Supplements Part 1: Creatine Monohydrate
Due to the popularity and the constant questions I receive, I have finally decided to do a couple blog posts on some specific supplements. I am going to write 3 different articles (this is part 1) each one going over the specific supplements I recommend (hint: it's a small list) and then a final article on what supplements are a complete waste of money - so a 4 part series. To make it clear, I am not a dietitian (RD) nor do I pretend to be, but again I guess anyone can become anything nowadays as long as they feel like they are that thing? I don’t know - joking aside I have spent hours and hours studying sports nutrition research as well as learning from countless RDs. I've always been intrigued with the nutrition side of sports, so much that in my undergraduate and graduate studies I always chose to take a sports nutrition or bioenergetic class. In the past I have written on Carbohydrates and Fats for performance if you are interested.
On a weekly basis I have a conversation with either an athlete or parent at which they start the conversation with “what supplements do you recommend”? This automatically makes me roll my eyes, but I keep the eye rolling to myself because I know they don't know any better. A better question would be “what should I or my kid be eating and drinking and how much”? I believe that a well-balanced diet with whole foods will check every single box nutritional taking away the need for the majority of supplements. The supplement industry is a multi-billion dollar industry and seems to be growing every year, so what does that mean? It could mean a couple things, but I ultimately think it has to do with the lack of education people have on supplements, hence me writing this. In Part 1 I will dive into creatine supplementation, Part 2 Protein, Part 3 will be a combination of Caffeine, Beta-Alanine and CBD with a final piece talking about certain supplements that are a complete waste of money. First, I think it's important to understand a couple things about the supplement industry.
There are a lot of problems with the supplement industry and unfortunately it makes a great breeding ground for unethical people and their practices. The supplement industry makes for a great breeding ground for unethical individuals because supplements are not regulated by the Food and Drug Administration (FDA) instead they are put through a post-market approval, which basically means that no legitimately clinical study has to be done to prove what is actually in the supplement or that it even works. Long story short, ANYONE can make a supplement and put it on the market. Why is that a problem? There was a research study that came out in 2018 showing that 776 supplements on the market had some kind of unapproved drug with 80% having at least 1 pharmactuel drug and some even having illegal drugs (Tucker et al., 2018). With the FDA not regulating supplements it allows people to lie about what and how much they put into their product and it also increases the chance of cross-contamination. The safest supplements to take are the ones that are sent and tested by a third-party such as USP or NSF, which is shown on the outside label of the supplement. When supplements are tested by a third-party you can trust what exactly is in the supplement and that the dosage of each ingredient is correct. Taking a supplement without a third-party test risks the chance of consuming something not listed and possibly failing a drug test or having a chemical interaction. With that being said, let's dive into creatine.
Creatine supplements are nothing new as they have been around for decades. With it being around for so long, creatine monohydrate is one of the most researched supplements on the shelf today, with a plethora of evidence and research behind it. Research is the only way we will ever know if something truly works, which is why I feel comfortable recommending creatine to my athletes or anyone who I think could benefit from supplementing with it. At some point every athlete and athlete's parent has at least heard of creatine - some good, some bad. There are a lot of myths pertaining to creatine, but overall there isn’t compelling evidence that it can cause any harm to the body. There are multiple ergogenic effects individuals can experience when supplementing with creatine including the ability to enhance strength, gain more muscle mass, help muscles recover faster from high-intensity anaerobic exercise and possibly even enhance brain function (Dolan, Gualano & Rawson, 2019). A significant ergogenic effect of creatine is its ability to help muscles recover faster and perform better during short bouts of anaerobic exercise. Before diving much further lets gain a broad understanding of the body’s three energy systems.
The science side of me is going to come out for this part, so bare with me. The body’s main source of energy comes from the molecule adenosine triphosphate (ATP), but the problem is it’s only stored in limited amounts in the muscle cell (Fink & Mikesky, 2018). ATP can be provided and replenished by three different energy pathways: phosphagen system (ATP-CP), anaerobic system (glycolytic/nonoxidative) and the aerobic system (oxidative phosphorylation).
Due to its ability to generate high rates of ATP quickly, the ATP-CP system is mostly responsible for initial short-quick bursts of high-intensity exercise that last 5-15 seconds. This system is able to produce energy on-demand without lag, which helps buy time for the other 2 systems to start producing ATP. Think about the initial start in a track event. The phosphagen system is limited in the amount of ATP it can produce - hence the other 2 energy systems. Power and strength performance are heavily reliant on the anaerobic energy system and phosphagen system (Fleck & Kraemer, 2014). When we look closer into the phosphagen system there is a molecule known as creatine phosphate (CP). Creatine phosphate is just the phosphorylated form of creatine. CP has the ability to donate its phosphate group to an adenosine diphosphate (ADP) in a one-step process via creatine kinase giving us an ATP (Fink & Mikesky, 2018).
Creatine kinase
Creatine phosphate + ADP 🡪 ATP + Creatine
During a high-intensity exercise such as sprinting, fatigue can start to set in because of the depletion of ATP and CP. Creatine phosphate (creatine) alone has been speculated to have an important responsibility for the regeneration of ATP, especially during the first 5-15 seconds of high-intensity exercise (Baker, Mccormick & Robergs, 2010). With creatine phosphate being an important role for high-intensity exercise, it’s been shown that supplementing with creatine monohydrate will increase levels of CP in the skeletal muscle. Creatine can be derived from multiple different sources like red meat, fish and it’s produced by the body in small amounts. Yes, our body produces creatine naturally.
When exercise extends past a couple of seconds carbohydrates (not CP) start to be the main fuel source through a pathway called anaerobic glycolysis (Baker, Mccormick & Robergs, 2010). The anaerobic system is mostly responsible for high intensity exercise lasting 1-3 minutes, but is a bit slower at producing ATP compared to that of the CP system due to the multi-step process of glycolysis. Glycolysis is a multi-step metabolic pathway that breaks down glucose (carbs) for energy. Glycolysis can be used with or without oxygen with the only difference being what the end product is converted into. The end product of glycolysis is pyruvic acid (pyruvate) and then depending on whether oxygen is available or not it is either converted to lactate (oxygen not available) or acetyl coenzyme A (oxygen available) (acetyl CoA) (Fink & Mikesky, 2018). Exercise lasting longer than a minute or two will require more from the aerobic system. This is where acetyl CoA enters the citric acid cycle stripping hydrogens to be sent to the electron transport chain (ETC) to produce energy (ATP). The aerobic system takes the longest time to produce ATP. I need to point out that all three energy systems will work together during different bouts of exercise, but usually one system will be more dominantly utilized over another depending on the intensity and duration of the exercise. Unlike that of the pathway of glycolysis, the aerobic system uses oxygen and is capable of utilizing carbohydrates, fats and proteins (Hawley & Hopkins, 1995). Because of the role that creatine phosphate has on the phosphagen system the following will reference mainly the ATP-CP system.
Creatine Monohydrate is the most effective type of creatine supplement. Any vitamin shop or major convenient store will have creatine monohydrate on the shelf ready for someone to purchase for a fairly inexpensive price. The sole purpose of creatine supplementation is to oversaturate the creatine phosphate stores in the skeletal muscle and brain allowing for an increased production of ATP. With increased CP levels in the skeletal muscle it allows athletes to maintain high-intensity exercise for a longer period of time resulting in better performance. Not only can athletes maintain high-intensity exercise for longer, they will also be able to perform it faster and more powerfully. There are two recommended protocols, either the typical loading phase of 20 to 25 grams a day split up into daily intakes of 5 grams or by consuming smaller amounts of 20 intakes of 1 gram every 30 min then both are maintained with 3-5 grams a day (Cooper et al., 2012). Personally I don’t like the loading phase of creatine and honestly it doesn’t seem to be necessary according to the research, so I recommend just 5 grams a day to my athletes that are taking creatine. Some individuals and athletes will have more subsequent increases in creatine phosphate stores than others. Those who do not consume animal products such as vegans or vegetarians, don’t eat enough calories, train constantly at high-intensities and utilize the phosphagen system frequently will be more likely to see increases in creatine phosphate stores. The rest of this article I will state a few research articles that back creatine supplementation with emphasis on its effects on bouts of anaerobic efforts.
Evidential Support of Creatine Supplementation on Bouts of Anaerobic Efforts
Research has shown that ingesting a creatine supplement can increase creatine phosphate levels in the body by 15 percent as well as the rate of CP resynthesis (Greenhaff et al., 1994). This specific study concluded that ingesting creatine can promote performance during repeated bouts of maximal isokinetic exercise, when each bout of exercise is separated by 60 seconds of recovery (Greenhaff et al., 1994). As mentioned earlier, athletes may benefit from delaying the depletion of CP in the muscle due to the saturation of CP levels in the skeletal muscle.
It’s proven that creatine supplementation will increase CP levels improving buffer capacity and CP resynthesis allowing for an enhancement in performance at high-intensity exercise (anaerobic). Kendall et al., presented a study using college aged males who were either put into a creatine supplementation group or a control group. Both groups performed high-intensity interval training (HIIT) and they found that the creatine group had increases in critical power compared to the control group, but no change was shown in anaerobic work capacity - max amount of ATP synthesized during a high-intense bout of exercise (Kendal et al., 2010). This made for an interesting point, but ultimately the intervals performed in the study were greater than 60 seconds with only a 2:1 work to rest ratio, which will put a greater reliance on the aerobic system. This proposed and as mentioned in their discussion, that in order to see changes in anaerobic work capacity, training exercises to fatigue may need to be less than 60 seconds with the correct amount of rest (Kendall et al., 2010).
It has been stated multiple times that the onset of fatigue within short bouts of high-intensity exercise is correlated with the inability to keep high rates of ATP production from creatine phosphate meaning; increased CP levels can improve performance (Casey & Greenhaff, 2000). There was a well performed study where cyclists performed 2 bouts of maximal cycling (30 seconds) with a 4-minute rest between bouts before and after creatine ingestion. They found that after the creatine supplement was consumed there was an increase in creatine phosphate levels in the vastus lateralis via biopsy (Casey et al., 1996). They concluded that there were improvements in performance after creatine intake because of the increased CP availability in type II muscle fibers, which makes sense because type II muscle fibers are the fast-contracting fibers and are responsible for the high-power output during high-intensity exercise (Casey et al., 1996). Study after study have shown that work output increases after exercise bouts in creatine supplementation groups compared to placebo groups (Birch et al., 1994).
It is fairly evident that increased creatine phosphate uptake has an ergogenic effect on specific sports (Casey & Greehaff, 2000). With what we know now, in order to utilize the ergogenic effect of creatine supplementation athletes must play sports that include a large amount of short bouts of high-intensity exercise such as, swimming, soccer, hockey, certain track events - to name a few. There is no research showing that creatine supplementation improves submaximal exercise (Casey & Greenhaff, 2000). When bouts of high-intensity exercise last longer than the phosphagen system can contribute energy it is assumed that creatine supplementation may not have an ergogenic aid effect.
Increased levels of creatine phosphate in skeletal muscle results in an improved capacity to sustain power, particularly when repeated exercise bouts with only short recovery periods are involved (Maughan, 1995). One reason for this could be the effect creatine has on muscle damage markers. Recovery is another great result of creatine supplementation. A study done by Veggi et al., used young men who were split into two groups - a creatine supplementation group or placebo group. On day one and day 15 four sets of bicep curls at 75% of 1 RM to concentric failure were performed. With increases of muscle soreness in each group happening after one day, the creatine supplementation group showed to have less creatine kinase activity and less soreness than the placebo group on the last day (Veggi et al., 2013).
Benefits and Risks. As mentioned above there are multiple benefits from creatine supplementation on sports performance, but there may be risks that should be noted as well. The benefits include, but not limited to enhancing strength and hypertrophy, improving high-intensity exercise and producing positive effects on strength, power and fat free mass (Cooper et al., 2012). The risks involved mostly have to do with the overconsumption of creatine itself and not following the short or long-term recommendations of creatine supplementation. Overconsumption of creatine could lead to muscle cramping, nausea, stomach pain and diarrhea, with muscle cramping being one of the more popular among athletes (Brudnak, 2004). The effects of creatine supplementation on renal function has also been a popular headline that might throw some red flags to athletes, but it's nothing to worry about. Yoshizumi and Tsourounis found that creatine supplementation may be a false indicator of renal dysfunction and is safe for healthy individuals who are taking the recommended amounts (Yoshizumi & Tsourounis, 2004). Even long-term creatine supplementation is considered effective and a safe ergogenic aid if taken appropriately (Bizzarini & De Angelis, 2004).
Creatine supplementation has shown to be a successful, safe and effective way to enhance performance, especially within repeated bouts of maximal anaerobic efforts. If taken within the recommended amounts of loading at 20-25 grams a day and a maintenance of 3-5 grams a day, no negative risks will be present. It is the ultimate supplement to improve performance with little to no risk. One item to take into consideration is creatine supplements’ positive correlation with an increase of body mass. Athletes who play sports that involve bouts of high-intensity exercise, such as soccer, swimming, hockey and certain track and field events could gravely benefit from creatine supplementation. There is no knowledge up to this point that creatine supplementation enhances improvement under submaximal exercise. Creatine supplementation increases creatine phosphate in the body, but may not increase or benefit every individual athlete, even in high-intensity exercise sports because of several factors regarding their diet and training level. As mentioned above, creatine monohydrate is an inexpensive and effective supplement that can have ergogenic aid with most healthy athletes. There has been a lack of research in recent years on creatine supplementation for sports performance mostly due to that fact it was so evident early on that it worked. Most research being done currently is creatine's effect on brain function, which is a very compelling and interesting topic for another time.
References
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