Authors: Jose Antonio, Darren G. Candow, Scott C. Forbes, Bruno Gualano, Andrew R. Jagim, Richard B. Kreider, Eric S. Rawson, Abbie E. Smith-Ryan, Trisha A. VanDusseldorp, Darryn S. Willoughby & Tim N. Ziegenfuss 

Creatine (α-methylguanidinoacetic acid) is a body’s natural substance that is mainly produced in the kidneys and liver from certain amino acids (arginine, glycine and methionine). Creatine can also be obtained exogenously from animal foods and/or as a nutritional supplement.  

This short entry summarizes some important aspects of the questions and answers addressed in the review published by Antonio et al. (2021) entitled “Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?”. This might help to promote practices based on the results of the most recent scientific research and to encourage a collective change in the way this supplement is perceived in the general population. 

1. Does creatine lead to water retention? 

• In summary, while there is some evidence to suggest that creatine supplementation increases water retention, primarily attributed to increases in intracellular volume, over the short term, there are several other studies suggesting it does not alter total body water (intra or extracellular) relative to muscle mass over longer periods of time. As a result, creatine supplementation may not lead to water retention. 

2. Is creatine an anabolic steroid? 

• Anabolic steroids are a synthetic version of testosterone, an androgenic hormone that is also produced endogenously in men and women. These molecules are characterized by having the sterane ring (cyclopentaneperhydrophenanthrene) in their structure. In summary, because creatine has a completely different chemical structure, it is not an anabolic steroid. 

3. Does creatine cause kidney damage/renal dysfunction? 

• After more than thirty (30) years of research and post-marketing surveillance there is no such evidence. It should be emphasized that the increase in creatinine levels is something inherent to creatine metabolism and does not represent a side effect per se. In addition, caution should be taken when interpreting changes in this marker considering there are certain problems when relying on serum creatinine as a diagnostic tool of kidney function (more reliable/valid parameters include cystatin C and glomerular filtration rate). In summary, experimental and controlled research indicates that creatine supplementation, when ingested at recommended dosages, does not result in kidney damage and/or renal dysfunction in healthy individuals. 

4. Does creatine cause hair loss / baldness? 

• In summary, the current body of evidence does not indicate that creatine supplementation increases total testosterone, free testosterone, dihydrotestosterone (DHT) or causes hair loss/baldness. 

5. Does creatine lead to dehydration and muscle cramping? 

• In summary, experimental and clinical research does not validate the notion that creatine supplementation causes dehydration and muscle cramping. 

6. Is creatine harmful for children and adolescents? 

• In summary, based on the limited evidence, creatine supplementation appears safe and potentially beneficial for children and adolescents. 

7. Does creatine increase fat mass? 

• In summary, creatine supplementation does not increase fat mass across a variety of populations. 

8. Is a creatine ‘loading-phase’ required? 

• In summary, accumulating evidence indicates that you do not have to ‘load’ creatine. Lower, daily dosages of creatine supplementation (i.e. 3-5 g/day) are effective for increasing intramuscular creatine stores, muscle accretion and muscle performance/recovery. However, unique and important results from a recent meta-analysis indicate that a creatine-loading phase is important for older adults wanting to improve muscle strength. Thus, while a lower daily dosage of creatine (≤5 g) appears sufficient to improve upper-body strength, a higher daily dosage of creatine (>5 g) after the loading phase is needed to increase lower-body strength in older adults (Forbes et al. 2021). 

9. Is creatine beneficial for older adults? 

• In summary, there is growing body of evidence showing that creatine supplementation, particularly when combined with exercise, provides musculoskeletal and performance benefits in older adults.  

10. Is creatine only useful for resistance / power type activities? 

• In summary, there is a variety of athletic events, not just resistance/power activities, which may benefit from creatine supplementation. 

11. Is creatine only effective for males? 

• In summary, there is accumulating evidence that creatine supplementation has the potential to be a multifactorial therapeutic intervention across the lifespan in females, with little to no side effects. 

12. Are other forms of creatine similar or superior to monohydrate and is creatine stable in solutions/beverages? 

• In summary, while some forms of creatine may be more soluble than creatine monohydrate when mixed in fluid, evidence-based research clearly shows creatine monohydrate to be the optimal choice. 

CONCLUSION 

As a nutritional supplement, creatine monohydrate is the most researched substance in the world and by far the most popular for gaining muscle mass. However, most people underestimate the promising effects of creatine supplementation and its benefits. In fact, creatine monohydrate can be used by anyone regardless of whether you are a bodybuilder, a high-performance athlete, a runner, a person attending a fitness center for aesthetics/health, a vegetarian/vegan person, an older adult, or even a healthy pregnant woman (de Guingand et al. 2020; Muccini et al. 2021).  

Learn more about why people should use creatine as a dietary supplement or food additive at Creatine For Health @creatineforhealth – The most comprehensive online resource on creatine.  

Recommended free book: “Creatine Supplementation for Health and Clinical Diseases“. 

REFERENCES 

1. Antonio, J., Candow, D.G., Forbes, S.C. Gualano, B., Jagim, A.R., Kreider, R.B., Rawson, E.R., Smith-Ryan, A.E., VanDusseldorp, T.A., Willoughby, D.S., Ziegenfuss, T.M. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. J Int Soc Sports Nutr 18, 13 (2021). https://doi.org/10.1186/s12970-021-00412-w 

2. de Guingand, D., Palmer, K. R., Bilardi, J. E., Ellery, S. J. Acceptability of dietary or nutritional supplementation in pregnancy (ADONS)–Exploring the consumer’s perspective on introducing creatine monohydrate as a pregnancy supplement. Midwifery 82 (2020): 102599. https://doi.org/10.1016/j.midw.2019.102599 

3. Forbes, S. C., Candow, D. G., Ostojic, S. M., Roberts, M. D., & Chilibeck, P. D. (2021). Meta-Analysis Examining the Importance of Creatine Ingestion Strategies on Lean Tissue Mass and Strength in Older Adults. Nutrients, 13(6), 1912. https://doi.org/10.3390/nu13061912  

4. Muccini, A.M., Tran, N.T., de Guingand, D.L., Philip, M., Della Gatta, P.A., Galinsky, R., Sherman, L.S., Kelleher, M.A., Palmer, K.R., Berry, M.J., Walker, D.W., Snow, R.J., Ellery, S.J. Creatine Metabolism in Female Reproduction, Pregnancy and Newborn Health. Nutrients 2021, 13, 490. https://doi.org/10.3390/nu13020490