Creatine

This is a quick summary of creatine. For full references, please see our complete Scientific Research section

Creatine is a molecule that's produced in the body from amino acids. It's primarily made in the liver and to a lesser extent in the kidneys and pancreas. It stores high-energy phosphate groups in the form of phosphocreatine which are donated to ADP, regenerating it to ATP, the primary energy carrier in the body. This role in energy production is particularly relevant under conditions of high energy demand such as intense physical or mental activity.

Creatine can be found in some foods and is most prevalent in meat and fish. Athletes commonly take it as a powder or in capsules.

The primary benefit of creatine is an improvement in strength and power output during resistance exercise. For this purpose, creatine is well-researched, and the effects are quite notable for a supplement. When used in conjunction with resistance exercise, creatine may modestly increase lean mass. It has also been tested for anaerobic running capacity in many studies, the results of which are fairly mixed but generally suggest a small improvement in performance.

While creatine has been researched far less for cognitive performance than physical performance, it may have benefits in some contexts. A reduction in mental fatigue has been observed in various scenarios such as demanding mental activity, sleep deprivation, and traumatic brain injury. Creatine may improve working memory, though likely only for those with below-average creatine levels such as vegetarians and the elderly. We need more research in these areas and other cognitive measures before creatine can be said to be effective.

When taken without sufficient water, stomach cramping can occur. Diarrhea and nausea can occur when too much creatine is taken at once, in which case doses should be spread out throughout the day and taken with meals.

Most of the supposed dangers of creatine are unfounded. Due to the bad reputation of performance-enhancing drugs, it has been wrongfully equated with the worst examples. It also increases levels of creatinine in the body, which are a marker of poor kidney function. However, the increase in creatinine isn't due to kidney damage, but simply more creatinine being produced. There is a lack of long-term studies in people with reduced kidney function, however, so caution could still be taken in that instance. Besides the minor gastrointestinal issues from excessive creatine, it is unlikely to be unsafe or bad for you.

Creatine is very safe, and has been proven to increase power ouput (which lets you build more muscle). Do note that it can cause bloating, but this is purely water weight.

There is promising yet very preliminary evidence for certain neurological benefits.

Taking into account efficacy, safety, and cost, creatine is among the surest supplement bets.

Have a specific health issue? If you are looking for exact health benefits, dosage, and when to take, and are also worried about side effects and potentially wasting money, you need our scienced-based Supplement Guides.

There are many different forms of creatine available on the market, but creatine monohydrate is the cheapest and most effective. Another option is micronized creatine monohydrate, which dissolves in water more easily and can be more practical.

Creatine monohydrate can be supplemented through a loading protocol. To start loading, take 0.3 grams per kilogram of bodyweight per day for 5–7 days, then follow with at least 0.03 g/kg/day either for three weeks (if cycling) or indefinitely (without additional loading phases).

For a 180 lb (82 kg) person, this translates to 25 g/day during the loading phase and 2.5 g/day afterward, although many users take 5 g/day due to the low price of creatine and the possibility of experiencing increased benefits. Higher doses (up to 10 g/day) may be beneficial for people with a high amount of muscle mass and high activity levels or for those who are non-responders to the lower 5 g/day dose.

Stomach cramping can occur when creatine is supplemented without sufficient water. Diarrhea and nausea can occur when too much creatine is supplemented at once, in which case doses should be spread out over the day and taken with meals.

There is no best form - creatine monohydrate is just as effective as other forms.

The Human Effect Matrix looks at human studies (it excludes animal and in vitro studies) to tell you what effects creatine has on your body, and how strong these effects are.

Grade	Level of Evidence [show legend]
	Robust research conducted with repeated double-blind clinical trials
	Multiple studies where at least two are double-blind and placebo controlled
	Single double-blind study or multiple cohort studies
	Uncontrolled or observational studies only

Level of Evidence ? The amount of high quality evidence. The more evidence, the more we can trust the results.	Outcome	Magnitude of effect ? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.	Consistency of research results ? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.	Notes
	Muscle Creatine Content	Strong	Very High See all 18 studies	Creatine supplementation is the reference compound for increasing muscular creatine levels; there is variability in this increase, however, with some nonresponders.
	Power Output	Strong	Very High See all 66 studies	Creatine is the reference compound for power improvement, with numbers from one meta-analysis to assess potency being "Able to increase a 12% improvement in strength to 20% and able to increase a 12% increase in power to 26% following a training regiment using creatine monohydrate".
	Weight	Strong	Very High See all 28 studies	Appears to have a large effect on increasing overall weight due to water retention in persons who respond to creatine supplementation. Degree of increase is variable.
	Creatinine	Notable	Moderate See all 12 studies	Creatine supplementation usually increases serum creatinine levels during the loading phase (but usually not during maintenance), since creatinine is the breakdown product of creatine. This is not indicative of kidney damage.
	Hydration (Total Body Water)	Notable	Very High See all 9 studies	Appears to be quite notable due to the increase in water weight in skeletal muscle tissue following creatine supplementation.
	Anaerobic Running Capacity	Minor	High See all 19 studies	Appears to increase anaerobic cardiovascular capacity, not to a remarkable degree however.
	Lean Mass	Minor	Very High See all 20 studies	Does appear to have inherent lean mass building properties, but a large amount of research is confounded with water weight gains (difficult to assess potency).
	Kidney Function	-	Very High See all 13 studies	In otherwise healthy persons given creatine supplementation, there is no significant beneficial nor negative influence on kidney function.
	Swimming Performance	-	Moderate See all 17 studies	No reliable improvement in swimming performance. Acute supplementation prior to short sprint tests (50-100 m) may reduce time by around 2%.
	Fatigue	Notable	High See all 7 studies	400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces fatigue frequency from around 90% down to near 10%. Fatigue is also reduced, though to a lesser degree, in cases of sleep deprivation.
	Blood Glucose	Minor	Low See all 4 studies	No apparent influence on fasting blood glucose, but an 11-22% reduction in the postprandial spike.
	Bone Mineral Density	Minor	Low See all 3 studies	There is limited evidence in favor of improvements in bone mineral density.
	Fatigue Resistance	Minor	Moderate See all 8 studies	Small degree of fatigue reduction during exercise, but appears unreliable.
	Lipid Peroxidation	Minor	Low See all 3 studies	A minor reduction has been observed.
	Muscle Damage	Minor	Moderate See all 6 studies	Not overly protective, but there appears to be a degree of protection.
	Muscular Endurance	Minor	High See all 3 studies	Somewhat effective.
	Subjective Well-Being	Minor	Moderate See all 11 studies	The influence of creatine on well being and general happiness is usually dependent on it treating a disease state; there does not appear to be a per se benefit to well being.
	Testosterone	Minor	High See all 6 studies	Degree of testosterone spike is not overly notable, although it appears to be present
	Treatment of Myotonic Dystrophy	Minor	High See all 3 studies	Preliminary evidence seems to support a minor to moderate benefit with regard to Myotonic Dystrophy type II (DM2) and a mild benefit or none with regard to DM1.
	VO₂ Max	Minor	Low See all 6 studies	Improvements in VO2 max are not wholly reliable, and appear to be low in magnitude.
	Aerobic Exercise	-	Very High See all 7 studies	Does not appear to confer any apparent benefit to prolonged cardiovascular exercise.
	Blood Pressure	-	Very High See all 4 studies	Does not appear to significantly influence blood pressure.
	Cognition (Omnivores)	-	High See all 3 studies	No inherent benefit to omnivore cognition appears apparent, but it may benefit cognition in the sleep deprived.
	Cortisol	-	Very High See all 4 studies	No effect on cortisol changes associated with sleep deprivation.
	Exercise Capacity (with Heart Conditions)	-	Very High See all 3 studies	Although there may be a small reduction of power output (typical of creatine), the main parameter of interest (cardiorespiratory output) is mostly unaffected by creatine supplementation.
	Exercise Capacity in COPD	-	Very High See all 3 studies	The main parameter of interest with exercise in COPD (cardiovascular capacity and aerobic exercise) is wholly unaffected with supplementation, although power output still can be increased.
	Fat Mass	-	Very High See all 9 studies	Creatine reliably increases lean mass (water at first, then muscle with more prolonged supplementation) but does not appear to significantly alter fat mass.
	Heart Rate	-	Very High See all 3 studies	No known influence on heart rate.
	IGF-1	-	Very High See all 5 studies	Insufficient evidence to support a role of creatine in increasing IGF-1
	Insulin	-	Very High See all 3 studies	No effect on fasting insulin.
	Lactate Production	-	Moderate See all 6 studies	No apparent reduction or increase in lactate in swimmers after sprinting exercises.
	Liver Enzymes	-	Very High See all 7 studies	No known influence on circulating liver enzymes, suggesting no liver toxicity in humans.
	Lung Function	-	Very High See all 7 studies	No effect on healthy people or on disease states characterized by impaired lung function.
	Total Cholesterol	-	High See all 4 studies	No effect on overall cholesterol levels in otherwise healthy males.
	Treatment of Amyotrophic Lateral Sclerosis (ALS)	-	Very High See all 6 studies	Short term usage may increase power output like usual, but prolonged supplementation of creatine has failed to alter the deterioration of muscle and lung function. While no reduction in mortality has been noted statistically, two studies have noted a trend towards reductions in mortality suggesting an unknown protective effect.
	Treatment of COPD	-	High See all 3 studies	No effect on cardiovascular exercise performance and lung and heart functions, the main parameters of concern when treating COPD.
	Depression	Notable	Very High See all 3 studies	Depression symptoms seem to improve noticeably. This improvement is probably related to serotonin (creatine supplementation appears to enhance SSRI therapy). Possible gender differences (a greater efficacy in females) require further study.
	Glycogen Resynthesis	Notable	- See study	Degree of improvement is somewhat more potent than other supplemental options, and may be related to the improvements in glycemic control seen with creatine.
	Growth Hormone	Notable	- See all 4 studies	During exercise, creatine supplementation can suppress growth hormone secretion: up to 35% during loading; up to 5% during maintenance. At rest, creatine supplementation can spike growth hormone by up to 83±45%. This bidirectional effect is similar to that of arginine supplementation.
	Myostatin	Notable	- See study	The reduction in circulating Myostatin, while notable (17%), is of uncertain practical relevance.
	Body Cell Mass	Minor	- See study	A possible increase in cell mass. Evidence is limited.
	Cognition (Vegetarians)	Minor	Very High See 2 studies	Appears to be reliable in increasing cognition in vegetarians, but is based on limited evidence and not yet compared to a reference drug.
	DHT	Minor	- See study	An increase in DHT independent of an increase in testosterone has been noted, but the study requires replication due to some potential issues (its location, the lack of biological plausibility, etc.).
	DNA Damage	Minor	Moderate See 2 studies	Creatine supplementation appears to reduce exercise-induced DNA damage. This is potentially promising with regard to cancer prevention.
	DNA Methylation	Minor	- See study	The effect of creatine supplementation on DNA methylation cannot be properly assessed due to a lack of comparisons with other agents.
	Functionality in Elderly or Injured	Minor	Moderate See 2 studies	Possibly an effect, but the less reliable effects of creatine in the older population (which seem to respond less) seems to manifest here.
	Glycemic Control	Minor	Very High See 2 studies	Appears to be somewhat effective in diabetics for improving glycemic control.
	Homocysteine	Minor	- See study	Decrease in homocysteine (biomarker of inflammatory cardiovascular disease) was present, but not to a remarkable magnitude
	Myonuclei Proliferation	Minor	- See study	Creatine supplementation appears to induce myonuclei proliferation, to a degree unknown relative to other agents.
	Satellite Cell Recruitment	Minor	- See study	Compared to reference drugs, creatine had no significant effect.
	Symptoms of Duchenne Muscular Dystrophy	Minor	Very High See 2 studies	There appears to be a mild therapeutic effect of creatine supplementation (2-5g) to boys with DMD, mostly related to an improvement in handgrip strength and body composition with some parent-rated improvements.
	Symptoms of McArdle's Disease	Minor	- See 2 studies	Two trials have shown differing effects, for reasons currently unknown.
	Symptoms of Osteoarthritis	Minor	- See study	Functionality seems to improve, although not to a remarkable degree.
	Symptoms of Sleep Deprivation	Minor	Very High See 2 studies	The cognitive dysfunction associated with prolonged sleep deprivation can be attenuated, to a small degree, with prior creatine loading.
	Uric Acid	Minor	Very High See 2 studies	A minor reduction has been observed.
	Adrenaline	-	- See study	No significant alterations in plasma adrenaline are seen with creatine supplementation during sleep deprivation.
	Aldosterone	-	- See 2 studies
	Anti-Oxidant Enzyme Profile	-	- See study
	Attention	-	- See study	No effect on attention during sleep deprivation.
	Bilirubin	-	- See all 3 studies
	C-Reactive Protein	-	- See study
	Cerebral Oxygenation	-	- See study
	Dopamine	-	- See study	No significant alterations in plasma dopamine are seen with creatine supplementation during sleep deprivation.
	Fat Oxidation	-	- See 2 studies
	Food Intake	-	Very High See 2 studies	No effect on food intake.
	General Oxidation	-	- See study
	Glycogen Content	-	- See 2 studies
	HDL-C	-	- See 2 studies
	Injury Rehabilitation Rate	-	- See study
	Insulin Secretion	-	- See study	No effect on the insulin secretion in response to a test meal.
	Insulin Sensitivity	-	- See study	No effect on insulin sensitivity.
	LDL-C	-	- See 2 studies
	Memory	-	Very High See 2 studies	No effect on short-term recall during sleep deprivation.
	Muscle Oxygenation	-	- See study
	Noradrenaline	-	- See study	No significant alterations in plasma noradrenaline are seen with creatine supplementation during sleep deprivation.
	Proteinuria	-	- See study	There is no significant influence on protein losses in the urine (proteinuria).
	Schizophrenia	-	- See study	Insufficient evidence to support a role in schizophrenia.
	Skeletal Muscle Atrophy	-	Very High See 2 studies	The study that noted a prevention of lean mass loss did not distinguish between water and muscle, while the study that measured muscle mass specifically failed to find a protective effect during limb immobilization.
	Sprint Performance	-	- See study
	Symptoms of Mitochondrial Cytopathies	-	- See all 3 studies
	TNF-Alpha	-	- See study
	Training Volume	-	Very High See 2 studies	No effect on the training volume of swimmers.
	Treatment of Huntington's Disease	-	Very High See 2 studies	There is insufficient evidence to support a rehabilitative role of creatine supplementation.
	Treatment of Parkinson's	-	Very High See 2 studies	There is insufficient evidence to support an improvement in the symptoms of Parkinson’s.
	Triglycerides	-	- See all 3 studies
	Urea	-	- See all 4 studies
	vLDL-C	-	- See study
	Dizziness	Notable	- See study	Dizziness as a side-effect of traumatic brain injury is reduced with 400 mg/kg/day.
	Treatment of Headaches	Notable	- See study	400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces headache frequency from around 90% down to near 10%.
	Alertness	Minor	Very High See 2 studies	Increases in alertness tend to be during sleep deprivation or stress, rather than outright increases in alertness. Not overly potent
	Blood Flow	Minor	- See study	One study has found that creatine can increase blood flow to the calf and leg when combined with resistance training in healthy men. Creatine alone was found to have no effect.
	Catabolism	Minor	- See study	Uncertain practical relevance.
	Range of Motion	Minor	- See study	One study, that needs to be replicated, noted a reduction in range of motion.
	Metabolic Rate	-	- See study
	Symptoms of Cystic Fibrosis	-	- See study	An increase in well-being and muscular strength has been noted in youth, but the main parameters under investigation (lung and chest symptoms) seemed unaffected.

Studies Excluded from Consideration

• Confounded with the inclusion of CoQ10^[2]

• Confounded with glycerol^[3]

• Do vegetarians lack CCC insurance? A look into creatine, carnitine, and carnosine in vegetarian diets

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