How Much Do You Know About Creatine?

Creatine is an amino acid, one of the building blocks that make up proteins. During intense exercise lasting approximately half a minute, phosphocreatine is broken down into creatine and phosphate. The energy released is used to regenerate the primary source of energy, adenosine triphosphate (ATP). Output power drops as phosphocreatine becomes depleted, because ATP cannot be regenerated fast enough to meet the demand of the exercise. It follows that a bigger store of phosphocreatine in muscle should reduce fatigue. Extra creatine in the muscle may also increase the rate of regeneration of phosphocreatine, which should mean less fatigue with repeated bursts of activity in training.

About half of the daily needs of creatine are provided by the body synthesizing creatine from amino acids. The remaining daily need of creatine is obtained from the diet. Meat or fish are the best natural sources. Dietary supplementation with synthetic creatine is the primary way athletes "load" the muscle with creatine. Daily doses of creatine for 5-7 days usually increase the total creatine content in muscle by 10-25 percent. 
There is some evidence that not all subjects respond to creatine supplementation. However, more recent studies indicate that taking creatine with large amounts of glucose increases muscle creatine content by 10 percent more than when creatine is taken alone 

Creatine supplementation appears to be less effective in the following situations: when less than 20 g per day was used for 5 days or less and when low doses (2-3 g per day) were used without an initial high-dose loading period. There have also been reports that caffeine may negate the benefit of creatine supplementation. Consequently, although most studies indicate that creatine supplementation may improve performance, creatine supplementation may not provide ergogenic value for everyone. Although some studies have found no effect, most indicate that short-term creatine supplementation increases total body mass. The gains in lean body mass were maintained while ingesting creatine during a 10-week period of training and in the four weeks after supplementation stopped.

Anecdotal reports from some athletic trainers and coaches suggest that creatine supplementation may promote a greater incidence of muscle strains or pulls. Theoretically, the gains in strength and body mass may place additional stress on the bones, joints and ligaments. 

The body seems to be able to dispose of the extra creatine without any problem. The extra creatine is eliminated mainly in the urine as creatine, with small amounts broken down and excreted as creatinine or urea. No study has shown that creatine supplementation results in clinically significant increases in liver damage or impaired liver function.

Studies have reported that it takes about four weeks after cessation of creatine supplementation for muscle creatine and phosphocreatine content to return to normal. It is unclear whether muscle content falls below normal thereafter. 

Although long-term side effects cannot be discounted, no significant short-term side effects other than weight gain have been reported. Furthermore, creatine and phosphocreatine have been used medically to reduce muscle wasting after surgery and to improve heart function and exercise capacity in people with ischemic heart disease. Creatine supplementation may even reduce the risk of heart disease by improving blood lipids. 

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