Creatine Supplementation: What the Science Really Shows

I have written and lectured extensively about creatine as a supplement and continue to receive queries about it in terms of both its safety as well as efficacy. So, let’s look at the science supporting this fascinating supplement.
Creatine is a naturally occurring compound made in the body from amino acids and obtained from food (especially red meat) or supplements. It’s popular among athletes and fitness enthusiasts for improving strength, muscle mass, and performance. More recently, I have described supportive research as it relates to creatine in the area of brain function and even in the treatment of Alzheimer’s disease. Despite hundreds of scientific studies confirming its safety and effectiveness, many misconceptions still circulate. Let’s look at the science:

1. Does Creatine Cause Water Retention?

The idea that creatine causes bloating or water retention comes from early studies showing short-term increases in water weight during the initial loading phase. However, long-term studies do not support this claim. When used properly, especially at maintenance doses (3–5 grams/day), creatine does not lead to significant or harmful water retention. Some water may shift into muscle cells, which can actually support muscle growth.

2. Is Creatine an Anabolic Steroid?

No. Creatine is not a steroid. Steroids are synthetic hormones with a completely different structure and mode of action. Creatine works by increasing energy production (ATP) in muscles during high-intensity exercise. It is classified as a dietary supplement, not a controlled drug like steroids.

3. Does Creatine Damage the Kidneys?

There is no reliable evidence that creatine harms kidney function in healthy individuals. Early concerns came from misinterpreting elevated creatinine levels (a breakdown product of creatine) as a sign of kidney stress. However, numerous clinical trials and long-term studies show no kidney damage from recommended creatine doses.

4. Does Creatine Cause Hair Loss?

This belief comes from a single 2009 study in rugby players that found a small, temporary rise in DHT (a hormone linked to male pattern baldness) during creatine use. But no study has shown creatine causes hair loss, and follow-up studies have failed to replicate this finding. More research is needed, but current evidence does not support the claim.

5. Does Creatine Cause Dehydration or Muscle Cramps?

Contrary to popular belief, creatine does not increase the risk of dehydration or cramps. In fact, some studies suggest it may improve hydration and reduce cramps. Athletes taking creatine in hot environments had fewer heat-related issues, muscle strains, and injuries than those not taking it.

6. Is Creatine Safe for Children and Teenagers?

While most research is in adults, limited evidence suggests creatine is safe and potentially beneficial for adolescents, especially those in sports. Clinical trials in children with medical conditions (e.g., muscular dystrophy or brain injury) have found creatine to be well tolerated and helpful. The FDA has classified creatine as “Generally Recognized As Safe” (GRAS) for older children and adolescents.

7. Does Creatine Increase Fat Mass?

Despite some people gaining weight after starting creatine, this is mainly from water and muscle, not fat. Multiple studies in various populations (including older adults, athletes, and women) found no increase in body fat. Some even saw slight reductions in fat when creatine was combined with exercise.

8. Is a Loading Phase Necessary?

No, loading (20 grams/day for 5–7 days) is not required. While it helps saturate muscles with creatine more quickly, daily low doses (3–5 grams/day) are equally effective over a few weeks. For those sensitive to water weight or stomach upset, skipping the loading phase is a good option.

9. Is Creatine Helpful for Older Adults?

Yes. Creatine, when combined with resistance training, can help older adults maintain or gain muscle, strength, and function, key to fighting sarcopenia (age-related muscle loss). It may also benefit bone health, cognitive function, and recovery after injury. However, creatine alone (without exercise) appears to have limited benefits in this age group.

10. Is Creatine Only Useful for Strength or Power Sports?

Creatine benefits more than just bodybuilders or sprinters. It helps with endurance, recovery, injury prevention, muscle damage, heat tolerance, and possibly brain protection. It supports athletes across many sports, including soccer, running, and swimming. It also shows promise in reducing the severity of traumatic brain injury and spinal cord damage in animal models.

11. Is Creatine Only Effective for Men?

Creatine works for both men and women, though research on females has been historically limited. Women may have slightly higher natural muscle creatine stores, which could reduce their responsiveness, but many studies still show clear benefits in muscle strength, performance, and recovery. And as I mentioned above, creatine may also support brain health and reduce symptoms of depression, especially in females.

In pregnancy, animal studies suggest creatine may protect against birth complications caused by oxygen deprivation, though no human data exists yet. Postmenopausal women also benefit from creatine when combined with resistance training.

12. Are Other Forms of Creatine Better Than Creatine Monohydrate?

Creatine monohydrate is the most studied, effective, safe, and affordable form. Despite claims from supplement companies, other forms (like ethyl ester, nitrate, buffered creatine) do not offer better results and may be less stable or less bioavailable. Some may contain contaminants if not produced properly.
Creatine is very stable as a dry powder, but not in liquid form where it breaks down into less effective creatinine. This is why creatine is best taken as a powder mixed just before use.

Bottom Line:

• Creatine is safe and effective when taken as recommended (3–5 g/day).
• It is not a steroid, nor does it damage kidneys, cause dehydration, or increase body fat.
• Benefits go beyond muscle, supporting bone, brain, and overall health.
• It helps both men and women, especially when combined with exercise.
• Creatine monohydrate is the best form, so no need to pay more for alternatives.
• Loading isn’t necessary, and long-term use is generally safe, even in older adults and adolescents.