Everything You NEED to KNOW About Creatine

Dr. Stengler: Creatine — one of the hottest supplements on the market. In this video, I'm going to answer the 13 most common questions asked about creatine. But first, let me start with a little background on creatine, what it is, and how it works.

Creatine is a nitrogen-containing compound. It's made within the body from the amino acids arginine, glycine, and methionine. It's mainly made in the liver and kidneys, but your pancreas can make it, and your brain can make it as well. Your body cannot make methionine in adequate amounts, so you must get it in the diet. Creatine is mainly found in meats, poultry, and fish — you don't get it in plant foods. This is why vegans and vegetarians have lower creatine levels, and they also may have low levels of B12, which is necessary for methionine synthesis. Research suggests that vegetarians and vegans, due to their lower baseline of creatine, may experience a more pronounced improvement in muscle creatine stores from supplementation compared to people who eat animal products.

Synthesized mainly in the liver and the kidneys, creatine is taken up by the cells and converted into phosphocreatine, also known as creatine phosphate, which is then rapidly broken down by the enzyme creatine kinase to make ATP. ATP is that energy molecule — it's your energy currency that your cells use. This is how creatine works: it's really supplying that energy production. When ATP is used, it becomes ADP — it loses a phosphate group. When a muscle contracts or a neuron fires, ATP loses a phosphate and becomes ADP. But creatine is stored as phosphocreatine, storing that phosphate group. In muscle and brain cells, creatine binds a high-energy phosphate, forming phosphocreatine. Phosphocreatine rapidly regenerates ATP so you can make energy, and this is where the benefit of creatine comes in, because ATP can be restored almost instantly. This reaction happens much faster than making ATP from glucose or oxygen, so the result is more immediate energy availability to your muscles and brain cells, and your cells can sustain short, high-energy demands longer before fatigue sets in.

In terms of metabolism, creatine and phosphocreatine are converted to creatinine — a different compound. That's what we doctors test on the blood test for kidney function, and creatinine can go up sometimes mildly, although it's not a big concern, which I'll talk about later. For people who eat plant and animal foods, people typically get about 1 to 2 grams of creatine daily in their diet. Lacto-vegetarians, those who consume dairy and egg products, consume only about 0.3 gram per day, and vegans consume next to nothing. 95% of the creatine is stored in skeletal muscle, but you do get a small amount in the brain as well, which is very important for brain function. Creatine levels tend to decline with age, likely due to factors including less dietary intake, decreased functioning of organs responsible for creatine production like the liver and kidneys, increased physical inactivity, and decreased muscle mass for supporting ample creatine storage.

Creatine monohydrate is the most effective and bioavailable form to increase your blood levels of creatine, as well as your tissue creatine, including in the brain and muscles, and to improve performance. There have actually been over 1,000 peer-reviewed papers published on creatine supplementation. Most research has been with exercise, primarily resistance-type training, for improving measures of muscle and lean muscle mass, muscle performance including strength, endurance, and power, and recovery from sport or exercise in young, healthy male adults. However, we're going to talk about other research as well. Low dietary availability of creatine has been associated with greater health risks. The National Health and Nutrition Examination Survey, known as NHANES, revealed that children and adolescents with low dietary creatine intake — less than 1.5 grams per day — were shorter, weighed less, had less lean body mass and bone mineral content, and had higher fat mass and body fat percentage than those consuming higher amounts.

Now let's get to the first of the 13 common questions and misconceptions. Question number one has to do with the safety of creatine, and my answer is based on a recent article published in 2025 in the Journal of the International Society of Sports Nutrition, titled "Safety of Creatine Supplementation: Analysis of the Prevalence of Reported Side Effects in Clinical Trials and Adverse Event Reports." In this study, they evaluated 685 human clinical trials on creatine supplementation and worldwide adverse event report databases. In the studies, on average, the dose used was 12.5 grams per day — a higher dose; a lot of people take 3 to 5 grams. The authors state that creatine supplementation does not increase the prevalence or frequency of side effects when compared to participants taking a placebo. Therefore, claims that creatine supplementation increases the risk of side effects are unfounded. They evaluated 35 side effects in general compared to those taking placebo, assessing general health markers, kidney function, and other reported side effects. Adverse event reports were extremely rare, and most were associated with taking creatine with other nutrients or drugs. They also cite a long-term safety study on American football players, where up to 21 months of supplementation using on average 5 to 10 grams a day did not significantly affect markers of health or kidney function, and the incidence of side effects and injury was about the same or lower than in athletes not taking creatine.

Question number two: does creatine lead to water retention? There is some evidence that creatine increases water retention, but if it occurs, it's very short-term — a few days or a week or so. Over long periods, creatine has not been shown to cause water retention.

Question number three: is creatine an anabolic steroid? No, definitely not. It's just a combination of three amino acids, and that's why it's approved for athletes at all levels — college, Olympic, professional. It's not banned at all.

Question number four: does creatine cause kidney damage or dysfunction? When you look at all the research, creatine supplementation at the recommended doses, usually 5 to 10 grams a day, does not result in kidney damage or dysfunction. Sometimes we see creatinine, a metabolite of creatine metabolism, go up mildly, but that's not indicating kidney damage — it's just a byproduct of metabolism. If you have serious or chronic kidney disease, check with your specialist; they may still not want you to use creatine. But for healthy people, it's not a problem.

Question number five: does creatine cause hair loss or baldness? No, creatine does not cause hair loss or baldness, and it doesn't increase testosterone or dihydrotestosterone, which may be associated with hair loss.

Question number six: does creatine lead to dehydration and muscle cramping? The research shows that no, it doesn't cause dehydration and muscle cramping. That is not a common occurrence with creatine supplementation.

Question number seven: is creatine harmful for children and adolescents? There's limited research, but so far it appears safe and potentially beneficial for children and adolescents. Check with your doctor or pediatrician if you plan to use it with kids.

Question number eight: does creatine increase fat mass? No, creatine does not increase fat mass. This has been studied in a variety of populations. It's really the opposite — if you're exercising while using creatine, it tends to make you more likely to have lean muscle mass.

Question number nine: is a creatine loading phase required? You see a lot on the internet about loading phases with higher doses, but no. When you look at all the evidence combined, you don't have to do a loading dose. Lower daily dosages, usually 3 to 5 grams a day, are effective for increasing muscle stores and helping with recovery and performance.

Question number ten: is creatine beneficial for older adults? Absolutely. There's a growing body of evidence showing that creatine supplementation, especially combined with exercise, provides benefits for the musculoskeletal system and performance in older adults.

Question number eleven: is creatine only useful for resistance or power-type activities? Most research has been with resistance and power-type activities, where the majority has shown benefit. However, there are athletic events that aren't resistance or power activities where creatine may help. For example, creatine with carbohydrates, or carbohydrate and protein, has been shown to increase muscle glycogen storage more than carbs alone. It may also reduce muscle damage and enhance recovery from intense exercise, inflammation, and muscle soreness during intensified training. There's evidence that athletes who supplement during training experience fewer musculoskeletal injuries and heal more quickly. There's also preliminary information that creatine may help with concussion and traumatic brain injuries — check with your specialist. The evidence was compelling enough that the International Society of Sports Nutrition recommended that athletes in sports with potential for concussion or spinal cord injuries take creatine for its neuroprotective effects.

Question number twelve: is creatine only effective for males? Definitely not. There's accumulating evidence that creatine has benefits for both males and females, especially across the lifespan of females, with little to no side effects.

Question number thirteen: are other forms of creatine similar or superior to creatine monohydrate, and is creatine stable in solutions and beverages? There are different forms of creatine, but by far creatine monohydrate is the most well-researched and the best type to use. And yes, there are powders which mix into water, fluids, and beverages very effectively.

Those are the top 13 questions on creatine. I hope you found that helpful. The science behind creatine is actually very impressive. If you liked this video, hit the like button, subscribe to the channel, and look for my other videos on a wide variety of health conditions. It's been great to be with you.

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