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Greater concentrations of creatine in muscle improves performance
The effect of creatine supplementation has been studied in people with different levels of fitness and athletic ability, ranging from elite athletes to relatively unfit beginners.

Creatine supplementation had a performance-enhancing effect for a wide range of sports.

For sports that require speed, such as sprinting, long jump, swimming, kayaking/rowing, and for intensive strength training by bodybuilders and cyclists, short-term creatine supplementation can greatly improve performance in the areas of maximum strength and endurance (5-15%), with interval training in the maximum range (5-20%), with power production in short sprints (approx. 30%,) and in training with repetitive sprints (5-15%).

Different mechanisms are involved in the ergogenic effects of creatine supplementation:

• Higher phosphocreatine concentrations serve as immediate reserves for ATP during exertion.
• Increased phosphocreatine resynthesis rate during and after exertion due to increased levels of creatine.
• Smaller decrease in muscle pH during exertion.
• Greater training capacity.
• Increase in muscle mass (absolute power output).

Short-term creatine supplementation over five days (20 g per day) increased the phosphocreatine resynthesis rate after recovery from intense exercise (Diagram 1)

Phosphocreatine resynthesis is critical for restoring muscle power at the beginning of the next set of intensive exercises. An increased resynthesis rate makes it possible to more intensive training sets, which is an advantage for explosive sports disciplines in particular.

During very intensive, repetitive forms of exercise there is enough ATP or 1-2 seconds, and phosphocreatine is available for the immediate regeneration of ATP. However, phosphocreatine stores last approximately 10 seconds. Increasing Phosphocreatine levels in muscle results in the delayed breakdown of phosphocreatine, which has a beneficial effect on muscle performance. More than 20 clinical trials have shown that creatine supplementation significantly improves muscle strength and/or performance during short bouts of high-intensity exercise.

The greatest improvements in performance can be found during series of repetitive high-intensity types of exertion that are interrupted by a fairly brief period of rest (e.g., 20-60 seconds). The rest breaks are sufficient to achieve greater recovery of phosphocreatine concentrations.

In one experiment, athletes were given 20 g creatine monohydrate per day for 6 days or placebo. They had to perform ten 6-second heats of high-intensity cycling exercise, interrupted by 30-second recovery periods. The athletes were requested to achieve a speed of 140 rpm. The resistance on the training bicycle was set so that the athletes were unable to maintain the target speed for more than 4 to 6 intervals. No differences were observed between the two groups prior to creatine supplementation, but short-term creatine supplementation resulted in significantly improved performance (Diagram 2).

Creatine supplementation likewise produced less formation of lactate, even though the same amount of work was done (Diagram 3).

In an additional study, muscle lactate accumulation was 70% lower after creatine supplementation after 5 standardized 6-second heats of high-intensity exercise.

Creatine supplementation is common in these sports: bodybuilding, weightlifting, wrestling, rowing, cycling, mountain biking, tennis, skiing, American football, soccer, rugby, basketball, ice hockey, volleyball, handball, and track and field (sprinting, shot put, javelin and discus).

Creatine supplementation increases the amount of creatine in muscle tissue
Orally administered creatine is absorbed by the intestines and then goes into the bloodstream. Small doses of creatine (1-10 g) result in maximum blood plasma concentrations after fewer than two hours (Diagram 4). For doses less than 10 g, maximum creatine levels are not reached for more than three hours.

Short-term supplementation with 15 to 25 g creatine for five days elevates the total creatine content in the muscles by 15-30% and the phosphocreatine stores by 10-40% (analyses of muscle biopsies). After a loading phase of five days, a maintenance does of 2-5 g is enough to maintain elevated creatine levels. Without the maintenance dose, creatine levels return to their original concentrations after four to five weeks. A comparable elevation of creatine levels can also be achieved with low-dose creatine supplementation of 3 g daily for four weeks (Diagram 5).

For concentrations of creatine in muscles there appears to be an upper limit that cannot be extended (~160 mmol per kg muscle dry matter) Ongoing supplementation with large amounts of creatine (15 g or more) does not raise the levels of creatine in muscle any more, so is not recommended.

Insulin-mediated stimulation improves the storage of creatine
Creatine storage can be improved by taking creatine together with simple carbohydrates, such as glucose, instead of just taking it in its pure form.
Ingesting carbohydrates raises blood sugar levels and therefore the secretion of insulin, an endogenous hormone.

The improved uptake of creatine into the muscles is attributed to stimulation of creatine transporters mediated by insulin.

Taking 4 x 5 g creatine for 6 days resulted in an increase of the total creatine of 17%. In contrast, it has been shown that total creatine can be increased 27% by taking 4 x 5 g creatine plus 90 g glucose for 6 days (Diagram 6).

Exercise also stimulates the uptake of creatine. The administration of 5 g creatine monohydrate 4 times a day for 3-5 days with subsequent training on an ergometer with only one leg resulted in an increase of total creatine in muscle of 37% in the leg that did the exercise compared to an increase of only 25% in the other leg, which served as the control.

The increase in creatine uptake can probably mostly be attributed to the increased perfusion of the muscle or to greater movement of the creatine transporters to the muscle cell membrane.

Taking carbohydrates at the same time does not increase creatine storage rates when the training sets are done before supplementation.

Dosage and intake recommendations for athletes
Dosage with a loading phase:
20 g (4 x 5 g) creatine monohydrate per day for 6 days, followed by a maintenance phase with 1 x 2-5 g per day or, alternatively, 0.3 g creatine monohydrate per kg body weight per day, followed by a maintenance phase of 0.03 g per kg body weight per day.

Dosage without a loading phase:
3 g per day for 4 weeks, followed by a maintenance phase with 2-5 g per day.

Creatine should always be taken with caffeine-free beverages, such as water, fruit juice or warm tea (which improves solubility). Make sure you take the creatine with enough fluids (rule of thumb: 1 g creatine/100 mL fluids).
The creatine drink should always be prepared fresh and drunk on the same day since creatine does not stay stable for long in liquids.

Creatine and Caffeine

Taking high doses of caffeine (5 mg per kg body weight per day) at the same time as creatine negates the ergogenic (performance-enhancing) effect of creatine. Small amounts of caffeine (e.g., 1-2 cups of coffee) appear not to negatively influence creatine’s effects.

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