Victorious Veteran: Creatine Monohydrate Still First Class! Usefulness & Safety of “Innovative” Creatine Formulas Questionable.

If we discount a high protein intake as a regular constituent of a healthy diet, creatine is unquestionable the King of Natural Ergogenics. Its impact on athletics way beyond the Gold’s Gyms of the bodybuilding world is evident from its being cited as “effective and safe” in almost each and every “position stand” published in one of the journals of the various sports & nutritional societies all over the world in regular intervals. Thus, with the (nephro-)toxity myth being finally dispelled, creatine has become a stable in the supplement regimen of both recreational, as well as professional athletes.

Now, the financial revenue you can make from a non-patentable amino acid that is commonly found in fish and meat products is obviously limited. Thus, the steadily increasing number of players on the supplement market is continuously trying to “reinvent the wheel”, by putting forward a new, better-absorbed, more effect, side-effect free or whatever else the marketing guys had on their minds forms of N-(aminoiminomethyl)-N-methyl glycine (=chemical formula of creatine). These “superior” forms of creatine are then put forward as the must have for every seriously training athlete and/or creatine non-responders (these are people, where – due to various not fully understood mechanisms – creatine has no measurable effect on performance, (intracellular) water retention and body weight) and usually disappear from the market just about at the same time, the first batch has been sold and disappointed customers begin to vent their anger on the blogs and bulletin boards of the fitness world.

With reference to the purported superiority of novel forms of creatine R. Jäger, one of the leading researchers in the field writes in a recently published paper (Jaeger. 2011), the results of which have previously been presented at the 2010 Creatine in Health and Sports conference:

[…] the efficacy, safety, and regulatory status of most of the newer forms of creatine found in dietary supplements have not been well established. Additionally, there is little to no evidence supporting marketing claims that these newer forms of creatine are more stable, digested faster, and more effective in increasing muscle creatine levels and/or associated with fewer side effects than CM.

In their extensive review of the literature Jäger et al. dissect many of the commonly held views on the purported “instability” and “low absorbtion rate” of creatine monohydrate, evaluate the different creatine contents of various supplemental forms and their individual solubility, stability and bioavailability. And while some other forms are in fact more soluble…

Creatine monohydrate dissolves at 14 g/L at 20°C resulting in a neutral pH of 7. A saturated solution of tricreatine citrate in water has a pH of 3.2; whereas a saturated solution of creatine pyruvate even has a pH of 2.6 (pyruvic acid is a stronger acid than citric acid). The decrease in pH results in an increase in solubility: 29 g/L creatine citrate at 20°C, and 54 g/L creatine pyruvate at 20°C. Normalized by the relative amount of creatine per molecule (monohydrate 87.9%, citrate 66%, pyruvate 60%), creatine citrate (19.14 g/L) shows a 1.55-fold and creatine pyruvate (32.4 g/L) a 2.63-fold better solubility when compared with the monohydrate (12.3 g/L).

The acidity of your stomach is high enough, anyway, so that even if you just swallow the powder it will eventually dissolve, when it comes in contact with your gastric acid - for monohydrate [CM] Jaeger reports the absorption to be as high as 99%.

Furthermore, pre-solving of creatine in water is counter-indicated, because, as Jaeger et al. write, …

[…] solution precludes the manufacture of shelf-stable standard ingredient. If creatine is not consumed immediately after it has been dissolved in water, it should be stored at a low temperature to retard the degradation.

So you better throw away your liquid creatine - chances are its 99% degraded even before you bought it from your retailer.

The instability is even more of concern in the case of Creatine Ethyl Ester (CEE) which has been found to be “actually less stable than CM.” (Child & Tallon. 2007).

CEE is mostly converted into creatinine under physiological conditions encountered during transit through the various tissues, suggesting no ergogenic effect is to be expected from supplementation of CEE.

The latter, i.e. creatine ethyl esther, is also less bioavailable, 

Figure 1:Changes in total muscle creatine content in response to placebo (PLA), creatine monohydrate (CRT), and creatine ethyl ester(CEE) supplementation (Spillane et al. 2009, cf, fig. 1).

and studies (Spillane. 2009) suggest that its higher rate of degradation to creatinine may pose a possible health risk.

Also, while Jaeger et al. report some evidence for the beneficial effects of co-supplementation with glucose, protein or (low dose) D-pinitol, I personally doubt that either of them is necessary to take advantage of the repeatedly proven ergogenic effects you can get from the cheapest, most researches, safest and easiest to obtain form of creatine – creatine monohydrate.

On a side note: My friends @ironmagazine.com have found an interesting study on the effect of creatine + nitrate, which is currently hyped as “the next big thing”. Although, I suppose that the amount of the carcinogen N-nitrososarcosine, which is a byproduct of their reaction, is hardly high enough to trigger cancerous growth, the lack of direct scientific evidence that creatine nitrate has any beneficial effect over the individual use of nitrates (for pump) and creatine (for performance) at least makes me wonder if you could not eat a buckload of beet roots (high in nitrate) with your creatine monohydrate to achieve the same effect ;-)

Another Good Reason to Take Creatine: Creatine Helps with Exercise Induced Arterial Stiffness

If there is one supplement out there on the fitness market that is really worth each cent you spend on it, it is probably creatine monohydrate.

In a recent study, scientists from the Florida State University (Sanchez-Gonzalez. 2011) report on the positive effects, of creatine supplementation (creatine monohydrate @ 2x5g /day for 3 weeks) on arterial stiffness and hemodynamics in 16 healthy male subjects:

Compared with the Pl group, the Cr group had attenuated (P\0.05) increases in SBP [systolic blood pressure] at PE5 [5 minutes post exercise] (Pl 14.0 ± 2.5, Cr 5.6 ± 2.3 mmHg), HR [heart rate] at both P5 (Pl 28 ± 4 vs. Cr 16 ± 2 beats/min) and PE15 (Pl 21 ± 3, Cr 11 ± 2 beats/min) and rate pressure product at P5 (Pl 45.8 ± 6.4, Cr 24.8 ± 2.2) and P15 (Pl 34.2 ± 5.0, Cr 15.9 ± 6.0). Compared with the Pl group, the Cr group had suppressed
increases in baPWV [brachial-ankle pulse wave velocity] at PE5 (Pl 1.5 ± 0.4, Cr-0.1 ± 0.4 m/s) and PE15 (Pl 1.1 ± 0.2, Cr -0.3 ± 0.3 m/s) and returned SBP to pre-exercise values at PE15 (Pl 10.6 ± 2.8, Cr 2.1 ± 2.6 mmHg). PWV in the exercised leg decreased at PE5 in both groups.

Overall, this indicates that creatine supplementation reduces cardiac stress from strength training. It would have been interesting, though, to see a more realistic setting for the study - with the single-leg extension exercise in an isokinetic dynamometer used in this you probably don't induce much cardiac stress, anyway. Sometimes, I am asking myself if any of those researchers have ever been to the gym to take a look at the intensity levels at which many ambitious gymrats work out...

Creatine + Caffeine = No-Go? Still Nothing but a Myth

You probably have heard both that a) caffeine would negate the ergogenic effects of creatine loading and b) that the latter is nothing but one of those gym-myths which just won't disappear.

A recent study by scientists from the Department of Recreational Sports Management, Yu Da University, Miaoli, Taiwan (Lee. 2011) provides practical evidence that "the no caffeine when on creatine"-advice is garbage. The scientists investigated the effects of acute caffeine ingestion on intermittent high-intensity sprint performance after 5 days of creatine loading and found no detrimental effects of 0.6mg/kg caffeine on the creatine induced increase in exercise performance. What's more the ergogenic effect of caffeine added to that of creatine, so that ...

[...] the mean and peak power observed in the CRE + CAF were significantly higher than those found in the CON during Sprints 1 and 3; and the CRE + CAF showed significantly higher mean and peak power than that in the CRE + PLA during Sprints 1 and 2. [...] Heart rates, plasma lactate, and glucose increased significantly with CRE + CAF during most sprints.

On the other hand, one has to consider that this does not ultimately refute that "caffeine loading", or rather binging on caffeine day by day, may well exhaust your adrenal reserves in a way that after a few weeks of epinephrine overload, you are so drained that it becomes hard to drag yourself to the gym. In this situation all the creatine in the world probably won't help you.

Oral ATP Supplementation Proves Completely Ineffective Even at Very High Doses

I think most supplement companies have hitherto given up on convincing you of the use of oral ATP supplements. About 2 month ago, I did however notice a new "high dosed" product (I cannot remember the figures out of my head, but the daily dose was far below 1.000mg) was released to be bought by the in-educated public ;-)

Just to discourage you from wasting your money on any such products, here is a very recent study (Coolen. 2010) on the futility of attempting to rise ATP levels via oral supplementation:

Thirty-two healthy subjects were randomised to receive 0, 250, 1250 or 5000 mg ATP per d for 28 d by means of enteric-coated pellets. In addition, on days 0 and 28, all thirty-two subjects received 5000 mg ATP to determine whether prolonged administration would induce adaptations in the bioavailability of ATP. ATP supplementation for 4 weeks did not lead to changes in blood or plasma ATP concentrations. Of all ATP metabolites, only plasma uric acid levels increased significantly after the administration of 5000 mg of ATP.

If you are an athlete and really intend to raise ATP levels orally, creatine supplementation (and thus increased ATP resynthesis) would be one way to go.