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!
“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.”
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, and its association with methylation..
Creatine and muscle building
What is creatine and what does it do?
First discovered in the 19th century and reaching peak popularity in athletic and research communities in the 1990s, creatine is now experiencing a new surge of attention. In the past year, more than 174,000 digital articles referenced creatine and Google shows that queries for creatine and related topics have nearly doubled over the past five years. In the past 50 years, there have been thousands of published researach papers on creatine, making it one of the most extensively researched current-day nutritional compounds. This contributes to a high level of safety with the supplement, but please note specific concerns and testing approaches discussed below, as negative experiences do occur.
Creatine is a compound found in animal foods and one also synthesized in the liver, pancreas and kidneys of the human body. It is a “conditionally essential” nutrient integral to cellular energy homeostasis. Conditionally essential means that it is an organic compound typically produced by the body in sufficient amounts, but becomes essential through diet during specific circumstances like illness, trauma, premature birth, or rapid growth. Poor diet, inflammation, toxicity & compromised methylation create the need for supplementation of creatine as well.
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.
Disruption of creatine synthesis or transport is associated with neurological dysfunction, cardiomyopathy, muscle weakness, and metabolic disease, and has been linked to conditions such as heart failure, epilepsy and neuromuscular disease
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Disruption of creatine synthesis or transport is associated with neurological dysfunction, cardiomyopathy, muscle weakness, and metabolic disease, and has been linked to conditions such as heart failure, epilepsy and neuromuscular disease 〰️
Additionally:
Creatine acts as an osmoregulator. Its molecular structure binds water and shifts fluid from extracellular spaces into the body’s cells. This supports hydration and fluid homeostasis.
Creatine exhibits antioxidant properties, acting as a reactive oxygen and nitrogen species (ROS/RNS) scavenger.
Via the tracking of DNA methylation markers, creatine appears to positively influence lifespan and be associated with lower mortality risks.
Creatine may help preserve bone by increasing mechanical loading through greater muscle mass and by supporting osteoblast function
What does creatine have to do with methylation?
First, a quick refresher on what methylation is - essentially, methylation is the contribution of methyl donors (such as B vitamins, SAMe, NAC, zinc) in the body to toxins that are non water-soluble. This contribution allows toxic compounds to be broken down in order to be excreted via the urine and bowels. Without successful completion of methylation processes, the body remains under the influence and recirculation of toxic compounds.
Creatine is not a toxic compound, but it is unique in that it requires methylation in order to become a functional molecule.
Creatine consumes approximately 40% of the body's total methylation capacity. That classifies creatine synthesis as a a “metabolically expensive” process. The synthesis of creatine is one of the most significant consumers of methyl groups in the body. Insufficient methyl groups (due to poor diet, high stress, or toxins) can hinder creatine synthesis and cause other health issues like fatigue, mood disorders, or brain fog.
Supplementing with creatine reduces the demand on this pathway, sparing methyl groups for other critical functions like DNA regulation and homocysteine regulation. This interaction is vital for metabolic health, particularly for those with MTHFR mutations or high homocysteine. Because methylation also breaks down homocysteine, supplemental creatine can help lower high homocysteine levels, which is particularly useful for individuals with the CBS and/or C677T MTHFR gene variants (activated by negative epigenetic influences mentioned above).
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, gut or liver stress/disease should not take creatine, many fitness instructors are not as clear, and this can be dangerous.
A baseline blood test can reveal these stresses “behind the curtain”.
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A baseline blood test can reveal these stresses “behind the curtain”. 〰️
Other risks include:
Diabetes (most notably with kidney disease complications)
Bipolar disorder and mania
Endometriosis - creatine may promote lesion progression
Cancer (research results are conflicting)
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.
Preservation of healthy levels in the body: endogenous creatine production decreases with age and in those consuming vegan and vegetarian diets (vegans and vegetarians have 10-15% lower muscle stores & 30-39% lower serum creatine)
It synergistically improves the core pathophysiological pathways of MAFLD (Metabolically Associated Fatty Liver Disease, (formerly called Non Alcoholic Fatty Liver Disease) by regulating lipid metabolism across various organs, including adipose tissue. (NOTE: creatine has the opposite effect in Alcoholic Fatty Liver Disease, increasing fatty deposits)
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)
Solutions and the True Nature functional approach
In order to remain safe & get the most out of a creatine supplementation plan, I recommend the following:
Begin with personalized nutrition that creates the sustained & foundational ATP reserves
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 liver and kidney markers, as well as functional methylation markers - this has connection with our ability to synthesize creatine in addition to other concerns such as detox.)
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.
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. Of special note also is that not everyone needs or tolerates the full recommended dose…hair loss and excess urination can occur for some, even without underlying organ stresses.
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.
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.) In those with high muscle mass and/or very high protein diets, the addition of cystatin-C in blood testing is recommended. It is not influenced by these factors, is formed at a constant rate and well filtered by healthy kidneys. Testing creatinine can falsely reflect increased creatine turnover in some cases.
Please email me today to discuss an intelligent, safe, personal approach to your health needs. Julie@truenaturehealthconsulting.com
