Creatine Supplementation and Changes in Total Body Water
Keywords:
Creatine, Creatine Supplementation, Total Body WaterAbstract
This study was survey research conducted as a review article incorporating a systematic search process. The objective was to synthesize evidence regarding the effects of creatine supplementation on total body water (TBW), intracellular water (ICW), and extracellular water (ECW), as well as to examine relevant covariates, including short-term high-dose creatine supplementation, commonly referred to as the loading phase, maintenance-phase supplementation, supplementation dose and duration, biological sex, systematic exercise training status, and methods used to assess body water compartments. Relevant studies were identified through searches of PubMed and Google Scholar, limited to human studies. A total of 2,970 records were retrieved. After screening, 12 studies were included in the review. Data were analyzed descriptively by comparing sample size and participant characteristics, creatine supplementation dose and duration, methods for assessing body water compartments, and relevant covariates.
The included studies were categorized according to sex, systematic exercise training status, supplementation dose, and supplementation duration. The findings indicated that creatine supplementation increased total body water (TBW) by approximately 1–2 L. This increase occurred predominantly in the intracellular water (ICW) compartment, with an increase of approximately 0.6–1.0 L, while extracellular water (ECW) increased by approximately 0.46 L. A maintenance dose of 3–5 g/day was sufficient to increase body water, which is consistent with the osmotic properties of creatine that promote water movement into muscle cells. Among the covariates examined, males appeared to show a greater increase in body water than females. In contrast, females in the luteal phase of the menstrual cycle demonstrated the greatest increase in body water following supplementation. However, no clear differences in body water changes were observed when stratified by supplementation dose, supplementation duration, or systematic exercise training status.
References
Harris RC, Söderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical Science. 1992;83(3):367-74.
Forbes SC, Candow DG, Krentz JR, Roberts MD, Young KC. Changes in fat mass following creatine supplementation and resistance training in adults≥ 50 years of age: a meta-analysis. Journal of functional morphology and kinesiology. 2019;4(3):62.
Powers ME, Arnold BL, Weltman AL, Perrin DH, Mistry D, Kahler DM, et al. Creatine Supplementation Increases Total Body Water Without Altering Fluid Distribution. J Athl Train. 2003;38(1):44-50.
Wilcock IM, Cronin JB, Hing WA. Physiological Response to Water Immersion. Sports Med. 2006;36(9):747-65.
Francaux M, Poortmans JR. Effects of training and creatine supplement on muscle strength and body mass. Eur J Appl Physiol Occup Physiol. 1999;80(2):165-8.
Kern M, Podewils LJ, Vukovich M, Buono MJ. Physiological response to exercise in the heat following creatine supplementation. Journal of Exercise Physiology Online. 2001;4(2).
Brilla LR, Giroux MS, Taylor A, Knutzen KM. Magnesium-creatine supplementation effects on body water. Metabolism. 2003;52(9):1136-40.
Deminice R, Rosa FT, Pfrimer K, Ferrioli E, Jordao AA, Freitas E. Creatine Supplementation Increases Total Body Water in Soccer Players: a Deuterium Oxide Dilution Study. Int J Sports Med. 2016;37(2):149-53.
Brooks SJ, Candow DG, Roe AJ, Fehrenkamp BD, Wilk VC, Bailey JP, et al. Creatine monohydrate supplementation changes total body water and DXA lean mass estimates in female collegiate dancers. J Int Soc Sports Nutr. 2023;20(1):2193556.
Ribeiro AS, Avelar A, Kassiano W, Nunes JP, Schoenfeld BJ, Aguiar AF, et al. Creatine Supplementation Does Not Influence the Ratio Between Intracellular Water and Skeletal Muscle Mass in Resistance-Trained Men. 2020.
Baltic S, Nedeljkovic D, Todorovic N, Ratgeber L, Betlehem J, Acs P, et al. The Impact of Short-Term Supplementation With Guanidinoacetic Acid and Creatine Versus Creatine Alone on Body Composition Indices in Healthy Men and Women: Creatine-Guanidinoacetic Acid Affects Body Composition. J Nutr Metab. 2024;2024:7815807.
Meshtel’ AV, Мирошников А. DYNAMICS OF WATER CHANGES IN THE BODY DURING WEEKLY INTAKE OF CREATINE SUPPLEMENTS: A PILOT STUDY. Russian Journal of Sports Science: Medicine, Physiology, Training. 2022;1.
Moore SR, Gordon AN, Cabre HE, Hackney AC, Smith-Ryan AE. A randomized controlled trial of changes in fluid distribution across menstrual phases with creatine supplementation. Nutrients. 2023;15(2):429.
Marini ACB, Schincaglia RM, Candow DG, Pimentel GD. Effect of Creatine Supplementation on Body Composition and Malnutrition-Inflammation Score in Hemodialysis Patients: An Exploratory 1-Year, Balanced, Double-Blind Design. Nutrients. 2024;16(5).
Wilkinson TJ, Lemmey AB, Jones JG, Sheikh F, Ahmad YA, Chitale S, et al. Can Creatine Supplementation Improve Body Composition and Objective Physical Function in Rheumatoid Arthritis Patients? A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2016;68(6):729-37.
Mor A, Karakaş F, Yılmaz AK, Mor H, Acar K, Arslanoğlu E. The Combined Effect of Glutamine and Creatine Supplementation on Body Hydration Level and Some Performance Parameters in Football Players. Herkes için Spor ve Rekreasyon Dergisi. 2024;6(2):169-79.
Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 2017;14(1):18.
Halliday D, Miller AG. Precise measurement of total body water using trace quantities of deuterium oxide. Biomedical mass spectrometry. 1977;4(2):82-7.
Van Marken Lichtenbelt WD, Westerterp KR, Wouters L. Deuterium dilution as a method for determining total body water: effect of test protocol and sampling time. British Journal of Nutrition. 1994;72(4):491-7.
Quiterio AL, Silva AM, Minderico CS, Carnero EA, Fields DA, Sardinha LB. Total Body Water Measurements in Adolescent Athletes: A Comparison of Six Field Methods With Deuterium Dilution. The Journal of Strength & Conditioning Research. 2009;23(4).
Cataldi D, Bennett JP, Quon BK, Liu YE, Heymsfield SB, Kelly T, et al. Agreement and Precision of Deuterium Dilution for Total Body Water and Multicompartment Body Composition Assessment in Collegiate Athletes. The Journal of Nutrition. 2022;152(9):2048-59.
Haas V, Schütz T, Engeli S, Schröder C, Westerterp K, Boschmann M. Comparing single-frequency bioelectrical impedance analysis against deuterium dilution to assess total body water. European Journal of Clinical Nutrition. 2012;66(9):994-7.
Moon JR, Smith AE, Tobkin SE, Lockwood CM, Kendall KL, Graef JL, et al. Total body water changes after an exercise intervention tracked using bioimpedance spectroscopy: A deuterium oxide comparison. Clinical Nutrition. 2009;28:516-25.
Paddon-Jones D, Børsheim E, Wolfe RR. Potential Ergogenic Effects of Arginine and Creatine Supplementation. The Journal of Nutrition. 2004;134(10):2888S-94S.
Zhang N, Zhang J, Du S, He H, Yan X, Ma G. Association between the content of intracellular and extracellular fluid and the amount of water intake among Chinese college students. Nutrition & Metabolism. 2019;16(1):67.
Serra-Prat M, Lorenzo I, Palomera E, Ramírez S, Yébenes JC. Total Body Water and Intracellular Water Relationships with Muscle Strength, Frailty and Functional Performance in an Elderly Population. A Cross-Sectional Study. The Journal of nutrition, health and aging. 2019;23(1):96-101.
Serra-Prat M, Lorenzo I, Palomera E, Yébenes JC, Campins L, Cabré M. Intracellular water content in lean mass is associated with muscle strength, functional capacity, and frailty in community-dwelling elderly individuals. A cross-sectional study. Nutrients. 2019;11(3):661.
Yoshida T, Yamada Y, Tanaka F, Yamagishi T, Shibata S, Kawakami Y. Intracellular-to-total water ratio explains the variability of muscle strength dependence on the size of the lower leg in the elderly. Experimental Gerontology. 2018;113:120-7.
Elstad K, Malone C, Luedke J, Jaime SJ, Dobbs WC, Almonroeder T, et al. The Effects of Protein and Carbohydrate Supplementation, with and without Creatine, on Occupational Performance in Firefighters. Nutrients. 2023;15(24).
Theodorou AS, Havenetidis K, Zanker CL, O'Hara JP, King RF, Hood C, et al. Effects of acute creatine loading with or without carbohydrate on repeated bouts of maximal swimming in high-performance swimmers. J Strength Cond Res. 2005;19(2):265-9.
Theodorou AS, Paradisis G, Smpokos E, Chatzinikolaou A, Fatouros I, King R, et al. The effect of combined supplementation of carbohydrates and creatine on anaerobic performance. Biol Sport. 2017;34(2):169-75.
Islam H, Yorgason NJ, Hazell TJ. Creatine co-ingestion with carbohydrate or cinnamon extract provides no added benefit to anaerobic performance. Eur J Sport Sci. 2016;16(6):685-93.
