TC Luoma
And It's Rampant in America
Creatine is no longer just a bodybuilding supplement. More scientists now believe it's actually a conditionally essential nutrient. Info here.
Boy, creatine has sure grown up.
When most of us first learned about her, she was just a bodybuilding supplement (that was often mischaracterized as a steroid by Karens of both sexes) – something that was sure to increase gym performance while quickly adding a few pounds of lean bodyweight (even though much of that weight was water).
Soon after, researchers and medicos began to see that she had rookie-of-the-year potential in treating various conditions or maladies.
Most recently, observant scientists are starting to make the argument that creatine is a "conditionally essential" nutrient. When children don't get enough, it jeopardizes their mental and physical development. When adults don't get enough, they run the risk of not maintaining normal energy flow and being more susceptible to neuromuscular and cardiometabolic diseases.
Good to know, you might say, but here's the thing: A 20-year-study with over 89,000 participants indicates that Americans aren't getting enough creatine from their food and it's getting worse almost every year.
Stand by for the emergence of legions of short, foggy-brained kids and multitudes of prematurely old (or at least old acting) adults with cardiovascular systems that need to be roto-rootered.
About 69% Aren't Getting Enough Creatine
I don't want to spend too much time on the subtleties of the aforementioned study so I'll just get straight to the tasty nougat of this scholarly Toblerone.
The National Health and Nutrition Examination Survey (NHANES) is an annual event that, just as the name implies, assesses the health status of adults and children in the U.S.
The authors of the study ("Temporal trends in dietary creatine intake from 1999 to 2018...") looked at ten consecutive rounds of NHANES dietary information from 89,161 respondents ranging in age from newborns to 85 years old.
It was determined that the average creatine intake among all age groups was 0.70 +/- 0.78 grams of creatine per day. The average for children an adolescents was even less, with the average daily amounts recorded in NHANES 2001-2002 being significantly higher than NHANES 2017-2018.
The results are relevant because most nutritionists recommend at least 1 gram per day for adults (obtained though an omnivorous diet) and the results of the study show that approximately 68.6% of adults aren't getting enough.
It's impossible to make that same kind of specific determination regarding children because there are currently no dietary creatine recommendations for children or adolescents.
We can, however, see what can happen when adults or children don't get enough creatine.
Creatine Deficiency Makes You Short and Mentally Impaired?
Russian researchers (Korovljev, 2021) found that the daily intake of creatine in shorter kids and adolescents (age 2 to 19 years) was lower than in their taller peers. In fact, each additional 0.1 g of creatine ingested per day equated to an additional 0.60 cm of height.
As far as the role of creatine in the brain development of juveniles, scientists are pretty sure it plays a critical role. However, most of their assumptions are based on sort of a "reverse engineering" thought model.
For instance, when kids who have some sort of traumatic brain injury were given creatine, they showed improvement in a variety of parameters including communication, locomotion, and cognitive function in general.
Likewise, adding creatine to the diets of children born with a genetic defect that affects the production of creatine normalizes their brain function.
The scientists, noting this research, figure that if the act of giving these children creatine helps offset the mental deficits caused by their injuries or conditions, then perhaps it shows that having a sufficient intake may play an important role in the brain development of healthy children, too.
The Lack of Creatine is Depressing
Creatine may well play a role in an assortment of adult maladies, perhaps most surprisingly, depression. The NHANES found that depression was 42% more prevalent in the lowest quartile of creatine consumption (0 to 0.26 grams a day).
Also surprising is creatine's apparent role in lessening the threat of heart and liver disease. Adults over 65 who consumed less than 1 gram a day had a 2.62 times higher risk of angina pectoris and a 2.59 times higher risk of liver disease (as compared to those who ingested over 1 gram of creatine a day).
The reason for creatine's benevolent role in heart health probably has something to do with how it reduces plasma cholesterol and homocysteine, both well-known risk factors for heart disease.
Creatine's effects on homocysteine are also what may reduce the risk of liver disease, as reductions of that chemical lead to diminished fat accumulation in that organ (fat in the liver can damage it and lead to impaired function).
Why Are People Getting Less Creatine?
The answer to this apparent epidemic of creatine deficiency appears simple. The primary sources of creatine are meat, fish, and poultry, along with dairy. While the majority of adults may have resisted the "eat less meat" mantra of a number of nutritionists, many children and adolescents have become quite comfortable with a vegetarian or semi-vegetarian diet, hence the apparent reduction in creatine intake among modern children.
As added evidence, it's well documented that vegans and vegetarians in general have an insufficient intake of creatine due to avoidance of creatine-rich food sources (even though their systems "kick up" its production in the absence of dietary intake).
As far as the apparent, nation-wide reduction of creatine intake in adults, it may well be traced to a widespread reduction in dairy intake as the advent of various plant-based "milks" (soy, oat, almond, etc.) has largely taken the place of cow's milk.
Mountain Dew, Now With Creatine!
The authors of said study took their findings seriously: "The diminution of creatine intake among the American public perhaps justifies backing diets rich in creatine-containing foods and low-dose supplementation or food fortification with creatine to optimize its dietary load in the general public."
Maybe so, but we're probably a few years away from being presented with creatine-enhanced, packaged foods, but I'm okay with that. I prefer to supplement creatine the old-fashioned way: by adding it to my coffee, juice, or oatmeal.
As far as dosages, we have to make a distinction here between bodybuilding purposes and health purposes. Bodybuilders were the first to adopt creatine and their intent was and is to supersaturate muscle cells with creatine.
They do/did this by "loading" creatine. The traditional protocol was to take between 20 and 25 grams a day in divided doses for a week, followed by a "maintenance dose" of 5 to 7 grams a day.
We later learned that just taking 5 grams a day for 30 days and then reducing it to about 3 grams a day thereafter seemed to work just as well.
(There's always been a running argument between bodybuilders and medicos, the former believing in the "super-saturation" model and the latter believing you can't raise levels any more than a certain amount. I tend to side with the docs on this one, but a "certain amount" may vary considerably from person to person.)
However, for general health purposes, taking 1 gram of supplemental creatine a day would probably easily fulfill most people's requirements for creatine, even if they're vegetarian. However, it needs to be said that taking slightly larger amounts of creatine – equal to the bodybuilding ones (3 to 5 grams) – might have effects that go beyond that of simple day-to-day health.
As evidence, a number of studies have found that creatine might attenuate and possibly enhance rehabilitation in a number of diseases, disorders, or conditions, e.g., during rehab, during immobilization, for muscle disuse atrophy, for neurodegenerative diseases, for cardiopulmonary disease, and for mitochondrial diseases.
You can read more about all that here: Creatine is Medicine.
Regardless of what dosage you deem is right for you, opt for a micronized version of creatine for better absorption.
References
- Korovljev D et al. "Temporal trends in dietary creatine intake from 1999 to 2018: an ecological study with 89,161 participants." J Int Soc Sports Nutr. 2021 Jun 30;18(1):53. PubMed: 34193199.
- Post A et al. "Creatine is a Conditionally Essential Nutrient in Chronic Kidney Disease: A Hypothesis and Narrative Literature Review." Nutrients. 2019 May 10;11(5):1044. PubMed: 31083291.
