Creatine is a nitrogenous organic acid that helps supply energy to cells throughout the body, particularly muscle cells.
It occurs naturally in red meat and fish, it is made by the body, and it can also be obtained from supplements.
Supplements are used by athletes to improve their performance, by older adults to increase muscle mass, and to treat problems that result when a body cannot metabolize creatine fully.
Some evidence suggests that it might prevent skin aging, treat muscle diseases, help people with multiple sclerosis (MS) to exercise, enhance cognitive ability, and more. Additional evidence is needed to confirm these uses.
This article will look at the uses of creatine, how it works, and how safe and effective it is.
Fast facts on creatine
Here are some key points about creatine. More detail and supporting information is in the main article.
- Athletes use creatine to assist in high-intensity training.
- It can cause body mass increase.
- Creatine is being studied for use in a number of diseases including Parkinson’s disease and depression.
- Because creatine helps build muscle, it may be useful for individuals with muscular dystrophy.
- There is some evidence that creatine can boost memory.
- Creatine appears to be safe in moderate doses, but long-term safety has not been proven.
What is Creatine?
Creatine is formed of three amino acids: L-arginine, glycine, and L-methionine. It makes up about 1 percent of the total volume of human blood.
Around 95 percentTrusted Source of creatine in the human body is stored in skeletal muscle, and 5 percent is in the brain.
Between 1.5 and 2 percent of the body’s creatine store is converted for use each dayTrusted Source by the liver, the kidneys, and the pancreas.
It is transported through the blood and used by parts of the body that have high energy demands, such as skeletal muscle and the brain.
Different forms of creatine are used in supplements, including creatine monohydrate and creatine nitrate.
No creatine supplement has yet been approved for use by the United States (U.S.) Food and Drug Administration (FDA). There are dangers associated with use of unrestricted supplements.
A person needs between 1 and 3 grams (g) of creatine a day. Around half of this comes from the diet, and the rest is synthesized by the body. Food sources include red meat and fish. One pound of raw beef or salmon provides 1 to 2 grams (g) of creatine.
Creatine can supply energy to parts of the body where it is needed. Athletes use supplements to increase energy production, improve athletic performance, and to allow them to train harder.
According to the International Society of Sports Nutrition (ISSN), larger athletes who train intensely “may need to consume between 5 and 10 g of creatine a day” to maintain their stores.
People who cannot synthesize creatine because of a health condition may need to take 10 to 30 g a day to avoid health problems.
Creatine is one of the most popular supplements in the U.S., especially among men who participate in ice hockey, football, baseball, lacrosse, and wrestling.
It is also the most common supplement found in sports nutrition supplements, including sports drinks.
There are claims for a number of uses, some of which are supported by research evidence.
Improving athletic performance
Athletes commonly use creatine supplements, because there is some evidence that they are effective in high-intensity training.
The idea is that creatine allows the body to produce more energy. With more energy, athletes can work harder and achieve more.
For some participants in some kinds of exercise, boosting the body’s creatine pool appears to enhance performance.
In 2003, a meta-analysis published in the Journal of Sports Science and Medicine concluded that creatine “may improve performance involving short periods of extremely powerful activity, especially during repeated bouts.”
The researchers added that not all studies had reported the same benefits.
In 2012, a review concludedTrusted Source that creatine:
- boosts the effects of resistance training on strength and body mass
- increases the quality and benefits of high-intensity intermittent speed training
- improves endurance performance in aerobic exercise activities that last more than 150 seconds
- may improve strength, power, fat-free mass, daily living performance and neurological function
It seems to benefit athletes participating in anaerobic exercise, but not in aerobic activity.
It appears to be useful in short-duration, high-intensity, intermittent exercises, but not necessarily in other types of exercise.
However, a study published in 2017 found that creatine supplementation did not boost fitness or performance in 17 young female athletes who used it for 4 weeks.
Increased body mass
Increased creatine content in muscles has been associated with greater body mass.
However, according to the U.S. National Library of Medicine, creatine does not build muscle. The increase in body mass occurs because creatine causes the muscles to hold water.
One review, published in 2003, notes thatTrusted Source “The gains in body weigh observed are likely due to water retention during supplementation.”
It is also possible that muscle mass builds as a result of working harder during exercise.
Repairing damage after injury
Research suggests thatTrusted Source creatine supplements may help prevent muscle damage and enhance the recovery process after an athlete has experienced an injury.
Creatine may also have an antioxidant effect after an intense session of resistance training, and it may help reduce cramping. It may have a role in rehabilitation for brain and other injuries.
Creatine and deficiency syndromes
Creatine is a natural substance and essential for a range of body functions.
An average young male weighing 70 kilograms (kg) has a store, or pool, of creatine of around 120 to 140 gTrusted Source. The amount varies between individuals, and it depends partly on a person’s muscle mass and their muscle fiber type.
Creatine deficiency is linked to a wide range of conditions, including, but not limited to:
- chronic obstructive pulmonary disease (COPD)
- congestive heart failure (CHF)
- multiple sclerosis (MS)
- muscle atrophy
- Parkinson’s disease
Oral creatine supplements may relieve these conditions, but there is not yet enough evidence to prove that this is an effective treatment for most of them.
Supplements are also taken to increase creatine in the brain. This can help relieve seizures, symptoms of autism, and movement disorders.
Taking creatine supplements for up to 8 years has been shown to improve attention, language and academic performance in some children. However, it does not affect everyone in the same way.
While creatine occurs naturally in the body, creatine supplements are not a natural substance. Anyone considering using these or other supplements should do so only after researching the company that provides them.
Creatine and muscular dystrophy
Creatine may help improve the strength of people with muscular dystrophy.
A review of 14 studies, published in 2013, found that people with muscular dystrophy who took creatine experienced an increase in muscle strength of 8.5 percent compared with those who did not take the supplement.
“Short- and medium-term creatine treatment improves muscle strength in people with muscular dystrophies and is well-tolerated.”
Dr. Rudolf Kley, of Ruhr University Bochum, Germany
Using creatine every day for 8 to 16 weeks may improve muscle strength and reduce fatigue in people with muscular dystrophy, but not all studies have produced the same results.
In mouse models of Parkinson’s disease, creatine was able to prevent the loss of cells that are typically affected by the condition.
An animal study involving a combined treatment of coenzyme Q(10) and creatine concludedTrusted Source that this might help treat neurodegenerative diseases such as Parkinson’s disease and Huntington’s disease.
However, research published in JAMA, with over 1,700 human participants, notedTrusted Source that: “Treatment with creatine monohydrate for at least 5 years, compared with placebo did not improve clinical outcomes.”
Similarly, a systematic review published in Cochrane foundTrusted Source that there was no strong evidence for the use of creatine in Parkinson’s.
In South Korea, 52 women with depression added a 5-gram creatine supplement to their daily antidepressant. They experienced improvementsTrusted Source in their symptoms as early as 2 weeks, and the improvement continued up to weeks 4 and 8.
A small-scale study found that creatine appeared to help treat depression in 14 females with both depression and an addiction to methamphetamine.
The results suggested that: “Creatine treatment may be a promising therapeutic approach for females with depression and comorbid methamphetamine dependence.”
Further research is needed.
In 2003, researchers published evidence that creatine can boost mental performance.
After taking a 5-g supplement each day for 6 weeks, 45 participants scored betterTrusted Source on working memory and intelligence tests, specifically tasks taken under time pressure, than other people who took a placebo.
A study published in 2007, concludedTrusted Source that “creatine supplementation aids cognition in the elderly.” Participants took a 5-g supplement four times a day for a week and then carried out some number and spatial tests. Those who took the supplement did better than those who took only a placebo.
At recommended doses, creatine is considered “likely safe” to consume.
In high doses, it is “possibly safe.” It is expected that it could affect the liver, kidneys, or heart, although these effects have not been proven.
Other possible effects include:
- stomach pain
- muscle cramping
People with kidney disease are advised not to use creatine, and caution is recommended for those with diabetes and anyone taking blood sugar supplements.
The safety of creatine supplements has not been confirmed during pregnancy or breastfeeding, so women are advised to avoid it at this time.
Use of creatine can lead toTrusted Source weight gain. While this may be mostly due to water, it can have a negative impact on athletes aiming at particular weight categories. It may also affect performance in activities where the center of gravity is a factor.
In 2003, a review of 14 studies on creatine supplementation and exercise performance, published in Cochrane concluded that it:
“Appears to pose no serious health risks when taken at doses described in the literature and may enhance exercise performance in individuals that require maximal single effort and/or repetitive sprint bouts.”
In 2007, the ISSN describedTrusted Source the use of creatine as, “safe, effective, and ethical.” They recommended it as a way for athletes to obtain extra creatine without increasing their intake of fat or protein.
Updating their statement in 2017, they conclude that creatine supplementation is acceptable within recommended doses, and for short-term use for competitive athletes who are eating a proper diet.
Overall, creatine, used appropriately, seems to be relatively safe.
However, one study, published in 2012, cautioned thatTrusted Source the “safe and ethical” status of creatine supplements could change.
“The perception of safety cannot be guaranteed,” the authors add, “Especially when administered for long periods of time to different populations.”
The FDA has not yet approved it as safe and effective.