Creatine is a nitrogenous organic acid found in meat, dairy products, and fish. The body also synthesizes creatine in the liver, kidneys, and pancreas. This amine is found primarily in skeletal muscle. There are many studies supporting the use of creatine to increase muscle mass, strength, stamina, and endurance. Creatine in skeletal muscle exists as free creatine and phosphocreatine. Phosphocreatine is involved with the conversion of adenosine diphosphate to adenosine triphosphate (ATP). ATP provides quick energy to cells.
Creatine supplementation is believed to allow quicker renewal of ATP, improving high-intensity short-duration activity.24 Creatine also improves the nitrogen balance, which indicates that the body has sufficient protein for muscle growth. Skeletal muscle has a saturation limit for creatine. Patients are often given an initial high loading dose for five to seven days, which is then followed by a maintenance dosage schedule. Muscle mass gain resulting from creatine supplementation is believed to be caused by an increase in water retention. Studies show that creatine increases intracellular water, which is hypothesized to signal cells to increase protein synthesis.25 Studies also indicate that creatine plus endurance training increases lean-body mass. Creatine levels return to baseline levels after four weeks upon discontinuation of supplementation.26 Creatine is metabolized to creatinine and excreted by the kidneys. Caution is advised when considering creatine use in individuals with kidney disease. Side effects of creatine supplementation include muscle cramping, nausea, diarrhea, gastrointestinal (GI) upsets, and possible dehydration. The typical dosage is 20 g per day as a loading dose for the first five to seven days, followed by 2 g per day as a maintenance dose.
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