What it is: A naturally occurring compound critical for cellular energy (ATP) production, found in meat/fish and synthesized by the body.
Key Benefits: Enhances high-intensity athletic performance, preserves muscle mass and bone health during aging, and supports cognitive brain function.
Safety Profile: Formally classified as GRAS (Generally Recognized as Safe) by the FDA. Decades of clinical data prove it does not cause kidney damage, hair loss, or cramping.
Best Form: Creatine monohydrate powder remains the gold standard for purity, efficacy, and cost-effectiveness. Avoid gummies due to manufacturing and stability issues.
By Dr. Amy Bodnarchuk, MD
I get so many questions about creatine on a daily basis. Because there is so much noise and misinformation out there about what it is, who it’s for, and what it actually does, I thought it was time to lay out the facts.
Despite its reputation as a supplement reserved strictly for the gym, creatine is actually one of the most thoroughly researched, safe, and versatile supplements available. Whether you are looking to support your workouts, preserve muscle mass as you age, or give your brain a cognitive boost, creatine has something to offer.
What Exactly Is Creatine?
Creatine is a naturally occurring compound that is made by the human body (specifically in the liver, kidneys, and pancreas). You also get it directly through your diet if you eat wild-caught fish like herring, salmon, halibut, tuna, and cod, or high-quality pork, beef, and chicken.
The average carnivore gets about 1-2 grams a day from food. Because it’s exclusively found in animal products, those living a vegetarian or vegan lifestyle will almost always run low on baseline creatine stores.
Our muscles are typically only 60-80% full of creatine at baseline and supplementation can raise those stores by 20-40%, which supports short energy bursts for high intensity movement and may aid in recovery between bouts of activity. (1)
How It Works in the Body
Creatine facilitates rapid regeneration of ATP (adenosine triphosphate), which is the primary energy carrier molecule in all living cells. Think of ATP as your body’s internal battery; creatine provides an immediate, high-energy spark to recharge that battery during exercise or energy-dense tasks. (2) It also serves as a neuromodulator (a chemical that alters cellular signaling) or neurotransmitter in the central nervous system and carries antioxidant properties. It also influences muscle growth through multiple mechanisms (3), and it appears to improve cognitive function, although the mechanism is less well understood. (4)
The benefits of creatine supplementation
High Intensity Exercise
Several hundred studies have investigated its effects. A staggering 70% of the studies have shown a positive effect (up to 15% improvement in performance) and the other 30% have shown a small or insignificant effect. No study has shown deleterious effects.
Improvements occur within days to weeks and would take years to obtain from training alone. (5)
Improvements were shown to occur in sprinting, high intensity cycling, swimming, soccer performance and basketball scoring and lower limb power (7, 8, 9)
Strength and power
Because ATP energy is critical for explosive movements, creatine optimizes these exercises.
Improvements occurred to 1-rep max bicep curl, maximum weight for squat and bench pressing, and the number of explosive jumps (10,11)
For endurance exercise
Because endurance exercises are low in intensity, they rely less on ATP regeneration, which makes creatine less helpful in track and cross-country sports.
In vegetarians
Creatine improves exercise performance in vegetarians compared to omnivores, and it also enhances memory and intelligence. (6)
For healthy aging
Men aged 59-77 years who took 10 mg/pound per day with 14 mg/pound of protein grew significant upper body muscle mass and reduced bone breakdown compared to the placebo group. (12)
Older adults who took 5-22 grams of creatine per day combined with resistance training improved muscle mass and strength compared to those doing resistance training alone. (13,16)
To improve brain health
Creatine supplementation can increase creatine levels in the brain by 10%. (14)
Doses of 5-20 grams per day may improve short term memory and intelligence in healthy people. (15)
Is Creatine Safe and Effective? What the Latest Science Says
I am frequently asked about the safety and efficacy of creatine supplementation in adults. My colleagues face the same questions, particularly regarding adolescents looking to build body mass and enhance athletic performance.
To provide clear, definitive answers, an internationally renowned team of research experts recently conducted a rigorous, evidence-based scientific evaluation of the literature. Their comprehensive recommendations, published in a 2024 landmark paper (16), offer the most up-to-date guidance on how creatine impacts both adult and youth athletes.
Key Takeaways from the 2024 Research:
- For Adults: Creatine remains one of the most thoroughly researched and proven supplements on the market, consistently demonstrating high efficacy for strength, power, and muscle recovery with an excellent safety profile.
- For Adolescents: While historically viewed with caution, the latest evidence-based consensus provides clearer, safer frameworks for younger athletes using creatine under proper guidance.
The following is a summary of their recommendations.
- Does creatine lead to water retention? Most studies show that there is no total body water increase with regular creatine supplementation.
- Is creatine an anabolic steroid? No. While both increase ATP, creatine fits well within the confines of the Dietary Supplement Health and Education Act of 1994 and there are no legal ramifications for the use of creatine in athletes.
- Does creatine cause kidney damage? There are over 20 years of study in over 500 papers which show no impact of creatine on the kidney. The myth of kidney damage may have arisen from the similarity of creatine the supplement and creatinine, a kidney metabolite.
- Does creatine impact testosterone? 10 studies have found no impact of creatine on testosterone levels or male pattern baldness.
- Does creatine cause muscle cramping or dehydration? No. In fact, in one study, it reduced symptomatic muscle cramping by 60%. (17)
- Is creatine safe for children and adolescents? In late 2020, the FDA categorized creatine as generally recognized as safe (GRAS), its highest safety signal.
- Is a loading phase required? In the older literature, a loading dose of 20-25g a day was recommended for a week. However, recent data suggests daily supplementation of 3-5 grams a day is preferable and leads to fewer GI side effects.
- Does creatine work in females? While females have higher intramuscular creatine concentrations possibly due to lower skeletal muscle mass, there is abundant evidence that creatine dosing of 5g/day in females increases muscle performance. (18)
Creatine supplementation
There are several forms of creatine supplements available, but creatine monohydrate is the most well studied, effective, and inexpensive form.
In 2007, the International Society of Sports Nutrition stated, “Creatine Monohydrate is the most effective ergogenic (energy producing) nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training.” (19)
Which Type of Creatine Should You Buy?
With so many expensive products on the market, it’s easy to get overwhelmed by marketing hype. When patients or clients ask me for a recommendation, I give them two simple rules to cut through the noise:
1. Stick to Powder, Skip the Gummies
I generally recommend avoiding creatine gummies and sticking to traditional powder. Because gummies are a newer delivery method, they carry much higher regulatory variability in how the active ingredient is processed and stabilized. Plain creatine powder is stable, highly effective, and much more budget-friendly.
2. Look for Third-Party Testing
Because supplements aren’t strictly regulated by the FDA before they hit shelves, quality control is up to the manufacturer. To ensure you are getting exactly what is on the label without harmful contaminants, always look for products that are:
- NSF Certified for Sport
- Informed-Choice or Informed-Sport certified
- Third-Party Tested (by independent labs like Eurofins or USP)
The Golden Rule: Talk to Your Doctor First
While the 2024 scientific consensus highlights an excellent safety profile for the general population, everyone’s biochemistry is unique. Before you or the young athletes in your home start taking creatine, or any new dietary supplement, it is essential to talk with your doctor first. This is especially important if you have any pre-existing health conditions, such as kidney disease, or take regular medications.
A quick conversation ensures that your supplementation strategy is safe, tailored to your specific health history, and aligned with your overall health goals.
Want to Read the Full Science?
If you want to dive into the exact data, safety metrics, and adolescent frameworks established by the international research team, you can review the full published findings here: Read the Complete Paper: Frontiers in Nutrition: 2024 Systematic Review & Meta-Analysis on Creatine Efficacy and Safety
References:
Why everyone’s talking about creatine | UCLA Health
Laboratory diagnosis of creatine deficiency syndromes: a technical standard and guideline of the American College of Medical Genetics and Genomics – PubMed
Creatine Supplementation and Skeletal Muscle Metabolism for Building Muscle Mass- Review of the Potential Mechanisms of Action – PubMed
Creatine in the central nervous system: From magnetic resonance spectroscopy to creatine deficiencies – PubMed
Effects of creatine supplementation on performance and training adaptations – PubMed
Benefits of Creatine Supplementation for Vegetarians Compared to Omnivorous Athletes: A Systematic Review – PMC
The effect of longer-term creatine supplementation on elite swimming performance after an acute creatine loading – PubMed
Creatine supplementation and sprint performance in soccer players – PubMed
Creatine supplementation delays onset of fatigue during repeated bouts of sprint running – PubMed
A randomized open-labeled study to examine the effects of creatine monohydrate and combined training on jump and scoring performance in young basketball players – PMC
Full article: Creatine supplementation and endurance performance: surges and sprints to win the race
Low-dose creatine combined with protein during resistance training in older men – PubMed
Creatine supplementation and aging musculoskeletal health – PubMed
Cerebral energetic effects of creatine supplementation in humans – PubMed
Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials – PubMed
Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?
https://academic.oup.com/ndt/article-abstract/17/11/1978/1896680?redirectedFrom=fulltext&login=false
Long-term creatine intake is beneficial to muscle performance during resistance training | Journal of Applied Physiology
International Society of Sports Nutrition position stand: creatine supplementation and exercise – PMC