Everything You Need To Know About Creatine

Creatine. 

The mysterious white powder that magically makes you lift more weight, sprint faster, and jump higher.

I get questions from clients almost every week, such as:

“What does it do?“

“Does it really work?“

“Is it dangerous?“

“Will it make me gain weight?“

“Is it even legal? I heard it’s the same thing as steroids..“

I’m going to answer all those questions and more. By the end of this article, you should know everything you need to know about creatine. 

Fair warning though.. I do get into the science of creatine a fair amount. 

I don’t want to sound like your average meathead trainer who says “Just take it bro. Trust me!”

There is tons of research on creatine, and I reference studies throughout the article. 

First, let’s start with what creatine is not.

Creatine is not an anabolic steroid.

Even though taking creatine and anabolic steroids can both increase strength and muscle mass, the way that each of them accomplish this is very different.  

Let’s dive in..

Anabolic steroids are an artificial version of the hormone testosterone. Testosterone enters into your muscle cells and activates hundreds of genes to increase something called muscle protein synthesis. Very simply put, muscle protein synthesis is the process in which your body takes protein that you eat (like protein powder, steak, etc.) and breaks it down into amino acids that your muscles use to grow bigger and stronger. 

Muscle protein synthesis is a natural process and it occurs after a strenuous weight training session. However, anabolic steroids increase the rate of muscle protein synthesis beyond what your body can naturally do.

Creatine is a substance found in the body and also in proteins like steak and fish. Creatine gets converted to something called creatine phosphate in your muscle cells. During short bouts of high intensity exercise (like lifting weights or short sprints), your muscle cells use creatine phosphate to help create a compound called Adenosine Triphosphate (ATP). ATP is broken down in your muscle cells to produce energy. 

Supplementing with creatine can help your muscle cells produce more ATP, which in turn allows you to produce more energy for longer periods of time. This means that you might be able to lift a heavier weight for more reps that you previously could. Over a period of time, the extra weight and reps add up and allow you to get stronger and build more muscle. 

The takeaway is that anabolic steroids change the expression of your genes to build bigger and stronger muscles, which is why they come with so many unwanted side effects. Anabolic steroids are a drug and are illegal to take without the prescription of a physician. 

Creatine is a supplement, and it provides more energy for your muscle cells. Creatine doesn’t alter your genes like anabolic steroids do. 

Does creatine really work?

The short answer is yes. 

It works very well.

Creatine has been shown to increase maximal strength/power by 5-15%, maximal effort muscle contractions by 5-15%, single effort sprint performance by 1-5%, and repetitive sprint performance by 5-15% (1).

Whether you’re an average gym-goer who just wants to put on a little muscle or you’re a serious athlete looking to get the most out of their training, those performance increases can really add up over time.

Creatine can help you lift more weight for more repetitions, increase your power output and increase your sprint performance. Over time, those increases could put you in an entirely different place than if you didn’t supplement with creatine.

Surely a supplement that works as well as creatine must come with some serious side effects? 

Read on to learn if creatine is bad for your kidneys, whether it can make you bald, if it makes you gain a bunch of water weight, and if it’s safe long-term.

Is creatine bad for your kidneys?

There is over 20 years of research showing no evidence that creatine causes kidney damage in people with healthy kidneys and when taken within the recommended doses (which we’ll get to later). 

This myth stems from the fact that after creatine is used to produce ATP, it gets broken down into a waste product called creatinine (2). Creatinine accumulates in your blood and is then filtered through your kidneys and excreted through urine. Everybody has creatinine in their blood, because creatine helps your muscle cells produce energy (even if you don’t take it as a supplement). 

When supplementing with creatine, there might be more creatinine in your blood and urine, simply because you are taking more than your body would be able to produce or you can get from food alone. This means that your kidneys will have to filter more creatinine than normal, which was once thought to be taxing on the kidneys and could lead to kidney damage. 

In practice, this theory doesn’t hold up. Studies have shown (3, 4, 5) that in individuals with healthy kidneys, creatine supplementation does not overly tax the kidneys and lead to kidney damage.

Even long term usage of creatine (up to five years) has been shown to not have any detrimental effects on kidney function (6).

The other concern around creatinine is that elevated amounts in the blood can be a sign that your kidneys aren’t functioning properly.

Notice I said can.

Creatinine levels are a common marker that gets checked during routine blood work. If your kidneys aren’t functioning properly, they won’t be able to process creatinine, which can lead to higher levels in your blood and or urine. 

The issue with this is elevated creatinine levels can simply be from supplementing with creatine, and have nothing to do with how well your kidneys are functioning.

Does creatine cause baldness? 

This myth comes from one study performed on college rugby players in 2009 (7). The study looked at 16 males who took creatine for 21 total days. The study found that their levels of DHT (a hormone associated with hair loss) increased significantly over the course of the study.

There are a few things to note about the study..

First of all, the researchers did not look at actual hair loss. They measured an increase in DHT, which is associated with hair loss. 

Secondly, the levels of DHT were lower to begin with (prior to supplementation) in the group that took creatine than the control group (the group that got a placebo- in this case just a sugar pill). This might explain why the increase was significant.

Third, the levels of DHT remained within normal clinical limits (meaning the increase in DHT was not over the normal amount for males of that age group).

There have been 5 other studies of creatine use (8, 9, 10, 11, 12) that measured no difference in free testosterone (which the body uses to produce DHT).

There are zero studies showing actual hair loss because of creatine usage.

Does creatine make you gain water weight?

This one might be true.. kind of..

Creatine is what’s called an osmolite, meaning it pulls water with it wherever it goes.

There is some evidence (13) that during the first few days of creatine supplementation, your body retains extracellular water and intracellular water (extracellular means outside the muscle cell, while intracellular means inside the muscle cell). 

Why should you care about the difference? 

Well, intracellular water is a good thing, and may act as a signal for muscle cell growth and prevent muscle cell breakdown (14).

The ratio of our intracellular water to extracellular water is greater, meaning that we store more water in our muscle cells than outside of them.

Evidence shows that creatine doesn’t alter the ratio of extracellular water to intracellular water (15). This means that overall, more of the water retained from creatine is stored inside the muscle cell, which may lead to overall greater health of the muscle cell (16).

This also means that creatine won’t cause you to look “puffy” because most of the water retention is inside the muscle cell. If anything, within the first few days of taking creatine you might notice that you look a little more muscular.

So yes, creatine may make you gain some water weight, but overall that water weight can be a good thing.

Will creatine cause dehydration? what about muscle cramps?

If you’ve heard about creatine, you’ve likely heard that you need to drink massive amounts of water with it.

Otherwise, you’ll get “dehydrated” and get muscle cramps, bro.

The idea that creatine leads to dehydration comes from the fact that it pulls water into your muscle cells. The thought was that this distribution of water could upset the electrolyte balance in your body and lead to muscle cramps.

There are two studies that show that not only is this untrue, but that creatine might actually prevent muscle cramps.

The first study followed a group of NCAA D1A football players. Participants received either a placebo or creatine supplement throughout their season. The study found that the players who supplemented with creatine either had lower rates or proportional rates of muscle cramps, strains, heat illness/dehydration, and total injuries compared to players that received a placebo (17).

The second study looked at patients receiving haemodialysis. Haemodialysis is a treatment that involves using a machine to filter blood in patients who have damaged kidneys.

A common side effect of haemodialysis is muscle cramps. 

Patients were given creatine 5 minutes before receiving haemodialysis. 

The results?

Patients experienced a 60% decrease in the frequency of muscle cramps (18). This decrease might be explained due to creatine’s ability to hydrate the muscle cell.

Is creatine safe long-term?

The long-term effects of any supplement should be taken into account, and creatine is no different.

A study on 26 current or former competitive athletes measured various health markers and found that up to four years of creatine use showed no adverse effects (19). 

Personally, I’ve been taking creatine for almost seven years. I’ve stopped for a few months here and there, but the majority of those seven years my muscle cells have been full of creatine phosphate.

The only side effect I’ve noticed?

Getting stronger in the gym.

How much creatine should I take? When should I take it?

In order for creatine to be effective, your muscle cells need to reach what’s called a saturation limit. This is a point at which your muscle cells have reached their maximum capacity for storing creatine phosphate. Once they reach that point, additional creatine isn’t more effective (20). 

If you take 3-5g of creatine per day (3g if you’re on the smaller side, 5g if you’re on the larger side), it will take about 28 days for your muscle cells to reach the saturation limit.

To reach the saturation point faster, you can use what’s called a loading phase.

This entails taking 20-25g of creatine per day for 5-7 days, followed by a daily dose of 3-5g of creatine.

The loading phase isn’t necessary, it just allows your muscle cells to reach their saturation limit faster than if you were to take 3-5g per day. It won’t make creatine any less effective in the long term.

As far as when to take creatine during the day? 

Should you take it before your workout? After? 

It really doesn’t matter. What’s important is your muscle cells reaching the saturation limit, which will happen regardless of when you take creatine. Whether you decide to do a loading phase or not, once you’ve reached the saturation limit, creatine will start to work its magic.

What kind of creatine should I take?  

There are a few different types of creatine on the market today. The most widely researched and most effective kind is called creatine monohydrate.

Creatine monohydrate is very cheap to manufacture, so supplement companies often try to “reinvent the wheel”. They make a small tweak to creatine monohydrate and market it as the next best thing. Then they charge 3-5x more money for a product that has no research on it!

Don’t fall for any of the marketing. Creatine monohydrate is the only form of creatine you need to supplement with.

Fortunately, creatine monohydrate is not only the most well studied, but it’s also the cheapest.

Wrapping up

Hopefully by now you realize that creatine is one of the safest and most studied supplements on the market. 

It won’t make you bald or destroy your kidneys, and the water weight you gain from taking it is actually helpful.

Taking creatine long-term (up to five years) has shown to be perfectly fine, as long as your kidneys are in good health.

So, unless you don’t care about getting stronger, building muscle, or performing better in your sport, I would recommend picking some up today!