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Creatine supplementation reduces my PEM

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by TravelChimp, Mar 19, 2014.

  1. TravelChimp


    Hi everyone, this is my first post on Phoenix Rising, and I thought I’d start by sharing my experiences with Creatine supplementation. I would love to hear the experiences of others, and I’ll share the results from further experiments I’m planning.

    I want to say upfront: I’m NOT advocating anyone using Creatine. BE VERY CAREFUL. Creatine worries me somewhat (more detail below), but I think it’s an important piece of the puzzle because supplementing with Creatine is the only thing that has ever allowed me to do moderate exercise without PEM.


    Subjectively, I would say that supplementing with Creatine for 6 weeks let me do 50-60% more intense exercise without encountering PEM. I even was able to gain some muscle mass at one point. That said, there are side effects (more details below), so do your due diligence if you want to try it. Personally, I found the side effects too much to make Creatine an everyday thing.

    I think a more promising avenue is to use Creatine as a way to interrupt/fix a PEM episode. I’ve had some luck with that and I plan to do more experiments toward that end.


    I have a somewhat, but not totally debilitating case of CFS. My PEM crashes take 12 hours to begin and last 3-6 days. When not experiencing PEM, I am generally pretty functional in life due to a saintly and consistent diet and light exercise regimen, but even so, CFS is a continual struggle for me that has made it a struggle to have a normal social life, have relationships, and perform the job(s) I want to perform.

    For the past 23 years or so, I've had an exercise ceiling that, if I hit it, would trigger an awful PEM crash lasting 3-6 days. The ceiling has always been slightly variable (and thus difficult to work around), and graded exercise therapy (GET) helped me raise it a bit, but there was a limit I couldn’t transcend with GET. The best I ever got to was light jogs, light yoga, and light hikes, but no weight lifting or pushups under any circumstances.

    A couple years ago, I tried Creatine supplementation. I was on it for about 6 weeks. I can’t remember the dose I was on, but it was a normal recommended dose, probably 10 grams/day. I did not “load” (take high doses) to start with as some sites recommend. Very soon after starting, I felt like I had more energy.

    · I started increasing my time and elevation on the walkers at the gym. No PEM.

    · I cautiously increased the intensity and duration of elliptical exercises. No PEM.

    · I cautiously started doing some super light leg lifts, leg presses, and bench presses. No PEM.

    · I increased the intensity of the leg lifts and leg presses, and still no PEM.

    Eventually, I found a limit to where PEM started to happen, but unlike most of my other PEM episodes, it was not a “binary” situation where I crashed from “normal” to zero, but in this case I crashed from “normal” to maybe 5 or 6 and stayed generally functional.

    It was all very encouraging. I felt like Superman, able to actually push a weight in the gym without a brutal crash! That said, there were side effects.


    The side effects of Creatine for me are not insignificant, and they make me wary of it until I can understand what’s happening so I can understand the risks.

    · Stomach upset (this is a common Creatine symptom that everyone gets.. the rest aren’t)

    · Light headedness

    · A lot of difficulty sleeping

    · Something like anxiety, but it felt more like everything went faster.. my mind was racing, but combined with the difficulty sleeping, I spent most of my days “tired but wired”

    Due to the side effects, I don’t make it a regular practice to take Creatine. It’s really uncomfortable being so “tired but wired” all the time. For that reason, the experiments I’m engaging in now are to see if I can reverse the course of a PEM episode with “spot” doses of Creatine (rather than taking Creatine all the time). I have some results on that front, but I’ll post that separately.


    Also, FWIW, by far the biggest improvements for CFS that I’ve had were from diet. I went from being sick, weak, foggy, stressed, dysfunctional, unable to sleep, and tired 99% of the time to having a spectrum that goes all the way as low as 20% of those symptoms. I usually waver between 30-60% of those symptoms and random crashes still happen (although far less often), but it’s a world of difference from before I started experimenting with diet. If anyone is interested, I’d be happy to share what helped me.
    Last edited: Mar 24, 2014
    Sancar, Theodore, Sherpa and 2 others like this.
  2. Valentijn

    Valentijn Activity Level: 3

    I tried Creatine. It gave me intense full-body swelling. Not going anywhere near it again.
  3. heapsreal

    heapsreal iherb 10% discount code OPA989,

    australia (brisbane)
    I had some help with it and add it every so often. Can be hard to tell if it's helping or just the normal ups and downs of cfs. It makes sense to give it atry as it can help with mitochondrial issues. Maybe if u add carnitine q10 and ribose might improve things more??
  4. GhostGum

    GhostGum Senior Member

    Vic, AU
    So what is your current dose? You mention 20mg but this is incredibly low, recommended for athletes is 3-5g a day. Curious though if you are having some success on a lower dose, because maybe a lot of ME sufferers have been trying too much then.

    I use now it then as well but maybe too high a dose, can make me flush and I can not handle the constant water upkeep on the dose, 1litre for each gram of creatine. But yeah it is no surprise it can help with PEM, is going to support any muscle recovery and as heaps said also the mitochondria, helps with ATP synthesis. Also been found to help congnition, studies on wiki showing IQ improvement in students and cognition in the elderly.

    Definitely worth throwing in some ribose too as suggested^, also supports muscle recovery and ATP. Interesting article here on ribose for recovery after a heart attack and cellular energy production,

    I notice ribose is mentioned in the methylation discussions as a co-factor, not sure why creatine is not there as well.

    Grats on your success anyway chimp, diet has helped me a lot over the last couple of years, a ton of leafy greens, vegies and clean proteins.
  5. TravelChimp


    GhostGum, I don't actually have a current dose because I don't take it regularly. I may try some more experiments in using Creatine to reduce PEM though. Sorry about the misquoted dose. I went ahead and corrected that in the post.

    Have you had luck using ribose to treat PEM?
  6. GhostGum

    GhostGum Senior Member

    Vic, AU
    I think success in treating PEM is always like a yes and no answer, I know creatine and ribose certainly have helped me reduce muscle fatigue (some electrolyte powder and magnesium does not hurt neither), so there is certainly benefit there; especially when I am having a good day (90% functioning) and exercising. A lot of my issues though now remain in the cognitive realm of things when things are bad, sometimes mild flu like symptoms and sinus issues, which these supplements will do nothing for.

    Certainly worth trying the cocktail though, most of these things are in a methylation cycle though already as well which many try, minus the creatine.
    Sporty likes this.
  7. Hip

    Hip Senior Member

    I have found creatine monohydrate a useful supplement, reducing brain fog, and increasing conscious awareness. I used a dose range from 2 to 6 grams of creatine monohydrate powder. Interesting that you found creatine reduced PEM.

    But a better option is creatine hydrochloride, because creatine HCl does not cause stomach aches, and also is much more water soluble and absorbable in the gut, and so you only need to take around ⅕ of the dose (so 10 grams of creatine monohydrate = 2 grams of creatine hydrochloride). Ref: 1

    Furthermore, creatine hydrochloride does not break down into toxic creatinine in the stomach (which causes stomach cramps and can cause swelling in the ankles, feet and legs due to fluid retention in the body); whereas the problem with creatine monohydrate is that a lot of this is turned into toxic creatinine by the stomach acid.

    If you want to use creatine monohydrate, though, you can completely avoid the stomach upset / stomach cramps side effect of creatine monohydrate supplementation by taking it on an empty stomach, away from meals, with a ¼ teaspoon of sodium bicarbonate (baking soda), to neutralize stomach acids.

    Stomach acid converts creatine monohydrate to toxic creatinine, and it is this creatinine which causes a stomach upset. But once you have neutralized the stomach acid, you will not get the stomach upset.

    As you can see by the following excerpt from this paper, acidic conditions cause creatine to breakdown to creatinine:
    Note that stomach acid is in the range of pH 1.5 to 3.5.
    Pure water of course has the neutral pH of 7.

    I posted the following on another forum, but it is useful to repost here:

    Note that creatine increases levels of the hormone dihydrotestosterone (DHT), which is one cause of hair loss. 1

    This study is interesting:
    Last edited: Dec 21, 2016
    cigana likes this.
  8. Hip

    Hip Senior Member

    Note that coincidentally, this recently started thread describes the anti-PEM effect of coenzyme Q10. It might be interesting to try both creatine and Q10 together, to see if they provide even better protection from post exertional malaise.
  9. Sherlock

    Sherlock tart cherry etc. for joints, insomnia

    Czechosherlockia, USA
    That's why creatine was never sold as a premixed drink in bottles through the years, though it probably is now because people will sell (and buy) anything. However, I'd have to doubt that short term exposure to acid in the stomach does much harm - else creatine wouldn't have worked.

    What would make creatine not work would be to take it in the absence of insulinogenic molecules, since it's always been said (and experienced) that insulin is necessary for full transport into myocytes.

    By "worked", I mean getting the expected intramyocyte water retention that also comes with increased strength.

    All of the above has todo with creatine use as a strength aid in non-CFS people. Note that there were always also some percentage of non-responders in the population.
    Last edited: May 17, 2014
  10. cigana

    cigana Senior Member

    You may be interested that Dr Shoemaker used to presrcibe large doses or creatine because he claimed it gave substantial increases in VO2max.
    Little Bluestem likes this.
  11. Sporty

    Sporty Senior Member

    Essex, UK
    You sound like me!
  12. aaron_c

    aaron_c Senior Member


    As you might be aware, the insomnia and "wired but tired" feeling sounds like it could be from "overmethylation." Creatine synthesis requres methyl donation from SAMe, so taking creatine supplements spares SAMe, allowing to methylate other things, like neurotransmitters. Heartfixer (a web site) has a good chart on the effects of vdr and comt genes on how sensitive one is to extra methyl groups.

    I am pretty methyl sensitive, but I have found that, at least so far, if I pace increases in methyl donors, the wired feeling disappears after a day or so. Relatively low B2 supplementation might be helping me as well, but I am not sure.

    Which is all to say: I wonder if with time, creatine could provide benefits without the side effects.

    Of course, another way would be to support your own synthesis of creatine through supporting your body's "methylation cycle."

    Where have you settled with this in the last two months?

    Aaron C
  13. Leopardtail

    Leopardtail Senior Member

    It can also cause serious constipation, and build up of ammonia
  14. Hip

    Hip Senior Member

    That most likely occurred because some of the creatine you took was converted into the toxic creatinine in your stomach, by the action of the stomach acid on the creatine.

    Creatinine can cause stomach cramps, and also cause swelling in the ankles, feet and legs due to fluid retention in the body.

    This can be for the most part avoided if you take your creatine monohydrate on an empty stomach, so that there is no stomach acid present.

    But a better option is to take creatine hydrochloride instead of creatine monohydrate, because for creatine hydrochloride, there is virtually no conversion to toxic creatinine in the stomach.

    Note that because creatine hydrochloride is much more absorbable in the gut, 10 grams of creatine monohydrate is equivalent to 2 grams of creatine hydrochloride.
    Little Bluestem and aaron_c like this.

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