Dr. Dwayne Jackson

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Supplement in focus: Creatine

Creatine biochemistry and physiology 101

Creatine has stood the test of time and the rigor of science with about a quarter century of clinical testing in the lab and field-testing gyms around the world. Synthesized in the liver from arginine, methionine, and glycine and found in high concentrations in meat and fish, creatine is the ideal supplement for strength and power athletes. This is because it is rapidly taken up and stored in skeletal muscle where it provides much needed high energy creatine phosphate to supply muscles with the substrates to quickly make ATP (energy for contraction). In the end, having elevated creatine stores in muscle promotes dramatic increases in strength and power during explosive and extended performances with less time needed for rest. 

Increased creatine phosphate levels also buffer (reduce) muscle acidity that occurs when you perform high repetition exercises or sports where you go all out for extended periods. Under these conditions your body gets its ATP from anaerobic glycolosis and most of us know that going all out for this long leads to lactic acid build up and a loss of muscle power. This loss of power is primarily due to lactic acid’s inhibitory effects on phosphofructokinase (which is the rate limiting enzyme for glycolysis), which results in decreased ATP (energy) output. The muscle acidity lowering effect of creatine supplementation will allow ATP production to go at top speed and enable you to perform longer at max 

Creatine as an anabolic agent

Beyond its dramatic effects on strength and athletic performance through increased energy production, there is an uncontested body of research illustrating creatine’s direct and indirect effects on protein synthesis and skeletal muscle growth. One proposed mechanism for creatine’s muscle-building effect is based on its ability to create an osmotic gradient in muscle cells, which promotes cell volumization by driving water into muscle cells. This not only makes creatine-loaded muscles appear larger, but the “stretching” of cells also turns on anabolism and protein synthesis—resulting in muscle growth. Support for creatine as an anabolic agent is highlighted by a study published in the International Journal of Sport Nutrition and Exercise Metabolism showing that creatine supplementation increases growth-promoting insulin-like growth factor 1 (IGF-1) content in resistance-trained skeletal muscle. In a more recent placebo controlled study published in Molecular and Cellular Endocrinology, it was reported that subjects who weight-trained while using creatine had twice the reduction in myostatin compared to those training with the placebo! (What is myostatin? It is a potent catabolic regulator of muscle mass, and consequently acts as a growth inhibitor in skeletal muscle). In the same study it was found that subjects using creatine had greater increases upper and lower body strength and lean body mass than resistance training with placebo. 


Creating the best creatine

As with most products, supplement companies are constantly trying to improve the digestibility, bioavailability and potency of creatine. This focus has led to the development of several forms of this great supplement. Read on to learn about the innovative compounds and products that have been developed in the quest to make this super supplement better. 

Creatine Monohydrate

Creatine monohydrate is so named because it contains one molecule of water bound to each molecule of creatine. This was the first form to start all the hype about creatine’s muscle- and strength-building properties and, as a result, it’s the most studied and scientifically supported form of creatine today. Creatine monohydrate provides great benefits for most and is generally well tolerated as a micro-ionized powder. Early versions of creatine were not micro-ionized, which caused some users to feel bloated and develop cramps, and even gave some individuals diarrhea. 

Creatine monohydrate is likely the most affordable form of creatine on the market, but be aware that there are substandard products out there. That said, buy from reputable and well-established companies for assurance that you’re getting uncontaminated pharmaceutical-grade micro-ionized creatine monohydrate. 

Creatine HCL

This relatively new player is simply a compound of creatine and hydrochloric acid and is patented under the name Con-Cret. Presently there hasn’t been an abundance of research using this form of creatine, but ProMera Health (who owns Con-Cret) had two major Universities conduct a full double blind, placebo-controlled, balanced cross-over trial to compare the absorption of Con-Cret vs. creatine monohydrate and other forms of creatine. The researchers reported Con-Cret was absorbed over 60% better than creatine monohydrate. This means you can take much less creatine HCL and get the same (or better) effects as creatine monohydrate. Many claim this form of creatine is better tolerated and results in less bloating compared to other forms. 

Creatine AKG

Creatine alpha-ketoglutarate is creatine bound to alpha-ketoglutarate (AKG). This form of creatine is supposed to be absorbed into the blood stream higher in the digestive tract body than creatine monohydrate. Users who commonly get cramps and diarrhea from creatine monohydrate claim that this form is easier on their system.  

Creatine Nitrate

Creatine Anhydrous

This is the same as creatine monohydrate, except that it has been dehydrated. Thus, you get a little more creatine per gram when you buy the anhydrous form (about 5-6%) and its effects are comparable to creatine monohydrate. 

Di- and Tri-Creatine Malate

This is a compound that’s formed by bonding two (Di) or three (Tri) creatine molecules to malic acid. Malic acid is an organic substance that serves as an important intermediate in the citric acid (Krebs) energy cycle. This form of creatine was developed based on the hypotheses that it would boost ATP (energy) production greater than creatine monohydrate and that it would be more tolerable in the body because it’s highly dissolvable in water. There is little to no research to support creatine malate as a superior form of creatine, but anecdotal evidence suggests that it’s well tolerated in those who cannot take creatine monohydrate because of gastrointestinal problems. 

Creatine Orotate

This is another compound that shows promise in theory but is yet to be studied extensively. Creatine orotate is a compound formed by binding creatine with orotic acid and is patented under the name CreaTate. The purported benefits of this supplement over creatine monohydrate include increased muscle phosphocreatine and free creatine levels (via augmented uridine concentration) and increased muscle carnosine levels. In theory, this supplement should increase muscular strength and endurance. In support, there are numerous studies illustrating orotic acid’s ability to increase muscle carnosine leading to increased muscular endurance. 

Creatine Kre-Alkalyn 

This is another patented form of creatine. It’s reported to be “buffered creatine” that’s produced at a higher pH, which apparently blunts the conversion of creatine to inactive creatinine, leaving more creatine to be absorbed. In addition, this form apparently doesn’t convert to creatine until it enters muscle cells, albeit there have been no clinical trials conducted to prove this. Thus, the founders claim that this form of creatine can be taken in much smaller doses with the same benefits as creatine monohydrate and, because doses are smaller, it’s taken in capsule form. Although there are no studies published on this supplement, numerous anecdotal reports support this form of creatine. 

Creatine Citrate

Like creatine malate, creatine citrate is a compound made by binding creatine to an important Krebs cycle intermediate, with citric acid used instead of malic acid. Based on the importance of citric acid in the production of ATP, the rationale behind formulating this compound was that creatine citrate might provide greater muscular energy compared to creatine taken on its own. As well, this compound readily dissolves in water, making it easier to digest. At present there have been no peer-reviewed articles to substantiate creatine citrate as superior to creatine on its own. Also, it should be noted that because this is formed by binding a single creatine molecule to a single citric acid molecule, there is less total creatine provided per gram (about 40-50% less) when compared to creatine monohydrate or anhydrous. 

Creatine Phosphate

As the name implies, this is creatine bound to phosphate, an essential step done in the body to make creatine active. This form of creatine was released soon after creatine monohydrate and quickly became popular; however, it was made obsolete when it was shown to be less effective than creatine monohydrate.

Creatine Serum

Also known as liquid creatine, this form is precisely what the name implies. The idea behind creating creatine serum was to increase digestibility and bypass the stomach’s acidic environment (known to degrade creatine). The problem is that creatine is very unstable in liquid and thus should be taken immediately after dissolving in water. Because of the unstable nature of creatine in liquid, early versions of this supplement were completely useless. However several companies have been working on versions of liquid creatine that they claim are stable for up to years. There is still no published data to substantiate these claims.


Creatine Tatrate 

You’re probably starting to notice a pattern in the creatine nomenclature. This form is the result of binding a creatine molecule with a molecule of tartaric acid. You rarely see this form used as a stand-alone supplement, however because of its stability when formed in a solid, it’s usually included in products like energy bars, capsules, tablets or chewables. An interesting and disturbing fact is that tartaric acid is a known muscle toxin at high doses.

Creatine Titrate

This is a pH-shifted form of creatine that increases the solubility of creatine in water. The theory is that more dissolved creatine makes for easier digestion and greater bioavailability. Users report less bloating and great outcomes, although evidence is purely anecdotal at present. 

Magnesium Creatine Chelate

You guessed it — chelating creatine and magnesium together forms this compound. The rationale behind the development of this compound was based on the fact that magnesium is essential for the conversion of creatine phosphate to ATP for energy. In addition, chelation increases the stability of the compound.  Scientific evidence proves that this form of creatine works better than taking a creatine and magnesium supplement separately. Researchers have reported greater increases in leg strength and cell volumization in those who took magnesium creatine compared to those who took the creatine and magnesium separately.  


This form comes from binding the amino acids taurine and glutamine with creatine. The basis for developing this supplement was to enhance muscle cell volumization. This is a reasonable postulate because all three of these are cell volumizers when supplemented on their own. Furthermore, the amino acids in this combination may enhance recovery and strength gains, however there has been no peer-reviewed studies published on this compound.  

Creatine HMB

This is what you get when beta-hydroxy beta methylbutyrate (HMB) is bound to creatine. It’s well documented that HMB speeds recovery, is anti-catabolic and aids in fat loss, especially in those who have just started heavy weight training. By binding HMB with creatine the compound is more soluble and apparently less prone to degradation in the stomach. As a result creatine HMB is speculated to be a more bioavailable form that gives you all of the benefits of creatine and HMB supplementation. Studies that have used this compound are lacking but users generally report good results. 

Creatine Ethyl Ester (CEE)

Also known as creatine ester or CEE, this is one of the newest creatine forms and is made by adding an alcohol and an acid to form creatine ester ethyl hydrochloride. The patent on CEE is in the hands of UNeMed at the University of Nebraska Medical Center. The motivation for developing CEE was in an effort to provide a more bioavailable form of creatine. The addition of an ester to creatine theoretically increases the lipophilicity (fat dissolvability) of creatine, making it very easy for it to cross cell membranes driving more creatine into muscle cells. Unfortunately, recent scientific evidence has shown that the addition of an ethyl group to creatine reduces its acid stability and is inactivated to creatinine in the physiological environment. 









Maximizing Muscle Gains: The Comprehensive Guide to Creatine Supplementation



In the realm of sports supplements, few substances have garnered as much attention and scientific scrutiny as creatine. Despite its widespread use among athletes and fitness enthusiasts, creatine has surprisingly never been the subject of a “Supplement in Focus” in this magazine. In this comprehensive guide, we’ll explore the multitude of benefits that creatine offers, as well as delve into the various forms of creatine supplements available, discussing their unique advantages and potential drawbacks.

The Benefits of Creatine:

Creatine is a naturally occurring compound found in small amounts in certain foods and synthesized within the human body. Its primary role is to facilitate the recycling of adenosine triphosphate (ATP), the body’s energy currency, during short bursts of intense physical activity. The benefits of creatine supplementation extend far beyond this fundamental role:


Enhanced Muscle Growth: One of the most well-established benefits of creatine is its ability to promote muscle growth. Creatine helps increase water content in muscle cells, which creates a more anabolic environment for muscle protein synthesis.


Improved Exercise Performance: Creatine supplementation has been shown to enhance strength, power, and overall exercise performance, making it a popular choice among strength athletes and bodybuilders.


Faster Recovery: Creatine can reduce muscle cell damage and inflammation, leading to quicker recovery between intense training sessions.


Brain Health: Emerging research suggests that creatine may have cognitive benefits, including improved memory and mental clarity, making it of interest not only to athletes but also to individuals seeking cognitive enhancement.


Therapeutic Potential: Some studies have explored creatine’s therapeutic potential in conditions like neuromuscular diseases and certain neurological disorders.



Forms of Creatine and Their Benefits:

Creatine monohydrate, the most extensively researched form of creatine, is widely known for its benefits. However, various other forms of creatine have entered the market, each with its unique properties and purported advantages. Let’s take a closer look at these forms:

  1. Creatine Monohydrate: This classic form is well-known for its effectiveness and affordability. It has a vast body of research supporting its muscle-building and performance-enhancing properties.
  2. Creatine Alpha-Ketoglutarate (AKG): Creatine AKG is thought to enhance creatine absorption due to its molecular structure. It may offer faster uptake, potentially leading to quicker results for some users.
  3. Creatine Hydrochloride (HCl): HCl is known for its solubility and potential reduction in digestive discomfort. Users with sensitive stomachs often prefer this form.
  4. Creatine Nitrate: Creatine nitrate combines creatine with a nitrate group, potentially promoting greater muscle pump and blood flow. This form is favored by some for its potential aesthetic benefits.
  5. Creatine Malate: Creatine malate pairs creatine with malic acid, potentially offering improved endurance and energy production during exercise.
  6. Creatine Citrate: Creatine citrate is another soluble form that may be gentler on the stomach while providing the expected benefits of creatine.
  7. Creatine Pyruvate: This form combines creatine with pyruvic acid and is believed to enhance endurance and reduce fatigue.

Choosing the Right Form:

Selecting the ideal form of creatine depends on individual preferences, goals, and tolerance. While all these forms offer the fundamental benefits of creatine, some users may find specific forms more suitable for their needs.


In the world of sports supplements, creatine remains a gold standard due to its well-documented benefits in muscle growth, exercise performance, and even potential cognitive enhancements. With various forms of creatine available, individuals have the flexibility to choose the one that aligns best with their goals and sensitivities. Whether you opt for the tried-and-true creatine monohydrate or explore newer forms, incorporating creatine into your fitness regimen can help you maximize your athletic potential and reach new heights in your training journey.


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