Creatine supplementation reduces my PEM

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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.


LONG STORY SHORT

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.


SHORT STORY LONG

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.



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.


DIET FWIW

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.
 
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heapsreal

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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??
 

GhostGum

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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,

https://www.lef.org/magazine/mag2008/may2008_D-Ribose-Energize-Your-Heart-Save-Your-Life_01.htm

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.
 
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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?
 

GhostGum

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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?
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.
 

Hip

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SIDE EFFECTS
Stomach upset (this is a common Creatine symptom that everyone gets.. the rest aren’t)
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:
"Researchers found that whereas creatine was relatively stable in solution at neutral pH (7.5 or 6.5), a lowering of pH resulted in an increased rate of degradation, and after only 3 days of storage at 25°C, creatine degraded significantly: 4% at pH 5.5; 12% at pH 4.5; and 21% at pH 3.5 (see Fig. 5). Similarly, Ganguly et al. (2003) reported that creatine monohydrate stored at room temperature degraded into creatinine within several days."
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:
Three Routes of Taking Creatine Without Causing Stomach Cramps:

(1) The first stomach cramp-free approach was taking creatine on an empty stomach, 3 hours after my last meal (and at least 90 minutes before the next meal) to ensure minimal stomach acid from food digestion; and in addition, I took half a teaspoon (2 grams) of sodium bicarbonate with the creatine to produce an alkaline condition in my gut, to inhibit creatine breakdown to toxic creatinine.

(2) The second solution to the creatine breakdown problem was to avoid the stomach altogether, and take creatine transdermally, by applying it to the skin. This is extremely easy to do if you have creatine in fine powder. You just take say 2 grams of creatine powder, and gently rub it into your dry skin. I usually rub it into the skin area on top half of my thighs, applied while I am sitting down. Creatine powder seems to sink into the skin very quickly, like rubbing in talcum power. I have applied up to 6 grams of creatine monohydrate powder in one go on my skin (using both arms and leg skin areas). I found the cognitive effects are very similar to taking oral creatine, so I think this transdermal method works.

(3) The third solution I tried was intranasal creatine: snorting a small amount of fine creatine monohydrate powder into each nostril (100 mg per nostril) . I tested a very minute amount of powder first (since not all supplements can be taken intranasally — any powders that are even slightly acidic will sting like hell in the nose). But I found that creatine monohydrate powder is very well tolerated in the nose — there is no sting or discomfort at all.

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

This study is interesting:
Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation

"Supplement of creatine (8 g/day for 5 days) reduces mental fatigue when subjects repeatedly perform a simple mathematical calculation. After taking the creatine supplement, task-evoked increase of cerebral oxygenated hemoglobin in the brains of subjects measured by near infrared spectroscopy was significantly reduced, which is compatible with increased oxygen utilization in the brain."
 
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Hip

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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.
 

Sherlock

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creatine monohydrate stored at room temperature degraded into creatinine within several days."
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.
 
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Sporty

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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.
You sound like me!
 

aaron_c

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@TravelChimp

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
 

Leopardtail

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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.


LONG STORY SHORT

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.


SHORT STORY LONG

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.



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.


DIET FWIW

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

Hip

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

Hugo

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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.
Is this version something like creatine hydrochloride: http://www.myprotein.com/sports-nut...15491980&variation=10530208&countrySelected=Y
 

Hugo

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Well I dont know if its exactly the same but its HCL for both supplements so I guess its nearly the same. Thank you for your answer. It seems like its a nasty taste, but thats generally something I can handle so I will try it.
 
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Interested in using creatine to improve physical stamina, any others benefiting?
I've been taking a mix containing 2g of creatine monohydrate for the past few weeks and I am seeing some improvement in steps per day and definite improvement in fatigue levels. I can't be sure it's due to what I'm taking though, it could be that my crash which started in February is coming to an end.

The mix I'm taking has:
2g Creatine monohydrate
2g Glutamine
250mg Taurine
1mg B1
1mg B2
4mg B3
1mg B6 (P5P)

I take it in the evening on empty stomach or with a small meal, depending on hunger :)
I think it helps me sleep (probably due to taurine and B3 which I'm very sensitive to).
Oh and I see B6 also helps sleep.