As educators, we are all too aware of how quickly retention rates drop during a lecture. So we are going to give you the "Cliffs Notes" version: Creatine works. It is extremely safe, improves explosive performance and enhances muscle mass. Yawn.

OK, so you knew that. Now, let us get to the new and exciting info on creatine. Research conducted over the past 16 months has uncovered some pretty cool facts about the current king of anabolic supplements. So grab your No. 2 pencils and take a seat. You are about to learn how to get even better gains with creatine.

Creatine Is Safe

Let us start here, just in case you have encountered one of those silly articles in the mainstream press that provides false information about creatine. A Netherlands study found that almost one year of continuous creatine supplementation had no adverse effects on kidney function. The research states that of 175 healthy subjects taking either 10 g per day of creatine or a placebo for 310 days, no deleterious effects were noted on blood or urinary markers of kidney function. While we are at it, we would also like to note that to date, no placebo-controlled, double-blind studies in humans have ever reported side effects from creatine supplementation. No cramping, no muscle strains, no abnormal blood work, nothing. And remember, while widespread creatine use began in the early 1990s, many athletes have been using it since the 1960s, so there is a fairly substantial history of safe use.

Take-home Lesson: Do not listen to disinformation. Creatine is safe. Period.

Creatine Gets High Grades

For fitness-minded folks, creatine plays its most important roles in skeletal muscle, where fast-twitch fibers can store about twice as much creatine as slow-twitch fibers. The uptake process, like synthesis, can be ramped up by several factors, such as exercise, catecholamines (e.g., adrenaline), insulin-like growth factor-1, insulin and the ingestion of carbohydrates and protein. Many savvy supplement manufacturers have taken notice and now incorporate creatine into nitric-oxide boosters, energy bars, meal-replacement products, pre- and post-workout drinks and protein powders. The truth is, not everyone needs an expensive creatine product to enhance their performance, muscle strength and size. For creatine "responders," a daily dose of 3–5 g mixed into fruit juice or hot chocolate does wonders. But for others with sensitive stomachs and/or limited ability to sponge up creatine into their muscles, the more esoteric, scientifically based creatine blends are godsends. And before anyone e-mails us, no - there are no head-to-head studies that show one form of creatine is better than another … yet.

Add High-Gi Carbs

In a review of the scientific basis and practical aspects of creatine supplementation for athletes, researchers from the University of Connecticut noted that:

Creatine supplementation does indeed augment gains in muscle strength and size during training, although the precise reason(s) why are still unclear.

Creatine supplementation is most effective in improving short, repeated bursts of high-intensity activity.

By virtue of its ability to improve performance, creatine supplementation increases training volume, which results in a greater training stimulus.

Creatine induces cell swelling in muscle, which allows muscle to hold greater quantities of glycogen (stored carbohydrates).

Not everyone "responds" to creatine supplementation. For some reason, individuals whose muscles do not absorb creatine very well notice very little, if any, performance enhancement from creatine supplementation.

Take-Home Lesson: An effective strategy to increase creatine storage in muscle is to elevate insulin levels during creatine ingestion (usually post-exercise) via the ingestion of high-glycemic-index carbohydrates.

Take-Home Lesson: Practically speaking, since lifting heavier weights relies on more fast-twitch muscle fibers, this may also mean that training with heavy weights during creatine supplementation might be more effective than training with light ones.

Take-Home Lesson: Two points here: First, as mentioned previously, creatine usually works best during repeated efforts, not single events; and second, creatine uptake often requires some help in the form of carbohydrates or protein. In other words, take your creatine with a meal.

Take-Home Lesson: Creatine works best at increasing lean mass when combined with protein and carbs. (There is a shocker.)

Take-Home Lesson: Still, beta-alanine has performed well in other studies, so this supplement is definitely worth taking for a test run.

Limit Java
Here is one that is bound to cause some controversy. Depending on the type of exercise, caffeine may negate some of the performance-enhancing effects of creatine. Subjects who ingested 40 g per day of creatine for six days improved their performance during a series of three leg-extension tests. However, when a single dose of approximately 350 mg of caffeine was given two hours prior to the same series of tests, performance only improved in one of the leg-extension tests.

Take-Home Lesson: While we are not overly concerned about caffeine and creatine combos, for now, if you co-ingest creatine and caffeine, keep the dose of the latter under 200 mg.

Take-Home Lesson: Since elevated homocysteine levels are a risk factor for cardiovascular disease, this indicates that creatine supplementation may be beneficial for reducing the risk of cardiovascular disease in certain individuals.

Take-Home Lesson: Endurance athletes can also gain from creatine. Previous research with endurance exercise has revealed that creatine loading prior to carbohydrate loading allows muscle to hold more carbohydrates.

"The mountain of data supporting creatine and its benefits for athletes continues to grow like a raging bonfire in a lumberyard."

Brain Aid
Researchers from Harvard Medical School noted that creatine has remarkable neuroprotective properties in experimental models of Huntington’s disease, Parkinsons disease and traumatic brain injury.

Take-Home Lesson: Regular use of creatine (similar to taking a baby aspirin every day) should be considered for patients at high risk for stroke.

Will Not Burn You Up
This study gauged the effects of using creatine in unusually hot conditions. Regardless of whether the subjects loaded with creatine (20 g per day for five days) or a placebo, no differences in core temperature or skin temperature were noted in 15 men who cycled for 40 minutes at 102 degrees Fahrenheit.

Take-Home Lesson: Creatine supplementation does not impair thermoregulation during submaximal exercise in heat. This flies in the face of certain smear tactics against creatine that blamed this valuable supplement of contributing to problems of overheating for some athletes. Once again, researchers have bolstered the safety record of creatine.

Helps Prevent Muscle Wasting
Creatine loading reduces muscle wasting induced by immobilization. Although this study was done on rats, it has sweeping implications for anyone put in a cast or stuck in bed due to illness or injury. Rats given creatine for seven days before and during a seven-day immobilization period lost less muscle than control rats.

Take-Home Lesson: OK, this is with rodents, but this study shows the promise creatine has for muscle-wasting diseases, and how that promise could benefit healthy exercisers.

There you have it! The mountain of data supporting creatine and its benefits for athletes continues to grow like a raging bonfire in a lumberyard. In our view, when used according to recommended guidelines, creatine is one of the safest, most beneficial dietary supplements available today. You can thank science (and lots of money spent on research) for that.

Tim Ziegenfuss, PhD, is the president of Z Sciences, Inc., a widely recognized consulting firm to the dietary supplement industry. Jamie Landis, MD, PhD, is an assistant professor in the department of biology at Lakeland Community College in Ohio. To obtain more details of the studies cited in this article, e-mail Tim Ziegenfuss, PhD, at labinsider@physicalmag.com.