The journey of creatine research mirrors the progress of scientific discovery, marking it as a cornerstone in the fields of science and health.
At the 2024 ISSN Conference, Dr. Darren G. Candow delivered a keynote speech on the evolution of creatine supplementation research. His presentation provided a comprehensive review of past and current studies while highlighting future directions in the field.
Darren G. Candow, PhD; CSEP-CEP
The history of creatine dates back to the 19th century:
1832: Michel Eugène Chevreul first discovered creatine. 1926: Alfred Chanutin demonstrated that creatine could be absorbed by the intestine. 1927: Scientists Eggleton, Fiske, and Subbarow identified phosphocreatine (PCr), uncovering creatine's critical role in energy metabolism. 1992: Linford Christie and Sally Gunnell won gold medals at the Barcelona Olympics, marking creatine’s entrance into the mainstream of sports supplements.
Breakthrough research by Dr. Roger Harris and Dr. Eric Hultman in the early 1990s laid the foundation for creatine dosage strategies, establishing its bioavailability, safety, and effectiveness.
Creatine Supplementation Strategies
The foundational research by Dr. Harris and Dr. Hultman in 1992 and 1996 established key principles for creatine supplementation. Early findings revealed that low doses of 1g did not elevate plasma creatine levels, while consuming 5g every two hours effectively maintained plasma concentrations. A daily intake of 20–30g for more than two days was shown to rapidly saturate muscle creatine stores without adverse effects.
Later studies refined these strategies, demonstrating that a six-day loading phase of 20g per day could increase muscle creatine concentrations by approximately 20%, with a maintenance dose of 2g per day sustaining this elevated level. Alternatively, a gradual approach of 3g per day over 28 days achieved similar saturation.
Today, dosing recommendations emphasize individualization based on body weight. 1) Loading 20 grams (0.3g/kg) per day for ≥ 2 days. 2) Low-dose: ≥ 3 grams/day for ≥ 28 days. 3) Relative Method: 0.1 grams/kg/day, control for the size of the individual.
Among creatine supplements, creatine monohydrate remains the gold standard, consistently supported by extensive evidence for its bioavailability, efficacy, and safety.
Mechanisms and Functions of Creatine
1. Exercise Performance
Creatine enhances muscle function by promoting anabolic processes (e.g., activating satellite cells and mTOR kinase) and reducing catabolic processes (e.g., protein breakdown and oxidative stress). Benefits include that can increased strength and explosive power and improve performance in high-intensity endurance activities. Also creatine extended fatigue resistance in sports requiring anaerobic capacity (e.g., cross-country skiing, cycling, triathlons, sprint rowing).
Creatine may also improve mood and cognitive function by restoring brain energy levels, with a pronounced effect on women’s brain energy metabolism.
2. Muscle and Lean Tissue
Creatine supplementation supports: 1) Increased muscle mass and strength. 2) Enhanced recovery and reduced fatigue. 3) Improved limb muscle density and functionality.
Creatine's synergistic effects with exercise make it particularly beneficial for muscle performance and growth.
3. Bone Health
Research indicates that creatine supplementation plays a role in promoting bone metabolism and mineralization. Low doses of creatine combined with protein supplementation have been shown to increase lean tissue mass and enhance relative performance in exercises like the bench press. Additionally, low-dose creatine reduces muscle protein degradation and bone resorption without increasing formaldehyde, a cytotoxic metabolite.
A study involving 71-year-old men demonstrated that 12 weeks of resistance training increased bone mineral density, with creatine supplementation offering further benefits in localized bone mineral content. Similarly, research on postmenopausal women found that creatine significantly slowed bone density loss in the femoral neck and showed positive effects on bone strength indicators. A two-year randomized controlled trial examining the impact of creatine supplementation during exercise on postmenopausal bone health revealed no effect on femoral neck bone mineral density but noted improvements in certain geometric characteristics of the proximal femur. Clinically, bone strength and area are critical predictors of hip fractures, which are a leading cause of functional impairment.
Overall, creatine supplementation (≥0.1 g/kg/day) combined with resistance training offers modest benefits for bone area and geometric properties, reduces urinary markers of bone resorption, and does not increase bone mineral density.
4. Brain Health
Creatine is closely linked to brain bioenergetics. Current findings in humans, along with evidence of the neuroprotective functions of creatine and phosphocreatine in animals, have broadened the potential therapeutic applications of creatine supplementation. Oral creatine may help maintain cellular integrity and support normal brain function.
Creatine can cross the blood-brain barrier and slightly elevate brain creatine levels (approximately 5–10%). Some studies suggest that creatine may offer benefits for cognitive function, memory, depression, and traumatic brain injuries (TBI). However, its effects on other neurological disorders such as multiple sclerosis and Alzheimer’s disease remain unclear.
Overall, creatine supplementation can increase brain creatine levels, but the optimal dosing strategy has yet to be determined.
5、Specific Populations
Children and Adolescents: There is compelling evidence supporting creatine use in adolescents, particularly male athletes, with the highest usage rates observed among elite-level international youth athletes. We recommend that creatine supplementation only be considered for use by younger athletes who:
a.) are involved in serious/competitive supervised training;
b.) are consuming a well-balanced and performance enhancing diet;
c.) are knowledgeable about appropriate use of creatine;
