Creatine: Far More Than a Performance Enhancer.

Creatine, best known for its ability to build muscle and enhance athletic performance, is also critical for fertility, digestion, mental health, protecting your hearing, and keeping your skin vibrant and youthful.

In this episode, Alex Leaf of Examine.Com and I discuss everything you need to know about creatine. I focus on the basic science of what it does in the body, and Alex takes the lead in discussing the practicalities of supplementation.

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This episode is brought to you by Paleovalley. I use their beef sticks as a convenient yet nutritious snack. They are made from 100% grass-fed beef and preserved through traditional fermentation. The fermentation makes them more digestible and gives them a fresher mouthfeel and texture compared to most other meat snacks I’ve tried, which tend to be too dry for me to fully enjoy. They also have a grass-fed organ complex that contains a blend of liver, heart, kidney, and brain, all stuffed into gel caps for those who can’t bring themselves to eat these incredibly nutritious meats with a fork. Head to paleovalley.com and enter the promo code masterjohn at checkout for 30% offyour order. This is a huge savings available for only a limited time. You can get 30% off everything on the site, ordering as much as you want, but only for the duration of the next three podcast episodes. Check it out now to make sure you get your discount!

This episode is brought to you by US Wellness Meats. I use their liverwurst as a convenient way to make a sustainable habit of eating a diversity of organ meats. They also have a milder braunschweiger and an even milder head cheese that gives you similar benefits, as well as a wide array of other meat products, all from animals raised on pasture. Head to grasslandbeef.com and enter promo code “Chris” at checkout to get a 15% discount on any order that is at least 7 pounds and is at least $75 after applying the discount but under 40 pounds (it can be 39.99 lbs, but not 40). You can use this discount code not once, but twice!

Ways You Can Use the Podcast Notes

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Creatine Supplement Recommendations

I recommend Optimized Nutrition micronized creatine powder. If you buy a single bottle, it is available for Amazon Prime free one-day shipping, and costs $13.60 per bottle, which is 2.3 cents per gram or 11.5 cents per day when taken at 5 grams per day. You can save 5% if you subscribe to it, 15% if you subscribe to at least four other items, and 20% if you also pay with an Amazon store card.

If you expect to take creatine while traveling, I recommend getting Optimized Nutrition creatine caps. Carrying around capsules is a lot easier than little baggies of powder. This raises the price to about 14 cents per day but the convenience may well be worth it.

Creatine in Foods: The Database

This is the only database of the creatine content of foods on the internet. Check it out here:

Creatine in Foods: The Database

Lab Tests Related to Creatine

If you are supplementing with creatine, you will likely have at least a moderate increase in your serum creatinine. Creatinine is a breakdown product of creatine and its serum level is usually used to estimate the rate at which your kidneys are working. This is called the glomerular filtration rate (GFR). If your creatinine rises in response to creatine supplementation, it could potentially give a false signal that your kidneys are working less efficiently. Quest Diagnostics offers an estimated GFR based on cystatin C, which should be independent of creatine supplementation and avoid this problem.

In theory, you can test your serum creatine (Quest, LabCorp) to see if your endogenous synthesis is adequate. However, these tests are designed to look at diseases that can elevate creatine levels and the reference range would be difficult to interpret. Similarly, Quest offers a creatine biosynthesis disorders panel that is actually designed to look for inadequate synthesis, but the reference range is designed to separate people with severe genetic disorders from everyone else, so will be too broad to be used for moderately decreased creatine synthesis.

A plasma amino acid analysis (my preference: Genova ION Profile + 40 amino acids; also: LabCorp, Quest, Great Plains, and the NutrEval) may reveal low glycine or arginine levels, which could compromise creatine synthesis. 

Homocysteine (LabCorp, Quest), when elevated, suggests deficient methylation, which also would compromise creatine synthesis. Homocysteine is included on the Genova ION and Great Plains amino acid profiles listed above but not the others.

For further methylation-related testing, see the lab tests listed in Living With MTHFR.

Show Notes for “Creatine: Far More Than a Performance Enhancer”

01:46 Cliff Notes

11:54 Introduction

12:36 Symptoms of rare creatine biosynthesis disorders: global developmental delay, intellectual disabilities, hyperactivity, autistic behavior, and gastrointestinal defects

14:49 Creatine’s role in skeletal muscle as a buffer of the ATP supply

20:28 Creatine increases muscular contractile power by reducing ionic strength.

22:28 Creatine acts as a pH buffer.

25:36 Creatine is constantly recycling ATP, even at rest, but during intense exercise, creatine is used up faster than it can be recycled.

28:23 The creatine kinase system is especially important in cells and tissues that have 1) fluctuating energy demands, 2) high energy demands, or 3) long, polarized structures.

31:50 Creatine’s role in cells with high energy demands: gastric acid secretion in the stomach, nutrient absorption in the intestines, maintenance of intestinal villi

34:37 Creatine’s role in cells that are long and polarized: sperm, photoreceptors of the retina, hair cells in the inner ear, and skin (keratinocytes, hair follicles, and sebaceous glands)

39:22 Creatine synthesis is dependent on methylation, glycine, and arginine; creatine supplementation can cut the demand for methylation almost in half.

42:32 We have about 120 grams of creatine in our body and lose 2-3 grams per day via spontaneous degradation to creatinine.

44:00 Creatine supplementation is a strategy to help with methylation problems.

45:59 Alex Leaf discusses the practicalities of creatine supplementation; for dosing, 3-5 grams per day on a consistent basis.

48:22 Some people (about 20-30% of the population) are non-responders to creatine.

49:56 The best form of creatine to take is monohydrate; there is no evidence for the superiority of any other form, and some are inferior.

55:18 Timing of creatine supplementation

01:00:59 Why it doesn’t make sense to cycle creatine

01:04:24 Creatine may increase DHT, which might worsen hair loss if you have male-pattern baldness, but there is no direct evidence of this.

01:08:00 Rare anecdotal reports of insomnia from creatine supplementation; this is likely a temporary effect of cutting the methylation demand in half.

01:12:12 Creatine will not damage your kidneys; cystatin C as an alternative marker of kidney function.

01:17:18 Creatine causes weight gain by drawing more water into muscle tissue.

01:19:15 Wrapping up

Creatine Links and Research

Walliman, et al. The creatine kinase system and pleiotropic effects of creatine. 2011.

Brosnan, et al. The metabolic burden of creatine synthesis. 2011

Brosnan and Brosnan. The role of dietary creatine. 2016.

Gualano et al. Effect of short-term high-dose creatine supplementation on measured GFR in a young man with a single kidney. 2010.

Gualano et al. In sickness and in health: the widespread application of creatine supplementation. 2012.

Rackayova, et al. Creatine in the central nervous system: From magnetic resonance spectroscopy to creatine deficiencies. 2017.

Jagim, et al. A buffered form of creatine does not promote greater changes in muscle creatine content, body composition, or training adaptations than creatine monohydrate. 2012.

van der Merwe, et al. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. 2009.

Steenge, et al. Stimulatory effect of insulin on creatine accumulation in human skeletal muscle. 1998.

Green et al. Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. 1996.

Syrotuik and Bell. Acute creatine monohydrate supplementation: a descriptive physiological profile of responders vs. nonresponders. 2004.

Gill et al. Creatine serum is not as effective as creatine powder for improving cycle sprint performance in competitive male team-sport athletes. 2004.

Spillane. The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels. 2009.

A patent on creatine nitrate.

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17 Comments

  1. Hello Chris,

    Would you think for someone who is not sedentary of low creatinine as an undermehtylation marker?
    Maybe along with an increased creatine kinase…?

  2. I just wanted to report I experienced insomnia and diarrhea from 5G or less daily of creatine. Within the first few days. I’m on day 4. Hoping but goes away.

  3. I 14 and I want to take creatine but my parents won’t let me because there worried about the side affects I’ve been reading a lot of articles and they seem to be 50 50 for it and against it I was hopping you could give me your opinion

  4. I listened to the podcast, especially interested in the use of creatine after surgery. I have had a number of arterial bypass surgeries (quadruple heart bypass, left illiac stent, left and right fem-pop leg bypass) and one to go and felt my muscle and nerve recovery was slow. I work out 6 – 7 times a week doing intense spinning and weights. I began a normal creatine intake routine after listening to the podcast and after 3 – 4 weeks found my recovery speeding up a great deal. With less pain and intermittent claudication (100% blockage above both knees) I am able to workout more comfortably and intensely. I know this is only anecdotal and not proof of it’s effectiveness, however, it works for me and I plan to continue the creatine intake after I get out of the hospital for my last surgery. Thank you Chris!

  5. Chris the insomnia issue is due to people being low in vitamin B6. P5P form does not work. You have to supplement 50mg-200mg b6 pyridoxine hydrochloride alongside the Creatine in order to offset this. Creatine can deplete B6 in some people, cause insomnia and a host of other issues.

  6. Hi.. Great article. Creatine is a very safe, healthy, and effective supplement that you can use to help increase your strength and muscle gains in the gym, as well as improving your overall physical energy levels. I feel MK-677 is the best combination for lean muscle mass. The main subject for it is its anabolic muscle-building properties. MK-677 minimizes wasting of muscle. It also promotes bone density.

  7. Hi Chris, great Information. What about creatine and the thyroid, I read that people suffering from Hashimoto, therefore taking thyroid hormones should not supplement with creatine, any notion about this

  8. Hi Chris,

    If you are a non responder to creatine would you still recommend taking it? I never gain weight or notice any improvement in the gym and track my training very closely. So although it doesn’t saturate my muscles will it still have all the other aforementioned benefits?

    Thanks.

  9. With the goal of addressing an MTHFR mutation, do you think taking 5 g creatine all at once is sufficient to maximally suppress endogenous synthesis, or would it be ideal to spread the dose across the day?

  10. Shortly after listening to the Living with MTHFR episode I started creatine supplementation and the effects have been astounding.

    I have been a long time sufferer of insomnia and haven’t have a proper circadian rhythm for several years. The past couple years have been really tough as I would be incredibly tired all day and often had to go to bed only 8-10 hours after waking up, resulting in only sleeping for 4-5 hours before waking up still very tired but unable to sleep, continuing the cycle. When I did manage to only sleep once per day I was still unable to properly fall asleep until I was dead tired, causing my bedtime to constantly move forward several hours every week. Nothing I tried to fix my circadian rhythm worked, I was just unable to fall asleep unless I was practically falling unconscious on my feet, and I was unable to get enough quality sleep to feel rested during the day.

    When I listened to the Living with MTHFR episode something clicked in my brain. My doctor had told me I had a slight folate deficiency and told me to supplement folic acid this spring. I thought this was a bit strange since my diet back then was decently healthy, at least only consisting of home-made whole foods, and when I did a quick accounting I was getting at least the RDA of folate. After listening to the MTHFR episode I did some more research and ended up getting a DNA test with 23andme. Sure enough I’m heterozygous for the C677T polymorphism in the MTHFR gene.

    I started creatine supplementation in early November and the results were pretty immediate. In just two days my resting heart rate dropped from 70 to 64 and I also spent 10 hours in bed both days (of which I got 8 hours 45 minutes of sleep according to my fitbit) and got the best sleep I’ve had in years. Encouraged by this I tried a little too hard to fix my circadian rhythm and my sleep was messed up as a result, I was sleeping mostly during the day when I started, but two weeks later I had gotten back on track going to sleep in the evening and waking up feeling refreshed in the morning. According to my fitbit my average time asleep (not just time in bed but actually sleeping) went from 6 hours 15 minutes to 7 hours 30 minutes two weeks after I started creatine supplementation. It also feels like I’m a lot less stressed; my hunger is much less insistent and stopped showing up if I just recently ate, I’m less worried in general and don’t stop to overthink everything, I’m able to properly relax to a much greater degree whereas before I would often feel like I was strung up by hooks etc.

    My insomnia still isn’t cured completely but it feels like the nature of the beast has changed entirely and that the problems I’m facing now are more amenable to conventional sleep therapies. The last year I’ve made many changes to my lifestyle that have been positive and I’ve made good progress climbing out of this hole I’ve been stuck in for years. Creatine supplementation doesn’t get all of the credit, but it’s absolutely been the single change with the largest impact as far as I can tell.

  11. Hi Chris. I have been using creatine about 2 months. It’s good to hear the show.
    I had been going anaerobic far to quickly and easily during intense exercise.
    I had read some european research on creatine with older people and decided to give it a go. The research had quantified creatine’s energy gains. With me at 60+, I just say its huge. Also, it provides balance with a Keto diet. Keto water loss, creatine water gain.
    It’s good to hear no cycling needed. Using 3-5 grams a day and buying it by the kilo.

    1. In my case, I started taking creatine and didn’t notice any difference in my rated perceived exertion (RPE) during my workouts, and I didn’t gain any water weight or see any increase in the scale weight. When I stopped taking it, I again didn’t feel any drop off in my RPE, and I didn’t drop any water weight. It’s pretty easy to determine if you are a non-responder. Just add the creatine without adding anything else and similar when you stop it.

      The only thing creatine did for me was rapidly accelerate my hair loss (and I mean rapidly). So unfortunately it’s no good for me personally, but I understand it works well for a lot of people.

      1. But if you’re taking creatine for reasons other than working out then it’s hard to tell I think. He talks a lot about mitochondrial function and gut lining; neither of which can be determined from a perceived rate of exertion (IMO).

  12. Do you think caffeine should be avoided when supplementing with creatine? There seems to a lot of information about the poor interaction between the two. There are even studies showing the link between caffeine with creatine supplementation and the progression of Parkinson’s disease. Does the creatine/caffeine combo mess with dopamine release?

  13. Any thought on making Creatine powder stomach friendly by dissolving it in hot water? I put in tea, it helped. Any concern on the effect of the hot water on Creatine?

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