All About Creatine and Who Can Benefit the Most

What Is Creatine?

Creatine is a naturally occurring compound found in the body. It is formed in the kidneys and liver from reactions involving the amino acids arginine, glycine, and methionine. (1)

You can get small amounts of creatine from the diet when consuming red meat and seafood.

About 95% of creatine is found in muscles, while the other 5% is in the brain, liver, kidney, and testes. Most of the creatine found in muscle is phosphocreatine (PCr), while the remaining is free creatine (Cr). (2, 3, 4)

There are many forms of creatine.

Creatine monohydrate is the most common form studied. It is also the main form of creatine that is sold as a supplement.

Creatine as a supplement is typically a tasteless, crystalline powder that can be easily dissolved in liquids. (5)

Factors that affect creatine levels in the body include meat intake, exercise, and the amount of lean body mass in an individual. (4)

What Does Creatine Do?

Creatine is one of the most studied supplements on the market that has consistently shown beneficial effects with little to no side effects. It is used not only for enhancing sports performance but also for therapeutic uses in disease. (6)

It is considered an ergogenic aid — which is a compound that enhances performance.

Creatine increases energy in the muscles, called ATP. This energy enhances exercise performance by increasing power, strength, and mass. (7)

It also prevents proteins from breaking down while increasing the production of new proteins.

These processes influence the ability to preserve and build muscle, increase muscle force and power, and increase the time it takes for muscles to fatigue. (8)

Not only does creatine influence the energy in muscles, but it also has a positive impact on the brain.

Taking a creatine supplement is correlated with increased energy production in the brain, which is correlated with improved cognitive functioning. (9)

Who Benefits the Most from Creatine Supplements?

People that may benefit from taking creatine include:

Those Wanting to Enhance Sports Performance

Substantial evidence has confirmed that creatine supplementation can improve muscle strength and performance when combined with strength training.

A review of 22 studies confirmed an average of a 20% increase in muscle strength with the combination of creatine supplementation and strength training.

This was compared to only a 12% increase in those strength training but not supplementing with creatine.

Additionally, in those supplementing creatine, weightlifting performance was increased by 26% compared to only 12% in the non-supplemental group. (10)

Although creatine has been primarily thought to benefit athletes involved in power-type activities and high-intensity intermittent resistance, evidence shows it may be beneficial for other activities as well, such as running. (8)

Pairing creatine with the right amounts of carbohydrates — or carbohydrates and protein — promotes greater glycogen storage in the muscle, which can prevent depletion and improve recovery.

This is helpful for athletes who deplete large amounts of glycogen — like long-distance runners, bikers, swimmers, or those in sporting events. (8)

It can also help reduce muscle damage, inflammation, and muscle soreness, which is helpful for anyone wanting to enhance sports performance. (8)

Related: Pre-Workout Supplements Explained in Simple Terms

Vegans and Vegetarians

The main source of dietary creatine is animal consumption — like beef and fish.

Therefore, vegans and vegetarians have lower stores of creatine in the muscle and may benefit from taking a supplement.

One study compared 8 weeks of creatine intake and strength training in vegetarians and non-vegetarians.

Vegetarians had significantly lower levels of creatine in the muscle compared to non-vegetarians. After supplementing creatine, these levels significantly increased.

This led to greater improvements in lean muscle mass and exercise output.

There was a 4% increase in lean muscle tissue in those who supplemented creatine versus only a 2% increase in the group who did not take creatine.

Not only that, but there was an increase in muscle fibers that are primarily responsible for higher power, force, and speed.

Vegetarians with initially lower stores of creatine are more responsive to supplementation. (11)

Those With Certain Neurodegenerative Diseases

Creatine has shown protective effects on brain health for older adults and specific populations.

One review of six studies on healthy individuals noted that creatine can improve short-term memory, intelligence, and reasoning. Dosing generally varied between 5–20 grams per day. (12)

Research is mixed on those with neurodegenerative diseases such as Duchenne muscular dystrophy, Huntington’s disease, ALS, and Parkinson’s. However, some benefits have been seen with little to no side effects.

In boys who have Duchenne muscular dystrophy, taking 5 grams of creatine monohydrate for 8 weeks improved creatine levels in the muscles and helped preserve muscle strength.

In addition, patients who supplemented creatine reported subjective improvement, and those who did not supplement reported worsening. (13)

When looking at Huntington’s disease, studies on mice have shown creatine supplementation to decrease brain deterioration, delay motor symptoms, decrease the onset of weight loss, and increase survival. (14, 15)

However, human studies on creatine supplementation and Huntington’s disease have not shown an improvement in functional, neuromuscular, and cognitive status. (16)

Patients with ALS who supplemented 5 grams of creatine daily for 9 months did not show obvious benefit for slowing disease progression, but patients reported improvements in fatigue. (17)

An analysis of five studies on creatine supplementation and Parkinson’s disease did not show an overall benefit in mental or motor scores. Results were mixed on whether creatine can improve activities of daily living in these patients. (18)

However, a positive effect on mood was found in those with Parkinson’s disease who supplemented creatine. This led to smaller dose increases of dopaminergic therapy — one of the treatments for Parkinson’s disease. (19)

Those with Creatine Synthesis Deficiencies

Creatine synthesis deficiencies are a group of inborn errors affecting the body’s ability to make and transport creatine.

Those with creatine synthesis deficiencies have lower creatine levels in the muscle and the brain.

Mental disorders, seizures, and speech delays are the main symptoms seen in those with these deficiencies.

Supplementing creatine monohydrate in much higher doses than the daily creatine requirement is a typical treatment and can improve outcomes. (20)

Always work with your doctor when managing creatine synthesis deficiencies.

Older Adults

Creatine stores in the muscle and brain decrease as we age. The ability to make creatine after exercise decreases by 8% each decade after age 30. (21)

Sarcopenia is the progressive loss of muscle mass and function and contributes to frailty and bone loss. This is more common among older people.

Combining creatine supplementation with strength training can protect the muscles and bones as we age. (22)

An analysis of 22 studies on men and women aged 57–70 who did resistance training 2–3 days per week and took creatine had greater increases in lean muscle tissue and upper and lower body strength than those who did not supplement creatine. (23)

How Much Creatine Is Enough?

Dosing will vary based on weight and reason for supplementation.

For example, someone with a creatine synthesis deficiency may need a much higher dose than a healthy young athlete who wants to improve muscle strength and recovery.

In general, a person weighing 70 kilograms (154 lbs) needs about 2 grams of creatine per day. Half of this amount (1 gram) can be obtained through a diet that includes meat. (24)

Here is the typical dosing of creatine:

• General Dose: 3–5 grams per day, or 0.1 grams per kilogram of body mass per day, for someone wanting to improve exercise performance. So for a weight of 70 kilograms, the range is 3–7.7 grams per day.

• Loading Dose, or Initial Higher Dose for a Short Period of Time: 5 grams taken four times per day, equaling 20 grams per day. This dose can be taken for 5–7 days. (25)

• Maintenance Dose: Same as the general dose, which is 3–5 grams per day, or 0.1 grams per kilogram of body mass per day. This can be taken after a loading dose to maintain levels of creatine.

Is It Safe to Take Creatine?

Creatine is a relatively safe supplement when taken within the recommended doses.

The most common side effects reported are water retention — particularly in the early stages of taking the supplement — and weight gain. (2, 9)

Over 1000 studies — including both short-term and long-term — have been conducted on people of all different ages, from infants to the elderly. (26)

No adverse health effects have been seen for doses ranging from 0.3 to 0.8 grams per kilogram of body weight per day for up to 5 years. (26)

Although some negative anecdotal claims have been made for creatinine supplementation, several well-controlled clinical studies have refuted these claims and their adverse effects.

Research has looked at creatine’s impact on musculoskeletal injuries, dehydration, gastrointestinal upset, muscle cramping, and renal dysfunction and has not shown negative effects.

The International Society of Sports Nutrition’s (ISSN) stance on the safety and efficacy of creatine has been positive for those from infancy to the elderly. (9)

Specifically, the ISSN has stated that government legislatures and sports organizations that restrict or discourage the use of creatine may be putting athletes at a higher risk for brain or spinal cord injuries.

This is particularly true for sports with high impact and higher likeliness for brain injury or head traumas. (9)

A study in 2003 showed that college football athletes who ingested creatine versus those who did not generally had a lower incidence of injury. (27)

This was also confirmed in more recent studies, which have discussed promising effects on decreasing traumatic brain injuries with creatine supplementation. (28)

When creatine degrades in the body, it produces formaldehyde. Very high doses of creatine can increase levels of formaldehyde in the blood. Formaldehyde is a potentially carcinogenic agent.

One study showed supplementing 21 grams of creatine per day for 14 days increased formaldehyde production by 348% in young adults.

Although this was a significant increase, the level of formaldehyde formed was below the upper limit range considered safe for a healthy population. A creatine dose of 8 grams per day did not increase formaldehyde production. (29)

Combining creatine with resistance training has shown to be relatively less toxic as it lowers levels of formaldehyde. (30)

Frequently Asked Questions

The Bottom Line

Overall, creatine is a very safe supplement to consume for people of all ages. It has shown positive benefits on exercise performance, muscle and bone preservation, and cognitive health.

People that may benefit from taking creatine include:

• Those wanting to improve exercise performance.
• Vegans and vegetarians.
• Those with neurodegenerative diseases.
• Those with creatine synthesis deficiencies.
• Those wanting to preserve aging muscles and bones.

Taking 3–5 grams of creatine monohydrate per day is an average dose for those wanting to improve sports performance.

Taking 20 grams per day in divided doses for 5–7 days can increase stores faster.

Follow this with the maintenance dose of 3–5 grams daily.