How to Maximize the Effects of Creatine

Creatine is one of the supplements with the most scientific evidence regarding its benefits, both for performance and health. In addition, focusing on the field of performance, more and more evidence shows that this supplement could be beneficial not only for strength or power sports – which are the ones in which creatine has traditionally been most popular – but also in endurance sports, as we mentioned in another post.

Creatine is a compound found primarily in skeletal muscle. This compound can be synthesized endogenously (i.e., by the body itself), although it also needs to be administered exogenously through the diet in order to maximize its levels and obtain the greatest benefits. In this sense, it has been observed that short periods of supplementation with relatively high doses of creatine are sufficient to saturate muscle creatine stores. For example, almost 30 years ago it was observed that the intake of 20 grams (divided into several doses of 5 grams throughout the day) for 6 days significantly increased creatine levels at the muscle level, and these levels could be maintained if supplementation was continued with lower doses maintained over time (2 grams per day for the following 30 days). 1 In addition, we currently know that supplementation with intermediate doses but maintained over time (3-5 grams per day for 3-4 weeks) also manages to increase creatine levels in a similar way without the need for an initial acute phase with very high doses.1

Maximizing the Benefits of Creatine

The importance of insulin

Although the effective doses of creatine to increase the levels of this amino acid at the muscle level seem quite clear, less is known about other factors that could maximize its effects. For example, there is preliminary evidence to suggest that administering creatine concomitantly with increased insulin levels could facilitate the uptake of this compound into muscle tissue. In fact, a now classic study compared the effects of administering creatine alone (5 grams, 4 times a day) or combined with carbohydrates (93 grams of carbohydrates in each 5-gram intake of creatine).2 After 5 days of supplementation, those who had eaten carbohydrates along with creatine had 60% higher total muscle creatine levels than those who had taken it alone.2 Therefore, the intake of creatine along with carbohydrates could maximize the benefits of supplementation.

The role of exercise

Just as carbohydrates can facilitate the passage of creatine into muscle, a growing body of evidence shows that acute physical exercise could have similar effects. Due to the increase in blood flow that occurs with exercise (known as hyperemia), as well as the increased permeability of muscle fiber at the ionic level, taking creatine around exercise may facilitate its uptake by muscle (Figure 1).

Figure 1. Mechanisms that could support greater assimilation of creatine when ingested around exercise. Obtained from Ribeiro et al.3

In fact, different studies have shown that creatine intake around exercise provides more benefits than if it is ingested away from exercise. For example, in one study, participants took creatine for 5 days, during which they only trained with one leg pedaling to fatigue.4 Interestingly, creatine levels increased to a greater extent in the trained leg compared to the untrained leg, suggesting that exercise activates a number of mechanisms that favor creatine assimilation.

Similarly, another study compared taking a creatine-containing supplement around exercise (immediately before or after strength training), or the same dose but ingested away from training (in the morning or evening). 5 As shown in Figure 2, after 10 weeks of training, the group that supplemented around the training not only showed higher levels of creatine at the muscle level, but also greater improvements in muscle mass and strength, as well as greater hypertrophy of type II fibers (fast fibers).

Figure 2. Changes in body composition (panel A) and muscle strength (panel B) after creatine consumption for 10 weeks around exercise (PRE/POST) or at a time away from exercise (MOR/EVE). Abbreviations: LBM: lean body mass. Retrieved from Cribb et al.5

Does the timing around exercise matter?

It is therefore clear that creatine intake around exercise could bring greater benefits. However, a topic of great controversy in the world of sports nutrition is whether the timing around exercise also matters; that is, whether we should supplement before or after it.

Evidence in this regard is still scarce, and the variables that can affect these effects are numerous. For example, from the moment creatine is ingested, we observe the peak of this amino acid in the blood 1-2 hours later. Therefore, we could hypothesize that the ideal would be to align this peak in blood creatine with exercise-induced muscle hyperemia. That is, ingest creatine before exercise so that it is absorbed during exercise. However, the evidence does not seem to confirm this hypothesis, at least so far. A study conducted on bodybuilders compared the effects of supplementing with 5 grams of creatine before training or after training.6 After 4 weeks, the post-workout supplemented group tended to increase their muscle mass (3% vs 1.3%) and strength (7.5% vs 6.8%) more than the pre-workout supplemented group. It is important to mention, however, that in this study they did not measure creatine levels at the muscle level.

The benefits of post-exercise supplementation have also been supported by another study conducted in older people over 8 months.7 In this study, participants who supplemented with creatine, either before or after training, increased muscle strength to a greater extent than those who ingested a placebo. However, those who supplemented with creatine immediately after strength training also increased their muscle mass to a greater extent. Despite these studies, we must be aware that the evidence is still scarce and not very conclusive, and in fact other studies have not observed differences between supplementing with creatine before or after exercise. 8,9

Conclusions
While creatine supplementation is generally beneficial for health and performance, several factors may maximize creatine uptake by muscle and potentially its benefits. The intake of creatine together with carbohydrates seems to increase its absorption at the muscle level, as does supplementing around exercise. Conversely, there is not enough evidence that there are consistent differences between supplementation before and after exercise. Therefore, adding creatine to your carbohydrate and protein supplement after workouts can be a useful and effective option.

Pedro Valenzuela
Researcher in the Physiology Unit of the University of Alcalá and in the Performance Control Unit at the Sports Medicine Center (AEPSAD, CAR of Madrid).
Web: www.fissac.com

References
1. Hultman E, Söderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol. 1996; 81(1):232-237. doi:10.1152/jappl.1996.81.1.232
2. Green AL, Hultman E. Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. Am J Physiol – Endocrinol Metab. 1996; 34:E821-E826.
3. Ribeiro F, Longobardi I, Perim P, et al. Timing of creatine supplementation around exercise: A real concern? Nutrients. 2021; 13(8):1-14. doi:10.3390/nu13082844
4. Robinson TM, Sewell DA, Hultman E, Greenhaff PL. Role of submaximal exercise in promoting creatine and glycogen accumulation in human skeletal muscle. J Appl Physiol. 1999; 87(2):598-604. doi:10.1152/jappl.1999.87.2.598
5. Cribb PJ, Hayes A. Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc. 2006; 38(11):1918-1925. doi:10.1249/01.mss.0000233790.08788.3e
6. Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Int Soc Sports Nutr. 2013; 10(1):1. doi:10.1186/1550-2783-10-36
7. Candow DG, Vogt E, Johannsmeyer S, Forbes SC, Farthing JP. Strategic creatine supplementation and resistance training in healthy older adults. Appl Physiol Nutr Metab. 2015; 40(7):689-694. doi:10.1139/apnm-2014-0498
8. Candow DG, Zello GA, Ling B, et al. Comparison of creatine supplementation before versus after supervised resistance training in healthy older adults. Res Sport Med. 2014;22(1):61-74. doi:10.1080/15438627.2013.852088
9. Forbes S, Krentz J, Candow D. Timing of creatine supplementation does not influence gains in unilateral muscle hypertrophy or strength from resistance training in young adults: a within-subject design. J Sports Med Phys Fitness. 2021; 61(9):1219-1225.