Curious About Creatine? Here Are The Functional Health Care Perspectives

Hello, I am Julie Donaldson and I am a clinical nutritionist with functional health training. I specialize in restoring balance in complex, chronic and acute health conditions. I welcome you to peruse other articles that may be of interest to you in your health investigation!

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“I have gotten myself into so many predicaments adding supplements from online recommendations. It really, really matters to know what your body is doing before taking anything, and Julie knows how to approach all of that. I feel so much better, after decades of guessing & suffering.”

— Alex, Washington

We’re here on the hot topic of creatine supplementation. Make no mistake, it’s like most hot topics - there are lots of good possibilities combined with multiple cautions. We need the specifics on both. As per usual, there are also different perspectives from the functional vantage point vs. the conventional fitness & medicine worlds. It pays to know what functional health care has to say about creatine (which also informs you of your personal status, not just the general ideas). We’re covering how it works, what the risks and benefits are and how it boosts (but doesn’t replace) ongoing energy generation in your mitochondria.

Creatine and muscle building

What is creatine and what does it do?

Creatine is a compound found in animal foods and one also synthesized in the liver, pancreas and kidneys of the human body. Approximately half of your body’s supply of creatine (1 to 2 grams/day, about the size of 1 to 2 jellybeans) comes from your diet of protein-rich foods such as red meat, seafood and dairy. (Clearly, vegan and vegetarian diets do not provide these nutrients.)

The other half is produced in the organs, about 95% of which is delivered to your skeletal muscles for use during physical activity. The remaining 5% goes to the brain, heart and other tissues. Skeletal muscles convert creatine into a compound of creatine and phosphoric acid (phosphocreatine or creatine phosphate). Phosphocreatine then helps create adenosine triphosphate (ATP). ATP is (as you hopefully know by now!) your body’s energy source. Every single one of your body’s 3 trillion cells utilizes ATP to complete its task, no matter what that is. As I’ve written about for a very long time, the optimization of ATP is critical for maintaining all body functions and systems. We’re not here to discuss supplementing with creatine as a replacement for the foundational production of ATP, but as an adjunct and for a couple of key purposes. These 2 purposes are boosting exercise efforts & muscle building as well as the potential for neurological support.

Comparing the Contributions of creatine and mitochondrial ATP production

• Speed and Duration: The creatine phosphate system offers rapid, almost instantaneous ATP regeneration for short bursts of energy, while mitochondrial oxidative phosphorylation provides a slower but much more sustained supply of ATP. The addition of about 5-8 seconds of energy/ATP burst come from creatine phosphate.

• Magnitude of ATP Production: Mitochondrial oxidative phosphorylation is the primary source of ATP in the body overall, responsible for meeting the long-term energy demands of various body tissues and functions. Mitochondrial respiration & ATP production via the Krebs cycle and glycogen production give us 1-2 seconds, but it is sustained vs. bursting. Of special note regarding ATP from the Krebs cycle is that the body requires the presence of pyruvate & lactate for muscular function - these are produced in partnership with LDH (lactate dehydrogenase) only via the Krebs cycle.

• Interplay and Regulation: The two systems are interconnected through the creatine phosphate shuttle, which facilitates the transport of high-energy phosphate from the mitochondria to sites of energy demand in the cell, helping to buffer and maintain cellular ATP levels, especially in tissues with fluctuating energy demands.  

Essentially, the creatine phosphate system acts as a quick "reserve tank" for ATP, enabling immediate, high-intensity efforts, while mitochondrial oxidative phosphorylation serves as the primary and more sustainable "generator" of ATP for continuous cellular functions and longer-duration activities. 

The risks and benefits of creatine supplementation

Creatine supplements are being touted by too many people as being “completely safe”. While the medical world is clear about the fact that those with kidney or liver stress/disease should not take creatine, many fitness instructors are not as clear, and this can be dangerous.

Other risks include:

• Pregnancy and breastfeeding

• Diabetes

• Bipolar disorder and mania

• Undermethylation (45% of methylation function is spent on creatine synthesis. Missing methyl cofactors can limit the amount of creatine we absorb and utilize. Increasing creatine via supplementation can complicate this process.)

Benefits include:

• Speeds up muscle recovery. When you exercise, you create micro-tears in your muscle fibers. As you recover, the micro-tears in your muscle fibers heal, and your muscles get stronger. Creatine helps activate satellite cells in your muscles, which help the micro-tears heal.

• Boosts water content in muscle cells. Better cell hydration may increase muscle growth and reduce dehydration and muscle cramps.

• Increases the amount of phosphocreatine in your brain. Research has shown some positive benefits for neurological and cognitive support from creatine. Some impact upon oxidant/antioxidant balances is posited.

What creatine cannot do, plus common side effects

First, many people advertise that creatine increases testosterone, but the jury is absolutely out on this aspect, with many more studies than not showing no notable effects on testosterone. While additional muscle can benefit metabolic efficiency and therefore potentially aid the glands in hormonal optimization, there is no direct link between supplementation and hormone levels.

Next, let’s circle back to the above conversation about the necessary presence of pyruvate and lactate in the muscles. These compounds can only be produced by the Krebs cycle. Therefore, creatine supplementation is not a substitute for proper individualized nutrition and the output of ATP it generates.

The most common side effects of creatine supplementation are:

• Nausea

• Fluid retention

• Stomach pain & bloating

• Headaches

• Anger & irritability

• Dizziness

• Excess sweating (hyperhidrosis)

The True Nature functional approach

In order to remain safe & get the most out of a creatine supplementation plan, I recommend the following:

1. Begin with personalized nutrition that creates the sustained & foundational ATP reserves

2. Know the details your blood chemistry and foundational health before considering or initiating any supplementation - be sure to utilize a qualified functional health care professional for this review and also to have a medical physical exam. While rare, episodes of severe kidney events have been recorded in young people with no medical or functional evaluation of biochemistry. (Note: LDH is always on the blood testing list at True Nature, unlike in most conventional medical offices - it is key to elements of the Krebs cycle/ATP production. Also always tested at True Nature are functional methylation markers - this has connection with our ability to synthesize creatine in addition to other concerns such as detox.)

3. Utilize the liposomal forms of creatine monohydrate to reduce symptoms, especially in the GI tract. Its unique delivery method bypasses some of the barriers to absorption in the digestive tract, leading to more efficient muscle uptake and fewer side effects.

4. I do not recommend the loading procedures, as many are more symptomatic with them. Simply take a regular daily dose of 3-5 grams - beginning slowly is advised, and always back down if symptoms arise. 3-4 weeks of a daily dose will begin to provide the benefits.

5. Consume the daily dose 30 minutes before exercise in combination with both carbohydrate and protein - a dairy or non-dairy milk or yogurt of your preference is a good choice for mixing.

6. Continue to monitor your basic blood chemistry throughout supplementation, approximately every 3 months. (This is especially crucial for vegans and vegetarians who may need to supplement in order to have adequate levels of creatine.)

Please email me today to discuss an intelligent, safe, personal approach to your health needs. Julie@truenaturehealthconsulting.com