Is creatine supplementation beneficial for all populations?

Is Creatine Supplementation Beneficial?

Yes, creatine monohydrate supplementation is definitively beneficial for most populations, particularly for improving muscle strength, power, high-intensity exercise performance, and potentially cognitive function, with an excellent safety profile at recommended doses of 3-5 g/day. 1, 2

Populations That Benefit Most

Athletes and Active Individuals

• Creatine consistently improves high-intensity, repeated sprint performance, increases muscle strength and power, and enhances training capacity by increasing phosphocreatine stores in muscle cells by approximately 20%, enabling faster ATP resynthesis during intense exercise 1, 2
• Increases lean body mass by 1-2 kg, primarily through intracellular water retention and enhanced protein synthesis 1, 3
• Most effective for short-duration, high-intensity activities rather than prolonged endurance exercise, as benefits diminish with longer exercise duration 4

Older Adults

• Creatine supplementation in older adults is particularly valuable as it can reverse age-related declines in muscle creatine, muscle mass, bone density, and strength 5
• When combined with resistance training, produces greater increases in lean body mass, muscle strength, bone mineral density, and performance of activities of daily living compared to training alone 5
• Even without exercise training, short-term creatine supplementation increases body mass, enhances fatigue resistance, and improves strength in older adults 5
• May improve quality of life and reduce disease burden associated with sarcopenia 5

Cognitive Benefits Across Populations

• Creatine may support brain function by increasing phosphocreatine stores in brain tissue 1
• Cognitive processing that is impaired (either experimentally through sleep deprivation or naturally through aging) can be improved with creatine supplementation 5
• Higher brain creatine levels are associated with improved neuropsychological performance 5

Clinical Populations

• The International Society of Sports Nutrition identifies potential benefits in neurodegenerative diseases, diabetes, osteoarthritis, fibromyalgia, brain and heart ischemia, adolescent depression, and pregnancy 2
• May enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and provide neuroprotection following concussion or spinal cord injury 2, 6
• Limited evidence in Parkinson's disease: two years of supplementation showed some mood benefits but did not influence overall quality of life or disease progression 7

Populations Requiring Caution or Avoidance

Kidney Donors and Patients with Renal Concerns

• Creatine supplementation should be discouraged in living kidney donors throughout the evaluation process due to unknown effects on kidney function 7
• If a patient develops evidence of renal dysfunction while taking creatine, discontinue the supplement immediately 3
• Important caveat: Creatine affects creatinine generation and can falsely suggest acute kidney injury on creatinine-based GFR measurements, but does not actually impair renal function itself 7, 1

COPD Patients

• Creatine supplementation does not improve exercise capacity, muscle strength, or health-related quality of life in individuals with COPD receiving pulmonary rehabilitation, based on systematic review 7

Recommended Supplementation Protocol

Loading Phase (Optional)

• 20 g/day divided into four equal doses (5g each) for 5-7 days 1, 3
• This rapidly saturates muscle creatine stores 1

Maintenance Phase

• 3-5 g/day as a single dose for the duration of supplementation 1, 3
• Alternative lower-dose approach: 2-5 g/day for 28 days avoids initial water weight gain while remaining effective 1

Optimization Strategy

• Consuming creatine with approximately 50g each of protein and carbohydrate enhances muscle uptake via insulin stimulation 1, 3
• After discontinuation, creatine levels return to baseline in approximately 4-6 weeks 1

Safety Profile

Well-Established Safety

• Short-term and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and various patient populations ranging from infants to elderly 2
• The primary side effect is a 1-2 kg body mass increase due to water retention or increased protein synthesis 1, 3
• No significant negative health effects have been reported when following appropriate supplementation protocols 1

Common Misconceptions to Address

• Creatine is not an anabolic steroid 8
• Does not cause kidney damage in healthy individuals (though it affects creatinine measurements) 8
• Does not lead to dehydration or muscle cramping 8
• Not harmful for children and adolescents when used appropriately 8
• Does not increase fat mass 8
• Effective for both males and females 8

Key Clinical Considerations

• Creatine monohydrate is the most studied and recommended form; other forms have not demonstrated superiority 8
• Not all individuals respond equally to supplementation (some are "non-responders"), but the majority experience benefits 4
• A loading phase is not required but accelerates the saturation of muscle creatine stores 8
• Long-term habitual low-dose ingestion (approximately 3 g/day) throughout the lifespan may provide significant health benefits 2