The Health Benefits of Creatine

This supplement is used to improve athletic performance and muscle strength

In This Article

Creatine tablets
Creatine in tablet form. Hugh Threlfall/Getty Images

Creatine is a naturally occurring substance made from amino acids, the building blocks of protein. Creatine is produced in the liver, kidneys, and pancreas; 95 percent of it is found in muscles, with the rest located in the brain, heart, and testes. Besides occurring naturally, small amounts of creatine are also found in foods, such as red meat and seafood. Synthetic versions are also sold as supplements.

Creatine is involved in making the energy that muscles need to work. Supplements are popular among athletes, bodybuilders, and those wanting to improve athletic performance, and there is science supporting creatine's ability to safely do that. The International Society of Sports Nutrition has concluded that creatine monohydrate, the most well-studied form of creatine, is the most effective nutritional supplement currently available to athletes for increasing high-intensity exercise capacity and lean body mass. Other groups, including the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine, have all drawn similar conclusions.

This helps explain why creatine has become one of the most widely used supplements. In the U.S., a majority of sports nutrition supplements, which total $2.7 billion in annual sales, contain creatine.

Health Benefits

Research has looked at the effectiveness of creatine for a number of uses.

Athletic Performance

Creatine is one of the few supplements that's undergone rigorous scientific scrutiny and been found to improve athletic performance. Over the past quarter-century, hundreds of well-controlled creatine studies have been published in the scientific literature. A 2017 review study published in the Journal of the International Society of Sports Nutrition found that creatine can improve exercise performance, play a role in preventing and/or reducing the severity of injury, enhance rehabilitation from injuries, and help athletes tolerate heavy training loads.

Creatine benefits athletes by increasing production of adenosine triphosphate (ATP), an energy source for muscles during brief, explosive periods of activity—hence the reason it's been primarily recommended for power/strength athletes who need to sprint intermittently and recover during competition (for example, football, soccer, basketball, and tennis players). The idea behind supplementation is to maximize muscle stores of creatine, which normally ranges from 60 to 80 percent saturation. Once the stores are filled, any excess creatine is broken down into creatinine, which is metabolized by your liver and excreted in your urine.

As the 2017 review study noted, the majority of research on creatine was performed on people who were training vigorously, so sedentary people aren't likely to obtain any benefit from creatine supplementation. It also hasn't been found to help with aerobic or endurance sports like marathon running.

One concern about creatine is that it can cause dehydration. However, there's evidence that supplementation with creatine, which causes water to be drawn away from other areas of the body and into muscle tissue, can actually help reduce the risk of heat-related illness in athletes engaged in intense exercise in hot, humid environments. This ability to retain water may explain why the only consistently reported side effect from creatine supplementation has been weight gain.

Many athletes and bodybuilders who use creatine do so because it has similar effects as anabolic steroids without the side effects. Because creatine is found in high amounts in the food supply, it hasn't been banned by athletic associations. Still, some organizations question whether it's ethical to permit athletes to take a supplement that could potentially enhance performance. Others have expressed concern that the use of performance-enhancing supplements could lead to the use of other potentially risky supplements and drugs.

Muscle Mass

According to the 2017 review article, a large number of studies shows that creatine supplementation leads to greater gains in strength and muscle mass.

Here's how that happens: Creatine supplementation increases muscle stores of a substance called phosphocreatine (PC), and during very short-duration high-intensity exercise (also known as anaerobic exercise), PC helps to replenish the muscle’s energy supply. The upshot is that the increased amount of creatine in your muscles replenishes energy more rapidly, so you can train at higher intensities and with higher weights without getting tired as quickly—and that can help you build more muscle.

Benefits from creatine have been reported in men and women, although the majority of studies have been conducted on men and some studies suggest that women may not see as much gain in strength and/or muscle mass during training in response to creatine supplementation.

Muscle Weakness

Because creatine may strengthen muscle, it's been suggested as a complementary treatment for conditions in which muscle weakness occurs, such as muscular dystrophy, congestive heart failure, Huntington's disease, McArdle's disease (also called glycogen storage disease type V), amyotrophic lateral sclerosis (ALS), myasthenia gravis, Parkinson's disease, and after injury or surgery.

The Natural Medicines Comprehensive Database (NMCD), a scientifically investigated resource for natural medicine, rates creatine as "possibly ineffective" for improving muscle strength in Huntington's disease and for slowing the progression of or improving survival in people with ALS. It also notes that there's insufficient evidence to rate the effectiveness for any other use.

Possible Side Effects

Creatine is "likely safe" when taken by mouth at doses up to 25 grams daily for up to 14 days, according to the NMCD. Lower doses up to 4 to 5 grams taken for up to 18 months are also likely safe. Some early research also suggests that creatine is "possibly safe" when taken in doses up to 10 grams daily for up to five years.

Creatine can cause:

  • Stomach cramps
  • Nausea
  • Diarrhea
  • Muscle cramps
  • Weight gain

High doses of creatine could potentially injure the kidneys, liver, and heart. Theoretically, creatine may cause kidney damage because its by-product, creatinine, is filtered through the kidneys into urine. Although studies haven't found adverse events in recommended doses, there have been a couple of case reports of people who've experienced kidney collapse and three deaths in people taking creatine, but there's no definitive evidence that creatine was the cause. People with kidney disease or liver disease should avoid creatine.

Creatine supplements may cause asthmatic symptoms, such as wheezing and coughing, in some people.

People with McArdle's disease shouldn't use high doses of creatine because it has been found to increase muscle pain.

One of the main safety concerns is that people using creatine to enhance athletic performance or muscle mass, particularly adolescents, may exceed recommended dosages and take it without supervision.

Because creatine could theoretically affect kidney function, it should not be taken with prescription drugs that could also potentially affect the kidneys, such as aminoglycoside antibiotics (Amikacin, Nebcin), immunosuppressant drugs like cyclosporine, and non-steroidal anti-inflammatory drugs like aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve).

Creatine supplements should not be taken with the herb ephedra because of increased risk of side effects. There was one case of stroke in a person taking creatine and ephedra. Although there was no definite link between the combination of herbs and the stroke, it's best to avoid the combination.

Dosage and Preparation

Much of the small amounts of creatine that's found in food is destroyed by cooking. It's also made naturally in the body from L-arginine, L-glycine, and L-methionine, amino acids that are principally found in animal protein.

Many different dosing regimens have been used for both athletic performance and muscle strength. Most use a short-term "loading dose" followed by a long-term maintenance dose. According to the 2017 study, the most effective way to increase muscle creatine stores is to ingest five grams of creatine monohydrate (or approximately 0.3 grams per kilogram of body weight) four times daily for five to seven days. Once muscle creatine stores are fully saturated, creatine stores can generally be maintained by ingesting three to five gram a day, although some studies indicate that larger athletes may need to ingest as much as five to 10 grams a day in order to maintain creatine stores

Insulin is needed for creatine to enter muscles, so consuming carbohydrates with creatine can increase the amount of creatine available to muscles. Supplementing five grams of creatine with 93 grams of simple carbohydrates four times a day for five days can increase muscle creatine levels as much as 60 percent more than creatine alone.

Creatine supplements are available in capsules or as a powder at health food stores, some drug stores and online.

Keep in mind that supplements haven't been tested for safety and due to the fact that dietary supplements are largely unregulated, the content of some products may differ from what is specified on the product label. Also be aware that the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications has not been established. You can get tips on using supplements here, but if you're considering the use of creatine supplements, talk with your primary care provider first. Self-treating a condition and avoiding or delaying standard care may have serious consequences.

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