By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living

What Is Creatine?

Creatine is a naturally occurring compound made from the amino acids arginine, glycine, and methionine. The majority is stored in skeletal muscle as phosphocreatine, where it acts as a rapid energy reserve for short, high-intensity activities.

Dietary sources include red meat and fish, but typical intake is far below what’s used in supplementation. That’s why creatine monohydrate remains one of the most widely used—and studied—performance supplements in the world.

Claimed Benefits vs. Proven Benefits

What It’s Claimed To Do

• Build muscle and strength
• Improve endurance
• Boost brain function
• Enhance recovery
• Slow aging
• Improve metabolic health

What the Evidence Actually Shows

• Muscle and strength: Strong evidence. Creatine supplementation increases muscle phosphocreatine stores, leading to improved strength, power, and lean body mass, especially when paired with resistance training .
• Endurance: Limited effect. Benefits are mostly in high-intensity, repeated-bout exercise, not long steady-state cardio .
• Brain function: Emerging evidence suggests creatine may support cognition under stress (sleep deprivation, hypoxia, or in older adults), but results are inconsistent .
• Recovery and injury: Some data suggest reduced muscle damage and faster recovery, though findings vary .
• Aging and sarcopenia: Promising. Trials show creatine may help preserve muscle and strength in older adults when combined with resistance training .
• Metabolic and chronic disease: Early studies point to benefits in glucose tolerance, depression, and even neurodegenerative disease models—but these remain experimental .

Common Dosing Strategies

1. Loading Phase (optional):

   • 20 g/day (divided into 4 doses of 5 g) for 5–7 days.
   • Rapidly saturates muscle creatine stores.

2. Maintenance Phase:

   • 3–5 g/day (typical for most adults).
   • Maintains elevated stores after loading or gradually builds them over ~4 weeks if no loading phase is used .

3. Special Populations:

   • Older adults: 3 g/day often sufficient.
   • Athletes >200 lbs: up to 5–10 g/day may be used.

Form: Creatine monohydrate is the gold standard. Other forms (HCl, ethyl ester, buffered creatine) have not consistently outperformed it.

Risks and Things to Watch Out For

Potential Side Effects (usually mild):

• Water retention and small weight gain (from increased intracellular water).
• Gastrointestinal upset (more common at very high single doses).

Concerns About Kidney Health:

• Despite myths, studies in healthy adults show no adverse kidney effects with recommended doses .
• Patients with pre-existing kidney disease should avoid unsupervised use.

When Taking Too Much Becomes a Problem:

• Very high doses (>20 g/day for long periods) provide no additional benefit and increase risk of GI upset.
• Over-supplementation won’t “supercharge” results once muscle creatine is saturated.

Lack of Benefit Situations:

• Non-responders: Some individuals (about 20–30%) already have high baseline muscle creatine from diet/genetics, and gain little from supplementation.
• If not combined with training: Benefits on strength/muscle are minimal without resistance training.

Beyond Health’s Perspective

Creatine monohydrate is one of the safest, most effective supplements for:

• Athletes needing short-burst performance.
• Older adults wanting to preserve muscle mass.
• Patients in targeted protocols for muscle, cognition, or metabolic support.

It’s not a magic pill—it works best as part of a system that includes progressive strength training, proper protein intake, recovery, and sleep optimization.

References

1. Kreider RB, et al. “International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine.” J Int Soc Sports Nutr. 2017;14:18.
2. Branch JD. “Effect of creatine supplementation on body composition and performance: a meta-analysis.” Int J Sport Nutr Exerc Metab. 2003;13(2):198-226.
3. Avgerinos KI, et al. “Effects of creatine supplementation on cognitive function of healthy individuals: a systematic review of randomized controlled trials.” Exp Gerontol. 2018;108:166-173.
4. Rawson ES, et al. “Effects of creatine supplementation on muscle recovery after eccentrically-induced damage.” J Strength Cond Res. 2007;21(4):1208-1213.
5. Candow DG, et al. “Effect of creatine supplementation on aging muscle: mechanisms, benefits, and safety.” Exp Gerontol. 2014;57:16-25.
6. Rae C, et al. “Oral creatine monohydrate supplementation improves brain performance: a double–blind, placebo–controlled, cross-over trial.” Proc R Soc Lond B Biol Sci. 2003;270(1529):2147-2150.
7. Hultman E, et al. “Muscle creatine loading in men.” J Appl Physiol. 1996;81(1):232-237.
8. Poortmans JR, et al. “Long-term creatine supplementation does not impair renal function in healthy athletes.” Med Sci Sports Exerc. 1999;31(8):1108-1110.