Creatine: Myths and Facts about Side Effects, Recommended Intake and Safety

Creatine is one of the most popular dietary supplements among athletes. It boasts scientifically proven effects on athletic performance, strength and muscle mass growth. Despite this, there are many myths and much misinformation about it. These relate mainly to its correct use, side effects or questions about who creatine is actually suitable for. In today’s article, we will take a closer look at the most persistent ones and reveal what is true and what is just unnecessary hype.

What is creatine?

Creatine is a natural substance found in the body, which is mainly found in the form of phosphocreatine (PCr) in the muscles and brain. The body can make it in a certain amount from 3 amino acids in the form of arginine, glycine and methionine. At the same time, creatine is naturally found in the food you eat, mainly in foods of animal origin (meat, fish, dairy products).

Creatine is used by the body for the most basic processes. It is involved in the creation of energy, which you then use for movement, mental functions and other needs.

It is mainly involved in the regeneration of ATP (adenosine triphosphate), which is the basic energy source of your body. Thanks to the optimal supply of creatine in the body, energy can be quickly restored, which can then be used for example for muscle work. It can thus increase physical performance, especially during short consecutive intervals of intense training, which is especially crucial in strength, speed and team sports.

Therefore, the intake of this substance is especially monitored by athletes. They most often take it in the form of creatine monohydrate, which is the most reliable form of creatine in terms of effect and safety. However, some people may prefer creatine hydrochloride (HCl), buffered creatine or other forms of creatine. With multi-ingredient supplements, however, you can also take creatine in several forms at once and get the maximum benefits from different types of this substance. [1]

If you’re interested in learning more about the different forms of creatine, read our article All You Need to Know About Creatine and Its Various Forms. 

What are the effects of creatine?

• Creatine can replenish ATP stores, which are quickly depleted in our body during intense physical activity. Thus, it supports the maintenance and improvement of performance.
• It is particularly useful during short power bursts lasting from 2 to 10 seconds.
• It is mainly used in strength (weightlifting, powerlifting, bodybuilding), speed and team sports (athletics, football, basketball, hockey).
• Beyond performance alone, however, studies show that it also promotes the growth of strength, muscle mass, recovery, and even endurance performance. [2-4]
• It also helps restore energy for brain functions such as memory, thinking and concentration. This also makes it one of the nootropics that are popular with students, artists, and others with mentally demanding jobs. [19]

In case you want to learn more about the effects of creatine on your health and athletic performance, you’ll find everything you need to know in our article Creatine Is Not Just For Muscles and Strength. What Effects Does It Have on the Brain, Immunity and Overall Health?

How long do the increased creatine stores in the body last?

• If you do not replenish creatine with supplements, but rely only on its natural production in the body and intake through nutrition, you have a capacity of approximately 60-80% in the body.
• If you also start taking creatine through supplements (3-5 g per day), you will increase your creatine stores by 20-40% in about 28 days.
• To maintain this value, it is enough to continue the intake of 3-5 g/day consistently.
• On the other hand, if creatine is discontinued, the levels in the body will return to their initial levels after 4-6 weeks. [5-6]

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The 13 biggest myths about creatine use

Creatine is one of the most popular dietary supplements among athletes. However, often even they are not clear about some of the issues regarding the correct intake, side effects and other aspects associated with the use of this substance. Let’s make this clear for you once and for all.

1. Creatine is a steroid

Androgenic anabolic steroids (AAS) are a group of substances that include the hormone testosterone and similar artificially produced hormones with like effects. The common denominator is also the somewhat similar chemical structure, the frequent need for injection, the high risk of damage to health and, above all, the illegality. They are used with the aim of maximising the building of muscle mass, which would not grow naturally to such an extent. Creatine is far from similar to these substances in terms of chemical structure and effects. It is a legal, natural substance for the body with confirmed health safety, unlike anabolics. [5, 7]

Creatine may not be a steroid, but it definitely has something to offer in terms of building muscle mass. You can read more about this in our article A Guide To Creatine for Maximum Muscle Growth. 

2. Creatine damages the kidneys and liver

The metabolism of creatine in the body produces the waste product creatinine, which is excreted from the body by the kidneys. The body may then have more work to do to remove this substance. For this reason, many people are concerned that taking creatine will put too much strain on their kidneys. Elevated creatinine levels are also a symptom of certain diseases of this organ. However, this does not automatically mean that you will damage your kidneys with creatine.

The scientifically based reality is that if the recommended intake (3-5 g per day) is followed, there will only be a short-term increase in creatinine levels, which healthy kidneys will easily remove. Even long-term studies have not proven a negative effect of creatine use on kidney function. The latter was not observed even with 12 weeks of creatine supplementation (20 g for 5 days, then 5 g) in people with a higher protein intake (≥ 1.2 g per kg body weight). [8-9]

Last but not least, it should not be forgotten that people with a higher proportion of muscle mass and a higher protein intake may have naturally higher creatinine values. [8-9]

Recommended intake values for creatinine:

• Males: 60–110 µmol/l*
• Females: 45–90 µmol/l*

*each laboratory may have slightly different recommended intake values [20]

The negative effect of creatine on liver function is not scientifically supported by any evidence. In current studies, normal dosage does not cause damage to the liver in healthy individuals. [5]

3. Creatine creates a diuretic effect

Creatine is an osmotically active substance similar to carbohydrates or salt. This means that it binds water to itself in the muscle. However, unlike salt, water is retained inside the cells. Thus, it won’t make you bloated like after eating a packet of salted chips, but rather pump up your muscles. More water in the muscles is also positive in terms of better hydration and tolerance of hot weather. [6-7]

There has also been speculation in the past that creatine causes dehydration and muscle cramps. This was due to its effect on cellular water retention, which could theoretically throw off the body’s overall water balance. However, more recent studies have refuted these claims and agree more on the positive effect of creatine on hydration and muscle function. [6-7]

We have good news for women who are afraid that they will gain a few kilos while taking creatine and become The Hulk’s sister. While there are exceptions and individual differences, studies have shown that taking a regular dose of creatine (3-5 grams) leads to minimal water retention, and therefore, overall weight gain. In the case of higher doses (>15 g/day), maximum body water gain was around 2 litres. But as you already know, taking higher doses is practically meaningless. [7, 10]

If you are worried about water retention and don’t know what it the cause and what to do about it, the advice in our article may be of some assistance How to Get Rid of Water Weight and Reduce Water Retention?

4. Creatine is to blame for digestive disturbances

If you put creatine side effects into a search engine, you’ll probably get indigestion immediately. Some people may actually experience bloating, stomach pain or other digestive problems. However, these cases are rather rare and are often associated with a higher intake of creatine at one time (>10g) or taking this supplement when fasting.

You can usually avoid digestive problems if you spread a larger amount of creatine (> 5 g/day) into several smaller portions and take it ideally with meals. Also, be sure to drink plenty of water. Plus, as already established, such large doses are completely unnecessary. [5, 11]

If you are suffering from a bloated stomach, the cause may lie elsewhere. The most common ones can be found in our article What Can Cause a Bloated Stomach and How to Get Rid of It?

5. Ceasing creatine leads to muscle loss

Creatine can help you build muscle, but it doesn’t mean you’ll lose all your #gains when you stop taking it. As long as you don’t change your training plan or diet and continue to make sure you’re getting enough protein, it shouldn’t affect your physique in any major way. You may lose a little muscle volume if you use higher doses of creatine, which is associated with more water retention. However, this does not mean that you have lost muscle tissue itself. In this case, it will just be a loss of fluid. [12]

You will still continue to have higher levels of creatine in your body for about 4–6 weeks after stopping it. On this point, it should also be mentioned that creatine does not need to be discontinued and is safe even with long-term use. Negative effects were not shown in one of the longest running studies, which lasted 5 years. [6, 12]

If you’re wondering what diet and training are key to building muscle, check out our article What to Eat and How to Workout to Gain Muscle. 

6. Creatine causes hair loss

This myth is based on an older study in which rugby players took 25 g of creatine for 7 days and then switched to a 5 g intake for 14 days. After this time, their levels of dihydrotestosterone (DHT), a derivative of testosterone, increased and higher levels have been associated with hair loss. However, according to researchers, the increase in DHT may have also been due to the intense strength training the players were engaged in. Since then, a number of other similar studies have been conducted, but with mixed results.

Current science has not confirmed the effect of creatine on the increase in total testosterone or DHT associated with hair loss. Neither has it shown a negative effect on sexual function, which is also sometimes mentioned in conjunction with creatine use. Both hair loss and impaired sexual health are more typical of steroid use. [6-7]

Healthy testosterone levels are especially important for men’s health. If you’re wondering what can cause it to drop, check out our article 10 Signs of Testosterone Deficiency – What Causes It and How to Solve It?

7. Creatine causes acne

The origin of this myth probably stems from the mistaken assumption that creatine is an anabolic steroid. Their side effects include skin deterioration and the development of acne. However, you already know that creatine is definitely not a steroid. Nor do any studies show evidence to suggest that taking creatine can worsen your skin. Rather, it seems that the reality is exactly the opposite and this supplement could help the skin.

Creatine is crucial for cell metabolism, even in the skin. It contributes to the renewal of skin cells and also helps to keep them hydrated. In addition, it has antioxidant effects, which help to protect the skin from free radicals (oxidative stress). A positive effect has been observed in studies with regular creatine supplementation, but also with topical application, for example in the form of a cream. [14-16]

If you are wondering what can help with problematic skin and acne, read our article How to Get Rid of Acne? Stress Reduction, Healthy Weight and Good Hygiene Can Help.

8. Creatine is only suitable for strength athletes

Although the effects of creatine mainly benefit bodybuilders, weightlifters, cross fitters and other iron enthusiasts, it can also help other athletes to perform better. In fact, it has proven effects not only on the growth of strength and muscle mass.

According to studies, creatine can improve:

• regeneration
• storage of the carbohydrate glycogen in the muscles
• acidification of muscles
• tolerance to heat and demanding workouts

Therefore, endurance athletes (runners, swimmers), sprinters and other athletes, team athletes (hockey players, football players, basketball players) or wrestlers (MMA, boxers) can also benefit from its supplementation. [6-7]

In the case that you run or engage in other endurance activities and you are wondering which other supplements can help improve your performance, you will find them in our article 11 Best Dietary Supplements for Running, Cycling and Other Endurance Sports.

9. Only men benefit from the use of creatine

It’s no longer true that only men want bigger muscles and strength, and women only exercise to lose weight. Many of them regularly work out and lift heavy weights because they know that this will give them a more attractive figure, more self-confidence and a healthier body. Women also want to feel and look strong, so there is no reason why they should not support their efforts with a functional supplement like creatine. Although the effectiveness of this supplement has been studied more often on men, this has also been confirmed in the case of women.

In addition, women naturally have lower levels of creatine in their bodies due to less muscle mass than men. They also typically take in less of it from their diet. In addition, the level of this substance in their body can change depending on the phase of their cycle and hormonal changes. Thus, supplementation can support a stable level of creatine in the body. When you add it all up, it shows that taking dietary supplements with creatine can be even more effective for women than for men. [7, 13]

Supplementation works best when combined with quality workouts. If you’re wondering what weight training can do for women, find out in our article Strength Training for Women? Yes! 12 Reasons to Pump Iron.

10. The saturation phase is necessary

The traditional supplementation protocol for creatine dosing assumes a saturation phase. It lasts 5–7 days during which you take 20-25 g of this substance, which will ensure a rapid replenishment of creatine reserves in the body (in about a week). Then you move on to maintenance intake in the form of 3-5 g of the substance.

During the saturation phase, however, the risk of side effects such as increased water retention or digestive upset is increased. So the good news is that, according to current studies, we already know that the saturation phase is not necessary in terms of creatine effectiveness. Feel free to start with a dose of 3-5 g of creatine per day.

Although the maximum creatine stores in the body will be reached a bit later (approximately 28 days compared to 5-7 days in the case of a saturation phase), you will most likely avoid possible side effects. [6-7]

11. Creatine must be cycled

Cycling, or taking a break and restarting dietary supplements after some time, is sometimes recommended because of the body developing a tolerance to the active ingredient. In the case of creatine, however, this tolerance generally does not occur and it is effective even in the long term. There is no need to worry about its safety either. At the recommended intake (3-5 g/day) it is safe in healthy people even in the long term (according to studies lasting up to 5 years). [6]

12. Creatine should be taken at a certain time

Opinions on the best time to take creatine vary. Some recommend it in the morning, others before or after training. In reality, it doesn’t matter that much in terms of effect and in the long term.

The main thing is to be consistent when taking it and not to forget the daily dose even on non-training days. But always remember that it is not advisable to take creatine on an empty stomach and do not forget to wash it down with plenty of water. Try to devise your own routine and take creatine at around the same time. This way you will form a habit and you won’t forget about taking this supplement. [6]

13. Creatine should never be taken together with caffeine

Caffeine, like creatine, is one of the most popular substances among athletes. It is mainly used before training as a pre-workout, which is guaranteed to kick-start your workout. So the question arises, is it advisable to combine creatine with caffeine?

Maybe you’ve heard the opinion that it’s not a good idea, because some old study from 1996 said that caffeine reduces the effect of creatine. However, there is not enough evidence in current literature to confirm the negative effect of caffeine. Even so, if you want to minimise any possible reduction in creatine’s effectiveness, it’s best to take the two substances separately. Caffeine (contained in a complex pre-workout, for example) before training and creatine after training or at other times during the day. [17-18]

Everything you need to know about taking caffeine before a workout can be found in our article Caffeine Before Exercise: Features, Benefits, Risks, and Recommended Intake. 

How to take creatine?

• You can choose a single-component supplement, ideally creatine monohydrate, which has the most proven effects, or a multi-component supplement containing 7 forms of creatine, and get the most out of the various benefits of these forms from the one product.
• You can also try creatine monohydrate in tablet form.
• Take 3-5 g daily before, during or after exercise. On a non-training day, use at any time of the day.
• Wash down the dose with plenty of water.
• Combined with protein or carbohydrates, you can increase the stores of creatine in the body. [5-6]

You can learn more about taking creatine in our article How to Choose the Best Creatine?

What should you remember?

In today’s article, we’ve taken a look at the greatest myths about creatine, which are not only heard in gyms. Based on scientifically proven facts, you know that it is an effective and safe substance that can boost athletic performance. It is suitable for both strength and speed athletes and both men and women can benefit from its properties.

Healthy people do not have to worry about any negative effects on kidney and liver function, skin quality or even hair loss. Even with prolonged use of creatine. However, do not forget the recommended intake, which is in the range of 3-5 g per day.

Did you find this article useful and learn something new? Don’t forget to share it with your friends who may still believe some of the myths out there regarding creatine.

Sources:

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[10] Lugaresi, R., Leme, M., de Salles Painelli, V., Murai, I. H., Roschel, H., Sapienza, M. T., Lancha Junior, A. H., & Gualano, B. Does long-term creatine supplementation impair kidney function in resistance-trained individuals consuming a high-protein diet? – https://doi.org/10.1186/1550-2783-10-26

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