If you are taking creatine then you are only addressing half of the equation of muscle energy, recovery, and growth!!!

Creatine works by enhancing your muscle’s energy supply and re-supply capacity through the anaerobic pathway. It does this by increasing concentrations of creatine phosphate, which is the muscle’s immediate storage house for valuable phosphate ions. In the form of creatine phosphate, these ions are readily available to restore the activity of the primary muscle fuel ATP. Creatine phosphate works in conjunction with glycogen to provide immediate energy to the muscle. These compounds do not require the presence of oxygen to do their work, hence they are termed anaerobic (without oxygen) substrates.

The down side of the story is that creatine phosphate is quickly used up. In addition to this, anaerobic breakdown of glycogen for energy (glycolysis) soon comes to a halt as lactic acid builds up.

At this point it is time for the aerobic re-supply of ATP to take over. The aerobic energy system is complex and involves many metabolic pathways that use glucose, glycolytic by-products, as well as fats for substrates.

As I explained, creatine works by supporting and enhancing the anaerobic production of energy in the muscle. Unfortunately, it does nothing to address the production of aerobic energy in the muscle.

This is where citrulline malate comes in. Citrulline malate has been shown to increase aerobic ATP production in the muscle by 34%!ⁱ The result is a marked decrease in fatigue and a substantial increase in aerobic exercise performance.ⁱⁱ Citrulline malate does this in part by stimulating the removal and utilization for energy of the lactic acid formed during anaerobic glycolysis.

Citrulline malate works synergistically with creatine in another way as well. After exercise your creatine phosphate levels are depleted and it takes a while for the free creatine in your muscles to be rephosphorylated. With citrulline malate, the rate of phosphocreatine recovery after exercise is increased by 20%!ⁱⁱⁱ This means that you recover more quickly between weight training sessions giving yourself a better opportunity to grow faster.

Ammonia is a toxic metabolic by product produced by your muscles, especially during intense exercise.  Ammonia is removed from the body by the liver’s urea cycle.  Ammonia is very toxic to the body and muscles; the build up of ammonia in the body results in a rapid onset of fatigue.  If the levels are not reduced, they can lead to muscle catabolism and interference with brain function.  Severe ammonia toxicity can lead to organ failure, and eventually death.

Citrulline Malate stimulates the urea cycle and therefore markedly increases the body’s ability to remove ammonia.^iv   Ammonia is thus converted to the harmless by-product urea, and excreted from the body. 

Citrulline Malate has been sold in France under the name Stimol™ for over 20 years. There, it has mostly been used in the clinical setting for use with weakened and elderly patients, as well in the general population for general fatigue. The results in many cases have been remarkable, with observations of renewed energy, vitality, and mental function to previously physically and mentally impaired patients (see abstracts at end of article)

StaminO2  is Ergopharm’s brand of Citrulline malate and it is sold in the same liquid based form that it has been successfully used for decades in France.  One capful of pleasant tasting sour apple StaminO2 provides 3 grams of Citrulline malate.  The recommended dosage is one 3 gram serving, twice a day.  Maximum results are usually seen after 15 days.  It usually is a good idea to take one of the doses before training, and it is also a very good idea to consume StaminO2 at the same time as creatine supplements.

Users of StaminO2 should notice greater stamina during intense workouts, better pumps, and quicker recovery – both between sets and between workouts.  Users may also experience enhanced well being, general energy, and mental and sexual function.

Randomized Double Blind Placebo Controlled Trial of Citrulline Malate in Geriatrics
M. Carbasse, Regional Teaching HospitalCenter, Nimes, France.

This double blind placebo controlled randomized trial thus refined and confirmed the results of an earlier open study with citrulline malate, confirming the efficacy of the preparation against the clinical manifestation of cerebral aging. Stimol®is therefore felt to be of particular value in geriatrics for the following:

• High level of safety
  
• High level of acceptability
  
• Ease of administration
  
• And above all, rapidity of action.

Results were clinically detectable by the 3rd or 4th and at least the 5th day of treatment. There was an improvement in skin color and a higher level of conscious awareness. While it is difficult at the present time to confirm a favorable effect on individual items (with the exception of vigilance), patients felt better and often reported this spontaneously. If no result is found after two weeks of treatment, it is felt to be of no value to continue. The action of the majority of pharmaceutical preparations aimed at improving cerebral function or oxygenation is far less rapid and clear cut.


Analysis of the Activity of Stimol®, Double Blind Trial on Fatigue.
F. Commandre. La Vie Medicale, April 3,l978.

Assessment of the efficacy of an antifatigue medicine is possible only by use of a meticulous methodological approach. It was with this in mind that the study reported here was undertaken, its objective being to evaluate the antifatigue activity of Stimol® by comparing it with a placebo. Stimol®, or citrulline malate is supplied in the form of 10 ml oral ampoules, prescribed at the dose of 3 per day for two weeks. The active ingredients are DL-malic acid and L-Citrulline (20g/100 ml). The cohort treated in this double blind study trial included 39 patients of both genders with a mean age of around 66 years. Dosage composed of 6 grams daily for 2 weeks. Fatigue in these patients was very markedly improved by Stimol®. Evidence was found of a statistically significant (P<.02) difference between the two groups with a 75% success rate for the active substance compared to 36.8% effectiveness for the placebo.


Evaluation of Stimol® In The Treatment Of Surgical Patient Fatigue
J. Taillade, Biocodex Laboratories, Paris France

Whatever the operation involved, surgery puts a patient under considerable stress: There is an element of psychological assault, with anguish, distress and insomnia, but there is also the physical assault of the act of surgery itself and the specific illness surrounding it, which is distinct from the underlying pathology being treated. Thus “the fact that a patient is tired after surgery, and that his or her tiredness is proportional to the surgery he or she has undergone, has long been accepted by the general public, and indeed is the justification invoked for post-operative rest.” There may be many causes of post-operative fatigue, but it is certain that the stress involved produces an increased and profound disturbance in catabolism: thus abnormalities in glucose breakdown have been demonstrated after surgery, with an accumulation of toxic metabolites such as pyruvate and lactate. Citrulline malate (Stimol®) is indicated in the treatment of physical fatigue, based on evidence from a number of studies, including several controlled trials. Malate conditions the recycling of lactate and pyruvate, while taking part, via its position in the tricarboxylic cycle, in the supply of immediately available energy. The citrulline fraction takes part in the elimination of the amino acid breakdown products of protein metabolism.


Activity of Citrulline Malate on Acid-Base Balance and Blood Ammonia and Amino Acid Levels Study In The Animal And In Man
A. Callis, B. Magnan de Bornier, J.J. Serrano, H. Bellet, and R. Saumade

An experimental evaluation of citrulline malate (Stimol®) CAS 54940-97, an antifatigue compound, was undertaken in man and in animal to study the pharmacological activity of the substance at hepatic and renal level. In man, the protocol involved a double-blind randomized, placebo-controlled cross-over technique. The study in the animal was blind and placebo-controlled with two randomized parallel groups. Results showed that citrulline malate stimulates hepatic ureogenesis and favors the renal reabsorption of bicarbonates. These metabolic actions had a protective effect against acidosis and ammonia poisoning and explain the antifatigue properties of citrulline malate in man.