Chemically, creatine is defined as an organic compound having the nominal formula (H2N)(HN)CN(CH3)CH2CO2H, or simply C4H9N3O2.

Creatine is a natural substance that is used in the human body as a source of energy for muscle contraction. Approximately half of the required amount of substance comes from specific foods normally included in one’s diet, while the other half is produced by the liver, pancreas and kidneys. These organs are able to produce about one gram of creatine everyday. The human body converts creatine into phosphocreatine and stores about 95% of it in the muscles, where it is used for energy during physical activity. The other 5% consists of small amounts of substance found in the heart, brain or other tissues.

Because of its characteristics, many athletes eat more foods that contain creatine or opt for creatine supplements in order to improve their athletic performances and increase their strength, especially during intense short-duration sports such as weight lifting. Recent studies suggest that creatine’s properties are also useful in fighting certain illnesses that are strongly linked to muscle weakness, such as heart failure or muscular dystrophy.

What is Creatine used for?

• Athletic performances

As mentioned above, creatine is considered to help athletes while performing high-intensity short-duration exercises. Studies have been made in laboratories and not in people actually playing certain sports. The results suggest that creatine works better for young people that are around twenty years old. Researchers believe that creatine is not effective for performances that require endurance.

Using creatine for athletic purposes tends to be controversial. The substance is not banned by the NCAA (National Collegiate Athletic Association) or the International Olympic Committee, yet they prohibit school members to give their athletes creatine or any other muscle-building supplements.

• Heart disease

One of heart failure's symptoms is represented by easily getting tired while attempting to be physically active. A few studies have determined that creatine increases the amount of time people can exercise before becoming fatigued.

It is believed that creatine has the ability to help lower levels of triglycerides (fats inside the blood) and homocysteine (that is associated with heart disease: heart attack and stroke).

• Cancer

Even though there is no strong evidence to back this information up, some researchers believe that creatine may have anticancer characteristics.

• COPD- Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease implies a set of diseases linked to airflow blockages and respiratory issues. Some of these diseases are emphysema and chronic bronchitis. Symptoms of COPD include shortness of breath, chest tightness, general lack of energy, unexpected weight loss, chronic cough that may also produce mucus, as well as recurring respiratory infections.

A study found that creatine is useful for people suffering from COPD, as it increases muscle mass, strength and endurance, improving their general health status.

• Muscular dystrophy

Characterized by muscle weakness, muscular dystrophy refers to a group of muscular diseases caused by genetic mutations. As creatine is strongly connected to one’s muscles, people suffering from muscular dystrophy may have less of this substance in their cells.

• Parkinson’s disease (PD)

As Parkinson’s disease decreases one’s muscular general fitness, taking creatine may positively affect their health condition by improving their exercise abilities and endurance. One study showed that it also improves patients’ moods, reducing their need for specific medication. Researchers are still debating on this, because other studies suggest that creatine and caffeine can worsen Parkinson’s disease.

• Amyotrophic Lateral Sclerosis (ALS)

Also known as Lou Gehrig’s disease is a progressive neuromuscular disease resulting in a set of symptoms, including cramping of muscles, loss of motor control of the hands and arms and impairment in their usage, as well as persistent fatigue. Creatine is considered helpful in ALS as it apparently slows the progression of the disease.`

What types of athletic performances can creatine improve?

As mentioned before, one of creatine’s main uses is helping athletes increase their strength levels during short-duration high-intensity exercises. Many sports require sudden bursts of activity. Some of these include:

• Sprinting – a division of Track and Field that consists in running at top speed, usually for a short distance. This means the action does not take much time, the exercise being described as a short-duration one. Unlike marathons, sprinting races may take less than a minute.
• Weightlifting - defined as the sport of lifting heavy weights for resistance. Some of the most common exercises include squats, bench presses and deadlifts. However, there are many other exercises included in the sport of weightlifting. In modern weightlifting there are two regular lifts. One of them is a single movement lift from the floor to extended position, while the other one lifts from the floor to shoulder level, then from shoulders to extended position. As equipment, dumbbells, barbells and weight machines are typically required for most exercises. There is a wide variety of benefits of this sport, including improved posture, better sleep, maintaining a healthy body weight, boost of metabolism and many others.
• American Football is a team sport requiring two teams of eleven members. As it is considered a very complex sport, the players need to be strong, fast and overall very tough in order to coordinate their movements accordingly. It is well known that most football players opt for creatine supplements because they need improved strength and endurance.  
• Basketball is another team sport consisting in two teams of five players. Creatine is not banned in NBA (National Basketball Association), WNBA (Women NBA), NCAA (National Collegiate Athletic Association) or any other professional basketball leagues. Famous basketball players confirmed that creatine helps them enhance strength, which is why they take the supplements before their matches. 
• As American football and basketball, soccer is a team sport generally known as football in most countries, especially throughout the European continent. Even though it does not require maximal speed and it is not exactly a short-duration sport, some studies indicate that supplementation with creatine products may help young soccer players improve some of their skills during performances. However, there is no strong evidence at the moment evidence to support this.

What are dietary sources of creatine?

As previously mentioned, about half of the required amount of creatine is supposed to come from dietary plans. The foods that contain large amounts of creatine include red meat and fish, especially herring, salmon and tuna. It can also be found in milk and seafood.

In typical omnivorous or carnivorous diets, people consume one to two grams of creatine every day. Since animal products are the primary dietary source of this substance, vegans and vegetarians usually have lower levels of creatine in their bodies. Both people that want an increased amount of creatine for specific reasons and people that don’t get enough of it from their diet can opt for creatine supplements. A study regarding vegetarians that take creatine supplements indicated a 20 to 50% improvement in memory and intelligence rates. Moreover, vegetarians are more likely to see greater gains from taking the supplements, yet it may take a longer amount of time to build up levels in the muscles.

Creatine supplements

Even though the main type of creatine supplements remains the powder form, there are several other options available on the market. These include liquids, capsules, tablets, energy bars and fruit-flavored chews, as well as other preparations.

Most people decide to take creatine supplements in order to improve their workout routine and recovery, as the supplements create a quick burst of energy and increased strength. Male athletes that are involved in power sports (football, wrestling, powerlifting, and others) are more likely to take creatine. Creatine benefits have been studied in both men and women, yet women who take these supplements may not see results as intense as men during training.

What are the six types of creatine?

1. Creatine monohydrate is the most common supplement form. This type is the one used in the majority of research and experiments on the topic. It is made up of a creatine molecule and a water molecule. When the water molecule is removed, creatine anhydrous results, increasing the amount of creatine in each dose. Creatine monohydrate contains about 90% creatine by weight. When creatine is micronized or mechanically processed, water solubility is improved, easing the process in which the human body absorbs the substance. Other than increasing strength, creatine monohydrate has the ability to increase water content in the muscle cells, leading to beneficial effects on the growth of the muscles. It is considered to be safe, effective, and affordable as well.
2. Creatine ethyl ester is claimed to be superior to any other forms of this supplement, including creatine monohydrate. Researchers believe this because evidence indicates that the body absorbs creatine ethyl ester more easily. However, other studies found that it doesn’t increase the creatine content in blood and muscles as effectively, therefore this form is not recommended for usage.
3. Creatine hydrochloride (HCl) has become very popular among some producers and supplement users due to its superior solubility in water. Because of this, it is speculated that lower doses are required. A study found that creatine hydrochloride was 38 times more soluble in water than creatine monohydrate. Since there are no published experiments regarding creatine HCl for humans, it cannot be recommended as superior.
4. Buffered creatine is a result of adding an alkaline powder to the substance in order to make the supplements more stable in the human stomach and reduce side effects such as bloating and cramping. A study has shown that there is no difference between buffered creatine and the monohydrate form regarding effectiveness or side effects.
5. Liquid creatine is a ready-to-drink version of the supplement, where the substance is already dissolved in water. It has been indicated that liquid forms are not as efficient as monohydrate powders. Moreover, researchers believe that creatine molecules may break down when they stay in a liquid for a longer amount of time. It is not an instant process, meaning that mixing the creatine powder with water right before consumption does not affect its quality.
6. Creatine magnesium chelate refers to a type of supplement that also contains magnesium attached to the creatine molecule. It is considered an effective form of the supplement, but not more effective than the classical monohydrate form.

What are the benefits of taking creatine?

Creatine is the world’s most effective supplement for muscle building and strength. It involves a wide variety of health benefits. Some of these are:

• It helps muscle cells produce more energy by increasing the muscles’ phosphocreatine stores, which are a facility for the formation of adenosine triphosphate (abbreviated as ATP). This is the main molecule used by muscles for energy and other life functions. Energy production occurs when ATP is broken down during physical exercise. The human body uses ATP faster than it is reproduced, causing one not to be able to continually perform at maximum intensity. When creatine supplements are consumed, the phosphocreatine stores are increased, leading to producing more ATP energy for high-intensity physical activities.
• It supports other functions of the muscles. Adding muscle mass is a process eased by boosting the formation of proteins that create brand new muscle fibers. Another way muscle mass is increased is by raising levels of the hormone known as IGF-1 (insulin-like growth factor 1). Moreover, muscle size grows when the water content in the muscles is increased. These are all properties of creatine. In addition, this substance also helps reduce levels of myostatin, a molecule that stunts muscle growth.
• It improves high-intensity exercise performance by up to 15%. Multiple factors are improved by taking creatine. These include strength, muscle endurance, resistance to tiredness, ballistic power, sprint ability, as well as recovery and brain performance. Creatine 1 month results show an increased resilience in high-intensity training. 
• It may help fight some neurological diseases. Other than Parkinson’s disease described previously, studies show that creatine can be used in order to treat other medical conditions as well: Alzheimer’s disease, ischemic stroke, epilepsy, brain or spinal cord injuries and others. Even though treatments do not only consist in creatine supplement consumption, this substance may help slow the progression of these specific diseases by increasing phosphocreatine levels in the human brain. It may also reduce the severity of the symptoms.
• Creatine may lower sugar levels inside the blood, meaning it could help fight diabetes. This happens because of creatine’s ability to improve the function of GLUT-4 (glucose transporter type 4). After a meal containing high carbohydrate levels, people that involve in physical activity and take creatine supplements are more likely to have better blood sugar control than those who only exercise.
• It is able to improve brain function, playing an important role in brain general health. While performing certain tasks, the human brain requires a significant amount of ATP. Another way creatine aids brain function is by increasing dopamine levels and mitochondrial function. It is well known that after a certain age, people tend to have difficulties with their memory. Supplementing with creatine is able to significantly improve recall ability.
• It reduces fatigue and tiredness levels by providing the brain with additional energy and increasing dopamine levels.
• Moreover, it helps with recovery after intense workouts and reduces the severity in cases of injury.

How to take creatine supplements?

There are many brands that produce and commercialize creatine supplement products. They are all available over-the-counter, without requiring a medical prescription. They can be found at most vitamin, drug and grocery stores and they can also be ordered online.

Consulting a healthcare professional is the best option for deciding the appropriate quantity of creatine supplements one’s supposed to consume. Typically the recommended dose for adults that are at least 19 years old is 5 grams of creatine monohydrate four times a day, adding up to a total of 20 grams daily. As it is a high amount of substance, this should only happen for a few days. The maintenance dose in exercise performance remains 2 grams per day. Another recommendation is taking creatine with carbohydrates such as fruits and juices in order for the body to absorb the substance better.

These supplements are not recommended for children and teenagers.

Is creatine safe?

The safety of creatine supplements has been researched for more than two hundred years and most studies support that it is one of the cheapest and safest supplements available on the market. No severe creatine side effects have been discovered in healthy people.

Are there side effects of taking creatine?

Even though creatine appears generally safe with few and not dangerous side effects, it is important to remember a few aspects.

Firstly, high doses of supplements may stop the human body from producing its own creatine. As described above, 50% of the substance inside the body is produced by the pancreas, liver and kidneys.

Secondly, various side symptoms have been discovered. These include muscle cramps, stomach issues including diarrhea, liver dysfunction, kidney damage, and dizziness. Additionally, weight gain may also be a factor due to the water retention in the muscles.

These usually occur when other health issues are involved or the dosage of creatine supplements is way too high. The International Society of Sports Nutrition confirms that there is no scientific evidence to support that short or long-term usage of creatine monohydrate leads to any harmful complications on healthy individuals. It is important to remember that people suffering from kidney disease, high blood pressure or liver disease shouldn’t take creatine.

There are many theories about the side effects of taking creatine, yet none of them are supported by real evidence. For example, some medical professionals believe that creatine may cause irregularities in the heartbeat. Other theories link creatine to the development of rhabdomyolysis or compartment syndrome.

Creatine hair loss is another indirect side effect that could occur both in men and women taking creatine supplements due to its capacity of increasing DHT (dihydrotestosterone) levels, which can further be transformed into testosterone.  Although this might be an indirect pathway of causing hair loss, it is not supported by large evidence. 

Not enough information is provided regarding women taking creatine supplements while being pregnant or nursing, yet no studies have proven that it is not safe. Researchers are still studying this topic in order to fully understand how creatine affects certain organs.

However, it is important to acknowledge that the U.S. Food and Drugs Administration (FDA) doesn’t regulate nutritional supplements, meaning that creatine products are not checked for their safety and purity standards and individual brands are allowed to modify certain aspects such as quantity, quality and additional components. 

To sum it all up, it is recommended to consult a healthcare provider before deciding to take creatine supplements in order to exclude any risks and complications, especially when one is being treated using one of the following medications. 

What are possible interactions?

• Non-steroidal anti-inflammatory drugs (NSAIDs)- combining creatine with these pain relievers may result in an increased risk of kidney damage. NSAIDs include ibuprofen and naproxen.
• Caffeine- using creatine may be difficult while taking caffeine, increasing the risk of dehydration and in extreme cases even stroke.
• Diuretics (water pills)- as non-steroidal anti-inflammatory drugs and caffeine, taking creatine with diuretics increases the risk of both dehydration and kidney damage.
• Cimetidine (Tagamet), probenecid and other drugs that affect the kidneys are all dangerous while taken with creatine supplements, as they increase the risk of kidney damage as well.

Conclusion

Considering all the information described previously, a general conclusion would state that creatine is an effective supplement that has powerful benefits for athletic performances and overall health. Other than improving physical activity, some of its advantages include boosting brain function, fighting specific neurological diseases and being a facility for muscle growth.

Creatine supplements come in multiple available forms, the most common one being creatine monohydrate powder. It is considered to be generally safe, as there’s too little information regarding its side effects and none of the theories are supported by strong evidence. Athletes playing certain sports usually feel the need of a supplementation with creatine products in order to enhance their strength, endurance and improve certain skills during their athletic performances.

As with any other dietary supplement, it is important to consult a specialist before deciding to take creatine supplements, as certain medical conditions and prescribed medication may strongly influence the way this substance affects the human body and its general abilities.