Creatine: The Best Forms
Muscular Development|December 2020
New products and formulations are introduced to the supplement market every day. However, it is very rare for a product or especially an ingredient to create noteworthy evolution in supplement performance. Arguably, the greatest leap up this axiomatic evolutionary ladder occurred with the advent of creatine supplements in the 1990s. Creatine has proven over and over to be “the real deal” in clinical research and broscience. It’s a muscle-building, performance-enhancing supplement that nearly all athletes should use.
By Victor R. Prisk, M.D. 

Many innovative forms of creatine have hit the market since the introduction of creatine monohydrate (CM) in the early 1990s. Companies bank on the fact that creatine, at least in monohydrate form, is a reliably effective supplement. Athletes and even average consumers are familiar with the name “creatine,” whether they think it is a performance-enhancing drug or a healthy supplement. In order to create new buzz about creatine, many different angles have been used.

First, creatine can come in various physical forms. These could be liquids, powders, gels, chews or pills. These products may mix creatine with other supplements in the hope to increase absorption or effectiveness. Second, creatine comes in different chemical forms (i.e., salts and esters). Also, because creatine is technically an amino acid, it can be combined with other amino acids to make a peptide chain (di- and tri-peptides). We will go into more detail about this in the content that follows. Third, it has been suggested that these various forms of creatine act physiologically different than CM. Claims of better absorption, greater strength gains, or less side effects are used in marketing to differentiate products from CM. With all of this variety, has any form been shown to outperform or even match the performance of original CM?

Structure and Function

For those who aren’t as familiar with creatine structure and function, I will provide a brief review. Creatine is made in the body from the amino acids arginine, glycine and methionine. Creatine is not an essential nutrient, but methionine is an essential amino acid that must be obtained in the diet. Otherwise, fish, meats and supplements act as an excellent source of creatine. Vegetarians (especially vegans) can be relatively deficient in their creatine intake.

Creatine is involved in energy production in many tissues. In muscle and brain cells, creatine is converted to creatine phosphate to act as a phosphate donor to recreate needed ATP (adenosine triphosphate) from ADP (adenosine diphosphate). Creatine phosphate makes sure that ATP is immediately available for short bursts of energy; a couple of examples would be a 30-second sprint or one set of lifts in the gym. Deficiency of creatine in a vegetarian diet results in poorer results on tests of cognitive function, with improvements in memory upon supplementation.1 Levels in muscle can be increased by up to 40 percent with dietary supplementation.2

It can be said that creatine is one of the most studied supplements on the planet. It has also been said that CM is the most effective, safe and well-studied performance-enhancing supplement.2 Studies show that using creatine enhances strength, speed and even endurance. It was initially thought that based on creatine’s mechanism of action, it would only be useful in buffering short bursts of energy. Research has demonstrated how increasing creatine stores through supplementation can improve endurance performance by increasing blood volume, glycogen storage and respiratory efficiency.3

More Lean Muscle Mass

More important for the bodybuilding community is creatine’s ability to improve lean muscle mass and muscle hypertrophy. Supplementation with creatine, protein and carbohydrate seem to be ideal for muscle growth. Creatine, when combined with exercise, induces an anabolic environment whereby changes in gene expression occur. This correlates well with notable rises in muscle IGF-1 production by muscle. In one study, creatine induced greater than 20 percent increases in IGF-1 and two times greater increases in lean body mass. More recent studies demonstrated the added antioxidant and DNA-protective effect of creatine supplementation, which presumably improves recovery.3

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