Is Creatine Safe?
Stephen Martin examines all of the benefits associated with creatine supplementation.
Creatine monohydrate is one of the most popular sports supplements on earth and one of the most studied. Creatine has been used by elite athletes since the 90s and has been huge in the bodybuilding community for decades.
With its near-ubiquitous use right now, it may seem unbelievable that during the late 90s creatine was seen by many as one of the most dangerous supplements on the market. Even today, many people still believe that it can cause kidney failure.
Is creatine safe, or is it the victim of so-called fake news? In this ingredient spotlight, we are going to examine all of the benefits associated with creatine supplementation, all of the side effects, and we will help you to decide for yourself whether creatine monohydrate is a supplement that you should be using.
What is Creatine Monohydrate?
Science has been aware of creatine since 1832 when it was discovered by the French chemist Michel Eugene Chevreul. He named it creatine after the Greek word for meat (kreas). The 1920s were a period where creatine was studied a lot. It was during the 20s that it was discovered that consuming larger quantities of creatine than usual led to the body storing it, rather than excreting it.
It was not until the 1990s that creatine became known to the general public, though it had been used in bodybuilding and among amateur athletes since the 1970s. The 1992 Olympics in Barcelona thrust creatine into the mainstream consciousness when British newspaper The Times ran an article identifying several British athletes (Linford Christie, Sally Gunnel, Colin Jackson) who had been taking creatine before their races.
It might seem crazy now, considering how many people use creatine, but at the time creatine was viewed as "the new steroid". The article and several articles afterward did not portray the British Olympians as progressives, but rather as reckless athletes who may not technically be breaking the rules but were in danger of crossing the line.
Even in 1998, six years later, the press was still reporting on creatine as if it were a dangerous supplement that should be avoided. Another British newspaper The Independent reported "fears over sport's new 'legal steroid'".
Italian scientists were petitioning the International Olympic Committee (IOC) to ban creatine "claiming it may be harmful" while the British Olympic Association refused to endorse the supplement.
But what is creatine? Creatine is a naturally occurring organic compound made from three amino acids (glycine, arginine, methionine). Creatine plays a vital role in energy production.
Energy production and creatine
When you eat food, it is turned into glucose which is then turned into something called Adenosine Triphosphate (ATP). ATP is one chemical called adenosine and three phosphate molecules. The bonds that connect the adenosine to the phosphate molecules contain the energy you need to perform any action. To turn ATP into usable energy, your body breaks down one bond holding a phosphate molecule. You use this energy immediately. Still, now your ATP has lost a phosphate and has become one adenosine and two phosphate molecules – known as ADP.
It can get quite complicated here, so let us keep things nice and straightforward. At this point, the creatine in your body creates a molecule called phosphocreatine. As you can probably guess, this molecule is made up of creatine and phosphate. Your body breaks down the phosphocreatine molecule and adds the phosphate molecule to ADP, creating ATP, which can be used again to produce energy. Creatine transfers phosphate molecules around and helps recycle ATP. The more creatine you have stored in your body, the more fuel you can generate.
Where does creatine come from?
Our body creates its creatine by synthesizing it in the liver and kidneys, but it only makes enough to cover the amount of creatine that is lost by the body each day. You can also get creatine through your diet, with certain foods containing it in small amounts. Red meat is an excellent source of creatine, though how much you cook can affect how much creatine you receive.
A 2014 study by Nair et al. found that cooking meat turned creatine into creatinine (the by-product of creatine that has been broken down by the kidneys). So, if you want creatine from your steak, you would better cook it rare!
Our body can store quite a lot of creatine, but it would be almost impossible to get enough creatine from your diet to stock up on creatine fully. That is where creatine supplementation comes into things.
Creatine monohydrate supplements are made in a lab and are entirely synthetic (rather than being extracted from food). This is a good thing because it makes creatine monohydrate vegan, and vegans are the most in need of creatine as they will not get it from a diet.
Synthetic creatine is made from placing sarcosine and cyanamide in a reactor where they are subjected to heat and pressure. Crystals are formed which are then turned into a very fine powder and then packaged up.
Many supplement companies now offer flavoured versions of creatine powder; all you have to do is add water. For the unflavored, it is often advised to mix with a high-sugar drink (orange juice is commonly used) as this is supposed to speed up absorption.
Benefits of Creatine
There are many benefits of taking creatine, in the interest of keeping this article to a reasonable size. We will only cover the more critical/better-researched benefits of creatine.
Creatine can increase lean muscle mass
The main reason why creatine is so prevalent in the bodybuilding world is that it has a significant effect on muscle mass. A meta-analysis of over 100 studies on creatine found that it did indeed increase lean muscle mass significantly.
A 2011 study in the Journal of Strength & Conditioning looked at the effect of creatine supplementation on muscle size in young adults. The study found that creatine supplementation during resistance training led to a small but significant increase in muscle size.
There are several reasons why creatine is effective at increasing lean muscle mass; most of them will be covered in this article. Allowing you to train harder for longer is one of the reasons, increasing protein synthesis (through increased testosterone) is another.
Creatine can also cause your muscle cells to hold water, which can cause temporary swelling. This leads to bigger muscles, but the effects only last for a short period.
Creatine can increase Power
While bodybuilders tend to use creatine to help them grow bigger muscles, athletes use it for its ability to increase their power. A 2003 study by Rawson & Volek looked at the effects of creatine and resistance training on muscle strength and weightlifting performance.
The study found that taking creatine led to an 8% increase in strength, and a 14% increase in power. The study also saw a 45% increase in bench press power in some participants (though others saw increases of just 3%).
There is a LOT of evidence supporting the fact that creatine supplementation can lead to significant increases in power output. This can help powerlifters, athletes, and even fitness models/bodybuilders. It can also help regular people who want to see an increase in their gym or sporting performance.
Creatine can reduce fatigue
When discussing sporting supplements, it is easy to think only in sporting terms. So, when we say that creatine can reduce fatigue, you are probably thinking of muscular fatigue. Well, there is evidence that creatine can reduce muscular fatigue. Studies have shown that creatine can help you to train longer before giving in to fatigue.
But fatigue is so much more than your muscles aching during a workout. Creatine can also help to reduce mental fatigue. A 2002 study published in Neuroscience Research found that taking 8g per day of creatine for five days led to a significant reduction in mental fatigue, allowing participants to perform simple mathematical calculations better.
Anyone who has ever suffered from fatigue will know how debilitating it can be, the effect that creatine supplementation can have on it could make a big difference to day to day life, particularly in the elderly.
Creatine can improve Anaerobic performance
There is little evidence that creatine can improve aerobic performance, but if you think about it, anaerobic performance will benefit from it. Not only does creatine increase the time it takes to fatigue (essential for anyone training anaerobically), it can also increase power.
A 2009 study in the Journal of the International Society of Sports Nutrition looked at the effects of creatine and HIIT sessions on cardiorespiratory fitness. The study found that four weeks of supplementation with creatine (10g per day) was able to increase VO2 max (the maximum amount of oxygen someone can use during a workout) and increase power output.
It is for this reason athletes like Linford Christie (sprinter), Sally Gunnell (400m hurdler), and Colin Jackson (110m hurdler) were "exposed" as using creatine in 1992. Their sports were anaerobic, and creatine helped them to increase power, prevent fatigue from affecting them too much, and therefore become successful.
Creatine may be able to increase testosterone
Testosterone has a massive role in many aspects of male health. The most obvious benefits are in sport and fitness, but testosterone is also crucial for reproductive health, as well as cognitive health. While creatine does not have a significant impact on testosterone, there is still a beneficial increase.
A 2011 study on amateur swimmers in Science & Sports looked into the effect of short-term creatine supplementation on swim performance and the hormonal response to it. The study found that growth hormone and cortisol levels were unaffected, but that testosterone levels spiked by 15% compared to the placebo group.
Creatine strengthen bones in the elderly
There is not too much evidence looking into the effect of creatine on bone density in the elderly, but of those studies that have looked into it, there does appear to be a small yet significant effect. A 2005 study by Chilibeck et al. found that 12 weeks of resistance training combined with creatine supplementation led to an increase in bone mineral density compared to resistance training alone.
Reduce muscle damage
As scary as muscle damage sounds, it is necessary for muscle growth. When bodybuilders are looking to build muscle, they are looking to create some muscle damage. It is then through the process of muscle protein synthesis that the damaged muscle fibres are repaired and become stronger.
However, excessive muscle damage can be a hindrance, particularly if you are training for other reasons. A professional tennis player who has to play two games within three days would want to minimize muscle damage as much as possible.
Creatine has been shown to decrease the amount of muscle damage caused by an intense workout, which means faster recovery between sessions.
A 2009 study by Cooke et al. looked at the effect of creatine supplementation on muscle damage after eccentric exercise. The study found that muscle damage decreased, and recovery rate improved when taking 21g of creatine each day for five days (technically it was 0.3g of creatine for each kg of bodyweight so would have been different for each participant).
If you are not aware already, eccentric exercise causes the most muscle damage of all exercises. It is where you only perform one part of the exercise – for example, a bicep curl where you start with the dumbbell at the top of the movement (by your shoulder) and lower it as slowly as possible, using a weight that is too heavy to lift.
This causes massive muscle damage, and it is very popular with bodybuilders as it can lead to considerable gains in muscle mass. However, it often causes too much muscle damage and therefore slows down recovery.
Creatine has cognitive benefits
Until recently, the effect on cognition that creatine had was barely considered. These days we know that creatine could be as effective as most nootropics in improving cognitive health, particularly in the elderly. A 2018 study published in Experimental Gerontology found that taking creatine can help to improve short-term memory and intelligence. Up till now, it was thought that creatine might only be useful to people who were vegetarians (who would, therefore, have the lowest levels of creatine from diet). However, this study found benefits for healthy adults regardless of diet (though vegetarians still responded best).
Other benefits of creatine
Creatine may increase growth hormone production, and there is evidence that it can increase IGF-1 (a hormone that can help with muscle growth). It may also improve mood and reduce some of the symptoms of depression. There may be an effect on cholesterol as well as blood pressure, though the evidence is mixed. As the years go by, more and more benefits are being attributed to this wonder-supplement. It will be interesting to see what the future brings.
How to Take It
There are many different ways to take creatine. One of the most common approaches is creatine loading. This is where you take a higher dosage of creatine for one week, which is designed to maximize the stores of creatine in your muscles. After the week of higher dosage, you can drop down to a maintenance dose. The downside of creatine loading is that it can lead to specific side effects that are much less likely if you take the maintenance dosage.
Studies have consistently found that in the short-term, creatine loading is more effective than taking a maintenance dose, but in the long-term, it makes no difference. If you want immediate results and do not mind some minor side effects, then creatine loading is the right move for you. However, if you are all about the long-term benefits and would rather avoid any side effects, you can stick to a maintenance dose. Another debate surrounding creatine is whether to take it pre-workout or post-workout, or whether you should be taking it independently at entirely separate times to your workout (i.e. first thing in the morning).
A 2013 study in the Journal of the International Society of Sports Nutrition found that taking creatine after a workout was slightly more effective than taking it pre-workout. However, as with many supplements, it is more important to be consistent and get your dosage right than worry about what time to take it. When it comes to dosage, you should be looking to get about 0.03g of creatine for every kg of bodyweight you have. If you weigh 100kg, then that would be 3g of creatine per day, if you weigh 50kg then that would be 1.5g per day.
People who are loading should start taking 10x their recommended amount. So 30g for the 100kg person and 15g for the 50kg person. If you have higher muscle mass (bodybuilders, powerlifters, and larger sportspeople), then you can have a little more creatine than regular people. This is because the more muscle you have, the more creatine you can store. Drink more water while taking creatine as creatine tends to drive water to the muscle cells, which can dehydrate you unless you increase your water intake.
Is it safe?
Unequivocally, creatine is safe. There have been many misleading "facts" that talk about creatine's effect on the liver. While it is true that people with pre-existing liver conditions should consider avoiding creatine, a healthy liver has no issues with handling anything that creatine supplementation can throw at it.
What are the side effects?
Most people will see no adverse side effects from taking creatine, particularly if you avoid the loading phase altogether. However, there are specific side effects associated with creatine loading: nausea, an upset stomach, and dehydration. Headaches are also associated – usually due to dehydration.
Creatine is the most researched and most effective legal supplement that you can buy, only matched by caffeine and whey protein. There are hundreds of benefits associated with it, and potentially hundreds more that have not been discovered yet.
Buying simple, unflavored creatine monohydrate is your best bet. It is ridiculously cheap, very effective, and has a very long shelf life. Please do not be put off by incorrect stories of creatine being a dangerous drug. Creatine is a naturally occurring substance that can help you build muscle, increase strength, improve cognition, and help perform better in the gym or on the sports field.
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About the Author
Stephen Martin is a supplement owner from the U.K who regularly reads scientific papers to see which ingredients work and which are placebos.