 Creatine is a compound formed naturally in the human body that is primarily involved in energy production in our muscles and brain. It's also naturally formed in the bodies of many animals we eat, and so when we eat their muscles, we can also take in some creatine through our diet. It was named after Crius, the Greek word for meat, in which it was first isolated. We need about two grams a day, so those we eat may get like one gram from their diet, and their body makes the rest from scratch. There are rare birth defects where you're born without the ability to make it, in which case you have to get it all externally through diet, but otherwise our bodies can make as much as we need to maintain normal concentrations in our muscles. When people cut out meat, the amount of creatine floating around their bloodstream goes down, but the amount in your brain remains the same, because your brain just makes all the creatine it needs. The level in vegetarian muscles is lower, but that doesn't seem to affect performance as both vegetarians and mediators respond to creatine supplementation with similar increases in muscle power output. And if vegetarian muscle creatine was insufficient, then presumably they would have seen an even bigger boost. So basically when you eat meat, that just means your body doesn't have to make as much. If creatine muscle content dropped as we grew older, that might help explain age-related muscle loss, but that doesn't seem to be the case. Biopsies taken from the muscles of young and old adults show no difference in creatine content. Still, if it improves performance, maybe it would help. According to the International Society of Sports and Nutrition, creatine monohydrate is the single most effective ergogenic supplement available to athletes for increasing exercise capacity and lean body mass during training. It's no wonder surveys show as many 70% plus college athletes have used creatine supplements. What can it do for older adults? Without exercise, nothing. Most studies on creatine supplementation alone show no benefits for muscle mass strength or performance. This makes sense given the mechanism. Creatine supplementation delays muscle fatigue. This enables people to work out longer and harder and it's that additional volume and intensity that leads to the muscle benefits. So creatine alone doesn't help. And creatine taken in the context of the same training that's carefully controlled and deliberately equalized, doesn't help either. But let people exercise as much as they can and most studies on creatine supplementation for the prevention and treatment of sarcopenia, meaning age-related muscle loss, show augmented lean mass as it does in young adults. Adding three to five grams of creatine a day to two to three days of resistance training a week added an additional three extra pounds of lean mass over an average duration of about four months. Some of that lean mass may be water, weight, and muscle. Creatine causes water retention that can show up as lean mass but compared to placebo, creatine combined with resistance exercise increases muscle strength as well. And the additional gains in mass and strength can persist as long as 12 weeks after stopping the creatine in older adults as long as the resistance training is maintained. So obviously it's not all just water weight. A reason I never advocated for creatine supplementation in older adults for muscle preservation was because systematic reviews up through 2017 concluded that adding creatine to training shows mixed results for muscle mass and strength and it did not appear to translate to improved functioning. However, an updated meta-analysis found a significant improvement over placebo in sit-to-stand test performance which is a decent predictor of reduced falls risk. Again, this was mostly only when accompanied by strength training there have still been no consistent benefits discovered for just supplementing with creatine alone. So creatine should always be prescribed with a progressive strength training regimen. The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel that, despite the lack of long-term trials, suggested creatine be indeed used for the management of sarcopenia. The recommended dose to achieve muscle saturation is 3 grams a day. Within a month at that slow, steady rate you achieve the same muscle levels as loading with 120 grams over a period of a week. Note, though, it takes at least 12 weeks of creatine-supplemented resistance training to see a significant additive effect. Recent evidence suggests taking it after exercise might be slightly preferable to before, but this has yet to be verified. Are there any side effects? We'll find out next.