Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the practical application of health information. Nutrition. Exercise. Diet. Supplementation. I look at the science behind them, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
The basis for this podcast came from a variety of news reports like “Research shows creatine doesn’t build muscle!” “Creatine comes up short.” As someone who uses creatine on a regular basis, I had to check it out. But first, a little background about creatine.
What exactly is creatine? Creatine is a naturally occurring chemical your body made by combining glycine, arginine, and methionine. It’s primarily used in energy production as a precursor in the manufacture of ATP in your body. In fact, it’s your immediate energy supply. Creatine binds with a phosphate molecule and can readily give up the phosphate group to ADP to make ATP. The problem is that you only have about a 7-30 second supply at maximal effort—and I mean maximal—in your muscles. Fortunately, your body shifts into other forms of energy production like glycolysis so you don’t run out of the ability to make more energy.
Creatine is often used to help increase muscle mass in people who train with weights and that’s the focus of the paper I’m going to review. But research has shown that creatine may help with conditions that result in deep muscle pain like fibromyalgia. The latest research shows that creatine may help with neurological degeneration in the brain. Why? Not there yet but I would suspect it has to do with energy production. Nerve cells need to make energy to do what they do. Or it may be related to the attribute that creatine has in muscle cells: it increases the fluid volume. More about that later.
There are also a variety of opinions about how much creatine to use and when to use in conjunction with a weight training workout. To me, research show that 5 g per day is about right with no preload at 20 grams for a week really necessary. As to when. I stick to 15-30 minutes before a workout to 15-30 minutes after a workout. When to supplement for all other reasons really doesn’t seem to matter. With that in mind, let’s get into the study.
Researchers in Australia recruited sedentary male and female subjects who had not done any form of resistance training or creatine supplementation in the prior year. They collected data on 33 controls and 30 experimental subjects for a 13 week creatine supplementation and resistance training study. The objective was to see if there were actual changes in muscle mass and lean body mass within the RT and supplementation program. Prior research had shown that creatine may only change water levels as creatine does increase fluid levels in muscle as mentioned earlier.
The tool they used to assess fluid levels was dual x-ray absorptiometry (DEXA) to scan for LBM before the study began, after the 7 day wash in period with creatine, and finally after the 13 week RT program. This was an intense training program so it should definitely put on some muscle. What they found was that LBM increased during the wash in period in the supplementation group before the RT program began. The difference in LBM was maintained throughout the RT program. In response to the RT program, both groups increased LBM by 4.4 pounds after accounting for the initial difference in total body water. Therefore, they concluded that creatine may not contribute to increases in LBM when used in a RT program because of the lack of difference between the supplement and the placebo group once the initial LBM was accounted for.
Or maybe it really does. To their credit, they pointed out that the small difference in fluid levels were within the standard error of the measurement method. That means the measurement using DEXA isn’t really precise enough to measure the water in muscle as precisely as necessary. Still, they maintained that because the difference was maintained throughout the RT part of the study, the benefit of creatine to muscle gain should be assessed with higher doses. I’m all for more research but they made some errors in logic and variables they tested.
The initial error was in their subject group. Using both men and women was a good idea as too many studies are done without female subjects. The problem was using such a diverse age group at 18 – 50 years old. Research has shown that muscle loss due to age can begin as early as 40 – 50 years of age. Because they had so few subjects at 63 people, that means there could be 15 men and women in each of the two groups. Dividing those few subjects into under 40 and over 40 means there could be as few as 6-7 subjects in each group. That’s just not enough subjects to get the necessary statistical power to make a meaningful comparison.
They also forgot one of the basic tenets of muscle physiology: the force a muscle can generate is directly proportional to its cross sectional area. The fact that creatine increases the cross sectional area of the muscle by increasing water content, albeit temporarily, might allow the people using creatine to lift heavier weights throughout the study. This was only a 12 week training program in non-exercisers. A better approach might have been to use currently lifting subjects who were not using any type of dietary supplement. It could take a longer time frame to assess whether there were differences in muscle mass due to creatine use between the experimental group and the controls. Then throw in the age factor and there really is a lot of research to be done.
But one thing may have been able to shed some light on this: where was the strength data? Looking at LBM is looking at a combination of factors but strength is strength: how much weight can you lift in several lifts like the dead lift, the squat, and the bench press. You can’t do such an intensive study and not measure the simplest variable. It’s a rookie mistake. I know because I did something like it. When I turned in my dissertation for review, I didn’t put in the exercise data—the change in fitness levels—as I was mostly concerned about how it impacted cardiometabolic variables. The discussion was short and I quickly saw the merit of putting the data into my dissertation. I had it but chose not to put it in. In a study that includes exercise. That’s why I said rookie mistake
Where does that leave us? Creatine is a natural substance that may be beneficial for a variety of things besides muscle growth. I use it every day because I lift to increase strength. Would I like to get bigger? Who wouldn’t but I’m more interested in increasing the strength I’ve lost due to age-related sarcopenia. There are also other benefits because it also benefits the skin, the brain, and other organs as well. I don’t think this study is definitive. While you should always check in with your healthcare professional to see if you’re fit enough to exercise and lift weights, I think everyone over 40 should probably take creatine as we appear to make less creatine the older that we get.
That’s all the time I have for this episode. If you like this podcast, please hit the like button and tell your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
Reference: Nutrients 2025, 17, 1081
