Choose a small amount of protein + fruit before and after rehab sessions.
Do not stop eating for fear of putting on weight. Consume plenty of protein and produce at meals and snacks to ensure you are getting in enough calories to promote healing and recovery. (WORK WITH A RD to manage your kcal intake).
Prioritize protein that is rich in leucine, low-fat Greek yogurt, fish, poultry, beef, steak, eggs, and low-fat dairy/full-fat dairy.
Consume foods rich in omega-3 fatty acids that reduce inflammation and swelling while speeding up recovery.
Wendi Irlbeck, MS, RDN, LD, CISSN is a registered dietitian nutritionist and performance coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. She partners with parents, sports performance staff, and special needs and recreational athletes to offer nutritional guidance and optimal athletic performance and lifestyle plans. Wendi provides virtual services including telehealth but is based in Nashville, TN. Wendi works with clients of all levels and ages across the US as well as Canada and the UK. You can find more about Wendi and scheduling an appointment with her on her website.
If you’re a man or woman reading this, excellent. It applies to both genders. Are you an aging adult, or someone who has experienced a traumatic brain injury (TBI)? Then yes, keep reading. Next, if you’re an athlete or non-athlete reading this, even better because it applies to you as well. Still aren’t with me, do you have a beating heart? If this answer is no, please seek medical attention at once. All jokes aside, if you’re a living breathing homo sapiens (homo = genus , sapiens = species) this article is for you.
If you’re a parent of a young athlete, coach, athlete or bodybuilder you likely have read up on creatine and have supplemented with creatine monohydrate before. Creatine is one of the most well-research and effective supplements to date. Creatine can support exercise performance by quickly producing energy during intense activity. Furthermore, creatine may also provide cognitive benefits, but further research is warranted. Studies have consistently illustrated how creatine supplementation increases intramuscular creatine concentrations that can help us understand the observed improvements in high-intensity exercise performance and overall training adaptations at large. We know creatine supplementation can bolster post-exercise recovery, decrease risk of injury and support injury prevention, expedite rehabilitation, thermoregulation, concussion and or spinal cord neuroprotection. Additionally, clinical applications of creatine supplementation have been investigated in neurodegenerative diseases like (muscular dystrophy, Parkinson’s Huntington’s disease), diabetes, aging, osteoarthritis, brain and heart ischemia, adolescent depression and even pregnancy as cited in the International Society of Sports Nutrition (JISSN) Position Stand on Creatine Supplementation in Exercise, Sport and Medicine . Studies are demonstrating short and long-term supplementation (up to 30 grams per day for five years) is not only safe, but well-tolerated in individuals and a range of clinical settings from infants to the elderly. So, creatine is not just for male athletes trying to build muscle and facilitate recovery. It is beneficial to all given the wide range of benefits associated with supplementation that have been documented in literature and several that are currently under investigation in a clinical setting.
Let’s review and clear up a common myth regarding creatine:
“Creatine is a steroid” Incorrect, please stop this nonsense from making its way into 2021 please. In my professional experience as a registered dietitian nutritionist , this must be one of the most obnoxious fallacies to date. Possibly behind “protein hurts my kidneys”, also false but that’s a whole other subject for a different blog. However, I am happy to direct you to the literature that dispels this myth publish in 2016 in the Journal of Nutrition and Metabolism compliments of Dr. Jose Antonio and colleagues . Now back to creatine, let’s clear this up quickly, creatine is not a steroid. It has no relation to a steroid structurally or with its mechanism of action. Why? Well, by scientific definition a steroid is any compound that possesses a common structural feature like 3 cyclohexane rings and a cyclopentane ring make up the structure that by definition is a steroid molecule. In fact, eggs contain a steroid compound which is called cholesterol and it is naturally produced in the body that become steroid hormones like testosterone and estrogen. But no, creatine is not a steroid.
What is creatine?
Creatine is a naturally occurring compound made up of three amino acids, which we would call a tripeptide (tri meaning three). Three amino acids (L-glycine, L-methionine and L-arginine) make up creatine. Creatine is largely made in the liver and to a limited extent, the kidneys and pancreas. It deposits high-energy phosphate groups in the form of phosphocreatine which are given to ADP, regenerating it to adenosine triphosphate (ATP), the sole energy carrier in the human body which can be called “energy currency” for cells to execute their functions. For example, in conditions of short-term high-energy demand activities (< 30 seconds) with limited recovery time, ATP runs out quickly, which brings us to creatine that is stored in muscles in the form of creatine phosphate explained here . Creatine phosphate can help restore ATP, giving muscle cells the ability to produce greater energy. The greater creatine you have, the greater energy your muscle cells can yield during high-intensity exercise, thus leading to increased exercise performance. Even though the most well documented and primary benefit is higher energy production this mechanism also supports muscle gain and strength increases explained here.
Creatine is naturally found in several of the foods we consume like, eggs, milk, tuna, salmon, herring, cod, shrimp, beef and pork. Consuming enough creatine from the diet is challenging given the total creatine pool available according to an article published in the Frontiers in Nutrition Sport and Exercise Nutrition via Candow et al., 2019 . Which suggests, the body needs to replenish about 1.0–3.0 g of creatine per day to maintain normal (un-supplemented) creatine stores depending on muscle mass. Creatine improves numerous factors including strength, power, sprint ability, muscular endurance, resistance to fatigue, muscle mass, recovery, cognition, and speeding up muscle growth.
More women should use creatine:
I am a female who participates in regular strength-training (4-5 times per week) along with (2-3 cardiovascular sessions per week). I eat a whole foods diet, supplement with 2,000 IU of vitamin D3, whey protein isolate, 1,200 mg of fish oil and a multivitamin. Those are my supplements; these are not recommendations for “you”, your “young athlete”, “teammate” or “your friend”. I make this clear because there is no one-size-fits all in nutrition, health and fitness. What works well for me, does not mean it will work well for you. I see too many mistakes made with people trying to adapt the same diet, training and lifestyle of those in their cohort when it simply is not sustainable or appropriate. As individuals we have different genetics, hormones, environment stimulus, training styles, body composition, sport and performance goals, resting metabolic rate, and the list goes on. It would be absurd to eat and train the same way as someone else and anticipate the same outcome with the previously listed differences as humans.
One certainty is we can all benefit from eating real food, but given the benefits of creatine supplementation it is an undervalued and written off supplement among my fellow ladies. Hear me out ladies, creatine will not make you fat, bulky, retain water, turn you into a man or any of the other nonsensical claims that exist on the web these days. I don’t care what Linda at the gym said about “creatine making you fat or how it is a steroid that will make you a man”. I hear these claims often, and not only are they flat out wrong, they misinform my fellow ladies out there trying to gain strength, lean mass and other health benefits that would occur with appropriate creatine supplementation.
Here is a side by side comparison of me, roughly 10 years ago when I ate too many carbohydrates, inadequate protein, some strength training and an abundance of cardiovascular exercise. I ran lots of miles. Now, ten years later, I am happy to report I engage in strength training sessions no greater than 45-minutes, 4-5 times per week with some sprints and daily walking. I supplement with 5 gm of creatine monohydrate post-workout , w
hey protein isolate, take a multivitamin and consume 2 gm/kg/body weight per day in protein. I infrequently track calories because I fuel my body with high-quality protein, as many fruits and veggies as I can get my hands on. Creatine won’t make you fat, bulky or manly ladies. It will help support a lean body composition. Let me be more specific to my fellow ladies, creatine can may help you improve your health, fitness, recovery and overall physique.
Trying to turn up the intensity of your workouts? Use creatine! Creatine is like a Koenigsegg Agera RS , the fastest vehicle in the world. Creatine is a vehicle for producing ATP, which as you have learned drives muscle contraction. Kind of important when trying to sprint, lift heavy weights, jump and train with max output? By regularly supplementing with creatine monohydrate (3 -5 gm/day) for 8 weeks or greater can help maximize the body’s stores of phosphocreatine, the necessary compound to product ATP. Thus, allowing for skeletal muscle to produce more energy, bolster power output and exert more work overall. Fitness hack: The greater the intensity expressed fourth the greater your muscles grow stronger, bigger and faster should you train appropriately. Therefore, creatine supplementation is a highly underrated supplement among the female population. I encourage and empower my fellow ladies reading this article who have been on the fence about using creatine to take note of its effectiveness. Creatine has shown to bolster muscular size, power and strength. More muscle equates to more energy burned, healthier body composition, bone mineral density and a decreased risk for musculoskeletal disorders. Not to mention the link between muscle mass and risk of cardiovascular disease. Keeping aging muscles fit is also linked to better health later on in life according to a study published in the Journal of Epidemiology and Community Health .
Even sedentary women who utilized creatine long-term experienced increases in maximal muscle strength during resistance training by 20 to 25% when compared to women who were given a placebo in a study published in the Journal of Applied Physiology . Another study examined the effects of long-term creatine supplementation (12-weeks) combined with resistance training on one-rep max strength, motor functional performance tests and body composition in eighteen older women. The creatine group gained significantly more fat-free mass, muscle mass and were able to efficiently perform submaximal-strength functional test than the placebo group. Special note the creatine group was also able to increase training volume and one-rep max bench press. Creatine contains no calories and does not lead to fat gain. The increase on the scale you may see from use is drawing water into the cell which is a desired response with training.
Many benefits of creatine
A number of studies have shown creatine supplementation can increase brain creatine content by roughly 5-15% along with reducing mental fatigue, and improving cognitive function according to research referenced in the ISSN’s Position Stand on Creatine. Another study carried out by Rawson & Venezia, 2011 reported creatine supplementation of (20 g/day for 5 days or about 2g per day for 30 days) resulted in increased skeletal muscle creatine phosphocreatine which lead to the enhancement of high-intensity exercise tasks. Moreover, there is well documented benefits of creatine supplementation in young adults, increased strength, lean body mass and delayed onset fatigue during resistance training. All of which are critical for older adults striving to maintain cognition, bone mineral density and overall health.
Research is scant but, a randomized, double-blind, placebo-controlled trial was carried out in using creatine in type 2 diabetes subjects that was published in Medicine and Science in Sports and Exercise . The study illustrated creatine supplementation improved glucose tolerance in healthy subjects. When creatine was supplemented in the diabetic subjects that participated in an exercise program the results lead to an improvement in glycemic control. The underlying mechanism could be contributed to the increase in GLUT-4 recruitment specific to the sarcolemma. More research is warranted in diabetics, but the current literature is promising.
Another study examined the potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease . The study illustrates the ability high-dose creatine supplementation has on cerebral creatine content and that it may have the capacity in humans to protect against stroke due to increasing not only the neuronal but also the endothelial creatine content. Emerging evidence also suggest that creatine supplementation with and without resistance training has the potential mechanistic effect to influence bone biology according to a study carried out by Candow & Chilibeck, 2010. A more recent study published in Experimental Gerontology examines pre-exercise and post-exercise creatine supplementation has similar effects on aging bone mineral density and content. A meta-analysis carried out by Forbes et al., 2018 illustrated creatine supplementation did not lead to greater bone mineral density during resistance training in older adults > 50 years of age.
Research in animals also suggested creatine supplementation to support managing Alzheimer’s disease, epilepsy and brain or spinal cord injuries. Furthermore, a study was conducted examining creatine supplementation following sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state and catecholamines. The study eludes to creatine supplementation decreasing the negative effects, like mood, focus, impulse and emotional reactions that are reliant on the prefrontal cortex.
Creatine is safe and easy to use
As you have learned creatine offers many diverse benefits beyond muscle. It is one of the least expensive and safest supplements available on the market. It has been studied for over 200 years and an abundance of literature supports is safety, efficacy and no reported adverse effects in healthy individuals as referenced in the ISSN’sPosition Stand: Creatine Supplementation and Exercise.
A good dose to begin with is simply taking 3.0 to 5.0 grams of creatine monohydrate post-exercise to support recovery, muscle growth and decreasing fatigue. If you’re a vegetarian or new to using creatine you may wish to start with a loading phase by taking (0.3g/kg/body weight/day). For example, if you’re a 60 kg female = 18 g total for the day but broken up into 4 doses for 5-7 days. This would mean a (4.5 g dose of creatine 4x/day) for 5-7 days. Then onto a maintenance phase of 5 g per day for 12 weeks. If you’re interested in looking at different phases of cycling creatine (short-term and long-term) you can refer to the literature in the Creatine Position Stand paper I have referenced throughout this article. For example, supplementing with (5g/day) for 12 weeks during training to truly help increase intramuscular creatine stores and support health and performance benefits outlined in this article. Dissolve the creatine in water or your protein-carb drink post-workout for best results. Take a break from supplementation after using for 12-16 weeks. Where to order creatine? I strongly advise supplements that are Informed Choice Certified, meaning they are free of any banned substances and ensure the product has been tested from any unsafe substances. Here is a comprehensive list of certified products updated March, 2020.
If you’re parent or coach of adolescent athletes and are considering creatine supplementation. Take note, limited research is available in this population highlighting the safety and efficacy of creatine supplementation in young athletes < 18 years of age. Jagim et al., 2018 published a review examining the limited studies in the adolescent population as a means to identify use of creatine in young athletes. The review suggests that adolescent athletes using creatine tolerated supplementation well, had no reported adverse events or incident. Ethically, we do not have enough research to recommend creatine monohydrate to young athletes, but many are using despite direction from professionals. My advice as a sports dietitian is to provide the literature and suggestions to support best interest of my athletes.
As registered dietitian nutritionist and sports nutrition specialist, I advocate for whole foods first and prioritizing nutrition to optimize your health, wellness, physique and performance goals. Creatine is a great supplement to incorporate in addition to great nutrition, enough hydration, adequate sleep and proper training. Creatine works best when paired with resistance training. I hope reading the science outlined in this article surrounding creatine has given clarity. Creatine can benefit everyone, if you have a beating pulse that’s you. Train hard, eat well and stay healthy my friends.
In good health,
Wendi Irlbeck, MS, RDN
Wendi Irlbeck, MS, RDN is a registered dietitian, nutritionist, and fitness coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. Wendi partners with parents, sports performance staff, special needs and recreational athletes to offer nutritional guidance and optimal athletic performance & lifestyle plans. Wendi is based in East Lansing, Michigan and is the founder of Nutrition with Wendi, LLC. Wendi is active on Twitter and other social media platforms as Nutrition_with_Wendi.