Creatine is a nitrogenous organic acid that helps supply energy to cells throughout the body, particularly muscle cells.
It occurs naturally in red meat and fish, it is made by the body, and it can also be obtained from supplements.
Supplements are used by athletes to improve their performance, by older adults to increase muscle mass, and to treat problems that result when a body cannot metabolize creatine fully.
Some evidence suggests that it might prevent skin aging, treat muscle diseases, help people with multiple sclerosis (MS) to exercise, enhance cognitive ability, and more. Additional evidence is needed to confirm these uses.
This article will look at the uses of creatine, how it works, and how safe and effective it is.
Creatine is formed of three amino acids: L-arginine, glycine, and L-methionine. It makes up about 1 percent of the total volume of human blood.
Around 95 percent of creatine in the human body is stored in skeletal muscle, and 5 percent is in the brain.
It is transported through the blood and used by parts of the body that have high energy demands, such as skeletal muscle and the brain.
Different forms of creatine are used in supplements, including creatine monohydrate and creatine nitrate.
No creatine supplement has yet been approved for use by the United States (U.S.) Food and Drug Administration (FDA). There are dangers associated with use of unrestricted supplements.
A person needs between 1 and 3 grams (g) of creatine a day. Around half of this comes from the diet, and the rest is synthesized by the body. Food sources include red meat and fish. One pound of raw beef or salmon provides 1 to 2 grams (g) of creatine.
Creatine can supply energy to parts of the body where it is needed. Athletes use supplements to increase energy production, improve athletic performance, and to allow them to train harder.
According to the International Society of Sports Nutrition (ISSN), larger athletes who train intensely “may need to consume between 5 and 10 g of creatine a day” to maintain their stores.
People who cannot synthesize creatine because of a health condition may need to take 10 to 30 g a day to avoid health problems.
Creatine is one of the most popular supplements in the U.S., especially among men who participate in ice hockey, football, baseball, lacrosse, and wrestling.
It is also the most common supplement found in sports nutrition supplements, including sports drinks.
There are claims for a number of uses, some of which are supported by research evidence.
Improving athletic performance
Athletes commonly use creatine supplements, because there is some evidence that they are effective in high-intensity training.
The idea is that creatine allows the body to produce more energy. With more energy, athletes can work harder and achieve more.
For some participants in some kinds of exercise, boosting the body’s creatine pool appears to enhance performance.
In 2003, a meta-analysis published in the Journal of Sports Science and Medicine concluded that creatine “may improve performance involving short periods of extremely powerful activity, especially during repeated bouts.”
The researchers added that not all studies had reported the same benefits.
In 2012, a review concluded that creatine:
- boosts the effects of resistance training on strength and body mass
- increases the quality and benefits of high-intensity intermittent speed training
- improves endurance performance in aerobic exercise activities that last more than 150 seconds
- may improve strength, power, fat-free mass, daily living performance and neurological function
It seems to benefit athletes participating in anaerobic exercise, but not in aerobic activity.
It appears to be useful in short-duration, high-intensity, intermittent exercises, but not necessarily in other types of exercise.
However, a study published in 2017 found that creatine supplementation did not boost fitness or performance in 17 young female athletes who used it for 4 weeks.
Increased body mass
Increased creatine content in muscles has been associated with greater body mass.
However, according to the U.S. National Library of Medicine, creatine does not build muscle. The increase in body mass occurs because creatine causes the muscles to hold water.
It is also possible that muscle mass builds as a result of working harder during exercise.
Repairing damage after injury
Research suggests that creatine supplements may help prevent muscle damage and enhance the recovery process after an athlete has experienced an injury.
Creatine may also have an antioxidant effect after an intense session of resistance training, and it may help reduce cramping. It may have a role in rehabilitation for brain and other injuries.
Creatine and deficiency syndromes
Creatine is a natural substance and essential for a range of body functions.
An average young male weighing 70 kilograms (kg) has a store, or pool, of creatine of around 120 to 140 g. The amount varies between individuals, and it depends partly on a person’s muscle mass and their muscle fiber type.
Creatine deficiency is linked to a wide range of conditions, including, but not limited to:
- chronic obstructive pulmonary disease (COPD)
- congestive heart failure (CHF)
- multiple sclerosis (MS)
- muscle atrophy
- Parkinson’s disease
Oral creatine supplements may relieve these conditions, but there is not yet enough evidence to prove that this is an effective treatment for most of them.
Supplements are also taken to increase creatine in the brain. This can help relieve seizures, symptoms of autism, and movement disorders.
Taking creatine supplements for up to 8 years has been shown to improve attention, language and academic performance in some children. However, it does not affect everyone in the same way.
While creatine occurs naturally in the body, creatine supplements are not a natural substance. Anyone considering using these or other supplements should do so only after researching the company that provides them.
Creatine and muscular dystrophy
Creatine may help improve the strength of people with muscular dystrophy.
A review of 14 studies, published in 2013, found that people with muscular dystrophy who took creatine experienced an increase in muscle strength of 8.5 percent compared with those who did not take the supplement.
“Short- and medium-term creatine treatment improves muscle strength in people with muscular dystrophies and is well-tolerated.”
Dr. Rudolf Kley, of Ruhr University Bochum, Germany
In mouse models of Parkinson’s disease, creatine was able to prevent the loss of cells that are typically affected by the condition.
However, research published in JAMA, with over 1,700 human participants, noted that: “Treatment with creatine monohydrate for at least 5 years, compared with placebo did not improve clinical outcomes.”
Similarly, a systematic review published in Cochrane found that there was no strong evidence for the use of creatine in Parkinson’s.
In South Korea, 52 women with depression added a 5-gram creatine supplement to their daily antidepressant. They experienced improvements in their symptoms as early as 2 weeks, and the improvement continued up to weeks 4 and 8.
The results suggested that: “Creatine treatment may be a promising therapeutic approach for females with depression and comorbid methamphetamine dependence.”
Further research is needed.
In 2003, researchers published evidence that creatine can boost mental performance.
After taking a 5-g supplement each day for 6 weeks, 45 participants scored better on working memory and intelligence tests, specifically tasks taken under time pressure, than other people who took a placebo.
A study published in 2007, concluded that “creatine supplementation aids cognition in the elderly.” Participants took a 5-g supplement four times a day for a week and then carried out some number and spatial tests. Those who took the supplement did better than those who took only a placebo.
At recommended doses, creatine is considered “likely safe” to consume.
In high doses, it is “possibly safe.” It is expected that it could affect the liver, kidneys, or heart, although these effects have not been proven.
Other possible effects include:
- stomach pain
- muscle cramping
People with kidney disease are advised not to use creatine, and caution is recommended for those with diabetes and anyone taking blood sugar supplements.
The safety of creatine supplements has not been confirmed during pregnancy or breastfeeding, so women are advised to avoid it at this time.
Use of creatine can lead to weight gain. While this may be mostly due to water, it can have a negative impact on athletes aiming at particular weight categories. It may also affect performance in activities where the center of gravity is a factor.
In 2003, a review of 14 studies on creatine supplementation and exercise performance, published in Cochrane concluded that it:
“Appears to pose no serious health risks when taken at doses described in the literature and may enhance exercise performance in individuals that require maximal single effort and/or repetitive sprint bouts.”
In 2007, the ISSN described the use of creatine as, “safe, effective, and ethical.” They recommended it as a way for athletes to obtain extra creatine without increasing their intake of fat or protein.
Updating their statement in 2017, they conclude that creatine supplementation is acceptable within recommended doses, and for short-term use for competitive athletes who are eating a proper diet.
Overall, creatine, used appropriately, seems to be relatively safe.
However, one study, published in 2012, cautioned that the “safe and ethical” status of creatine supplements could change.
“The perception of safety cannot be guaranteed,” the authors add, “Especially when administered for long periods of time to different populations.”
The FDA has not yet approved it as safe and effective.
More research is needed into how high doses of creatine can affect other body functions.
The Mayo Clinic advises caution, noting that creatine could potentially:
- lower blood glucose, which could affect individuals with diabetes or hypoglycemia
- raise blood pressure, affecting those with hypertension
They also advise caution for people with:
- deep vein thrombosis (DVT)
- electrolyte disorders or imbalances
- gastrointestinal disorders
- irregular heartbeat
- kidney stones or liver disease
- low blood pressure when standing up
- bipolar disorder
This is not an exhaustive list.
Creatine is a bioactive substance. People should approach it with caution.
Creatine affects water levels in the body. Taking creatine with diuretics may lead to dehydration.
Creatine is big business. People in the U.S. are thought to spend some $2.7 billion a year on sports supplements, most of which contain creatine.
The International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) allow the use of creatine, and it is widely used among professional athletes. In the past, the NCAA allowed member schools and colleges to provide creatine to students with school funds, but this is no longer permitted.
Creatine has not been shown to be effective for all kinds of sport, nor has it been found to benefit people who already have naturally high levels of creatine in their body, or those who are already high-performing athletes.
While it may turn out to be helpful in treating some medical conditions, individual athletes need to investigate if it is really worthwhile for them. Creatine supplements should never be used long term.
As with any supplement, it is best to opt for moderate use, and to discuss it first with a physician. Whenever possible, nutrients should first come from natural sources.
Most health authorities would recommend following a healthful, balanced diet and getting nutrients from dietary sources, before using supplements as a backup.