The Versatility of Creatine for Optimal Health and Athletic Performance

Q&A for Session #3
Sports Nutrition Symposium 3.0
Monday June 24th, 2021 @ 7 pm CST

Scott Forbes, Ph.D., CISSN 400 x 400 Black Background

In the presentation I will outline what creatine is, and how creatine supplementation can impact muscle, bone, and brain health. It is one of the few supplements that has consistently been shown in the scientific literature to be effective.

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  •  Is there gender differences in response to creatine supplementation? what are the side effects of creatine and how can they be avoided?
    • Yes, females have a lower baseline level of creatine, which means they're more likely to respond better to creatine. However there are not a lot of comparative studies on female vs. male use of creatine. The most common side effects include nausea & GI distress, however these side effects are quite rare except weight gain. The weight gain comes with water retention and lean tissue mass. Those that take creatine and exercise lose fat mass compared to those who don't exercise.
  • If we take the creatine only in the training days, should it be before or after? does it matter?
    • 0.1g/kg on training days (about 6-10g creatine). A training day can be defined as any type of exercise that involves resistance training.
  • Are there any contraindications for creatine use for athletes that have Afib, SVT or other arrhythmias?
    • Talk to your primary care physician about how creatine impacts these conditions. There has been a recent study on creatine and heart health.
  • Is there research indicating which delivery method is more effective: powder or capsules?
    • Both powder and capsule are most likely effective.
  • Is creatinine appropriate for individuals who may only train/exercise recreationally? If so, would dosing and maintenance be the same?
    • Yes! There have been studies involving many populations. It is ok to take the same recommended amount for recreational athletes.
  • So it doesn’t matter before or after exercise - just close to session.
    • Ideally you want to take creatine close to session. Taking it before or after doesn't matter.
  • Does creatine have an indirect effect on bone in individuals who don't exercise? sine they aren't enhancing muscle strength..
    • In theory, creatine does not have effect on individuals who do not exercise.
  • May be silly question. But do you suggest pure creatine monohydrate? or is it ok if pre workout has creatine in it?
    • Based off of one single study, combining caffeine and creatine is not ideal. Try to avoid taking it too close together.
  • Some of the research you presented was in older adults. What is the typical age range for the older adult population?
    • 55+ age range
  • Would creatine have a positive effect on migraines?
    • It's possible that creatine has a positive effect on migraines, however its not part of Dr. Forbes research
  • Are there any contraindications for creatine supplementation? (eg. any comorbidities elderly populations may typically have?)
    • Creatine has been seen as safe even for the elderly population, even from 75-85 years of age. This inclues possible benefits on muscle, bones, and possibly cognition.
  • Any future research planned around creatine use in youth athletes, specifically from a dosing and safety standpoint? I have reviewed some of the literature and haven’t found anything to contraindicate use in youth, but also no research directly looking at long-term safety and dosing. What are your thoughts on use in youth and dosing recommendations? Of course, keeping in mind other nutrient needs are being met through food first.
    • Typically Dr. Forbes does not recommend supplements to youth athletes. However, evidence suggests that it can be effective in youth athletes to enhance exercise performance. Primarily Dr. Forbes recommends to get quality sleep, good diet, and exercise prior to creatine supplementation.
  • Is it safe to take creatine everyday if you don't exercise? and at what dose? thank you!
    • Creatine is safe to consume in the recommended dosages even if you don't exercise.
  • Can you suggest any common dosages for support after TBI?
    • There haven't been enough studies for recommendations on creatine for TBI. Studies have shown that higher dose may be required for bone health. Upwards of 10-20 g/day have been seen to be effective for cognition in 2 studies. Although we need additional studies to confirm creatine for cognition.
  • Are gains seen lost when athlete discontinues use?
    • You will retain the muscle that you gain with creatine as long as you continue to exercise.
  • If an individual were taking creatine for some time and then stopped for whatever reason, is it necessary to complete another loading phase or simply go back to how much was being taken during maintenance?
    • If an individual was taking creatine phase loading v maintain ( 0.1g/kg ). After 4-6 weeks an individual will return back to baseline creatine stores after a loading phase. However, loading is not necessary, it just depends if an individual wants to quickly saturate their muscles. If an individual will be taking creatine for shorter than 4-6, then you don't need to cycle. There have also been no studies directly comparing cycling v continuous consumptions of creatine.
  • Has there been in any relationship with aggression and creatine?
    • There is no relationship linking aggression and creatine.
  • Do you need any female strength training athlete participants for studies? 😜🙋‍♀️🙋‍♀️
    • As of now, no. There is possibility in the future!
  • What does the research indicate regarding creatine and hair loss?
    • Research does not currently show a link between male patterned baldness and creatine.
  • Is there any evidence of benefit at lower daily doses (i.e. less than 2g/day)?
    • Consuming less than 2g/day even for older adults shows enhanced muscle mass and upper body strength. However with less than 2g/day of creatine, there was not evidence of an increase in lower body strength.
  • How does creatine supplementation affect physical speed, e.g., 40 yard sprint?
    • Yes! It has also been shown to help with recovery as well.
  • Considering older individuals have a natural lower kidney function (or should I say, that as we get older and older, kidney function decreases, glomerular filtration rate more precisely), how can we reconciliate creatine supplementation consumption in said individuals?
    • Research currently shows that there is no impact of creatine on kidney function.
  • Any studies you know of about creatine and Alzheimer's?
    • Research has shown that individuals with Alzheimer's have lower brain creatine content than those without Alzheimer's. In theory creatine could benefit those with Alzheimer's, however there are no studies at this time.
  • Are there many studies on creatine helping concussion or post concussion syndrome?
    • Currently there is little evidence to support creatine helping concussion or post concussion syndrome. I'd be cautious to promote creatine for concussion recovery.
  • If an individual were taking creatine for some time and then stopped for whatever reason, is it necessary to complete another loading phase or simply go back to how much was being taken during maintenance?
    • An individual does not have to take time off of consuming creatine. Your liver and kidneys won't be effected.
  • Is creatine safe for pregnant women?
    • Animal models have shown a positive effect.
  • Is it safe for adolescent and high school athletes?
    • When considering a certain age to take creatine, multiple moral & ethical aspects come into play. Dr. Forbes doesn't promote supplements to those under to 18. However, there is evidence to suggest 16 and 17 year old's can enhance exercise performance with creatine supplementation. Evidence suggests it is very safe for those under 18 years of age.
  • For endurance athletes, should we take creatine only on strength training days?
    • Creatine may impact runners different due to weight gain. Studies in cyclists have shown in a 120k time trial, that creatine and carbohydrates combined enhanced performance.
  • What is creatine's impact on weight loss besides preserving lean muscle mass?
    • The best available evidence suggests higher protein diets (2.4g/kg/day) during wt loss phase paired wtih reisstance training, is the best way to mitigate muscle loss during weight loss. In terms of mobilization, such as an individual in a cast due to an injury, taking creatine may help preserve muscle mass.
  • Is all creatine created equal?
    • No, there are different forms. Current evidence suggests that creatine monohydrate is the best. It has also been the most studied and is the cheapest form. As of now, no other form of creatine has been shown to be more beneficial.