Several types of creatine exist. Which one is best and how should I take it?

You are correct, a number of types exist and if you count also the different nutrients which creatine has been combined with, the number of possibilities grows even more. For example, studies have used creatine phosphate, creatine citrate, creatine ethyl ester, creatine monohydrate and creatine magnesium-chelate. Creatine phosphate was tested in 1999 against creatine monohydrate for its ability to impact strength and body composition (Peeters 1999). Over a six week period healthy college aged males loaded with 20 grams per day for the first three days and then took ten grams each day in a double-blind, placebo-controlled manner. All subjects followed the same resistance training program and had their strength and body composition tested before and after the training and supplementation. The authors reported that both creatine groups were better than placebo at increasing strength and lean tissue, but the changes between the two creatine groups were similar suggesting that the phosphate group may be just as beneficial as monohydrate (Peeters 1999). Why then isn’t creatine phosphate more popular? The most likely reason is that it’s more difficult and expensive to make when compared to creatine monohydrate and as a result less interest was there for its production. Another reason is that while this study provides sound support, much more published research is available to support creatine monohydrate.

The first study which compared creatine ethyl ester against monohydrate versions was published in 2009. Creatine ethyl ester is alleged to increase creatine bio-availability and alleviate symptoms of bloating (which have only been anecdotally reported). Over a seven week period, Spillane and colleagues had 30 non-trained men consume in a randomized, double-blind, placebo-controlled manner either creatine monohydrate, creatine ethyl ester or a placebo. All subjects followed a loading phase (approximately 20 grams per day for five days) and a daily maintenance dose of five grams per day for the remainder of the study. The authors concluded that creatine monohydrate increased serum and muscle creatine levels to a greater extent when compared to creatine ethyl ester. They also found that creatine ethyl ester was not as effective at improving body composition, muscle mass, strength and power (Spillane 2009).

In comparison, the overwhelming majority of published studies have used the monohydrate version and are responsible for much of the findings associated with creatine use. A comprehensive review by Kreider in 2003 at the time indicated that approximately 300 research studies had been completed examining the performance-enhancing potential of creatine supplementation and that 70% of these studies report significant improvements in performance while the remaining 30% generally caused non-significant gains in performance. Collectively, these studies report 5 – 15 % improvements in maximal strength and power, work performed during sets of maximal effort muscle contractions, single and repetitive sprints in addition to greater gains in lean and/or fat-free mass. This report has been followed up with other reviews (Buford 2007; Bishop 2010; Mujika 2010) which have indicated similar conclusions, indicating that creatine monohydrate supplementation comes with strong evidence to be an effective ergogenic aid.

Oftentimes, interest develops to identify situations where combining creatine with other nutrients may lead to additional improvements. In this respect, creatine has been studied in combination with HMB, glycerol, glutamine and most recently beta-alanine. While some positive effects have been reported, the majority of studies investigating these combinations have failed to illustrate improvements over supplementing with just creatine (or the other nutrient) (REFS 30-38). As noted by Buford in his review (Buford 2007), the one combination which seems to be an exception and is being researched in more detail is the combination of creatine with beta-alanine. Initial studies have suggested that the combination of creatine and beta-alanine has greater effects on strength, lean mass, body composition and even neuromuscular fatigue (Hoffman 2006; Stout 2006).

In one of these studies, the combination of creatine and beta-alanine was used to determine the changes in strength, power and body composition over a ten week period (Hoffman 2006). Thirty-three college-aged males supplemented in a double-blind, placebo-controlled fashion over a ten week period while following a heavy resistance training program. The athletes who ingested a combination of creatine and beta-alanine experienced greater increases in body mass and improvements in body composition when compared to those who ingested just creatine or the placebo. In addition, both creatine-ingesting groups experienced similar significantly greater increases in strength when compared to the placebo. As expected, the authors concluded that the combination of creatine and beta-alanine exerted greater improvements in lean tissue and body composition while consumption of creatine (with or without beta-alanine) significantly improved strength levels (Hoffman 2006).

The other study used untrained men (51 of them) and had them supplement with either a carbohydrate placebo, creatine + carbohydrate, beta-alanine + carbohydrate or creatine + beta-alanine + carbohydrate (Stout 2006). In all groups, the 34 gram dose of carbohydrate was the same, when beta-alanine was consumed the dosage was 1.6 grams and when creatine was ingested the dosage was 5.25 grams. Four daily doses were taken for the first six days and two doses were taken for the 22 days after the loading period. Before and after the supplementation period, participants were tested for their threshold for fatigue as well as their maximal physical working capacity. Increases in both of these tests would suggest an improvement in some aspect of performance. When compared directly to the placebo (carbohydrate) group, a significant increase in physical working capacity was found, while no differences were noted between the improvements in the other groups.

In conclusion, supplementing your diet with creatine is an excellent consideration as hundreds of papers are available which suggest adding creatine to the diet can improve performance and recovery. While several different forms of creatine have been developed for mainstream use, the majority of scientific research supports supplementing your diet with creatine monohydrate versus other formulations. In addition, several studies have attempted to combine creatine with other nutrients in hopes of findings a superior combination. In these instances, preliminary research suggests that combining creatine with beta-alanine while resistance training may improve fatigue thresholds in untrained men over a four week period and strength and body composition improvements in resistance-trained men over ten weeks. More research is needed to see what types of training and exercise modes best improve adaptations to exercise.

REFERENCES

1. Bishop, D. “Dietary supplements and team-sport performance.” Sports medicine (2010) 40(12): 995-1017.
2. Buford, T. W., R. B. Kreider, et al. “International Society of Sports Nutrition position stand: creatine supplementation and exercise.” J Int Soc Sports Nutr (2007) 4: 6.
3. Hoffman, J., N. Ratamess, et al. “Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes.” International journal of sport nutrition and exercise metabolism (2006) 16(4): 430-446.
4. Mujika, I. and L. M. Burke. “Nutrition in team sports.” Annals of nutrition & metabolism (2010) 57 Suppl 2: 26-35.
5. Peeters, B. M., C. D. Lantz, et al. “Effect of oral creatine monohydrate and creatine phosphate supplementation on maximal strength indices, body composition and blood pressure.” J Strength Cond Res (1999) 13(1): 3-9.
6. Spillane, M., R. Schoch, et al. “The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels.” Journal of the International Society of Sports Nutrition (2009) 6: 6.
7. Stout, J. R., J. T. Cramer, et al. “Effects of twenty-eight days of beta-alanine and creatine monohydrate supplementation on the physical working capacity at neuromuscular fatigue threshold.” Journal of strength and conditioning research / National Strength & Conditioning Association (2006) 20(4): 928-931.

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