What are the guidelines for taking creatine (Creatine Monohydrate) supplementation?

Creatine Monohydrate Supplementation Guidelines

For creatine monohydrate supplementation, begin with a loading phase of 20 g/day divided into four equal 5 g doses for 5-7 days, followed by a maintenance dose of 3-5 g/day as a single daily dose. 1

Loading Phase Protocol

• Administer 20 g/day divided into four equal doses (5 g per dose) for 5-7 days to rapidly saturate muscle creatine stores 1, 2
• This loading phase is the standard recommendation from the British Journal of Sports Medicine, though it is not absolutely required—maintenance dosing alone will eventually achieve saturation, just more slowly 1, 3
• Expect a 1-2 kg body mass increase during loading due to intracellular water retention, which is a normal physiological response 1, 2

Maintenance Phase Protocol

• Continue with 3-5 g/day as a single dose for the entire supplementation period after completing the loading phase 1, 2
• Alternative dosing without loading: 0.03 g/kg/day (approximately 2-3 g/day for a 70 kg person) can be used if the loading phase is skipped, though this takes longer to achieve muscle saturation 3
• Muscle creatine levels return to baseline approximately 4-6 weeks after discontinuation 1

Optimization Strategy for Enhanced Absorption

• Consume creatine with approximately 50 g of mixed protein and carbohydrate to enhance muscle uptake via insulin-mediated transport into muscle cells 1, 2
• This co-ingestion strategy significantly improves creatine transport efficiency compared to taking creatine alone 1

Special Application for Post-Exercise Recovery

• For promoting muscle glycogen resynthesis in the first 24 hours post-exercise, use 20 g of creatine divided into 5 g doses on four occasions beginning on the same day of fatiguing exercise 1

Safety Considerations and Contraindications

Renal Function Monitoring

• If evidence of renal dysfunction develops during creatine supplementation, discontinue immediately 2
• Creatine supplementation appears safe in healthy adults at recommended doses (loading: 20 g/day for 5 days; maintenance: ≤3 g/day), but caution is warranted in those with pre-existing renal disease 4
• Creatine supplementation can elevate serum creatinine levels independent of actual renal dysfunction, potentially serving as a false indicator of kidney disease 4
• In patients with history of renal disease or those taking nephrotoxic medications, creatine may increase risk of renal dysfunction 4

Dosing Thresholds and Medical Supervision

• Doses exceeding 6 g/day should be considered therapeutic intervention and require physician supervision, as this exceeds three times the daily creatine turnover of approximately 2 g/day in a 70 kg individual 5, 6
• For recreational athletes on a balanced diet, supplementation should not exceed 2.5-3 g/day 5, 6
• For high-intensity strength or sprint-training athletes, maximum supplementation should be less than 5-6 g/day for less than 2 weeks under medical supervision 5, 6

Product Quality Concerns

• Industrial production of creatine monohydrate can generate contaminants including dicyandiamide, dihydrotriazines, creatinine, and various ions—ensure pharmaceutical-grade products are used 6
• Creatine monohydrate is the most extensively studied form; other forms such as creatine ethyl ester have not demonstrated added benefits 3

Common Pitfalls to Avoid

• Do not use creatine in patients with pre-existing kidney disease or those on nephrotoxic medications without close monitoring 4
• The most common adverse effect is transient water retention in early supplementation stages, which should not be confused with pathological edema 3
• When combined with other supplements or taken at higher than recommended doses for several months, cases of liver and renal complications have been reported 3
• Safety in children and adolescents has not been established through rigorous clinical trials 4