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Creatine. Yes or No?

What the Evidence Says:

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Benefits, Risks, and Optimal Dosing for Men and Women

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Creatine monohydrate is one of the most extensively researched and effective dietary supplements for improving high-intensity performance, lean muscle mass, and recovery. Beyond athletics, emerging evidence suggests benefits for cognition, particularly in older adults, vegetarians, and under conditions of sleep deprivation or stress (Avgerinos et al., 2018; Dolan et al., 2019).

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Benefits

  • Muscle and Performance: The International Society of Sports Nutrition (ISSN) identifies creatine monohydrate as the most effective ergogenic aid for enhancing lean mass and strength when combined with resistance training (Kreider et al., 2017).

  • Cognition: Meta-analyses show small improvements in memory and cognitive tasks, with stronger effects in populations with lower baseline creatine (Avgerinos et al., 2018).

 

Safety and Risks

  • Kidney Health: Controlled trials demonstrate no harmful effects on kidney function in healthy individuals; mild serum creatinine rises reflect metabolism, not kidney damage (Poortmans & Francaux, 2000).

  • Myths: Evidence does not support increased cramps, dehydration, or hair loss. A single 2009 study linked creatine to increased DHT levels, but follow-up studies have not confirmed hair loss risk (Van der Merwe et al., 2009).

  • Side Effects: The most common are mild gastrointestinal upset (if taken in large single doses) and transient water retention.

 

 

Optimal Dosage General Guidelines

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  • Maintenance dose: ~0.03 g/kg/day, equating to 3–5 g/day for most adults (Kreider et al., 2017).

  • Loading phase (optional): ~0.3 g/kg/day (~15–25 g/day) split across 4 doses for 5–7 days, followed by 3–5 g/day (Kreider et al., 2017). Skipping loading and taking 3–5 g/day will also saturate muscles within 3–4 weeks (Rawson & Persky, 2007).

 

Men vs Women

  • Body weight matters more than sex.

    • <68 kg (~150 lb): ~3 g/day

    • 68–91 kg (~150–200 lb): 3–5 g/day

    • 91 kg (~200 lb): 5–8 g/day (Kreider et al., 2017; Bodybuilding.com, 2024)

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  • Women typically have lower baseline creatine stores, so they may experience greater relative benefits, though dosing strategies remain the same (Brosnan & Brosnan, 2007).

 

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Comparisons With Alternatives

Other performance enhancing aids—such as beta-alanine, sodium bicarbonate, caffeine, protein, and HMB—offer niche benefits but often come with greater side-effect risks (e.g., paresthesia from beta-alanine, GI upset from bicarbonate, or sleep disruption from caffeine).

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Creatine remains the most reliable and well-tolerated option for performance and cognitive support (Kreider et al., 2017).

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Creatine monohydrate is safe, effective, and inexpensive. A daily dose of 3–5 g/day suits most adults, regardless of sex, with optional short-term loading for faster results. 

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References

  1. Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental Gerontology, 108, 166–173. https://doi.org/10.1016/j.exger.2018.04.018

  2. Brosnan, J. T., & Brosnan, M. E. (2007). Creatine: Endogenous metabolite, dietary, and therapeutic supplement. Annual Review of Nutrition, 27(1), 241–261. https://doi.org/10.1146/annurev.nutr.27.061406.093621

  3. Dolan, E., Gualano, B., & Rawson, E. S. (2019). Beyond muscle: The effects of creatine supplementation on brain creatine and cognitive functioning in healthy individuals. Journal of the International Society of Sports Nutrition, 16(1), 33. https://doi.org/10.1186/s12970-019-0293-8

  4. Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., … Lopez, H. L. (2017). International Society of Sports Nutrition position stand: Safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14(1), 18. https://doi.org/10.1186/s12970-017-0173-z

  5. Poortmans, J. R., & Francaux, M. (2000). Long-term oral creatine supplementation does not impair renal function in healthy athletes. Medicine & Science in Sports & Exercise, 31(8), 1108–1110. https://doi.org/10.1097/00005768-199908000-00019

  6. Rawson, E. S., & Persky, A. M. (2007). Mechanisms of muscular adaptations to creatine supplementation: Review article. International SportMed Journal, 8(2), 43–53.

  7. Van der Merwe, J., Brooks, N. E., Myburgh, K. H. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sport Medicine, 19(5), 399–404. https://doi.org/10.1097/JSM.0b013e3181b64e9e

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