Creatine Simply Explained

1. What Is Creatine?

Creatine is a substance that the body produces itself. Liver, kidney, and pancreas make it from three protein building blocks. In muscles and the brain, it helps provide energy quickly as creatine phosphate. We also take in creatine through food, mainly from meat and fish. Those who follow a vegetarian or vegan diet absorb hardly any creatine from food.

2. Where Is It Found, and What Is It Made From?

Naturally, creatine is found primarily in meat and fish. With a vegetarian and vegan diet, this source is missing. For supplements, creatine is chemically manufactured. Most common is creatine monohydrate, the form used in most studies too. Other forms such as hydrochloride, ethyl ester, or buffered creatine are offered as well.

3. What Does Creatine Do? What Research Shows

Strength and Muscle Mass

Creatine together with strength training increased maximum strength more than a sham supplement in several large analyses 381421. Fat-free mass and muscle mass also improved in several studies 36374459. Many studies were small and short, so what remains open is for whom the benefit is greatest.

Sprint and Endurance Performance

The picture is mixed for sprint and endurance performance. Several studies found better sprint performances than with a sham supplement 415257, while others found no difference, for example in swimmers 2056. Benefits appeared at very hard efforts such as a cycling sprint test, but not in endurance performances 331. Other creatine forms brought no consistent advantage, and buffered creatine was not superior to creatine monohydrate 2938.

Muscles and Bones in Older Age

In older people, creatine showed benefits for fat-free mass in several studies, mostly along with strength training 1416182130. The stand-up test also turned out better under creatine 921. For bones, results diverge: one study found more mineral in the arm bone 55, another a larger bone area in the shinbone 46. However, several studies found no difference in bone density 816244849. What remain open are the best dose and whether the benefit transfers to bones and fall risk over the longer term.

Memory and Brain

For memory and brain, the picture is mixed. Several large analyses found better memory performance after creatine monohydrate, in one of them especially in older adults 172228. Attention and processing speed also improved in some studies 41758. For overall cognition, planning ability, and logical thinking, no difference was found 172733. What remains open is which form, dose, and group of people actually benefit.

Mood and Depression

In adults with depression, creatine monohydrate as an addition to behavioral therapy improved the complaints 45. As an addition to a medication called escitalopram, it also alleviated symptoms in women with severe depression 34. A review article found a decrease in depression severity and more remissions, but treatment response did not differ 7. In physically active men, one study found no difference in mood after a single dose 43. The findings come predominantly from small, short studies in special groups.

Kidney Values and Tolerability

Most studies show that creatine does not impair kidney function. Several studies found no differences in kidney values 5060 or in kidney and liver function 123542. Side effects occurred about equally often as with a sham supplement 12124751. Although one laboratory value, serum creatinine, rose, directly measured kidney performance remained unchanged 1154. What remains open is how long-term intake affects people with pre-existing kidney disease.

Other Outcomes

A wide range of values has been measured in this area, with mixed results. Several large analyses found a lower body fat percentage under creatine with strength training 81523; absolute fat mass did not differ 1523. Creatine and phosphocreatine levels in muscle rose more strongly than under placebo (sham agent) in several studies 394053. What remains open is which dose and type of exercise are most beneficial for the individual outcomes.

4. How Was Creatine Taken in the Studies?

Across the studies, creatine monohydrate was predominantly used. Sometimes there was first a loading phase with a high dose followed by a maintenance dose. Usually creatine was taken together with strength training. Buffered creatine monohydrate performed no better than regular creatine monohydrate in one test 38. Combination preparations were tested less frequently.

5. Is Creatine Safe? Side Effects in the Studies

Several studies and reviews report tolerability similar to that of a sham supplement 121247. One large analysis found a higher serum creatinine level and a calculated lower filtration rate, but on direct measurement no difference 1154. In a large study in Huntington's disease, gastrointestinal complaints occurred more frequently under creatine than under placebo 32. Side effects were also more frequent under creatine in a study on thinking 33. Many studies were small and short, so what remains open is for whom and under which conditions the benefit is greatest.

All details with tables and sources: full expert page on Creatine