Competitive athletes and recreational exercisers are always on the lookout for ways to improve their performance. For individuals specifically concerned with increasing lean muscle mass, gaining strength, or increasing power output, creatine stands the test of time for contributing to each of these goals. Recent research adds to the already large body of scientific literature substantiating the safety and efficacy of creatine for athletic performance. 

Let’s look at a study published in the Journal of the International Society of Sports Nutrition (ISSN) that found supplementation with a combined creatine and electrolyte supplement improved anaerobic power and strength in healthy subjects. Subjects were recreationally trained young adults (age 19–24). (Recreationally trained was defined as participating in strength training 2–3 days per week for a minimum of 6 months prior to the study.) Specifically, the study was a double-blind, randomized trial to examine the effects of the creatine/electrolyte supplement on upper and lower limb strength and power performance measures. Subjects had to be creatine supplementation-free for at least 1 month prior to participating. 

The supplement consisted of the following: 4 g creatine, 857 mg phosphorus, 286 mg magnesium, 171 mg calcium, 171 mg potassium, and 114 mg sodium. (The placebo was 5599 mg maltodextrin provided in similar packaging.) The study protocol called for one dose daily, taken with 16 oz water along with a meal following a workout. Six weeks was decided on for the study period to ensure tissue creatine saturation. (Creatine supplementation often calls for a relatively high loading dose taken for a few days followed by a lower maintenance dose, but the authors of this study noted that six weeks at 4 g/day would be sufficient for tissue saturation.) Subjects were instructed to maintain their current and typical training programs, although this was not controlled for.

The results were notable, especially considering subjects were already engaged in weight training. The 1-rep max (1RM) for back squat increased by 13.4% and bench press maximal strength increased by 5.9% in the supplement group, compared to a decrease of 0.2% and an increase of 0.7% (non-significant) for placebo, respectively. The supplement group also showed significant increases in total concentric work and mean power in a maximal repetition bench press test at 80% of their 1RM.

Results were perhaps not shocking, because creatine is among the most effective supplements for supporting athletic output. The authors of an ISSN review on exercise and sports nutrition noted that creatine monohydrate is backed by strong evidence to support efficacy with apparent safety for building muscle. In fact, they state in no uncertain terms that creatine is “the most effective nutritional supplement available to athletes to increase high intensity exercise capacity and muscle mass during training.” (Emphasis added.) They wrote, “Body mass increases are typically one to two kilograms greater than controls during 4–12 weeks of training. The gains in muscle mass appear to be a result of an improved ability to perform high intensity exercise enabling an athlete to train harder and thereby promote greater training adaptations and muscle hypertrophy.” One or two kilograms (2-4 pounds) of added mass in just 4-12 weeks is remarkable and the potential for this would certainly be enticing to those looking to gain muscle mass and increase strength, and to those who simply enjoy weightlifting and want to increase their capacity to train. 

According to the authors of an ISSN position paper on the safety and efficacy of creatine supplementation in exercise, sport, and medicine:

“Studies have consistently shown that creatine supplementation increases intramuscular creatine concentrations which may help explain the observed improvements in high intensity exercise performance leading to greater training adaptations. In addition to athletic and exercise improvement, research has shown that creatine supplementation may enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and concussion and/or spinal cord neuroprotection.”

It should be noted that individual responses to creatine supplementation are highly variable. Most research subjects show increased muscle strength and improved weightlifting performance with creatine supplementation, but the magnitude of these improvements may differ greatly among individuals. For example, a review of creatine found that the increase in bench press 1RM ranged from 3 to 45%, and improvement in bench press weightlifting performance ranged from 16 to 43%.

With the ISSN’s rousing endorsements for creatine supplementation, it appears reasonable to assume that it has a strong probability to aid in increasing muscle mass, strength, and power output, but by how much may depend on individual factors. Athletes following vegetarian and strictly vegan diets may particularly benefit from creatine supplementation, as creatine is found exclusively in animal foods and vegetarians typically exhibit lower plasma and muscle creatine levels compared to omnivores.

By Amy Berger, MS, CNS