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By: Churan Chang, dietetic student-volunteer University of British Columbia, reviewed by Alexander Leritz, Sports Dietitian and the JM Nutrition Team

Creatine 101: Introduction

Creatine is one of the most extensively studied sports supplements available. Although it is often associated with bodybuilders and competitive athletes, its potential benefits extend beyond the gym.

Creatine may enhance performance, improve strength and recovery, support muscle growth and healthy aging, and may also have potential benefits for cognitive function and certain medical conditions (Antonio et al., 2021; Kreider & Stout, 2021).

Despite decades of research, creatine remains surrounded by questions.

Does it damage the kidneys?

Does it cause bloating or hair loss?

Is it similar to a steroid?

With so much conflicting information online, it can be difficult to separate established evidence and what is simply a myth.

This post explains what creatine is, how it works, its potential benefits, and what research says about its safety. It will also address some of the most common questions people have before deciding whether supplementation is right for them.

What is creatine?

Creatine is a naturally occurring compound that is essential for energy production in the body. It is synthesized primarily in the kidneys and liver from three amino acids: arginine, glycine and methionine (Kreider & Stout, 2021).

About 95% of the body’s creatine is stored in the skeletal muscle and the other 5% is found in tissues with high energy demands, including the brain and heart (Kreider & Stout, 2021).

Creatine is also obtained through food, particularly red meat and fish (Antonio et al., 2021). However, food generally provides much less than the amounts commonly used in supplementation studies. Creatine supplements offer a practical way to increase the body’s creatine stores.

How does creatine work?

Every movement depends on muscle contraction, and every muscle contraction requires adenosine triphosphate (Kreider & Stout, 2021), or ATP. ATP is often described as the body’s energy currency because cells break it down to release usable energy.

Muscles only store a small amount of ATP (Kreider & Stout, 2021). During maximal effort, those stores can support activity for only a few seconds.

Most creatine in muscle is stored as phosphocreatine (Kreider & Stout, 2021). When energy demand rises, phosphocreatine donates a phosphate group to help regenerate ATP. This process allows muscles to produce energy quickly during brief, intense activities.

Supplementation increases the amount of creatine and phosphocreatine stored in muscle. In practical terms, this may help someone complete another repetition, lift a slightly heavier weight, or maintain power across repeated efforts.

These differences may seem small within one workout, but they can add up over weeks of training. A 2025 systematic review and meta-analysis found that creatine supplementation significantly improved muscle strength across multiple populations (Zhang et al., 2025).

Creatine is often mistakenly believed to be an anabolic steroid. However, it does not directly stimulate muscle growth in the way steroids do. Instead, it supports the body’s existing energy system, which may allow for a higher training volume or intensity. The resulting strength and muscle gains come largely from improved training adaptations (Antonio et al., 2021).

What are the benefits of creatine?

Not every proposed benefit of creatine is supported by the same amount or quality of research. Some effects have been demonstrated consistently for decades. Others remain promising but preliminary.

Benefits supported by strong evidence

Increased muscle strength

Improved muscle strength is one of the most firmly established benefits of creatine supplementation.

By helping regenerate ATP, creatine may allow a person to sustain greater effort during resistance exercise. Over time, this can support larger improvements in strength than training alone.

A 2025 systematic review and meta-analysis found that creatine supplementation significantly improved muscle strength across the general population (Zhang et al. 2025). The greatest effects appeared among previously untrained individuals and when supplementation was combined with high-intensity exercise.

The review could not determine whether age meaningfully influences the response to creatine because larger studies are still needed. However, the overall findings support decades of evidence showing that creatine can enhance strength development.

Improved high-intensity exercise performance

Creatine is most useful for activities involving brief, repeated bursts of effort. These include weightlifting, sprinting, jumping, interval training, and many team sports.

Increasing muscle creatine stores may help maintain strength, speed, or power across repeated efforts. For example, a person may recover more effectively between short sprints or complete more high-quality repetitions during a workout.

Its effects are generally less noticeable during continuous, low-intensity endurance activity. However, endurance athletes may still benefit when their training includes intervals, sprint finishes, or resistance exercise (Antonio et al., 2021; Kreider & Stout, 2021).

Greater gains in lean body mass

Creatine may support increases in lean body mass, especially when combined with resistance training.

Part of the initial increase may come from water being drawn into muscle cells. This is not the same as gaining body fat. This is often mistaken for “true” weight gain, but it actually reflects increased intracellular water within the muscle cells. Over longer periods, improved training quality may contribute to actual muscle growth, rather than simply an increase in water weight.

Across multiple systematic reviews, creatine consistently produces greater gains in lean body mass when combined with resistance training than resistance training alone. Controlled studies have not supported the claim that creatine increases fat mass (Antonio et al., 2021; Kreider & Stout, 2021; Gutiérrez-Hellín et al., 2025).

Benefits with growing evidence

Supporting muscle health in older adults

Muscle mass, strength, and physical function commonly decline with age. More severe age-related muscle loss may contribute to sarcopenia, which can affect mobility, independence, and quality of life.

Resistance training remains one of the most effective ways to preserve muscle. Creatine may provide additional support when used alongside it.

Current evidence suggests that older adults who combine creatine with resistance training may experience improvements in lean tissue mass, strength, muscular endurance, and physical function (Kreider & Stout, 2021).

Some studies also report possible benefits for balance and bone density, although these findings are less consistent (Kreider & Stout, 2021; Gutiérrez-Hellín et al., 2025).

The current evidence is stronger for creatine combined with resistance exercise than for supplementation on its own.

Potential benefits for women

Women may consume less dietary creatine and may have different rates of creatine synthesis than men. Changes associated with menstruation and menopause may also influence energy metabolism and muscle health (Gutiérrez-Hellín et al., 2025).

Current findings suggest that creatine may support exercise performance, strength, recovery, and body composition in women (Gutiérrez-Hellín et al., 2025). It may also help offset some age-related losses in muscle and bone, particularly when combined with resistance training.

However, there is not enough evidence to recommend adjusting creatine intake according to the menstrual cycle. More research is needed across different stages of women’s lives.

Potential benefits for vegetarians and vegans

Meat, fish, and poultry are the main dietary sources of creatine. Plant foods contain little to none. As a result, vegetarians and vegans often have lower muscle creatine stores than people who eat animal products.

Supplementation can increase these stores. Some studies suggest that vegetarians may experience a larger increase because they begin with lower baseline levels (Gutiérrez-Hellín et al., 2025).

This may support strength, recovery, and high-intensity performance. However, studies have not consistently shown that vegetarians and vegans experience greater performance improvements than omnivores (Gutiérrez-Hellín et al., 2025). The response still varies between individuals.

Most creatine monohydrate powder is made synthetically and does not contain animal-derived ingredients (Gutiérrez-Hellín et al., 2025). However, capsules may contain gelatin, so vegans should check product labels carefully.

Emerging areas of research

Brain health and cognitive performance

The brain requires a constant supply of energy. Because creatine helps buffer energy availability, researchers have investigated whether supplementation could support memory, attention, processing speed, and mental performance.

Early findings suggest that any cognitive effects may be more noticeable when the brain is under increased stress, such as during sleep deprivation, aging, or illness (Pratt et al ., 2026).

In one small study involving 15 healthy young adults, participants who received a high dose of creatine during 21 hours of sleep deprivation showed improvements in brain energy metabolism and experienced smaller declines in processing speed and cognitive performance (Gordji-Nejad et al., 2024).

However, the study was small and used an unusually high dose of 0.35 grams per kilogram of body weight. The results should not be treated as evidence that this dose is appropriate for routine use.

However, a recent review found that evidence for brain-related benefits remains limited and inconsistent (Pratt et al., 2026). Researchers have not yet established the most effective dose or duration for increasing creatine levels in the brain. Differences in brain-imaging and measurement methods also make studies difficult to compare.

Creatine may prove useful during periods of high brain energy demand, but its effects on everyday cognition in healthy, well-rested adults remain uncertain.

Clinical applications

Creatine has been studied in relation to creatine-deficiency disorders, muscle-wasting conditions, rehabilitation, mood disorders, neurological diseases, and metabolic health.

Some of the clearest clinical benefits have been observed in people with rare disorders that prevent normal creatine production. In these cases, medically supervised, long-term supplementation can help restore severely depleted brain creatine and may improve or stabilize symptoms (Kreider & Stout, 2021).

Research in other clinical populations remains mixed. A plausible biological mechanism or a positive early study does not prove that creatine can prevent or treat a disease.

Creatine should not replace established medical or nutrition care. Anyone considering it for a medical condition should consult a physician, pharmacist, or registered dietitian first (Kreider & Stout, 2021; Gutiérrez-Hellín et al., 2025; Pratt et al., 2026).

Creatine Questions

Is creatine safe?

For most healthy adults, creatine monohydrate is considered safe and generally well tolerated when used at recommended doses.

Current evidence supports the safety of creatine monohydrate at commonly studied doses of 3–5 g/day (Antonio et al., 2021).

A supplement that is safe for many people, however, may not be appropriate for everyone. Health conditions, medications, age, and the intended purpose of supplementation should still be considered.

Does creatine damage the kidneys?

Concerns about kidney damage often arise from confusion between creatine and creatinine.

Creatinine is a breakdown product of creatine (Antonio et al., 2021). Blood creatinine is commonly used as one marker when estimating kidney function. Supplementation may cause a small increase in creatinine because more creatine is available for normal breakdown.

This rise does not automatically mean the kidneys have been damaged.

Controlled studies have not found that recommended creatine doses impair kidney function in healthy people. Case reports linking creatine to kidney problems have often involved other factors, including pre-existing kidney disease, unusually high doses, medications, anabolic steroids, or the use of several supplements at once (Antonio et al., 2021).

Evidence in people with existing kidney disease is more limited. Anyone with impaired kidney function, abnormal kidney test results, or a history of kidney disease should seek medical advice before taking creatine (Gutiérrez-Hellín et al., 2025).

People taking creatine should inform their primary care provider before blood tests, particularly if their kidney function is being monitored. Creatine supplementation can raise blood creatinine levels, which may complicate the interpretation of kidney function tests despite not necessarily reflecting impaired kidney function (Antonio et al., 2021).

Does creatine cause dehydration or muscle cramps?

Available research does not support the claim that creatine causes dehydration or muscle cramping.

Creatine draws water into muscle cells, which may temporarily change fluid distribution (Antonio et al., 2021). This effect initially led to concerns that less water would remain available elsewhere in the body. However, experimental and clinical research has not confirmed this theory.

Some studies have even observed fewer episodes of cramping, dehydration, heat illness, and muscle injury among creatine users. Nevertheless, creatine does not replace adequate fluid intake. People should still hydrate appropriately based on their activity level, climate, and individual needs (Antonio et al., 2021).

What about water retention and weight gain?

Creatine may cause a temporary increase in body weight, especially during a loading phase.

This early change usually reflects increased water within muscle cells rather than increased body fat. Loading protocols, which typically consist of 20g/day (typically divided into four 5g doses) for 5-7 days, may produce more rapid and noticeable changes in body weight because they saturate muscle creatine stores more quickly (Antonio et al., 2021; Kreider & Stout, 2021).

In contrast, a standard daily dose of 3-5g/day generally increases muscle creatine more gradually and results in less pronounced early changes in body weight.

Water retention is not necessarily harmful. Increased water inside muscle cells may support cellular hydration.

Temporary weight gain, however, may matter to people competing in weight-class sports or closely monitoring changes on the scale (Antonio et al., 2021; Gutiérrez-Hellín et al., 2025).

Does creatine cause hair loss?

Current evidence does not show that creatine causes hair loss or baldness (Lak et al., 2025).

The concern largely originated from one small study involving male rugby players (Antonio et al., 2021). Researchers observed a change in dihydrotestosterone, or DHT, but did not measure hair loss. The finding has not been consistently reproduced.

Broader reviews have not found that creatine meaningfully raises testosterone or DHT, and human studies have not demonstrated that it causes hair loss. Direct long-term research would be useful, but the available evidence does not support this claim (Antonio et al., 2021; Lak et al., 2025).

Are very high doses of creatine equally safe?

Unusually high doses do not have the same safety evidence as standard daily amounts.

For example, the sleep-deprivation study by Gordji-Nejad et al. (2024) used a single dose of 0.35 grams per kilogram under controlled research conditions. This protocol was designed to test a specific hypothesis and should not be copied for routine supplementation.

Clinical studies may also use high doses to manage rare creatine-deficiency disorders. These are medical treatment protocols conducted under professional supervision (Kreider & Stout, 2021; Pratt et al., 2026).

For general use, three to five grams of creatine monohydrate per day is the most widely studied approach. Taking more is unlikely to provide greater long-term benefits once muscle stores are saturated.

Who should seek professional advice first?

Speak with a physician, pharmacist, or registered dietitian before using creatine if you:

have kidney disease or abnormal kidney-function results
are pregnant or breastfeeding
are younger than 18
have a chronic medical condition
take medications that may affect kidney function
or plan to use creatine to manage a health condition

Evidence in these groups is less extensive than it is for healthy adults. A healthcare professional can help determine whether creatine is appropriate and whether additional monitoring is needed.

Conclusion

Creatine is one of the most well-researched supplements available, with strong evidence supporting its benefits for strength, high-intensity exercise performance, and gains in lean body mass when combined with resistance training. Research into its potential role in healthy aging, cognition, and clinical conditions is promising, but many of these applications require further study.

For most healthy adults, creatine monohydrate is considered safe when taken at recommended doses. As with any supplement, it should complement, not replace a balanced diet, regular exercise, and guidance from a healthcare professional when appropriate.

Should you feel you require personalized nutritional sessions and support, book a free consultation or contact us for an appointment. As always if you have comments or questions, we encourage you to let us know.

References

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

Gordji-Nejad, A., Matusch, A., Kleedörfer, S. et al. Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation. Sci Rep 14, 4937 (2024). https://doi.org/10.1038/s41598-024-54249-9

Gutiérrez-Hellín, J., Del Coso, J., Franco-Andrés, A., Gamonales, J. M., Espada, M. C., González-García, J., López-Moreno, M., & Varillas-Delgado, D. (2025). Creatine supplementation beyond athletics: Benefits of different types of creatine for women, vegans, and clinical populations—A narrative review. Nutrients, 17(1), Article 95. https://doi.org/10.3390/nu17010095

Kreider, R. B., & Stout, J. R. (2021). Creatine in Health and Disease. Nutrients, 13(2), 447. https://doi.org/10.3390/nu13020447

Lak, M., Forbes, S. C., Ashtary-Larky, D., Dadkhahfar, S., Robati, R. M., Nezakati, F., … Tinsley, G. M. (2025). Does creatine cause hair loss? A 12-week randomized controlled trial. Journal of the International Society of Sports Nutrition, 22(sup1). https://doi.org/10.1080/15502783.2025.2495229

Pratt, J., Fuchs, C. J., van Loon, L. J. C., Kennerley, A. J., & Sale, C. (2026). Creatine supplementation and brain health: Methodological challenges, current evidence, and translational perspectives. The Journal of Nutritional Physiology, 5, 100017. https://doi.org/10.1016/j.jnphys.2026.100017

Zhang, H., Lan, T., Yan, X., Gu, H., Li, Y., & He, E. (2025). Effects of creatine supplementation on muscle strength gains-a meta-analysis and systematic review. PeerJ, 13, e20380. https://doi.org/10.7717/peerj.20380

About Author:

Alexander Leritz is a Toronto-area based dietitian who provides personalized nutritional support for athletes. Alexander is registered with the College of Dietitians of Ontario.

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Creatine 101: What You Need to Know Before Taking It