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Creatine Supplementation: Yes or No?

Creatine is everywhere. It’s a hot topic in health trends right now. Patients ask me about it all the time. It’s all over social media. But what is it? What is it supposed to do, and does it actually do it? Can anyone take it? Is it harmful in anyway? These are the questions. Let’s get the answers.

What is Creatine and What does it do?

We need to pause and discuss some very basic human physiology before we define creatine. ATP (adenosine triphosphate) is a crucial source of energy our body uses for muscle contraction, nerve transmission, and the synthesis of DNA and proteins vital for survival. Without ATP, we die. Creatine is a compound that acts as a buffer for ATP regeneration, especially in our muscles and brain. Our bodies synthesize about half of our creatine, and the other half comes from dietary sources such as meat and fish. It’s stored in muscle as phosphocreatine and provides a rapidly available source of high-energy phosphate for ATP production during muscle use.1

Again, this is an extremely oversimplified explanation of complex physiology but it’s enough to stress the importance of creatine.

What is Creatine Supplementation?

This means taking exogenous creatine orally, usually in a powder form. The most common type is creatine monophosphate. Nearly all of the ingested creatine is either taken up by the body or excreted in the urine.2

Benefits of Creatine Supplementation

About 25 years ago, I played rugby for Penn State’s women’s rugby football club and took creatine. Back then we knew creatine supplementation increased muscle mass, improved strength, and expedited post-workout recovery, especially with resistance training.3 But creatine has come a long way in the last 25 years. We now know its benefits extend far beyond athletics.

Cognitive function – Two systematic review and meta-analyses suggest that older adults and those with a lower baseline creatine level may experience improved cognitive function with creatine supplementation.4-6 The exact dose and duration needed to provide benefit are unknown, and the results are inconsistent. Because of this, European Food Safety Authority (EFSA) concluded that a definitive cause-and-effect relationship between creatine supplementation and broad cognitive improvement has not been established.7

Sarcopenia – Sarcopenia is age-related, progressive skeletal muscle loss that leads to functional decline. (Read this prior blog post to find out more.) Multiple studies have demonstrated that creatine supplementation in combination with resistance training can increase lean muscle mass and strength in older adults.8-10 The greatest benefit was seen when patients loaded creatine and followed a higher dose regimen (at least 5 grams/day) for 24 weeks. A smaller benefit existed when patients did not load or only took creatine on resistance training days.11

Neuroprotection – Animal studies suggest that creatine supplementation may offer neuroprotection in some neurodegenerative disorders such as Parkinson’s disease, Huntingdon’s disease, and dementia.12-14 Smaller clinical trials demonstrated slowed brain atrophy in some conditions, but larger trials have not consistently demonstrated significant benefit.15-17 We need some more trials to help clear this up.

Stay Tuned – Several studies are underway evaluating creatine supplementation for conditions such as concussion treatment, bone strength, perimenopause/menopause, and mood disorders.

Is it Safe?

Creatine monohydrate at the recommended dose of 3-5 grams/day is considered safe and well tolerated for both short- and long-term use in healthy individuals. There are no reported adverse effects on the kidneys, liver or heart, even with doses as high as 30 grams/day for 5 years.3,18-23 The most commonly reported adverse effects are weight gain (usually due to water retention), gastrointestinal symptoms such as nausea, diarrhea, and cramping, and occasional muscle cramping.18,23-26

While creatine is considered safe, there are some people who should not take it. There is no robust evidence that creatine causes kidney dysfunction in healthy individuals, but people with pre-existing renal disease or those at increased risk for renal dysfunction, such as patients with uncontrolled diabetes and high blood pressure, should not take it.21,23,26 Caution is also advised in patients with liver disease.21

There is insufficient evidence about the use of creatine in children, adolescents, pregnant patients, and breast-feeding women.19,24 As such, creatine supplementation is not advised in these patient populations.

So, What’s the Final Word?

I’ve been taking creatine for about two weeks now. I’m 47, menopausal, have no medical issues, and am terrified of being that little frail old lady who falls and breaks a hip. I’ve seen it time and again in the emergency department. One of my main health goals has been to increase my skeletal muscle mass and strength. I started major lifestyle modifications and put myself on a personalized nutrition and exercise plan in March. In six weeks, I dropped 6 pounds of fat and gained 4 pounds of muscle without creatine. If creatine supplementation can help with that further, potentially improve other aspects of my health and aging, and has no major serious adverse effects, why not?

Have the conversation with your doctor to see if you might be a candidate to start creatine supplementation.

Disclaimer: Even though I’m a doctor, I’m not your doctor—and reading this blog does not establish a doctor–patient relationship. This information is intended for general educational purposes only and should not be taken as personalized medical advice. Always speak with your own healthcare provider before making decisions about your health.

References

  1. Lieberman M, Marks AD. Marks’ basic medical biochemistry: a clinical approach. Lippincott Williams & Wilkins; 2009.
  2. Persky AM, Brazeau GA, Hochhaus G. Pharmacokinetics of the dietary supplement creatine. Clin Pharmacokinet. 2003;42(6):557-74. doi:10.2165/00003088-200342060-00005
  3. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. doi:10.1186/s12970-017-0173-z
  4. Prokopidis K, Witard OC. Understanding the role of smoking and chronic excess alcohol consumption on reduced caloric intake and the development of sarcopenia. Nutrition Research Reviews. 2022;35(2):197-206.
  5. Prokopidis K, Giannos P, Triantafyllidis KK, Kechagias KS, Forbes SC, Candow DG. Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. Mar 10 2023;81(4):416-427. doi:10.1093/nutrit/nuac064
  6. Avgerinos KI, Spyrou N, Bougioukas KI, Kapogiannis D. Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Exp Gerontol. Jul 15 2018;108:166-173. doi:10.1016/j.exger.2018.04.013
  7. Turck D, Bohn T, Cámara M, et al. Creatine and improvement in cognitive function: Evaluation of a health claim pursuant to article 13(5) of regulation (EC) No 1924/2006. Efsa j. Nov 2024;22(11):e9100. doi:10.2903/j.efsa.2024.9100
  8. Candow DG, Chilibeck PD, Forbes SC. Creatine supplementation and aging musculoskeletal health. Endocrine. 2014;45(3):354-361.
  9. Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open access journal of sports medicine. 2017:213-226.
  10. Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults—a meta-analysis. Medicine & Science in Sports & Exercise. 2014;46(6):1194-1203.
  11. Forbes SC, Candow DG, Ostojic SM, Roberts MD, Chilibeck PD. Meta-Analysis Examining the Importance of Creatine Ingestion Strategies on Lean Tissue Mass and Strength in Older Adults. Nutrients. Jun 2 2021;13(6)doi:10.3390/nu13061912
  12. Klopstock T, Elstner M, Bender A. Creatine in Mouse Models of Neurodegeneration and Aging. Amino Acids. 2011;40(5):1297-1303. doi:10.1007/s00726-011-0850-1
  13. Leem YH, Park JS, Park JE, Kim DY, Kim HS. Creatine Supplementation With Exercise Reduces Α-Synuclein Oligomerization and Necroptosis in Parkinson’s Disease Mouse Model. The Journal of Nutritional Biochemistry. 2024;126:109586. doi:10.1016/j.jnutbio.2024.109586
  14. Zhu S, Li M, Figueroa BE, et al. Prophylactic Creatine Administration Mediates Neuroprotection in Cerebral Ischemia in Mice. The Journal of Neuroscience. 2004;24(26):5909-5912. doi:10.1523/JNEUROSCI.1278-04.2004
  15. Beal MF. Neuroprotective effects of creatine. Amino Acids. May 2011;40(5):1305-13. doi:10.1007/s00726-011-0851-0
  16. Bender A, Klopstock T. Creatine for neuroprotection in neurodegenerative disease: end of story? Amino Acids. Aug 2016;48(8):1929-40. doi:10.1007/s00726-015-2165-0
  17. Roschel H, Gualano B, Ostojic SM, Rawson ES. Creatine Supplementation and Brain Health. Nutrients. Feb 10 2021;13(2)doi:10.3390/nu13020586
  18. Antonio J, Candow DG, Forbes SC, et al. Common Questions and Misconceptions About Creatine Supplementation: What Does the Scientific Evidence Really Show? Journal of the International Society of Sports Nutrition. 2021;18(1):13. doi:10.1186/s12970-021-00412-w
  19. Antonio J, Brown AF, Candow DG, et al. Part II. Common Questions and Misconceptions About Creatine Supplementation: What Does the Scientific Evidence Really Show? Journal of the International Society of Sports Nutrition. 2025;22(1):2441760. doi:10.1080/15502783.2024.2441760
  20. Almeida D, Colombini A, Machado M. Creatine Supplementation Improves Performance, but Is It Safe? Double-Blind Placebo-Controlled Study. The Journal of Sports Medicine and Physical Fitness. 2020;60(7):1034-1039. doi:10.23736/S0022-4707.20.10437-7
  21. Kim HJ, Kim CK, Carpentier A, Poortmans JR. Studies on the Safety of Creatine Supplementation. Amino Acids. 2011;40(5):1409-1418. doi:10.1007/s00726-011-0878-2
  22. Persky AM, Rawson ES. Safety of Creatine Supplementation. Sub-Cellular Biochemistry. 2007:275-289.
  23. Rodriguez NR, Di Marco NM, Langley S. American College of Sports Medicine Position Stand. Nutrition and Athletic Performance. Medicine and Science in Sports and Exercise. 2009;41(3):709-731. doi:10.1249/MSS.0b013e31890eb86
  24. Andres S, Ziegenhagen R, Trefflich I, et al. Creatine and Creatine Forms Intended for Sports Nutrition. Molecular Nutrition & Food Research. 2017;61(6)doi:10.1002/mnfr.201600772
  25. de Guingand DL, Palmer KR, Snow RJ, Davies-Tuck ML, Ellery SJ. Risk of Adverse Outcomes in Females Taking Oral Creatine Monohydrate: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):E1780. doi:10.3390/nu12061780
  26. Poortmans JR, Francaux M. Adverse Effects of Creatine Supplementation: Fact or Fiction? Sports Medicine (Auckland, NZ). 2000;30(3):155-170. doi:10.2165/00007256-200030030-00002

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