8 weeks to increase muscle creatine stores.

*Cycling protocol*

Load/maintain for 12-16 weeks, and then stop supplementing for 3-6 weeks. Then start another cycle with the loading phase followed by a maintenance phase followed by a break for a desired numbers of cycles.

Most studies that have shown performance enhancing effects used the creatine loading protocol. The purpose the creatine loading is to maximize creatine storage in the muscles. The magnitude of the increase in muscle creatine content is important because studies have reported that performance improvements are dependent on the increase in muscle creatine 1, 2. In a typical creatine loading phase, a dose of 20-30 g creatine (5-6 g taken four times per day) is taken during 5-6 days 3, 4.

To find out your optimal loading dose, multiply your body weight in pound (lb) with 0.14 (or multiply your body weight in kg with 0.3). Thus, for a male weighing 220 lb (100 kg) and a female weighing 140 lb (63 kg), the appropriate loading dose is 30-31 g (220×0.14 or 100×0.3) and 20 g (140×0.14 or 63×0.3), respectively.

Thereafter,a maintenance dose is taken with the purpose to maintain the elevated muscle creatine stores. A maintenance dose corresponding to 0.03 g/kg/body weight/day (0.014 g/lb/body weight) is enough to maintain elevated muscle creatine levels 4.

To find out your optimal maintenance dose, multiply your body weight in pound (lb) with 0.014 (or multiply your body weight in kg with 0.03). Thus, for a male weighing 220 lb (100 kg) and a female weighing 140 lb (63 kg), the appropriate maintenance dose is 3 g (220×0.014 or 100×0.03) and 2 g (140×0.014 or 63×0.03), respectively. Some people might prefer a slightly higher maintenance dose of 5 g per day.

Cessation of creatine maintenance doses after loading causes muscle creatine stores to return to baseline within 4-6 weeks 4-8.

An alternative supplementation protocol is to ingest 3-5 g creatine per day (with no loading phase) for at least 28-30 days 4, 9. Studies have shown that this method can increase muscle creatine levels as effectively as the creatine loading 4. However, this low-dose creatine supplementation will result in a more gradual and slower increase in muscle creatine levels compared to the more rapid loading protocol, and it will therefore take longer before any performance enhancement will be noticeable. Thus, the constant low-dose creatine supplementation protocol is only beneficial for people who cannot do the loading phase because of for example a busy working schedule. Also, while loading dosages of 20-30 g creatine per day are well tolerated in the majority of individuals, some can experience gastrointestinal upset (for example diarrhea) when large daily dosages of creatine are consumed10-12. For those people, the constant low-dose creatine supplementation protocol is the way to go. Some discomfort can occur if creatine is incompletely dissolved before ingestion 12. Thus, make sure to dissolve the creatine powder properly, especially if you are taking larger doses.

I’d recommend you also listen to Will’s take on loading versus not loading: Creatine Loading

Finally, we have the cycling protocol of creatine supplementation 13-15. One argument behind creatine cycling is that it will keep the body’s ability to synthesize creatine, intact. However, while the body’s endogenous synthesis of creatine (which amounts to about 1 g per day 16, 17) is decreased during creatine supplementation 8, cessation of creatine supplementation merely causes the creatine levels in the body to return to baseline 4, 5. If creatine supplementation were to permanently decrease the body’s capability to synthesize creatine, the creatine levels in the body would have dropped below baseline (pre-supplementation) levels, which would have caused an increased fatigue and loss of strength. This does not happen 5, 6, 8, 14, 18, 19. Thus, cycling of creatine supplementation has no scientific foundation and is completely unnecessary. It confers no advantage over loading + chronic maintenance. Continuous creatine supplementation without cycling actually might confer multiple health benefits (which I will cover in a separate article).

*Wrap-up*

When supplementing with creatine I therefore recommend the classic loading / chronic maintenance supplementation protocol. To get maximal effects ingest your creatine with carbohydrates and protein 13, 20. Also, take the majority of your creatine during the loading phase after your workouts, and during the chronic maintenance phase take the whole 3-5 g dose in the meal right after your workouts. The reason for this is that co-ingestion of creatine, protein and carbohydrates increases muscular retention of dietary creatine 13, 20. And when creatine is ingested after workouts the uptake of creatine to the muscles that have been trained is further increased, and results in even greater muscle thickness 3, 21-23.

And remember to dissolve your creatine before you ingest it, or it will end up in the toilet unused by your body. Thus, putting some creatine in your protein shake won’t cut it. Creatine has to be completely dissolved in order for the body to absorb it. I use to dissolve my creatine in glass of water heated in the micro wave oven for about 2 minutes. Then I drink it when I get back from the gym, after it has cooled down to room temperature (I cannot stand drinking warm water).

For more info about the importance of dissolving your creatine, check out Will’s great videos.

REFERENCES:

1. Greenhaff PL, Bodin K, Soderlund K, Hultman E. Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. Am J Physiol. May 1994;266(5 Pt 1):E725-730.

2. Greenhaff PL, Casey A, Short AH, Harris R, Soderlund K, Hultman E. Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clin Sci (Lond). May 1993;84(5):565-571.

3. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci (Lond). Sep 1992;83(3):367-374.

4. Hultman E, Soderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol. Jul 1996;81(1):232-237.

5. Vandenberghe K, Goris M, Van Hecke P, Van Leemputte M, Vangerven L, Hespel P. Long-term creatine intake is beneficial to muscle performance during resistance training. J Appl Physiol. Dec 1997;83(6):2055-2063.

6. Febbraio MA, Flanagan TR, Snow RJ, Zhao S, Carey MF. Effect of creatine supplementation on intramuscular TCr, metabolism and performance during intermittent, supramaximal exercise in humans. Acta Physiol Scand. Dec 1995;155(4):387-395.

7. Lemon P, Boska M, Bredle D, et at. Effect of oral creatine supplementation on energetics of during repeated maximal muscle contraction. Med Sci Sport Exer. 1995;27:S204.

8. Williams MH, Kreider RB, Branch JD. Creatine: The Power Supplement. Champaign, IL: Human Kinetics Publishers; 1999.

9. Burke DG, Silver S, Holt LE, Smith Palmer T, Culligan CJ, Chilibeck PD. The effect of continuous low dose creatine supplementation on force, power, and total work. Int J Sport Nutr Exerc Metab. Sep 2000;10(3):235-244.

10. Juhn MS, Tarnopolsky M. Potential side effects of oral creatine supplementation: a critical review. Clin J Sport Med. Oct 1998;8(4):298-304.

11. Juhn MS, O’Kane JW, Vinci DM. Oral creatine supplementation in male collegiate athletes: a survey of dosing habits and side effects. J Am Diet Assoc. May 1999;99(5):593-595.

12. Poortmans JR, Francaux M. Adverse effects of creatine supplementation: fact or fiction? Sports Med. Sep 2000;30(3):155-170.

13. Buford TW, Kreider RB, Stout JR, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr. 2007;4:6.

14. Kreider RB, Leutholtz BC, Greenwood M. Creatine. In: Wolinsky I, Driskel J, eds. Nutritional Ergogenic Aids. Boca Raton, FL: CRC Press; 2004:81-104.

15. Kreider RB. Creatine. In: Driskell J, ed. Sports Nutrition: Fats and Proteins. Boca Raton, FL: CRC Press; 2007:165-186.

16. Walker JB. Creatine: biosynthesis, regulation, and function. Adv Enzymol Relat Areas Mol Biol. 1979;50:177-242.

17. Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism. Physiol Rev. Jul 2000;80(3):1107-1213.

18. Kreider RB, Greenwood M, Melton C, et al. Long-term creatine supplementation during training/competition does not increase perceptions of fatigue or adversely affect health status. Med Sci Sport Exer. 2002;34:S146.

19. Candow DG, Chilibeck PD, Chad KE, Chrusch MJ, Davison KS, Burke DG. Effect of ceasing creatine supplementation while maintaining resistance training in older men. J Aging Phys Act. Jul 2004;12(3):219-231.

20. Steenge GR, Simpson EJ, Greenhaff PL. Protein- and carbohydrate-induced augmentation of whole body creatine retention in humans. J Appl Physiol. Sep 2000;89(3):1165-1171.

21. Preen D, Dawson B, Goodman C, Beilby J, Ching S. Creatine supplementation: a comparison of loading and maintenance protocols on creatine uptake by human skeletal muscle. Int J Sport Nutr Exerc Metab. Mar 2003;13(1):97-111.

22. Robinson TM, Sewell DA, Hultman E, Greenhaff PL. Role of submaximal exercise in promoting creatine and glycogen accumulation in human skeletal muscle. J Appl Physiol. Aug 1999;87(2):598-604.

23. Chilibeck PD, Stride D, Farthing JP, Burke DG. Effect of creatine ingestion after exercise on muscle thickness in males and females. Med Sci Sports Exerc. Oct 2004;36(10):1781-1788.


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