Creatine Supplement Uses, Benefits, Dosages, and Side Effects

Creatine is a nonessential amino acid the body makes in the liver, pancreas and kidneys. It is also found in many animal and seafood products common in the human diet.

Our cells require creatine to facilitate energy metabolism. It is involved in recycling adenosine triphosphate (ATP), the primary energy currency used in muscle tissue and brain cells.

Research shows that supplementing with creatine may have benefits for exercise performance, muscle strength, power output, and cardiovascular capacity.

This supplement also has a modest effect on increasing lean muscle mass and body weight, but most of the weight gain comes from water retention.

In addition to its usage for athletic performance enhancement, creatine is also used to promote cognitive function, improve resistance to stress, reduce fatigue and support overall health and well-being.

This article will discuss how creatine works in the body, common uses, possible health benefits, food and supplement sources, recommended dosages, safety and side effects.

Creatine

Energy Supplement

Energy

Mental Clarity

Strength

How It Works:

• Increases ATP production; boosts energy
• Enhances mental clarity & physical strength
• Combats signs of aging throughout body

Dosage:

Between 2.5 - 25 g per day

Safety:

Rated Likely Safe

Top Creatine Products* ❯

View User Ratings* ❯

What is Creatine?

Creatine is one of the most popular dietary supplements due to its purported capacity to enhance athletic performance. In addition to ergogenic effects, it may benefit certain health conditions.

Research is ongoing using creatine for heart disease, cancer, diabetes, muscular dystrophy, Parkinson’s disease, Lou Gehrig’s disease, and other conditions. [1]

People in the United States spend an estimated $14 million annually on creatine supplements. This product is used largely by bodybuilders, sprinters, and other athletes that rely on short-duration, high-intensity strength moves. [1]

According to the Natural Medicines Comprehensive Database (NMCD), about 95% of creatine is stored in muscle tissue. The other 5% is present in the brain, heart, testes, retinas, and some other tissues. [2]

The pancreas, kidneys, and liver work together to produce between 1-2 grams of creatine each day. [2]

Eating fish, poultry, and other animal meats commonly supplies another 1-2 grams daily. Research shows that creatine from the diet is almost completely absorbed in the intestines. [2]

Creatine is not considered an essential nutrient because the body can produce it endogenously. This means that even if you do not consume dietary sources, healthy adults will not experience symptoms of deficiency.

However, there may be cases in which supplementing the diet with this amino acid can have additive benefits for health.

Research shows that total muscle creatine levels are significantly lower in vegetarians that do not consume animal products in their diet. Using supplements may be especially beneficial for athletes who are vegan or vegetarian.

How Does Creatine Work inside the Body?

Creatine is converted in the body into a compound comprised of three different amino acids: arginine, methionine, and glycine. [1]

This compound, called phosphocreatine, can further be converted into the body’s primary energy source, adenosine triphosphate (ATP). [1]

Through this eventual conversion into ATP, creatine plays an important role in energy metabolism within skeletal muscle tissue. [2]

When the body uses phosphocreatine to supply the muscles with energy, a waste by-product called creatinine is produced. Creatinine serves no beneficial purposes in the body and is filtered by the kidneys and excreted largely in urine. [2]

Creatine can be converted into creatinine, however creatinine cannot be converted back into creatine. The two compounds remain in a balanced state (dynamic equilibrium) within muscle tissue. [2]

As creatine is a precursor of ATP, it is hypothesized that increasing levels might help to improve the ability to renew spent ATP. In research, this has hypothesis has been validated during short bursts (10 – 20 seconds) of intense physical activity. [2]

Higher levels of creatine are also thought to improve phosphocreatine resynthesis after intense exercise. However, there is some debate around this, and some researchers are not sure if phosphocreatine resynthesis is actually increased. [2]

Research on Creatine Supplementation Effects

Research has shown that taking creatine supplements increases muscle levels of this compound as well as phosphocreatine. [2]

People who do not consume animal meats generally have lower total creatine levels. Supplementation seems more effective in those with low initial levels of this compound. [2]

The NMCD states, “Skeletal muscle has a saturation point at which additional supplemental creatine will not increase intracellular creatine levels.” [2]

Those with high initial total levels may not respond to supplementation much or at all.

Using a supplement regularly may reduce the body’s natural production of this amino acid. When supplementation is ceased, endogenous biosynthesis normally returns to baseline levels within 4 weeks. [2]

Preliminary research suggests that creatine might upregulate the activities of muscle cell precursors called satellite cells. [3]

According to British researchers, muscle satellite cells, “proliferate in response to injury and give rise to regenerated muscle and to more satellite cells.” [3]

Some research suggests that creatine can cause muscular hypertrophy (growth of component cells) by stimulating satellite cell activity. This indicates that increasing intake of this nutrient may promote growth in muscle size. [3]

However, in clinical research studies most weight gain induced has been due to water retention in muscle cells and not actual hypertrophy or tissue growth. [2]

Increased muscle size from water retention is a short term effect that is not sustained. This type of muscle enlargement does not increase structural or contractile muscle proteins the way that strength training does. [2]

However, there is some clinical evidence that creatine supplementation may increase muscle strength and power output when engaging in weight-lifting. [2]

Preliminary evidence from human studies suggests that supplementation might be helpful for increasing strength and improving muscular weakness that is caused by illness and disease, particularly in the cases of muscular dystrophy and heart failure. [2]

There is some clinical evidence that creatine and phosphocreatine supplementation may have positive cardiovascular effects. It may modestly improve anaerobic cardiovascular capacity.

In clinical research, administration of creatine phosphate (another term for phosphocreatine) seems to improve congestive heart failure (CHF) by preserving energy-producing phosphates inside of the thickest cardiac muscle tissue (myocardium). [2]

This research also suggests that phosphocreatine may affect CHF by inhibiting lipid oxidation (peroxidative) damage to cardiac tissue, improving microcirculation, and by stabilizing cell membranes called sarcolemma that enclose muscle cells. [2]

Some preliminary evidence suggests that creatine may also affect blood lipid balance. In one study, supplementation modestly reduced very low density lipoprotein (VLDL) cholesterol and total cholesterol levels. [2]

Other research shows similar results, with total cholesterol, low-density lipoprotein cholesterol (LDL cholesterol, “bad cholesterol”), and triglycerides being reduced with supplementation for 25 days.

The ratio of cholesterol to high-density lipoprotein cholesterol (HDL cholesterol, “good cholesterol”) was also improved. [2]

It is hypothesized that creatine may also possess neuroprotective properties. Some researchers think that it might be beneficial in conditions like Parkinson’s disease, Huntington’s disease, and amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). [2]

Changes in energy production in the brain is believed to be one marker of schizophrenia. This may be due to decreased ATP synthesis in the left temporal and frontal lobes of the brain. [2]

Creatine is being studied for its capacities to increase brain ATP and possibly benefit schizophrenia and other neurological disorders. [2]

Common Uses for Creatine Supplements

Creatine supplements are most commonly used for increasing muscle strength and improving athletic performance.

According to the NMCD, “In the U.S., a majority of sports nutrition supplements, which total $2.7 billion in annual sales, contain creatine.” [2]

According to the NMCD and ConsumerLab, there are various other uses that people take this nutrient for besides athletic performance. Some of these uses include:

• Age related muscle loss
• Bone mineral density
• Chronic obstructive pulmonary disease COPD)
• Congestive heart failure (CHF)
• Depression
• Diabetes
• Fibromyalgia
• Huntington’s disease
• Lou Gehrig’s disease, ALS
• McArdle’s disease
• Multiple sclerosis
• Muscular dystrophy
• Normalizing triglyceride levels
• Osteoarthritis and rheumatoid arthritis
• Parkinson’s disease
• Improving ratio of body muscle to fat
• Weight loss [2, 5]

The NMCD states that creatine is also used for muscle cramps, muscle weakness from polymyositis, muscle atrophy (wasting), spinal muscular atrophy, idiopathic inflammatory myopathies, and multiple muscular dystrophies marked by a loss of muscle mass and weakness. [2]

Health Benefits

The NMCD rates creatine as Possibly Effective for age-related muscle loss, improving athletic performance, cerebral creatine deficiency syndromes, and improving muscle strength.

Creatine is currently being studied for its effects in various health conditions. Promising results have been seen in clinical studies using the compound for COPD, depression, diabetes, fibromyalgia, muscle cramps, muscular dystrophy, osteoarthritis, Parkinson’s disease, and rheumatoid arthritis. [2]

Research in these areas is limited however, and more clinical research is needed to determine the therapeutic efficacy of this supplement for these and other uses.

Creatine is regulated as a dietary supplement in the United States and the FDA has not approved it as a drug to prevent or improve any medical conditions.

Creatine and Athletic Performance

Multiple clinical studies suggest that creatine supplements are able to enhance strength and performance during short periods of intense exercise. It may work by helping the body use available fuel more efficiently.

Studies on competitive rowers using creatine supplements have seen improvements to aerobic and anaerobic performance, improved rowing times, and increased time to fatigue compared to placebo. [2]

In male soccer players, research has shown that supplementation increases performance on dribbling speed tests.

In female soccer players, supplementation combined with plyometric training increased jump and power performance, repeated sprinting performance, and body mass index compared to training with a placebo or compared to standard soccer training drills. [2]

Creatine does not universally enhance athletic performance. According to the University of Maryland Medical Center (UMM), this product:

• Does not seem to improve performance in endurance or non-repeated activities
• Has been studied mainly in laboratories, not in actual performing athletes
• Seems to affect those around 20 years old more than others [1]

The NMCD notes that not all human studies have shown creatine to benefit athletic performance or muscle growth. Not everyone responds to this supplement the same way. [2]

For example, those with high initial levels of this nutrient in muscle tissue do not seem to experience the same energy-boosting effects as those with low initial levels. [2]

Positive results have been seen in many studies using creatine for athletic performance, however there have been mixed results in other studies. More clinical research is needed to be certain about its effects, and the safety of long-term use.

If you are interested in taking creatine as an ergogenic aid, it is recommended that you speak with your doctor for more information and to determine if this supplement is right for your needs.

Cardiovascular Disease

There is clinical evidence that creatine supplementation may have various positive cardiovascular effects.

Some research suggests that taking a creatine supplement might help to improve blood lipid balance. This has been demonstrated in both women and men. [2]

In several studies involving patients with heart failure, those who received creatine in addition to conventional medical treatment increased the amount of physical activity they could endure before becoming fatigued.

This result was significant when compared with patients who received a placebo along with conventional care. [2]

Animal research and some preliminary human trials have shown that creatine supplementation may help to reduce homocysteine levels. [2]

Homocysteine is a non-protein alpha amino acid. It is a homologue of an amino acid called cysteine. High levels of homocysteine are associated with increased risks for stroke, heart attack and heart disease, among other conditions.

However, it is still unknown if elevated homocysteine levels are a cause of cardiovascular disease, or an effect of it. It is not yet known if reducing levels decreases incidence of disease or mortality.

More clinical research is needed to determine the therapeutic efficacy of creatine for cardiovascular disease and heart health.

If you are interested in taking this supplement for cardiovascular then speak with your doctor to determine if it is appropriate for yout.

Creatine and Cancer

Creatine might possess certain anticancer activities, but research is currently limited.

This amino acid and some of its analogues like cyclocreatine have been seen in in vitro (cultured cell) and animal studies to slow down the growth of existing tumors. [2]

In one study, nude mice that were transplanted with human colon adenocarcinoma cells were given creatine. Significant tumor inhibition directly related to tissue creatine concentration was seen in the treated mice compared to mice given a placebo. [2]

The NMCD states that this supplement might also alter the production of energy resulting from the creatine kinase system. This system is thought to play roles in modulating growth in certain types of tumors particularly neuroblastomas and breast tumors. [2]

Methylglyoxal is a derivative of pyruvic acid with established antibacterial and anticancer properties.

According to 2016 research from India, “Creatine supplementation may gain importance as a safe and effective supplement in therapeutic intervention with the anti-cancer agent methylglyoxal.” [4]

Clinical research is needed to determine whether creatine can improve cancer outcomes in humans, either alone, with methylglyoxal, or in any other combination.

Cerebral Creatine Deficiency Syndromes

There are three possible genetic metabolism disorders that can cause low levels of cerebral creatine:

• Arginine-glycine amidinotransferase (AGAT) deficiency
• Creatine transporter defect
• Guanidinoacetate methyltransferase (GAMT) deficiency [2]

Any of these deficiencies can cause autism, movement disorders, seizures, and/or mental retardation.

In children with GAMT deficiency, oral supplementation between 400 and 500 mg/kg of bodyweight for up to 25 months improves movement disorders and seizure frequency. Supplementation increases brain creatine, but seems to have little effect on intellectual abilities. [2]

Creatine doses between 400 and 800 mg/kg daily for up to eight years seems to improve academic performance, language development, and attention span in children with AGAT deficiency. [2]

However, in children with creatine transporter defect, taking this supplement with glycine and L-arginine for 10 years did not seem to increase brain levels of this amine or improve cognitive or motor functioning. [2]

More research is still needed in this area.

Creatine-Containing Foods

The UMM states that wild game is the best-known source of natural creatine. Lean red meats from grass-fed stock animals are also excellent sources. [1]

There are about 2 grams of creatine in sixteen ounces of raw beefsteak. Salmon, tuna, herring, and some other fish are also good sources of creatine. [1]

It is recommended that when possible you choose grass-fed or fresh-caught animal products to help ensure the highest levels of creatine and other nutrients.

Vegetables are not a good source of this amino acid. Those who do not eat animal products are more likely to develop low creatine levels over time, and may therefore be more in need of a supplement.

Creatine Supplements

The NMCD states that there are over 3300 dietary supplement products available that contain creatine. It is most commonly sold in powder form, but also is available in tablets, capsules, liquids, drink mixes, energy bars, and other forms. [2]

Creatine is available as a single ingredient as well as in combination with other athletic performance enhancers. These combination supplements are often labelled as pre-workout or post-workout products, or both.

Some other ingredients available in these combination supplements typically include caffeine, theanine, and various amino acids such as beta-alanine and citrulline.

This nutrient is listed as creatine monohydrate in many supplements. Many products state that their creatine is micronized, meaning the powder has been created with a very small particle size and greater solubility in liquid.

Most powder formulations suggest taking one rounded teaspoons per day providing 5 g of creatine. Products typically come with a measuring scoop provided.

Powder supplements are meant to be dissolved in a liquid such as water, juice, a sports drink, or a smoothie. Most manufacturers recommend dissolving one scoop in at least 8-10 oz of liquid.

It is also typically recommended that you drink at least 8-10 glasses of water per day for proper hydration and best results. It is typically recommended to take creatine supplements either before or after a workout to promote muscle recovery.

Some products recommend a loading phase when first starting the supplement. The amount varies between products, but typically consists of four 5g dosages per day for between three to five days. After the initial loading period, maintenance dosages of 5g per day are taken.

Supplements should be stored in a cool, dry place in tightly sealed containers to maintain freshness (especially important for powder supplements). Settling may occur with powder formulations and it is recommended to shake the container before each use.

Be aware that some creatine supplements will claim that they can improve the physique and athletic performance simply via supplementation, with no exercising needed. These claims are unfounded and irresponsible.

High-quality supplements often state on their labels that the product should be taken in conjunction with a healthy diet and regular exercise for best results.

It is recommended to always follow manufacturer suggested dosage amounts or speak with your doctor about determining the best dosage for your needs.

Common Dosages

Because it is a dietary supplement and not a drug, creatine does not have a recommended dosage set by the FDA.

According to the NMCD, 5-gram doses have been taken 4 times daily for up to 5 days for loading creatine in athletes. A common maintenance dose for athletes is 5 grams daily. [2]

Similar dosages of 5 grams per day have been used in studies on various conditions as well.

Most supplements brands recommend a similar dosing schedule and amounts as have been used in clinical research.

The UMM states that your body may better absorb creatine if it is taken with carbohydrate sources like fruits and starches.

Follow dosing instructions of the supplement you choose, unless otherwise instructed by your doctor.

Side Effects

The Natural Medicines Comprehensive Database rates creatine as Likely Safe when used orally and appropriately, and Possibly Safe when used orally and appropriately long-term.

There is insufficient data available to rate the safety in pregnant and breastfeeding women, and use is to be avoided in these groups.

Creatine is generally well-tolerated in the majority of users. Some side effects have been reported in some cases, including:

• Dehydration
• Diarrhea
• Electrolyte imbalance
• Fever
• Gastrointestinal pain
• Heat intolerance
• Muscle cramping
• Nausea
• Reduced blood volume [2]

The UMM states that creatine is generally safe, but has the potential to cause serious side effects when taken in high doses, or for too long.

Excessive supplementation might cause damage to kidneys and/or inhibit production of creatine naturally within the body. [1, 2]

In a single case, an athlete taking 10 grams of creatine every day for 6 weeks developed rhabdomyolysis (muscle breakdown) and subsequent renal failure. [2]

However, the majority of studies completed to date have found no side effects associated with proper oral use of this supplement. [2]

Drug and Supplement Interactions

Creatine may interact with certain health conditions and medications. Talk to your doctor first about using this supplement if you have kidney disease, liver disease and/or hypertension (high blood pressure). [1, 2]

Creatine supplements may increase the risk for renal damage when taken along with NSAIDs (nonsteroidal anti-inflammatory drugs). Some of the most common NSAIDs include Aleve (naproxen) and Advil (ibuprofen).

Be careful using this supplement with diuretic medications that increase urine volume and urination frequency. Taking it with “water pills” may increase the risk for developing kidney damage and chronic dehydration.

Tagamet (cimetidine) is used to heal stomach ulcers and stop them from redeveloping after they are successfully treated. Taking this supplement with Tagamet may increase the risk for kidney damage.

Probenecid is a prescription drug used to treat gout that can also increase the risk for damage to the kidneys when taken with creatine.

If you have a serious health condition, or use prescription medications, talk to a doctor who understands your health history before beginning to take creatine supplements.

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