Creatine monohydrate, provides us muscle and brain energy.
2-5 grams supplement may be beneficial for older adults, athletes, and people with fatty liver - early liver disease. Meat & fish are good sources.
Creatine monohydrate has been found to be protective for treatment of NAFLD - non-alcoholic fatty liver - homocysteine levels were reduced, but it was not helpful or made alcoholic fatty liver disease worse. (Brave AI summary) Dosage used in sports nutrition is 3-5 grams per day. (Naderi, et al., 2016; Brave AI summary)
Our physiological need might be 1-2 grams based on the amount typically excreted daily. Supplementation has not shown adverse effects typically and 20 grams per day has been included as a dose in a blood lipid study.
“In humans, a study performed on 34 subjects showed how creatine monohydrate supplementation for 56 days (20 g/day for 5 days and then at 5 gr/day for 51 days) might significantly reduce blood lipids at 4 and 8 weeks (significant reductions in total plasma cholesterol by 6% and 5% respectively, triacylglycerols and very-low-density lipoprotein-C by 23% and 22% respectively) [53].” (Casciola, et al., 2023)
Supplement use has shown benefit in sports health, and for reducing risk of sarcopenia (muscle wasting) in older adults. (Casciola, et al., 2023) A loading dose of 20 grams followed by 5 grams that has been recommended by marketers, per this reference, isn’t needed because the body can only use about 5 grams at once. (ww1.udel.edu/creatine) Based on sarcopenia research, more frequency is needed for older adults - have more later in the day to use a larger amount. Twice a day is the example by Naderi, et al., 2016, excerpt later in the post.
Animal-based trials have shown benefit of creatine supplementation for fatty liver conditions. Human clinical trials are recommended by Casciola, et al., to check if supplementing creatine would help patients with “advanced chronic liver disease and its complications, …sarcopenic cirrhotic patients”. (Casciola, et al., 2023)
Elite sports nutrition by Naderi, et al., 2016, gets into a level of detail that is not seen in standard nutrition counseling:
This and other sources suggest having an on and off again pattern to use - use creatine for a few weeks and then take a break for a week or so. We want the body to keep making it for us too, and not get too used to depending on a supplement.
“[Conclusion]
Consumption of the supplements are usually suggested into 5 specific times, such as
pre-exercise (nitrate, caffeine, sodium bicarbonate, carbohydrate and protein),
during exercise (carbohydrate),
post-exercise (creatine, carbohydrate, protein),
meal-time (β-alanine, creatine, sodium bicarbonate, nitrate, carbohydrate and protein), and
before sleep (protein).
In addition, the recommended dosing protocol for the supplements nitrate and β-alanine are fixed amounts irrespective of body weight, while dosing protocol for sodium bicarbonate, caffeine and creatine supplements are related to corrected body weight (mg/kg bw). Also, intake duration is suggested for creatine and β-alanine, being effective in chronic daily time < 2 weeks while caffeine, sodium bicarbonate are effective in acute daily time (1-3 hours). Plus, ingestion of nitrate supplement is required in both chronic daily time < 28 days and acute daily time (2- 2.5 h) prior exercise.” (Naderi, et al., 2016) *Numbering and bold added by me.
Creatine supplementation also reduces the burden of methylation cycles and re-methylation needs.
Creatine is involved in energy utilization - the exchange of phosphorus groups with ATP releasing energy from glucose or acetyl CoA in mitochondrial glycolysis. Creatine is needed in greater amounts in active tissues like muscles and the brain.
“Definition: Creatine is a guanidino compound naturally present in nature and mainly synthesised in the liver, kidneys, and pancreas [6]. It is known for its role in the intracellular storage of metabolic energy. Creatine is converted to phosphocreatine (PCr) by creatine kinase (CK), which catalyses the reversible transference of a phosphoryl group, allowing a rapid phosphate high energy bond exchange operated to generate adenosine triphosphate (ATP). This form of energy storage is particularly important in tissues with high and rapid energetic needs, such as muscles and the brain [1,6,7].” (Casciola, et al., 2023)
Lab values might show elevated homocysteine - which suggests there is a problem in the methylation cycles.
Accumulation of homocysteine occurs means that it is not being converted back into methionine or it is not leading to glutathione production. The study cited by Casciola, et al., 2023, “[52],” included in the experimental design a high fat diet deficient in choline in a fatty-liver disease model - suggesting the smart lab rat would try to eat a moderate fat diet with adequate choline in order to have a healthy liver.
Section 5.1: Fat accumulation and NAFLD/NASH progression are strictly associated with the shortage of methionine metabolism in the liver, leading to diminished availability of SAM, an elevation in homocysteine (Hcy) levels and oxidative stress generation. Normally creatine biosynthesis uses SAM stores and also produces Hcy in the liver. In line, creatine supplementation is known to decrease the consumption of SAM and to reduce the Hcy production in the liver, leading to a decrease of triglycerides and fat synthesis and subsequent liver accumulation [52].” (Casciola, et al., 2023)
Divided doses might help prevent sarcopenia and be easier for the liver to process.
Supplementing with creatine monohydrate powder might be at a level of 2 to 5 grams per day, up to 20 grams per day but ideally, divide that into 5-gram amounts (B, L, D, Snack for example). It is in protein foods like meat and fish and a much smaller amount in dairy. Plant foods do not have creatine. People with a vegetarian or vegan diet who are willing to take an animal sourced powder might benefit. We can make it internally also, generally making about half our need. Intake of one to two grams per day from the diet is typical turnover - typical amount lost in the urine. (Casciola, et al., 2023)
Branch chain amino acid supplement might also benefit people at risk for sarcopenia - muscle lost later in life. See this post: BCAA supplementation may improve Sarcopenia and reduce risk of liver toxicity; serendipitous Nestle Ed webinar, “BCAA include valine, leucine and isoleucine. Their molecular structure includes a branching shape. They are considered essential amino acids and extra may be helpful for liver support.” (Substack).
Animal protein sufficient diets would be providing 1-2 grams of creatine per day and we typically lose about that much in urinary losses. Meat and fish are better sources than dairy.
Creatine is present naturally in food, particularly in meat and fish; humans on a western diet get about one-half of their creatine from the diet and one-half by synthesis. From diet intake, the daily nutritional requirement averages 1–2 g of creatine [8]. The importance of endogenous synthesis of creatine is related to the physiological spontaneous and irreversible conversion to creatinine and, subsequently, urine loss. For example, in a 70-kg male in normal conditions, there is a loss of about 1–2 g of creatine [1,3,4,8,9].” (Casciola, et al., 2023)
Vegetarian or vegan diets wouldn’t provide creatine. It would need to be made from three precursor amino acids, arginine, glycine and methionine, and then be methylated by SAMe in the methylation cycles.
“Creatine can be synthesized in the liver, kidney, and pancreas from the three common amino acids Arginine, Glycine and Methionine. This involves a reversible transfer of an amidine group from arginine to glycine to form guanidinoacetic acid. An irreversible transfer of a methyl group then follows up this step from S-adenosylmethionine to the guanidinoacetic acid to form creatine.” (ww1.udel.edu/creatine)
Creatine content in foods
Foods that are rich in creatine:
Fish:
Herring: 3-4.5 grams per pound
Cod: 341 mg per 4-ounce serving
Salmon: 511 mg per 4-ounce serving
Tuna: 455 mg per 4-ounce serving
Meat:
Beef: 1.4-2.3 grams per pound
Pork: 568 mg per 4-ounce serving
Chicken: 443 mg per 4-ounce serving
Milk: 13 mg per 4-ounce serving
Cooking Methods and Creatine Content
Boiling meat can lower the creatine content, especially with prolonged cooking times (e.g., 60 minutes).
Food can also lose creatine if it leaches into the cooking water and the broth is not consumed. (Brave AI summary)
Creatine supplementation might help prevent muscle loss (sarcopenia) in older people and it is used to enhance muscle development in athletes. It would likely help people with fatty liver conditions as it has shown benefits in animal-based trials, however human clinical trials are still a need. (Casciola, et al., 2023)
Section 5.1: “In our knowledge, only in rat models of NAFLD/NASH, the benefit of creatine supplementation has been demonstrated by decreasing homocysteine (Hcy) production in the liver, diminishing fat accumulation and bringing beneficial effects in the fatty liver [3]. Moreover, creatine supplementation can also prevent fatty liver, as shown in two studies [60,61] performed in rats fed with a high-fat diet and choline-deficient diet plus creatine compared to those without creatine. In humans, a study performed on 34 subjects showed how creatine monohydrate supplementation for 56 days (20 g/day for 5 days and then at 5 gr/day for 51 days) might significantly reduce blood lipids at 4 and 8 weeks (significant reductions in total plasma cholesterol by 6% and 5% respectively, triacylglycerols and very-low-density lipoprotein-C by 23% and 22% respectively) [53]. (Casciola, et al., 2023)
Disclaimer: This information is being provided for educational purposes within the guidelines of Fair Use and is not intended to provide individual health care guidance.
Reference List
(Naderi, et al., 2016) Naderi A, de Oliveira EP, Ziegenfuss TN, Willems MT. Timing, Optimal Dose and Intake Duration of Dietary Supplements with Evidence-Based Use in Sports Nutrition. J Exerc Nutrition Biochem. 2016 Dec 31;20(4):1-12. doi: 10.20463/jenb.2016.0031. PMID: 28150472; PMCID: PMC5545206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545206/
(Casciola, et al., 2023) Casciola R, Leoni L, Cuffari B, Pecchini M, Menozzi R, Colecchia A, Ravaioli F. Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives. Nutrients. 2023 Feb 8;15(4):863. doi: 10.3390/nu15040863. PMID: 36839220; PMCID: PMC9958770. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958770/
Excellent write up and extremely informative. Many thanks for sharing…
Thanks a lot !