Is it recommended to take creatine (a naturally occurring substance found in muscle cells) supplements?

Creatine Supplementation Recommendation

Yes, creatine monohydrate supplementation is recommended for healthy individuals seeking to improve muscle strength, power, and lean body mass, particularly when combined with resistance training, as it is safe and effective with no significant adverse effects on organ function when following appropriate dosing protocols. 1, 2

Evidence-Based Benefits

Muscle Performance and Hypertrophy

• Creatine increases phosphocreatine stores within muscle cells by approximately 20%, enhancing rapid ATP resynthesis during high-intensity exercise 1
• Improves high-intensity repeated sprint performance and enhances training capacity, promoting chronic adaptations including increased muscle strength, power, and lean body mass 1, 3
• Supplementation combined with resistance training consistently shows greater increases in strength and fat-free mass compared to resistance training alone 3, 4

Brain Health Potential

• May support brain function by increasing phosphocreatine stores in brain tissue, potentially improving cognitive processing during periods of high cognitive demand 1, 2
• Evidence for cognitive benefits is more modest and limited compared to well-established muscle benefits 2

Recommended Dosing Protocol

Standard Approach

• Loading phase: 20 g/day divided into four equal doses (5g each) for 5-7 days 1, 2, 5
• Maintenance phase: 3-5 g/day as a single dose for ongoing supplementation 1, 2, 5
• Consuming creatine with approximately 50g each of protein and carbohydrates may improve absorption through insulin stimulation 2, 5

Alternative Low-Dose Approach

• 2-5 g/day for 28 days may be effective while avoiding body mass increases 1, 2
• This approach takes longer to saturate muscle stores but achieves similar results 4

Safety Profile

General Safety

• No significant negative health effects have been reported when following appropriate supplementation protocols in healthy individuals across short-term (5 days), medium-term (9 weeks), and long-term (up to 5 years) studies 1
• The primary side effect is a predictable 1-2 kg increase in body mass, typically attributable to water retention or increased protein synthesis rather than pathological changes 1, 2, 5
• Short- and long-term supplementation is safe and well tolerated in healthy individuals 6

Critical Contraindications and Monitoring

Absolute contraindication: If a patient is taking creatine and has evidence of renal dysfunction, it is necessary to discontinue this supplement 1, 2, 5

Important Monitoring Considerations

• Creatine may affect the evaluation of glomerular filtration rate (GFR) by altering exogenous creatinine generation, but does not affect actual kidney function 1, 2
• When interpreting creatine phosphokinase (CPK) levels in athletes taking creatine, consider that levels above 3000 U·L⁻¹ have been detected after maximal resistance exercise without pathological significance 1
• Individuals with pre-existing kidney conditions should avoid creatine supplementation due to potential risks 1

Special Populations to Avoid

• Pregnant women should avoid creatine supplementation due to lack of evidence on safety in this population 1
• Living kidney donors should discontinue dietary supplements including creatine during evaluation and donation process, as it may influence GFR estimation and carries unknown risks 7

Common Pitfalls to Avoid

• Do not use creatine before or during exercise without completing the loading phase first, as the potential acute effects on body fluid balance have not been fully investigated 4
• Do not confuse elevated serum creatinine with kidney damage - creatine supplementation increases creatinine generation but does not cause nephrotoxicity in healthy individuals 1, 2
• Do not expect benefits for all exercise types - effects diminish as the length of time spent exercising increases, with minimal benefit for aerobic or endurance activities 3, 4
• Loading phase is not mandatory - while 20g/day achieves rapid saturation, 3g/day will achieve the same increase in phosphocreatine given sufficient time 4

Performance Context

• Creatine is most effective for short periods of extremely powerful activity, especially during repeated bouts of high-intensity exercise 4
• Does not increase maximal isometric strength, rate of maximal force production, or aerobic exercise performance 4
• The enhanced training capacity allows for greater volume and intensity of training, which contributes to long-term strength gains 4, 8