News on the Creatine Front

Not Just for Muscle!

I’ve been pretty out of the loop for a few months of travel and gardening, but there have been a lot of interesting reports surfacing in the scientific literature. I’m going to tell you about some of these in the next few posts.

Let’s start with some news about creatine. I’ve written about and probably raved about creatine supplementation for years now, because of its well-known and well-studied role in promoting and maintaining muscle growth and performance. In the past few years, it has been implicated in maintaining bone density and cognitive abilities – both of which are extremely important to us as we get older.

Before I get into the weeds with those new studies, let me briefly summarize the role of creatine in muscles. What exactly is going on in our muscles when we supplement with this stuff? Briefly, creatine is a reservoir of phosphate (P), which is essential in producing ATP, the energy currency of all cells. With a little extra P, your muscles can contract longer and harder, allowing you to build more muscle mass – a really good thing as we age. There’s a catch though (isn’t there always?) – if you want to get these muscle benefits, you have to train while taking creatine. (Not necessarily true for cognitive boosts, read on.)

If you want a nice visual overview:

Of course, the enhanced muscle-building and -maintaining seen with creatine supplementation are hugely important to us as we age. This is another topic I’ve harped on because muscle may be the single most important tissue to carry along with us as we get older. The benefits range from improved balance and responsiveness which protect from falls (one of the leading causes of death and incapacity in older adults) to improved blood sugar and fat balance which are protective against a host of chronic diseases that plague and ultimately kill many of us (e.g. diabetes, heart disease, metabolic syndrome).

There are over four decades of data showing the efficacy and safety of creatine. Virtually all of the early work focused on strength or resistance training. Some newer studies show that supplementation also has a positive effect in aerobic or cardiovascular activities. This makes sense: Creatine gives you an extra reserve in all your muscles, whether you use them for resistance or cardio work. It just so happens that weight or resistance training depletes the limited amount of ATP in the muscle much more than aerobic activities because the latter allow your mitochondria to keep producing some ATP while working.

Another exciting new finding is that if you supplement with creatine while eating a diet that has a reasonable amount of carbs (i.e. not a ketogenic or paleo diet), the glycogen stored in the muscles increases. This is important because glycogen is a food bank kept in the muscles to power the contractions during exercise. If you have experienced or read about ‘hitting the wall’ or ‘bonking’ during exercise, it’s usually because the glycogen stores in the muscles have run out.

Although there are a lot of variations on how much and when to take creatine, for most of us, 5 grams per day is an easy round figure to remember. It dissolves easily in water and doesn’t have much taste making it easy to drink down. If you want a more precise dosage you can go with 0.1 gram per kilogram of body weight. And while I’m on the topic, when I talk about creatine supplementation, I mean creatine monohydrate powder. There are other (more expensive) forms but this stuff is easy to find and pretty cheap.

These and other details and myths (such as the over-hyped claims of water retention) about creatine supplementation are covered clearly in this review.

Now, let’s move on to some newer findings. For the XX individuals out there, a couple fascinating findings. In younger, i.e. premenopausal women, besides building muscle and strength (not controversial), compared to the placebo group, consuming creatine on training days resulted in significant increases in total sleep; sadly I haven’t been able to replicate that in my older body.

As women age, and experience the drop in estrogen caused by menopause, bone density takes a big hit. There are a lot of drug and exercise regimes out there to build bone density, and several recent studies suggest creatine can have a beneficial effect. Before I give you those results, we need to take a side trip into just what bone density means.

This important feature of bones is usually measured by a type of X-ray (abbreviated as DEXA) that assesses the amount of mineral (mostly calcium) in a given volume of bone. Ergo, lower bone density means less mineral, which correlates with the rigidity or strength of bone. There is another feature of bone that is important to this discussion which is more difficult to measure and that is bone elasticity. You can think of this as the ability of bone to accommodate bending – an important aspect of bones that allows them to absorb stress without breaking.

In a two-year study of post-menopausal women, when compared to the placebo group (i.e. not taking creatine), the treatment group did not see any significant increase in bone mineral density at the sites typically measured (the top of the femur, the hip, and the lumbar spine). However, creatine at the 5 gram dose did have two important effects. Women in the supplementation group maintained the cross-sectional area of the femur (i.e. its size), and its ‘buckling ratio’ which is a measure of its resistance to bending. In my mind, these are more important metrics than bone density as density alone without flexibility can result in stiffer, more fracture-prone bones.

Finally, some very preliminary data suggest that high dose creatine may boost cognitive skills in people with Alzheimer’s – a disease of aging that slowly in irrevocably eats away at brain tissue causing what has been thought to be irreversible losses of memory, personality and intellectual abilities.

Some researchers believe the damage caused by Alzheimer’s is due to an energy deficit, possibly because blood vessels in the brain deteriorate with age, especially with diets and lifestyles that cause vascular damage, there is a problem with how the brain produces and uses energy. As you now know, creatine, provides an energy reserve in cells such as muscle and brain that require a lot of energy.

The typical dose we’ve discussed is 5 grams per day, but because creatine exits the blood into muscles first, a higher dose was used in this study, in hopes of improving creatine’s odds of making its way to the brain. For this trial, 19 participants with Alzheimer’s disease ages 60-90, took 20 grams of creatine monohydrate every day for eight weeks. The higher dose appeared to work, as study participants showed an 11% increase in brain creatine levels.

A few behavioral tests were done on the study group. They showed a moderate improvement in working memory, which is task-oriented memory. Participants also demonstrated a moderate boost in executive functioning, another cognitive domain highly affected by Alzheimer’s disease that includes a person’s ability to focus and ignore distractions.

This study clearly needs replication, but some results from disabled and elderly populations support the benefits of creatine for general health, of both body and mind. And, it seems you don’t have to work out to get these benefits, though to build and maintain muscle the training part of the equation is non-negotiable. Here’s Stuart Phillips, PhD, professor of kinesiology at McMaster University in Hamilton, Ontario, Canada describing some of these studies.

In a younger (18-65), apparently healthy group (a number of criteria were used to establish health status, including BMI, alcohol and drug use, psychological stability) creatine was supplemented at the lower standard dose (5 gm per day). The 150 subjects were tested in both treatments, creatine and placebo, in alternate ordering (one group had creatine first, for 6 weeks, then placebo for 6 weeks; the other group the opposite order). Supplementation resulted in a small improvement in abstract reasoning (as measured by one test) and working memory (assessed by the backward digit span test – kind of a fun thing to test yourself on).

Unfortunately, age was not included as a variable but diet choice was. Vegetarians and omnivores were analyzed separately, and there was no difference in cognitive benefit between the two groups. Why, you might wonder, was this hypothesis tested? Well, like some other nutrients (B12 and amino acid quality), creatine is present in animal foods but not plants. However, the amount you get from a typical diet is pretty small, you’d have to eat kilos of beef or salmon to get 5 grams of creatine! Probably best to use the powder form.