| Occurrences in food | |
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Creatine is mainly found in meat and fish in quantities of about 2 - 7 g/kg food. In addition, the human body is able to produce 1 - 2 g creatine per day in the liver, kidneys and pancreas and store it in the skeletal muscles. |
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| Physiological effects | |
| Energy metabolism |
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| Ion transport |
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| Nerves and Musculature |
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| Health Claims | EFSA Opinion | |
| Creatine |
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| Nutrient requirement | |||
| Normal requirement adults | 1 – 2 g/d | ||
| Higher demand | Vegetarian diet, weight training, stress, Duchenne muscular dystrophy (DMD), amytrophic lateral sclerosis (ALS) | ||
| Safety of the nutrient | Creatin | |
| UL |
Long-term daily intake, at which none negative effects on health are to be expected |
EFSA 3 g/d |
| NOAEL |
Maximum intake dose, not used in studies harmful effects caused |
k. A. |
| Creatine - a natural performance enhancer |
| Creatine is an endogenous compound synthesized from the amino acids glycine, arginine and methionine in the kidneys, pancreas and liver. About 95 % of the total body pool is located in the skeletal muscles, about 5 % is distributed to the brain, testicles and heart muscle. Creatine plays a central role in the energy metabolism of cells with high and fluctuating energy requirements, such as those found in the CNS, heart and skeletal muscles and sperm. The key enzyme of creatine action is creatine kinase, which catalyses the transfer of the phosphate group from creatine phosphate to ADP, resulting in energy-rich ATP. Creatine phosphate is therefore a kind of cellular “energy buffer“ that can rapidly regenerate ATP during exercise (1). |
| Creatine increases performance in advanced age |
| With increasing age there is an increase in body fat mass, a decrease in muscle mass and a decrease in creatine concentration in skeletal and cardiac muscles as well as in the brain. These processes lead to lower muscle strength, coordination and general performance – motility and physical and cognitive performance may decrease as a result. The alimentary intake of creatine is therefore indicated in older people (2). For example, three different performance measurements showed an improvement in strength, performance and movement coordination of the lower limbs in senior women who took creatine for a short time (3). |
| Creatine in rehabilitation |
| However, the use of creatine is more urgent in individuals whose muscle mass and strength have decreased significantly after periods of immobilization, such as injuries, fractures, or bed-ridden conditions. Creatine supplementation during complete immobilization does not seem to interfere with muscular atrophy, but can support muscle reconstruction during rehabilitation – muscle strength and muscle cross-section recover significantly better than in the placebo group (4).
A new study in pediatric leukemia patients shows that creatine prevents the accumulation of fat tissue caused by corticosteroid treatment and improves BMI (5). |
| Therapeutic Use of Creatine in Neuromuscular Diseases |
| Many neuromuscular diseases are associated with disturbed cell energetics and can be influenced by creatine monohydrate. In Duchenne muscular dystrophy, the genetic absence of the dystrophin protein leads to an overloading of the muscle fibers with calcium creatine posphate, which is increasingly consumed. Studies show that creatine lowers cytoplasmic calcium levels and increases intramuscular and cerebral phosphocreatine stores (6). Clinical studies in patients with muscular dystrophy of the Duchenne or Becker-Kiener types confirm that targeted substitution with creatine monohydrate improves the parameters of muscular function and fat-free body mass (7). Although the administration of creatine and thus the increase in creatine phosphate levels cannot eliminate the actual causes of various neuromuscular diseases, creatine supplementation improves the cellular energy balance of muscles and nerves (8). Early intervention may not only improve the symptoms, but also slow down the course of the disease. |
| Creatine improves cognitive performance |
| The creatine kinase system plays an important role in the energy balance of brain cells and is crucial for the optimal functioning of the central nervous system and sensory cells. Supplementary creatine intake increases stress tolerance, improves cognitive function of the brain under stress, and supports intelligence and memory (5).
In a group of vegetarians, oral administration of creatine (5 g over 6 weeks) led to a highly significant improvement in memory and intelligence (Raven’s Advanced Progressive Matrices) (9). Recent studies show that creatine is also neuroprotective and can protect neurons from various stressors (10). Creatine also appears to be a new therapeutic treatment strategy for neurodegenerative diseases and Parkinson's disease (11). |
| Creatine for growth and mineralization of bone and cartilage |
| Another application of creatine is bone and cartilage health. Here, too, the improvement of cellular energetics seems to play a role. Studies show that supplementing creatine with training – has a positive effect on bone and cartilage growth and mineralization (12). |
| Creatine in popular and competitive sports |
| An increase in muscular creatine phosphate stores (“creatine loading“) delays ATP consumption during repeated short-term stress peaks. Necessary muscular regeneration phases are shortened by increased creatine phosphate and ATP resynthesis and an increase in performance is also achieved in the anaerobic-alactacid range (1). |
| Oral creatine monohydrate administrations may increase creatine content in skeletal muscle |
| The major part of the muscular creatine increase is already achieved after one week of supplementation, but can be further increased by concomitant training or insulin stimulus. The increased creatine content leads to an improved muscular performance, whereby more strength and higher intensity can be trained. However, lasting ergogenic effects can only be expected after several weeks of supplementation during training (13).
The efficacy of oral creatine supplements in sports is subject to strong fluctuations, whereby there are responders and non-responders (5). Especially persons with low baseline values, as is often the case with vegetarians, can be expected to improve their performance (14). |
| Application modes for achieving maximum muscular creatine charge |
| In principle, two application modes are possible for (competitive) athletes: Creatine supplement with loading phase: On the first 5-7 days, 5 x daily 4 g creatine (= 20 g creatine/day) are taken together with water or a carbohydrate-containing drink between meals. Afterwards a 5-week holding phase with 2-5 g creatine per day begins. It should be taken in the morning after getting up or after training. After this phase a one-month break is taken (15) (16). Creatine supplementation without loading phase: Alternatively, 2-3 g creatine can be taken daily for 28 days. This ensures a sufficient total creatine concentration, but weight gain does not occur as quickly (17). This method is particularly recommended for athletes who do not want to gain weight so quickly but are primarily interested in a higher strength development, as well as for athletes who develop stomach or intestinal problems with higher creatine doses. During both application modes, make sure that the liquid supply is sufficient. |
| Creatine Training Accompanying in strength sports |
| creatine increases the expression of insulin-like growth hormones, activates essential stem cells of muscle building and accelerates muscle differentiation (5). The stimulation of muscle growth and lean lean mass is accompanied by increased muscle strength and an improved ability to regenerate (13). In the first few days, weight gain of approx. 1 kg can already occur. This is due to the increase in muscle water. Muscle build-up through protein synthesis only occurs through longer-term dietary supplements. |
| Creatine Training in other sports |
| The intake of creatine helps to improve “charging“ of the muscle battery, higher muscle speed, improved repetitive maximum strength performance and faster recovery after intensive exercise. Taken together with carbohydrates after intensive training, it leads to higher glycogen storage in the muscles (5). Studies have also shown that creatine protects the glycogen pool during repetitive short-term stress peaks (18). Creatine supplementation benefits sports where short-term endurance is required and team sports such as football, where sprinting capacity is improved (19). An increase in performance can also be observed in endurance sports which include sprinting, running or cycling (15). |
| Creatine for sports injuries |
| Another field of application of creatine is sports injuries such as muscle tears and strains, where it causes faster healing (20). |
| Creapure® - a question of quality |
| Die Qualität des Kreatins ist ein wichtiger Sicherheitsaspekt. Insbesondere wenn Kreatin über eine längere Zeit supplementiert wird, sollte das Präparat von bester Qualität und frei von Verunreinigungen sein. Bei den am Markt angebotenen Kreatinpräparaten gibt es große Qualitätsunterschiede, daher setzt Biogena auf hochwertige und geprüfte Markenqualität. Der deutsche Anbieter AlzChem AG bietet mit Creapure® bietet bestes, reinstes Kreatin, HPLC-getestet und frei von Abbauprodukten und Verunreinigungen aus patentierter Kreatinherstellung. |
| Effect on | Symptomatics |
| General condition | Susceptibility to stress, reduced regenerative ability, fatigue, muscle weakness, muscular atrophy |
| Energy metabolism | Disorders of the mitochondrial and cardiac energy metabolism |
| Effect | Indication | Dosing |
| Physiological effects with low Nutrient dosages |
Preventive for deceleration Age-related muscular or neurodegenerative changes | 2 g/d |
| To ensure creatine supply in case of insufficient alimentary intake as in vegetarian or vegan diets | 2 g/d | |
| Therapeutic in phases of Reconvalescence by accelerated muscle structure as with cachexia, after accidents and sport injuries or after illness | 5 – 10 g/d | |
| Therapeutic as concomitant dietary treatment of muscle diseases such as Duchenne muscular dystrophy | 5 – 10 g/d | |
| Zur Optimization of performance for high-intensity short-time loads such as in athletics (shot put, javelin and discus throw, sprint), hurdles or speed skating | 2 – 10 g/d | |
| Zur Performance enhancement in endurance or team sports such as football or handball, by increasing sprint capacity | 2 – 10 g/d | |
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To improve repetitive maximum force performance, e.g. in training for repeat sprints, to optimize maximum force, to promote the muscle building and for increasing muscle mass in strength sports as well as for shortening of regeneration time after training units |
2 – 10 g/d | |
| Pharmacological effects with high nutrient dosages |
In the form of a loading phase for creatine supplementation in Performance sport | 20 – 30 g/d in 2 – 3 single doses over 5 days |
| General Revenue Mode | |
| When |
Creatine should be taken together with water or a carbohydrate drink between meals. |
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Note:
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| Side effects | |
| When used for a short time, no side effects are to be expected. Long-term and high-dose use may result in increased muscular cramp susceptibility, weight gain due to water retention and increased kidney load. The possibility of a reduced body's own creatine synthesis with permanent supplementation is also being discussed; therefore, a regular break should be observed when using it in sports. | |
| Contraindications | |
| Serious renal insufficiency (because creatine is excreted as creatinine via the kidney) | |
| Interactions with drugs | |
| None | As far as we know, no relevant interactions are known. |
| Track elements | A combination with magnesium can reduce the tendency to muscle cramps. |
| Coffein | A concomitant intake with caffeinated beverages may reduce the ergogenic effects of creatine. |
| Description of the micronutrient |
| Low molecular weight substance which is endogenously formed from the amino acids L-arginine, glycine and L-methionine |
| Connections |
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Creatine monohydrate Buffered creatine („Kre-Alkalyn“) - pH of creatine was increased Creatine in other bonds (creatine nitra, malate, citrate, -HCL, -pyruvate) - unproven special effects |
| References |
| (1) Gröber U: Orthomolekulare Medizin. Ein Leitfaden für Apotheker und Ärzte. 2008. (2) Dalbo VJ, Roberts MD et al.: The effects of age on skeletal muscle and the phosphocreatine energy system: can creatine supplementation help older adults. Dyn Med. 2009 Dec 24;8:6. (3) Gotshalk LA, Kraemer WJ et al.: Creatine supplementation improves muscular performance in older women. Eur J Appl Physiol. 2008 Jan;102(2):223-31. (4) Hespel P, Op't Eijnde B, et al.: Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001 Oct 15;536(Pt 2):625-33. (5) Wallimann T.: Kreatin in der Allgemeinmedizin. Ars Medici Dossier VII+VIII, 2009. (6) Pearlman JP, Fielding RA.: Creatine monohydrate as a therapeutic aid in muscular dystrophy. Nutr Rev. 2006 Feb;64(2 Pt 1):80-8. (7) Tarnopolsky MA: Clinical use of creatine in neuromuscular and neurometabolic disorders. Subcell Biochem. 2007;46:183-204. (8) Gualano B, Artioli GG et al: Exploring the therapeutic role of creatine supplementation. Amino Acids. 2010 Jan;38(1):31-44. (9) Rae C, Digney AL, McEwan SR, Bates TC.: Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. 2003 Oct 22;270(1529):2147-50. (10) Riesberg, L. A., Weed, S. A., Mcdonald, T. L., Eckerson, J. M., & Drescher, K. M.: Beyond muscles: The untapped potential of creatine. International Immunopharmacology, 2016, 37, 31-42. (11) Adhihetty PJ, Beal MF.: Creatine and its potential therapeutic value for targeting cellular energy impairment in neurodegenerative diseases. Neuromolecular Med. 2008;10(4):275-90. (12) Candow DG, Chilibeck PD.: Potential of creatine supplementation for improving aging bone health. J Nutr Health Aging. 2010;14(2):149-53. (13) Hespel P, Derave W.: Ergogenic effects of creatine in sports and rehabilitation. Subcell Biochem. 2007;46:245-59. (14) Barr SI, Rideout CA.: Nutritional considerations for vegetarian athletes. Nutrition. 2004 Jul-Aug;20(7-8):696-703. (15) Twycross-Lewis, R., Kilduff, L. P., Wang, G., & Pitsiladis, Y. P.: The effects of creatine supplementation on thermoregulation and physical (cognitive) performance: A review and future prospects. Amino Acids, 2016, 48(8), 1843-1855. (16) Preen D, Dawson B et al.: Creatine supplementation: a comparison of loading and maintenance protocols on creatine uptake by human skeletal muscle. Int J Sport Nutr Exerc Metab. 2003 Mar;13(1):97-111. (17) Hultman E, Söderlund K et al.: Muscle creatine loading in men. J Appl Physiol. 1996 Jul;81(1):232-7. (18) Roschel H, Gualano B, et al.: Creatine supplementation spares muscle glycogen during high intensity intermittent exercise in rats. J Int Soc Sports Nutr. 2010 Jan 29;7(1):6. (19) Ostojic SM: Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103. (20) Cooke MB, Rybalka E et al.: Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. 2009 Jun 2;6:13. References Interactions: (1) Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008 (2) Gröber Uwe: Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011 (3) Gröber Uwe: Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 2. Auflage, 2012 |
