A review paper just published examined the studies published on the various forms of creatine that at least have studies, and as expected, concluded as I did over a decade ago per below: Monohydrate is still the form to go with. The authors concluded:
“Due to the paucity of studies on alternative forms of creatine as well as high prices on the market of these alternative forms, CrM remains as the most extensively studied form of creatine that shows efficacy, safety, and lowest cost to consumer.”
So, since writing this article and updating it as new studies have come out, nadda has changed as far as best bang for the $ in creatine supplements.
The abstract and link to paper are below.
2020 update: HCL vs CM study can be found HERE
See 2012 update to this article HERE
The Creatine Grave Yard © 2009
Looks like another “high tech” form of creatine has got one foot planted firmly in the creatine grave yard. What is the creatine graveyard? It’s where forms of creatine – other then monohydrate – go when either science has shown them inferior to monohydrate, and or it’s life cycle of hype has come to and end.
I refer specifically to creatine ethyl ester (CEE). As with the many “high tech” forms of creatine before it, all manner of claims were/are made about how superior it is to creatine monohydrate (CM). It always starts the same. First the company will invent a long list of negatives about CM such as “poorly absorbed” or “causes bloat” or “is not stable” and then goes onto claim their form of creatine has solved all those invented negatives. The problem is, the data already shows CM does not suffer from virtually any of the negatives they invent, nor do they show their form “cures” those negatives.
Sellers of CCE for example claimed CEE was better absorbed and utilized vs. CM, and that has been shown to be nonsense. There have been several in vitro (test tube) studies pointing to the fact CEE is inferior to CM, but a recent study done in humans puts a final nail in the coffin as far as I am concerned. This study is titled “The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels” The full study is public access and can be read here:
Warning, the abstract is confusing and not well written. If you read the full paper, it’s clearer. If you don’t have the time or interest to read it, the take home is: although all subjects in this study (CEE vs. CM vs. Placebo) experienced approximately the same effects; they all had improvements in bodycomp and got stronger. Why? Because they used untrained subjects in the study. Thus, a drawback of this study was due to using untrained people, they couldn’t differentiate between PL, CEE, and CM in terms of effects on bodycomp and strength within that time period as newbies always make fast progress in the beginning. No news there.
However, the study did achieve the essential point, which is it clearly showed the claims of CEE false: CEE had much higher creatinine levels and lower muscle creatine levels compared to CM in this study, thus, yet again, the claims by sellers of CEE that it’s superior to CM and that CM is “poorly absorbed” or “causes bloat,” or my favorite “CM is not stable,” etc are false. They also looked at changes in water compartments (CEE actually had a trend toward greater extra cellular water then CM BTW, so there goes that stupid “no bloat” claim for CEE…) and other issues claimed to make CEE superior, and it failed.
CEE is less stable then CM, increases creatinine to a much greater extent then CM, and is inferior for increasing muscle creatine levels to CM. This study is not perfect by any means, but when combined with what else exists, and the counter studies sellers of CEE offer (which is to say zero), well you don’t have to be a scientist to see the writing on the wall there…
CEE will be added to the creatine graveyard with a ton of others all claiming to be superior to CM which all started with big claims and now sit in the grave yard.
Two essential points about the grave yard before we get to that:
(1) Because they are in the grave yard does not mean they are worthless. Some forms, such as magnesium creatine chelate for example looked promising, but a head to head study with CM found it no better. Remember, another form does not have to show it’s the equal of CM, it has to show it’s superior to CM per its claims. Forms such as creatine pyruvate and many others on the list may be just as effective as CM, but not superior, so it comes down to cost. Others on the list have in fact been proven inferior to CM in studies, such as serum creatine, various liquid creatine versions, and now CEE. Serum creatine was all the rage a few years ago, and studies found not only was it inferior to CM in every respect, it contained virtually no creatine! Of course, there were still those on the various forums using ‘bro logic’ with “bro, I don’t care what the studies say, it works like da bomb for me!” posts, but I digress….Finally, other forms on the list simply lack any data at all to compare to CM. The companies selling these forms will routinely make claims of superiority with nadda for hard data to support them. Therefore, it’s impossible to really separate fact from fiction (i.e., marketing hype) to recommend them.
Me, I will use what has literally hundreds of studies to support its efficacy and safety over a form with zero data to support it’s claims of superiority over CM. Thus, they get put into the grave yard. Future studies may get them out of the graveyard, but I aint holding my breath…
(2) CM is not perfect. It’s not very soluble, and in about 30% of users, does not appear to work at all. At higher doses, generally above 3g-5g or so in a single dose, can cause stomach upset for some, among other small, but significant drawbacks for some users. Therefore, I am in favor of continued research into improved delivery technologies, improved forms of creatine, and so on. I’m all for it, but as they say, don’t piss on me and tell me it’s raining. In God we trust, everyone else must show data. Hard data talks, BS walks.
I could randomly take two forms from the list below, say dicreatine malate and creatine ethyl carbonate ester and make dicreatine malate creatine ethyl carbonate*, but would it be superior to CM? Unknown as there would be no data. I could just invent a bunch of unproven claims like others do and sell the stuff… Do companies just invent a form of creatine for no other reason then it sound “high tech”? Hell, one company (BSN) is currently in court over one form they sell, called CEM3 or “Creatine Ethyl Ester Malate” which according to the charges “does not exist and is impossible to manufacture”! As I said, CM is not perfect and I am all for continued research into improved (vs. just different!) forms of creatine and or improved delivery technologies, but companies should do their due diligence on these products and stop with all the hype and CM bashing to sell unproven products.
So, without further delay, here is my current list for the creatine graveyard:
The Creatine Graveyard List:
Creatine ethyl ester (CEE)
creatine ethyl ester malate
creatine ethyl carbonate ester
creatine-6,8-thioctic Acid-ketoisocaproic Acid Calcium (CREAKIC)
“conjugated creatine” (Con-Cret)
magnesium creatine chelate
creatine alpha-amino butyrate
* = for the sake of an example. I have no idea if such a form is chemically possible, nor do I care.
Journal of Strength and Conditioning Research: February 11, 2021
Novel forms of creatine have appeared in the marketplace with substantial claims of improved efficacy compared to creatine monohydrate (CrM). The purpose of this study was to conduct a systematic review on alternative forms of creatine to determine (a) whether they are effective ergogenic aids and (b) whether they outperform CrM.
A separate comparison was conducted to determine average cost of various forms of creatine. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Medline, and Google Scholar were systematically reviewed according to PRISMA guidelines. The design of the review was set to answer the PICOS model (participants, interventions, comparators, outcomes, and study design).
Seventeen randomized placebo controlled clinical trials examining exercise performance outcomes and body composition were included in the analysis. Magnesium-creatine chelate and creatine citrate, malate, ethyl ester, nitrate, and pyruvate were the only forms researched in the literature.
Of these studies, only 3 studies compared the alternative creatine form to CrM, making it difficult to compare efficacy to CrM. There were no consistent findings of performance enhancement among alternative forms of creatine when compared to placebo.
A review of the marketplace shows that CrM is the lowest cost form of creatine. Due to the paucity of studies on alternative forms of creatine as well as high prices on the market of these alternative forms, CrM remains as the most extensively studied form of creatine that shows efficacy, safety, and lowest cost to consumer.
Will Brink is the owner of the Brinkzone Blog. Will has over 30 years experience as a respected author, columnist and consultant, to the supplement, fitness, bodybuilding, and weight loss industry and has been extensively published. Will graduated from Harvard University with a concentration in the natural sciences, and is a consultant to major supplement, dairy, and pharmaceutical companies.
His often ground breaking articles can be found in publications such as Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Penthouse, Women’s World and The Townsend Letter For Doctors.
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