"What Is Creatine? Can It Treat Sarcopenia (Muscle Loss with Age)?"
Creatine is a compound formed naturally in the human body
that is primarily involved in energy production
in our muscles and brain.
It’s also naturally formed in the bodies of many animals we eat,
and so, when we eat their muscles,
we can also take in some creatine through our diet.
(It was named after kreas the Greek word for “meat,”
in which it was first isolated.)
We need about two grams a day;
so, those who eat meat may get like one gram from their diet,
and their body makes the rest from scratch.
There are rare birth defects where you’re born
without the ability to make it,
in which case you have to get it all externally through diet.
But otherwise, our bodies can make as much as we need to maintain
normal concentrations in our muscles.
When people cut out meat, the amount of creatine floating around
in their bloodstream goes down,
but the amount in your brain remains the same,
because your brain just makes all the creatine it needs.
The level in vegetarian muscles is lower,
but that doesn’t seem to affect performance,
as both vegetarians and meat-eaters respond to creatine supplementation
with similar increases in muscle power output.
And if vegetarian muscle creatine was insufficient,
then presumably they would have seen an even bigger boost.
So basically, when you eat meat, that just means your body
doesn’t have to make as much.
If creatine muscle content dropped as we grew older,
that might help explain age-related muscle loss,
but that doesn’t seem to be the case.
Biopsies taken from the muscles of young and old adults
show no difference in creatine content.
Still, if it improves performance, maybe it would help.
According to the International Society of Sports Nutrition,
creatine monohydrate is the single most effective ergogenic supplement
available to athletes for increasing exercise capacity
and lean body mass during training.
It’s no wonder surveys show as many as 70+ percent
of collegiate athletes have used creatine supplements.
What can it do for older adults?
Without exercise? Nothing.
Most studies on creatine supplementation alone show no benefits
for muscle mass, strength, or performance.
This makes sense, given the mechanism.
Creatine supplementation delays muscle fatigue.
This enables people to work out longer and harder,
and it’s that additional volume and intensity
that leads to the muscle benefits.
So, creatine alone doesn’t help,
and creatine taken in the context of the same training
that’s carefully controlled and deliberately equalized
doesn’t help either.
But let people exercise as much as they can,
and most studies on creatine supplementation
for the prevention and treatment of sarcopenia
(meaning age-related muscle loss) show augmented lean mass,
as it does in young adults.
Adding three to five grams of creatine a day
to two to three days of resistance training a week
added an additional three extra pounds of lean mass
over an average duration of about four months.
Now, some of that lean mass may be water weight, not muscle.
Creatine causes water retention that can show up as lean mass,
but compared to placebo, creatine combined with resistance exercise
increases muscle strength as well.
And the additional gains in mass and strength can persist
as long as 12 weeks after stopping the creatine in older adults,
as long as the resistance training is maintained,
so obviously, it’s not all just water weight.
A reason I never advocated for creatine supplementation in older adults
for muscle preservation was because systematic reviews
up through 2017 concluded that adding creatine to training
shows mixed results for muscle mass and strength,
and it did not appear to translate to improved functioning.
However, an updated meta-analysis found a significant improvement
over placebo in sit-to-stand test performance,
which is a decent predictor of reduced falls risk.
Again, this was mostly only when accompanied by strength training.
There have still been no consistent benefits discovered
for just supplementing with creatine alone.
So, creatine should always be prescribed
with a progressive strength training regimen.
The Society for Sarcopenia, Cachexia, and Wasting Disease
convened an expert panel that, despite the lack of long-term trials,
suggested creatine be indeed used for the management of sarcopenia.
The recommended dose to achieve muscle saturation is 3 grams a day.
Within a month at that slow steady rate you achieve
the same muscle levels as loading
with 120 grams over a period of a week.
Note, though, it takes at least 12 weeks
of creatine-supplemented resistance training
to see a significant additive effect.
Recent evidence suggests taking it after exercise
might be slightly preferable to before,
but this has yet to be verified.
Are there any side effects?
We’ll find out next.