What Is Creatine?

Creatine is one of the most popular and effective dietary supplements. Used mostly to support muscle health and exercise performance, creatine also exerts anti-aging, brain health, and other positive health benefits.

Creatine is a natural substance produced in the body in addition to a dietary supplement. It is composed of three amino acids: L-arginine, L-glycine, and L-methionine. The liver, kidneys, and pancreas produce about half of the body's creatine supply, approximately 2 grams per day. 

Food Sources of Creatine

Creatine is also provided from dietary sources such as red meat and seafood. One pound of raw beef or salmon provides 1 to 2 grams of creatine. Since plant-based diets lack creatine-rich sources such as animal meat and seafood, creatine supplementation may be important to maintain adequate total body creatine levels. 

As a dietary supplement, creatine is available in several different forms. Creatine monohydrate is the recommended form based upon the scientific evidence.

What Does Creatine Do in the Body?

Creatine in the form of creatine phosphate enhances energy production in muscles for quick bursts of power and speed. When a muscle cell contracts, it requires energy produced by the release of one phosphate group from adenosine triphosphate (ATP), which is then converted to adenosine diphosphate (ADP). Creatine phosphate donates its phosphate group to convert ADP back to ATP. The energy-producing effects of creatinine also occur in other tissues, particularly the brain.

In addition to its role as an energy source, creatine exerts antioxidant, anti-inflammatory, and immune-supportive effects. 

Benefits of Creatine

Enhances Physical Performance

Creatine is one of the most well-researched dietary supplements. In sports nutrition, it is used to promote enhanced physical performance and muscle growth and repair. The data is so strong from over 1,000 published human clinical trials showing creatine can increase the performance of high-intensity and/or repetitive strength exercises by 10 to 20% that the International Society of Sports Nutrition (ISSN), American College of Sports Medicine (ACSM), American Dietetic Association (ADA), and others have concluded that “creatine is the most effective dietary supplement for increasing exercise performance and muscle mass.”¹

Given creatine’s role in energy production, its effectiveness makes sense. Since creatine helps replenish ATP, it allows athletes and fitness enthusiasts to train harder and longer. This benefit also allows muscles to respond to power and speed training to increase strength, muscle mass, and performance. 

However, while creatine works to enhance performance power and speed training, results from studies looking at creatine supplementation in endurance sports or aerobic training have shown no benefit in trained individuals regarding enhanced performance.^1,2 Endurance sports or aerobic training is defined as large muscle mass activities over 3 minutes. While creatine supplementation may not help endurance athletes with enhanced performance, it has been shown to prevent muscle damage and recover quickly.³ Furthermore, creatine supplementation may enhance performance in endurance activities requiring multiple intensity surges and/or during a spurt at the end of a race or event.⁴ Included in these sorts of sports are mountain biking, cycling, triathlon, cross-country skiing, and rowing.

Boosts Muscle Growth and Lean Body Mass

Creatine supplementation has been shown to increase measures of lean body mass in human double-blind studies.^1,5,6 These benefits are mainly due to creatine-enhancing training efforts. Still, creatine also enhances the growth factors for muscle protein synthesis and decreases muscle breakdown, which may also contribute to its ability to increase lean body mass. 

To determine the specifics of the benefits of creatine supplementation for muscle growth, researchers recently analyzed the results from 28 human clinical studies.⁶ What the statistics demonstrated was that when creatine supplementation was combined with weight or resistance training in men, regardless of age, it produced an average increase in lean body mass of 1.46 kg (3.2 lbs), while in women, this increase was significantly less at 0.29 kg (0.6 lbs). Creatine failed to increase lean body mass in those not engaged in regular strength training exercises. 

The benefits of muscle mass in older subjects are particularly important. As we age, there is a significant loss of muscle. This process is known as sarcopenia. For healthy aging, a primary goal is preventing sarcopenia, which is critical as it is a major factor in physical function and quality of life. Creatine supplementation has been shown to improve physical performance, muscle function, and lean body mass in elderly men and women.^7-10 Supplementation with creatine (0.1 g per kg body weight) immediately after exercise produced the greatest benefit. 

Promotes Water Retention

Creatine exerts additional effects beyond energy-enhancing and promoting muscle growth in response to high-intensity training. One key effect of creatine is that it promotes water retention in a way that promotes hydration,¹ which can improve exercise performance and heat tolerance. In a double-blind, placebo-controlled study of collegiate football players, those taking 5 g of creatine daily for four months had significantly less muscle cramping or strains, dehydration, and heat illness than those in the placebo group.¹¹

Aids Recovery

Creatine also helps to reduce muscle damage and aids in recovery post-exercise. These results are again related to creatine’s effect on muscle energy production and some anti-inflammatory effects. Less muscle damage during exercise results in less after-exercise muscle soreness and quicker recovery. Human double-blind, placebo-controlled studies have shown creatine to lower blood markers for inflammation and improve other metabolic markers in endurance and high-intensity exercise, indicating that creatinine supplementation may be useful in aerobic and anaerobic exercise recovery.^3,12-15 Less muscle damage and better recovery from training is an important goal, especially for elite athletes.

Aging and Brain Health

Creatine exerts some anti-aging and positive effects on brain health. It is well-known that aging leads to a decline in muscle mass, bone density, cognitive function, and memory. Research suggests creatine can improve overall health as we age by slowing the progression of these declines in functional ability and improving blood sugar control and cholesterol and triglyceride levels. Regarding brain health, several studies in older adults have shown that supplementation with 5g of creatine daily for six weeks improves memory and performance on intelligence and cognitive function tests.^16-18

Mood and Brain Function

Creatine shows tremendous promise in improving mood and feelings of well-being.¹⁹ Several human double-blind, placebo-controlled studies have confirmed creatine supplementation can boost mood scores compared to a placebo.^20,21 Not only has creatine improved mood scores, but researchers have shown that creatine supplementation enhances brain energy production in key brain areas. Higher levels of brain energy were associated with more positive mood scores. 

Is Creatine Safe?

The International Society of Sports Nutrition has concluded that creatine is safe and well-tolerated in both short and long-term use, including at dosages as high as 30 grams a day for 5 years in healthy individuals. This opinion is based upon over a thousand human clinical studies with participants ranging from infancy to the elderly and frail. Creatine has also been in the marketplace since the 1990s with billions of servings of creatine. Previous reports of side effects or potential adverse reactions have all been refuted in well-controlled human clinical studies Rather, as noted above, creatine monohydrate supplementation has been found to reduce the incidence of many of these anecdotally reported side effects.¹

Dosage

Generally, a daily dose of 3 to 5 grams is recommended. Taking it after a workout may produce the best results. A loading phase of 5 grams of creatine taken four times daily for 5-7 days is often recommended to saturate muscles with creatine to ramp up benefits quicker. Since creatine draws water into muscles, it is important to ensure adequate water intake to support proper function. That means roughly 8-10 glasses of water daily, especially during the loading phase.

References:

1. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. 
2. Fernández-Landa J, Santibañez-Gutierrez A, Todorovic N, Stajer V, Ostojic SM. Effects of Creatine Monohydrate on Endurance Performance in a Trained Population: A Systematic Review and Meta-analysis. Sports Med. 2023 May;53(5):1017-1027.
3. Wax B, Kerksick CM, Jagim AR, et al. Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations. Nutrients. 2021 Jun 2;13(6):1915. 
4. Forbes SC, Candow DG, Neto JHF, Kennedy MD, Forbes JL, Machado M, Bustillo E, Gomez-Lopez J, Zapata A, Antonio J. Creatine supplementation and endurance performance: surges and sprints to win the race. J Int Soc Sports Nutr. 2023 Dec;20(1):2204071. 
5. Burke R, Piñero A, Coleman M, Mohan A, Sapuppo M, Augustin F, Aragon AA, Candow DG, Forbes SC, Swinton P, Schoenfeld BJ. The Effects of Creatine Supplementation Combined with Resistance Training on Regional Measures of Muscle Hypertrophy: A Systematic Review with Meta-Analysis. Nutrients. 2023 Apr 28;15(9):2116. 
6. Delpino FM, Figueiredo LM, Forbes SC, Candow DG, Santos HO. Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials. Nutrition. 2022 Nov-Dec;103-104:111791. 
7. Davies TW, Watson N, Pilkington JJ, et al. Creatine supplementation for optimization of physical function in the patient at risk of functional disability: A systematic review and meta-analysis. JPEN J Parenter Enteral Nutr. 2024 May;48(4):389-405.
8. Johannsmeyer S, Candow DG, Brahms CM, Michel D, Zello GA. Effect of creatine supplementation and drop-set resistance training in untrained aging adults. Exp Gerontol. 2016 Oct;83:112-9. 
9. Gualano B, Macedo AR, Alves CR, Roschel H, Benatti FB, Takayama L, de Sá Pinto AL, Lima FR, Pereira RM. Creatine supplementation and resistance training in vulnerable older women: a randomized double-blind placebo-controlled clinical trial. Exp Gerontol. 2014 May;53:7-15. 
10. Candow DG, Vogt E, Johannsmeyer S, Forbes SC, Farthing JP. Strategic creatine supplementation and resistance training in healthy older adults. Appl Physiol Nutr Metab. 2015 Jul;40(7):689-94.
11. Kilduff LP, Georgiades E, James N, et al. The effects of creatine supplementation on cardiovascular, metabolic, and thermoregulatory responses during exercise in the heat in endurance-trained humans. Int J Sport Nutr Exerc Metab. 2004;14(4):443–460. 
12. Cooke MB, et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr. 2009;6:13. doi: 10.1186/1550-2783-6-13.
13. Yamaguchi S, Inami T, Ishida H, et al. The Effect of Prior Creatine Intake for 28 Days on Accelerated Recovery from Exercise-Induced Muscle Damage: A Double-Blind, Randomized, Placebo-Controlled Trial. Nutrients. 2024 Mar 20;16(6):896.  
14. Deminice R, Rosa FT, Franco GS, Jordao AA, de Freitas EC. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013 Sep;29(9):1127-32.  
15. Roberts PA, Fox J, Peirce N, et al. Creatine ingestion augments dietary carbohydrate mediated muscle glycogen supercompensation during the initial 24 h of recovery following prolonged exhaustive exercise in humans. Amino Acids. 2016 Aug;48(8):1831-42.
16. Jaramillo AP, Jaramillo L, Castells J, Beltran A, Garzon Mora N, Torres S, Barberan Parraga GC, Vallejo MP, Santos Y. Effectiveness of Creatine in Metabolic Performance: A Systematic Review and Meta-Analysis. Cureus. 2023 Sep 15;15(9):e45282.
17. Forbes SC, Candow DG, Ferreira LHB, Souza-Junior TP. Effects of Creatine Supplementation on Properties of Muscle, Bone, and Brain Function in Older Adults: A Narrative Review. J Diet Suppl. 2022;19(3):318-335. 
18. Roschel H, Gualano B, Ostojic SM, Rawson ES. Creatine Supplementation and Brain Health. Nutrients. 2021 Feb 10;13(2):586. 
19. Kious BM, Kondo DG, Renshaw PF. Creatine for the Treatment of Depression. Biomolecules. 2019 Aug 23;9(9):406. 
20. Kondo DG, Forrest LN, Shi X, et al. Creatine target engagement with brain bioenergetics: A dose-ranging phosphorus-31 magnetic resonance spectroscopy study of adolescent females with SSRI-resistant depression. Amino Acids 2016:1941–1954.
21. Yoon S, Kim JE, Hwang J, Kim TS, Kang HJ, Namgung E, Ban S, Oh S, Yang J, Renshaw PF, Lyoo IK. Effects of Creatine Monohydrate Augmentation on Brain Metabolic and Network Outcome Measures in Women With Major Depressive Disorder. Biol Psychiatry. 2016 Sep 15;80(6):439-447.