appear that, as might be expected, a 2–3-week
period of lower dose creatine supplementation
(3 g · day–1) increases tissue creatine content at a
slower rate than a 6-day regimen of 20 g · day–1.
However, following 4 weeks of supplementa-
tion, no difference in muscle creatine stores is
evident when comparing the two dosage regi-
mens. The same study clearly demonstrated that
muscle creatine stores can be maintained at an
elevated concentration when the 6-day supple-
mentation dose of 20 g · day–1is immediately fol-
lowed by a lower dose of 2 g · day–1(Fig. 27.3).
This lower dose was aimed at sustaining dietary
creatine intake at a slightly higher level than
degradation of muscle creatine to creatinine. The
natural time-course of muscle creatine decline
following supplementation was also investi-
gated by Hultman et al. (1996), where it was
found to take at least 4 weeks for muscle creatine
‘wash-out’ to occur following 6 days of creatine
ingestion at the rate of 20 g · day–1. This fits
with earlier studies which investigated the time-
course of creatinine excretion following creatine
ingestion (Benedict & Osterberg 1923; Chanutin
1926), and with the suggestion of Fitch (1977)
that creatine is ‘trapped’ within skeletal muscle
once taken up. Thus, it would appear that a rapid
370 nutrition and exercise
way to ‘load’ and then maintain muscle creatine
stores is to ingest 20 g · day–1for 5–6 days fol-
lowed by 2 g · day–1thereafter.
It is also clear from the literature that there is
considerable variation between subjects in the
extent of muscle creatine accumulation during
supplementation (Harris et al. 1992; Greenhaff et
al.1994). A concentration of 160 mmol · kg–1dry
muscle (d.m.) appears to be the maximal total
creatine concentration achievable as a result of
creatine supplementation, and occurs in about
20% of subjects. Conversely, about 20–30% of
subjects do not respond to creatine ingestion, i.e.
they demonstrate less than 10 mmol · kg–1d.m.
increase in muscle total creatine as a result of
supplementation. Of particular importance,
recent work has revealed that muscle total crea-
tine accumulation can be increased by a further
60% when creatine is ingested in solution (5 days
of creatine at 20 g · day–1) in combination with
simple carbohydrates (370 g carbohydrate · day–1;
Green et al. 1996a, 1996b), elevating muscle crea-
tine concentration in all subjects closer to the
upper limit of 160 mmol · kg–1d.m. As might be
expected, urinary creatine excretion and plasma
creatine concentration were reduced in parallel
with the increase in muscle total creatine (Green
et al. 1996a, 1996b).
The mean and individual increases in muscle
total creatine concentration from the study of
Green et al. (1996b) are shown in Fig. 27.4. This
figure highlights the major difference between
ingesting creatine in combination with carbohy-
drate compared with ingesting creatine alone. As
can be seen, 50% of the subjects who ingested cre-
atine alone (4¥5 g · day–1for 5 days) experienced
an increase in muscle total creatine concentration
of less than 20 mmol · kg–1d.m. (Fig. 27.4a). This
contrasts with the subjects who ingested creatine
in combination with carbohydrate, all of whom
experienced an increase of more than 20 mmol ·
kg–1d.m. (Fig. 27.4b). In agreement with the
work of Harris et al. (1992), there was a significant
inverse relationship between the initial muscle
total creatine concentration and the magnitude
of accumulation seen following creatine
supplementation alone (r=–0.579, n=12; P<150100140130120Day 0110
Total creatine (mmol.kg–1 d.m.)Day 7 Day 21 Day 35Fig. 27.3Total muscle creatine concentration before
and after 34 days of creatine ingestion. Creatine was
ingested at a rate of 20 g · day–1for the initial 6 days and
at a rate of 2 g · day–1thereafter.