It is important to consider and clarify that not everything goes in the world of sports nutrition. In a growing market for supplements and discount codes, interests over truth and scientific evidence sometimes prevail. Finding us a strange picture where most commercial products do not need to prove their effectiveness and do not do what they say and promise to do.

However, Cr monohydrate is one of the few supplements where the evidence is solid, both in its effectiveness and its safety and legality, knowing almost all of us its functions at the level of energy production and consequent improvement of performance for multiple causes (Figure 1).

We currently know that creatine is one of the most popular ergogenic nutritional aids for athletes (or should be). Studies have consistently shown that creatine monohydrate supplementation increases intramuscular creatine concentrations, which may help explain the improvements seen in high intensity exercises leading to greater training adaptations (Figure 1).

For all this, creatine is well known for its functions in the sports field, but without a doubt, somewhat less, in the clinical field and especially its important role at the brain and cognitive level that we will talk about in this post (among other things).

Both endogenous and dietary Cr are transported through the bloodstream to other organs (i.e., skeletal muscle, heart and brain). The majority of Cr in the body is absorbed and used by the skeletal muscle, being only a small portion absorbed by the brain.

The uptake of Cr in the brain is much slower compared to skeletal muscle, suggesting that the blood-brain barrier hinders this transport so it could be effective that protocols to increase brain creatine may require larger doses and / or more lengths of the conventional protocol (0.07g / kg).

Once in the brain, it uses it in the same way as the heart and muscle to produce ATP. Oral supplementation of Cr increases the physiological concentration at the brain level, which leads to an increase in PCr levels.

Cognitive deficiencies have been linked to inherent decreases in Cr in the brain, but it has been shown that increases in oral Cr supplementation successfully replenish Cr levels in the brain to theoretically reverse these deficits in cognition (Figure 2).

The increase in oral Cr supplementation results in better brain function, working memory, recognition memory and reduction of mental fatigue. This positive effect and other cognitive properties are supposed to be due to the greater availability of Cr in the brain.

Although according to the latest evidence, it seems that most of these effects in terms of supplementation, are of greater relevance in conditions of acute stress (mental fatigue, sleep deprivation, exhaustive exercise) or chronic (aging, depression, post-traumatic stress disorder) It can even exert a neuroprotective effect in an athlete population with a higher risk of head trauma (contact sports, collectives …) while a zero or minimal effect is observed in healthy individuals without these mentioned stress conditions.

Another of the most recent studies at the same time interesting, is the use of creatine monohydrate in the prevention of sarcopenia, decreased bone mineral density and inflammation in the elderly.

We found that sarcopenia (considered as a disease according to the WHO) is a muscular condition related to the passage of age (8-13% Adults> 60 years), characterized by a reduction in muscle quantity, muscular strength (dynapenia) and physical performance (that is, tasks of functionality) associated in turn with increased mortality and multiple comorbidities such as fragility, increased risk of falling and fractures, disability, cachexia etc …

Being multifactorial, sarcopenia can be caused by changes in muscle morphology, muscle protein kinetics, neuromuscular function, inflammation, physical activity and nutrition.

The main focus has been on nutritional interventions as a possible therapeutic approach to counteract it. Finding that when creatine is consumed by applying and without applying (to a lesser extent) strength training, it has been seen that there is an increase in muscle mass and its functionality in the elderly population.

Possibly influencing the metabolism of ATP and increasing the rate of calcium absorption in the sarcoplasmic reticulum, which would reduce the time of muscle relaxation and increase the development of strength, improving the kinetics of muscle proteins and factors such as inflammation.

At this last point, such as inflammation, it is proposed that, during the biological process of aging, there is an inherent damage at the mitochondrial level that adds to a high and sustained inflammation of low grade, causing defects in the electron transport chain, as well. as a negative effect on muscle and bone aging, which would lead to the overproduction of reactive oxygen species. These ROS can cause mutations in mitochondrial DNA, also damaging and altering cell membranes, causing inflammation, muscle damage and degradation of muscle proteins.

Creatine supplementation thanks to its role as an antioxidant can be effective in mitigating this damage at the mitochondrial level, which leads to reducing oxidative stress, cell apoptosis and low-grade inflammation.

However, the variability in the ability to respond to creatine supplementation is quite high in older adults and factors such as the initial concentration of intramuscular PCr, content and size of type II muscle fiber (which we know decreases with age ) together with the usual dietary intake of creatine can explain inconsistent findings in individual studies (since normally in the elderly population we know that dietary protein intake is somewhat lower).

Finally, other recent studies focus on creatine supplementation to improve bone mineral density, but this is only confirmed or supported in some trials, explaining thanks to a certain cellular activation involved in both bone formation and resorption. . Therefore, creatine could also have the potential function of reducing the risk of falls experienced by the elderly population, which would subsequently reduce the risk of fracture.

Even so, although there is a lack of evidence to confirm these latest findings, for all this, discussed above and knowing in advance its safety as chronic consumption in all types of healthy populations (renal and hepatic) and its other multiple mechanisms of action not mentioned (Figure 3). Older adults are considered one of the target populations where the use of this ergogenic aid would make more sense.



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