By Brooks Gillerlain, MPH, RD, CSCS
Creatine is a commonly used supplement across all levels of sport due to its well-established positive effects on sports performance. As a naturally occurring organic compound within the body, 95% of creatine is stored in the skeletal muscle and the remaining 5% is stored in the brain and testes. While creatine can be stored as free creatine or phosphocreatine, two thirds of the intramuscular creatine is found in the form of phosphocreatine.3 The phosphocreatine energy system provides energy for high intensity activity lasting 10-15 seconds. Creatine is used when it joins a phosphate group making phosphocreatine that can be used for energy and then will replenish if given enough rest.
It is obtained from the diet via red meat and fish; an omnivorous diet often amounts to ~1 g / day of dietary creatine.2 This intake level is far below the commonly recommended supplemental dose, an amount that will be discussed later on. Creatine supplementation can also benefit vegetarian or vegan athletes who do not obtain dietary creatine from red meat or fish. Creatine monohydrate is the form of creatine that has been extensively researched evaluating the ergogenic effects it has optimizing training adaptations. Creatine monohydrate should be chosen over other forms of creatine due to the extensive research that has been completed supporting its safety and effectiveness.3 Supplementing with creatine, in addition to a well-rounded diet can increase creatine stores in the body between 10% and 40%.2
Supplementally, creatine has primarily been studied for use as an ergogenic aid to augment power and strength exercises. It is important to note that although the body produces creatine, it is most likely not enough to maximize the athletic benefits. Ergogenic benefits include reduction in recovery time between high intensity efforts and increase in work capacity, strength adaptations, maximal effort work performed, sprint performance, muscle mass adaptations, training tolerance, and enhanced recovery.2, 3, 5
More recently, research has found creatine supplementation to play a role in reducing injury severity, speeding up the injury recovery process, improving neuroprotection, and enhancing recovery from concussion. In relation to soft tissue and bone injuries, creatine supplementation has been found to decrease muscle atrophy and consequences on the muscle after immobilization, in addition to promoting greater strength increases during rehabilitation.3 Research is emerging to support the notion that athletes who correctly supplement with creatine have less incidences of muscle cramping and muscle injuries.
Research is continuing to evolve surrounding creatine supplementation and concussions. During a concussion or traumatic brain injury (TBI), creatine levels in the brain are greatly decreased and energy metabolism is disrupted.4 Creatine supplementation after initial injury can help alleviate damage if secondary injury is sustained.1 Pertaining to symptoms of concussions and TBIs, creatine supplementation led to less headaches, dizziness, and general fatigue, and improvements in cognition, behavior, and communication.5,6 Overall, creatine helps manage the energy metabolism disruption and formation of reactive oxygen species (ROS) and oxidative cell damage that occurs from a concussion and TBI. The accessibility, safety, and ease of supplementation makes creatine a valuable intervention for helping the treatment of concussions and decreasing the severity of injury when given prior.
Type, Dosage and Adverse Effects
Creatine can come in many different forms, however, creatine monohydrate is the most researched and supported type of creatine to use as a supplement. Effective dosing of creatine supplementation should include a 5 to 7 day loading phase, followed by a maintenance phase or solely using a maintenance phase from the start of supplementation. The loading phase includes a dose of 0.3 g per kg of body weight each day. This is normally between 25 to 40g a day for athletes 200 to 300lbs. This dose should be divided into 4 equal amounts and dissolved in liquid. The maintenance phase includes a daily dose of 0.03 g for each kg of body weight. This is normally between 2-5 g per day. If one does not want to complete the loading phase 3 to 5 g/day can be consumed daily, however, the creatine stores in the body will take longer to become fully saturated compared to following a loading phase and then a maintenance phase.3
It is important to note that creatine is an impermissible supplement according to the National Collegiate Athletics Association (NCAA), so institutions are not able to purchase and provide it to student-athletes. While creatine is generally safe for athletes to use, as a dietary supplement that is not regulated by the Food and Drug Administration (FDA) it holds a higher risk for being adulterated or contaminated. Please refer to a Sports Dietitian and look for products that go through strict third-party testing procedures to decrease risk as a NCAA athlete. No adverse effects have been found in the literature when creatine was supplemented in the appropriate dosage outside of weight gain, due to water retention, during initial supplementation.
Use in Football
Considering the mentioned information regarding how creatine is used ergogenically, American Football is a perfect sport to reap the benefits previously laid out. American Football is an intense sport that requires a vast amount of strength and power. In addition to the physical demands, injury and concussion risk remain high. A football athlete’s body composition and strength goals will vary based on position and assignments. Creatine can act as an additional enhancement to a strength program to reach muscle mass, strength, and power goals. Soft tissue injuries are sustained throughout the season, most often with the knees, shoulders, and ankles often causing an immobilization period. Creatine used as an intervention method can directly affect muscle mass loss and enhance regaining strength during rehabilitation periods.3 Many concussions are sustained each year, all with varying recovery timelines depending on concussion history and severity. Evidence supports creatine supplementation as a prevention and intervention role to help lower injury severity and recovery time.1 Lastly, the physical demands required for American Football will vary between preseason, regular season, postseason, and offseason with each having a different performance goal. Creatine supplementation proves to be beneficial at all phases of training to maximize sport performance.
Creatine is produced by the body and obtained through a diet including red meat and fish. It plays a major role in the phosphocreatine energy system used for short, high intensity exercise. Supplementation with creatine can enhance recovery and the capability to tolerate heavier training loads which leads to increasing training adaptations and enhancing body composition. Creatine is an affordable dietary supplement with prices averaging $0.20-0.85 per serving. The ergogenic, injury, and neuroprotective benefits of creatine in addition to the affordable and safe nature of creatine make it a supplement many American Football players could consider taking to enhance their overall performance and maximize their potential.
Ainsley Dean, P. J., Arikan, G., Opitz, B., & Sterr, A. (2017). Potential for use of creatine supplementation following mild traumatic brain injury. Concussion, 2(2), CNC34. https://doi.org/10.2217/cnc-2016-0016
Hall, M., & Trojian, T. H. (2013). Creatine Supplementation. www.acsm-csmr.org
Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: Safety and efficacy of creatine supplementation in exercise, sport, and medicine. In Journal of the International Society of Sports Nutrition (Vol. 14, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s12970-017-0173-z
Oliver, J. M., Anzalone, A. J., & Turner, S. M. (2018). Protection Before Impact: the Potential Neuroprotective Role of Nutritional Supplementation in Sports-Related Head Trauma. In Sports Medicine (Vol. 48, pp. 39–52). Springer International Publishing. https://doi.org/10.1007/s40279-017-0847-3
Roschel, H., Gualano, B., Ostojic, S. M., & Rawson, E. S. (2021). Creatine supplementation and brain health. In Nutrients (Vol. 13, Issue 2, pp. 1–10). MDPI AG. https://doi.org/10.3390/nu13020586
Sakellaris, G., Nasis, G., Kotsiou, M., Tamiolaki, M., Charissis, G., & Evangeliou, A. (2008). Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study. Acta Paediatrica, International Journal of Paediatrics, 97(1), 31–34. https://doi.org/10.1111/j.1651-2227.2007.00529.x
This article was written by a Collegiate and Professional Sports Dietitian Association Registered Dietitian (RD). To learn more about sports nutrition and CPSDA, go to www.sportsrd.org