Creatine

If you have heard of creatine, it is likely that it is associated with steroids and other supplements used by bodybuilders to bulk up on muscle.   You may also have heard that creatine supplements may damage your liver and kidneys and contribute to body fat and hair loss.  Are these perceptions true or are they misconceptions?  Fortunately, for clarity’s sake, creatine and its effects on the body are well researched.

What is creatine?

Creatine is a naturally occurring chemical ingredient that is vital to our bodies and is mainly stored in the muscles as well as other organs, such as the heart and brain.  The body naturally produces creatine, about 1 gram per day, made in the liver, kidneys, and pancreas from three amino acids – arginine, glycine, and methionine.  The body typically does not produce enough creatine for its total requirements and relies on creatine-rich sources in the diet, such as meat, seafood (fish and shellfish), and animal milk.  About 2-3 grams of the body’s daily supply of creatine comes from the diet.

Creatine plays an essential role in the production of energy in the cells in the body.  Most creatine goes to skeletal muscles, where creatine is converted into a compound of creatine and phosphoric acid, namely phosphocreatine, which the body uses to replenish the primary energy currency of cells, called adenosine triphosphate (ATP), especially during high-intensity muscle activities. 

In this way, creatine plays a vital role in creating a steady supply of energy in the muscles so they can keep working while exercising.

About 95% of creatine is delivered to skeletal muscles, to be used during physical activity, while the rest goes to the brain, heart, and other tissues.

Common beliefs, perceptions, and misconceptions about creatine:

Supplementation with creatine is very popular amongst athletes and other sports people to improve muscle mass, performance, and recovery.  It has been used for many years, but still some concerns remain about the efficacy and safety of creatine supplementation.  Fortunately, creatine has been well researched over the years, and evidence-based research is available to either validate or nullify these concerns.

Does creatine cause kidney damage and renal dysfunction?

• Research findings: This concern persists, even after more than 20 years of research that found no adverse effects from recommended dosages of creatine supplementation.  This concern probably results from a poor understanding of creatine and creatine metabolism, as well as the misconception that if the kidneys are “forced” to excrete higher than normal levels of creatine, some kidney “overload” will take place than can cause kidney damage or renal dysfunction.  In reality, increases in blood or urinary creatine as a result of creatine supplementation are unlikely to indicate a decrease in kidney function.  Research shows no adverse effects from taking recommended doses of creatine supplements on kidney or renal function in healthy individuals.

Is creatine an anabolic steroid?

• Research findings: Anabolic steroids are drugs, with a different chemical structure than creatine.  Anabolic steroids are a synthetic version of testosterone and are used together with resistance training with the aim of increasing muscle mass and strength.  Testosterone is able to enter the muscle cell and bind with the intracellular androgen receptor and increase the expression of various muscle-specific genes.  Creatine supplementation increases energy production in cells during heavy exercise and possibly increases muscle power, repetition, and exercise volume.  Although the physiological and performance outcomes of anabolic steroids and creatine may be similar, their mechanisms of action are quite different.

Does creatine lead to water retention?

• Research findings: Early short-term studies showed that creatine supplementation at 20 g/day over 6 days was associated with water retention has led to this myth.  A number of later and longer-term exercise training studies (5-10 weeks), incorporating creatine supplementation, have shown no increase in total body water.

Does creatine lead to dehydration and muscle cramping?

• Research findings: There is still persisting speculation that creatine supplementation causes dehydration and muscle cramping.  These perceptions result from small studies where some participants reported cramping and symptoms of dehydration.  Unfortunately, these studies failed to control the use of other supplements and the dosage of creatine that was ingested.  Wider clinical and experimental research does not validate the perception that creatine supplementation in recommended doses causes dehydration and muscle cramping.

Does creatine increase fat mass?

• Research findings: As some exercising individuals experience a gain in body mass form creatine supplementation, there is a concern that creatine supplementation increases fat mass.  However, various controlled trials, varying in duration from one week to two years, showed that creatine supplementation had no effect on fat mass.

Is a creatine “loading phase” needed?

• Research findings: Creatine loading refers to supplementing creatine for 5-7 days with a dosage of 20-25 g/day, often taken as smaller doses four or five times a day.  The “loading phase” is followed by a daily maintenance phase of 3-5 g/day.  The misconception is that individuals have to “load” with creatine to increase intramuscular stores in order to experience the benefits of creatine supplementation.  However, accumulating evidence from studies indicates that it is not necessary to ‘load’ creatine, as lower daily dosages of 3-5 g/day are effective for increasing intramuscular creatine stores and muscle performance and recovery.

Is creatine only useful for power type activities?

• Research findings: Although creatine supplementation is deemed to primarily benefit those involved in high-intensity intermittent power and resistance activities, there is a growing body of evidence from studies that creatine supplementation benefits a variety of athletic events, not only resistance/power activities.

Is creatine harmful to children and adolescents?

• Research findings: The majority of research findings in adult populations indicate that creatine supplementation is safe and generally well tolerated over both the short-term and long-term.  It is however not clear if this holds true for children and adolescents.  Several clinical trials in teens implemented strict surveillance measures, which included continual monitoring of laboratory markers of kidney health, liver function, and inflammation, none of which were negatively impacted by creatine supplementation.  Based on the limited evidence from studies, creatine supplementation appears to be safe for children and adolescents. 

Is creatine beneficial for older adults?

• Research findings: One of the age-related conditions that could benefit from creatine supplementation is sarcopenia, which is a progressive skeletal muscle condition with a decrease in muscle mass, strength, and functionality.  Research results indicate that creatine supplementation alone without exercise may be ineffective to prevent sarcopenia and is unlikely to result in substantial gains in muscle strength and functional performance.

Is creatine only effective for males?

• Research findings: Increasing evidence from research over the past decade in postmenopausal females has indicated that creatine supplementation during a resistance training programme can improve muscle mass and body strength.  When combined with resistance training, creatine supplementation may also have favourable effects on bone in postmenopausal females.  Scientists are of the opinion that creatine supplementation, in conjunction with exercise, is potentially a therapeutic intervention across the lifespan in females.

Effect of creatine supplementation on exercise performance:

Most athletes who take creatine supplements participate in power sports, such as bodybuilding, wrestling, football, bicycling, and sprinting.  They take creatine supplements to aid their workout routines, as creatine increases energy and strength, which improves performance in anaerobic activity, resistance training, and high-intensity sport.

As creatine supplementation increases phosphocreatine levels and replenishes ATP, it increases the body’s capacity to perform fast, explosive movements.  This enhances weightlifting, sprinting, and high-intensity interval training.  Creatine is also linked to activating cellular pathways involved in muscle protein synthesis, which plays a major role in cellular growth and repair.  It also appears to reduce the activity of proteins that play a role in muscle breakdown.

As creatine attracts water into muscle cells, the effect of this hydrated state aids muscle performance.

The injury prevention potential of creatine supplementation is still under investigation.  Some studies found that as creatine boost muscle mass and strength during resistance training, it improves joint stability and lowers the risk of injuries from muscle weakness and imbalances.  Creatine supplementation can reduce exercise-induced muscle damage, which would result in faster recovery after high-intensity workouts and possibly reduce the risk of overuse injuries.

Creatine and Brain Health

Recent research indicates that creatine may have possible neuroprotective effects, as creatine is involved in ATP production and mitochondrial function in the brain.  This is suspected to offer some protection against neurodegenerative diseases, especially conditions that impair cellular energy metabolism, such as Alzheimer’s disease and Parkinson’s disease.  

The involvement of creatine in ATP production and mitochondrial function in the brain has resulted in some trials to try and determine to possible benefits of creatine supplementation on cognitive function.  Although some studies suggest that it may improve cognitive performance under certain conditions, for example mental fatigue and sleep deprivation, scientific evidence is still limited.  Further studies are required to determine whether creatine supplementation may act as a neuroprotective factor and whether it may influence long-term cognitive performance.

Dosage:

Instead of the traditional method of loading followed by a maintenance phase, recent findings have shown that low-dose routines of 3-5 g/day without a loading phase are equally effective in saturating the muscles over an extended period.

Interestingly, post-exercise intake of creatine supplementation may provide more significant benefits than pre-exercise consumption.  This results from increased exercise-induced blood flow to muscles, which enhances nutrient delivery and uptake.

Further research is needed to determine how exercise type, age, and gender may influence optimal dosing strategies.

Although short-term studies have repeatedly shown creatine supplementation to be safe, there is limited research on long-term effects beyond five years.

Conclusion:

Creatine is a compound the body naturally makes, and one also gets it from protein-rich foods.  It supplies energy to your muscles and many people with a robust exercise routine take creatine supplements to increase strength and improve performance.

Creatine supplementation is not a silver bullet and alone does not build muscle, it requires fairly high-intensity exercise and a well-balanced diet to reap its benefits.

There is a need for further studies to determine long-term outcomes, gender and age-specific differences, as well as dosing strategies.

References:

What is creatine?  Potential benefits and risks of this popular supplement.  Published 20 March 2024.  Harvard Health Publishing.    Harvard Medical School.  (www.health.harvard.edu)

Creatine.  Published online and reviewed 26 April 2023.  Cleveland Clinic.  USA.  (A nonprofit multi-specialty medical centre that integrates clinical and hospital care with research and education.)  (www.clevelandclinic.org)

Common questions and misconceptions about creatine supplementation; What does the scientific evidence really show.  Published February 2021 in Journal of the International Society of Sports Nutrition.  PubMed Central.  National Centre for Biotechnology Information.  US National Library for Medicine. National Institutes of Health.  USA.  (www.ncbi.nlm.nih.gov)

Creatine: The bodybuilding supplement that boosts brainpower.  Published 27 May 2025.  BBC.  UK.  (www.bbc.com)

Creatine supplementation: effects on athletic performance, cognitive processing, and long-term health consequences.  A review of the literature.  Published in the journal Medical Science. 29 e12ms 3516 (2025).  (www.discoveryjournals.org)

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