Creatine is a nonessential amino acid produced in the body from other amino acids. It is found mostly in muscles, including the heart, and in the brain in small amounts. Most people can get creatine through food, such as meat, poultry, and seafood. It is also available in supplement form.
Creatine is a common supplement used by athletes due to its evidence-based benefits for muscle mass and exercise performance. It has also been researched for its ability to support brain function and blood sugar control, with conflicting results.
In the United States, the Food and Drug Administration (FDA) does not regulate supplements the way it does for prescription medications. This means some supplement products may not contain what the label says. When choosing a supplement, look for independently tested products and consult a healthcare provider, registered dietitian nutritionist (RDN or RD), or pharmacist.
1. Muscle Mass Growth
Creatine is a popular supplement among athletes to enhance muscle mass growth.
A review of 16 clinical studies published in Nutrients found that creatine (compared to a placebo) led to increased muscle strength in healthy young adults when combined with resistance training. Positive effects on muscle mass were seen whether the individuals were trained or untrained. This included increases in muscle hypertrophy (muscle size), muscle strength, and improved sports performance.
Another systematic review showed that using creatine along with resistance training led to a small increase in muscle hypertrophy compared with resistance training alone over six weeks.
There is some evidence to suggest that creatine supplementation appears to increase lean body mass in males in conjunction with resistance training to a greater extent than in females.
2. High-Intensity Exercise Performance
Research has found that the performance-based benefits of creatine may include:
- Enhanced recovery
- Greater training tolerance
- Improved performance in maximal effort muscle contractions (using as m any muscle fibers as possible to create force)
- Improved performance in single or repetitive sprints
- Increased muscle mass
- Increased work capacity
- Lower incidence of injuries
- Possibly, greater muscle gains during rehab
- Reduced muscle atrophy after injury
Studies suggest that creatine is particularly useful for short-term, high-intensity periods of exercise rather than endurance activities. This is because creatine helps to make adenosine triphosphate (ATP), supplying the body's muscles with energy.
It may be more beneficial in those who have low baseline creatine levels (e.g., vegetarians). However, studies are mixed on whether creatine supplementation benefits vegetarians more than omnivores (people who eat meat).
3. Age-Related Muscle Loss
As we age, we lose muscle mass. This age-related loss of muscle mass is sometimes called sarcopenia.
Creatine supplementation has been studied in older adults at risk of sarcopenia and loss of muscle mass. Some research has found that creatine supplementation, when combined with resistance training, results in improved muscle mass gain and functional capacity in older adults.
Creatine supplementation has also been suggested to preserve muscle loss when restricting energy intake for weight loss. However, researchers of creatine in older adults caution that more high-level research is still needed before routinely recommending creatine supplementation for older adults.
While creatine is mostly safe for older adults, discussing appropriate supplementation with your healthcare provider is recommended.
4. Brain Function and Cognition
Small amounts of creatine are present in the brain. Studies have shown that creatine supplementation can increase this amount.
Researchers have theorized that increasing creatinine levels in the brain could improve cognitive function or delay cognitive decline as we age. One systematic review concluded that creatine supplementation may enhance memory, attention time, and information processing speed.
Another recent systematic review found that while creatine supplementation improved brain creatine levels, it did not benefit cognition.
The research on creatine has not shown convincing results in improving memory or cognition. Further well-designed trials are still needed.
5. Blood Sugar Control
Glucose (blood sugar) control in people with diabetes is crucial to prevent the effects of high and low glucose levels. Well-controlled glucose levels can also prevent long-term complications that affect circulation, eyesight, and kidney function.
Some research has shown that creatine supplementation may enhance glucose uptake (allowing cells to take up sugar from the blood) and insulin sensitivity (the ability of cells to respond to and use insulin, which helps take up blood sugar), helping with glucose control in people with diabetes when used with exercise.
However, other studies found no effect of creatine on glucose parameters.
Further research is still needed before creatine can be recommended for this use.
People with diabetes should work with their healthcare provider or certified diabetes educator to determine their individualized plan for blood sugar management.
Creatine vs. Creatinine: What's the Difference?
Creatine is a nonessential amino acid found mostly in muscle. It is also available in animal products like beef, poultry, and fish. Creatine monohydrate is the most popular form of creatine supplement used by athletes.
Creatine breaks down to form creatinine, a waste product excreted in the urine. Blood levels of creatinine are used as a marker of kidney function, with high blood levels of creatinine sometimes indicating problems with the kidneys.
Side Effects and Safety
Creatine supplementation is generally safe for healthy people.
Although labels caution against children or teenagers from using it, research has not reported ill effects from creatine supplementation in this age group. So long as they are following proper dosages and are knowledgeable about proper creatine use, young athletes can safely implement creatine supplementation.
Based on research to date, creatine monohydrate is safe and well-tolerated, with minimal side effects in healthy people. One consistently reported side effect is weight gain.
Anecdotally, side effects of creatine use have been reported to include nausea, diarrhea, cramps, and gastrointestinal (GI) distress, but the research does not support this.
Does Creatine Cause Hair Loss?
There is no evidence that creatine supplementation causes hair loss. This misconception started with a small study of 16 male rugby players who took creatine of 25 grams (g) daily for seven days, then 5 g daily for 14 days. After supplementation, researchers found increased serum dihydrotestosterone (DHT) levels. Elevated DHT levels have been associated with some incidences of hair loss.
Additional studies have not been able to confirm these findings. There is no evidence to establish a cause-and-effect relationship between creatine and hair loss.
Precautions
There is no evidence that creatine harms kidney function in healthy people. Yet for anyone with preexisting kidney conditions, it's a good idea to discuss creatine with your healthcare provider before starting.
There is not enough safety data on creatine supplementation during pregnancy or when breastfeeding to recommend it.
Creatine may interact with certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) and Aleve (naproxen), caffeine, and drugs that affect kidney function.
Is Creatine Right for Me?
Creatine is popular among athletes, but it is only helpful for those whose goals are muscle gain or increased performance involving short bursts of energy.
Creatine may be most beneficial for:
- Athletes looking to gain muscle, especially in conjunction with powerlifting, Olympic weight lifting, or bodybuilding.
- Athletes looking to improve performance in sports that involve short, high-intensity bursts, such as football, rugby, lacrosse, soccer, hockey, or certain track and field events (e.g., sprinting).
- People with a rare creatine synthesis deficiency or creatine transport deficiency who require additional creatine intake.
- Athletes who are also vegetarians.
Creatine does not provide much benefit for endurance events like marathons, triathlons, or long cycling races.
Is Creatine Banned in Sports?
Since creatine is also available in certain foods, it is not banned by any sports organizations. The National Collegiate Athletic Association (NCAA), which governs student athletics, reports that creatine is the most popular nutrition supplement used by male athletes.
How Much Creatine Should I Take?
Small amounts of creatine get broken down into creatinine daily, which is excreted through urine. These small losses then need to be replenished to maintain normal creatine stores.
Creatine is replenished either through the diet or through what the body makes. Consuming 1–3 grams of creatine daily may be needed to maintain normal creatine stores. Creatine is synthesized from arginine and glycine in the liver and kidneys. A normal diet will provide about 1–2 g of creatine daily.
To increase muscle creatine stores, a loading dose of 5 g of creatine monohydrate taken four times daily for five to seven days is suggested. Then a maintenance dose of 3–5 g daily should be sufficient to maintain creatine stores. Larger athletes engaged in intense activity may need 5–10 g daily.
Alternatively, some may choose to skip the loading dose and take 3–6 g of creatine daily for three to four weeks. This can also produce an ergogenic effect (enhance performance, energy, and recovery), but it may take longer to get there.
Taking creatine with carbs and protein may promote greater creatine retention. It is also recommended to drink plenty of water daily while taking creatine.
Types of Supplements
The most common form of creatine is creatine monohydrate. This form provides the largest amount of free, usable creatine. It is also the most studied form.
Creatine supplements are available in powders, gummies, tablets, and liquid formulations. Since creatine breaks down in water over time, powders should be mixed in warm water to more easily dissolve. Consume the mixture right away.
Liquid creatine supplements should be avoided because creatine is broken down to creatinine in water. These supplements may have no detectable level of creatine by the time you purchase them and will, therefore, be of no benefit.
A Word From Verywell
Creatine supplements are not regulated by the FDA, so it's essential to research products to ensure their quality, such as checking if the creatine was tested and certified by an independent laboratory. It's also wise to check with your provider about the safety of creatine for you, especially if you have a medical condition or are taking other medications.
— MARY CHOY, PHARMD, MEDICAL EXPERT BOARD
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Summary
Creatine is an amino acid mostly stored in the muscle. It is broken down and replenished through diet and the body's ability to make creatine from other amino acids.
Creatine supplements are widely available and popular among athletes. Research shows that supplementation can increase muscle strength and improve high-intensity exercise performance. Several professional organizations recognize creatine as an effective ergogenic aid (used to enhance performance, energy, and recovery).
While there is increasingly more research on creatine supplementation for different health conditions, the evidence is preliminary and sometimes with mixed results.
