Despite the plethora of studies and a 2017 position by the International Society of Sports Nutrition (ISSN), there are still misconceptions and questions about creatine.
This blog will address lingering doubts and provide evidence-based insights on creatine’s safety, effectiveness, and usage, backed by around 200 research papers and journals.
Whether you’re curious about water retention, kidney health, or the best form of creatine, we’ve got you covered. So, join us as we debunk myths and explore what does creatine do and the science behind this popular supplement to help you make informed decisions on your fitness journey!
Creatine and Water Retention
While some early research suggested that creatine supplementation might be associated with water retention, especially in the initial days, more recent studies indicate that creatine may not cause significant water retention in the long run.
So, it’s essential to understand the full picture before deciding.
Science Behind Creatine and Water Retention
Creatine is an osmotically active substance, which could theoretically lead to increased water retention.
When creatine is taken up into the muscles, it’s dissolved in water and transported with sodium, which could, in turn, cause water to be taken up as well.
However, the sodium-potassium pumps in our body likely prevent dramatic changes in intracellular sodium concentrations due to creatine supplementation.
Recent Studies: Debunking the Myth
Several long-term exercise training studies (5-10 weeks) with creatine supplementation have shown no significant increases in total body water (TBW). Here are a few examples:
- Resistance-trained males who took creatine for five weeks experienced no significant changes in intracellular water (ICW), extracellular water (ECW), or TBW.
- Another study involving males and females taking creatine for six weeks found no significant increase in TBW.
- In contrast, one study found that creatine supplementation did increase body mass and TBW without altering ICW or ECW volumes.
The key takeaway from these studies is that while some short-term creatine supplementation may cause a slight increase in water retention, primarily in intracellular volume, the long-term effects do not alter total body water relative to muscle mass.
Why Increased Intracellular Water Could Be a Good Thing
Contrary to popular belief, increasing intracellular water can be beneficial. This increase can act as a cellular signal for protein synthesis, ultimately driving muscle growth.
So, if you want to gain muscle, a temporary increase in intracellular water might not be bad after all.
Is Creatine an Anabolic Steroid?
Anabolic steroids are synthetic versions of testosterone, a natural hormone in both men and women. Anabolic steroids can increase muscle mass and strength by increasing protein synthesis with resistance training.
They enter muscle cells, bind to intracellular androgen receptors, and increase the expression of various muscle-specific genes.
How is Creatine Different from Anabolic Steroids?
Creatine is not an anabolic steroid. Here’s why:
Different Mechanisms of Action
While both anabolic steroids and creatine can lead to similar physiological and performance outcomes, they work through entirely different mechanisms. Creatine is converted to phosphocreatine (PCr) in the muscles and used to create intracellular adenosine triphosphate (ATP), the energy currency of cells.
By supplementing with creatine, you can increase your muscles’ ATP capacity, improving muscle power, repetitions, and exercise volume during anaerobic exercise. This, in turn, can contribute to muscle performance and hypertrophy over time.
Legal Categorization and Regulation
Anabolic steroids and creatine also differ in their legal categorization and regulation.
Anabolic steroids are Class C, Schedule III controlled substances regulated by the Food and Drug Administration (FDA) and subject to the Controlled Substances Act (CSA) enforced by the Drug Enforcement Administration (DEA).
Possession and administration of anabolic steroids without a prescription are illegal.
On the other hand, creatine is classified as a dietary supplement. It falls under the Dietary Supplement Health and Education Act of 1994 (DSHEA), which defines and regulates dietary supplements for Good Manufacturing Practices (GMP). There are no legal ramifications for possessing or ingesting creatine.
Creatine and Kidney Health: Debunking the Misconceptions
The myth that creatine supplementation causes kidney damage is a prevalent one, and it’s likely due to misunderstandings surrounding creatine and creatinine metabolism, as well as a case study published in 1998.
Creatine and Creatinine Metabolism
In our muscles, creatine and phosphocreatine (PCr) are degraded non-enzymatically to creatinine, which is then excreted in the urine.
Blood creatinine levels can serve as an indicator of kidney function. However, these levels are influenced by muscle mass, dietary creatine, and creatinine intake.
Creatine supplementation or creatine-rich foods such as meat may increase blood and urinary creatinine levels. Some people believe that if the kidneys are “forced” to excrete higher-than-normal levels of creatine or creatinine, it could lead to kidney damage or renal dysfunction.
However, transient increases in blood or urinary creatine or creatinine due to creatine supplementation are unlikely to reflect decreased kidney function.
Creatine Supplementation and Kidney Health
Over the past 20 years, extensive research has shown no adverse effects from recommended dosages of creatine supplements on kidney health in healthy individuals. Numerous studies have concluded no link between creatine supplementation and kidney damage or renal dysfunction.
Medications, pre-existing kidney disease, concomitant supplement ingestion, inappropriate creatine doses, and anabolic androgenic steroid use have confounded some case studies reporting renal dysfunction in individuals using creatine supplements.
Creatine and Hair Loss: Separating Fact from Fiction
The idea that creatine supplementation causes hair loss or baldness primarily stems from a single study on college-aged male rugby players. In this study, participants who were supplemented with creatine experienced an increase in serum dihydrotestosterone (DHT) concentrations.
Since DHT has been linked to some cases of hair loss or baldness, the theory that creatine supplementation leads to hair loss gained some traction.
However, it’s crucial to note that this study’s results have not been replicated, and intense resistance exercise alone can cause increases in androgenic hormones like DHT.
Science Behind DHT and Hair Loss
DHT is a metabolite of testosterone, formed when the enzyme 5-alpha-reductase converts free testosterone to DHT. In males, DHT can bind to androgen receptors in susceptible hair follicles, causing them to shrink and eventually leading to hair loss.
However, the study that sparked the creatine-hair loss concern found no increase in total testosterone among participants. Furthermore, the increase in DHT and the DHT: testosterone ratio remained well within normal clinical limits.
- To date, 12 other studies have investigated creatine supplementation’s effects on testosterone, ranging from 3-25 g/day for 6 days to 12 weeks.
- Two studies reported small, physiologically insignificant increases in total testosterone, while the remaining ten reported no change in testosterone concentrations.
- In five of these studies, free testosterone, which the body uses to produce DHT, was also measured, and no increases were found.
The existing body of evidence does not support the notion that creatine supplementation increases total testosterone, free testosterone, and DHT or causes hair loss or baldness. So, as you explore the benefits of creatine supplementation, you can confidently do so, knowing that your hair is not at risk!
Creatine, Dehydration, and Muscle Cramping
While exploring creatine supplementation, you may have encountered claims that it causes dehydration and muscle cramping. We will sift through the research and address these concerns, so you can decide to incorporate creatine into your fitness routine.
The Dehydration and Muscle Cramping Myth
In the early 2000s, the American College of Sports Medicine (ACSM) recommended that individuals controlling their weight and exercising intensely or in hot environments should avoid creatine supplementation.
This recommendation was primarily based on the idea that creatine could alter whole-body fluid distribution, potentially leading to dehydration through frequent urination and muscle cramping. However, it is essential to note that this was based on limited data and speculation.
Anecdotal Evidence vs. Clinical Research
While some anecdotal evidence suggests that creatine users may experience negative effects like cramping, these self-report surveys contradict experimental and clinical evidence.
For example, one study involving NCAA Division IA collegiate football players found that creatine users had significantly less cramping, heat illnesses, dehydration, muscle tightness, muscle strains, and total injuries than non-users.
In a clinical setting, hemodialysis patients frequently reported muscle cramping and were provided creatine before hemodialysis.
Creatine supplementation reduced the frequency of symptomatic muscle cramping by 60%. The beneficial effects of creatine may be explained by fluid distribution and electrolyte imbalances.
Creatine Supplementation for Children and Adolescents: Is It Safe?
As a health enthusiast, you may have heard about the potential benefits of creatine supplementation for adults. But what about children and adolescents?
Safety Concerns and Research
Most evidence in adult populations suggests that creatine supplementation is safe and generally well-tolerated. However, whether this holds for children and adolescents remains relatively unclear.
A comprehensive review found no evidence of adverse effects in adolescent athletes. It is important to note that these performance-focused studies did not provide data on specific clinical health markers.
Clinical Benefits and Safety in Young Populations
From a clinical perspective, creatine supplementation can offer health benefits with minimal adverse effects in younger populations. Studies have shown improvements in pediatric patients with
- Systemic lupus erythematosus
- Duchenne muscular dystrophy
- Traumatic brain injury-related outcomes
The improvements are visible without negatively impacting laboratory markers of kidney function, oxidative stress, and bone health. These findings support the hypothesis that creatine supplementation is safe for children and adolescents.
GRAS Classification and Current Usage
In late 2020, creatine was classified as Generally Recognized as Safe (GRAS) by the United States Food and Drug Administration (FDA).
This classification suggests that the available scientific data on the safety of creatine is sufficient and has been agreed upon by qualified experts. While infants and young children are excluded from GRAS, this classification applies to older children and adolescents.
Surveys indicate that a relatively high percentage of youth and adolescent athletes are currently or have previously supplemented with creatine, further emphasizing the need for more research on its safety.
Does Creatine Supplementation Increase Fat Mass?
As a health enthusiast, you might have heard rumors about creatine supplementation leading to increased fat mass. This concern may stem from the fact that some individuals experience a gain in body mass after using creatine.
Let’s explore the available research to determine whether creatine supplementation increases fat mass.
Short-term Studies on Creatine and Fat Mass
Numerous short-term, randomized controlled trials have investigated the impact of creatine supplementation on fat mass.
Studies ranging from one week to two months have consistently shown no effect on fat mass in various populations, including young and older adults, swimmers, recreationally active females, and resistance-trained males. These findings indicate that creatine supplementation does not increase fat mass in the short term.
Long-term Studies on Creatine and Fat Mass
Several investigations have looked at longer treatment periods to address concerns that short-term studies may not provide a definitive conclusion on creatine’s effect on fat mass.
Studies with treatment durations of 12 weeks to two years have also found no increase in fat mass due to creatine supplementation in various populations, such as older males and females and resistance-trained individuals.
Some studies even reported a decrease in fat mass with creatine supplementation.
Systematic Review and Meta-Analysis
A recent systematic review and meta-analysis examined 19 randomized controlled trials involving creatine supplementation and resistance training in older adults (≥ 50 years).
The review found that participants supplementing with creatine significantly reduced body fat percentage. Although there was no significant difference in total fat mass loss, the creatine group lost around 0.5 kg more fat mass than those on placebo.
Creatine Loading Phase: Is it Necessary for Optimal Results?
A creatine loading phase typically involves supplementing with 20-25 grams of creatine daily for 5-7 days, often divided into smaller daily doses.
This loading phase is followed by a daily maintenance phase with 3-5 grams of creatine daily. This approach aims to rapidly increase intramuscular creatine stores to enhance muscle mass, performance, and recovery.
Do You Need a Loading Phase?
Although the loading phase can quickly increase intramuscular creatine stores, it’s not the only way to achieve this result.
Lower daily creatine supplementation (3-5 grams daily) has also been shown to effectively increase intramuscular creatine stores and improve muscle mass, performance, and recovery.
However, the non-loading approach takes longer to reach maximum intramuscular creatine storage. For example, a study by Hultman et al. showed that creatine accumulation in muscle was similar after participants consumed either 3 grams per day for 28 days or 20 grams per day for 6 days.
Thus, it is recommended that individuals consume 3-5 grams of creatine daily for a minimum of 4 weeks to achieve similar muscle saturation levels.
Which Approach is Right for You?
The preferred creatine supplementation strategy depends on your individual goals. If you want to maximize the ergogenic potential of creatine in a short period (less than 30 days), a loading phase might be a good option.
However, if you plan to use creatine over an extended period (more than 30 days) or want to avoid potential weight gain associated with creatine loading, the maintenance strategy would be more suitable.
It’s important to note that if you choose to go through a creatine loading phase, stick to smaller doses throughout the day (less than or equal to 10 grams per serving) to avoid gastrointestinal distress.
What Does Creatine Do for Older Adults: A Promising Solution for Sarcopenia and Aging
Maintaining muscle mass and strength becomes increasingly important for overall health and functionality as we age. One potential supplement that has gained attention recently for its potential benefits in older adults is creatine.
Creatine and Age-Related Sarcopenia
Sarcopenia is a progressive loss of muscle mass, strength, and functionality associated with aging. Although resistance training is a cornerstone treatment for sarcopenia, studies suggest that creatine supplementation may enhance the anabolic environment produced by resistance training, mitigating the effects of sarcopenia.
Creatine supplementation has been shown to improve functionality, strength, and muscle mass in older adults, particularly when combined with resistance training.
However, it’s important to note that without a concomitant resistance training program, creatine alone is unlikely to result in substantial gains in muscle strength and functional performance.
This suggests that creatine’s main mechanism of action is its ability to enhance training volume and intensity, influencing muscle protein kinetics, growth factors, satellite cells, inflammation, and oxidative stress, ultimately leading to greater skeletal muscle adaptations.
Creatine and Aging Bone Health
Emerging research has shown the potential benefits of creatine supplementation on aging bone health.
For example, healthy older males supplemented with creatine and performing whole-body resistance training for 10-12 weeks experienced increased upper limb bone mineral content and reduced bone resorption compared to placebo.
Additionally, a study showed that 52 weeks of creatine supplementation and supervised whole-body resistance training attenuated the rate of bone mineral loss in the hip region compared to placebo in postmenopausal females.
Recommendations and Future Research
From a clinical and healthy aging perspective, it is recommended that creatine supplementation be combined with resistance training to produce the greatest adaptations in older adults.
Future clinical trials involving frail populations with long-term follow-up(s) and larger samples are needed to explore further the therapeutic potential of creatine supplementation for cachexia, myopathies, post-surgery rehabilitation, bed rest, and other muscle/bone wasting conditions and diseases, as well as brain health.
Creatine Supplementation for Women
When it comes to creatine supplementation, the focus is often on its benefits for men. However, recent research suggests that creatine can benefit women in various life stages.
Creatine Kinetics and Female Hormones
Research has shown that creatine kinetics may vary between healthy males and females, with females potentially having higher intramuscular creatine concentrations.
Hormone-driven changes in creatine synthesis, transport, and creatine kinase (CK) kinetics alter creatine bioavailability throughout various stages of female reproduction, including
These hormone-related changes in creatine kinetics are often overlooked in performance-based studies but could have significant implications for women’s health.
Creatine Supplementation and Pregnancy
In preclinical animal studies, maternal creatine supplementation during pregnancy has shown protective effects against fetal death and organ damage associated with intrapartum hypoxia.
Creatine supplementation during pregnancy has also been found to enhance neuronal cell uptake of creatine and support mitochondrial integrity in animal offspring, reducing brain injury induced by intrapartum asphyxia.
Although human studies are still needed, creatine supplementation during pregnancy could provide a safe, low-cost nutritional intervention for reducing intra- and post-partum complications associated with cellular energy depletion.
Creatine Supplementation and Mood
Creatine supplementation has significantly increased cerebral phosphocreatine (PCr) levels, particularly in females.
The increase in cerebral PCr from creatine supplementation has been reported to be inversely related to symptoms of depression in adolescent females resistant to selective serotonin reuptake inhibitors.
This suggests that creatine supplementation may effectively support creatine kinetics, mood, and pregnancy/fetal outcomes for women.
Creatine Supplementation and Female Performance
A growing body of research has investigated the effects of creatine supplementation in younger and postmenopausal females.
Studies have shown that creatine supplementation can increase intramuscular concentrations, muscle mass, and strength in females and improve sprint and agility performance in elite female athletes.
Furthermore, research in postmenopausal females has demonstrated that creatine supplementation during a resistance training program can improve muscle mass, upper- and lower-body strength, and functionality tasks.
Creatine Forms and Stability: What You Need to Know?
If you’ve been researching creatine supplements, you may have noticed that there are different forms available. But which one is the best for you, and are they all stable in beverages?
Let’s look at creatine monohydrate, the most widely studied and used form, and compare it to other available forms.
Creatine monohydrate has existed since the early 1990s and is well-known for its efficacy, safety, and low cost. It has been used in numerous studies to establish proper dosages and assess its impact on blood creatine and intramuscular creatine stores. Consuming 3-5 grams daily can increase blood concentrations for 3-4 hours, allowing creatine uptake into tissues.
Although creatine monohydrate has proven benefits, some marketing campaigns claim that other forms of creatine are more effective or safer.
However, no solid scientific evidence shows that other forms, such as creatine salts, effervescent creatine, or creatine ethyl ester, increase muscle storage more effectively than creatine monohydrate. Most studies show that these alternative forms have less impact on muscle creatine stores and performance.
Why is this important? Creatine monohydrate powder contains the highest percentage of creatine (87.9%) other than creatine anhydrous. High-quality creatine monohydrate, primarily sourced from Germany, is 99.9% pure and free from contaminants.
Other sources, especially those from China, may contain contaminants due to differences in synthesis processes and filtration methods. For this reason, it’s recommended to use German-sourced creatine monohydrate in dietary supplements.
As for stability, creatine monohydrate powder is very stable and shows no signs of degradation into creatinine over the years, even at elevated storage temperatures. However, creatine is unstable in solution, as it can convert to creatinine at higher temperatures and lower pH levels.
Creatine’s lack of solubility and stability in solution is the main reason it’s primarily marketed in powder form and why stable creatine beverages containing effective doses (3-5 grams per serving) have been unsuccessful.
Creatine monohydrate remains the gold standard for creatine supplementation. With a well-established safety profile and proven efficacy, it is the preferred choice for enhancing their performance and muscle growth.
So, when shopping for creatine supplements, stick with the tried-and-true creatine monohydrate from a reputable source to ensure you’re getting the most benefits possible.
Creatine supplementation is safe and effective for enhancing athletic performance and muscle growth. Contrary to some misconceptions, creatine is not a steroid and does not cause kidney damage, hair loss, dehydration, or muscle cramping when recommended.
So what does creatine do?
It’s suitable for individuals of all ages, including children, adolescents, and older adults, and offers various sports and activities benefits. Women can also enjoy its advantages throughout their lives.
Creatine monohydrate remains the top choice, as other forms are not superior. So, confidently embrace creatine supplementation and take your fitness goals to new heights!
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I started my professional career as a sports medicine consultant in Rola, Missouri. My primary role was to suggest suitable supplements for my patients according to their pre-existing conditions and lifestyle goals. I believe a healthy lifestyle is the most important if you want to make your life really meaningfull.