Creatine is no longer the stereotypical supplement limited to gym buffs or athletes who want to look bigger and get stronger. Creatine is trending and going more mainstream, exploding in popularity on social media and store shelves promising benefits for the sleep-deprived, for women’s health, and for aging adults. But what does science really say?
What is Creatine?
Creatine is a natural compound that plays an important role in energy production, with about 50% made by the body and 50% coming from the diet. The body produces about 1 gram of creatine each day in the kidneys, liver, and pancreas by breaking down several amino acids (glycine, arginine and methionine). The typical non-vegetarian diet adds 1-2 grams of creatine per day from animal food sources. Taken together, what the body makes plus what comes from the diet is usually enough to replace the approximately 2 grams per day lost when the body metabolizes creatine into creatinine and excretes it in the urine. Although not an essential nutrient, some groups like vegetarians, vegans, and older adults have lower amounts of creatine in their diet, and thus, must rely more on what their body makes to maintain creatine stores.
Creatine Content of Select Foods
| Food | Typical Serving Size (ounces) | Creatine Amount (grams) |
| Pork | 3 oz | 0.4 |
| Beef | 3 oz | 0.4 |
| Salmon | 3 oz | 0.4 |
| Tuna | 3 oz | 0.3 |
| Cranberries | 1 oz | Trace |
Adapted from Williams MH, Krider RB, Branch D. Creatine: The Power Supplement (p 15). Human Kinetics, Champaign, IL, 1999
How is Creatine Involved in the Body’s Energy Production?
Creatine is responsible for resynthesizing ATP (adenosine triphosphate), the body’s primary source of energy, during intense exercise like sprinting or heavy lifting. For example, creatine supports energy needed during a high intensity hill climb or sprint at the end of a race but would not directly contribute to energy production during an easy, slow-paced run.
Any healthy adult—not just the performance athlete—who wants to combine an active lifestyle with resistance training to improve their muscular strength can benefit from creatine supplementation.
What are the Usual Benefits of Creatine Supplementation?
Creatine supplementation beyond what’s consumed in the typical diet increases the amount stored in the muscle by as much as 50 percent. This means more creatine reserves are available to be an energy buffer during high intensity activity. Supplementation leads to improvements in muscle strength, performance, and power when combined with resistance training (strength training). There are two ways to get these benefits while reaching appropriate creatine saturation in muscles:
- Creatine loading: 20 grams creatine per day for 7 days and 3-5 grams per day afterward as a maintenance dose
- Steady maintenance dose creatine: 3-5 grams creatine per day for 28 days and beyond
If the goal is to achieve benefits faster, then creatine loading is the fastest method while maintaining a steady maintenance dose of 3-5 grams per day for 3-4 weeks has similar benefits but with less gastrointestinal side effects that can sometimes occur, like stomach upset or diarrhea.
Who Can Benefit from Creatine Supplementation?
Any healthy adult—not just the performance athlete—who wants to combine an active lifestyle with resistance training to improve their muscular strength can benefit from creatine supplementation. This is especially important in older adults who naturally have age-related loss of muscle and strength and have less creatine coming from their diet. In fact, two recently published studies showed that older adults (60+ years of age) eating 3 g creatine and 3 g β-hydroxy β-methylbutyrate (HMB), from a building block of protein, per day combined with an exercise training program for 6 weeks had improved mobility and functional strength and endurance, all important to support everyday activities and healthy aging.
Can Creatine Improve Cognition and Brain Health?
While the brain relies on creatine for high energy, demanding tasks, very little dietary creatine reaches the brain, making the proposed benefits of creatine supplementation on brain health controversial. Yet, higher supplemented amounts may be needed to provide a benefit. For example, there’s emerging evidence that taking more than 20 grams per day may help with cognitive tasks during stress such as sleep deprivation.
Are There Benefits for Women During the Menopause Transition?
While studies show creatine improves muscle strength and exercise performance with resistance training in both pre- and post-menopausal women, evidence is lacking specifically during the menopause transition. During this time, women often experience age-related weight gain, muscle loss, and changes in fat distribution. Creatine may provide a benefit when combined with a routine strength training program to improve muscular strength and body composition.
Common Misconceptions
Despite the extensive research on creatine supplementation, myths and misconceptions remain.
- Does creatine cause weight gain or fluid retention?
No. Early research showed that water retention is common in the first few days of creatine supplementation. However, more recent and longer studies with creatine supplementation lasting up to 6 weeks did not show significant changes in water retention or weight gain.
- Does creatine cause kidney damage/renal dysfunction?
No. In the skeletal muscle, creatine and its active form phosphocreatine go through non-enzymatic breakdown to creatinine, a well-established biomarker of kidney function. Both blood and urinary creatinine may increase during creatine supplementation or after eating foods high in creatine, like meat.
While creatine supplementation has largely been used by athletes to improve performance and recovery, creatine has been studied and shown benefits in a variety of clinical conditions including diabetes, sarcopenia, bone health, and cognitive function.
Early case reports associated creatine intake with elevated serum creatinine, thus translating to a conclusion that there was impaired kidney function. Yet, further studies have not supported this conclusion. A 2011 study conducted in people with type 2 diabetes demonstrated that 12 weeks of creatine intake at 5 g/day did not adversely affect renal function. In addition, a recent meta-analysis found that creatine supplementation did not diminish renal function.
- Is creatine only beneficial for bodybuilders or athletes?
No. While creatine supplementation has largely been used by athletes to improve performance and recovery, creatine has been studied and shown benefits in a variety of clinical conditions including diabetes, sarcopenia, bone health, and cognitive function.
Conclusion
Creatine is a well-researched, widely used supplement with benefits that extend beyond athletic performance. Emerging evidence supports its role in improving muscle strength, functional capacity, and potentially cognitive resilience across a variety of groups, including older adults and women. As creatine continues to gain mainstream attention, professionals working with older adults play a key role in helping them separate science from hype and make informed decisions about creatine supplementation.
Jillian Hyttenhove, MA, RD, CSOWM, LD, CHES, is a Medical Science Liaison at the Nutrition Division of Abbott.
Sara Thomas, PhD, RDN, is a Senior Research Scientist at the Nutrition Division of Abbott.
Photo credit: Shutterstock/Chay_Tee
