CREATINE

101
DECEMBER 2020 • ISSUE 3 • PATRICK MCCARTHY

HOW STUDIED IS
CREATINE?
Find out all about the most
well-studied supplement

CAN CREATINE IMPROVE

PERFORMANCE?
High-intensity, sub-maximal
and aerobic exercise

CAN CREATINE IMPROVE

MUSCLE SIZE
Find out why creatine can help
you to increase muscle mass

THE STUDY
Title:
Effect of Creatine Supplementation
on Body Composition and
Performance: A Meta-analysis
Authors:
David Branch
Journal (Impact Factor):
International Journal of Sports and
Exercise Metabolism (2.1)
Study Link
RESEARCH-BITES.COM
1
PREFACE
What will I learn?
This is an exhaustive article, and to be honest
it’s a monster! There is so much to cover, so
I’ll only hit the most important aspects
including -
What is creatine and how much do we
know about it?
Does it help improve body composition
Does it enhance performance?
How does it work for different energy
systems?
Are there differences between males and
females supplementing with it?
Does the loading phase matter for body
composition and/or performance
benefits?
DECEMBER 2020

What piece of the puzzle is this?
Creatine is probably the most well-studied
ergogenic supplement today! At the time this
article was written in 2003, you might
imagine that the body of evidence was not
nearly what it is now. That might not be
entirely true, and the author does
acknowledge the vast amount of previous
evidence in support of creatine. So, why did
he even conduct this study?
In the background section, the author
describes that there are an abundance of
single studies along with reviews, looking at
creatine benefits on body composition OR
aerobic capacity OR anaerobic performance.
The different energy systems had not yet
been looked at allinclusively and he wanted
to do so, to capture a true picture.
RESEARCH-BITES.COM
2
THE STUDY
What did they do?
The paper had one author, which can be a
good and bad thing. In this case, it is a very
good thing, because the search strategy
would have been the same throughout. When
multiple people conduct a systematic search
of studies, they often split the workload
because there are so many abstracts they will
need to cover.
This can lead to differences in the
interpretation of the criteria they use, the
methods used in the study and more like this.
Instead, Branch took it upon himself to tear
through almost 500 abstracts! But at least we
know the methods he used were consistent
throughout.
DECEMBER 2020
 Anyway, this worked like any other
metaanalysis. If you haven’t yet, head back to
our ‘Reading Research’ series to learn more
about these. Branch used the search term
‘Creatine Supplementation’ on SPORTDiscus
and MEDLINE. This gave him almost 500
eligible studies of which he only included
those that were peer reviewed, placebo-
controlled, randomized, blinding and assessed
body composition and/or physical
performance.
This resulted in 96 eligible studies
(approximately 20% of the initial search) with
1,847 subjects in them. From here, studies
were grouped according to the bodycomp and
performance measures they assessed. The
author then estimated effect sizes, using
methods that are most definitely outside the
scope of this BITE.
3
FINDINGS
What were the findings?
I will structure this article slightly different. I
will STUDY-RELATED FAQ’s breeze through
the main findings in this section, followed by a
longer Q&A section. The answers to the
common questions around creatine will
however be answered in context to what
Branch found here, and not toward creatine in
general. That cool?
RESEARCH-BITES.COM
OK, the first inquiry was of the overall impact
of creatine on a range of body composition
measures. A small, but significant effect size
was observed here and the average change
across all of them was 5.7% compared to no
change in the placebo groups. BUT a small
effect size usually means that creatine won’t
be a magical pill for all populations and
groups!
Next, to assess potential performance
benefits, Branch used a peculiar method. In
short, he included seven of the studies that
assessed preand post-creatine levels in the
muscle as well as performance measures. He
wanted to observe if those that up took more
creatine in the muscle had improved
performances.
If I use more creatine while performing a task
better, I am surely showing that it is beneficial
right?
Maybe because there were only seven
studies, the author took a unique approach by
taking the median uptake, and using this,
classified the studies as “high” or “low”
uptake. He then compared these to the
performance measures, finding that
performance effect sizes were superior in the
“high” creatine uptake groups. This is not an
optimal method of assessing this relationship,
but it may have been used only because so
little of the studies included these measures.
As promised, I will discuss the remainder of
the findings in the form of Q & A’s to make
this even more practical!
DECEMBER 2020
 Anyway, not surprisingly, the loading +
4 maintenance had a greater effect size of 0.26
compared to 0.21 with loading only on overall
mean performance measures. It is interesting
STUDY-RELATED FAQ'S to note though, that a loading phase may in
fact be a suitable short-term strategy for
Was creatine loading beneficial athletes that do not have time to supplement
for performance? for several weeks and months.

Creatine loading, for those that do not know, Of course, it is not advised to simply load
is a 5 to 7-day period at the outset of a creatine for the first time, In the week before
supplementation period during which a major sporting event. You may encounter
individuals consume 4 times the regular some water-retention or other side effects
dosage. The dose of 20g should be split into (stomach discomfort) that might hamper
four different periods, and this has been performance.
shown to help saturate muscle stores rapidly.
However, whilst it may help to reach muscle
saturation quicker, no research has shown
that it is more beneficial than simply taking 5g
a day consistently when time is not an issue.

Well, the study didn’t exactly answer the

loading + maintenance vs. just maintenance
question in relation to performance. Instead,
they compared short term studies that just
used a creatine loading phase to those that
had both a loading and maintenance phase.
So, I guess these studies were aiming to find
Was creatine loading beneficial
for lean and body mass gains?
out if simply loading was an effective short-
term strategy for performance.
This is one of the most interesting aspects of
the study. It has been long reported that
creatine supports increased lean and overall
body mass. It does this through osmotic
action promoting water uptake in the cell
(Powers et al). But, because we know that
water uptake is most pronounced in the
loading phase, does this benefit still remain
during maintenance?

RESEARCH-BITES.COM DECEMBER 2020

 Indeed, the effect size was positive for body
mass in both loading-only and long-term
maintenance groups. However, it was larger
and more pronounced (ES = 0.26) in the short-
term loading than the maintenance (ES =
0.04). The author did mention here though,
that the long term maintenance studies
mostly included resistance training that both
they and the placebo engaged in. Because
training is the most important factor for mass
gain, these may have diminished the impact of
the creatine.

Was creatine beneficial for

maximal intensity exercise (< 30
secs)?
Yep! This analysis included 14 variables
assessing overall performance in maximal
intensity exercise. These include bouts less
than 30 seconds in duration that rely heavily
on the ATPPCr energy system (largely
dependent on creatine for energy). Results Was creatine loading beneficial
showed that an effect size of 0.24 for all for performance?
measures when supplementing with creatine
which was significantly greater than the Anyway, not surprisingly, the loading +
placebo groups. maintenance had a greater effect size of 0.26
compared to 0.21 with loading only on overall
mean performance measures. It is interesting
to note though, that a loading phase may in
fact be a suitable short-term strategy for
athletes that do not have time to supplement
for several weeks and months.

Of course, it is not advised to simply load

creatine for the first time, In the week before
a major sporting event. You may encounter
some water-retention or other side effects
(stomach discomfort) that might hamper
performance.

RESEARCH-BITES.COM DECEMBER 2020

 Was creatine beneficial for
anaerobic submaximal
performance tasks?
These included tasks that were between 30 -
150 secs in duration and included 8
performance variables. Overall, the effect
size in supplement groups was 0.19, a 4.9%
improvement that was significantly different
than the placebo groups, which had -2%
regression.
Not all modes of exercise or performance
variables showed improvements, with the
most notable being work accomplished and
power on the ergometer as well as isokinetic
and isometric tasks.
Was creatine beneficial for
aerobic exercise?
Because the phosphocreatine energetic system
is active only during high-intensity non-aerobic
bouts of activity, there is little rationale for it
having benefits on aerobic endurance.
Supporting this, many studies have failed to find
impacts of creatine on endurance. However,
several of the studies included here did in fact
include aerobic performance (on the ergometer
a.k.a bike). Of the 18 studies that did examine
aerobic performance, the overall effect size was
a small, but positive one (e.g. 0.20).
However, the author did note that as exercise
duration grew longer, the impact was less and
less. Also mentioned by the author here, was
the way in which creatine may enhance aerobic
performance. He relates to another study that
proposed creatine could alter substrate use in
the way of improving endurance capacity.
RESEARCH-BITES.COM
Was creatine beneficial for
aerobic exercise?
This is an interesting question, because as the
author alludes to, creatine research in
females is widely underdeveloped. He also
goes on to say that the potential reasoning
for this is the higher endogenous (i.e. internal)
store of creatine that females possess in
relation to men (Greenhaff et al), make
finding improvements to supplementing
more difficult.
However, there were nine studies that either
had female-only or female/male cohorts.
From this the author says that females
showed greater improvements (14.8% vs.
5.5%) than males in overall mean
performance. However, whilst the
percentage improvements were significantly
different, the effect sizes were very similar
(0.21 and 0.22).
Was creatine beneficial for
aerobic exercise?
This is one of the widely held benefits of
creatine. Because it is an immediate source of
ATP, it is believed to support rapid ATP
resynthesis. Thus, supplementing should help
in those tasks with repeated high-intensity
bouts right?
In fact, this study did show that the effect size
was greater in overall performance in tests
with repeated bouts of 0.25, which was
significantly greater that those with one of
0.18.
DECEMBER 2020
 Here are a few:
Was creatine beneficial for
aerobic exercise?
This is one of the widely held benefits of
creatine. Because it is an immediate source of
ATP, it is believed to support rapid ATP
resynthesis. Thus, supplementing should help
in those tasks with repeated high-intensity
bouts right?
In fact, this study did show that the effect size
was greater in overall performance in tests
with repeated bouts of 0.25, which was
significantly greater than those with one of
0.18.
This means that if you are regularly engaging
in weightlifting, Crossfit, swimming, athletics
or other training that have multiple bouts,
creatine can help you recover in between!
5 counterparts. However, the eligibility
CONSIDER THESE...
But first, were there any
shortcomings?
This study was very straight-forward, kept
the research questions quite simple and so
offers a bunch of practical takeaways.
However, before we throw caution to the
wind, there will always be aspects to consider.
RESEARCH-BITES.COM
When comparing genders, female-only
studies had only 49 total subjects
compared to 548 male subjects.
Effect sizes were significantly greater
(0.25 vs. 0.14) in lab-based performance
measures compared to field-based tests.
Many of the performance tasks included
actions that are not necessarily inherent
in sport e.g., isokinetic strength is the
maximal contraction you can produce
while pushing against a static lever. It
does give us insights to the strength of the
extremity but isn’t directly applicable.
In meta-analyses, best practice is to grade
the studies that are included. Many do
this, many do not. This study did not, and
it was one of the limitations that the
author mentions. Without assessing the
quality of the study, it is possible for
rigorously controlled studies to be
lumped in with loosely controlled
protocol was quite redeemable and rigid
which speaks in the studies favour.
DECEMBER 2020
 6

TAKEAWAYS
OK, lemme have the takeaways!
This study was very straight-forward, kept the research
questions quite simple and so offers a bunch of practical
takeaways. However, before we throw caution to the wind,
there will always be aspects to consider.

Here are some of the main learning points and takeaways:

Creatine was beneficial and promotes lean mass and body

mass increases compared to placebo.

Creatine offers performance benefits in tasks that rely on

the ATP-PCr system (<30 secs).

Creatine’s benefits here were more pronounced in

repeated bouts of shortduration performance.

Creatine may offer some benefits in aerobic exercise,

although more research is needed here. As time of
exercise increases >150 secs, the impact of creatine is
reduced.

This study did not support the idea that

females are less responsive to creatine,
although further research is needed.

If rapid improvements are required, a

short-term loading phase may be
beneficial, although it should be
practiced with caution, if it is the
firsttime supplementing.

I hope you enjoyed this as much as I did!

Stay Classy!
P

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