What is creatine?

Creatine is one of your body’s natural sources of energy for muscle contraction. Its name comes from the Greek word for meat. About half of the body’s supply comes from a carnivorous diet and about half is produced in the liver, kidneys and then delivered to the skeletal muscles for use. About 95% of creatine is stored in the skeletal muscle of your body and is used during physical activity. Creatine helps to maintain a continuous supply of energy to working muscles by keep production up in working muscles. Small amounts are also found in your heart, brain and other tissues.

Creatine is also found in foods such as milk, red meat and seafood. In a normal omnivorous /carnivorous diet, you consume one to two grams/day of creatine. Vegetarians may have lower amounts of creatine in their bodies.

Creatine exists in a steady state with a similar compound named creatinine that can be measured in lab tests as a marker of kidney function. It is passed out of your body in the urine. This means your body must release stored creatine each day to keep normal levels, the amount depending on your muscle mass. Although creatine is created naturally in your body, you must keep up your levels and do so through your daily diet.

Uses

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)
• depression
• diabetes
• multiple sclerosis (MS)
• muscle atrophy
• Parkinson’s disease
• fibromyalgia
• osteoarthritis

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.

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.

Safety

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
• nausea
• muscle cramping
• diarrhea

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.

Overall, creatine, used appropriately, seems to be relatively safe.

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.

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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.

Effects at high doses

More research is needed into how high doses of creatine can affect other body functions.

• lower blood glucose, which could affect individuals with diabetes or hypoglycemia
• raise blood pressure, affecting those with hypertension

We also advise caution for people with:

• deep vein thrombosis (DVT)
• electrolyte disorders or imbalances
• gastrointestinal disorders
• irregular heartbeat
• kidney stones or liver disease
• migraines
• low blood pressure when standing up
• bipolar disorder

This is not an exhaustive list.

Creatine is a bioactive substance. People should approach it with caution.