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 What does Creatine Monohydrate do?

Creatine (creatine monohydrate) is a colorless, crystalline substance used in muscle tissue for the production of phosphocreatine, an important factor in the formation of adenosine triphosphate (ATP), the source of energy for muscle contraction and many other functions in the body.^{1 2}

Creatine monohydrate supplementation increases phosphocreatine levels in muscle in most people, especially when accompanied by exercise or carbohydrate intake.^{3 4} However, about 30% of people who take creatine supplements fail to retain significant quantities in the muscle,^{5 6} which may explain the inconsistent results reported in studies of the effects of creatine on athletic performance.

Creatine may increase exercise-related gains in lean body mass,^{7 8 9} though how much of these gains represents more muscle and how much is simply water retention is unclear.¹⁰ Most, though not all, controlled studies have shown that 20 grams per day of creatine monohydrate taken for five to six days by sedentary or moderately active people, improves performance and delays muscle fatigue during short-duration, high-intensity exercise such as sprinting or weight lifting.^{11 12 13} However, elderly people appear to gain only minimal, if any, exercise performance benefits from creatine supplementation,^{14 15} and performance outcomes for trained athletes using creatine supplements in competitive situations have not been consistent.^{16 17 18} Creatine supplementation does not appear to increase endurance performance and may impair it by contributing to weight gain.¹⁹

Very little research has been done to investigate the exercise performance effects of long-term (over one month) creatine supplementation. Two controlled long-term trials using untrained women²⁰ or trained men²¹ found that creatine improved gains made in strength and lean body mass from weight-training programs. However, a third preliminary trial found only insignificant gains from creatine supplementation in weight-training football players.²²

The amount of creatine within cells may be deficient in people with muscular dystrophy. This deficiency may contribute to the weakness and degeneration of muscle tissue seen in this condition. A case report described a 9-year old boy with muscular dystrophy who experienced improved muscle performance after creatine supplementation.²³ A double-blind trial found that creatine supplementation (10 grams per day for adults, 5 grams per day for children) slightly but significantly improved muscle strength and performance of daily activities in people with varying types of muscular dystrophy.²⁴ Creatine supplementation has also been reported to improve strength in certain rare diseases of muscle and energy metabolism.^{25 26 27}

For people with congestive heart failure, intravenous creatine has been found to improve heart function, but oral supplementation has not been effective, though skeletal muscle function does improve.^{28 29}

A double-blind, study found that 20 grams per day of creatine taken for five days followed by 10 grams per day for 51 days significantly lowered serum total cholesterol and triglycerides, but did not change either LDL or HDL cholesterol, in both men and women.³⁰ However, another double-blind trial found no change in any of these blood levels in trained athletes using creatine during a 12-week strength training program.³¹ Creatine supplementation in this negative trial was lower—only 5 grams per day was taken for the last 11 weeks of the study.