Creatine Monohydrate is the Best Form for Supplementation
Creatine monohydrate is the only form of creatine you should recommend, as it has the most extensive safety and efficacy data, with no evidence that any newer forms are superior. 1, 2
Why Creatine Monohydrate is Superior
The International Society of Sports Nutrition and American College of Sports Medicine support creatine monohydrate specifically because it:
- Increases muscle phosphocreatine stores by approximately 20% with consistent improvements in high-intensity, repeated sprint performance 1
- Has been studied in over 500 peer-reviewed publications demonstrating safety and efficacy 3
- Shows nearly 99% bioavailability, with the supplement either taken up by muscle or excreted in urine without degradation during normal digestion 2
- Has an excellent safety profile at recommended doses of 3-5 g/day, even with long-term use up to 30 g/day for 5 years 1
The Problem with "Novel" Forms
Despite aggressive marketing claims, there is little to no evidence that newer forms of creatine (such as creatine ethyl ester, buffered creatine, or liquid creatine) are more effective or safer than creatine monohydrate 2, 4. These alternative forms lack the extensive safety data and regulatory clarity that creatine monohydrate possesses 2.
Recommended Supplementation Protocol
Standard Dosing (Two Options)
Option 1 - With Loading Phase:
- Loading: 20 g/day divided into four equal doses (5g each) for 5-7 days 1, 5
- Maintenance: 3-5 g/day as a single dose thereafter 1, 5
Option 2 - Without Loading Phase:
- Simply take 3-5 g/day (or 0.03-0.1 g/kg body weight/day) continuously 4, 3
- Loading phases are not necessary to increase intramuscular creatine stores, though they achieve saturation faster 4
Optimize Absorption
- Consume creatine with approximately 50g each of protein and carbohydrate to enhance muscle uptake via insulin stimulation 1, 5
Expected Benefits and Effects
Athletes and active individuals can expect:
- Increase in lean body mass by 1-2 kg, primarily through intracellular water retention and enhanced protein synthesis 1
- Enhanced muscle strength and power 1
- Improved training capacity and high-intensity exercise performance 1, 5
- Potential cognitive function benefits 1
Critical Safety Precautions and Contraindications
Absolute Contraindications
Creatine supplementation should be discouraged in living kidney donors throughout the evaluation process due to unknown effects on kidney function 6, 1. This is a firm recommendation from the American Journal of Kidney Diseases 6.
Important Clinical 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 6, 1
- This is a measurement artifact, not true nephrotoxicity, but can lead to misclassification of kidney injury 6
- If a patient develops evidence of renal dysfunction while taking creatine, discontinue the supplement 5
Populations Where Creatine Shows No Benefit
- COPD patients receiving pulmonary rehabilitation show no improvement in exercise capacity, muscle strength, or quality of life 1
- Parkinson's disease patients show limited mood benefits but no influence on overall quality of life or disease progression after two years 1
Common Side Effects
The primary side effect is transient water retention causing 1-2 kg body mass increase in the early stages of supplementation 1, 5, 4. This is not harmful but should be explained to patients to avoid concern.
When combined with other supplements or taken at higher than recommended doses for several months, there have been isolated cases of liver and renal complications 4. Stick to recommended doses and avoid combining with multiple other supplements 4.