Dr Paul Greenhaff of Nottingham University, leading researcher into the use of Creatine in sport.  (...

Leg Day Observer

Is creatine necessary? A shortage of the cult-like supplement forces lifters to question its importance

Creatine has a long history as a strength and performance supplement.

Steve Mitchell - EMPICS/PA Images/Getty Images

Bought creatine lately? If so, your order may have been more expensive than usual. Prices for the supplement, which generally flutter around $35 for a small 10 oz tub, rose dramatically over the winter, with some varieties doubling in price. Some stock, including flavored varieties and specific brands are now no longer for sale.

As lifters shelled out extra for the supplement, complaints turned to questions: What is creatine and is it actually necessary for gains — and are there more affordable substitutes?

What is creatine?

Creatine is an organic compound derived from the amino acids arginine, glycine, and methionine. Our bodies produce creatine naturally, at a rate of about 1 gram a day. It’s stored in the muscles as phosphocreatine, and its main job is delivering energy to cells, which allows us to complete daily tasks.

Creatine also plays a role in how our bodies use energy: When we convert adenosine triphosphate (ATP) to adenosine diphosphate (ADP) to burn it, creatine helps convert some ADP back into ATP. In this sense, creatine is also a sort of recharging agent. People who can synthesize enough creatine (or who get enough from their diets or supplementation) generally have creatine reserves in their body. About 95 percent is stored in the muscles, and 5 percent in the brain.

Creatine sources: Powder vs meat

Some foods naturally contain creatine, particularly red meat and fish. But for the most part, it’s found in food in low quantities: One hundred grams of ground beef yields only about 1 gram of creatine; herring and salmon have a little bit more. (Trace amounts are also in milk and some vegetables.) Richard Kreider, the Executive Director of the Human Clinical Research Facility and Director of the Exercise & Sport Nutrition Lab at Texas A&M University, who studies the nutrient, recommends three grams a day either through diet or supplementation.

Supplementing creatine has been shown to improve athletic performance and strength and increase muscle size, and can lead to higher energy levels, which is why strength athletes favor it. Ironically, bodybuilders and powerlifters, who require high protein diets, seem to be the populations most likely to get enough creatine naturally, without supplementation, providing they eat lots of meat and fish on the way to hitting their macros.

Most creatine supplements are available as powder — there are a few different kinds. Creatine monohydrate (CMH) is the most distilled, purest version. CMH is produced in either China or Germany, with the latter responsible for CreaPure, a patent-protected type of CMH made by AlzChem, a chemical company. AlzChem CEO Steve Krask tells Inverse that of the 4500 tonnes of CMH imported to the U.S. in 2018, CreaPure comprised 25 percent, and Chinese imports made up the rest. Currently, no creatine is made in America, though some is “assembled” from Chinese materials.

It’s hard to find information on how creatine is produced. As Krask notes, CreaPure is made from a chemical reaction: It’s a precipitate that collects when hydrogen cyanamide and sodium sarcosinate react in a vessel, with the pH and temperature raised. CMH production often uses carbide — an organic, metallic compound used, among other things, to strengthen steel — for materials; for economic reasons, creatine plants are often adjacent to carbide plants. Because of its patent, CreaPure runs about 99.99 percent pure; Chinese CMHs come in one or two percentage points lower. Krask concurs that some non-CreaPure monohydrate “is really good,” in terms of purity, but that some is occasionally produced to lower quality standards. Much of the academic research on creatine uses CreaPure over other varieties.

Why the price increase?

Prices rose for several reasons, according to Kreider. Chinese production, centered in Mongolia, was held back recently as part of that government’s attempts to reduce pollution and smog ahead of the 2022 Olympics. Water quality issues there scuttled production: “Creatine production is very water-intensive,” says Kreider, and as China looked into water quality issues, they “reduced their production, which caused suppliers to only have one source.”

These factors, coupled with broader supply-chain issues, acted as a bottleneck to getting the powder in front of American manufacturers and retailers. Kreider hears orders are “two, three years behind” supplement suppliers’, which explains why those flavored versions are hard to find, and why prices went up. It all goes back to Krask’s three-to-one figure: While AlzChem’s production seems to be steady, the company’s minority market share wasn’t enough to stave off a price hike.

Kreider also suggests that increased demand for creatine may explain rising prices. As people have begun working out more during the pandemic and reading about supplementation, they may have made CMH part of their routine. But some of the demand, Kreider says, may be more than athletic: he points to a recent proliferation of studies that show creatine’s broader health benefits, like a potential ability to help patients recover from viral diseases, like long Covid. While that research is young, it speaks to a new breadth of work being conducted on creatine, and a broader attempt to recast it as something more than a sports supplement.

What are the benefits of creatine?

Creatine’s research initially focused on its benefits for healthy and athletic populations. In the ‘80s and 90s, according to Kreider, research would focus on student-athletes. Studies would track how CMH improved strength and muscle mass. This helped, Kreider says, creatine “blow up” as a supplement for lifters, and become almost standard.

Over time, research progressed into other areas, and academics began focusing on less healthy populations: individuals who might not be able to synthesize that 1 gram of creatine into their bloodstream, or who be less athletically inclined. Studies began asking, according to Kreider, “what happens if we give [creatine] to kids with Muscular Dystrophy, creatine synthesis deficiencies, or elderly people?”

But despite the relatively long history, there’s still some confusion around the supplement, even in the lifting community. Type the word into a search bar and you’ll see it mistaken for a performance enhancer, or tied into cramping or weight gain. And while CMH does help enhance performance for some people, it does so in the same way caffeine or good nutrition might, not as testosterone does. It’s not a banned substance. And while research has previously suggested that individuals with renal disorders should not load up on creatine, the water retention and weight gain issues are fairly debunked.

Mostly, though, the supplement is pretty accepted, both by lifters and by the medical community. It’s been shown to be safe long-term in a five-year study of supplementing consumers, and in a long-term study tracking aged patients with Parkinson’s.

To be sure, the unregulated, anything-goes athletic supplement space just about requires consumers to be skeptical of anything: It’s difficult to get clear, substantive answers about what we put in our bodies. But lifters have been effectively co-signing creatine as helpful for decades: a supplement that works as well as caffeine or protein powder, and which seems to have no long-term effects.

And according to research, there are even more benefits outside athletics. Recent studies on creatine have shown that it may be an antitumor agent, that it helps protect the fetal brain during pregnancy, it aids with IBS, and in growth rates among children. Creatine has even been shown to help in recovery from concussions and to improve cognitive function.

So the disconnect seems to be mental. Even though CMH has been tested, for decades, in studies, and across a big population — lifters — questions still hang around. Can a powder produced in a lab actually be necessary? Is getting creatine through real foods more ideal?

In real life

Some of the benefits of high creatine supplementation echo those found in the high animal protein-based diets described, and proselytized, in Cate Shanahan’s 2017 book, Deep Nutrition. Shanahan’s rough anthropological argument is that other cultures’ “primal” diets — ones high in animal proteins, specifically meat on the bone and organ meats, and raw and sprouted/fermented food — are healthier than what we eat now. She gives examples of how the nutrients in these rich meaty diets have raised health markers and cognitive development. Some of the examples seem to echo the ways creatine, in studies, comes off as a miracle powder.

This is surprising, especially in light of the significant research on red meat and heart disease, and the general inching towards plant-based nutrition. But Shanahan, a medical doctor herself, doesn’t promote high meat intake reflexively; instead, she shows, with examples, the nutritional particulars of the “French paradox” diet. That well-worn story — in which low heart disease rates in France existed in spite of people there eating lots of animal fat — is distilled into lists of healthy, and unhealthy foods.

Shanahan’s successful throwback nutritional protocols get defined by balance: In different parts of the world, and in different eras, cultures would eschew sugar and carbs, and avoid processed oils, creating caloric room to eat butter and higher-fat meats.

And it seems to sync up, in a very smooth way, with research from Kreider and co.: Shanahan recommends beef and salmon, two of the foods highest in creatine. Bone broth, high in glycine — one of the amino acids that make up creatine — is also on her list. Are these high animal-protein diets healthier because they’re so high in creatine? In some ways, getting the nutrient this way feels more appealing than downing a powder.

This all speaks to the discrete nature of understanding nutrition. As a collection of nutrients, food can be endlessly improvable, and constantly discredited. But as food, it’s a little bit simpler: We have to eat something, and everyone does.

It can be equally difficult to translate isolated, controlled studies into real life: There’s a dichotomy between what we read about, and what we actually do. And so it’s important to mention that some scientists studying creatine may have their research funded by AlzChem, and studies on the topic have the conflict of interest statement filled out on PubMed.

But there’s also a good swath of people who supplement with CMH in real life, track it, and have real results. Creatine has been used widely, among lifters, for decades, without serious incident — and its safety has been borne out in studies. While nothing is fool-proof, it’s fair to call it safer than pre-workout powders, or, indeed, lots of other things we put in our bodies. Creatine supplementation seems to have a whole raft of benefits for many different populations. It’s the supplement’s historical relationship — possibly showing up in primal, high-animal protein-based diets — that is a bit more tenuous scientifically, and which would no doubt benefit from plenty more research.

At its best, creatine may be the cruelty-free way to get some of the benefits of Shanahan’s high meat and fish diet. Indeed, CMH supplementation has been shown, in studies, to help vegetarians and vegans fairly significantly. Both Kreider and Krask envision creatine being placed into meat substitutes down the line.

This feels like both a fix to its branding problem, as well as a possible problem, long term, regarding its price. Creatine may be more of a nutrient than a supplement, one in a league of its own: Only people who eat three pounds of meat every day might hit Kreider’s recommendation naturally, and match the benefits of supplementation. These lifters may be able to get by skipping a day — or a week — of the powder. But the rest of us might have to supplement. There’s less redundancy with creatine than there is with a multivitamin.

If creatine is this helpful for so many people, then many more of us will presumably supplement with it down the line, which may lead to more price hikes if demand outpaces supply. To be sure, Krask and Kreider are both bullish that production will increase in the last quarter of the year, and that the industry, long-term, is working on ways to produce much more creatine.

As consumers, the choices we have now we’ll face in the future. If we want to get enough creatine, we either need to eat lots of animal protein or take a supplement whose production requires proximity to carbide plants, or high water usage. Both options could get very expensive. If creatine is as good as research suggests, the new problem might be making enough.

LEG DAY OBSERVER is an exploratory look at fitness, the companion to GQ.com’s Snake America vintage column, and a home for all things Leg Day. Due to the complicated nature of the human body, these columns are meant to be taken as introductory prompts for further research and not as directives. Read past editions of Leg Day Observer for more thoughtful approaches to lifting and eating.