Amount of Evidence: Very High Potential Benefits: Very High Safety: Very High
TABLE OF CONTENTS
What is creatine?
Creatine is one of the safest and most beneficial supplements on the market and there are hundreds of studies that can back it up. This supplement is most efficacious when paired with high-intensity exercises, such as weight-lifting and sprinting. However, even sedentary people can derive massive benefits from taking creatine.
Potential benefits
It is important to note that all of the potential benefits mentioned below are dose-dependent. In general, the higher the dose you take, the more pronounced the effects will be. However, they do reach a plateau at a certain point. We will discuss the best dosing protocol later in this article.
Major benefits
Increased power output – Creatine was shown by a meta-analysis to increase your power output during high-intensity exercise (including resistance training) by 12-26%.
Increased strength – People who work out experience on average a 12-20% increase in strength when they start taking creatine.
Increased lean muscle mass – When paired with weight lifting, creatine significantly increases muscle growth. The increases in strength are more notable but muscle growth is undeniably improved by taking the supplement.
Reduced symptoms of depression – This effect is most significant for women but appears to be notable for men as well. While the exact cause for this is unknown, creatine has been shown to have an impact on serotonin pathways and appears to enhance SSRI therapy so the effect is probably serotonin-related.
Minor benefits
Increased overall weight – This effect is large and has to do with increases in muscle mass, as well as higher water retention. Fortunately, creatine does not lead to an increase in unhealthy weight. It can actually aid fat loss.
Fat loss – This is not a direct effect of creatine. However, gaining muscle mass increases your metabolism and improves your insulin sensitivity. Both of these effects lead to fat loss. Unfortunately, creatine doesn’t seem to aid fat loss in individuals who do not work out.
Reduced fatigue – This effect was mainly noted in two groups of people: those with traumatic brain injury (TBI) and sleep-deprived individuals. In teenagers and younger children with traumatic brain injury, creatine was able to reduce symptoms of fatigue by around 90%. In healthy people who get enough sleep, this effect is minor but still likely to occur to some degree, especially during intense exercise.
Reduced headaches – This benefit was also noted in people with TBI but may also occur in healthy individuals to a lesser degree.
Lowered blood glucose – While creatine doesn’t seem to impact fasting blood glucose, there is an 11-22% reduction in blood glucose spikes after food.
Improved bone mineral density – While the evidence is limited (at least compared to the other effects of creatine), the supplement appears to increase bone mineral density.
Improved hydration – since creatine leads to higher water retention, it makes you more immune to potential dehydration.
Lower uric acid – A minor reduction was observed.
Increased anaerobic running capacity – This has to do with sprints and even high-intensity VO2 max training (such as the popular 4 minutes on, 4 minutes off protocol). While the effect of creatine on these types of exercise is not as notable as its effect on weight training, it still is significant.
Decreased lipid peroxidation – Creatine seems to have mild antioxidant properties. However, it does not influence the antioxidant enzyme profile in a notable way.
Lower chance of injury – Specifically, the risk of muscle injury during a workout is reduced to some degree. However, this effect is not that significant.
Increased muscular endurance – Creatine appears to be quite effective in this regard but not as much as when it comes to increasing strength or power output.
Cancer prevention – While a direct correlation hasn’t yet been established, creatine is likely to have a positive effect on preventing cancer. This mostly has to do with markers such as reduced exercise-related DNA damage and an increase in strength.
Improved well-being – This effect mostly occurs in people where the supplement is used for treating a certain condition (such as traumatic brain injury) but may be relevant to healthy people as well.
Increased testosterone – While this effect is somewhat minor, creatine does appear to slightly increase testosterone levels. It also increases DHT levels independent of an increase in testosterone.
Treatment of myotonic dystrophy – There appears to be a moderate benefit when it comes to treating myotonic dystrophy type II but little to no benefit when it comes to type I.
Increased VO2 max – While this effect is minor, only a few supplements can increase VO2 max. Creatine is one of the few that can.
Changes in growth hormone – During exercise, the supplement suppresses growth hormone secretion (up to 35% during loading and up to 5% during maintenance) At rest, creatine supplementation can spike growth hormone by up to 45%.
Reduced DNA damage – Specifically, creatine has been shown to reduce exercise-induced DNA damage.
Improved blood flow – This effect was only observed when creatine was combined with resistance training.
Reduced homocysteine – A decrease in this biomarker of inflammatory cardiovascular disease has been observed but this effect is minor.
Reduced symptoms of DMD – Creatine is somewhat helpful for decreasing the symptoms of Duchenne muscular dystrophy.
Unproven benefits
(The effect of creatine on these parameters is either not sufficiently researched or the science shows little to no efficacy in these areas.)
Cholesterol – There is no significant change in neither LDL nor HDL cholesterol levels.
Triglycerides – No influence on fasting or postprandial triglycerides was ever noted.
Kidney function – In healthy people, creatine doesn’t impact kidney function in any way, positive or negative. While some people believe the supplement may cause kidney damage because of the increase in creatinine levels (which happens )during the loading phase), this effect was never confirmed and it was disputed by many studies. Therefore, the claim that creatine causes kidney damage is a myth.
Aerobic exercise performance – Creatine does not impact your cardio performance in a significant way. It is only useful for short bursts of effort.
Blood pressure – The supplement does not appear to significantly influence blood pressure.
Cognition – Unfortunately, creatine doesn’t seem to be as potent of a nootropic as some people claim. It does not increase cognition to a significant degree with the exception of sleep-deprived people and those suffering from traumatic brain injury. Vegetarians and those on a plant-based diet may also notice an increase in cognition.
Cortisol – Creatine does not affect resting cortisol. It could potentially raise cortisol after exercise but this is simply because the supplement helps you exercise more intensely and raises your power output.
Heart rate – We do not yet know how creatine influences heart rate. From the research we have so far, it appears that there is little to no effect in this regard.
IGF-1 – The supplement doesn’t have a direct effect on IGF-1 (Insulin-like growth factor 1) levels.
Liver enzymes – Creatine doesn’t influence circulating liver enzymes, meaning it isn’t beneficial for or damaging to the liver.
Lung function – There is no evidence to support any effect.
Treatment of ALS (Amyotrophic Lateral Sclerosis) – Unfortunately, creatine doesn’t seem to protect muscle and lung function from ALS-related deterioration. One study found a reduction in mortality among those who take creatine so it may have a minor, indirect protective effect.
Adrenaline – Creatine does not have an impact on adrenaline. The same can be said about noradrenaline.
Sleep quality – The supplement was never shown to have a direct effect on sleep quality and duration.
Attention – Creatine failed to increase focus and attention span even in sleep-deprived individuals. However, it has been shown to increase alertness when you are sleep-deprived.
Memory – Just like with attention, no improvement was ever noted.
Inflammation – Creatine has no notable effect on inflammation and its markers, such as CRP (C-reactive protein).
Dopamine – Creatine does not directly increase or decrease your dopamine levels.
Insulin – There may be a slight decrease in fasting insulin but it is caused by the other, more direct effects of creatine.
Pain – Creatine doesn’t decrease physical pain.
Possible side effects
These side effects are dose-dependent and the risk for them increases (most often linearly but sometimes exponentially) as the dose is increased. Some of the side effects are relevant only at very high doses.
Decreased range of motion – This effect was only noted in one study and is not significant.
Nausea – This effect is by no means dangerous but can happen when you take high doses of creatine at once. If you experience nausea after taking the supplement, spread the dose to more but smaller doses.
Diarrhea – Just like nausea, this effect can sometimes occur but is easily preventable by spreading the dose.
Muscle cramps – While this effect is not supported by strong evidence, some people claim that they experience this effect.
Hair loss – This is the most talked-about side effect. The fear of hair loss is valid to some extent because creatine increases DHT and testosterone levels, which can lead to hair loss if you are genetically predisposed to it. However, the same could be said about exercise and many other things that raise testosterone and DHT.
Weight gain – While the weight you gain is going to almost exclusively consist of water weight and muscle mass, this can still be viewed as a side effect for those competing in sports that have a weight class system, such as martial arts.
Who should not take creatine?
You should probably avoid taking high doses of creatine if you:
are genetically predisposed to hair loss and care about your hair more than about the benefits of creatine
Who will benefit the most?
You should definitely consider taking creatine if you:
are a professional athlete or wish to become one (almost every high-level athlete supplements with creatine and if you didn’t, you would put yourself at a huge disadvantage)
do resistance training and wish to see improvements in strength and power output
are on a plant-based or mostly plant-based diet
suffer from TBI (traumatic brain injury)
are often sleep-deprived
suffer from serotonin-related depression
suffer from type II myotonic dystrophy
Types of creatine
While there are more types of creatine, these are the most popular:
Creatine monohydrate – This is by far the most popular type. It is also the cheapest form of creatine. Most of the scientific studies were done studying creatine monohydrate.
Creatine hydrochloride – In this type, creatine is bound to HCl molecules, making it more acidic and easier to dissolve in water. There is a theory that because of this, the absorption of creatine may be improved. Some people claim that this version doesn’t cause muscle cramps. Other than that, creatine HCl is almost identical to the monohydrate form as far as its effects.
pH-Buffered Creatine – This form of creatine is more alkaline than either the monohydrate or the hydrochloride form. Just like with the HCl form, some people claim that pH-Buffered creatine is easier to absorb. However, there is no evidence to support that claim. On the other hand, there is one study disputing that claim, finding no difference in absorption between pH-Buffered creatine and creatine monohydrate.
Creatine nitrate – Nitrate is a molecule made from nitrogen and oxygen and is linked with nitric oxide production. Nitric oxide can increase blood flow and improve exercise performance (both aerobic and anaerobic). Creatine nitrate has been shown to also lead to these benefits, as well as all the benefits associated with other forms of creatine.
Creatine magnesium chelate – This form appears to be just as effective as monohydrate and also likely to give you the benefits of magnesium glycinate.
Creatine ethyl ester – This form is less effective at increasing muscle creatine content compared to monohydrate and other forms. It also increases the amount of creatinine, a waste product of creatine that kidneys need to excrete. This is the worst form of creatine.
Except for the ethyl ester form, all other forms are a great way to supplement with creatine. While there are some extra benefits to the other forms (particularly, creatine nitrate, Mg chelate, and HCl), taking the monohydrate form is usually the best way to go because it is the form most supported by science, and it is also the cheapest one on the market.
How much creatine should you take?
When you start taking creatine, you can but don’t have to go through a loading protocol. The reason to do it is so you get to reap the benefits of elevated creatine levels faster.
If you decide to go through the loading phase, take 0.3 grams of creatine per kg of body weight per day for 7 days and spread your dose to at least 3 smaller doses to increase the absorption. After that, you can switch to regular doses.
People usually recommend a dose of 2-5 grams per day. While this is a great recommendation for most people, you also need to take into account your weight and muscle mass to find the optimal dose for you.
In general, at least 0.03 grams/kg of body weight is a good amount to take. Therefore, if you weigh 80 kg, you want to supplement with at least 2.4 grams a day.
While this amount would give you the majority of the benefits, supplementing with more creatine (5 grams, for example) is going to be slightly more beneficial. This applies especially if you have a lot of muscle mass and/or are working out intensely and consistently.
Taking more than 0.06 grams/kg is usually unnecessary and increases your chance of unwanted side effects. Even very high doses (over 10 grams) are not toxic but they can cause diarrhea and nausea in some people.
It is important to note that the effects of creatine are cumulative. Therefore, you need to take it regularly to notice long-term benefits.
Food sources of creatine
Meat is the only food source of creatine that contains a reasonable amount (typically 0.3-0.5 grams of creatine per 100 grams). However, this should not be a reason to go out of your way to eat more meat since creatine can be taken as a supplement and meat would likely not provide an optimal amount of creatine anyway (unless you are on a carnivore diet, which is rarely a good idea for a healthy individual).
Best time to take creatine
Since the effects of the supplement are cumulative, it does not matter at what time you take it. It also doesn’t matter whether you take creatine with or without food. However, taking the supplement without enough water leads to muscle cramps for some people.
The main thing that might make a difference is splitting your dose. Not only does this help you prevent potential side effects, such as nausea and diarrhea, but splitting your dose also makes the supplement easier to get absorbed, thus increasing your muscle levels of creatine more effectively.
So if you are taking more than 5 grams a day, it is definitely worth it to split the dose and take it in two smaller doses. If you are taking less than 5 grams, splitting the dose could still lead to better absorption but it is not necessary.
Interactions with other supplements
Beta-alanine Taking both supplements together leads to positive changes in body composition (muscle gain and fat loss). These effects are bigger than if you were to take each of them at separate periods.
ALA When creatine is taken with ALA, it gets uptaken into muscle cells more reliably. Therefore, the combination increases muscle creatine levels more than creatine alone. ALA is especially useful during the loading phase.
CoQ10 Taking these two supplements together can improve mitochondrial function and have neuroprotective effects.
Leucine Research shows that combining creatine and leucine (also found in BCAA supplements) together can enhance muscle growth and reduce the negative effects of myostatin.
Caffeine There is a concern that high doses of caffeine (300+ mg) co-ingested with creatine lead to the inhibition of some beneficial effects of creatine (such as the atherosclerotic effect). However, the scientific evidence for this is still limited and the impact of caffeine likely isn’t significant.
NSAIDs The supplement may increase some side effects related to NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen and Cyclosporine.
SSRIs Creatine increases the effects of SSRIs. This effect is most significant in women and not as significant but still notable in men.
Where to buy creatine
Amazon seems to be the best option for ordering creatine supplements in most countries. They offer some very affordable products that are backed by many positive reviews. Also, you can choose from a wide range of brands there without having to spend time searching through other markets on the Internet.
One thing you should pay attention to is that some brands display the dosage per serving and not per pill or capsule. Therefore, you may accidentally buy something that is less potent than you intended. Do not fall for this marketing trick.
FAQ
Creatine can be taken daily and does not need to be cycled.
Yes. The supplement doesn’t impact your sleep in any negative way.
The supplement does not expire. It can, however, lose potency over time. To minimize this effect, keep your supplements in a cold, dark, and dry place. In these conditions, the supplement should stay just as potent for months if not years.
Unfortunately, no human study shows a positive or negative impact on skin elasticity, wrinkles, acne, or anything else.
No. There is no scientific evidence to support this and very few anecdotal reports by people who take creatine.
Even very high doses (over 10 grams) are not toxic but they can cause diarrhea and nausea in some people. There is no reason to take such high doses.
This is the most talked-about side effect. The fear of hair loss is valid to some extent because creatine increases DHT and testosterone levels, which can lead to hair loss if you are genetically predisposed to it. However, the same could be said about exercise and many other things that raise testosterone and DHT.
About the same things as it does for men. In some ways, the supplement can be even more beneficial for women, though. For example, creatine’s ability to modulate serotonin levels is more notable in women.
It depends on whether or not you go through the loading phase or not. If you do (and you take 0.3 or so grams a day for the first 7 days), you should start noticing the benefits right after that. If you do not go through the loading phase, it will take around a month or two to start noticing significant benefits.
It is important to note that the effects of creatine are cumulative. Therefore, you need to take it on a regular basis to notice long-term benefits.
If you decide to go through the loading phase, take 0.3 grams of creatine per kg of body weight per day for 7 days and spread your dose to at least 3 smaller doses to increase the absorption. After that, you can switch to regular doses.
The loading phase doesn’t have to be repeated if you keep taking lower doses consistently.
The reason you are drinking water along with creatine is to prevent nausea and muscle cramps. Therefore, the way you know you are drinking enough water is if you are not getting these side effects. Typically, 200 ml should be enough. Some people do just as fine without drinking water at all.
Yes, most types (including monohydrate) are vegan-friendly. However, beware that if you buy the supplement in capsules, the capsules are sometimes made from bovine gelatine.
No, it doesn’t. Creatine does not interfere with fasting in any way.
References
Most of the information provided in this guide is based on scientific research that can be found and verified in the PubMed medical library. We excluded from consideration studies that are either confounded or have a high conflict of interest.
Anecdotal evidence (from reports on Reddit, YouTube, and other sources) is also taken into account unless it contradicts scientific research.
