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DOES CREATINE CAUSE WATER RETENTION, DEHYDRATION & CRAMPS?

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A common doubt pertaining to creatine use is that we need to increase the water intake post creatine consumption. If not, then it will cause cramping, dehydration etc. especially when working out in a hot environment. The concern about dehydration when taking creatine supplements is largely due to your muscle tissue retaining water. This is the reason you may experience weight gain after just a week of supplementing creatine.

  1. In a 2001 study in the Journal of Exercise Physiology, US researcher Mark Kern & team, evaluated 1) the changes in total body weight and body water in response to creatine monohydrate supplementation, and 2) if the hypothesized increases did occur, to determine whether this was sufficient to alter thermal regulation as measured by rectal temperature during a 60min ride at 37deg C.

The results of this study indicate that creatine supplementation elevates body mass. These increases may partially reflect changes in body water stores and may be enough to improve thermal regulation during exercise in the heat, as evidenced by an attenuated rise in rectal temperature over a 60min period of exercise post-supplementation. Further, amid anecdotal reports that creatine causes dehydration, muscle cramping, and heat exhaustion, the subjects in this study reported no overt side effects of creatine supplementation.

  • A 2001 study in the journal Medicine & Science in Sports & Exercise, by US researchers J.S. Volek & team, examined the influence of creatine (Cr) supplementation on acute cardiovascular, renal, temperature, and fluid-regulatory hormonal responses to exercise for 35 min in the heat. Twenty men were assigned to consume 0.3g/kg Cr monohydrate or placebo for 7 days. Before and after supplementation, both groups cycled for 30 min at 60-70% VO2 immediately followed by three 10 sec sprints in an environmental chamber at 37deg C and 80% relative humidity.

Body mass was significantly increased in Cr subjects. Heart rate, blood pressure, and sweat rate responses to exercise were not significantly different between groups. Sodium, potassium, and creatinine excretion rates obtained from 24h and exercise urine collection periods were not significantly altered in either group. Serum creatinine was elevated in the Cr group but within normal ranges. Peak power was greater in the Cr group during all three 10 sec sprints after supplementation and unchanged in the placebo group. There were no reports of adverse symptoms, including muscle cramping during supplementation or exercise. Researchers thus concluded that, Cr supplementation augments repeated sprint cycle performance in the heat without altering thermoregulatory responses.

  • In a 2003 study in the Journal of Strength & Conditioning Research, US researchers M.R. Kutz & M.J. Gunter, examined the effects of creatine monohydrate supplementation on total body weight (TBW), percent body fat, body water content, and caloric intake, in seventeen men. Subjects were assigned to a creatine or placebo group. Supplementation was given for 4 weeks (30g/day for the initial 2 weeks and 15g/day for the final 2 weeks). Subjects reported 2 days a week of strength training of the lower extremity.

Significant increases before and after the study were found in TBW and body water content for the creatine group. No significant changes were found in percent body fat or daily caloric intake in the creatine group. No significant changes were noted for the placebo group. These findings support the fact that creatine supplementation increases TBW. Mean percent body fat and caloric intake was not affected by creatine supplementation. Therefore, weight gain in lieu of creatine supplementation may in part be due to water retention.

  • In a 2003 study in the Journal of Athletic Training, a team of elite researchers led by Michael Powers, examined the effects of oral creatine (Cr) monohydrate supplementation on muscle Cr concentration, body mass, and total body water (TBW), extracellular water (ECW), and intracellular water (ICW) volumes. After an overnight fast, urinary Cr and creatinine concentrations, muscle Cr concentration, body mass, TBW, ECW, and ICW were measured, and subjects were randomly assigned to either a Cr or a placebo (P) group. The Cr group ingested 25g/d of Cr for 7 days (loading phase) and 5g/d for the remaining 21 days (maintenance phase), whereas the P group ingested a sucrose P using the same protocol. Sixteen men and 16 women involved in resistance training participated in this study.

The results indicated that the supplementation protocol was effective in increasing muscle Cr concentrations. Increased muscle Cr content was associated with an increased body mass and TBW volume. Thus, supplementation does result in water retention.

It was initially hypothesized that the water would be preferentially retained intracellularly, altering fluid distribution. However, this was not observed. Therefore, the theory of a Cr-related fluid shift is not supported because fluid distribution remained normal.

An alteration in fluid distribution during supplementation had been suggested as a cause of muscle cramping and other heat-related problems anecdotally associated with Cr supplementation. Because the subjects failed to experience any side effects beyond weight gain, it cannot be determined whether athletes supplementing their habitual diet with oral Cr monohydrate will be more predisposed to muscle cramping and heat illness than athletes who are not ingesting Cr. However, the results do not support the fluid-shift theory behind Cr supplementation and heat illness. 

Acc. to writer & researcher T.C. Luoma, “creatine does indeed cause cellular volumization and that’s an important determinant of protein breakdown and protein synthesis in skeletal muscle (and other cell types, too). Working out turns on protein synthesis while simultaneously breaking down protein, but creatine shifts the balance towards protein synthesis.

Yes, creatine supplies an extra phosphate group to help regenerate ATP during high-intensity contractions, but cell volumization is an even more important cause of creatine’s muscle-building effect.

Long-term use is a slightly different scenario because that’s when creatine increases fat-free mass without a concomitant increase in total body water. Muscle fibre diameter goes up, along with strength, so long-term effects appear to be caused largely by increased muscle mass.”

  • A 2003 study in the journal Molecular & Cellular Biochemistry, by a US research team led by M. Greenwood , examined the effects of creatine supplementation on the incidence of injury observed during 3-years of college football training and competition. Athletes participating in the 1998-2000 football seasons were elected to take creatine or non-creatine containing supplements following workouts/practices. Subjects who decided to take creatine were administered 15.75g of creatine for 5 days followed by ingesting an average of 5g/day thereafter administered in 5-10g doses. Subjects practiced or played in environmental conditions ranging from 8-40deg C and 19-98% relative humidity.

Researchers found that, the incidence of cramping, heat/dehydration, muscle tightness, muscle pulls/strains, non-contact joint injuries, contact injuries, illness, number of missed practices due to injury, players lost for the season, and total injuries/missed practice, were generally lower or proportional to the creatine use rate among players. Creatine supplementation does not appear to increase the incidence of injury or cramping in Division IA college football players.

  • In a 2005 study in the journal Nutrition, by a research team led by Dr. Ronald W. Mendel, hypothesized that creatine supplementation would interfere with normal body fluid shifts that occur during exercise in a hot environment. This study examined the effects of acute creatine loading (20g/d for 5 days) on the thermoregulatory response of the body during a bout of exercise at 39deg C.

Subjects (15 men and 1 woman) performed a cycle test of maximum oxygen consumption to determine the proper work rate for the heat-stress test (40min at 39deg C) and were assigned to a creatine group or a placebo group. Each group performed the heat-stress test on two separate occasions: before supplementation and after supplementation (20g/d of creatine with Gatorade or placebo plus Gatorade). Researchers found that, short-term creatine supplementation (20g/d for 5 days) did not have a negative effect on thermoregulatory responses during exercise at 39deg C.

  • In a 2006 study in the Journal of Athletic Training, a team of researchers led by Greig Watson , assessed whether 1 week of creating monohydrate supplementation would compromise hydration status, alter thermoregulation, or increase the incidence of symptoms of heat illness in dehydrated men performing prolonged exercise in the heat. For the study, 12 active males, consumed 21.6gms/day of creatine monohydrate or a placebo for 7 days. On day 7 of each treatment, subjects lost 2% body mass by exercising in 33.5deg C and then completed an 80-minute exercise heat-tolerance test. The test consisted of four 20-minute sequences of 4 minutes of rest, alternating a 3-minute walk and 1-minute high-intensity run 3 times, and walking for 4 minutes.

The study showed that, short-term Creatine monohydrate supplementation does not adversely affect thermoregulatory, cardiorespiratory, metabolic, or perceptual responses in people exercising under thermal stress; and short-term creatine monohydrate supplementation was not associated with increased incidence of negative side effects (i.e., cramping or heat illnesses and injuries). Thus, Short-term creatine supplementation did not increase the incidence of symptoms or compromise hydration status or thermoregulation in dehydrated, trained men exercising in the heat.

  • In a 2007 study in the Journal of Strength & Conditioning Research, a US research team led by G.A. Wright, determined the effects creatine (Cr) loading may have on thermoregulatory responses during intermittent sprint exercise in a hot/humid environment. Ten physically active, heat-acclimatized men performed 2 sessions of an exercise test consisting of a 30-minute low-intensity warm-up followed by 6 x 10 second maximal sprints on a cycle in the heat (35deg C). Subjects then participated in 2 different weeks of supplementation. The first week, subjects ingested 5g of a placebo (maltodextrin) in 4 flavoured drinks (20g total) per day for 6 days and were retested on day 7. The second week was similar to the first except a similar dose (4 x 5g/day) of creatine monohydrate (Cr) replaced maltodextrin in the flavoured drinks. 

Six days of Cr supplementation produced a significant increase in body weight, whereas the P did not. Compared to pre-exercise measures, the exercise test in the heat produced a significant increase in core temperature, a loss of body water determined by body weight change during exercise, and a relative change in plasma volume; however, these were not significantly different between P and Cr. Sprint performance was enhanced by Cr loading. Peak power and mean power were significantly higher during the intermittent sprint exercise test following 6 days of Cr supplementation. It appears that ingestion of Cr for 6 days does not produce any different thermoregulatory responses to intermittent sprint exercise and may augment sprint exercise performance in the heat.

  • In a 2008 study in the British Journal of Sports Medicine, by  a US researcher V.J. Dalbo & team, suggested that, despite the abundance of research suggesting the effectiveness and safety of creatine, a fallacy appears to exist among the general public, driven by media claims and anecdotal reports, that creatine supplementation can result in muscle cramps and dehydration. Acc. to the researchers “Recent reports now suggest that creatine may enhance performance in hot and/or humid conditions by maintaining haematocrit, aiding thermoregulation and reducing exercising heart rate and sweat rate. Creatine may also positively influence plasma volume during the onset of dehydration. Considering these new published findings, little evidence exists that creatine supplementation in the heat presents additional risk.”
  1. In a 2009 study in the Journal of Athletic Training, a team of researchers led by Rebecca Lopez , researched the effect of creatine supplementation on exercise heat tolerance and hydration status. Lopez & team found that, the first time creatine gained attention was in 1997 when three NCAA wrestlers died, for which creatine was blamed. However, autopsy results determined that exertional heat stroke, not creatine, was responsible for these deaths. Such speculations also came later, blaming creatine, but all of them have been debunked. Theoretically, creatine uptake by the muscles results in an increase in fluid volume within skeletal muscle cells. Acc. to the researchers, theoretically, creatine uptake by the muscles results in an increase in fluid volume within skeletal muscle cells. Whether this increase helps, hinders, or does not influence thermoregulation has not been determined.

Lopez & team, after analysing over fifteen studies, concluded that, “No substantial evidence currently exists showing that creatine supplementation hinders the body’s ability to dissipate heat or body fluid balance when appropriate doses are consumed. Controlled experimental trials of athletes exercising in the heat over a short period of time resulted in no adverse effects from creatine supplementation.”

  1. Acc. to a 2011 study in the American Journal of Lifestyle Medicine, by a US research team led by Eric Sobolewski: “Although many recent studies have addressed the safety concerns of creatine supplementation on hydration status in hot and humid environments, anecdotal reports still exist linking creatine usage to heat-related problems. These concerns are based on the premise that creatine is an osmotically active substance resulting in an alteration in fluid balance by increasing intracellular fluid volume and preventing fluid from entering the extracellular environment to aid in thermoregulation. However, a number studies have demonstrated that when recommended amounts of creatine are consumed, creatine does not appear to increase the risk of heat-related problems during exercise and may actually have a positive influence on core temperature and heart rate responses.”
  1. Acc. to a 2015 study by a team of Spanish researchers from the Association of Dietitians and Nutritionists of Extremadura (ADIEX), led by L. Munoz Salvador, creatine has the ability to remove plasma water from the blood-stream into skeletal muscle in a process called muscle myofibrillar hydration. Although this benefits the skeletal muscles, less water is available to other tissues since most cell physiological and chemical reactions in the body need water.

For the study, adult males between the age of 18-35yrs were advised to use 0.3grams of creatine per kilogram for several weeks. Researchers found that, 34.5% of people who used creatine experienced weight gain, but did not manifest signs of dehydration at the indicated dose. Acc. to the researchers, although at lower doses of 3grams there is no scientific evidence that risk of dehydration occurs, the recommendation is to maintain a high fluid intake (200-250ml of water per 2.5grams of creatine) since this water needs to be stored and if the availability is low, it decreases absorption and retention within the cell. There is no evidence that taking creatine in normal doses increases heat stress or adversely affects the performance of the athlete in warm environments.

  1. In a 2015 study in the International Journal of Sports Medicine, a team of Brazilian researchers led by R. Deminice, evaluated changes in total body water (TBW) in soccer athletes after 7 days of creatine supplementation. 13 (under-20) soccer players were divided randomly in 2 supplementation groups: Placebo and creatine supplementation. Before and after the supplementation period (0.3g/kg/d during 7 days), TBW was determined. 7 days of creatine supplementation lead to a large increase in TBW and a small but significant increase in total body weight in creatine group compared to placebo group.

Acc. to examine.com research, only potential side-effects are nausea, stomach cramps, and diarrhoea from too large a dose. Creatine causes some water retention, but if you exercise, with time the proportion of added muscle to added water will increase.

Acc. to a 2018 study in the journal Sports Health, by Dr. Jessica Butts & team , creatine is known to cause mild water retention and decreased urinary volume due to its osmotic effect. This may result in temporary weight gain, particularly during the loading phase. However, no adverse effects have been reported because of this.

So, creatine does draw water from in your blood stream and stores additional water within your muscles, which is why when you begin taking creatine, your muscles may feel fuller.  This means that it can also draw water away from other parts of the body.  However, this does not make you dehydrated, as the studies have shown. Also, there is no relation to taking creatine and dehydration, cramping and other adverse effects when working out in heat. People saying that, they have gained weight in stomach after taking creatine are just fat. The water retention happens in the muscles, not in the stomach.

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