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Knowledge · Natural Compounds

Creatine

Creatine is an energy store produced by the body; human studies show benefits for strength and muscle mass, but mixed results for performance and the brain.

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We evaluated 367 human studies on Creatine, including 165 randomised controlled trials and 70 meta-analyses or systematic reviews; the controlled studies include 8,940 participants in total. As of 3 October 2026.

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1. What Is Creatine? Occurrence, Origin and Forms

Creatine is a substance the body makes itself in the liver, kidneys and pancreas from three amino acids. As creatine phosphate it serves as a rapid energy store in muscles and the brain.

Food provides creatine mainly from meat and fish; vegetarian and vegan diets lack this source.

Creatine for supplements is made chemically, mostly as creatine monohydrate, which is the form used in most studies.

Forms and Preparations Studied

  • Creatine monohydrate
  • Other creatine forms (hydrochloride, ethyl ester, buffered creatine)
  • Loading phase with a high dose and maintenance dose
  • Combination products with creatine – the other ingredients are named in each case

Not covered on this page:

  • Creatine kinase and creatinine as laboratory values without creatine supplementation

2. What Does Creatine Do? Results by Area

AreaResult in controlled studiesStrength of evidenceStudiesParticipants
Strength and muscle massmixedhigh30 meta-analyses · 102 controlled · 33 other1,122
Sprint and endurance performancemixedhigh13 meta-analyses · 78 controlled · 23 other698
Muscles and bones in older agemostly no differencehigh16 meta-analyses · 19 controlled · 17 other193
Memory and brainmixedhigh12 meta-analyses · 21 controlled · 25 other379
Mood and depressionmixedhigh3 meta-analyses · 12 controlled · 9 other140
Kidney values and tolerabilitymostly no differencelow7 meta-analyses · 26 controlled · 23 other474
Other outcomesmixedhigh24 meta-analyses · 141 controlled · 62 other8,324

How to read the table: counted are human studies whose results concern the area. “High” means at least one meta-analysis and two controlled studies showing improvement, or at least three controlled studies of which three quarters show improvement, with at least 300 participants in total. “Moderate” means at least two controlled studies showing improvement, as a majority, or one meta-analysis alongside controlled studies. “Low” means one controlled study showing improvement. Where an area has no controlled study, the strength of evidence is at most “low” (result “reviews only” or “observational data only”). Everything else is “unclear”. A study counts as showing improvement when at least half of its outcomes in this area improved. Reviews of combination products do not count as meta-analyses; results that only describe side effects or shares of users do not count as an effect. The same study is counted only once.

3. What the Studies Show in Detail

Creatine, Strength and Muscle Mass: Human Studies

Creatine with strength training increased maximal strength more than placebo in several meta-analyses, for example in bench and chest press 381422. Isometric muscle strength was also higher than with placebo in several controlled studies 8990216. Fat-free mass improved in several controlled studies 8793. Handgrip strength improved in several controlled studies 156231. Muscle mass was improved in several controlled studies 155256. The number of repetitions and Wingate performance were higher than with placebo in two controlled studies 146198. Muscle thickness increased more with creatine than with placebo in one controlled study 174. Individual strength measures such as leg press, upper body strength or knee extension showed no established difference in the same meta-analyses 31822. Several controlled studies also found no difference in muscle strength 101107113. Several controlled studies found no difference in fat-free mass 101107188. Several controlled studies found no difference in isometric strength 124202226. One meta-analysis and one controlled study found no difference in handgrip strength 393. During immobilization of the leg, creatine did not preserve muscle mass better than placebo 108. One controlled study found no difference in muscle thickness 180. The findings apply to creatine monohydrate, sometimes with a loading phase and maintenance dose, usually in combination with strength training. Creatine monohydrate with conjugated linoleic acid increased strength and fat-free mass more than placebo in older people 97; with HMB, the results were inconsistent 66. The evidence is strong, but many studies were small and short, and the heterogeneity between populations, training protocols and dosages leaves open for whom and under what conditions the benefit is greatest.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
1 Kreider et al. 2025systematic review · 12,839 participantsCreatine, mostly creatine monohydrate; mean 0.166 g/kg/d (about 12.5 g/d); mean 64.7 days, studies up to 14 yrs; vs. Placebo (13,452 participants in 652 studies)Muscle cramping/pain (study percentage): worsened (PLA 0.9%, Cr 2.9%, p = 0.008); Muscle cramping/pain (participant percentage): no difference (PLA 0.07%, Cr 0.52%, p = 0.085)
3 Kazeminasab et al. 2025meta-analysis · 1,937 participantsCreatine supplementation; vs. PlaceboBench/chest press strength: improved (WMD = 1.43 kg, p = 0.002); Squat strength: improved (WMD = 5.64 kg, p = 0.001); Handgrip strength: no difference (WMD = 4.26 kg, p = 0.10)
5 Wang et al. 2026meta-analysis · 1,211 participantsCreatine supplementation (compared with protein and omega-3); vs. Protein, omega-3 supplementation and controlMuscle strength (SMD): improved (SMD = 0.46, 95% CI: 0.29 to 0.63, SUCRA = 82.4%)
6 Delpino et al. 2022meta-analysis · 1,192 participantsCreatine supplementation; vs. Placebo or control, with/without exerciseLean body mass (all studies): improved (0.68 kg (95% CI, 0.26-1.11)); Lean body mass with resistance training: improved (1.10 kg; 95% CI, 0.56-1.65); Lean body mass with mixed exercise: no difference (0.74 kg; 95% CI, -3.89 to 5.36)
8 Sharifian et al. 2025meta-analysis · 1,093 participantsCreatine supplementation plus exercise training; vs. Placebo plus exercise training1RM (kg): improved (mean difference = 2.122, Z = 3.255, P = 0.001)
9 Davies et al. 2024meta-analysis · 1,076 participantsCreatine supplementation; vs. PlaceboUpper-body muscle strength: improved (SMD: 0.25; 95% CI: 0.06-0.44; I2 = 0%; P = 0.01); Handgrip strength: improved (SMD 0.23; 95% CI: 0.01-0.45; I2 = 0%; P = 0.04)
10 Davies et al. 2023meta-analysis · 1,076 participantsCreatine supplementation; vs. PlaceboUpper body muscle strength: improved (SMD 0.25, 95% CI 0.06 to 0.44; I =0%; p=0.01); Handgrip strength: improved (SMD 0.23, 95% CI 0.01 to 0.45; I =0%; p=0.04)
13 Chen et al. 2026meta-analysis · 763 participantsCreatine monohydrate (3 studies) plus structured exercise; vs. Exercise alone or placebo plus exerciseBench press strength: improved (g=0.279, 95% CI: 0.008 to 0.550, p=0.043); Handgrip strength: improved (g=0.412, 95% CI: 0.039 to 0.786, p=0.031); Skeletal muscle mass: no difference (g=0.065, 95% CI: -0.353 to 0.482, p=0.762)

Further studies in this area: 14 16 18 22 25 29 31 38 41 42 43 44 45 47 50 53 55 60 61 63 64 65 66 67 69 70 80 87 89 90 93 94 97 98 100 101 102 103 107 108 109 112 113 114 115 116 117 120 121 122 123 124 125 126 127 133 134 136 137 141 143 144 145 146 147 152 155 156 157 160 161 162 163 164 167 170 173 174 175 176 178 180 181 183 187 192 193 194 198 199 200 201 202 206 208 209 211 213 214 216 218 223 224 225 226 229 231 233 234 235 237 242 243 244 248 249 252 254 256 257 258 261 263 265 266 273 274 276 283 285 288 291 296 305 307 308 309 310 311 312 321 322 323 324 330 332 334 335 337 339 346 352 353 356 358 360 362

Creatine, Sprint and Endurance Performance: Human Studies

For sprint and endurance performance, the picture is mixed. Several controlled studies found better sprint performance than with placebo 131215248, while others found no difference, for example in swimmers 21232. Meta-analyses showed advantages for Wingate performance and anaerobic performance, but not for aerobic performance 365. In active women, creatine monohydrate improved the fatigue index in repeated sprints, especially in the high-hormone cycle phase; heart rate variability remained unchanged 96. The findings apply predominantly to creatine monohydrate, sometimes with a loading phase and maintenance dose. Buffered creatine monohydrate (Kre-Alkalyn) did not perform better than creatine monohydrate (Creapure) in the Wingate test 98. A systematic review of alternative creatine forms such as magnesium chelate, citrate, malate, ethyl ester, nitrate and pyruvate found no consistent performance improvement over placebo 57. Creatine monohydrate with maltodextrin showed no differences in sprint time, fatigue index and blood lactate 88. Creatine monohydrate plus conjugated linoleic acid improved muscular endurance and isokinetic knee extension strength 97. Creatine monohydrate plus HMB improved anaerobic performance in some of the studies; the only study on aerobic performance found no advantage 66. The evidence is strong, but the heterogeneity between studies, populations and training support leaves open for whom and under what conditions the benefit is greatest.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
3 Kazeminasab et al. 2025meta-analysis · 1,937 participantsCreatine supplementation; vs. PlaceboVertical jump: improved (WMD = 1.48 cm, p = 0.01); Wingate peak power: improved (WMD = 47.81 Watts, p = 0.004)
5 Wang et al. 2026meta-analysis · 1,211 participantsCreatine supplementation (compared with protein and omega-3); vs. Protein, omega-3 supplementation and controlEndurance performance (SMD): no difference
20 Gras et al. 2023systematic review · 424 participantsCreatine supplementation (form not stated); vs. Placebochange in VO2max: worsened (ES = -0.32, 95%CI = -0.51 to -0.12, p = 0.002); VO2max after supplementation: worsened (ES= -0.20, 95%CI = -0.39 to -0.001, p = 0.049)
21 Huang et al. 2024meta-analysis · 361 participantsCreatine supplementation; vs. PlaceboSingle sprint swimming time: no difference (SMD: -0.05, 95% CI: -0.26, 0.15; p = 0.61); Repeated interval swimming: no difference (SMD: -0.11; 95% CI: -0.46, 0.25; p = 0.56)
23 Aguinaga-Ontoso et al. 2023systematic review · 310 participantsCreatine supplementation (form not specified); vs. Other nutrition interventions or controlSoccer performance (endurance, speed, agility, strength, power, explosiveness): improved
26 Metzger et al. 2023systematic review · 268 participantsCreatine supplementation; vs. Randomized controlled trials in over 75% of studiesAthletic performance: unclear
37 Wesołowski et al. 2026systematic reviewCreatine monohydrate; Loading 20 g/day, sometimes maintenance 2-5 g/day; Loading phase 5-7 days; vs. Placebo or baseline valuesRepeated-sprint performance and high-intensity power output: improved; Sprint performance, peak power, total work output: improved; End-phase sprint capacity during prolonged exercise: improved
42 Tam et al. 2025systematic reviewCreatine supplementation; range of dosage strategies; 5 days to 12 weeks; vs. Placeboanaerobic outcomes: improved (4/17 showed an improvement in anaerobic outcomes); aerobic outcomes: improved (1/5 showed an improvement in aerobic outcomes)

Further studies in this area: 44 56 57 58 63 65 66 68 84 88 92 95 96 97 98 102 107 112 119 120 122 123 129 131 133 134 135 136 140 143 144 146 149 151 152 154 155 157 159 160 162 166 174 175 176 181 182 183 187 190 193 194 196 197 198 199 202 207 208 210 215 216 220 225 227 228 232 233 236 240 242 247 248 249 251 257 258 260 261 263 265 271 272 273 274 275 285 305 306 312 315 316 321 322 324 327 335 336 339 341 348 350 353 356 357 358

Creatine, Muscles and Bones in Older Age: Human Studies

In older people, creatine showed benefits for fat-free mass in several controlled trials and meta-analyses, mostly in combination with strength training 1416182260. Muscle mass also improved in individual studies and meta-analyses 70214. The sit-to-stand test was better under creatine in several controlled trials 922. A single randomized controlled trial also found better physical function 80. Bone findings are inconsistent: one randomized controlled trial found more bone mineral content in the arm 230, another a larger bone area in the shinbone 179. Several controlled trials and meta-analyses, by contrast, showed no difference in bone density 81630188191. No difference was found in bone mineral content or bone quality either in controlled trials 180188. Mostly creatine monohydrate was studied, usually with or without accompanying strength training. What remains open is the optimal dose, a possible loading phase, and whether the benefit extends to bones and fall risk over longer periods.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
8 Sharifian et al. 2025meta-analysis · 1,093 participantsCreatine supplementation plus exercise training; vs. Placebo plus exercise trainingBone mineral density of total body (g/cm2): no difference (mean difference = 0.009, Z = 0.587, P = 0.557)
9 Davies et al. 2024meta-analysis · 1,076 participantsCreatine supplementation; vs. PlaceboSit-to-stand test (physical function): improved (SMD 0.51 (95% CI: 0.01-1.00; I2 = 62%; P = 0.04)); Lean tissue mass: improved (MD 1.08 kg; 95% CI: 0.77-1.38; I2 = 26%; P < 0.01)
10 Davies et al. 2023meta-analysis · 1,076 participantsCreatine supplementation; vs. PlaceboSit-to-stand test (physical function): improved (SMD 0.51 (95% CI 0.01 to 1.00; I =62%; p=0.04)); Lean tissue mass: improved (MD 1.08kg; 95% CI 0.77 to 1.38; I =26%; p<0.01)
13 Chen et al. 2026meta-analysis · 763 participantsCreatine monohydrate (3 studies) plus structured exercise; vs. Exercise alone or placebo plus exerciseBone mineral content: no difference (g=0.195, 95% CI: -0.281 to 0.671, p=0.421); Bone mineral density: no difference (g=0.087, 95% CI: -0.129 to 0.303, p=0.430)
14 Chilibeck et al. 2017meta-analysis · 721 participantsCreatine supplementation; 7-52 weeks; vs. Placebo during resistance training 2-3 days/weekLean tissue mass: improved (mean difference =1.37 kg [95% CI =0.97-1.76]; p<0.00001)
16 Naddafha et al. 2026systematic review · 608 participantscreatine monohydrate, with or without resistance training; ≥5 g/day effective; ≤3 g/day without RT no effect; 12-104 weeks, median 38 weeks; vs. placeboLean mass (DXA): improved (MD +0.37 kg (95% CI +0.05 to +0.69; I² = 25%)); Bone mineral density: no difference (unchanged overall)
18 Liu et al. 2025systematic review · 482 participantscreatine plus resistance training (2–3 sessions/week); 8–104 weeks; vs. placebo plus resistance traininglean tissue mass: improved (SMD = 0.27 [95% CI 0.02–0.53]; p = 0.03); lean tissue mass (≤32 weeks): improved (SMD = 0.57 [95% CI 0.19–0.96]; p = 0.004)
22 Devries et al. 2014meta-analysis · 357 participantsCreatine (form not stated in abstract); Resistance training 12.6 ± 4.9 weeks; vs. Creatine + resistance training vs. resistance training alone (placebo-controlled)Total body mass: improved (P = 0.004); Fat-free mass: improved (P < 0.0001); Fat mass: no difference

Further studies in this area: 30 38 43 47 53 60 64 68 70 80 106 117 122 134 153 167 178 179 180 184 188 191 200 205 211 214 230 252 307 308 309 310 313 318 319 323 328 331 332 333 337 338 345 346

Creatine, Memory and Brain: Human Studies

For memory and brain, the studies show a mixed picture: several meta-analyses found better memory performance after creatine monohydrate, in one of them especially in older adults 172454. Attention also improved in controlled trials 417, and processing speed in further ones 17253. Studies found no difference in overall cognition, executive function, and logical thinking 175279. One randomized controlled trial with creatine monohydrate added to escitalopram found more favorable neurochemical markers in women with major depression 85. It remains open which form, dose, and population actually benefit.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
4 Marshall et al. 2026systematic review · 1,542 participantsCreatine monohydrate (in intervention studies) or estimated dietary creatine intake; vs. Not uniform; two double-blind intervention studies, four cross-sectional studiesCognition (memory and attention): improved (Five of the six (83.3%) studies reported a positive relationship)
17 Xu et al. 2024meta-analysis · 492 participantscreatine monohydrate; short <4 weeks vs. long ≥4 weeks; vs. placebo or controlmemory: improved (SMD = 0.31, 95% CI: 0.18-0.44); attention time: improved (SMD = -0.31, 95% CI: -0.58 to -0.03); processing speed time: improved (SMD = -0.51, 95% CI: -1.01 to -0.01)
24 Avgerinos et al. 2018systematic review · 281 participantsOral creatine supplementation; vs. Placebo or control within the RCTsshort-term memory: improved; intelligence/reasoning: improved; long-term memory, spatial memory, attention, executive function and other cognitive domains: unclear
33 Jeryous et al. 2026systematic reviewCreatine monohydrate as adjunct treatment; 2 to 10 g/day; 4-8 weeks; vs. Placebo, added to SSRI, pharmacotherapy or psychotherapyCorrelation of brain N-acetylaspartate and phosphocreatine with improvement: improved
39 Williams et al. 2026systematic reviewCreatine supplementationCognitive outcomes: improved
46 Xu et al. 2025systematic reviewCreatine supplementationCognitive function: unclear
51 McMorris et al. 2024systematic reviewCreatine supplementationBrain creatine content: improved; Cognition: unclear (somewhat equivocal results)
52 EFSA et al. 2024systematic reviewCreatine supplementation; 20 g/day, 2.2-14 g/day, 5 g/day; 5-7 days, 6 weeks after 5-day loading; vs. Lower doses, continuous intake, placebo/control; manufacturer-fundedWorking memory: unclear (20 g/day for 5-7 days); Response inhibition: unclear (20 g/day for 7 days); Cognitive function overall: no difference

Further studies in this area: 54 63 64 68 79 82 85 92 128 135 136 143 152 169 172 204 212 213 216 241 243 247 253 262 267 281 285 286 287 290 291 292 297 303 307 310 312 317 320 321 323 324 325 326 329 333 337 346 347 355

Creatine, Mood and Depression: Human Studies

In adults with depression, creatine monohydrate as an addition to cognitive behavioral therapy showed improvement in depression severity 158. Also as an addition to escitalopram, creatine monohydrate improved depressive symptoms in women with major depression 85. A systematic review found a decrease in depression severity and a higher remission rate, while treatment response did not differ 7. Another systematic review found creatine as an addition to escitalopram or cognitive behavioral therapy more effective than placebo, but not in adolescents or bipolar depression 33. In bipolar depression, a randomized controlled trial found no change in the MADRS score, but a higher remission rate 99. By contrast, a randomized controlled trial in physically active men found no difference in mood after a single dose 143. A randomized controlled trial with a combined preparation of creatine monohydrate, beta-alanine, L-taurine, L-leucine, and caffeine showed no change in mood states 122. A randomized controlled trial with creatine monohydrate plus maltodextrin found no difference in mood state 162. The findings come predominantly from small, short studies in specific patient groups; dose, loading phase, and training accompaniment were reported only partially, and transferability to broader populations remains open.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
7 Eckert et al. 2025systematic review · 1,093 participantsCreatine supplementation; vs. PlaceboDepressive symptoms (SMD): improved (-0·34 (95 % CI -0·68, -0·00)); Remission: improved (OR 3·60; 95 % CI 1·76, 7·56); Treatment response: no difference (OR 0·72; 95 % CI 0·28, 1·88)
33 Jeryous et al. 2026systematic reviewCreatine monohydrate as adjunct treatment; 2 to 10 g/day; 4-8 weeks; vs. Placebo, added to SSRI, pharmacotherapy or psychotherapyDepression severity in MDD (escitalopram + creatine vs SSRI + placebo): improved (Cohen's d = 1.13 at 8 weeks); Depression severity in MDD (pharmacotherapy augmentation in adolescents): no difference (no difference vs placebo); Depression severity in MDD (CBT + creatine vs CBT + placebo): improved
39 Williams et al. 2026systematic reviewCreatine supplementationMood: unclear
85 Yoon et al. 2016randomised controlled · 52 participantscreatine monohydrate added to escitalopram; 8 weeks; vs. placebo added to escitalopramimprovement in depressive symptoms: improved
99 Toniolo et al. 2018randomised controlled · 35 participantsCreatine monohydrate as adjunctive therapy; 6 g daily; 6 weeks; vs. Placebo added to regular medicationMADRS score change (ITT): no difference (p = 0.560; Cohen's d = 0.231); Remission (MADRS ≤ 12) at week 6, ITT: improved (52.9% remission in the creatine group vs. 11.1% remission in the placebo group); Remission (MADRS ≤ 12) at week 6, completers: improved (66.7% remission in the creatine group vs. 18.2% remission in the placebo group)
122 Outlaw et al. 2014randomised controlled · 20 participantsPre-workout blend with creatine monohydrate, beta-alanine, L-taurine, L-leucine, caffeine; 30 g supplement 30 minutes before training; 8 days supplementation and 4 resistance-training bouts; vs. Maltodextrin placeboMood states: no difference
143 Ben et al. 2026randomised controlled · 11 participantsCreatine monohydrate or placebo; 0.1 g/kg body mass, single dose; Single dose per experimental condition; vs. Placebo, no supplement control, timing of ingestionPOMS: no difference
152 Butchart et al. 2022randomised controlled · 8 participantsCreatine supplement (form not stated); 10 weeks; vs. Placebo plus supervised progressive resistance trainingCES-D depression scale: improved (p = 0.045)

Further studies in this area: 158 162 204 213 219 243 269 301 303 312 317 324 326 337 346 354

Creatine, Kidney Values and Tolerability: Human Studies

In this area, the studies predominantly show that creatine administration does not impair kidney function. Several controlled studies found no differences in kidney function 201257 and in kidney and liver function 1286138. Urine parameters also remained unchanged in several controlled studies 138185217266. Side effects were as common in systematic reviews and controlled studies as with placebo 1212180205. One meta-analysis found higher serum creatinine and a calculated lower filtration rate, but no difference on direct measurement 11217. Creatine monohydrate was predominantly investigated; with conjugated linoleic acid, plasma creatinine rose, while creatinine clearance remained unchanged 97. It remains open how long-term intake affects people with pre-existing kidney disease, since most studies ran in healthy individuals or small groups.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
1 Kreider et al. 2025systematic review · 12,839 participantsCreatine, mostly creatine monohydrate; mean 0.166 g/kg/d (about 12.5 g/d); mean 64.7 days, studies up to 14 yrs; vs. Placebo (13,452 participants in 652 studies)Overall prevalence of side effects (13.2% of studies in the PLA groups and 13.7% of studies in the Cr-supplemented groups); Total frequency of side effects among participants (PLA 4.21%, Cr 4.60%, p = 0.828); Gastrointestinal issues (study percentage): worsened (PLA 4.3%, Cr 4.9%, p < 0.001)
2 Gonzalez et al. 2026systematic review · 12,800 participantsCreatine monohydrate; grouped into tertiles (low, moderate, high); grouped into tertiles (low, moderate, high); vs. Placeborenal side effects
11 de et al. 2026systematic review · 1,036 participantsCreatine supplementation; vs. PlaceboSerum creatinine: worsened (MD, 0.14 mg/dL; 95% CI 0.05-0.22; P = .002); GFR (creatinine-based): worsened (MD, -10.75 mL/min; 95% CI -17.48 to -4.02; P = .002); GFR (Cr-EDTA): no difference (MD, 5.89 mL/min; 95% CI -0.30 to 12.08; P = .06)
12 de et al. 2020systematic review · 951 participantsCreatine monohydrate (oral); vs. Placebo or control (stratified by dosing regimen)Total adverse events (risk ratio) (RR 1.24 (95% CI 0.51, 2.98)); Renal and hepatic function: no difference
16 Naddafha et al. 2026systematic review · 608 participantscreatine monohydrate, with or without resistance training; ≥5 g/day effective; ≤3 g/day without RT no effect; 12-104 weeks, median 38 weeks; vs. placeboRenal indices: no difference (unchanged)
32 Mancini et al. 2022systematic review · 87 participantsCreatine supplementation; vs. Placebo, metformin, glibenclamideAdverse effects (No major adverse effects were observed)
34 Tsiaras et al. 2026meta-analysisCreatine supplementation; Subgroups <1 month and >1 month; vs. Control group without creatineSerum creatinine: worsened (MD = 0.13 mg/dL, 95% CI: 0.07 to 0.18, n=19); Urea: no difference (MD = -0.60 mg/dL; 95% CI: -2.15 to 0.96, n=12); estimated glomerular filtration rate: no difference (MD = -5.20 mL/min/1.73 m2; 95% CI: -15.00 to 4.60, n=8)
40 Rubinchuk et al. 2026systematic reviewCreatine monohydrateRenal function: no difference (no consistent short-term safety signals)

Further studies in this area: 48 64 78 86 97 98 101 109 116 118 130 134 138 143 147 150 155 157 159 180 185 188 189 201 203 204 205 209 217 223 235 257 266 273 281 282 285 291 293 294 306 313 316 346 348 349 350 361

Creatine: Further Outcomes in Studies

Many different outcome measures have been investigated in this field, and results are mixed. Several meta-analyses found a lower body fat percentage under creatine with strength training 81527; absolute fat mass did not differ 1527. Creatine and phosphocreatine levels in muscle rose more strongly than under placebo in several controlled trials 109110216, while in others phosphocreatine remained unchanged 101133201. Muscle soreness and pain decreased more strongly than under placebo in several controlled trials 89127146270, as did inflammatory markers such as TNF-α 80215. Overall certainty is high because numerous randomized controlled trials and meta-analyses exist. Mostly creatine monohydrate was studied, sometimes with a loading phase and training accompaniment. Which dosage and type of exercise are most beneficial for the individual outcomes remains open; in early Huntington's disease, creatine did not slow functional decline 77.

StudyDesign · participantsPreparation · dose · duration · comparisonResult
1 Kreider et al. 2025systematic review · 12,839 participantsCreatine, mostly creatine monohydrate; mean 0.166 g/kg/d (about 12.5 g/d); mean 64.7 days, studies up to 14 yrs; vs. Placebo (13,452 participants in 652 studies)Multivariate analysis of 49 side effects (p = 0.340); Mention of creatine in 28.4 million adverse event reports (0.00072%)
2 Gonzalez et al. 2026systematic review · 12,800 participantsCreatine monohydrate; grouped into tertiles (low, moderate, high); grouped into tertiles (low, moderate, high); vs. Placebogastrointestinal side effects; liver side effects; musculoskeletal side effects
5 Wang et al. 2026meta-analysis · 1,211 participantsCreatine supplementation (compared with protein and omega-3); vs. Protein, omega-3 supplementation and controlRecovery outcomes (SMD): no difference
8 Sharifian et al. 2025meta-analysis · 1,093 participantsCreatine supplementation plus exercise training; vs. Placebo plus exercise trainingFat percentage (%): improved (mean difference = -0.548, Z = -2.231, P = 0.026)
12 de et al. 2020systematic review · 951 participantsCreatine monohydrate (oral); vs. Placebo or control (stratified by dosing regimen)Gastrointestinal events (risk ratio): no difference (RR 1.09 (95% CI 0.53, 2.24)); Weight gain (mean difference): no difference (1.24 kg pre-intervention, (95% CI -0.34, 2.82))
15 Forbes et al. 2019meta-analysis · 609 participantsCreatine supplementation; vs. Placebo during resistance trainingBody fat percentage: improved (0.55%, p = 0.04); Fat mass: no difference (~0.5 kg more fat mass, p = 0.13)
19 Del et al. 2025systematic review · 463 participantsCreatine supplementation (CrS); vs. Creatine vs. placebo group or baselineBody weight: no difference (three found no changes, while two reported increases); Lean body mass: no difference (differences were not significant); Fat mass: unclear (reductions, no changes, or mitigated increases)
21 Huang et al. 2024meta-analysis · 361 participantsCreatine supplementation; vs. PlaceboPhysiological response: no difference (SMD: 0.04, 95% CI: -0.16, 0.23; p = 0.71); Body composition: no difference (SMD: 0.18; 95% CI: -0.05, 0.41; p = 0.12)

Further studies in this area: 25 27 28 31 32 33 35 36 37 39 40 41 44 49 50 56 57 59 61 62 63 66 68 71 72 73 74 75 76 77 78 79 80 81 83 84 86 88 89 90 91 92 93 94 95 97 98 99 100 101 103 104 105 108 109 110 111 113 114 116 117 118 119 120 121 122 123 125 126 127 130 131 132 133 134 135 136 138 139 141 142 143 146 147 148 149 150 152 153 154 155 156 157 158 159 160 162 163 164 165 167 168 169 170 171 173 175 176 177 178 181 182 184 186 190 195 196 197 199 201 202 203 206 208 210 211 212 214 215 216 221 222 223 224 226 229 231 232 234 235 236 237 238 239 240 243 244 245 246 250 251 254 255 256 257 259 262 264 265 266 268 269 270 272 273 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 297 298 299 300 302 304 305 310 312 313 314 316 321 324 326 327 332 335 336 340 342 343 344 345 347 348 351 352 354 357 358 359 361 362

4. How Is Creatine Dosed? Preparation, Dose and Duration in Studies

The studies predominantly used creatine monohydrate, sometimes with a loading phase and maintenance dose, usually in combination with strength training. Buffered creatine monohydrate (Kre-Alkalyn) did not perform better than creatine monohydrate (Creapure) in the Wingate test 98. Combination products were tested less often: with HMB, some advantages for strength and anaerobic performance were seen 66; with conjugated linoleic acid, more strength and fat-free mass than with placebo 97.

Preparation or formDoseDurationStudy
creatine monohydrate vs. placebo10 g/dat least 5 years (maximum follow-up 8 years)71
creatine monohydrate 10 g/day (parent trial intervention)10 gm/day1-6 years of longitudinal data72
Creatine 3 g/day, partly with folic acid3 g creatine daily12 weeks73
Creatine 3 g/day, partly with folic acid 400 µg/day3 g creatine per day24 weeks74
Creatine 3 g/day, some with 400 µg folic acid3 g creatine daily24 weeks75
Creatine (comparison arms: folic acid 400/800 µg/d, placebo)3 g/d creatine12 weeks76
Creatine monohydrateup to 40 g dailyup to 48 months77
Oral creatine monohydrate10 g dailyaverage 310 days78
creatine supplement5 g daily6 weeks per phase (cross-over)79
Daily creatine plus high-load resistance training (elastic bands or water) or control3 g daily16 weeks80
creatine monohydrate plus physical exercise5 g/day8 weeks81
Creatine or placebo—7 days82
creatine supplement vs. placebo vs. control without supplement/exercise25 g/d for 5 days, then 5 g/d8 weeks83
creatine monohydrate (CrMH) vs. carbohydrate drinks vs. placebo25 g CrMH daily for 5 days5 days84
creatine monohydrate added to escitalopram—8 weeks85

5. Is Creatine Safe? Side Effects in Studies

Several controlled studies and systematic reviews report tolerability comparable to placebo without differences in side effects 1212180. One meta-analysis found higher serum creatinine and a calculated lower filtration rate, but no difference on direct measurement 11217. In a large study in Huntington's disease, gastrointestinal complaints occurred more often with creatine than with placebo 77. In a cognition study, side effects were also more common with creatine 79.

StudyReported side effects
1 Kreider et al. 2025Side effects in 13.7% creatine vs 13.2% placebo studies, no significant difference
2 Gonzalez et al. 2026reported side effects infrequent, primarily mild and nonspecific
11 de et al. 2026No kidney injury; creatinine and GFR changes reflect creatine metabolism
12 de et al. 2020No deaths or serious adverse outcomes; no differences in total, GI events, weight, renal/hepatic
13 Chen et al. 2026No increase in adverse events
16 Naddafha et al. 2026mild and similar to placebo; renal indices unchanged
19 Del et al. 2025CrS appears safe
24 Avgerinos et al. 2018Creatine is described as safe
26 Metzger et al. 2023No studies designed to address safety
31 Salazar-Méndez et al. 2026No major adverse events reported
32 Mancini et al. 2022No major adverse effects observed
33 Jeryous et al. 2026Generally well tolerated; 2 of 17 participants had hypomania/mania

6. What Remains Open: Limits of the Evidence

  • Many studies were small and short, which limits the transferability of the results.
  • The heterogeneity between populations, training protocols and dosages leaves open for whom and under what conditions the benefit is greatest.
  • Long-term data in people with pre-existing kidney disease are still pending.
  • The EFSA, on application by a manufacturer, saw no established cause-and-effect relationship between creatine and better cognitive function 52.
  • The optimal dose, a possible loading phase and the transferability to bone and fall risk over longer periods remain open.

7. Bottom Line: What Is Established About Creatine

Creatine with strength training increased maximal strength and fat-free mass more than placebo in several meta-analyses 3, including in older people 1422. For sprint performance and memory, the results are mixed 215254131. Bone density remained unchanged in several controlled studies and meta-analyses 830188. Kidney function remained unchanged in several controlled studies 86201, and side effects were as common in reviews and studies as with placebo 112180. The evidence is strong, but many studies were small and short, and the heterogeneity between populations, training protocols and dosages leaves open for whom and under what conditions the benefit is greatest.

Frequently Asked Questions

How well has Creatine been studied in humans?

We evaluated 367 human studies on Creatine, including 165 randomised controlled trials and 70 meta-analyses or systematic reviews; the controlled studies include 8,940 participants in total. As of 3 October 2026.

Does Creatine help with strength and muscle mass? What the studies show

We evaluated 30 meta-analyses or systematic reviews, 102 controlled studies and 33 further studies; the controlled studies include 1,122 participants in total. Result of the controlled studies: mixed. Strength of evidence under our published rules: high. Sources: 1356

Does Creatine help with sprint and endurance performance? What the studies show

We evaluated 13 meta-analyses or systematic reviews, 78 controlled studies and 23 further studies; the controlled studies include 698 participants in total. Result of the controlled studies: mixed. Strength of evidence under our published rules: high. Sources: 352021

Does Creatine help with muscles and bones in older age? What the studies show

We evaluated 16 meta-analyses or systematic reviews, 19 controlled studies and 17 further studies; the controlled studies include 193 participants in total. Result of the controlled studies: mostly no difference. Strength of evidence under our published rules: high. Sources: 891013

Does Creatine help with memory and brain? What the studies show

We evaluated 12 meta-analyses or systematic reviews, 21 controlled studies and 25 further studies; the controlled studies include 379 participants in total. Result of the controlled studies: mixed. Strength of evidence under our published rules: high. Sources: 4172433

Does Creatine help with mood and depression? What the studies show

We evaluated 3 meta-analyses or systematic reviews, 12 controlled studies and 9 further studies; the controlled studies include 140 participants in total. Result of the controlled studies: mixed. Strength of evidence under our published rules: high. Sources: 7333985

Does Creatine help with kidney values and tolerability? What the studies show

We evaluated 7 meta-analyses or systematic reviews, 26 controlled studies and 23 further studies; the controlled studies include 474 participants in total. Result of the controlled studies: mostly no difference. Strength of evidence under our published rules: low. Sources: 121112

Which form of creatine was investigated in the studies?

The studies predominantly used creatine monohydrate, sometimes with a loading phase and maintenance dose, usually in combination with strength training. Buffered creatine monohydrate (Kre-Alkalyn) did not perform better than creatine monohydrate (Creapure) in the Wingate test 98. Combination products were tested less often: with HMB, some advantages for strength and anaerobic performance were seen 66; with conjugated linoleic acid, more strength and fat-free mass than with placebo 97.

How safe is creatine for the kidneys?

Several controlled studies found no differences in kidney function 201257. Urine parameters remained unchanged in several controlled studies 138185217266. One meta-analysis found higher serum creatinine and a calculated lower filtration rate, but no difference on direct measurement 11217.

Which side effects were reported?

Tolerability was comparable to placebo in several controlled studies and systematic reviews, without differences in side effects 1212180. In a large study in Huntington's disease, gastrointestinal complaints occurred more often with creatine than with placebo 77. In a cognition study, side effects were also more common with creatine 79. In one study, significant weight gain was reported in the creatine group 84.

Does creatine show an effect in older people?

In older people, creatine showed advantages for fat-free mass in several controlled studies and meta-analyses, usually in combination with strength training 1416182260. The sit-to-stand test was better with creatine in several controlled studies 922.

Is there evidence of benefits for the brain?

Several meta-analyses found better memory performance after creatine monohydrate, in one of them especially in older adults 172454. Attention also improved in controlled studies 417, and processing speed in further studies 17253. Studies found no difference in overall cognition, executive function and logical reasoning 175279. The EFSA, on application by a manufacturer, saw no established cause-and-effect relationship between creatine and better cognitive function 52.

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    Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation
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    Can Creatine Supplementation Interfere with Muscle Strength and Fatigue in Brazilian National Level Paralympic Powerlifting?
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    Effect of age, diet, and tissue type on PCr response to creatine supplementation
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    Effects of a High Protein and Omega-3-Enriched Diet with or Without Creatine Supplementation on Markers of Soreness and Inflammation During 5 Consecutive Days of High Volume Resistance Exercise in Females
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    Effects of a dietary supplement on golf drive distance and functional indices of golf performance
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    The effects of creatine supplementation on thermoregulation and isokinetic muscular performance following acute (3-day) supplementation
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    Oral creatine supplementation augments the repeated bout effect
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    Effects of Combined Creatine Plus Fenugreek Extract vs. Creatine Plus Carbohydrate Supplementation on Resistance Training Adaptations
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    The use of varying creatine regimens on sprint cycling
    Havenetidis K, Matsouka O, Cooke CB, Theodorou A · 2003
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    Creatine monohydrate in DM2/PROMM: a double-blind placebo-controlled clinical study. Proximal myotonic myopathy
    Schneider-Gold C, Beck M, Wessig C, George A, Kele H, Reiners K et al. · 2003
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    Bioenergetic data from a creatine monohydrate pilot trial in Alzheimer's disease
    K Taylor M, Smith AN, Choi IY, Lee P, Kelly E, Arora T et al. · 2026
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    Creatine monohydrate pilot in Alzheimer's: Feasibility, brain creatine, and cognition
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    Urinary nandrolone metabolite detection after ingestion of a nandrolone precursor
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    Arginine:glycine amidinotransferase (AGAT) deficiency: Clinical features and long term outcomes in 16 patients diagnosed worldwide
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    Cerebral creatine deficiency disorders - A clinical, genetic and follow up study from India
    Passi GR, Pandey S, Devi ARR, Konanki R, Jain AR, Bhatnagar S et al. · 2022
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    Creatine Use and Thromboembolism Risk in Athletes: A Case Report
    Abdalla OS, Mudassir H, Green H, Katarki P · 2025
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    Creatine Monohydrate in Adolescent Athletes: A Critical Narrative Review of Performance, Safety, and Responsible Use
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    Creatine monohydrate supplementation for older adults and clinical populations
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    Creatine in women's health: bridging the gap from menstruation through pregnancy to menopause
    Smith-Ryan AE, DelBiondo GM, Brown AF, Kleiner SM, Tran NT, Ellery SJ · 2025
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    Creatine Supplementation Combined with Exercise in the Prevention of Type 2 Diabetes: Effects on Insulin Resistance and Sarcopenia
    Młynarska E, Leszto K, Katańska K, Prusak A, Wieczorek A, Jakubowska P et al. · 2025
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    Creatine and post-viral fatigue syndrome: an update
    Ostojic SM, Candow DG, Tarnopolsky MA · 2025
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    A short review of the most common safety concerns regarding creatine ingestion
    Longobardi I, Solis MY, Roschel H, Gualano B · 2025
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    The role of brain creatine in behavioral health conditions
    Han ES, Yancey JR, Yurgelun-Todd DA, Kondo DG, Boxer DJ, Renshaw PF · 2025
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    Acute Sarcopenia: Mechanisms and Management
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    Creatine Supplementation Beyond Athletics: Benefits of Different Types of Creatine for Women, Vegans, and Clinical Populations-A Narrative Review
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    The Top 5 Can't-Miss Sport Supplements
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    "Heads Up" for Creatine Supplementation and its Potential Applications for Brain Health and Function
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    Creatine supplementation and endurance performance: surges and sprints to win the race
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    Creatine Activity as a Neuromodulator in the Central Nervous System
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    Creatine Use in Sports
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    Safety of Creatine Supplementation in Active Adolescents and Youth: A Brief Review
    Jagim AR, Stecker RA, Harty PS, Erickson JL, Kerksick CM · 2018
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    Risk assessment for creatine monohydrate
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Every statement on this page carries its evidence tier — proven, plausible or hypothesis — and leads to the original work. The decision in the individual case rests with the practitioner; we provide the connections.

International Health Research · https://ih-research.com/en/knowledge/creatine/ · Last updated: 2026-10-15