The most commonly studied form of creatine in the literature is creatine monohydrate [ 53]. The uptake of creatine involves the absorption of creatine into the blood and then uptake by the target tissue [ 53]. Plasma levels of creatine typically peak at about 60 min after oral ingestion of creatine monohydrate [ 7]. An initial rise in plasma creatine levels, followed by a reduction in plasma levels can be used to indirectly suggest increased uptake into the target tissue [ 53]. However, the gold standards for measuring the effects of creatine supplementation on target tissues are through magnetic resonance spectroscopy (MRS), muscle biopsy, stable isotope tracer studies, and/or whole body creatine retention assessed by measuring the difference between creatine intake and urinary excretion of creatine [ 53]. Sipila I, et al. Supplementary creatine as a treatment for gyrate atrophy of the choroid and retina. N Engl J Med. 1981;304(15):867–70. Lyoo IK, et al. Multinuclear magnetic resonance spectroscopy of high-energy phosphate metabolites in human brain following oral supplementation of creatine-monohydrate. Psychiatry Res. 2003;123(2):87–100.

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Mercimek-Mahmutoglu S, et al. GAMT deficiency: features, treatment, and outcome in an inborn error of creatine synthesis. Neurology. 2006;67(3):480–4. Stone MH, et al. Effects of in-season (5 weeks) creatine and pyruvate supplementation on anaerobic performance and body composition in American football players. Int J Sport Nutr. 1999;9(2):146–65. Felber S, et al. Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31P magnetic resonance spectroscopy study. Neurol Res. 2000;22(2):145–50.Mason MA, et al. Use of nutritional supplements by high school football and volleyball players. Iowa Orthop J. 2001;21:43–8. Like carbohydrate, creatine monohydrate has osmotic properties that help retain a small amount of water. For example, initial studies reported that creatine loading promoted a short-term fluid retention (e.g., about 0.5 – 1.0 L) that was generally proportional to the acute weight gain observed [ 22, 46]. For this reason, there was interest in determining if creatine supplementation may help hyper-hydrate an athlete and/or improve exercise tolerance when exercising in the heat [ 76, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126]. For example, Volek and colleagues [ 76] evaluated the effects of creatine supplementation (0.3 g/kg/day for 7 days) on acute cardiovascular, renal, temperature, and fluid-regulatory hormonal responses to exercise for 35 min in the heat. The researchers reported that creatine supplementation augmented repeated sprint cycle performance in the heat without altering thermoregulatory responses. Kilduff and associates [ 123] evaluated the effects of creatine supplementation (20 g/day for 7 days) prior to performing exercise to exhaustion at 63% of peak oxygen uptake in the heat (30.3 °C). The researchers reported that creatine supplementation increased intracellular water and reduced thermoregulatory and cardiovascular responses to prolonged exercise (e.g., heart rate, rectal temperature, sweat rate) thereby promoting hyper-hydration and a more efficient thermoregulatory response during prolonged exercise in the heat. Watson and colleagues [ 117] reported that short-term creatine supplementation (21.6 g/day for 7 days) did not increase the incidence of symptoms or compromise hydration status or thermoregulation in dehydrated (−2%), trained men exercising in the heat. Similar findings were observed by several other groups [ 118, 119, 127, 128] leading researchers to add creatine to glycerol as a highly effective hyper-hydrating strategy to help athletes better tolerate exercise in the heat [ 116, 120, 121, 122, 125, 126]. These findings provide strong evidence that creatine supplementation (with or without glycerol) may serve as an effective nutritional hyper-hydration strategy for athletes engaged in intense exercise in hot and humid environments thereby reducing risk to heat related-illness [ 5, 129]. Enhanced rehabilitation from injury Tyler TF, et al. The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial. Am J Sports Med. 2004;32(2):383–8.

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Radley HG, et al. Duchenne muscular dystrophy: focus on pharmaceutical and nutritional interventions. Int J Biochem Cell Biol. 2007;39(3):469–77. FDA. CFSAN Adverse Event Reporting System (CAERS). 2017. [cited 2017 March 27, 2017]; Available from: https://www.fda.gov/Food/ComplianceEnforcement/ucm494015.htm. Accessed 18 Apr 2017. Sullivan PG, et al. Dietary supplement creatine protects against traumatic brain injury. Ann Neurol. 2000;48(5):723–9. Robinson TM, et al. Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function. Br J Sports Med. 2000;34(4):284–8. Our high quality, ultra-pure Creatine Monohydrate supplement, manufactured to 99.9% purity, available in flavoured formulas and unflavoured for easy mixing.

Weiss BA, Powers ME. Creatine supplementation does not impair the thermoregulatory response during a bout of exercise in the heat. J Sports Med Phys Fitness. 2006;46(4):555–63. Groeneveld GJ, et al. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005;26(4):307–13. Vallet JL, Miles JR, Rempel LA. Effect of creatine supplementation during the last week of gestation on birth intervals, stillbirth, and preweaning mortality in pigs. J Anim Sci. 2013;91(5):2122–32. Ogborn DI, et al. Effects of creatine and exercise on skeletal muscle of FRG1-transgenic mice. Can J Neurol Sci. 2012;39(2):225–31. Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults-a meta-analysis. Med Sci Sports Exerc. 2014;46(6):1194–203.