Creatine is naturally in muscle and the most studied sports supplement. It promotes muscle strength and muscle growth while delaying muscular fatigue.*
- Increases ability to do high-intensity, anaerobic repetitive work*
- Volumizes muscle cells, so they rapidly appear larger*
- Helps muscles recover more quickly in-between sets*
- Improves brain function*
- Reduces overall fatigue and tiredness*
- Supports heart and nerve health*
Creatine is an amino acid primarily in skeletal muscle and brain tissue. The most-advertised benefit is it facilitates the recycling of adenosine triphosphate (ATP).
In practical terms, this means that it increases your capacity to do high-intensity anaerobic repetitive work by about 15% so that on any given set, you should be able to do one to two more reps with extra weight.
In the long run, this added work capacity should lead to additional muscle gain. However, about two-thirds of users will gain about 0.8 to 2.9 percent of their body weight after just the first few days of supplementation. Results vary tremendously, of course. In his research, creatine researcher Tarnopolsky found that some subjects gained about 2 pounds while one subject purportedly gained 17 pounds.
Is It Mostly "Water Weight"?
The weight gain is so rapid that most assume it's mostly water. That may be largely true, but it's irrelevant: muscle is 73% water, so if you gain ten pounds of muscle from using creatine, about 7.3 pounds of that is water. Still, creatine does volumize cells (a process by which the cells fill with fluid), an essential determinant of protein breakdown and protein synthesis in skeletal muscle. Working out turns on protein synthesis while simultaneously breaking down protein, but creatine shifts the balance toward protein synthesis.
How Creatine Builds Muscle
Creatine also increases anabolic hormones (like IGF-1), lowers myostatin (a type of protein that inhibits muscle growth), improves cell signaling of satellite cells that help repair and new muscle growth, and reduces protein breakdown.
Creatine helps with recovery too. A recent study found that lifters (in this case, guys who did curls to failure) felt less muscle soreness than a placebo group. The researchers didn't know why but thought it was "likely due to a combination of creatine's multifaceted functions."
Creatine: A "Conditionally Essential" Nutrient
Surprisingly, observant scientists are starting to reason that creatine is a "conditionally essential" nutrient. When children don't get enough, it jeopardizes their mental and physical development. And adults who don't get enough are more susceptible to neuromuscular and cardiometabolic decline.
A 20-year study (National Health and Nutrition Examination Survey; NHANES) examined dietary information from 89,161 respondents ranging in age from newborns to 85 year-olds. It found that the average creatine intake among all age groups was 0.70 grams of creatine per day. The average for children and adolescents was even less.
The NHANES results are relevant because most nutritionists recommend at least 1 gram of dietary creatine per day for adults, and the study shows approximately 68.6% of adults aren't getting enough.
It's impossible to make that same kind of specific determination regarding children because there are currently no dietary creatine recommendations for children or adolescents. We can, however, see what can happen when adults or children don't get enough creatine.
Creatine Deficiency Makes You Shorter
For example, Russian researchers found that the daily creatine intake in shorter kids and adolescents (age 2 to 19 years) was lower than in their taller peers. The study also shows each additional 0.1 gram of creatine ingested daily equated to an extra 0.60 cm of height.
The Role of Creatine in Mood
Regarding the role of creatine in the brain development of juveniles, scientists are pretty sure it's critical, and a deficiency might be associated with depression. The NHANES found that depression was 42% more prevalent in the lowest quartile of creatine consumption (0 to 0.26 grams a day).
Creatine for Heart and Liver Health
Also surprising is creatine's apparent function in protecting the heart and liver, which might be related to how it reduces plasma cholesterol and homocysteine.
Creatine Deficiency Is Epidemic
The answer to this apparent epidemic of creatine deficiency appears simple. The primary sources of creatine are meat, fish, poultry, and some dairy. While most adults may have resisted the "eat less meat" mantra, many children and adolescents have become quite comfortable with a vegetarian or semi-vegetarian diet, thereby reducing creatine intake.
Creatine deficiency is probably also linked to the widespread reduction in dairy intake, as various plant-based milk (soy, oat, almond, etc.) have largely replaced cow's milk.
The authors of the said study took their findings seriously:
"The diminution of creatine intake among the American public perhaps justifies backing diets rich in creatine-containing foods and low-dose supplementation or food fortification with creatine to optimize its dietary load in the general public."
Maybe so, but we're probably a few years away from being presented with creatine-enhanced packaged foods. In the meantime, it seems prudent to supplement creatine the old-fashioned way: by adding it to coffee, juice, or oatmeal.
What's the Right Creatine Dose?
As far as dosages, we have to make a distinction between bodybuilding and health purposes.
At first, bodybuilders supersaturated muscle cells with creatine by "loading" it. The traditional protocol was to take between 20 and 25 grams daily in divided doses for a week, followed by a "maintenance dose" of 5 to 7 grams daily. We now know that taking 5 grams daily for 30 days and then reducing it to about 3 grams a day after that works just as well.
However, for general health purposes, taking 1 gram of daily supplemental creatine should fulfill most people's requirements, even if they're vegetarian.
Micronized Creatine Is the Best
Regardless of your purpose for taking it, make sure you use micronized creatine for better absorption.
- Antonio J et al. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Int Soc Sports Nutr. 2013 Aug 6;10:36.
- Di Biase S et al. Creatine uptake regulates CD8 T cell antitumor immunity. J Exp Med. 2019 Dec 2;216(12):2869-2882.
- Forbes SC et al. Timing of Creatine Supplementation and Resistance Training: A Brief Review. Journal of Exercise and Nutrition, 2018.
- Gowayed M et al. Enhanced mitochondrial biogenesis is associated with the ameliorative action of creatine supplementation in rat soleus and cardiac muscles. Exp Ther Med. 2020 Jan;19(1):384-392.
- Gualano B et al. Effects of creatine supplementation on glucose tolerance and insulin sensitivity in sedentary healthy males undergoing aerobic training. Amino Acids. 2008 Feb;34(2):245-50.
- Harmon KK et al. The Application of Creatine Supplementation in Medical Rehabilitation. Nutrients. 2021 May 27;13(6):1825.
- Johnston A et al. Effect of Creatine Supplementation During Cast-Induced Immobilization on the Preservation of Muscle Mass, Strength, and Endurance. J Strength Cond Res. 2009 Jan;23(1):116-20.
- Nunes JP et al. Creatine supplementation elicits greater muscle hypertrophy in upper than lower limbs and trunk in resistance-trained men. Nutr Health. 2017 Dec;23(4):223-229.
- Persky AM et al. Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacological Reviews. 2001 Jun;53(2):161-176.