INTRODUCTION
Creatine supplementation or ingestion leads to increase the amount of creatine and creatine phosphate stored in our body. Creatine is belived to aid in the process of creating energy usable by muscles. [1] Therefore, creatine supplements have been used in some athletes.
CREATINE HEALTH BENEFITS
PERFORMANCE Creatine supplementation can also improve performance during high intensity exercise in humans and improve muscle strength in certain myopathies. Head SI et al at University of New South Wales, Australia, isolated the extensor digitorum longus muscle from mice and stimulated with field electrodes to measure force characteristics in 3 different states.(i) before fatigue; (ii) immediately after a fatigue protocol; and (iii) after recovery. The muscle was then incubated in a creatine solution and washed. In un-fatigued muscle, creatine incubation increased the maximal tetanic force. In fatigued muscle, creatine treatment increased the force produced at all frequencies of stimulation. Incubation also increased the rate of twitch relaxation and twitch contraction in fatigued muscle. During repetitive fatiguing stimulation, creatine-treated muscles took 55.1±9. 5% longer than control muscles to lose half of their original force. Measurement of weight changes showed that creatine incubation increased EDL muscle mass by 7%. [PLoS One. 2011;6(8):e22742.] ]5]
Recent reports suggest that creatine may enhance performance in hot and/or humid conditions by maintaining haematocrit, aiding thermoregulation and reducing exercising heart rate and sweat rate. Creatine may also positively influence plasma volume during the onset of dehydration. [2] Progressive muscle weakness is a main symptom of most hereditary muscle diseases. In trials with 138 participants with muscular dystrophies treated with creatine, there was a significant increase in maximum voluntary contraction in the creatine group compared to placebo, with a weighted mean difference of 8.47% (95% confidence intervals 3.55 to 13.38). There was also an increase in lean body mass during creatine treatment compared to placebo. [3]
When we exercise or tense a muscle, energy is required for the muscle to function properly. The energy it uses comes mainly from the food. The nutrients in the food are broken down to smaller compounds, e.g. adenosine triphosphate (ATP) for energy production and storage. When muscle energy is needed, ATP is broken down to form adenosine diphosphate (ADP). This process releases energy for muscles to contract. Without sufficient ATP, muscles do not perform properly. [1]
Muscle can store only limited amounts of ATP. As a result, within about 5-10 seconds of muscle exertion, the amount of stored ATP is depleted. The depletion of ATP results in fatigue. When this happens, the body tries to restore its immediate source of ATP by borrowing a high-energy phosphate, i.e. creatine phosphate (CP). [1]
Muscle cells can store creatine phosphate. If high intensity exercise goes beyond 10 seconds, the body will continue to try and restore its ATP levels by a process called glycolysis. This process is complicated and is slow to restore the ATP levels. This can be a problem when we require instant energy to maintain a sustained muscle contraction. [1]
Creatine Phosphate Supplementation may help to recharge the creatine molecule in our body. However, ATP or creatine phosphate cannot be ingested orally because they are digested in our GI tract. However, creatine can be ingested and converted to creatine phosphate in our body. [1]
Creatine monohydrate, creatine citrate and creatine pyruvate are popular creatine supplements. It is supplied in form of powder, capsule or tablets. It can be mixed or taken with water or juice. Some people athletes take 20-30 grams of creatine monohydrate a day. [1]
NEURAL SUPPORT Creatine may provide health benefits of neural support. Exogenous creatine supplementation has been shown to reduce neuronal cell loss in experimental paradigms of acute and chronic neurological diseases. In line with these findings, first clinical trials have shown beneficial effects of therapeutic creatine supplementation. Furthermore, creatine was reported to promote differentiation of neuronal precursor cells that might be of importance for improving neuronal cell replacement strategies. Based on these observations there is growing interest on the effects and functions of this compound in the central nervous system. [A1]
Creatine synthesis makes major demands on the metabolism of glycine, arginine, and methionine. Large doses of creatine monohydrate are widely taken creatine supplements are also taken by patients suffering from gyrate atrophy, muscular dystrophy, and neurodegenerative diseases. Children with inborn errors of creatine synthesis or transport present with severe neurological symptoms and a profound depletion of brain creatine. It is evident that creatine plays a critical, though underappreciated, role in brain function. [A3]
MUSCLE MASS Sarcopenia, defined as the age-related loss of muscle mass, is a serious health concern. Contributing factors to sarcopenia include physical inactivity and undernutrition. Resistance training has a positive effect of muscle mass in the elderly. However, muscle loss is still observed in older adults who perform weight bearing exercise; suggesting that nutrition is important. Intake of creatine has the potential to increase muscle accretion during resistance training, although the mechanism for its ergogenic effect is unclear. Creatine has the potential to increase cellular hydration and myogenic transcription factors and facilitate the up-regulation of muscle specific-genes such as myosin heavy chain possibly leading to muscle hypertrophy. [A2]
CANCERS Creatine may have the health benefits of anti-cancer activities. [4] The creatine/creatine kinase (CK) system plays a key role in cellular energy buffering and transport. In the process of creatine biosynthesis several other important metabolites are formed. Recent literature has reported low creatine content in several types of malignant cells. Furthermore, creatine can protect cardiac mitochondria from the deleterious effects of some anticancer compounds. Patra S, et al at Indian Association for the Cultivation of Science showed progressive decrease of phosphocreatine, creatine and CK upon transformation of skeletal muscle into sarcoma. The anticancer effect of methylglyoxal had been known. Patra S' work shows that this anticancer effect of methylglyoxal is significantly augmented in presence of creatine. On creatine supplementation the effect of methylglyoxal plus ascorbic acid was further augmented and there was no visible sign of tumor. [8]
BONE Supplementation of creatine has shown health benefits on cortical and trabecular bone composition of ovariectomized rats. [6]
DIABETES In a study of type II diabetics received either creatine (3 g) or glibenclamide (3.5 mg) for five successive days, creatine and glibenclamide both decreased glucose concentrations vs. basal glucose. Treatment with both creatine and glibenclamide increased insulin and c-peptide concentrations after 120 and 240 min. [7]
EHLERS-DANLOS SYNDROME (EDS) Many EDS patients struggle with chronic pain and fatigue, making daily activities difficult. Treatments like physical therapy and exercise can be helpful, but the pain and fatigue can make it hard to benefit from them. A study reports on a 39-year-old woman with EDS whose chronic pain and fatigue severely limited her daily life. The doctors then tried creatine monohydrate. After taking creatine, the woman reported significant improvement in her fatigue. This allowed her to participate in daily activities and exercises more easily. [B1]
CREATINE SIDE EFFECTS
Creatine converts to creatinine at lower pHs (acidic environment). Creatinine is toxic, side effects may include stomach cramps, edema, bloodedness and dehydration. [1] In addition, one trial reported a significant increase in muscle pain during high-dose creatine treatment (dosage 150 mg/kg body weight) in glycogen storage disease type V. [3]
REFERENCE
[1] Golini; Jeffrey M. (Billings, MT) U.S. Patent 6,399,661 June 4, 2002 [2] Dalbo VJ, Roberts MD, Stout JR, Kerksick CM. Department of Health and Exercise Science, University of Oklahoma, Putting to rest the myth of creatine supplementation leading to muscle cramps and dehydration. Br J Sports Med. 2008 Jul;42(7):567-73. Epub 2008 Jan 9. [3] Kley RA, Vorgerd M, Tarnopolsky MA. Kliniken Bergmannsheil, Ruhr University Bochum, Germany, Creatine for treating muscle disorders. Cochrane Database Syst Rev. 2007 Jan 24;(1). [4] Mesa JL, Ruiz JR, González-Gross MM, Gutiérrez Sáinz A, Castillo Garzón MJ. University of Granada, Spain, Oral creatine supplementation and skeletal muscle metabolism in physical exercise. Sports Med. 2002;32(14):903-44. [5] Head SI, Greenaway B, Chan S. Incubating Isolated Mouse EDL Muscles with Creatine Improves Force Production and Twitch Kinetics in Fatigue Due to Reduction in Ionic Strength. PLoS One. 2011;6(8):e22742. [A1] Functions and effects of creatine in the central nervous system.Brain Res Bull. 2008 Jul 1;76(4):329-43. Epub 2008 Mar 24 [A2] Effect of creatine supplementation during resistance training on muscle accretion in the elderly. J Nutr Health Aging. 2007 Mar-Apr;11(2):185-8. [A3] Creatine: endogenous metabolite, dietary, and therapeutic supplement. Annu Rev Nutr. 2007;27:241- 61 [6] de Souza RA, Xavier M, da Silva FF, de Souza MT, Tosato MG, Martin AA, de Melo Castilho JC, Ribeiro W, Silveira L Jr. Influence of creatine supplementation on bone quality in the ovariectomized rat model: an FT-Raman spectroscopy study. Lasers Med Sci. 2011 Aug 12. [7] Ročić B, Znaor A, Ročić P, Weber D, Vučić Lovrenčić M. Comparison of antihyperglycemic effects of creatine and glibenclamide in type II diabetic patients. Wien Med Wochenschr. 2011 Jul 29. [8] Patra S, Ghosh A, Roy SS, Bera S, Das M, Talukdar D, Ray S, Wallimann T, Ray M. A short review on creatine-creatine kinase system in relation to cancer and some experimental results on creatine as adjuvant in cancer therapy. Amino Acids. 2011 Jul 19. B1. Christopher R Behringer et al, Creatine Monohydrate as an Effective Supplement for Muscular Fatigue in an Ehlers-Danlos Patient, Cureus. 2024 Jun 5;16(6):e61721.