I have been asked over the last little while about creatine.


The questions I get asked are: Should I be taking it?  Is it effective?  Does it damage my kidneys if I take it for too long?


Ok, great questions.  The simple answer to the first one is – YES.   However, let’s discuss why you should be taking it. The answers to the other questions and some others are shown below.

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Creatine is a substance the body produces naturally in both the liver and pancreas.  It is present in every human cell.  It functions as an energy storehouse. Creatine is required for physical and mental exertion. It is found naturally in our diets and is rich in red meat and some fish.  Creatine is generally stored in the body as phospho-creatine (PCr) – creatine linked to a high energy phosphate molecule. Creatine is an endogenous (made by the body) substance that is present in every human cell.


How does it work?


In order for a muscle to contract, adenosine triphosphate (ATP) must break off a phosphate group, leaving behind ADP (adenosine diphosphate). The only problem with this is that our body cannot use ADP for energy. The solution? ADP takes a phosphate from your body’s store of creatine phosphate (PCr) to form more ATP. Supplementation with creatine serves to increase creatine stores and PCr availability in the body, resulting in faster ATP formation.


Bottom line: The more PCr you have, the more work you can accomplish before fatigue sets it. Taken appropriately and consistently, creatine can be one of the most effective supplements for increasing lean body mass and improving body composition, strength, and high-intensity performance.



In the body, creatine is synthesized from the amino acids glycine, arginine and methionine, primarily in the liver, kidneys and pancreas and is transported from there to all the cells in the body via the bloodstream. Since creatine is involved in all processes that require energy, muscle, brain and nerve cells receive correspondingly larger amounts.



The creatine reserves of a person who weighs 155 lb is equal to about 120 grams. The vast majority of creatine (c. 95%) is stored in the skeletal muscles. Approximately 60-70% of the total creatine in muscle is stored in the form of the high energy molecule phosphocreatine. The remaining 30-40% is present in the form of free creatine. Besides adenosine triphosphate, phosphocreatine is the most important source for energy in the body. All of the body’s cells can use only adenosine triphosphate (ATP) as an energy-releasing substance. Since the ATP reserves in the body are limited, ATP has to be continuously resynthesized. ATP is produced from the energy sources fat and carbohydrate over a fairly long time frame.

Phosphocreatine resynthesis is critical for restoring muscle power at the beginning of the next set of intensive exercises. An increased resynthesis rate makes it possible to complete more intensive training sets, which is an advantage for explosive sports disciplines in particular.


During very intensive, repetitive forms of exercise there is enough ATP for 1-2 seconds of exercise and phosphocreatine is available for the immediate regeneration of ATP. However, phosphocreatine stores last approximately 10 seconds. Increasing phosphocreatine levels in muscle results in the delayed breakdown of phosphocreatine, which has a beneficial effect on muscle performance. More than 20 clinical trials have shown that creatine supplementation significantly improves muscle strength and/or performance during short bouts of high-intensity exercise.


The greatest improvements in performance can be found during a series of repetitive high-intensity types of exertion that are interrupted by a fairly brief period of rest (e.g. 20-60 seconds). The rest breaks are sufficient to achieve greater recovery of phosphocreatine concentrations.


Different mechanisms are involved in the ergogenic effects of creatine supplementation:

  • Higher phosphocreatine concentrations serve as immediate reserves for ATP during exertion.
  • Increased phosphocreatine resynthesis rate during and after exertion due to increased levels of creatine.
  • Smaller decrease in muscle pH during exertion.
  • Greater training capacity.
  • Increase in muscle mass (absolute power output).



As a supplement, it is widely accepted as offering relatively immediate and very tangible benefits to both gym goers and sports people alike and is one of the most widely used of supplements. Creatine supplementation has a performance enhancing effect for those involved in a wide variety of sports. For sports that require speed, such as sprinting, rugby, football, swimming, and for intensive strength training by bodybuilders and cyclists, short-term creatine supplementation can greatly improve performance in the areas of maximum strength and endurance (5-15%), with interval training in the maximum range (5-20%), power production in short sprints (30%) and in training with repetitive sprints (5-15%).



Try to avoid taking high amounts of Caffeine when supplementing with Creatine. Simultaneous supplementation of large amounts of Caffeine (e.g. 4 cups of coffee) eliminates the ergogenic effects of Creatine by interfering with the resynthesis of Phosphocreatine. Lower amounts of Caffeine (e.g. 1-2 cups of Coffee) does not seem to influence the efficacy.



Creatine absorption can be improved by taking creatine together with simple carbohydrates, such as maltodextrin or dextrose, instead of just taking it alone. Ingesting carbohydrates raises blood sugar levels and therefore the secretion of insulin, an endogenous hormone.


The improved uptake of creatine into the muscles is attributed to stimulation of creatine transporters mediated by insulin.


Exercise also stimulates the uptake of creatine. The increase in creatine uptake can probably mostly be attributed to the increased perfusion of the muscle or to greater movement of the creatine transporters to the muscle cell membrane. Taking carbohydrates at the same time does not increase creatine storage rates when the training sets are done before supplementation.



If they report no results this may be because their body is able to produce enough creatine to keep its pools of creatine full or because their body finds it hard utilising the supplement. In this instance, it would be recommended that they combine creatine with simple sugars. The sugars cause a peak in insulin and help drive creatine into the muscles. In fact, studies amongst non responders have shown that the addition of sugars can increase creatine uptake by 60%.



Creatine has been thoroughly evaluated in long term clinical safety studies. Creatine is the most comprehensively researched supplement with over 2000 research studies focused upon it.  Clinical assessments included analysing a comprehensive panel of serum and whole blood markers (electrolytes, muscle and liver enzymes, substrates, lipid profiles, red and white blood cells, etc.), renal function tests determined by creatinine clearance, monitoring of injuries treated by the medical/athletic training staff, as well as the collection of medical safety and fatigue/weakness data.

The results of these safety studies on the long-term use of creatine monohydrate have consistently shown that, in comparison to athletes who did not take creatine, those who took creatine did not experience a greater incidence of injuries, heat-related disorders, dehydration, cramping, musculoskeletal injuries, or gastrointestinal disturbances. Additionally, athletes who took creatine over a long period did not have significantly higher muscle and liver enzymes, altered electrolytes, or increased renal stress determined by creatine clearance.


Creatine is one of the most popular supplements on the market. Unfortunately, there are a lot of myths and misconceptions about its side effects and uses. Learn the facts about creatine.


Creatine is one of the most highly researched supplements available. Simply put, creatine helps to combat fatigue during your workouts, allowing you to work out longer and with more intensity, ultimately improving your strength and muscle size.



Yet myths and misinformation about safety and potential side effects still dog this supplement. Is it safe? Does it cause weight gain? Is it damaging to your kidneys?


Here’s a look at some common myths about creatine and the truth behind them.




Fact: There have been numerous studies conducted on creatine supplementation, all of which have concluded long-term creatine use does not appear to have any negative side effects on the liver or kidneys.


There is no truth to the occasional rogue media stories claiming that creatine causes kidney stones or liver failure. Most of the concerns about the safety of creatine supplementation revolve around how well the kidneys are filtering blood.

Perhaps the confusion comes from elevated levels of creatinine (a marker used to diagnose kidney problems), which occurs following supplementation with creatine. However, this “false positive” is in no way harmful to your body. Moreover, there is no scientific evidence to suggest that chronic supplementation with the recommended creatine dose is detrimental to kidney function. Several studies have found no adverse effects of creatine supplementation on how well the kidneys filter blood.




Fact: All available evidence suggests creatine is safe to use, although it may cause some minor GI distress.


There is some truth to gastrointestinal (GI) issues with creatine supplementation, but it’s rare. In fact, it’s reported than only 5-7 percent of people who take creatine experience stomach aches. Stomach distress typically occurs when you take too much creatine at once (e.g., a loading phase) or on an empty stomach.




Fact: There is no data that shows creatine causes muscle cramps or dehydration.

One of the most common concerns about creatine supplementation is that it can cause dehydration or cramping, particularly in hot and humid environments. This is simply not the case. On the contrary, creatine supplementation has been proposed to increase total body water, helping to maintain hydration status.




Fact: While there may be a transient increase in pressure following high doses of creatine, supplementation at recommended doses does not induce compartment syndrome.


Compartment syndrome is a condition referring to excessive pressure in the muscle compartment. So theoretically, the risk of compartment syndrome may be increased while supplementing with creatine because of fluid retention in the muscle cell and increased overall size of the muscle tissue. But let’s be real for a second. Compartment syndrome is more likely the direct result of injury or trauma—or potentially later on as a result of treatment to an injury—that leads to inadequate blood flow to tissue.




Fact: There is no direct evidence that creatine supplementation promotes rhabdomyolysis.


This myth became a media favorite shortly after an article published in the New York Times claimed creatine supplementation was possibly linked to rhabdomyolysis in high school football players. Rhabdomyolysis refers to a severe breakdown of skeletal muscle due to injury that typically presents with elevated creatine kinase levels and anterior compartment syndrome.  This condition can result from excessive exercise in hot humid climates, especially when the exercise is continued for several days.


The suggestion that creatine supplementation induces rhabdomyolysis has no backing in scientific literature. Indeed, creatine kinase levels are elevated following supplementation, but these levels are nowhere close to the levels associated with rhabdomyolysis.




Fact: Creatine loading may lead to an initial weight gain of 0.8 to 2.9 percent of body weight in the first few days due to water being pulled into the muscle; however, this is less likely to occur following a low-dose protocol.


There is a common claim that all the weight gained with creatine supplementation is due to water weight. Indeed, several researchers have found acute increases in total body water as a result of creatine supplementation. However, while an initial weight gain may be a result of an increase in water, research consistently shows that creatine supplementation, in addition to resistance training, results in an increase in lean body mass and a decrease in fat mass, leading to improvement in body composition.




Fact: This is another rather ludicrous supposition, almost on par with the idea that creatine is a steroid (which is also dispelled herein).  I’m not even sure where the connection comes from between the premature closure of epiphyseal plates and creatine. Creatine is a biomolecule present in all humans and found in a variety of foods, it’s just as safe for teenagers as it is for anybody else.




Fact: Not a necessity, rather just a way to expedite the process of saturating your creatine stores. Most companies purport that the front-loading protocol is necessary to reach peak creatine levels but even a nominal dose of creatine taken over a few weeks will suffice just fine. Furthermore, consider the fact that many companies post such outlandish claims on their labels to get you to use up the product quicker and thus re-purchase it.




Fact: There are few supplements, especially over-the-counter, I can really think of that stand to benefit from cycling usage (on and off); creatine, however, is not one of them. In fact, I would suggest that creatine be taken rather consistently since it exerts most of its benefits once a saturation point has been established.




Fact: All I can really do in response to this somewhat moronic claim is shake my head. If I must elaborate, creatine isn’t even close to being chemically related to steroid molecules. Creatine is an amino acid, so this theory would be analogous to me saying that protein molecules are full of steroids…Hmmmm.




Fact: Despite the fact that creatine is indeed found in some foods (especially beef), the amounts of these foods you would have to consume on a daily basis to achieve the benefits of a nominal dose of supplemental creatine would be exorbitantly large.




Fact: Read the myth above myth about “creatine stunting growth of teenagers” and you should be caught up on why creatine is not a “sexist” supplement.



So to benefit from creatine in your diet, you need to eat a crapload of meat and fish.




Earnest CP, Snell PG, Rodriguez R, Almada AL, Mitchell TL. The effect of creatine monohydrate ingestion on anaerobic power indices, muscular strength and body composition. Acta Physiol Scand. 1995;153(2):207-209.

Kutz MR, Gunter MJ. Creatine monohydrate supplementation on body weight and percent body fat. J Strength Cond Res. 2003;17 (4):817-821.

Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M., … & Antonio, J. (2007). International Society of Sports Nutrition position stand: Creatine Supplementation and Exercise. Journal of the International Society of Sports Nutrition, 4 (6), 6.

Lugaresi R, Leme M, de Salles Painelli VT, et al. Does long-term creatine supplementation impair kidney function in resistance-trained individuals consuming a high-protein diet? Journal of the International Society of Sports Nutrition. 2013;10 (1):1-1.

Kim HJ, Kim CK, Carpentier A, Poortmans JR. Studies on the safety of creatine supplementation. Amino Acids. 2011;40(5):1409-1418.

Volek JS, Duncan ND, Mazzetti SA, Putukian M, Gómez AL, Kraemer WJ. No effect of heavy resistance training and creatine supplementation on blood lipids. Int J Sport Nutr Exerc Metab. 2000;10 (2):144-156.

Schilling, B., Stone, M., Utter, A., Kearney, J., Johnson, M., Coglianese, R., … & Stone, M. (2001). Creatine supplementation and health variables: a retrospective study. Medicine and science in sports and exercise, 33(2), 183-188.

Persky, A. M., & Rawson, E. S. (2007). Safety of creatine supplementation. In Creatine and Creatine Kinase in Health and Disease (pp. 275-289). Springer Netherlands

Kreider, R. B., Melton, C., Rasmussen, C. J., Greenwood, M., Lancaster, S., Cantler, E. C., … & Almada, A. L. (2003). Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. In Guanidino Compounds in Biology and Medicine (pp. 95-104). Springer US.

Hezave AZ, Aftab S, Esmaeilzadeh F. Micronization of creatine monohydrate via Rapid Expansion of Supercritical Solution (RESS). The Journal of Supercritical Fluids. 2010;55(1):316-324.

Sobolewski EJ, Thompson BJ, Smith AE, Ryan ED. The Physiological Effects of Creatine Supplementation on Hydration: A Review. American Journal of Lifestyle Medicine. 2011;5(4):320-327.

Lopez RM, Casa DJ, McDermott BP, Ganio MS, Armstrong LE, Maresh CM. Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses. J Athl Train. 2009;44(2):215-223.

Wright GA, Grandjean PW, Pascoe DD. The effects of creatine loading on thermoregulation and intermittent sprint exercise performance in a hot humid environment. J Strength Cond Res. 2007;21(3):655-660.

Mendel RW, Blegen M, Cheatham C, Antonio J, Ziegenfuss T. Effects of creatine on thermoregulatory responses while exercising in the heat. Nutrition. 2005;21(3):301-307.

Bemben MG, Bemben DA, Loftiss DD, Knehans AW. Creatine supplementation during resistance training in college football athletes. Med Sci Sports Exerc. 2001;33(10):1667-1673.

Kern, M., Podewils, L., Vukovich, M., & Buono, M. (2001). Physiological response to exercise in the heat following creatine supplementation. JEP online.

Volek, J. S., Mazzetti, S. A., Farquhar, W. B., Barnes, B. R., Gomez, A. L., & Kraemer, W. J. (2001). Physiological responses to short-term exercise in the heat after creatine loading. Medicine and Science in Sports and Exercise, 33(7), 1101-1108.

Greenwood M, Kreider RB, Melton C, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem. 2003;244(1-2):83-88.

Robinson, S. J. (2000). Acute quadriceps compartment syndrome and rhabdomyolysis in a weight lifter using high-dose creatine supplementation. The Journal of the American Board of Family Practice, 13(2), 134-137.

Schroeder, C., Potteiger, J., Randall, J., Jacobsen, D., Magee, L., Benedict, S., & Hulver, M. (2001). The effects of creatine dietary supplementation on anterior compartment pressure in the lower leg during rest and following exercise. Clinical Journal of Sport Medicine, 11(2), 87-95.

Hile, A. M., Anderson, J. M., Fiala, K. A., Stevenson, J. H., Casa, D. J., & Maresh, C. M. (2006). Creatine supplementation and anterior compartment pressure during exercise in the heat in dehydrated men. Journal of Athletic Training, 4(1), 30.

Sauret, J. M., Marinides, G., & Wang, G. K. (2002). Rhabdomyolysis. American Family Physician, 65(5), 907-912.

Hamer, R. (1997). When exercise goes awry: exertional rhabdomyolysis. Southern Medical Journal, 90(5), 548-551.

Clarkson, P. M. (2007). Exertional rhabdomyolysis and acute renal failure in marathon runners. Sports Medicine, 37(4-5), 361-363.

Dalbo, V. J., Roberts, M., Kerksick, C., & Stout, J. (2008). Putting the myth of creatine supplementation leading to muscle cramps and dehydration to rest. British Journal of Sports Medicine, 42(7), 567-73.

Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. Journal of the International Society of Sports Nutrition. 2013;10(1):36.

Becque MD, Lochmann JD, Melrose DR. Effects of oral creatine supplementation on muscular strength and body composition. Med Sci Sports Exerc. 2000;32(3):654-658.

Dangott B, Schultz E, Mozdziak PE. Dietary creatine monohydrate supplementation increases satellite cell mitotic activity during compensatory hypertrophy. Int J Sports Med. 2000;21(1):13-16.

Stockler, S., Hanefeld, F., & Frahm, J. (1996). Creatine replacement therapy in guanidineoacetate methyltransferase deficiency, a novel inborn error of metabolism. The Lancet, 348(9030), 789-790.

Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition, 9(1), 33.

Grindstaff, P. D., Kreider, R., Bishop, R., Wilson, M., Wood, L., Alexander, C., & Almada, A. (1997). Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers. International Journal of Sport Nutrition, 7(4), 330-346.

Pline, K. A., & Smith, C. L. (2005). The effect of creatine intake on renal function. The Annals of pharmacotherapy, 39(6), 1093-1096.

Poortmans, J. R., Auquier, H., Renaut, V., Durussel, A., Saugy, M., & Brisson, G. R. (1997). Effect of short-term creatine supplementation on renal responses in men. European journal of applied physiology and occupational physiology,76(6), 566-567.

Buford TW, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr. (2007)

Steenge, G. R., Lambourne, J., Casey, A., Macdonald, I. A., & Greenhaff, P. L. (1998). Stimulatory effect of insulin on creatine accumulation in human skeletal muscle. American Journal of Physiology-Endocrinology And Metabolism,275(6), E974-E979.

Giese, M. W., & Lecher, C. S. (2009). Non-enzymatic cyclization of creatine ethyl ester to creatinine. Biochemical and biophysical research communications, 388(2), 252-255.

Jagim, A. R., Oliver, J. M., Sanchez, A., Galvan, E., Fluckey, J., Reichman, S., … & Kreider, R. B. (2012). Kre-Alkalyn® supplementation does not promote greater changes in muscle creatine content, body composition, or training adaptations in comparison to creatine monohydrate. Journal of the International Society of Sports Nutrition, 9(Suppl 1), P11.

International Journal of Clinical Pharmacology and Therapeutics; Creatine and Caffeine in Anaerobic and Aerobic Exercise: Effects on Physical Performance and Pharmacokinetic Considerations; Vanakoski J., et al.; May 1998