Is taking creatine for running and other endurance sports worth it? Sports physio and runner Maryke Louw takes a look at the research into creatine for endurance events and finds that it does improve performance for certain types, but that there are tricky trade-offs to be made for runners. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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What does creatine do?
Natural creatine
Creatine occurs naturally in our bodies. It helps to supply energy to various cells, in particular muscle cells.
We “use up” approximately 1% to 2% of the creatine in our muscles every day, and we need between 1 gram and 3 grams of new creatine per day to maintain our natural levels.
A diet that includes foods such as meat, fish, seafood, and milk would supply about half of this, and the other half is manufactured in the liver, kidneys, and pancreas.
The research indicates that a vegetarian or a vegan diet would reduce the creatine in one’s muscles, and a vegan diet would not supply any external creatine. It is recommended that athletes on these diets use a vegan creatine supplement.
Creatine as a sports supplement
Creatine monohydrate (one of various types of creatine supplement) has been used as a performance enhancing supplement in sports since the early 1990s.
There is a vast body of research that backs up its benefits for certain sportspeople. These include:
Enhancing single or repeated bursts of explosive power or speed for short time periods – so, anaerobic (non-endurance) efforts. Think of activities such as the sprint events in track running, track cycling, and swimming, high jump, football (both kinds), rugby, and weightlifting.
Helping muscles to recover faster after intense training or competition – when taken with sufficient carbohydrates and protein.
Aiding the muscle healing process after injury.
Effects that may or may not be a benefit, depending on the type of sport and the situation, are:
“Loading up” on creatine in the days leading up to an event causes water retention, which adds to your body weight. This effect disappears after the loading phase. (The dosage guidelines below explain how to avoid this effect).
It increases your muscle mass, especially when the creatine supplementation is combined with strength training, which leads to an overall increase in body weight.
👉 Both of these effects sound as if they could be detrimental to endurance runners, but what does the research show? Do the seemingly negative effects outweigh the positive ones?
Creatine for running and other endurance sports
More recently, researchers began looking into the possible benefits of creatine supplementation for athletes competing in endurance sports.
In 2023, a group of ten researchers published the results of their review of all the available studies on creatine supplementation and endurance performance in the Journal of the International Society of Sports Nutrition. What follows is mostly a summary of their findings and recommendations.
Creatine helps for certain types of endurance sport
Creatine supplementation works best for endurance sports that require multiple speed surges and/or a final “kick” or “spurt” to cross the finish line. These might be required due to e.g. the nature of the course (very hilly) or race tactics (either your own or those of other competitors). This is not surprising, given that creatine has long been used to enhance single or multiple short-term bursts of power or speed, as we discussed above.
Think of a triathlon, where cyclists would benefit from the effects of creatine supplementation during climbs, when initiating or chasing a breakaway, and in the running sprint for the finish line. Creatine might also be of benefit if you need a surge at the end of e.g. a marathon.
Other examples mentioned in the research are:
Tactical 5000-metre track races
Road cycling races, e.g. the Tour de France
Mountain biking
Rowing
Kayaking
Cross-country skiing.
The researchers found that these benefits apply to elite and recreational endurance athletes.
What about creatine for endurance runners?
Weight gain
The 2023 research review found a significant difference between non-weight-bearing endurance sports (such as cycling and rowing) and weight-bearing endurance sports (such as running).
They point to several studies that assessed whether the added body weight caused by creatine supplementation (due to added muscle mass and/or water retention) cancelled out or reduced its benefits. The studies found that this added body weight did not affect the benefits in non-weight-bearing activities but that it nullified the benefits in weight-bearing activities or even made things worse overall.
VO2max
In addition to causing weight gain, it seems that creatine supplementation has a negative effect on VO2max – the maximum amount of oxygen your body can absorb during exercise or when racing, which is quite important for endurance runners.
A research review into creatine and VO2max, published in the journal Critical Reviews in Food Science and Nutrition, analysed the results of 19 high-quality studies involving 424 people.
The studies all took a similar approach: Some people were put on a creatine supplementation regime while others were given a placebo, and most of them were put through an exercise programme. Afterwards, their VO2max was measured.
The VO2max of both types of group increased, but the increase of the creatine groups was smaller than that of the placebo groups.
Ventilatory threshold
Interestingly, the ventilatory threshold of the creatine group improved compared to the placebo group.
Ventilatory threshold refers to the point during exercise at which breathing increases significantly, and it is usually triggered by an accumulation of lactate. The ventilatory threshold occurs at a higher VO2max in well-trained endurance athletes and has been shown to predict endurance performance, regardless of the level of training.
So, it seems that the creatine supplementation somehow (researchers a not yet sure how) led a decreased need for oxygen and better exercise efficiency in these athletes.
👉 This might mean that the slower increase in VO2max during training may be offset by an improvement in ventilatory threshold.
Creatine – unanswered questions
There are some aspects of creatine supplementation and endurance sports that have not yet been studied properly. Among these are:
Does creatine supplementation affect men and women differently? Women have more natural creatine in their muscles, and the researchers speculate that creatine supplementation might therefore have a lesser effect on women. They also mention that creatine supplementation might influence women differently across their menstrual cycle.
Research has shown that creatine supplementation causes a bigger improvement in strength in vegetarians (with lower muscle creatine levels to start with) than in omnivores. However, it is not known whether this will be the same for endurance.
There is also a lack of evidence on the impact of creatine on the endurance performance of children and adolescents.
Are creatine supplements safe and legal?
Unlike some other performance enhancing supplements such as TB-500 and SARMS, creatine is not prohibited in sports. This may provide a clue as to how much of a difference it really makes. According to the U.S. Anti-Doping Agency (USADA), “creatine can have a small effect on performance, [but] the effects are not guaranteed and the specific training program remains most influential.”
USADA does, however, warn athletes that some creatine supplements that are contaminated with banned substances do make it into stores.
On a health level, a daily adult dose of 3 to 5 grams is safe, according to the Harvard Medical School. Unlike some other sports supplements, creatine is not an anabolic steroid, and it will not increase your testosterone levels. But they do point out the following:
The USA’s FDA [and similar bodies elsewhere] does not regulate supplements, so there may be less or more creatine than is stated on the label, and there might be other harmful stuff in there.
People with kidney disease should consult a doctor before taking it.
Some people will initially gain some weight due to water retention, but this isn’t a long-term issue.
My recommendations on creatine supplements
It will benefit you more if you are doing shorter races, e.g. track, 5 Ks and 10 Ks, which require a very hard effort and rely more on your anaerobic system.
If you're a competitive triathlete, you might also benefit from it.
The biggest benefit of creatine supplementation for a runner lies in leg strength, so be sure also to follow a solid leg strength training programme.
As noted above, runners who follow a vegetarian or vegan diet might benefit from taking a creatine supplement, because your natural creatine intake via food and drink would be less than that of an omnivorous runner.
Make sure your training plan is optimal. Low-quality training with supplements will never beat high-quality training without supplements.
How much creatine to take and when
If you are going to take a creatine supplement, please note that it is usually taken together with higher amounts of carbohydrates, because creatine on its own does not provide energy; it facilitates the process in which carbohydrates are converted into kinetic energy.
It seems that taking creatine directly after a strength workout is more beneficial than taking it before the workout.
The authors of the 2023 research review recommend the following dosages:
👉 For weight-bearing activities (e.g. running):
To avoid the water retention and weight gain caused by “loading up”, take 3 to 5 grams (depending on your body mass) per day for 28 days to reach creatine saturation.
Thereafter, take a maintenance dose of 0.03 grams per kilogram of body mass per day.
Some creatine supplement options available on Amazon:
👉 For non-weight-bearing activities (e.g. cycling):
First, to load up so that your muscles become saturated with creatine, take 20 grams in four equal portions per day for 5 to 7 days.
Thereafter the same maintenance dosage as above.
Taking more than these dosages will not add any benefits and might be bad for your kidneys.
The authors advise that athletes practise with creatine supplementation during the off-season, because people react in various ways due to differences such as their starting creatine levels, muscle fibre distribution, and genetics.
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About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.