Creatine benefits and drawbacks
Executive summary
Creatine monohydrate is one of the most studied dietary supplements and reliably increases high‑intensity exercise capacity, lean mass during training, and—emerging evidence suggests—some aspects of cognition and clinical recovery; most large reviews find it generally safe at recommended doses (3–5 g/day) for healthy adults [1] [2] [3]. The main drawbacks are predictable and usually benign—water retention and temporary weight gain, occasional gastrointestinal upset—and lingering uncertainties remain for long‑term use in children, certain clinical populations, and unregulated supplement quality [4] [5] [6].
1. What creatine does and why athletes use it
Creatine supplies rapid cellular energy by replenishing phosphocreatine and ATP in muscle cells, which translates into improved repeated sprint performance, greater gains in strength and lean mass during resistance training, and faster recovery between high‑intensity efforts—findings supported by position statements and systematic reviews that call creatine “the most effective ergogenic nutritional supplement” for these outcomes [1] [2].
2. Evidence beyond lifting: cognition, aging and therapeutic promise
Beyond sports, randomized trials and reviews report cognitive benefits—especially in sleep‑deprived or low‑creatine individuals—and growing evidence that creatine can help older adults preserve muscle mass and function and may have neuroprotective and therapeutic roles in conditions from traumatic brain injury to certain metabolic diseases, though results vary by population and study design [2] [7] [1].
3. Typical dosing, loading myths, and practical use
Most clinical protocols use creatine monohydrate as the preferred form, with common regimens including a short loading phase (0.3 g/kg/day for 5–7 days) followed by maintenance (≈0.03 g/kg/day), yet several experts and reviews warn that high‑dose “loading” offers no functional advantage for many users and can increase kidney workload—so modest daily dosing (3–5 g) is widely recommended [2] [6] [8].
4. Safety profile: what large studies say and where concerns persist
Longstanding reviews of clinical trials and surveillance data report creatine is generally well tolerated and not linked to clinically significant renal dysfunction or cancer in humans when used at recommended doses, with GI complaints and weight gain being the most commonly reported adverse effects; nevertheless, idiosyncratic reactions and rare reports still drive public concern and media alarm [9] [3] [5].
5. Common drawbacks—what users actually notice
The common, expected downsides are water retention and modest increases in body mass (which some athletes consider a negative), occasional nausea or diarrhea at high doses, and transient cramping reports—evidence suggests these effects are typically dose‑related and uncommon in controlled trials [4] [5] [3].
6. Populations that need caution and regulatory blind spots
Caution is advised for people with preexisting kidney or liver disease and for those taking interacting medications; regulators do not tightly police supplement label accuracy, so products sometimes contain differing creatine amounts or contaminants—an important quality‑control and safety caveat not always highlighted in promotional material [10] [6] [8]. Adolescents and children remain an evidence gap: orthopaedic and pediatric guidance notes insufficient long‑term safety data for growing populations [11].
7. Conflicting signals, industry incentives and research priorities
While meta‑analyses and position stands consistently support benefit and tolerability, some individual trials show no effect on specific outcomes and social-media anecdotes amplify rare adverse reports; the supplement industry’s profit motives and uneven regulation can bias marketing, and researchers call for more long‑term, population‑specific trials (adolescents, pregnant people, chronic disease) and stricter manufacturing oversight [12] [9] [6].