Of all the muscle-building supplements on the market, creatine is the most well-researched and effective supplement. Hundreds of scientific studies have been published on this supplement, and in almost every study, it was found to be the most effective supplement in muscle building. However, there are still some controversies around the usage of creatine supplements. People often link creatine usage to hair loss, kidney damage, water retention, and cancer. Is there any reality in these claims? Before moving into the research studies on creatine supplements, I want you to understand what creatine is and how it functions in our body?
Creatine is a molecule produced in our body from amino acids. Most of it is made in the liver and produced in our kidneys and pancreas. Creatine’s primary function is ATP’s regeneration, which is the primary energy carrier in our body. Creatine-generated ATP help in the performance of high-intensity activities lasting less than 10 seconds. It can be found in meat, egg, and fish, but creatine supplementation is recommended for optimum performance.
1. Creatine monohydrate increases creatine stores in our body, especially in our muscles. The more creatine our muscle has, the more ATP they will produce. An increase in ATP is directly linked to increased performance.
2. Creatine enhances muscle growth by holding water in muscle cells. It makes our muscles look bigger and creates a positive nitrogen balance. Positive nitrogen balance is related to muscle building.
3. Some research suggests that creatine has anti-catabolic properties, which further help in muscle building.
4. A meta-analysis of more than 100 studies found that creatine supplementation can increase strength and power output by 20% and 26%, respectively.
5. Creatine monohydrate can increase overall body weight due to water retention in our muscles and liver cells. However, the degree of the increase can vary according to an individual’s response to creatine.
6. Some research studies found that creatine can increase anaerobic running capacity, but the improvement was minimal.
7. Creatine supplementation may increase cognitive performance and memory; however, we need more research on these areas.
I encounter this question whenever I recommend this supplement to someone. Most of the claims regarding the safety of creatine are unfounded. If taken without sufficient water intake, creatine can cause stomach cramping. Some people may suffer from diarrhea and nausea if too much creatine is taken at once. That is why it is recommended to spread out the creatine intake throughout the day. Some link creatine intake to hair loss, kidney damage, and cancer. Let’s see what science has to say about all these claims-
Concerns have been raised regarding the adverse effect of creatine on kidney damage. Why has kidney damage been linked to creatine use? As we know, our liver produces creatine, so to ingest that creatine, our muscles and brain need to transform this creatine into phosphocreatine. And when we use these stores to regenerate ATP, one of the end products is creatinine.
Over 20 years of research show no adverse effects from recommended creatine doses on kidney health. This misconception likely stems from a misunderstanding of creatine and creatinine metabolism and a 1998 case study of a patient with pre-existing kidney disease. The 1998 case study involved a young male with severe kidney disease who experienced rising creatinine levels after taking creatine, but other factors like medications and pre-existing conditions were overlooked.
Our kidneys are responsible for excreting creatinine from our bodies. When our kidneys do not function well, the creatinine level increases in our blood. The normal range of creatinine is 0.7-1.3mg/dl for men and 0.6-1.1 for women. So if your blood creatinine level is higher than this normal range, it is assumed that your kidneys are not working well.
However, this normal range does not apply to highly active people who carry greater muscle mass because more than 90% of creatine is stored in our muscles. More muscles mean more creatinine production. Also, if your diet includes animal protein, your creatinine level will be higher than vegetarian people. Supplement creatine also increases the creatinine level in your blood. Let’s see what science has to say about this;
If you are worried about taking creatine, my advice would be to check your creatinine level before buying a creatine supplement.
The second claim that is associated with creatine use is hair loss, especially in males. According to Michael Hull, senior research manager at examine.com, Creatine may cause hair loss in men, but in most cases, it doesn’t. Instead, the number one reason behind male pattern hair fall is increased DHT (Dihydrotestosterone) levels in the blood. DHT is an androgen that causes hair loss, particularly in males.
A 2009 study suggests that creatine supplementation may worsen hair loss. This study was conducted on 20 healthy adult male professional rugby players. They were divided into two groups- one group took a placebo, and the second group was given 20 grams of creatine per day for the first 7 days, followed by 5 grams/per day for 14 days. There was not much difference in the testosterone levels between both groups, but the DHT levels were increased significantly among the creatine group. Rugby players experienced a 56% increase in dihydrotestosterone (DHT) levels after a week of creatine loading. DHT, a hormone linked to hair loss, remained elevated by 40% during a maintenance phase. This is the only randomized control trial that tested creatine’s effect on the DHT level. DHT is formed from testosterone, but van der Merwe’s study found no rise in total testosterone. Free testosterone levels were not assessed Other studies on creatine’s effects on testosterone and DHT have shown no significant changes. It’s important to highlight that the findings from van der Merwe et al. have not been reproduced in other studies, and that intense resistance training alone can lead to increases in these androgenic hormones.
Furthermore, Before starting the creatine supplementation, DHT levels were 23% lower in the creatine group (0.98 nmol/L) compared to the placebo group (1.26 nmol/L). After 7 days of creatine use, DHT levels in the creatine group increased by 0.55 nmol/L, and after 21 days, by 0.40 nmol/L. At the same time, the placebo group’s DHT levels dropped by 0.17 nmol/L after 7 days and by 0.20 nmol/L after 21 days. This combination of a slight increase in the creatine group and a small decrease in the placebo group explains the “statistically significant” rise in DHT found in the study by van der Merwe et al.
Before concluding, it is crucial to understand that even though creatine increased DHT levels among adult males in this study, DHT stayed within the normal range. Therefore, even if creatine increases DHT, as long as your DHT levels are within a normal range, you won’t need to worry about hair fall. So, an increase in DHT due to creatine supplementation may or may not result in hair loss. Unfortunately, no study has been conducted so far that directly tests creatine’s effect on hair fall.
To date, 12 studies have examined the effects of creatine supplementation (with doses ranging from 3-25 g/day over 6 days to 12 weeks) on testosterone levels. Two studies reported minor, clinically insignificant increases in total testosterone after six and seven days of supplementation, while the other ten studies found no changes in testosterone levels. Additionally, five of these studies also measured free testosterone, which is used by the body to produce DHT, and none showed any increase.
No, no study links creatine use to any kind of cancer development. Furthermore, all the claims regarding this are not supported by scientific data. So, creatine is not only safe but even helps in the protection of DNA from oxidative damage.
Does creatine lead to water retention?
Creatine supplementation has often been associated with water retention, especially due to early studies that showed water retention during the first few days of supplementation, particularly at doses of 20 g/day over six days. Creatine, being an osmotically active substance, theoretically causes water to be drawn into the muscle cells, as it is transported alongside sodium. However, because of sodium-potassium pump activity, significant long-term changes in intracellular sodium concentrations are unlikely.
Several studies on creatine supplementation lasting between 5 and 10 weeks have found no significant changes in total body water (TBW), intracellular water (ICW), or extracellular water (ECW). This includes resistance-trained males who took both high and low doses of creatine over various periods. In contrast, some research, such as a study by Powers et al., showed an increase in body mass and TBW after 28 days of creatine supplementation, but no change in ICW or ECW. Additionally, a recent study combining creatine supplementation with resistance training over 8 weeks found increases in both TBW and ICW, suggesting that intracellular water may play a role in protein synthesis and muscle growth over time.
In conclusion, while short-term creatine supplementation may cause temporary water retention, longer-term studies suggest that it does not consistently alter total body water levels relative to muscle mass, implying that creatine may not lead to sustained water retention.
So it is clear from the above research studies that creatine is completely safe to take apart from minor side effects. Now, the question is how and when to take it for maximum results? There are three types of creatine available in the market, but creatine monohydrate is the cheapest and most effective one. Some people recommend taking creatine in two phases-loading phases and then the maintenance phase. Although there is no harm in loading creatine, it does not produce superior results in the long run. Most studies suggest that “5 grams of creatine per day is optimal”.
I would recommend you take it after your workout. There are two reasons behind this-First,
Research shows that creatine intake with a moderate amount of protein and carbohydrates increases its effectiveness. Secondly, some research studies show that post-workout creatine intake is slightly better in increasing strength and power than pre-workout.
^ a b c van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects the dihydrotestosterone to testosterone ratio in college-aged rugby players. Clin J Sports Med. (2009)
^ Kreider RB, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. (2017
Poortmans JR, Francaux M. Adverse effects of creatine supplementation: fact or fiction?.
Sports Med. (2000)^ Farquhar WB, Zambraski EJ. Effects of creatine use on the athlete’s kidney. Curr Sports Med Rep. (2002)
a b c d Pline KA, Smith CL. The effect of creatine intake on renal function. Ann Pharmacother. (2005)
^ Francaux M, Poortmans JR. Side effects of creatine supplementation in athletes. Int J Sports Physiol Perform. (2006)
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