Wednesday, October 7, 2015

Creatine Loading - Unnecessary or Counterproductive? No Significant Difference, but Slight Advantage for Low Dose, No-Loading Protocol in 10-Week Study W/ Elite Footballers

Not just for women who are always afraid of an increase in water retention, loading protocols may not exactly be the best way of taking creatine monohydrate.
Let's be clear, here: I do not doubt that using 20g of creatine per day for 1-2 weeks aka "creatine loading" is the fastest way to supercompensate one's intra-muscular phosphocreatine and thus short-term energy stores.

What I seriously doubt, though, is that more than 0.1% of the SuppVersity readers have a good reason to make sure that they achieve maximal creatine levels in the shortest period of time. Rather than that, most of you are probably interested in augmenting their size and strength gains in the long(er) run and that's exactly where an older 10-week study shows that increased creatine dosages and / or loading are neither necessary nor beneficial for well-trained athletes.
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The study was designed to compare the effects of low doses of creatine (3g/day) and creatine loading (20g/day for 7 days + 5g/day thereafter) on strength, urinary creatinine concentration, and percentage of body fat. To this ends, Wilder et al. recruited 25 "highly trained" division IA collegiate football players who took creatine monohydrate for 10 weeks during a sport-specific, periodized, off-season strength and conditioning program. Onerepetition maximum (1-RM) squat, urinary creatinine concentrations, and %-age of body fat were analyzed. As previously pointed out, the subjects were
"randomly placed 25 subjects into 1 of 3 groups: (1) creatine supplementation of 3 g·d21; (2) creatine supplemen tation of 20 g·d21 for 7 days, followed by creatine supplementation of 5 g·d21 for the remainder of the study; or (3) a placebo group" (Wilder. 2001).
Creatine supplementation took place in a single-blind fashion, with each subject receiving a high or low dose of creatine or the placebo. Each creatine tablet (Createam Chewables, NutraSense Co, Shawnee Mission, KS) contained 1 g of creatine and 1.4 g of dextrose. The placebo tablet (Nutrasense) contained 2.4 g of dextrose.
"For the first week (loading phase), ingestion occurred 4 times per day. High-dose creatine (5 cre atine tablets), low-dose creatine (3 creatine tablets and 2 placebo tablets), or placebo (5 placebo tablets) was taken when the subjects awoke, before and after the workout session, and in the evening before bed. For the subsequent 9 weeks, the high or low dose of creatine or the placebo dose was ingested once per day after workouts and at the same time on off days" (Wilder. 2001).
During the 10-week supplementation period, all subjects participated only in the University’s off-season conditioning program, which consisted of periodized resistance and agility workouts. More specifically, the program consisted of 4 h/week of heavy resistance training and 4 h/week of conditioning. Weight training and conditioning were performed on Monday, Tuesday, Thursday, and Friday.
  • Strength program: The primary exercises in the strength program were the front squat, back squat, hang clean, power clean, overhead press, bench press, single-arm dumbbell press, 1-arm rows, straight-leg dead lift, power shrugs, upright rows, chin-ups, dips, medicine ball plyometrics, and bumper-plate push-ups. 
  • Periodization scheme: The periodization protocol was a 5-week base hypertrophy phase (4 to 6 sets at 50% to 80% 1-RM), followed by a 2-week power phase (3 to 5 sets at 80% to 88%). After this 7- week period, a 2-week strength phase (1 to 3 sets at 90% to 95%) was implemented, followed by a 1-week peak strength phase (1 to 3 sets at 95% to 100%). 
All sessions (strength and conditioning) were supervised by the strength and conditioning staff, athletic trainers, and football coaches.
Figure 1: Changes in strength and lean mass gains over the course of the 10-week study (Wilder. 2001).
If you look exclusively at the statistically significant study outcomes that are based on blood analyses as well as the results of the standardized performance tests, there are two surprising and one obvious results:
  • Creatine loading + high dose supplementation did not produce significantly different effects on strength, urinary creatinine, or percentage of body fat than training, alone.
  • There were no significant inter-group differences for loading + high dose vs. low dose supplementation over the course of the 10-week study.
  • Significant side effects weren't observed in any of the three study groups.
Now, I could probably stop right here and cite the authors' conclusion that their data suggest "that creatine monohydrate in any amount does not have any beneficial ergogenic effects in highly trained collegiate football players," (Wilder. 2001), but that's not what I am going to do.
Let's talk safety - briefly! It should be obvious that the increased dose of creatine during the loading phase poses a greater risk of side effects. Aside from diarrhea and anecdotal reports of muscle cramps, however, there is little evidence that creatine supplementation in general and creatine loading in particular would produce side effects such as changes in live enzymes, urea or and kidneys health (glomerular filtration urea and albumin excretion rates) in healthy subjects supplemented with creatine, even during several months, in both young and older populations (Kim. 2011). In addition, the potential increase in urinary methylamine and formaldehyde after a heavy load of creatine (20 g/day | levels will still be in the normal range) will have no effect on kidney function and the claim that they may trigger carcinogenesis appears far-fetched (read more). Still, Kim et al. advise that "high-dose ([3–5 g/day) creatine supplementation should not be used by individuals with pre-existing renal disease or those with a potential risk for renal dysfunction (diabetes, hypertension, reduced glomerular filtration rate)" (Kim. 2011). For everyone else, health should thus not be an argument to stick to lower dosages of creatine.
Figure 2: Pre- / post changes in body fat (%) - Note: The differences didn't reach statistical significance due to inter-individual differences (Wilder. 2001)
If we discard the criteria of statistical significance (which was low, because of large inter-individual variations), there are inter-group differences that may even matter.

If you review the data in Figures 1+2, you can easily see that the low dose supplementation group saw (on average) the greatest improvements in strength and lean mass; and that in the absence of the albeit non-significant, but still measurable unwanted fat gain of 0.96% in the loading and 0.78% in the placebo group (vs. -0.39% body fat loss in the low dose group).
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Bottom line: I am not saying that the study at hand can prove the superiority of low vs. high dose (+loading) supplementation for creatine monohydrate. All that I am saying is that the still commonly used loading scheme for creatine, as well as the often practiced "more helps more" approach to creatine supplementation lack scientific backup - unless, obviously, it is used specifically to maximize the phosphocreatine stores in your muscles in the shortest amount of time (in this case loading may be the way to go).

Eventually, it would obviously be nice if we had more studies that investigate the differential effects of loading and/or high vs. low dosing. In view of the number of creatine studies, it is pretty surprising that Wilder's study practically the only one dealing with this issue, right? Comment!
  • Kim, Hyo Jeong, et al. "Studies on the safety of creatine supplementation." Amino Acids 40.5 (2011): 1409-1418.
  • Wilder, Nathan, et al. "The effects of low-dose creatine supplementation versus creatine loading in collegiate football players." Journal of athletic training 36.2 (2001): 124.