Creatine Supplementation

An Annotated Bibliography Submitted in

Partial Fulfillment of the Requirements for

HES 474 Physiology of Exercise

Professor: Anil Joseph, MA

By

Nicholas Evans

April 30, 2018

Annotation #1

Source:
Antonio, J., & Ciccone, V. (2013). The effects of pre versus post workout supplementation of
creatine monohydrate on body composition and strength. Journal of the International
Society of Sports Nutrition,10(1), 36. doi:10.1186/1550-2783-10-36

Purpose of the Article:

Since it is already known that creatine monohydrate supplementation is effective in improving
strength, power, and body composition, this article sought to find out if there is greater benefit
taking the supplement pre vs post workout.

Conclusions by Author:
While both pre and post workout supplementation saw gains in both strength and body
composition, post workout supplementation was superior to pre workout supplementation.

Bulleted Notes from Article:

1. There was no placebo group for either pre or post

2. Subjects were given the same workout routine to maintain uniformity in training.
3. Post testing had a greater change in body weight in regard to FFM and FM
4. Article admits that the differences in body comp and muscle strength could be attributed
to muscle strength.
5. All of the subjects had at least 1 year of prior lifting experience.
6. Each subject was given 5 grams of Cr for both groups. This may explain some
differences because dosage should be dependent on body weight.

Thoughts and Comments:

While creatine supplementation is beneficial overall, when you take it may help improve the
ergogenic effects from it. It would be interesting to see a study that involves a placebo group for
both pre and post supplementation and see how each compare.
Annotation #2

Source:
Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with
specific view to exercise/sports performance: An update. Journal of the International
Society of Sports Nutrition, 9(1), 33. doi:10.1186/1550-2783-9-33

Purpose of the Article:

This was a meta-analysis that explored the different impacts of performance and body
composition with creatine monohydrate with varying dosages, supplementation protocols,
populations, testing protocols, as well as training protocols.

Conclusions by Author:
It was concluded that creatine supplementation has positive effects on:
 Amplifying the effects of resistance training for enhancing strength and hypertrophy
 Improving the quality and benefits of high intensity intermittent speed training
 Improving aerobic endurance performance in trials lasting more than 150s
 Seems to produce positive effects on strength, power, fat free mass, daily living
performance and neurological function in young and older people
 Research on the mechanisms of creatines effect has progressed since 2007 showing an up
regulation of gene expression when creatine is administered together with resistance
training exercises.
 Regarding predominantly aerobic endurance performance, the increased bodies' creatine
stores, seems to amplify favorable physiological adaptations such as: increased plasma
volume, glycogen storage, improvements of ventilatory threshold and a possible
reduction of oxygen consumption in sub maximal exercise.

Bulleted Notes from Article:

1. People with low natural Cr levels are known to be more responsive to Cr supplementation
2. Causes hypertrophy by increasing proliferation for satellite cells.
3. Crea T1 transports Cr into the cell when Cr levels inside the cell are low
4. Supplementation can allow for greater recovery times for events and in training
5. There are two supplementation protocols:
a. Loading + maintenance dose 20-30g/day; 0.03g/kg/day
b. 0.03-1g/day
6. Statistically there are not any changes in kidney health and function

Thoughts and Comments:

This article was incredibly insightful for information on many aspects on creatine
supplementation.
Annotation # 3

Source:
França ED, Avelar B, Yoshioka C, et al. Creatine HCl and Creatine Monohydrate Improve
Strength but Only Creatine HCl Induced Changes on Body Composition in Recreational
Weightlifters. Food and Nutrition Sciences. 2015;06(17):1624-1630.
doi:10.4236/fns.2015.617167.

Purpose of the Article:

To compare two dosages of creatine HCl (1.5g and 5g) to creatine monohydrate in terms of
strength and body composition in recreational weightlifters over 28 days of supplementation.

Conclusions by Author:
Both creatine HCl and creatine monohydrate induce improvements in strength but only creatine
HCl showed changes on body composition.

Bulleted Notes from Article:

1. While both supplements showed increases in fat free mass, only HCl showed decreases in
fat mass.
2. CrHCl 5.0g/day seemed to lower body fat more than the 1.5g/day dose.
3. Since the HCl is more water soluble than monohydrate it requires less water to fully
dilute. This makes it more permeable in the intestinal tract than monohydrate.
4. Testing was done one week prior and after supplementation
5. There was no loading phase for this study.
6. Skinfold testing was used to analyze bodyfat instead of hydrostatic weighing.

Thoughts and Comments:

With these promising results from his study it will be interesting to see if CrHCl will replace Cr
monohydrate because of the more positive effects it seems to have in improving body
composition.
Annotation #4

Source:
Moon A, Cobbold C. The Effect of Creatine Supplementation on Body Composition and Bone
Health in the Elderly. Journal of Obesity & Weight Loss Therapy. 2016;06(01).
doi:10.4172/2165-7904.1000298.

Purpose of the Article:

Since loss in muscle mass and decrease bone health accompanies aging this study sought to see if
creatine monohydrate supplementation would improve body composition and bone health in an
elderly population.

Conclusions by Author:
In combination with resistance training body composition can improve lean mass and muscular
strength in the elderly which will then lead to increased bone strength and bone mineral density.

Bulleted Notes from Article:

1. Dosage amounts seem to have a correlation to efficacy. Studies with higher dosages often
saw better effects with an elderly population.
2. Much like in younger populations it did not show a change in fat mass.
3. Many studies done on the elderly population are short term and low dosage, article
suggests that more long-term studies at higher dosages should be implemented to see
additional effects.
4. The article suggests that there be more studies done to see if lean body mass can be
increased without resistance training.
5. It can be difficult to compare some studies because the dosing protocols vary widely.
6. Studies are often performed on healthy individuals so there may be decreases in fat mass
if studies are done in obese subjects.

Thoughts and Comments:

Since it is understood that creatine should not be taken with those with compromised renal
function, since it is excess creatine is excreted in urine, is it safe for the elderly, which is a
population that usually has decreased renal function, to use this supplement?
Annotation # 5

Source:
Nunes JP, Ribeiro AS, Schoenfeld BJ, et al. Creatine supplementation elicits greater muscle
hypertrophy in upper than lower limbs and trunk in resistance-trained men. Nutrition and
Health. 2017;23(4):223-229. doi:10.1177/0260106017737013.

Purpose of the Article:

The purpose of this article is to evaluate the effect of creatine supplementation in combination
with resistance training on lean soft tissue, specifically hypertrophy, changes in the upper and
lower and trunk in resistance-trained young adult men.

Conclusions by Author:
Both groups showed improvements in Upper Limb Lean Soft Tissue, Lower Limb Lean Soft
Tissue, and Trunk Limb Soft Tissue for both creatine and placebo groups, however the creatine
group showed greater outcomes compared to the placebo group. Additionally, in the creatine
group upper limbs saw greater increases than the placebo group.

Bulleted Notes from Article:

1. Creatine is better taken up by fast twitch fibers than compared to slow twitch.
2. The main goal of the study was to see if creatine induces more hypertrophy in a certain
body segment; Upper, lower, and trunk.
3. Study was 12 weeks long with 4 weeks dedicated to obtaining measurements; week1-2
and 11-12.
4. One of the only studies I looked at that based dosages off of body weight. Loading phase
4 doses of 0.3g/kg a day. Maintenance phase of 7 weeks of 0.03g/kg a day.
5. Study requirement was for subjects to have prior lifting experience
6. Study brings up that since these subjects had prior lifting experience and they still
achieved hypertrophy gains, it can be used to overcome plateaus.

Thoughts and Comments:

This study was very insightful in the aspect that creatine has a greater effect on upper limb
hypertrophy in comparison to lower limb and trunk hypertrophy. This could supplement could be
used in sports and activities where upper body power strength are important for performance.
Annotation #6

Source:
Rawson ES, Stec MJ, Frederickson SJ, Miles MP. Low-dose creatine supplementation enhances
fatigue resistance in the absence of weight gain. Nutrition. 2010;27(4):451-455.
doi:10.1016/j.nut.2010.04.001.

Purpose of the Article:

This study examined the effects of a 6-week supplementation of a low dose of 0.03g/kg/day of
creatine on body comp, muscle function, and body creatine retention.

Conclusions by Author:
A 6-week supplementation of a low dosage of creatine (0.03g/kg/day) showed a significant
increase in plasma creatine and enhanced resistance to fatigue during repeated bouts of high-
intensity contractions.

Bulleted Notes from Article:

1. Subject age was 21±2 years.

2. Much unlike studies at a higher dose there was no change in body composition; fat-free
mass, fat mass, BF%, or total body water.
3. Study showed that test leg extensor strength had not increased.
4. They researchers hypothesized that since the majority of supplemented creatine is
excreted in the urine a lower dose could be equally effective. It was not
5. If there was a loading phase incorporated would that have shown better results?
6. This was one of the few studies that measured Cr levels in the body

Thoughts and Comments:

In this study subjects did not have a loading phase for supplementation. However, another article
I have included, uses the same maintenance dosage amount (0.03g/kg/day) with an addition to a
loading phase of 20-25g/day. But both studies have similar outcomes in regard to body
composition. This article showed there were no changes in strength but the other showed
increase in power. It would be interesting to see effects on both strength and power using a low
maintenance dosage with and without a loading phase.
Annotation # 7

Source:

Taner B, Aysim O, Abdulkadir U. The effects of the recommended dose of creatine monohydrate
on kidney function. Clinical Kidney Journal. 2010;4(1):23-24.
doi:10.1093/ndtplus/sfq177.

Purpose of the Article:

The purpose of this article to report a case of a healthy individual who had severe adverse effects
to creatine monohydrate after taken at 20g/day for 2 days.

Conclusions by Author:
While using creatine as a supplement it should be kept in mind that, even when using
recommended dosages, it is possible for it to cause kidney damage. Anyone who is using this
should monitor kidney function for a period of time.

Bulleted Notes from Article:

1. The subject was healthy with no prior health concerns.

2. The maintenance dosing (1g/day) was very low in comparison to the loading dose
(20g/day).
3. Even though the subject took the recommended dosage for the loading phase, it was on
the far end because it usually varies from 5-20g/day.
4. The subject experienced renal failure with acute tubular necrosis. Which is is a medical
condition involving the death of tubular epithelial cells that form the renal tubules of the
kidneys.
5. Patients with kidney disease should avoid using this supplement.
6. The subject fully recovered 25 days after cessation of use.

Thoughts and Comments:

While it is known that creatine monohydrate is a relatively safe supplement to take, if it is

someone first time they should approach with caution. This case study may be an outlier
however it is known to often cause some GI distress or muscle cramps. Taking this into
consideration when you first use it you should either use a low dosage during the loading phase
or just skip the loading phase while you learn how it effects your body.

Additional information regarding the side effects of creatine monohydrate are in the “Additional
Readings” section.
Annotation #8

Source:
Yáñez-Silva A, Buzzachera CF, Piçarro IDC, et al. Effect of low dose, short-term creatine
supplementation on muscle power output in elite youth soccer players. Journal of the
International Society of Sports Nutrition. 2017;14(1). doi:10.1186/s12970-017-0162-2.

Purpose of the Article:

This article wanted to see the effect of low dose (0.03g/kg/day), short term (14 days) creatine
supplementation on the power output of elite youth soccer players.

Conclusions by Author:
Testing showed that the power output of these athletes improved after short term low dose
creatine supplementation.

Bulleted Notes from Article:

1. Much like the other article there was no change in body composition with low dosage of
creatine.
2. Peak Power Output increased 8% in the Cr group and only 3% in the placebo group.
3. Mean power output increased 8% in the Cr group and only 4 % in the placebo group.
4. Total work increased slightly more in the Cr group (7%) compared to the placebo group.
5. Loading phase very effective but not necessary.
6. Increases in intercellular Cr levels, increased ATP levels available during maximal
exercise, and increased potential for Cr acts as a cellular buffer on H ions produced by
anaerobic glycolysis are what the ergogenic effects of Cr are attributed too.

Thoughts and Comments:

Since with low creatine dosage there are no changes in body mass or composition this may be a
strategy that athletes of weight dependent sports, such as wrestling, fighting, or weightlifting, can
use to increase power and fatigue resistance.
 Narrative Summary

Introduction

Creatine monohydrate is a sports supplement used an ergogenic aid that has been heavily

researched over the past thirty years. It is one of the most used supplements because it has been

proven to be effective at improving performance, body composition, and health in a wide range

of population groups; such as children, adolescents, athletes, elderly, and those participating in

recreational fitness. Creatine monohydrate is produced endogenously within the body in the liver

and kidneys at a rate of 1g/day. Additionally, it is obtained exogenously also at a rate of about

1g/day in a normal diet and is found in meat. It is stored in the body in two ways, in

phosphorylated form making up about 60% of bodily stores and the other 40% being in free

form. [2] This stored creatine is what is used to make to help energy in the form of ATP in the

adenosine triphosphate – phosphocreatine energy system. During short and high intensity

exercise, adenosine triphosphate (ATP) is used to provide energy for muscle contractions, this

energy is released when ATP loses a phosphate molecule and is converted into adenosine

diphosphate (ADP) is ATP is resynthesized when ADP is phosphorylated by phosphocreatine

(PCr). [4] This is the bases of reasoning as to why creatine monohydrate improves performance; if

you can increase the amount of stored Cr in the body you have a more readily available energy

source for this system.

Key Thoughts Gleaned

Dosing is a widely varying aspect of supplementation of creatine monohydrate with dose

dependent effects. There are two routes of supplementation; one being a high dose loading phase

(20-30g/day)with a low dose maintenance phase (0.03g/kg/day) and the second being just a low

to moderate dose (0.03-1g/kg/day) maintenance phase. [2] It was shown in low doses of
0.03g/kg/day showed increases in power and strength with no increase in body mass or

composition. This aspect could be beneficial in weight dependent sports such as wrestling,

competitive weightlifting, or fighting. [6][8] Additionally, there are better results, in terms of

strength, power, and fat-free mass when you consume creatine post-workout as opposed to pre-

workout.[1]

There are two different forms of creatine supplementation available for consumers, that

being: creatine monohydrate and creatine HCl. Creatine HCl is different in the aspect that it

causes a decrease in fat mass as and does not cause bloating while having the same effects on

strength, power, and fat-free mass. This is attributed to the fact that it is more water soluble

compared to monohydrate; to dissolve 5-10g of CrM it takes 400-600 ml water, where CrHCl

only requires 21ml for the same amount. Additionally, less creatine is excreted in the urine

because it can pass through cell membranes easier. [3]

Much like in younger populations, creatine is shown to increase strength, power, and fat-

free mass in elderly populations. This is significant because sarcopenia happens as a result of

aging and creatine supplementation along with resistance training shows promising results to the

point of gaining muscle mass and increase bone strength. [4] It would be interesting to see the

effects of creatine, not paired with resistance training, on an elderly population to see if there are

similar effects. This is because an elderly population may not be to motivated to partake in

resistance training.

The side effects of creatine are a huge subject for unprecedented reasons. There are only

two documented side effects that include bloating and GI distress, which both are not severe or

life threatening. There have been several studies that after laboratory liver tests show that it does

not cause renal damage when used with proper dosages. However, there are isolated reports that
show kidney failure correlated with creatine supplementation, but these seem to be extreme

outliers.[2][7] Nevertheless, if someone has decrease renal function they should maybe consider not

taking the supplement or consulting with their doctor.

Conclusion

Based on the research creatine monohydrate is a very safe supplement to take, despite a

misunderstanding of the side effects, while at the same time has very established ergogenic

effects. It is shown to be effective to for a varying amount of populations from athletes to the

elderly. There are reports of an increase in strength, power, and fat-free mass when paired with

resistance training with a wide variation of dosages. This is a supplement that hands down is

effective and should be utilized by anyone trying to perform better.

 Additional Readings

9. Becque MD, Lochmann JD, Melrose DR. Effects of oral creatine supplementation on
muscular strength and body composition. Medicine & Science in Sports & Exercise.
2000;32(3):654-658. doi:10.1097/00005768-200003000-00016.

10. Bird SP. Creatine Supplementation and Exercise Performance: A Brief Review. Journal of
Sports Science & Medicine. 2003;2(4):123-132.

11. Kutz, M. R., & Gunter, M. J. (2003). Creatine Monohydrate Supplementation on Body
Weight and Percent Body Fat. The Journal of Strength and Conditioning Research,17(4),
817. doi:10.1519/1533-4287(2003)0172.0.co;2

12. Rawson, E. S., & Volek, J. S. (2003). Effects of Creatine Supplementation and Resistance
Training on Muscle Strength and Weightlifting Performance. The Journal of Strength and
Conditioning Research, 17(4), 822. doi:10.1519/1533-4287(2003)0172.0.co;2

13. Pearson, D. R., Russel, D. G., & Harris, T. (1999). Long-Term Effects of Creatine
Monohydrate on Strength and Power. Journal of Strength and Conditioning
Research,13(3), 187-192. doi:10.1519/00124278-199908000-00001

14. Vandenberghe, K., Gillis, N., Leemputte, M. V., Hecke, P. V., Vanstapel, F., & Hespel, P.
(1996). Caffeine counteracts the ergogenic action of muscle creatine loading. Journal of
Applied Physiology,80(2), 452-457. doi:10.1152/jappl.1996.80.2.452