Optimal Creatine Intake for Healthy Adults
For generally healthy adults, the evidence-based standard is a maintenance dose of 3-5 g/day taken as a single daily dose, which can be preceded by an optional loading phase of 20 g/day divided into four doses for 5-7 days to rapidly saturate muscle stores. 1
Standard Dosing Protocol
The British Journal of Sports Medicine recommends a structured approach to creatine supplementation 1:
- Loading Phase (Optional): 20 g/day divided into four equal doses (5 g each) for 5-7 days to rapidly saturate muscle creatine stores 1, 2, 3
- Maintenance Phase: 3-5 g/day as a single daily dose for the duration of supplementation 1, 3
- Alternative Approach: 2-5 g/day for 28 days without loading can achieve similar muscle saturation while avoiding initial weight gain 1
The loading phase is not required - lower doses of 2-5 g/day will eventually achieve the same muscle creatine saturation, though it takes approximately 28 days instead of 5-7 days 1, 4.
Timing and Administration
- Daily consumption is essential because muscle creatine levels return to baseline approximately 4-6 weeks after stopping supplementation 1
- Concurrent consumption with protein/carbohydrate may enhance muscle creatine uptake via insulin stimulation 1
- The effective weight-based dosing is 0.3 g/kg/day for loading and 0.03 g/kg/day for maintenance 3
Expected Benefits
Creatine supplementation provides several performance advantages 1, 5:
- Improves high-intensity repeated sprint performance by increasing muscle phosphocreatine stores 1
- Enhances training capacity and chronic adaptations including muscle strength, power, and lean body mass 1
- May support brain function with regular supplementation 1
- Most effective for short-duration, high-intensity activities rather than endurance sports 2, 4
Safety Considerations
Creatine monohydrate is well-tolerated at recommended doses with no negative health effects following appropriate protocols 1, 5:
- Expect 1-2 kg body mass increase after the loading phase due to water retention 1, 3
- Transient water retention is the most common side effect in early supplementation 3
- Creatine monohydrate is the most studied form - other forms like creatine ethyl ester have not shown added benefits 3
Important Contraindications
Avoid creatine supplementation in specific populations 6:
- Individuals with chronic kidney disease (GFR <45 mL/min/1.73 m²) 6
- Persons with a solitary kidney 6
- Patients with pre-existing kidney disease or risk factors (diabetes, hypertension) should use with caution 6
Diagnostic Pitfall: Creatinine Elevation
A critical caveat: Creatine supplementation increases serum creatinine by 0.2-0.3 mg/dL through non-pathologic conversion to creatinine, which can falsely suggest kidney dysfunction 6. This elevation does not indicate actual kidney damage 6, 5. If kidney function assessment is needed during supplementation, use cystatin C-based GFR or measured GFR rather than creatinine-based estimates 6.
Clinical Bottom Line
Daily maintenance dosing of 3-5 g is the evidence-based standard for athletes in high-intensity strength or sprint training 1. The loading phase accelerates saturation but is optional 1, 4. Discontinuation leads to return to baseline levels within 4-6 weeks, requiring continuous daily intake to maintain benefits 1.