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Creatine
Executive Summary
Creatine is a well-researched, naturally occurring compound stored primarily in muscle that reliably increases short-duration, high-intensity exercise performance and supports gains in muscle mass when paired with resistance training; evidence across systematic reviews and guideline summaries shows consistent benefit for strength, power, and sprint outcomes [1] [2] [3]. Safety data collected over decades indicate creatine monohydrate is generally safe for healthy adults at common dosing regimens (3–5 g daily or short-term loading), with transient water retention the most reported adverse effect and no consistent evidence of long-term kidney damage in healthy populations, though people with preexisting kidney disease should consult clinicians [1] [4] [5]. Multiple sources also note emerging, but less conclusive, evidence for cognitive, cardiac, and aging-related benefits, and point to variability by diet, age, and baseline muscle creatine stores, especially in vegetarians and older adults [6] [7] [2].
1. Why athletes and trainers keep recommending creatine: proven gains in short bursts and strength
Randomized trials and reviews consistently show creatine supplementation improves performance in high-intensity, short-duration activities—sprints, jumps, and resistance sets—because creatine increases intramuscular phosphocreatine stores that rapidly regenerate ATP during maximal efforts, translating into measurable gains in maximal strength, power output, and repeated-sprint ability [1] [2]. Practical dosing strategies include a loading phase (e.g., ~20–30 g/day split for 5–7 days) followed by 3–5 g/day maintenance, or a lower daily dose without loading, both producing benefits over weeks when combined with resistance training [5] [7]. The International Society of Sports Nutrition and multiple practitioner-focused guides summarize similar takeaways: creatine is one of the few supplements with robust, reproducible performance effects [5] [2].
2. Safety profile: generally safe for healthy adults, watchful monitoring for specific groups
Longitudinal and review-level sources report creatine monohydrate is well-tolerated with the most common complaints being transient weight gain from intracellular water retention and occasional gastrointestinal upset; serious adverse events are rare in healthy volunteers [1] [3]. Clinical guidance consistently cautions that individuals with preexisting renal disease or on nephrotoxic drugs should obtain medical clearance, because safety data are limited for those populations despite reassuring findings in healthy cohorts [4] [6]. Some guideline summaries cite long-term use studies and expert statements suggesting multi-year use at standard doses appears safe in healthy adults, but they nonetheless call for continued surveillance and individualized clinical judgment [5] [2].
3. Beyond muscle: promising signals, not settled science on brain, heart, and aging
A number of reviews and consumer-health writeups highlight potential benefits of creatine for brain energy metabolism, cardiac function, and age-related muscle decline, but emphasize these areas are less definitive than sports-performance data and require larger, targeted clinical trials to establish clinical efficacy, dosing, and populations most likely to benefit [6] [2]. Some small trials and mechanistic research suggest creatine could support cognition during sleep deprivation or in neurodegenerative contexts, and it has been proposed as an adjunct in sarcopenia management when paired with resistance training, but systematic evidence and consensus are not yet established [6] [4]. The literature advises cautious optimism and further high-quality trials before expanding routine therapeutic indications [2].
4. Who benefits most: diet, age, and baseline status change the equation
Dietary intake and baseline muscle creatine stores influence supplement responsiveness: vegetarians and vegans, who consume little dietary creatine, and older adults with lower baseline stores tend to show larger relative gains, while individuals already consuming creatine-rich diets may have smaller absolute improvements [7] [6]. Performance and body-composition responses also vary by sex, training status, and genetic differences in creatine transporter function; clinical and consumer sources recommend personalized dosing and expectation-setting rather than one-size-fits-all claims [6] [7]. Practitioners summarize that pairing creatine with resistance training maximizes benefits across demographic groups [2].
5. Practical guidance and unresolved questions that researchers still probe
Consensus practical guidance from reviews and expert summaries recommends creatine monohydrate as the preferred form, typical maintenance dosing of 3–5 g/day for most adults, and consideration of a short loading phase when rapid effect is desired [4] [5]. Unresolved research questions include long-term safety in vulnerable clinical populations, optimal protocols for cognitive or cardiac indications, and mechanistic heterogeneity among responders; these gaps drive current calls for targeted randomized trials and registries [1] [2]. Consumers are advised to consult healthcare providers when chronic disease, kidney impairment, pregnancy, or complex medication regimens are present, while providers weigh individual risks and potential benefits [3] [6].