Creatine Benefits vs. Side Effects, Plus Dosage - Dr. Axe

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Creatine Benefits for Muscles & Brain (Plus Safety Considerations)


Creatine monohydrate - Dr. Axe

Creatine (sometimes referred to as creatine monohydrate) has been called a “phenomenon” in the bodybuilding community and is among the best-selling supplements to gain muscle. To date, well over 500 research studies have evaluated the effects of its supplementation on muscle growth, metabolism, exercise capacity and many other markers of health.

According to researchers at the Exercise and Sport Nutrition Laboratory at Baylor University, “About 70 percent of these studies report statistically significant results, while remaining studies generally report non-significant gains in performance.”

So which is it? What are the benefits of taking creatine (if any) according to the medical literature? People who take creatine supplements usually do so because it has been shown in studies to offer help with physical performance, body composition, energy output and even cognitive enhancement.

While it might be effective for building muscle and increasing strength, there can also some negative effects that have been associated with this supplement.

Is creatine safe? Depending on whom you ask, it may be “remarkably safe for most people” or potentially capable of causing reactions like water retention and indigestion.


What Is Creatine?

Creatine monohydrate is a small peptide that is made up of amino acids (the “building blocks of protein”). It is formed in the liver, pancreas and kidneys, mostly with the help of the amino acids glycinearginine and methionine.

In supplement form, it was first introduced to the public in the 1990s after Olympic athletes were reported to be using it to improve performance. Today, this supplement is one of the “most widely used nutritional supplements or ergogenic aids” available on the market.

What does creatine do to your body exactly to cause the physical and mental changes described above? Despite what many people think, it is not a steroid, and it’s not an unnatural/man-made product.

Creatine monohydrate is a molecule that is naturally present in the human body, especially in the skeletal muscles. About 90 percent to 95 percent of creatine is stored in the muscles, with the rest found in the heart, brain, liver, kidneys, testes and almost every cell.

It is taken in supplement form to help boost the production of energy in the body. This compound has the job of storing phosphate groups in the form of phosphocreatine — aka creatine phosphate — which support the release of energy and therefore help build strength and the growth of muscle mass.

Taking this supplement can be useful for boosting production of energy in the form of adenosine triphosphate (ATP).

ATP is sometimes referred to as the “molecular currency” of the body, since it helps store and transport chemical energy within cells. ATP is needed for cellular functions. It is the source of fuel for our muscles — especially when they are working hard, such as during exercise.

When we eat foods we acquire a mix of macronutrients (carbohydrates, fats and proteins) that are used to produce ATP, and creatine helps this process by donating a phosphate group that helps with ATP creation.


Most researchers today, including Dr. Paul Greenhaff, whose work has been published in the American Journal of Clinical Nutrition, feel that creatine can be safely consumed. This is true not only of athletes, but also for people looking to give their energy and metabolism a boost.

Most studies have found that not every person reacts to this supplement in the same way. Some may experience more results and health improvements, while others deal with creatine side effects like indigestion and fluid retention. Below we’ll look a the pros and cons of using it, what to expect if you begin “creatine loading,” and how you can maximize your results while still using this supplement safely.

1. Helps With Protein Synthesis

Creatine helps with protein synthesis, which increased growth of lean muscle mass. Creatine also increases body weight due to muscles filling with more water. Some research found that one week of taking creatine supplements increased body mass by about 0.9–2.2 kilograms (2.0–4.6 pounds).

2. Improves Strength and Performance

Studies indicate that creatine improved strength and power output. Creatine storage capacity in our muscles is limited, but it increases as muscle mass increases. Supplementation has the ability to regenerate ATP stores faster during intense physical activity, helping sustain effort and prevent fatigue.

In addition, creatine helps maximize performance during high-intensity interval training (HIIT). Studies find that it improved work performed during sets of maximal effort muscle contractions, single-effort sprint performance and during repetitive sprint performance.

3. May Help Muscle Recovery

A 2021 study indicates that creatine may help improve muscle recovery and recovery from exercise, such as maximizing results from strength training.

Creatine may also potentially reduce fatigue.


4. Boosts Brain Health

Creatine also offers neuroprotective properties, which may help protect the brain. Additionally, cognitive enhancement — such as improved alertness, concentration and attention — was also observed.

Creatine may help reduce severity of depression symptoms, according to animal studies and small pilot studies in humans.

5. May Improve Heart Health

Another creatine study shows that it may offer cardioprotective properties, as it may help protect the heart and blood vessels. It has also been shown to support increased endurance and anaerobic cardiovascular capacity.

6. May Improve Bone Density

Creatine potentially helps improve bone density when combined with resistance training.

Side Effects

Generally speaking, creatine seems to be safe, but there are some dangers of creatine. Some people might not react very well to taking higher doses, such as if they have an existing kidney problem or enzyme defect that makes digesting protein difficult.

Certain studies suggest that side effects of creatine may include:

  • Weight gain due to water retention (sometimes up to three to five pounds of weight gain in a day due to fluid accumulation if taking high doses)
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Cramping
  • Constipation
  • Restlessness

Certain studies have looked at the supplement’s effect on the kidneys, but a 2019 systematic review and meta-analysis did not find any evidence that it will damage the kidneys of mostly healthy people without kidney disorders. The kidneys do have the job of metabolizing creatine and breaking it down so it can be eliminated from the body via urine, but in normal/moderate doses this does not seem to be dangerous for most people.

However, if someone does have a kidney disorder or is being treated with diuretic medications in order to manage fluid levels in the body, he or she should discuss using it and similar supplements with a health care professional before starting.

Supplement Dosage

How much creatine is safe per day? Should I take creatine daily?

  • When just beginning to use this supplement, most experts recommend that if you’re “creatine loading,” you take about 0.3 grams per kilogram of bodyweight (or about 0.136 per pound) for the first five to seven days.
  • During this loading phase, you’ll take much higher amounts than during the weeks to follow. To give you an example, a man who weighs 175 pounds (79.4 kilograms) would take about 25 grams per day when loading.
  • After the first five to seven days, take a lower dose of five to 10 grams per day for about three weeks. To be more precise, aim for about 0.03 grams per kilogram of bodyweight for about three weeks.
  • Once the three weeks are over, you can either continue taking the lower dosage for as long you’d like to, or can go back to loading. You might choose to cycle your intake every three weeks or so.

If you are going to use oral supplements, you can reduce the potential for experiencing creatine side effects by making sure not to take too much at once. Avoid very high doses, and always read directions for dosage/serving recommendations, since each product is a bit different.

Many experts feel that pure creatine monohydrate is the best type to take, since it’s typically the least expensive and has been shown to be effective. If you can find micronized creatine monohydrate, it is a good option, since in this form tends to be easier to dissolve in liquid and potentially easier to digest.

Another type is creatine nitrate, which seems to have stronger effects than creatine monohydrate but does not appear to be any more effective or well-tolerated. Then there is creatine ethyl ester as well, which “is alleged to increase creatine bio-availability.” This type may be beneficial, but research has not confirmed it’s actually more bioavailable than creatine monohydrate.

Creatine-Rich Foods

Certain foods provide creatine, but creatine from food is digested more slowly than the kind we get from taking supplements. Plus, it can be destroyed when the foods that provide it are cooked. The NHANES III survey found that on average, Americans adults get approximately 5 to 7.9 mmol (0.64 to 1.08 grams) of creatine from their diets per day.

You can get some from eating foods that are high in protein, including meat (especially beef), poultry, fish and eggs.

Consuming collagen protein and sources of collagen like bone broth is a great way to increase intake of the amino acids that form creatine (arginine and glycine). Organ meats like liver and kidneys have lower concentrations.

Some creatine can also be found in breast milk, dairy products and milk from cows/sheep/goats, along with the blood of both humans and animals. Because vegetarians/vegans avoid the highest sources of this compound, it’s been found that they have lower resting creatine concentrations. This may contribute to problems gaining muscle and strength when eating a low-protein diet.

Common Questions

What is the best time for when to creatine?

Space out servings throughout the day. If you use it more than once daily, make sure to divide doses (take one early in the day and one at least several hours or more later). If you consume between 20–30 grams daily during the initial five- to seven-day loading phase, try to divide this amount up in four to five equal doses for the best absorption.

Can I take creatine forever?

Many athletes and bodybuilders choose to use creatine by following a “loading protocol.” This means they start out by taking a higher dose in order to build their bodies’ stores quickly and then either abruptly or gradually decrease their dosage as time goes on.

Some people may also cycle their intake, alternating between time periods of taking higher doses followed by time periods of taking lower doses. Cycling might continue for several months or go on indefinitely if it’s leading to results and not causing side effects.

The effects of creatine seem to diminish as the length of time spent exercising increases. Additionally, it may stop providing results if it’s used for a long period of time, such as many years. The most results might be experienced within the first several months or year of use (although people react differently).

Can you take creatine without working out? Should I take creatine on off days?

There’s some evidence that creatine may work better to improve muscle growth and strength when taken after exercise, rather than before. However, athletes have reported using it effectively at all times of day, so it may be an individual preference. Creatine can be used by people who are active but not bodybuilders — however, it has the most benefits when combined with exercise.

Can I take creatine before bed? Can creatine affect sleep?

Some people may experience mild restlessness if they use this supplement too close to bedtime, so it might be best to have it earlier in the day. However, if it doesn’t cause any issues when taken before bed, this is a fine approach since spacing out servings is recommended.

Should I take it with meals or on an empty stomach?

Some studies have found that creatine works better when taken with meals, rather than taken alone on an empty stomach, because consuming carbohydrates and protein with creatine helps it work more effectively.

Also make sure to drink enough water when taking it. If you take this supplement while dehydrated you’re more likely to deal with digestive symptoms and to lack energy.

Can I take it with caffeine?

There’s some some concern that creatine and caffeine have somewhat opposite effects when it comes to water loss/water retention. Caffeine is a stimulant and diuretic that can cause increased urination and water loss, while creatine pulls more water into muscle cells.

However, both caffeine and creatine can help improve performance, and overall research doesn’t suggest that caffeine use should cancel out the benefits of creatine. As long as the two don’t cause indigestion when used together, it seems to be okay to use them simultaneously.

Creatine vs. Protein Powder

Due to the benefits that creatine may offer, it’s not hard to see why there’s a connection between this supplement and bodybuilding. If you’re looking to gain muscle, you might be wondering if creatine or whey protein is better (or another type of protein powder)?

Both have been shown to have similar benefits in terms of supporting muscle growth, but whey protein is not always easy for many people to digest if they have a sensitivity to dairy. Creatine also seems to have some unique benefits, such as improving heart health and bone density. If you do choose whey protein, consume organic whey protein from grass-fed cows.

Final Thoughts

  • Creatine is a small peptide that is made up of amino acids. It is found in the body naturally, consumed from certain high-protein foods and taken by some people, such as athletes or bodybuilders, in supplement form.
  • Benefits associated with this supplement include building lean muscle mass, improving strength and power output, reducing fatigue, improving cardiovascular capacity, improving bone density and improving moods.
  • Why is creatine bad for you? While it is usually safe, it can cause side effects in some people such as weight gain due to water retention, abdominal pain, diarrhea, cramping and restlessness. It’s more likely to cause side effects among people taking high doses or those with kidney problems.
  • The best way to use it is follow dosage directions, space out intake, use it after exercise, take it with meals containing carbs and protein, and drink plenty of water when using it.

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